Poliomyelitis Dept. Of Infectious Disease 2nd Affiliated Hospital CMU
Definition Poliomyelitis is acute infectious disease caused by poliovirus. Infantile paralysis. Pathologic lesions: motor neurons in the gray matter in the anterior horn of the spinal cord.. Clinical feature:
Etiology Causative agent: poliovirus family Picornaviridae, genus Enterovirus single strain RNA Resistance: Sensitive to heat, oxidant ultraviolet rays
Etiology Serotype: on the basis of neutralization tests. Type I Type II Type III no cross immunity
Epidemiology Source of infection patients and carriers: inapparent inf. & non-paralytic inf. Route of transmission air-borne, respiratory tract: fecal-oral route:
Epidemiology Susceptibility: universal susceptible to polio covert infection >90% paralytic patients<1% lifelong immunity to same type virus Epidemiologic features children under 5yrs, 6m~5yrs summer & fall
poliovirus oralair epithelial cells (in pharynx, intestine) first viremia second viremia non-paralytic type regional lymphatics CNS Ab covert infection Ab blood stream blood-brain barrier abortive infection paralytic type
Pathology Place of lesion: all of CNS spinal cord, brain stem motor neurons in anterior horns of cervical & lumbar enlargement of spinal cord.
Pathology Pathologic features neuron necrosis inflammatory infiltrate of leukocyte,lymphocyte.
Clinical manifestation Paralytic period paralysis types spinal type brain stem type mixed type brain type
Clinical manifestation Paralytic period Spinal type: most common paralysis features : flaccid (hypomyotonia,tendon reflexes are weak or absent) asymmetric distribution: without sensory loss
Clinical manifestation Paralytic period Spinal type: most common paralysis muscles paralysis of extremities: leg >arm; proximal > distal paralysis of diaphragmatic & intercostal muscles affects respiratory movement paralysis of abdominal muscle -- stubborn constipation
Clinical manifestation Paralytic period Brain stem type cranial nerve paralysis: 7&10, then 9&12, facial paresis dysphagia, high-pitched voice respiratory center paralysis: central respiratory failure: cacorhythmic breathing ect. vasomotor center paralysis:
Clinical manifestation Paralytic period brain type - polio-encephalitis high fever, convulsion, disturbance of consciousness, tonic paralysis mixed type spinal type + brain stem type
Clinical manifestation Convalescent period paralytic muscles begin to recover distal > proximal, at first 3~4 month quick recovery, 6 month later recovery slowly,the recovery process reaches its limit around 18 months
Clinical manifestation Sequela period persistent paralysis muscular atrophies deformities of limbs
Laboratory Findings Cerebrospinal fluid aseptic menigitis pleocytosis: 50~500×10 9 /L protein: normal or slightly increase albuminocytologic dissociation glucose and chloride; normal virus isolation: pharynx, feces, blood or CSF,brain.
Laboratory Findings Serological test: Specific IgM Ab (blood & CSF) Neutralized Ab Complement combining Ab four fold rise
Diagnosis Epidemiological data: Clinical manifestation: Laboratory findings: Abortive or non-paralytic polio - isolation of virus or serological test paralytic polio - clinical diagnosis
Differential Diagnosis Guillain-Barre Syndrome symmetric, ascending paralysis with loss of sensation CSF: protein elevate with absent or minimal pleocytosis, albuminocytologic dissociation rapid and complete recovery Coxsackie or ECHO: no epidemic no seqela
Differential Diagnosis Paralysis caused by other enterovirus Coxsackie or ECHO viruses: no epidemic no sequelae
Treatment Prodromal & preparalytic P isolation & rest in bed: not accept muscular injection & operation hot moist pack to muscles 50%GS&VitC 1~2g iv, IFN hydrocortison
Treatment Paralytic period: limb paralysis nursing for paralytic limbs Put the limbs on function position Vit C ATP ivdrop Galanthamin or Prostipmin iM
Treatment treatment for respiratory obstacle bulbar paralysis dysphgia keep air way clear (sputum aspiration postural drainage ) tracheal intubation tracheotomy tank respirator
Treatment treatment for respiratory obstacle respiratory center paralysis respiratory stimulant tracheotomy tank respirator respiratory muscle paralysis mild observation tank respirator
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