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Poliomyelitis

Heine Medin Disease

Poliomyelitis is an infectious disease caused by poliovirus, a human enterovirus belonging to the family Picornaviridae.


Presentation

Poliomyelitis shows a wide range of possible clinical scenarios. In the majority of them (around 95%), the disease is asymptomatic or shows flu-like symptoms which do not represent a major concern for the patient. The remaining 5% of the cases are divided in two major groups: non-paralytic poliomyelitis, representing 4% of the cases, and paralytic poliomyelitis, representing around 1% of the cases. The non-paralytic form shows the usual flu-like symptoms plus aseptic meningitis. The paralytic type, instead, shows a series of other clinical manifestations which follow a gradual progression. At the beginning, the disease appears as a flu-like illness whose symptoms subside within a few days. Then, an asymmetrical, flaccid motor paralysis begins to appear, which mainly affects the lower limbs and peaks after 48 hours. In about 10-25% of the cases this second stage might progress into a third one, represented by a bulbar form of paralysis. The classical symptoms of this third stage include hyper- or hypotension, respiratory failure, dysphagia and dysphonia. In rare cases, the penetration of the central neuron system might be so severe that acute encephalitis can occur.

Fever
  • Both patients had fevers but no signs of meningitis at onset. Tendon reflexes were absent or reduced in affected regions.[ncbi.nlm.nih.gov]
  • In contrast to GBS, weakness occurs at the height of the fever and generally does not progress after the fever subsides. An asymmetrical, flaccid paralysis develops in most patients, typically affecting proximal more than distal muscles.[archneur.jamanetwork.com]
Malaise
  • Symptoms are slight fever, malaise, headache, sore throat, and vomiting 3-5 days after exposure. Recovery occurs in 24-72 hours. This is termed the abortive type of polio. Polio as a major illness may or may not be paralytic.[medicinenet.com]
  • They include malaise, headache, sore throat, slight fever, vomiting.[wikilectures.eu]
  • Symptomatic disease is classified as Abortive poliomyelitis Paralytic or nonparalytic poliomyelitis Most symptomatic infections, particularly in young children, are minor, with 1 to 3 days of slight fever, malaise, headache, sore throat, and vomiting,[merckmanuals.com]
  • SUBCLINICAL INFECTION SYMPTOMS General discomfort or uneasiness ( malaise ) Headache Red throat Slight fever Sore throat Vomiting People with subclinical polio infection might not have symptoms, or mild symptoms may last 72 hours or less.[nlm.nih.gov]
Difficulty Climbing Stairs
  • climbing Stairs N/A 61% 67%[ a ] 82% Difficulty with ADLS 14% 17% 16% 62% a Most common new problem.[web.archive.org]
Hoarseness
  • […] the neck and along the spine For paralytic poliomyelitis the symptoms of nonparalytic and abortive poliomyelitis muscle weakness all over severe constipation muscle wasting weakened breathing difficulty swallowing weak cough flushed or blotchy skin hoarse[childrenshospital.org]
  • Watch for: Difficulty breathing Weakness Hoarseness or wheezing Rapid heart rate Hives Dizziness If you or your child has an allergic reaction after any shot, get medical help immediately.[mayoclinic.org]
  • Although most rhinovirus infections manifest as mild common colds with rhinorrhea, nasal obstruction, fever, sore throat, coughs, and hoarseness lasting for a few days, serious lower respiratory tract illnesses in infants are common.[ncbi.nlm.nih.gov]
Sleep Apnea
  • Common symptoms of post-polio syndrome (PPS) are: continuing muscle and joint weakness muscle pain that gets worse becoming easily exhausted or fatigued muscle wasting, also called muscle atrophy trouble breathing and swallowing sleep apnea, or sleep-related[healthline.com]
  • apnea) Trouble swallowing Causes Poliomyelitis Polio is caused by the poliovirus, a highly contagious virus specific to humans.[nigeriagalleria.com]
  • Common signs and symptoms include: Progressive muscle or joint weakness and pain Fatigue Muscle wasting (atrophy) Breathing or swallowing problems Sleep-related breathing disorders, such as sleep apnea Decreased tolerance of cold temperatures When to[mayoclinic.org]
  • Pulmonary problems include both obstructive and restrictive lung disease, with symptoms of exertional dyspnea, sleep apnea, and reduced pulmonary endurance.[web.archive.org]
Vomiting
  • The most common include For abortive poliomyelitis fever (up to 103º F) decreased appetite nausea and/or vomiting sore throat not feeling well constipation abdominal pain For nonparalytic poliomyelitis headache, nausea and vomiting may be worse child[childrenshospital.org]
  • The most common include For abortive poliomyelitis fever (up to 103º F) decreased appetite nausea and/or vomiting sore throat not feeling well constipation abdominal pain For nonparalytic poliomyelitis headache , nausea and vomiting may be worse child[childrenshospital.org]
  • Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent.[who.int]
  • Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent. Polio can only be prevented by immunization.[paho.org]
  • The remaining 5% show the typical signs of this disease which include fever, headache, vomiting, diarrhea, neck stiffness and pain in arms and legs.[symptoma.com]
Diarrhea
  • The remaining 5% show the typical signs of this disease which include fever, headache, vomiting, diarrhea, neck stiffness and pain in arms and legs.[symptoma.com]
  • The signs and symptoms of subclinical polio last approximately 72 hours and may include: No symptoms in some Headache General discomfort Sore throat Vomiting The signs and symptoms of nonparalytic polio last approximately 1 – 2 weeks and may include: Diarrhea[infdisease.iaff.org]
  • Abortive polio: In these cases, polio is a mild illness, with viral-like symptoms such as fever, fatigue, headache, sore throat, nausea, and diarrhea.[historyofvaccines.org]
  • He had a mild frontal headache and diffuse arthralgias during the preceding week, without fever or diarrhea.[archneur.jamanetwork.com]
Constipation
  • The most common include For abortive poliomyelitis fever (up to 103º F) decreased appetite nausea and/or vomiting sore throat not feeling well constipation abdominal pain For nonparalytic poliomyelitis headache, nausea and vomiting may be worse child[childrenshospital.org]
  • The most common include For abortive poliomyelitis fever (up to 103º F) decreased appetite nausea and/or vomiting sore throat not feeling well constipation abdominal pain For nonparalytic poliomyelitis headache , nausea and vomiting may be worse child[childrenshospital.org]
  • Muscle stiffness or spasms Rash The signs and symptoms of paralytic polio may not resolve and include: Drooling Muscle pain, contractions, spasms Muscle weakness (especially on only one side) Abnormal sensations Breathing difficulty Bloating and/or constipation[infdisease.iaff.org]
  • The symptoms of paralytic infections are: abnormal sensations bloated feeling in abdomen constipation difficulty beginning to urinate breathing difficulty drooling fever 5-7 days headache irritability muscle spasms in the calf stiff neck and back swallowing[lifesafe.wordpress.com]
  • Triphala: is an ayurvedic remedy that helps to cure a lot health related issues such as constipation, digestion, purification of blood and it also aids in treating polio – a deadly disease that has been haunting human kind for centuries now.[nigeriagalleria.com]
Nausea
  • The most common include For abortive poliomyelitis fever (up to 103º F) decreased appetite nausea and/or vomiting sore throat not feeling well constipation abdominal pain For nonparalytic poliomyelitis headache, nausea and vomiting may be worse child[childrenshospital.org]
  • The most common include For abortive poliomyelitis fever (up to 103º F) decreased appetite nausea and/or vomiting sore throat not feeling well constipation abdominal pain For nonparalytic poliomyelitis headache , nausea and vomiting may be worse child[childrenshospital.org]
  • Symptoms Non-specific symptoms which may also occur with other virus infections are seen in the early stages of the illness: nausea, headaches, fever and possibly diarrhoea.[ottobock-export.com]
  • Patients may complain of fever, sore throat, headaches, nausea and vomiting and generalised muscular pains. Diarrhoea may be a presenting symptom. In those with progressive disease paralysis may develop.[tmb.ie]
  • Abortive polio: In these cases, polio is a mild illness, with viral-like symptoms such as fever, fatigue, headache, sore throat, nausea, and diarrhea.[historyofvaccines.org]
Dysphagia
  • The classical symptoms of this third stage include hyper- or hypotension, respiratory failure, dysphagia and dysphonia. In rare cases, the penetration of the central neuron system might be so severe that acute encephalitis can occur.[symptoma.com]
  • Dysphagia, nasal regurgitation, and nasal voice are usually the earliest signs of bulbar involvement, but some patients have pharyngeal paralysis and cannot control oral secretions.[merckmanuals.com]
  • Modified barium-swallow esophagogram demonstrated moderate pharyngeal-phase dysphagia with aspiration of thin liquids.[archneur.jamanetwork.com]
Cyanosis
  • The lack of oxygen which resulted from the respiratory insufficiency produced the foul blue skin color known as cyanosis.[web.archive.org]
  • In addition to cold intolerance, patients may also develop color changes ranging from cyanosis to violet color and blanching of the affected extremity, flushing, and hot and cold flashes. [ 137, 138 ] This can be accompanied by hyperesthesia, burning[web.archive.org]
Muscle Weakness
  • BACKGROUND: Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints.[ncbi.nlm.nih.gov]
  • It is characterized by new muscle weakness seen in survivors of acute poliomyelitis.[ncbi.nlm.nih.gov]
  • The primary criteria necessary for the diagnosis of PPS are a history of paralytic poliomyelitis, partial or complete recovery of neurological function followed by a period of stability (usually several decades), persistent new muscle weakness or abnormal[ncbi.nlm.nih.gov]
  • Some of these patients develop post-poliomyelitis muscular atrophy (PPMA) which is characterized by a slowly progressive muscle weakness.[ncbi.nlm.nih.gov]
  • Some of these patients develop slowly progressive muscle weakness known as post-poliomyelitis muscular atrophy (PPMA). We describe an unusual form of amyotrophic lateral sclerosis (ALS) in a patient with acute poliomyelitis in childhood.[ncbi.nlm.nih.gov]
Muscular Atrophy
  • We report the case of PPS in a patient, 40 years, that thirty-five years after had had paralytic poliomyelitis, developed new symptoms of fatigue, muscular atrophy, dyspnea, difficulties in deambulation and muscular and joint pain.[ncbi.nlm.nih.gov]
  • Some of these patients develop post-poliomyelitis muscular atrophy (PPMA) which is characterized by a slowly progressive muscle weakness.[ncbi.nlm.nih.gov]
  • Some of these patients develop slowly progressive muscle weakness known as post-poliomyelitis muscular atrophy (PPMA). We describe an unusual form of amyotrophic lateral sclerosis (ALS) in a patient with acute poliomyelitis in childhood.[ncbi.nlm.nih.gov]
  • atrophy Increasing joint instability/joint deformities Cramping Subsultus (fasciculation) Changes in gait pattern and/or an increased tendency to fall Therapy Since no causative antiviral therapy exists, treatment is limited to symptomatic measures.[ottobock-export.com]
  • Figarella-Branger , Expression of developmentally regulated cytoskeleton and cell surface proteins in childhood spinal muscular atrophies , Journal of the Neurological Sciences , 133 , 1-2 , (155) , (1995) .[doi.org]
Myalgia
  • In paralytic poliomyelitis, muscle weakness is preceded by intense myalgias of the involved limbs and axial skeleton.[medlink.com]
  • GBS, the fever, short latent period, and CSF pleocytosis suggested an acute infectious process, and with the MRI findings were characteristic of poliomyelitis. 3, 5, 7 - 12 The prodrome of paralytic poliomyelitis consists of malaise, headache, fever, myalgias[archneur.jamanetwork.com]
  • , the fever, short latent period, and CSF pleocytosis suggested an acute infectious process, and with the MRI findings were characteristic of poliomyelitis. 3 , 5 , 7 - 12 The prodrome of paralytic poliomyelitis consists of malaise, headache, fever, myalgias[doi.org]
Muscle Tenderness
  • Symptoms/Signs of Nonparalytic Poliomyelitis Arm and leg pain or stiffness Abnormal reflexes Back and neck pain and stiffness, Fatigue Fever Headache Muscle tenderness and spasms Problems swallowing and/or breathing Sore throat in the absence of upper[nigeriagalleria.com]
  • Non-paralytic poliomyelitis Symptoms include back pain or backache, diarrhea, excessive tiredness, fatigue, headache, irritability, leg pain (calf muscles), moderate fever, muscle stiffness, muscle tenderness and spasm in any area of the body, neck pain[wikilectures.eu]
  • These include: fever sore throat headache vomiting fatigue back and neck pain arm and leg stiffness muscle tenderness and spasms meningitis, an infection of the membranes surrounding the brain Paralytic polio symptoms Paralytic polio affects only a small[medicalnewstoday.com]
  • In those cases patients become irritable and develop pain in the back and limbs, muscle tenderness, and stiff neck. Many recover at that stage, but approximately 1 in 200 persons with polio develops what is known as flaccid paralysis.[britannica.com]
Muscle Cramp
  • Exercise should never be performed to the point of pain or muscle cramps ( Cashman, Maselli, et al., 1987 ).[web.archive.org]
  • It is characterized by muscle cramps, fasciculations, or a crawling sensation. Typically, it occurs at night or the end of the day when the patient tries to relax.[web.archive.org]
Flaccid Paralysis
  • The objective of this paper was to review the need for acute flaccid paralysis surveillance by presenting two cases.[ncbi.nlm.nih.gov]
  • Abstract This report describes a case of acute flaccid paralysis after administration of oral polio vaccine (OPV).[ncbi.nlm.nih.gov]
  • Surveillance relies on reporting of acute flaccid paralysis (AFP) cases and laboratory confirmation through isolation of poliovirus from stool. However, delayed sample collection and testing can delay outbreak detection.[ncbi.nlm.nih.gov]
  • The annual AFP incidence rate was 0.87/100'000 children KEYWORDS: Polio Eradication Initiative; acute flaccid paralysis surveillance system; environmental surveillance system; non-polio enterovirus; poliovirus[ncbi.nlm.nih.gov]
  • We discuss over the biological and clinical implications in the context of the Global Polio Eradication Program and emphasize on the importance of the Acute Flaccid Paralysis surveillance.[ncbi.nlm.nih.gov]
Headache
  • She had a history of high fever, headache, and gait disturbance. Neurologic examination confirmed spastic triparesis, urinary incontinence, diminution of tactile sensation, and vision deterioration.[ncbi.nlm.nih.gov]
  • Symptoms are fever, severe headache, stiff neck and back, deep muscle pain, and sometimes areas of hyperesthesia (increased sensation) and paresthesia (altered sensation).[medicinenet.com]
  • Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent.[who.int]
  • Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent. Polio can only be prevented by immunization.[paho.org]
  • The remaining 5% show the typical signs of this disease which include fever, headache, vomiting, diarrhea, neck stiffness and pain in arms and legs.[symptoma.com]
Meningism
  • Both patients had fevers but no signs of meningitis at onset. Tendon reflexes were absent or reduced in affected regions.[ncbi.nlm.nih.gov]
  • Common manifestations of paralytic poliomyelitis in addition to aseptic meningitis include deep muscle pain, hyperesthesias, paresthesias, and, during active myelitis, urinary retention and muscle spasms.[merckmanuals.com]
  • […] non-septic meningitis, followed by a few days of being symptoms free then paralysis develops lower limbs more often affected than upper limbs Plain radiograph and CT With acute infection, no radiographic features are typically evident.[radiopaedia.org]
  • Related: Cholera on the Horn of Africa Niger meningitis outbreak: MSF teams have vaccinated more than 358,800 people Meningitis established as cause of Liberia cluster Nigeria meningitis outbreak climbs past 14,000 cases, situation improving Malaria outbreak[outbreaknewstoday.com]
Guillain-Barré Syndrome
  • The most severe cases of Guillain-Barré Syndrome often have persistent objective sensory loss, associated with greater weakness in the feet and hands, which show no resemblance to FDR's impairment and disability.[ncbi.nlm.nih.gov]
  • It has superficial similarities to a motor axonal variant of Guillain-Barré syndrome but can be distinguished by clinical, cerebrospinal fluid, and, perhaps specifically, magnetic resonance imaging characteristics.[ncbi.nlm.nih.gov]
  • Ropper AHWijdicks EFMTruax BT Guillain-Barré Syndrome. Philadelphia, Pa: FA Davis Co Publishers; 1991. 5. Yohannan MDRamia SAl Frayh ARS Acute paralytic poliomyelitis presenting as Guillain-Barré syndrome. J Infect. 1991;22:129-133.[archneur.jamanetwork.com]
Limb Weakness
  • The condition usually begins with a fever and upper respiratory tract or gastrointestinal tract symptoms that progress to a "paralytic" phase characterized by limb weakness, areflexia, and, occasionally, respiratory failure that superficially resemble[ncbi.nlm.nih.gov]
  • We describe a rare case of a 50 year old man; with a previous history of poliomyelitis in right lower limb who now presented with complaints of progressive left lower limb weakness for past two years.[ncbi.nlm.nih.gov]
  • CLINICAL PICTURE AND INVESTIGATION: A 57-year-old Chinese man with a history of poliomyelitis affecting both lower limbs presented with left upper limb weakness. Physical examination revealed atrophy of his left upper limb muscles.[ncbi.nlm.nih.gov]
  • We report a previously well 10-month-old Somalian girl who acquired asymmetric lower limb weakness in July 2013 in Mogadishu, Banadir, before arriving in Malaysia at 12 months of age.[ncbi.nlm.nih.gov]
Urinary Retention
  • Common manifestations of paralytic poliomyelitis in addition to aseptic meningitis include deep muscle pain, hyperesthesias, paresthesias, and, during active myelitis, urinary retention and muscle spasms.[merckmanuals.com]
  • A 50-year-old man had a 3-day history of urinary retention, abdominal cramping, diarrhea, and chills without fever, followed by leg weakness. Within several days he became lethargic and developed arm weakness.[archneur.jamanetwork.com]
Urinary Incontinence
  • Neurologic examination confirmed spastic triparesis, urinary incontinence, diminution of tactile sensation, and vision deterioration. Hemography, serum laboratory findings, and urinalysis were normal.[ncbi.nlm.nih.gov]

Workup

Physical examination of the subjects affected might show acute onset of flaccid paralysis in one or more limbs. Furthermore, the limbs affected appear to have decreased or absent tendon reflexes not related to another etiological factor, with no sensory or cognitive loss associated [25].

Laboratory studies reveal the presence of poliovirus, especially in the blood, very early during the course of the infection [2]. Moreover, by performing a lumbar puncture it is possible to reveal high concentrations of white blood cells and slightly elevated protein levels in the cerebrospinal fluid of the patient. PCR is also frequently used as diagnostic test, as it can allow to distinguish the wild type of poliovirus, which is usually found in nature, from the vaccine type, coming from a strain developed to produce vaccine [26].

Hypercapnia
  • A similar finding of central involvement of respiration was noted by Plum, who also stressed the importance of hypercapnia. Plum emphasized measurements of vital capacity and techniques to minimize trauma with suctioning after tracheostomy.[ncbi.nlm.nih.gov]
  • When not corrected, insidiously progressive hypercapnia leads to a compensatory metabolic alkalosis.[web.archive.org]

Treatment

There is no treatment of poliomyelitis, apart for the treatment of minor pathological conditions like paralysis and respiratory complications whose aim is to prevent or limit disease progression.

The gastrointestinal complications are usually treated through oral rehydration and/or fluids administered intravenously to prevent volume depletion. Unfortunately, paralytic poliomyelitis too has no treatment, and the limb affected is simply immobilized early to perform physical therapy and minimize handicaps [24] [27] [28] [29]. Limb paralysis might progress into respiratory paralysis, a dangerous and life-threatening stage which requires supportive measures including incubation and ventilation [30].

There might be another poliomyelitis-related syndrome that usually manifests itself many years after the appearance of paralytic poliomyelitis, known as postpoliomyelitis syndrome. This pathological condition consists if fatigue, weakness and wasting of the affected limbs that requires immobilization and physical therapy [31] [32] [33].

It is important to notify any case of poliomyelitis to the local health authorities when it appears.

Prognosis

The prognosis of poliomyelitis is generally good. The milder types of poliovirus infections are asymptomatic and carry no specific complication, while in the cases of paralytic poliomyelitis muscle function gradually returns back to normal with no residual paralysis for most of the time. Rare instead, are the cases of death, which occur much more frequently in adults than children usually as bulbar poliomyelitis. If death comes, this generally occurs within 2 weeks from infection.

Etiology

Poliomyelitis is caused by poliovirus, an enterovirus belonging to the family Picornaviridae. This is a classical RNA virus, made up of a RNA genome of around 7500 nucleotides [10] protected and enveloped by a protein capsid [11]. The virus mainly attacks the gastrointestinal tract [12] especially the oropharynx and intestine, with an incubation time ranging from 3 to 35 days. So far, three serotypes have been identified, type 1, type 2, and type 3. Type 1 is the most common of these three and certainly the one closely associated with muscle weakness and paralysis [13].

Poliomyelitis is mainly transmitted via fecal-oral route [14], especially in poor regions, but in areas with good hygienic conditions it can occasionally spread via oral-oral route [13]. The disease has a seasonal transmission trend, with a peak during summer and winter, and appears to affect only human beings.

Epidemiology

Poliomyelitis has been eradicated in the western world since 1991 [15], apart from some travel-related cases which occurred in the US [16] over the last few years. The other countries can be divided in two major groups: the ones where the disorder is endemic and the ones where it is sporadic. 131 new cases were reported in 2012, 115 of which occurred in endemic countries and 16 in non-endemic ones [17]. Endemic regions include countries like Afghanistan, Pakistan, and Nigeria, while non-endemic ones include countries like Somalia, Equatorial Guinea, Cameron, and Iraq. The majority of these countries are in the tropical region, with a peak of transmission at the end of summer perhaps due to the confluence of hot temperatures and rainy conditions. Unfortunately, the vast majority of these cases is represented by children less than 36 months of age. There is no epidemiological difference in the epidemiology between females and males [18] [19].

Sex distribution
Age distribution

Pathophysiology

Poliovirus enters the body through the mouth, where it begins to move towards the gastrointestinal system. From here, it spreads to the tonsils, the intestinal lymphoid tissue and the deep cervical and mesenteric lymph nodes, where the virus finds the perfect conditions to multiply. Poliovirus then returns to the bloodstream and the other sites of the body [20], such as brown fat, reticuloendothelial tissues, and muscles [21]. The central nervous system [22] is another site sometimes reached by poliovirus, even though experts believe this is just an accidental deviation from the normal intestinal infection, with no relation with the age, gender, and socioeconomic position of the individual affected [23]. Here, poliovirus mainly affect motor neurons in the anterior horn and brainstem, and this is the reason why it causes the development of acute flaccid paralysis [24].

Prevention

Vaccination is the primary means of prevention [34]. The polio vaccine has proved to be effective in blocking person-to-person transmission and therefore preventing the spread of the infection in large communities. Vaccines should not be given to those who have experienced anaphylactic reaction to a previous dose of IPV-containing vaccines or to neomycin, streptomycin and polymyxin B.

Summary

Poliovirus can invade several parts of the human body. It usually firstly affects the lymphatic tissue and enters the blood stream, where it can reach motor neurons causing flaccid paralysis. For this broad action, poliovirus can cause a wide spectrum of possible effects, from asymptomatic to meningitic or paralytic acute illness, many of which can provoke a characteristic permanent muscle weakness. The majority of the cases, from 90% to 95%, have no symptoms [1], while the remaining 5 to 10% are characterized by several signs such as fever, headache, vomiting, diarrhea, neck stiffness and pain in arms and legs [1] [2]. Unfortunately, from 2% to 5% of children and from 15% to 30% of adults who show muscle weakness die.

Poliovirus usually spreads from person to person through infected feces generally found in food, water, or saliva. There is no particular treatment for poliomyelitis, and even though a vaccine has been developed, the disease is still widespread, especially in poor countries such as Afghanistan, Nigeria, and Pakistan, where polio vaccination is highly recommended [3].

With descriptions of its effects present in ancient Egyptian art, poliomyelitis is one of the most ancient diseases known by human beings. The infection was first described at the end of the 18th century, while poliovirus was first identified at the beginning of the 20th century [4]. Although the vaccine was developed in the 1950s [5], the disorder still remains a concerning childhood disease [6], especially in poor regions like Asia, Africa and the Middle East [7]. New cases have been reported in Syria in 2013 [8], but experts hope to globally eradicate the disease by 2018 [9].

Patient Information

Poliomyelitis is the infectious disease caused by poliovirus. This virus can invade many parts of the body, causing a wide range of clinical manifestations. The great majority of the cases, around 95%, show no signs and symptoms, and are therefore called “asymptomatic”. The remaining 5% show the typical signs of this disease which include fever, headache, vomiting, diarrhea, neck stiffness and pain in arms and legs. The condition might degenerate and cause paralysis of the limbs, especially legs, with great negative consequences for the life of the people affected.

The infection is still widespread in poor countries, especially the tropical ones, where the cases of death number around several hundred each year. In the western world the disease has been totally eradicated, apart from some travel-related cases of people who got the infection abroad.

There is no treatment for poliomyelitis, and prevention is only possible through vaccination.

References

Article

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  2. WHO. Poliomyelitis Fact sheet N°114. October 2014. 
  3. Centers for Disease Control and Prevention (CDC). Guidance to US Clinicians Regarding New WHO Polio Vaccination Requirements for Travel by Residents of and Long-term Visitors to Countries with Active Polio Transmission. June 2, 2014. 
  4. Daniel, edited by Thomas M, Robbins, Frederick C. Polio (1st ed. ed.). Rochester, N.Y.: University of Rochester Press. p. 11. 1999
  5. Aylward R. Eradicating polio: today's challenges and tomorrow's legacy. Ann Trop Med Parasitol 2006 100 (5–6): 401–13. 
  6. Wheeler, Derek S, Wong, Hector R, (eds.), Shanley TP. Science and practice of pediatric critical care medicine. London: Springer. pp. 10–11. 2009
  7. WHO. WHO statement on the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus. 5 May 2014. 
  8. WHO. Polio in the Syrian Arab Republic - update. 26 November 2013. 
  9. WHO. Global leaders support new six-year plan to deliver a polio-free world by 2018. 25 April 2013. 
  10. Hogle J. Poliovirus cell entry: common structural themes in viral cell entry pathways. Annu Rev Microbiol 2002 56: 677–702. 
  11. Ryan KJ, Ray CG (eds.). Enteroviruses. Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 535–7. 2004
  12. Cohen JI. Enteroviruses and Reoviruses. In: Kasper DL, Braunwald E, Fauci AS, et al. (eds.). Harrison's Principles of Internal Medicine (16th ed.). McGraw-Hill Professional; 2004. p. 1144.
  13. Linda K Ohri, Jonathan G. Marquess. Polio: Will We Soon Vanquish an Old Enemy?. Drug Benefit Trends 1999 11 (6): 41–54. 
  14. Kew O, Sutter R, de Gourville E, Dowdle W, Pallansch M. Vaccine-derived polioviruses and the endgame strategy for global polio eradication. Annu Rev Microbiol 2005 59: 587–635. 
  15. Centers for Disease Control and Prevention (CDC). International notes certification of poliomyelitis eradication - the Americas, 1994. MMWR Morb Mortal Wkly Rep. 1994;43:720-722. 
  16. Centers for Disease Control and Prevention (CDC). Poliovirus infections in four unvaccinated children-Minnesota, August-October 2005. MMWR Morb Mortal Wkly Rep. 2005;54:1053-1055. 
  17. World Health Organization, Global Polio Eradication Initiative. Polio this week. October 2014. http://www.polioeradication.org 
  18. Lahariya C, Pradhan SK. Prospects of eradicating poliomyelitis by 2007: compulsory vaccination may be a strategy. Indian J Pediatr. 2007;74:61-63. 
  19. American Academy of Pediatrics. Poliovirus infections. In: Pickering LK, Baker CJ, Kimberlin DW, et al, eds. Red Book: 2009. Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:541-545. 
  20. Yin-Murphy M, Almond JW. Picornaviruses: The Enteroviruses: Polioviruses. Baron's Medical Microbiology (Baron S et al., eds.) (4th ed.). 1996 Univ of Texas Medical Branch. 
  21. Sabin A. Pathogenesis of poliomyelitis; reappraisal in the light of new data. Science 1956 123 (3209): 1151–7. 
  22. Chamberlin SL, Narins B (eds.). The Gale Encyclopedia of Neurological Disorders. Detroit: Thomson Gale. pp. 1859–70. 2005
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  27. Cochi SL, Kew O. Polio today: are we on the verge of global eradication? JAMA. 2008;300:839-841.
  28. Khan OA. Polio and post-polio syndrome. In: Zhang Y, ed. Encyclopedia of global health. Thousand Oaks, CA: Sage; 2008.
  29. Neumann DA. Polio: its impact on the people of the United States and the emerging profession of physical therapy. J Orthop Sports Phys Ther. 2004;34:479-492. 
  30. Miller AH, Buck LS. Tracheotomy in bulbar poliomyelitis. Calif Med. 1950;72:34-36. 
  31. Ramaraj R. Post-poliomyelitis syndrome: clinical features and management. Br J Hosp Med. 2007;68:648-650.
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Last updated: 2019-07-11 22:08