polio myelitis - disease condition in detail
TRANSCRIPT
“I wanted to be a dancer, and dancing was my passion. But at the age of 13, I started feeling stiff, my joints
ached, and over a two week period, I lost my coordination and 20 pounds
& the saddest of all is I became paralyzed. My “Passion” thus
became my “Pain”……”????????..........
POLIOMYELITIS
SHEBA SUSAN BENNY
OBJECTIVES
Students will recall what they have already learned about Poliomyelitis and will update their knowledge regarding the topic and will demonstrate confidence in taking care of patients with polio and participate actively in awareness of polio eradication & vaccination
SPECIFIC OBJECTIVES
DEFINITION
“ Poliomyelitis is a highly infectious viral disease, which destructs the motor neurons and damages brain and spinal cord and is characterized by muscle weakness and paralysis”
1580–1350 BC
EPIDEMIOLOGYThis disease is seasonal, occurs
commonly in summerThe America in 1994, Eastern
Pacific in 2000 & Europe in 2002 are certified free from circulation of wild polio virus
Polio is currently reported wildly in mainly 4 countries- Nigeria, Pakistan, Afghanistan, Egypt
STATUS OF POLIO IN LAST 12 MONTHS
CLASSIFICATION
Non-paralytic
Paralytic
Asymptomatic Abortive
Asymptomatic Contribute more than 90% of the casesOccurs when the replication of virus is
restricted to gastro-intestinal tractThis is the case with attenuated vaccine
strain
Abortive
Also known as subclinicalAround 5% of cases are subclinicalAffected persons suffers from minor
symptoms starts with febrile disease & occurs in the first week of infection
Non-paralyticAbout 2% cases are experiencing this typeSevere form of polioStarts 3-4 days later to the onset of
infectionSymptoms last for 2 weeksSymptoms are associated with aseptic
meningitisVirus progress to brain and infects
meninges
Paralytic Less than 1% of cases are this
typeThis is the most severe form of
polioAbout 4 days after the end of
first minor symptoms, virus spread to the anterior horn cells of the spinal cord and to the motor cortex of brain
Degree of paralysis depends upon the neuron affected & amount of damage it sustain
Spinal
Bulbar
Bulbospinal
TYPES OF PARALYTIC POLIO
ETIOLOGYIt is caused by 3 poliomyelitis virus
types with different antigenic characteristics
Brunhilde Lansing Leon
MODE OF SPREADIn developing countries- ‘feco
oral’ transmission (poor sanitation)
Industrialized countries- ‘oral pharyngeal’ transmission
During outbreaks- ‘oral pharyngeal’ transmission
COMMUNICABILITY PERIODAs the virus is shed in feces,
transmission is via feco-oral route through ingestion of contaminated food or water
Virus is shed in stools for 6-8 weeksAverage incubation period is 7-10 daysVirus spreads rapidly to non-immune
personsHumans are the only reservoir of polio
virus and infection is spread from person to person
PATHOPHYSIOLOGY
Virus enters the body through feco-oral route
Reaches digestive tract and attaches to specific receptors
Replicates in the intestinal mucosa
Path physiology…..contd
Enters the blood stream
Virus enters the nervous system through blood
Spread along the axons of peripheral nerves to CNS
Path physiology…….contd
Progress along the fibers of motor neuron of brain and spinal cord
Destroys anterior horn cells of spinal cord or nerves within bulbar region
Nerve cell death results in failure of contraction of muscles
Path physiology…….contd
Muscle dysfunction results in respiratory failure and paralysis of legs
Virus is excreted through feces and contributes in further contamination & spread
CLINICAL MANIFESTATIONSSub-clinical
Headache Fever
Fatigue Sore throat
Vomiting
C/M….contd
C/M……contdParalytic
DIAGNOSISIt is based on symptomsAbsence of history of immunization or
presence of an epidemic in a particular region strengthens the diagnosis
Diagnosis……..contd Lab investigations & findings
Isolation of polio virus from the stool
WBC count will be normal or slightly elevated
Virus can be detected from onset to >_8weeks after paralysis
CSF findings:-Appearance-clearProtein-normal initially & rise up to
300mg% in 2-3 weeks after onset
DIFFERENTIAL DIAGNOSIS
Most common two are..Guillian Barre syndromeTransverse myelitisOther conditions are..Traumatic neuritisMeningitisencephalitis
TREATMENT OF POLIO IN EARLY YEARS
TREATMENT
“Treatment should be early and appropriate to the stage and degree of paralysis”
Acute stage (2-4 weeks)Strict bed rest to minimize extent of paralysisSymptomatic relief of muscle tightness & spasm, by administering analgesics, combined with application of hot packs for 15-30 mts to affected part, every 4 hours
Parasympathetic stimulant such as Urocholine can be given for urinary retention
Suitable body alignment in paralytic cases to avoid skeletal deformity
A firm bed prevents sagging of spine
Treatment Acute stage contd….
If muscles of foot are involved, feet should be kept at right angle to the legs
In bulbar poliomyelitis, with pooling of secretion main concern is airway maintenance & avoid risk of aspiration. Tracheostomy may be required.
Recovery or convalescent (3-6 mnths)
At this stage, emphasis is on physiotherapy
As soon as the pain subsides, passive movements can be started to prevent joint stiffness
Rehabilitation Certain patients remain permanently
paralyzed despite vigorous physiotherapy
Severe deformities & contractures require surgical corrections
Any idea who they are?...
VACCINESTwo types of vaccines are available
world wide◦The live attenuated oral polio vaccine(Salk)◦Inactivated or killed poliovirus
vaccine(Sabin)Both the vaccines are available as
trivalent preparations containing 3 types of polio virus and both when used as recommended, provide good protection from paralytic poliomyelitis as well as control of disease
PROGNOSIS
Decreased incidence of polio cases and improved medical care has resulted in a marked reduction in the Mortality rate
Bulbar polio is the most severe form with relatively poor prognosis
Estimation was that 10-15% of all cases of polio results in permanent paralysis
PREVENTION
Immunization with polio vaccine is the mainstay in the prevention of polio
Infant born to mothers with antibodies are protected naturally against paralytic disease for a few weeks
Immunity is acquired through infection with the wild virus through immunization
The Global Polio Eradication Initiative has significantly reduced the no.of cases reported
OUR ROLE
Strengthening of routine immunizationImprove environmental sanitation
LET US JOIN OUR
HANDS TOGETHER
TO ERADICATE
POLIO
THANK YOU