AFP
Acute accid paralysis
weakness in one or more limbs,or the
respiratory or bulbar muscles, resulting
from damaged lower motor neurones.
Signs
there is weakness with reduced
tone
(accidweakness)
and reduced or absent reexes
D/d
Polio
Enterovirus 71
Gullian barre syndrome
Injection neuritis
Tick bite
Botulinum toxicity
Diptheritic neuropathy
Rabies
differences of AFP
Direct viral damage to
anterior horn cells eg
polio
Immune medicated
damage to peripheral
nevers
Paralysis onset
Several weeks after
During(or straight after) febrile illness
febrile illness
Pattern of
paralysis
Asymmetrical
Symmetrical
Time to reach
maximum weakness
Short(e.g.23days)
Long (e.g.714days)
Sensory involvement
No
Often (depending on
exact disease)
CSF
Increased lymphocytes
increased
protein(e.g.100mg/dLes
peciallylate in the
disease)
Pain
Often limb muscle pain
Often back pain
polio- mobin
historical background
First recorded case of polio is a
hieroglyph from Memphis, drawn
in approximately 1400BC, which
depicts a temple priest called
Siptah showing typical clinical
signs of paralytic poliomyelitis
was recorded in the late 1700s
with the first epidemic in the late
1800s.
The cases that were reported in
1979 where mild and self-limited
and do not result in paralysis
modern history
1789 - British physician Michael Underwood provides the first
clinical description of polio, referring to it as "debility of the
lower extremities."
1840 - German physician Jacob von Heine publishes a 78page monograph in 1840 which not only describes the
clinical features of the disease, but also notes that its
symptoms suggest the involvement of the spinal cord.
1908- Austrian physicians Karl Landsteiner and Erwin Popper
make the first hypothesis that polio may be caused by a
virus.
Treatment history
Polio patients whose
muscles were paralysed
faced months, perhaps
years, of arduous physical
therapy to strengthen
weakened muscles
Patients were often placed
in iron lungs to help with
breathing regulation
Bacteriological history
Poliovirus was first identified in
1909 by inoculation of specimens
into monkeys. The virus was first
grown in cell culture in 1949 which
became the basis for vaccines
vaccine history
1955 Inactivated vaccine
1961 Types 1 and 2 monovalent OPV
1962 Type 3 monovalent OPV
1963 Trivalent OPV
1987 Enhanced IPV (IPV)
Enterovirus
Serotypes
polio= gray matter
Myelitis= inflammation
of the spinal cord
Poliovirus
Enterovirus (RNA)(Picornavirus)
Three serotypes: 1, 2, 3
Rapidly inactivated by heat, formaldehyde,
chlorine, ultraviolet light
no cross immunization
Transmitted by oronasal route
By water and milk
Poliomyelitis Pathogenesis
Entry into mouth
Replication in pharynx, GI tract,
local lymphatics
Hematologic spread to lymphatics and central
nervous system
Viral spread along nerve fibers
Destruction of motor neurons
Outcomes of poliovirus infection
Prognosis
Epidemiology
Reservoir
Human
Transmission
possible
Fecal-oral
Oral-oral
Communicability
7-10 days before onset
Virus present in stool
3-6 weeks
Epidemiology
Most affects children under the age of 5 years in
developing tropical countries.
Incubation period ranges from 6 to 20 days
risk factors
infants and elderly
living with infected person
compromised immune system
lack of immunization
extreme stress or strenuous activity
travel to an area that has experienced polio
outbreak
incubation period
The
incubation
period
for
poliomyelitis is commonly 6 to 20
days with a range from 3 to 35
days. The response to poliovirus
infection is highly variable and
has been categorized based on
the
severity
of
clinical
presentation.
symptoms
Acute stage: generally lasts 7 to 10
days.
May include fever, pharyngitis, headache,
anorexia, nausea, and vomiting.
Illness may progress to aseptic meningitis and
menigoencephalitis in 1% to 4% of patients.
These patients develop a higher fever & sever
headache with stiffness of the neck and back
symptoms
Paralytic disease occurs 0.1% to 1% of those who
become infected with the polio virus.
Paralysis of the respiratory muscles or from cardiac
arrest if the neurons in the medulla oblongata are
destroyed.
signs
In cases with paralysis superficial reflexes
usually are absent first, and deep tendon
reflexes disappear when the muscle
group is paralyzed.
Recovery
Patients have some or full recovery from
paralysis, most clinical recovery occurs during
the 1 month and almost complete within 6
months
.
Limited recovery may occur for about 2 years.
fate
Among children who are paralysed by polio:
30% make a full recovery
30% are left with mild paralysis
30% have medium to severe paralysis
10% die
paralytic polio-3 types
Spinal polio - the most common, and
accounted for 79% of paralytic cases
from 1969-1979. It is characterized by
asymmetric paralysis that most often
involves the legs.
Bulbar polio - accounts for 2% of cases
and leads to weakness of muscles
innervated by cranial nerves.
Bulbospinal polio - it accounts for 19%
of cases and is a combination of bulbar
and spinal paralysis
diagnostic studies
Virus Culture
The laboratory diagnosis of polio is confirmed by isolation of virus
by cultures, from the stool or throat swab or cerebrospinal uid
(rare). In an infected person, the virus is most likely to be cultured
in stool cultures.
Serologic test
Acute and convalescent serum sample may be tested for rise in
antibody titer (antibodies to the poliovirus), but the report can be
difficult to interpret as in many cases, the rise in titer may occur
prior to paralysis.
Cerebrospinal fluid test
Infection with polio virus may cause an increased number of
white blood cells and a mildly elevated protein level in
cerebrospinal uid
Treatment-acute stage
Bed rest, analgesics, hot packs, and
anatomical positioning of the limbs
gentle passive ROM exercises of all joints
treatment-acute stage
close monitoring of respiratory and cardiovascular
functioning is essential during the acute stage of
poliomyelitis along with fever control and pain relievers for
muscle spasms.
Mechanical ventilation, respiratory therapy may be needed
depending of the severity of patients.
Convalescent stage
From 2 days after the temperature return to normal and
continues for 2 years
Muscle power improves
Physical therapy is recommended for full recovery.
Passive stretching exercises and wedging casts can be
used for mild to moderate contractures.
convalescent stage
Surgical release of tight fascia and muscle
aponeuroses and lengthening of tendons may be
necessary for contractures persisting longer than 6
months.
Orthoses should be used until no further recovery is
anticipated.
chronic stage
Static joint instability can be controlled by
Orthoses.
Dynamic joint instability result in a fixed
deformity that cannot be controlled by
Orthoses.
chronic stage
Soft tissue surgery, such as tendon transfers, should be
done in young children before the development of any
fixed bony changes.
Bony procedures for correcting a deformity can be
delayed until skeletal growth is near completion.
prevention
The best preventive measure for
poliomyelitis is ensuring hygiene and
encouraging good sanitation practices.
But, polio prevention begins with polio
vaccination. Polio vaccine has been
developed against all 3 subtypes of the
poliovirus and is very effective in
producing protective antibodies that
induces immunity against the poliovirus
and provides protection from paralytic
polio.
vaccine
Two types of vaccine are available:
an inactivated (killed) polio vaccine (IPV) and
a live attenuated (weakened) oral polio vaccine
(OPV
Comparison of Oral Polio Vaccine (OPV) and Inactivated Poliovirus Vaccine (IPV).
Aamir Shahzad Clin Infect Dis. 2009;49:1287-1288
2009 by the Infectious Diseases Society of America
schedule
epi
End game
In 2013, the World Health Assembly
endorsed a plan that calls for the
ultimate withdrawal of oral polio
vaccines (OPV) from all immunization
programs globally.
End game
Removal of the type 2 component of OPV
in 2016 through a global switch from
trivalent OPV to bivalent OPV (containing
only types 1 and 3).
End game
all 126 OPV-only using countries
introduce at least one dose of
inactivated polio vaccine into routine
immunization programs by end-2015,
before the trivalent OPV-bivalent OPV
switch.
End game
reduce risks of reintroduction of type 2
poliovirus by providing some level of
seroprotection,
facilitating interruption of transmission if
outbreaks occur
and accelerating eradication by
boosting immunity to types 1 and 3
polioviruses.
feeling in my legs
when I lost the use of
them.
It was just such a weird
feeling.
It was just like it went
through me,
just a surge went
through my body.
I can feel it right now
just thinking about it.
It was very frightening
for a little 14-year-old
girl to think,
gosh, my lifes gone,
