• Poliomyelitis

    (Polio)

    Definition

    Poliomyelitis (polio) is viral infection. It is very contagious. Infection can lead to paralysis.
    Polio is now extremely rare in the Western world. This is due to very effective vaccination programs. Polio is still a significant problem in parts of Africa and Asia.

    Causes

    Polio is caused by the poliovirus. You can get the virus from contact with:
    • An infected person
    • Infected saliva or feces
    • Contaminated water or sewage
    The virus enters the body through the mouth. It travels to the intestines. There it reproduces quickly. The virus travels through the blood and lymph fluid. It attacks and destroys areas of the nervous system.
    Interaction of Lymph, Blood Vessels, and Intestines
    Lymph and vessels in Abdomine
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    The following factors increase your chance of developing polio:
    • Lack of vaccination or incomplete vaccination
    • Travel to countries where polio is still common (areas of Africa and Asia)
    • Preschool child with immune disorder exposed to live poliovirus through vaccination
    • Young adult exposed to poliovirus through contact with someone recently vaccinated with live poliovirus vaccine
    • Elderly adult
    • Pregnancy
    • Strenuous exercise
    • Recent tonsillectomy or dental procedure
    • Immunodeficiency

    Symptoms

    If you experience any of these, do not assume it is due to polio. These symptoms may be caused by other, less serious health conditions. Contact your physician if you experience these symptoms.
      Minor illness
      • Headache
      • Fever
      • Sore throat
      • Illness lasts about a week
      Major illness
      • Fever
      • Headache
      • Nausea and vomiting
      • Diarrhea
      • Stiff neck
      • Neck pain
      • Severe muscle pain
      • Muscle spasms
      • Muscle weakness
      • Paralysis
      • Usually asymmetric (affecting each side to varying amounts, or only affecting a single side)
      • Muscles become flaccid (loose, floppy)
      • Legs more commonly affected than arms
      • Muscles required for breathing may become paralyzed
      • Urinary retention
      • Decades later, previously stable muscle weakness may worsen due to postpolio syndrome

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done.
    Tests may include the following:
    • Throat swabs, rectal swabs, stool samples, or cerebrospinal fluid to look for the virus
    • Spinal tap —removal of a small amount of cerebrospinal fluid to check for the virus
    • Immunological tests—looks for antibodies designed to fight the virus to prove that the body has responded to the presence of poliovirus

    Treatment

    Talk with your doctor about the best plan for you. There are no treatments available to get rid of the virus. Treatment is designed to be supportive. It will treat your symptoms. It will also help you avoid complications.

    Bedrest

    The doctor may recommend bedrest during the initial phase of the illness.

    Fever Control

    Medicines can be given to lower fever and decrease muscle pain. These may include:
    • Acetaminophen
    • Nonsteroidal anti-inflammatory agents

    Assisted Ventilation

    If the muscles you use to breathe become too weak or paralyzed, you may require a period of time on a mechanical ventilator. This machine will take over the work of breathing for you.

    Rehabilitation

    The virus can cause contractures. This is a tightening of tissue around a joint. You may be fitted with splints. They will keep your joints from becoming too stiff. You may also receive physical therapy. In therapy your limbs will be moved for you. These are called passive exercises.
    After your fever passes, exercises and therapy will help you regain mobility. They will also help to improve your muscle strength.

    Prevention

    The polio vaccine, a series of four injections, is routinely given to children at the ages of:
    • Two months
    • Four months
    • 6-18 months
    • 4-6 years
    Most adults have already received this vaccine when they were children. But, if you are at high risk for getting this infection, you may need the vaccine. High risk includes:
    • Traveling to areas where polio is present
    • Caring for people with polio
    • Working in labs where poliovirus is handled
    The number of doses that you need depends on how many you have had in the past. Talk to your doctor if you are at high risk.

    RESOURCES

    American Academy of Pediatrics http://www.aap.org/

    Centers for Disease Control and Prevention http://www.cdc.gov/

    World Health Organization http://www.who.int/en/

    CANADIAN RESOURCES

    BC Health Guide, British Columbia Ministry of Health http://www.bchealthguide.org/

    Ontario March of Dimes http://www.dimes.on.ca/

    References

    Baker CJ, Pickerling LK, Chilton L, et al. Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2011. Ann Intern Med. 2011;154(3):168-173.

    Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2011. MMWR. 2011;60(5).

    Ferri FJ, ed. Ferri's Clinical Advisor: Instant Diagnosis and Treatment . St. Louis: Mosby Inc; 2005.

    Goldman L et al, eds. Cecil Textbook of Medicine . 22nd ed. St. Louis: WB Saunders Company; 2004.

    Mandell GL et al, eds. Principles and Practice of Infectious Diseases . 5th ed. London: Churchill Livingstone Inc; 2000.

    Mandel GL et al, eds. Principles and Practice of Infectious Diseases. 6th ed. Churchill Livingstone Inc; 2005.

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