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:

Definition
 Clinical feature: fever sore throat muscle pain paralysis

 Causative agent: poliovirus
 family Picornaviridae, genus Enterovirus
 single strain RNA

Resistance: Sensitive to heat, oxidant ultraviolet rays

 Serotype: on the basis of neutralization tests.
 Type I
 Type II
 Type III
 no cross immunity

 Source of infection patients and carriers: inapparent inf. & non-paralytic inf.
 Route of transmission air-borne, respiratory tract: fecal-oral route:

 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 air oral epithelial cells (in pharynx, intestine) regional lymphatics
Ab covert infection blood stream first viremia Ab abortive infection second viremia blood-brain barrier
CNS paralytic type non-paralytic type

 Place of lesion:
 all of CNS
 spinal cord, brain stem
 motor neurons in anterior horns of cervical & lumbar enlargement of spinal cord.

 Pathologic features
 neuron necrosis
 inflammatory infiltrate of leukocyte,lymphocyte.

Clinical manifestation

Incubation period: 5~14 days

Clinical types

Covert infection: >90%

Abortive poliomyelitis: 4~8%

Non-paralytic poliomyelitis:

Paralytic poliomyelitis: 1%~2%

Clinical manifestation

Paralytic poliomyelitis

Prodromal period
 preparalytic period
 paralytic period
 convalescent period
 sequela period

Clinical manifestation
Prodromal period:(1~4d)
 upper respiratory tact infection: fever, fatigue, sore throat, headache
 intestinal tract infection: vomiting, diarrhea, constipation abortive poliomyelitis

Clinical manifestation
 Preparalytic period
 progressing this phase without prodromal phase
 1~6days after symptoms of prodromal phase
 without prodromal phase

Clinical manifestation
 Preparalytic period
 fever: two-hump fever(10~30%)
 symptoms & signs of CNS
 severe headache & vomiting
 dysphoria or lethargy
 muscle pain

Clinical manifestation
 Preparalytic period
 symptoms & signs of CNS
 cutaneous hyperesthesia
 hyperhidrosis
 meningeal irritations (neck stiffness Kernigs & Brudzinskis signs positive) 3~6d , nonparalytic poliomyelitis

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

 Epidemiological data:
 Clinical manifestation:
 Laboratory findings:
 Abortive or non-paralytic polio
isolation of virus or serological test
 paralytic polio - clinical 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

 Paralysis caused by other enterovirus
Coxsackie or ECHO viruses: no epidemic no sequelae

 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

 Paralytic period:
 limb paralysis
 nursing for paralytic limbs
Put the limbs on function position
Vit C ATP ivdrop
Galanthamin or Prostipmin iM

 treatment for respiratory obstacle
 bulbar paralysis
 dysphgia
 keep air way clear (sputum aspiration postural drainage )
 tracheal intubation
 tracheotomy tank respirator

 treatment for respiratory obstacle
 respiratory center paralysis
 respiratory stimulant
 tracheotomy tank respirator
 respiratory muscle paralysis
 mild observation
 tank respirator

 Convalescent & sequela period
 acupuncture
 massage

 control of source of infection:
 isolation: 40 days after the onset of illness
 protection of susceptible population :

 attenuated live vaccine by oral killed virus vaccine