polio final yr

8/17/2019 Polio Final Yr

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AFP

Acute flaccid paralysisweakness in one or more limbs,or therespiratory or bulbar muscles,

resulting

from

damaged

lower

motor neurones.


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Signs

there

is weakness with reducedtone (flaccidweakness)and reduced or absent reflees


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!"d

• Polio

• #ntero$irus %&

•'ullian barre syndrome

• nection neuritis

• *ick bite

•

+otulinum toicity• !iptheritic neuropathy

• abies


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di-erences of AFP

Direct viral damage toanterior horn cells eg

polio

Immune medicateddamage to peripheralnevers

Paralysis onset During(or straight after)

febrile illness

Several weeks after febrile illness

Pattern of

paralysis

Asymmetrical Symmetrical

Time to reachmaimum weakness

Short(e!g!"#$days) %ong (e!g!'days)

Sensory involvement No ften (depending oneact disease)

*S+ Increased lymphocytes increased protein(e!g!',,mg-d%es peciallylate in thedisease)

Pain ften limb muscle pain ften back pain


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polio mobin


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historical background

First recorded case of polio is a

hieroglyph from Memphis, drawn

in approximately 1400BC, which

depicts a temple priest calledSiptah showing typical clinical

signs of paralytic poliomyelitis

was recorded in the late 1700’s

with the first epidemic in the late

100’s!"he cases that were reported in

1#7# where mild and self$limited

and do not res%lt in paralysis


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modern history

1789 - British physician Michael Underwood provides the firstclinical description of polio, referring to it as "debility of the

lower extreities!"18# - $eran physician Jacob von Heine p%blishes a 78-page onograph in 18# which not only describes theclinical feat%res of the disease, b%t also notes that itssyptos s%ggest the involveent of the spinal cord!

19#8- &%strian physicians 'arl (andsteiner and )rwin *oppera+e the first hypothesis that polio ay be ca%sed by avir%s!


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*reatment history

•&olio patients whose

m%scles were paralysed

faced months, perhapsyears, of ard%o%s physical

therapy to strengthen

wea'ened m%scles

•&atients were often placedin iron l%ngs to help with

(reathing reg%lation


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+acteriological history

&olio)ir%s was first identified in

1#0# (y inoc%lation of specimensinto mon'eys! "he )ir%s was first

grown in cell c%lt%re in 1#4# which(ecame the (asis for )accines


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$accine history

1955 Inactivated vaccine

1961 Types 1 and 2 monovalent OPV

1962 Type 3 monovalent OPV

1963 Trivalent OPV

1987 Enhanced IPV IPV!


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#ntero$irusSerotypes


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polio* gray matter Myelitis* inflammation

of the spinal cord


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Poliovir"sEnterovir"s #$%!Picornavir"s!Three serotypes& 1' 2' 3

#apidly inactivated (y heat' )ormaldehyde'

chlorine' "ltraviolet li*ht

no cross imm"ni+ation

Transmitted (y oronasal ro"te

,y -ater and mil.


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Poliomyelitis Patho*enesis

Entry into mo"th

#eplication in pharyn/' 0I tract'local lymphatics

ematolo*ic spread to lymphatics and central

nervo"s system

Viral spread alon* nerve )i(ersestr"ction o) motor ne"rons


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/utcomes of polio$irus infectionPrognosis


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#pidemiology

#eservoir "man

Transmission ecal4oral Oral4oral

possi(le

omm"nica(ility 741 days (e)ore onset

Vir"s present in stool 346 -ee.s


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#pidemiology

Most affects children %nder the age of + years in

de)eloping tropical co%ntries!

nc%(ation period ranges from - to .0 days


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risk factors

• infants and elderly

• li$ing with infected person

• compromised immune system

• lack of immuni0ation

•

etreme stress or strenuous acti$ity• tra$el to an area that has eperienced polio

outbreak


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incubation period *he incubation period forpoliomyelitis is commonly 1 to 23

days with a range from 4 to 45days. *he response to polio$irusinfection is highly $ariable andhas been categori0ed based onthe se$erity of clinicalpresentation.


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symptoms

/c%te stage generally lasts 7 to 10

days!May incl%de fe)er, pharyngitis, headache,anorexia, na%sea, and )omiting!

llness may progress to aseptic meningitis and

menigoencephalitis in 1 to 4 of patients!

"hese patients de)elop a higher fe)er 2 se)er

headache with stiffness of the nec' and (ac'


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symptoms

&aralytic disease occ%rs 0!1 to 1 of those who(ecome infected with the polio )ir%s!

&aralysis of the respiratory m%scles or from cardiac

arrest if the ne%rons in the med%lla o(longata are

destroyed!


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signs

n cases with paralysis s%perficial reflexes%s%ally are a(sent first, and deep tendon

reflexes disappear when the m%scle

gro%p is paraly3ed!


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eco$ery

&atients ha)e some or f%ll reco)ery from

paralysis, most clinical reco)ery occ%rs d%ring

the 1 month and almost complete within -months

!

imited reco)ery may occ%r for a(o%t . years!


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fate

Among children who are paralysed by polio:30% make a full recovery

30% are left with mild paralysis

30% have medium to severe paralysis

10% die


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paralytic polio4 typesSpinal polio the most common, andaccounted for %67 of paralytic casesfrom &616&6%6. t is characteri0ed by

asymmetric paralysis that most oftenin$ol$es the legs.Bulbar polio accounts for 27 of casesand leads to weakness of muscles

inner$ated by cranial ner$es.Bulbospinal polio it accounts for &67of cases and is a combination of bulbarand spinal paralysis


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diagnostic studiesVirus Culture *he laboratory diagnosis of polio is con8rmed by isolation of $irusby cultures, from the stool or throat swab or cerebrospinal fluid(rare). n an infected person, the $irus is most likely to be culturedin stool cultures.

Serologic test

Acute and con$alescent serum sample may be tested for rise inantibody titer (antibodies to the polio$irus), but the report can bedi9cult to interpret as in many cases, the rise in titer may occurprior to paralysis.

Cerebrospinal fuid test

nfection with polio $irus may cause an increased number ofwhite blood cells and a mildly ele$ated protein le$el incerebrospinal fluid


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*reatmentacute stage

Bed rest, analgesics, hot pac's, and

anatomical positioning of the lim(sgentle passi)e 56M exercises of all oints


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treatmentacute stage

close monitoring of respiratory and cardio)asc%larf%nctioning is essential d%ring the ac%te stage of

poliomyelitis along with fe)er control and pain relie)ers for

m%scle spasms!

Mechanical )entilation, respiratory therapy may (e needed

depending of the se)erity of patients!


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:on$alescent stage

From . days after the temperat%re ret%rn to normal andcontin%es for . years

M%scle power impro)es

&hysical therapy is recommended for f%ll reco)ery!

&assi)e stretching exercises and wedging casts can (e

%sed for mild to moderate contract%res!


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con$alescent stage

S%rgical release of tight fascia and m%scle

apone%roses and lengthening of tendons may (enecessary for contract%res persisting longer than -

months!

6rthoses sho%ld (e %sed %ntil no f%rther reco)ery is

anticipated!


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chronic stage

Static oint insta(ility can (e controlled (y6rthoses!8ynamic oint insta(ility res%lt in a fixed

deformity that cannot (e controlled (y

6rthoses!


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chronic stage

Soft tiss%e s%rgery, s%ch as tendon transfers, sho%ld (edone in yo%ng children (efore the de)elopment of any

fixed (ony changes!

Bony proced%res for correcting a deformity can (e

delayed %ntil s'eletal growth is near completion!


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pre$ention *he best pre$enti$e measure for

poliomyelitis is ensuring hygiene andencouraging good sanitation practices.

+ut, polio pre$ention begins with polio$accination. Polio $accine has beende$eloped against all 4 subtypes of thepolio$irus and is $ery e-ecti$e in

producing protecti$e antibodies thatinduces immunity against the polio$irusand pro$ides protection from paralyticpolio.


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$accine

*wo types of $accine are a$ailable;

an inacti$ated (killed) polio $accine (P


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omparison o) Oral Polio Vaccine OPV! and Inactivated Poliovir"s Vaccine IPV!

%amir hah+ad lin In)ect is 29:9&128741288

9 .00# (y the nfectio%s 8iseases Society of /merica


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scheduleepi


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#nd game

•

n 23&4, the =orld >ealth Assemblyendorsed a plan that calls for theultimate withdrawal of oral polio$accines (/P


51/54

#nd game

• emo$al of the type 2 component of /P<in 23&1 through a global switch fromtri$alent /P< to bi$alent /P< (containingonly types & and 4).


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#nd game

• all &21 /P


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#nd game

• reduce risks of reintroduction of type 2polio$irus by pro$iding some le$el ofseroprotection,

• facilitating interruption of transmission ifoutbreaks occur

•

and accelerating eradication byboosting immunity to types & and 4polio$iruses.

h I l t th f


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when I lost the use ofthem.It was just such a weirdfeeling.It was just like it wentthrough me,

just a surge wentthrough my body.I can feel it right now just thinking about it.It was very frighteningfor a little 14-year-oldgirl to think,

polio final yr

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