The clinical features and manifestations of of poliomyelitis

Clinical features of Poliomyelitis

1. Department of Pediatrics
Rural Medical College

2. NOT ALL POLIO CASES ARE AS LUCKY OR AS DETERMINED
B S CHANDRASEKHAR

4. Early History of Poliomyelitis
•1840 – First described by Von Heine
•1887 – Earliest and best description of an
epidemic in Stockholm
•1894 – First known epidemic in North
America
•1908 – Landsteiner and Popper transmit
disease to monkeys

5. Poliomyelitis in the 20
th
Century
•Before 1955 – Increasingly larger epidemics
•1948 – Enders, Weller and Robbins succeeded in growing
a strain of polio virus in culture cells
•1955 – Inactivated (Salk) polio virus vaccine (IPV)
licensed in the US
•1961 – Live, attenuated (Sabin) polio virus monovalent
vaccine licensed in the US (1963 licensed as trivalent oral
polio virus vaccine, OPV)
•1987 – Enhanced Inactivated Polio virus Vaccine (e IPV)
licensed in the US
•1988 – World Health Assembly: Polio Eradication
Initiative

6. TYPES OF POLIO VIRUSES
•TYPE 1 MORE NEUROVIRULENT
•TYPE 2
•TYPE 3
Enterovirus: Picorna virus : RNA; great at surviving
inextremes of ph, varying temp for days to weeks

7. Pathogenesis of Polio Virus
Infection

8. Time course of poliovirus infection

9. EPIDEMIOLOGY
•TRANSMISSION: FAECO –
ORAL. ONLY HUMANS
•INCUBATION PERIOD:7-10
DAYS
•PERIOD OF INFECTIVITY:
FEW DAYS BEFORE
SYMPTOMS TO 6-8WKS

10. Transmission of Poliomyelitis
•Direct contact or contaminated water.
•People infected with poliovirus, whether symptomatic
or not, excrete the virus via the feces from several
weeks to months, and in respiratory secreta
•The fecal oral route is the main way of transmission
of poliovirus infection in developing countries
•The oral route of transmission is dominant in
industrialized countries
•Excretion of poliovirus for several years has been
documented in immunocompromised patients

11. Clinical Diagnosis (WHO case
definition)
“ A case of poliomyelitis is defined as any
child under fifteen years of age with acute
flaccid paralysis (including Guillain Barre
syndrome) or any person with paralytic
illness at any age when polio is suspected”

12. CINICAL
MANIFESTATIONS
INAPPARENT INFECTION 90-95%
ABORTIVE POLIOMYELITIS 5%
NON-PARALYTIC POLIOMYELITIS 1%
PARALYTIC POLIOMYELITS 0.1%

13. ABORTIVE POLIO
INFLUENZA LIKE SYNDROME
HEADACHE, NAUSEA, VOMITING
ABD PAIN MUSCLE PAIN
SHORT LIVED ILLNESS: 2-3 DAYS
COMPLETE RECOVERY

14. NON-PARALYTIC POLIO
ABORTIVE POLIO= MORE SEVERE SYMPTOMS
2-3 DAYS SYMPTOM FREE, BIPHASIC ILLNESS
NUCHAL & SPINAL RIGIDITY
TRIPOD POSITION
HEAD DROP
AF TENSE
CHANGES IN REFLEXES INDICATE
IMPENDING PARALYSIS

15. TRIPOD SIGN KISS THE KNEE TEST
HEAD DROP SIGN
NUCHAL RIGIDITY

16. PARALYTIC POLIOMYELITIS
•SPINAL
•BULBAR
•POILIOENCEPHALITIS

17. SPINAL PARALYTIC POLIO
•BIPHASIC 2
nd
= STORMY
•SEVERE MUSCLE PAIN
•SENSORY/MOTOR PHENOMENA,
HEADACHE,PARASTHESIAE,
FASCICULATIONS, SPASMS
•PARALYSIS/PARESIS:
•ASYMMETRIC, FLACCID
•PHANTOM HERNIA
PROVOCATION
PARALYSIS

18. BULBAR POLIO
WITH OR WITHOUT SPINAL POLIO
NASAL TWANG, NASAL
REGURGITATION,DYSPHONIA
DEVIATION OF PALATE, UVULA,
TONGUE
SWALLOWING DIFFICULTY
INEFFECTIVE COUGHING
VITAL CENTRES: CVS; BP
FLUCTUATIONS,ARRHYTMIAS

RESP DIFFICULTY
HYPO / HYPERTHERMIA
ROPE SIGN

19. POLIOENCEPHALITIS
HIGHER CENTRES
SEIZURES
COMA
SPASTIC PARALYSIS ,HYPERREFLEXIA
ALTERD CONSCIOUSNESS
CRANIAL NV PALSY
INADEQUATE VENTILATION, HYPOXIA,
HYPERCAPNIA
SPECIFIC VIRAL DIAG OR SPINAL POLIO ALSO

20. DIFFERENTIAL DIAGNOSIS
Acute flaccid paralysis
poliovirus
transverse myelitisGuillain-Barré Syndrome
other enterovirusestraumatic neuritis
BOTULISM,
PSEUDOPARALYSIS: DON’T REPORT

21. DD POLIO vs GBS
•POLIO
•AFP SOON AFTER
•ASYMMETRICAL
•MUSCLE
TENDERNESS
•MUSCLE ATROPHY
•CSF: ASEPTIC
MENINGITIS
•GBS
•AFP 2 WKS LATER
•SYMMETRICAL
•NO MUSCLE
TENDERNESS
•NO
•CSF: ALBUMINO
CYTOLOGICAL
DISSOCIATION

22. VAPP
(VACCINE ASSOCIATED PARALYTIC
POLIOMYELITIS)
ONLY WITH OPV, NOT WITH IPV
1 PER 700000 FIRST VACCINEES
USUALLY TYPE 2 & 3 ATTENUATED
VIRUSES
IMMUNOCOMPROMISED/ IMMUNE
DEFICIENT