What is it?

Poliomyelitis or polio, is an infection caused by the poliovirus leading to nerve damage and muscle paralysis. Transmission of the poliovirus occurs by contact with infected secretions from the nose and throat (airborne), or contact by the faeces (faeco-oral). The virus enters mouth and nose, multiplies in the throat or digestive tract, and spreads through the blood to the rest of the body.

What are the causes?

Poliovirus may infect a person who is not vaccinated against the disease. There are 3 types of polioviruses. All three can cause paralysis, but type 1 causes paralysis most often followed by types 3 and 2. Most epidemics

What are the symptoms?

Polio occurs in three forms: abortive, nonparalytic, and paralytic.Abortive form is the most common and is a brief febrile illness that may go unnoticed. Symptoms are nonspecific and may include:Fever, sore throat, headache and muscle ache Malaise, general discomfort or uneasiness Loss of appetite, nausea, vomiting and constipationIn cases of nonparalytic poliomyelitis, the symptoms last one to two weeks and include:Moderate fever (38-390C) and headache Anxiety and excessive sweating Nausea and vomiting and constipation Excessive tiredness, weakness and irritability Soreness or stiffness of the muscles of back, arms, legs, and abdomen Muscle tenderness and spasm in any part of the bodyIn about one-third of cases this resolves in a week without developing paralysis. Approximately two thirds of these children have a short symptom free interlude between minor and major (CNS) illnesses. The symptoms in cases of paralytic polio are:Fever, headache, irritability and stiff neck and back Rapid onset of weakness of one or more muscle groups leading to paralysis of any part of the body. Paralysis typically begins during fever. It is often the first symptom. Pattern of paralysis is asymmetrical involving usually only one limb, lower extremities more than upper extremities. Paralysed muscles atrophy over time. Abnormal (but not loss of) sensation: sensitivity to touch, mild touch may be painful Difficulty in passing urine Constipation and feeling of bloatedness in the abdomen Difficulty in swallowing and breathing Occasionally rapid deterioration with drowsiness, respiratory failure and sudden collapse.

How is the diagnosis made?

Several diseases can be associated with muscular weakness. Polio is suspected in a patient who develops sudden paralysis on one side of the body following a short febrile illness. Rigidity of the neck and spine are the hallmarks of nonparalytic form. The virus can be easily cultured from stool, throat secretions and cerebrospinal fluid (CSF). Blood can be tested for antibodies against polioviruses. CSF tests help to confirm the diagnosis in cases with neurological involvement.

What is the treatment?

The aims of management are to allay fear, minimize skeletal deformities, anticipate and prevent complications and prepare the child and family for a prolonged treatment of the disability. Abortive and nonparalytic forms are treated similarly. They usually get better after few days of bed rest. The treatment generally includes pain relievers to treat the muscle spasm and pain, antipyretics for fever and sedatives with good diet. Avoid exertion for the next two weeks. Hot packs (warm water fomentation) for 10-15 minutes every 2-4 hours can relieve muscle stiffness and spasm. A child with paralytic form of disease during acute stage requires complete bed rest. Stress on the affected muscles should be avoided. Massage and injections are contraindicated. Positioning of limbs using sand bags, splints or footboards helps in relaxation of affected muscles. Passive movements of joints within the range of pain are allowed. Hospitalisation is necessary for progressive paralysis, breathing difficulty and worsening sensorium. Once the virus is no longer active, physical therapy can improve muscle function.

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