polio

Polio

 

Definition

Poliomyelitis, also called polio or infantile paralysis, is a highly infectious viral disease that may attack the central nervous system and is characterized by symptoms that range from a mild nonparalytic infection to total paralysis in a matter of hours.

Description

There are three known types of polioviruses (called 1,2, and 3), each causing a different strain of the disease and all are members of the viral family of enteroviruses (viruses that infect the gastrointestinal tract). Type 1 is the cause of epidemics and many cases of paralysis, which is the most severe manifestation of the infection. The virus is usually a harmless parasite of human beings. Some statistics quote one in 200 infections as leading to paralysis while others state that one in 1,000 cases reach the central nervous system (CNS). When it does reach the CNS, inflammation and destruction of the spinal cord motor cells (anterior horn cells) occurs, which prevents them from sending out impulses to muscles. This causes the muscles to become limp or soft and they cannot contract. This is referred to as flaccid paralysis and is the type found in polio. The extent of the paralysis depends on where the virus strikes and the number of cells that it destroys. Usually, some of the limb muscles are paralyzed; the abdominal muscles or muscles of the back may be paralyzed, affecting posture. The neck muscles may become too weak for the head to be lifted. Paralysis of the face muscles may cause the mouth to twist or the eyelids to droop. Life may be threatened if paralysis of the throat or of the breathing muscles occurs.

Man is the only natural host for polioviruses and it most commonly infects younger children, although older children and adults can be infected. Crowded living conditions and poor hygiene encourage the spread of poliovirus. Risk factors for this paralytic illness include older age, pregnancy, abnormalities of the immune system, recent tonsillectomy, and a recent episode of excessively strenuous exercise concurrent with the onset of the CNS phase.

Causes and symptoms

Poliovirus can be spread by direct exposure to an infected individual, and more rarely, by eating foods contaminated with waste products from the intestines (feces) and/or droplets of moisture (saliva) from an infected person. Thus, the major route of transmission is fecal-oral, which occurs primarily with poor sanitary conditions. The virus is believed to enter the body through the mouth with primary multiplication occurring in the lymphoid tissues in the throat, where it can persist for about one week. During this time, it is absorbed into the blood and lymphatics from the gastrointestinal tract where it can reside and multiply, sometimes for as long as 17 weeks. Once absorbed, it is widely distributed throughout the body until it ultimately reaches the CNS (the brain and spinal cord). The infection is passed on to others when poor handwashing allows the virus to remain on the hands after eating or using the bathroom. Transmission remains possible while the virus is being excreted and it can be transmitted for as long as the virus remains in the throat or feces. The incubation period ranges from three to 21 days, but cases are most infectious from seven to 10 days before and after the onset of symptoms.

There are two basic patterns to the virus: the minor illness (abortive type) and the major illness (which may be paralytic or nonparalytic). The minor illness accounts for 80-90% of clinical infections and is found mostly in young children. It is mild and does not involve the CNS. Symptoms include a slight fever, fatigue, headache, sore throat, and vomiting, which generally develop three to five days after exposure. Recovery from the minor illness occurs within 24-72 hours. Symptoms of the major illness usually appear without a previous minor illness and generally affect older children and adults.

About 10% of people infected with poliovirus develop severe headache and pain and stiffness of the neck and back. This is due to an inflammation of the meninges (tissues which cover the spinal cord and brain). This syndrome is called "aseptic meningitis." The term "aseptic" is used to differentiate this type of meningitis from those caused by bacteria. The patient usually recovers completely from this illness within several days.

About 1% of people infected with poliovirus develop the most severe form. Some of these patients may have two to three symptom-free days between the minor illness and the major illness but the symptoms often appear without any previous minor illness. Symptoms again include headache and back and neck pain. The major symptoms, however, are due to invasion of the motor nerves, which are responsible for movement of the muscles. This viral invasion causes inflammation, and then destruction of these nerves. The muscles, therefore, no longer receive any messages from the brain or spinal cord. The muscles become weak, floppy, and then totally paralyzed. All muscle tone is lost in the affected limb and the muscle becomes soft (flaccid). Within a few days, the muscle will begin to decrease in size (atrophy). The affected muscles may be on both sides of the body (symmetric paralysis), but are often on unbalanced parts of the body (asymmetric paralysis). Sensation or the ability to feel is not affected in these paralyzed limbs.

When poliovirus invades the brainstem (the stalk of brain which connects the two cerebral hemispheres with the spinal cord, called bulbar polio), a person may begin to have trouble breathing and swallowing.

In its most severe form, polio causes paralysis of the muscles of the legs, arms, and respiratory system. All muscle tone is lost in the affected limb, and the muscle becomes flaccid and begins to atrophy, as shown in the illustration above.

(Illustration by Electronic Illustrators Group.)

If the brainstem is severely affected, the brain's control of such vital functions as heart rate and blood pressure may be disturbed. This can lead to death.

The maximum state of paralysis is usually reached within just a few days. The remaining, unaffected nerves then begin the process of attempting to grow branches which can compensate for the destroyed nerves. Fortunately, the nerve cells are not always completely destroyed. By the end of a month, the nerve impulses start to return to the apparently paralyzed muscle and by the end of six months, recovery is almost complete. If the nerve cells are completely destroyed, however, paralysis is permanent.

Diagnosis

Fever and asymmetric flaccid paralysis without sensory loss in a child or young adult almost always indicate poliomyelitis. Using a long, thin needle inserted into the lower back to withdraw spinal fluid (lumbar puncture) will reveal increased white blood cells and no bacteria (aseptic meningitis). Nonparalytic poliomyelitis cannot be distinguished clinically from aseptic meningitis due to other agents. Virus isolated from a throat swab and/or feces or blood tests demonstrating the rise in a specific antibody is required to confirm the diagnosis.

Treatment

There is no specific treatment for polio except symptomatic. Therapy is designed to make the patient more comfortable (pain medications and hot packs to soothe the muscles), and intervention if the muscles responsible for breathing fail (for instance, a ventilator to take over the work of breathing). During active infection, rest on a firm bed is indicated. Physical therapy is the most important part of management of paralytic polio during recovery.

Prognosis

When poliovirus causes only the minor illness or simple aseptic meningitis, the patient can be expected to recover completely. When the patientis diagnosed with the major illness, about 50% will recover completely. About 25% of such patients will have slight disability, and about 25% will have permanent and serious disability. Approximately 1% of all patients with major illness die. The greatest return of muscle function occurs in the first six months, but improvements may continue for two years.

A recently described phenomenon called postpolio syndrome may begin many years after the initial illness. This syndrome is characterized by a very slow, gradual decrease in muscle strength.

Prevention

There are two types of polio immunizations available in the United States. Both of these vaccines take advantage of the fact that infection with polio leads to an immune reaction, which will give the person permanent, lifelong immunity from re-infection with the form of poliovirus for which the person was vaccinated.

The Sabin vaccine (also called the oral polio vaccine or OPV) is given to infants by mouth at the same intervals as the DPT (three doses). It contains the live, but weakened, poliovirus, which make the recipient immune to future infections with poliovirus. Because OPV uses live virus, it has the potential to cause infection in individuals with weak immune defenses (both in the person who receives the vaccine and in close contacts). This is a rare complication, however, occurring in only one in 6.8 million doses administered and one in every 6.4 million doses from having close contact with someone who received the vaccine.

The Salk vaccine (also called the killed polio vaccine or inactivated polio vaccine) consists of a series of three shots that are given just under the skin. This immunization contains no live virus, just the components of the virus that provoke the recipient's immune system to react as if the recipient were actually infected with the poliovirus. The recipient thus becomes immune to infection with the poliovirus in the future.

In the 13 years following the launching of the Global Polio Eradication Initiative, the number of cases has fallen 99% from an estimated 350,000 cases to less than 3,500 cases worldwide in 2000. At the end of 2000, the number of polio-infected countries was approximately 20, down from 125. The goal of the World Health Organization (WHO) is to have polio eliminated from the planet by the year 2005. The virus has still been identified in Africa and parts of Asia, so travelers to those areas may want to check with their physicians concerning booster vaccinations.

Resources

Books

Braunwald MD, E., A. Fauci MD, D. Kasper MD, S. Hauser MD,D. Longo MD, and J. Jameson MD. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 2001.

Cecil, R., and L. Goldman. Cecil Textbook of Medicine. Philadelphia: W.B. Saunders, 1999.

Periodicals

Centers for Disease Control and Prevention. "Poliomyelitis prevention in the United States: Updated recommendations of the AdvisoryCommittee on Immunization Practices (ACIP)." MMWR 2000. http://www.cdc.gov/.

Other

World Health Organization. "Global Polio EradicationProgress 2000." http://www.polioeradication.org/.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

poliomyelitis

 [po″le-o-mi″ĕ-li´tis]

an acute infectious disease occurring sporadically or in epidemics and caused by a virus, usually a poliovirus but occasionally a coxsackievirus or echovirus. Called also polio.

Initial clinical characteristics include fever, sore throat, headache, and vomiting, often with stiffness of the neck and back. In the minor illness these may be the only symptoms. The major illness (called also infantile paralysis), which may or may not be preceded by the minor illness, is characterized by involvement of the central nervous system, stiff neck, pleocytosis in the spinal fluid, and perhaps paralysis within a week. Bulbar poliomyelitis is a serious form involving the medulla oblongata and usually becomes evident within three days. The muscles of swallowing and breathing are affected, so that the patient has difficulty swallowing, speaking, and breathing. In all forms, there may be subsequent atrophy of groups of muscles, ending in contraction and permanent deformity.

There are three known types of poliovirus, each causing a different type of the disease. Most paralytic cases are caused by type 1. Poliovirus is found in the throat of a patient for the first few days of the disease, and in the intestines for a longer period, sometimes as long as 17 weeks. The disease spreads by means of droplets of moisture from an infected person's throat or by waste products from the intestines. The contagious period is 7 or more days from the time of onset of the disease. The poliovirus is short-lived, and cannot survive long in the air. The incubation period of polio is from 1 to 2 weeks, and occasionally as long as 3 weeks. Members of the family or other contacts may be carriers, but only for a short period of time.

Treatment. There is at present no cure for polio; once the disease begins it must be allowed to run its course. Supportive care is important, however, and proper symptomatic treatment can reduce discomfort and prevent some crippling aftereffects. Applications of heat in the form of hot wet packs, diathermy, warm baths in the form of hydrotherapy, and gentle exercising can reduce pain caused by muscle spasms and prevent deformities. During the acute stage of the disease bed rest is essential and the patient is kept warm and quiet.

Postpolio Weakness. Although immunization efforts to eradicate polio have reduced its current incidence in the United States to fewer than 10 cases each year, survivors of previous epidemics are experiencing a second encounter with the illness. Weakness in one or more muscles appears to be a late complication of the infection. The weakness can affect muscles that were first involved in the disease or it can affect those that were not formerly weakened. The cause of this phenomenon is not yet known and there is no treatment available, other than medications known to be effective in combating autoimmune diseases. It is hoped that this form of therapy will retard or arrest the process causing the weakness.

Prevention. The first safe, effective vaccine against polio used killed polioviruses to stimulate production and release of antibodies. It was developed under the direction of Dr. Jonas E. Salk, and was nicknamed the Salk vaccine; its proper name is poliovirus vaccine inactivated (IPV). It was later replaced by an oral preparation of attenuated viruses called poliovirus vaccine live oral, nicknamed the Sabin vaccine after its discoverer, Dr. Albert Sabin. In recent years in the United States, the Salk vaccine has come back into use. It does not induce intestinal immunity and so is not effective for poliovirus eradication in areas where wild-type polioviruses still exist in large numbers. However, it does not cause vaccine-associated paralytic poliomyelitis and so is preferred for routine immunization in areas where the risk of infection by a wild-type polivirus is very low.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

po·li·o

(pō'lē-ō),

Abbreviated term for poliomyelitis.

Farlex Partner Medical Dictionary © Farlex 2012

polio

(pō′lē-ō′)

n.

See poliomyelitis.

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

polio

See Poliomyelitis.

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

po·lio

(pō'lē-ō)

Shortened common form of poliomyelitis.

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

polio

Abbrev. for POLIOMYELITIS.

Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

Patient discussion about polio

Q. is polio contagus If i have a friend that had it when he was younger and it went away and then came back can i get it?

A. highly contagious, it's an Enterovirus. if your friend didn't wash his hands after the bathroom and touched your sandwich it can infect you. he can even contaminate water sources...but no air-born contamination. but most western countries vaccinated against that, so you should be fine.

Q. Polio Syndrome pain One of my aunt is taking Neurontin for Post Polio Syndrome pain in her left leg and arm. she did not realize that she had so much pain and that it was keeping her from doing so many things. Is Neurontin recomended for this treatment and how does it help? Will she have problems with Neurontin if she take it long term? Neurontin is greatly helping the pain but not the fatique in these limbs. Should it help the fatigue?

A. Neurontin is being given as medication for nerve pain now also...I take 800 mg a day and it was started for back pain and it is also being used in some fibro patients I am learning( i also have fibromyalgia) It didn't cause me a lot of drowsness but amount of medication and medications affect people differently so each person can be different. But with the fatigue fibromyalgia causes maybe I just can't tell the difference b/c before I started it I was tried all the time and that is not any worse. But if your Aunt and yourself feel uncomfortable with this treatment I would suggest a second opinion. Good Luck to your Aunt

Q. Help for/with post-polio problems

A. Clemon -you'll have to be more specific on what kind of help do you ask for. you seek info? seek other people suffering from post-polio? what?
all i can do is give you a good link about it with some info..hope that what you look for:
http://www.post-polio.org/edu/pabout.html

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