Polio (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Overview
Poliomyelitis is a viral disease that can affect nerves and can lead to partial or full paralysis. It is caused by the Poliovirus, a member of the enterovirus subgroup, transient inhabitant of the gastrointestinal tract. It may be manifested as subclinical infection, non paralytic poliomyelitis, or paralytic poliomyelitis. Subclinical infection presents with unspecific symptoms, such as: headache, fever, and vomiting. Nonparalytic poliomyelitis includes symptoms, such as: diarrhea, back pain, muscle tenderness and spams, and skin rash. Paralytic poliomyelitis may manifest as: constipation, muscle weakness and pain, and changes in sensitivity. People with highest risk for the disease include: those who lack immunization against polio and are exposed to it, and persons who travel to an area that has experienced a polio outbreak. The diagnosis is made after clinical evaluation and after routine CSF examination, testing for levels of antibodies to the polio virus, and viral cultures of throat washings, stools, or cerebrospinal fluid (CSF). Treatment is based on symptomatic treatment while the infection runs its course. The prognosis of the disease depends on its manifestations, if the spinal cord and brain are not involved (90% of the time), complete recovery is likely.
What are the symptoms of Polio?
There are three basic patterns of polio infection: subclinical infections, nonparalytic, and paralytic. Approximately 95% of infections are subclinical infections, which may not have symptoms.
Subclnical Infection
- General discomfort or uneasiness (malaise)
- Headache
- Red throat
- Slight fever
- Sore throat
- Vomiting
People with subclinical polio infection might not have symptoms, or these may last 72 hours or less. Clinical poliomyelitis affects the central nervous system (brain and spinal cord), and is divided into nonparalytic and paralytic forms. It may occur after recovery from a subclinical infection.
Nonparalytic Poliomyelitis
- 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 and stiffness
- Pain in the front part of neck
- Pain or stiffness of the back, arms, legs, abdomen
- Skin rash or lesion with pain
- Vomiting
Symptoms usually last 1 - 2 weeks.
Paralytic Poliomyelitis
- Fever 5 - 7 days before other symptoms
- Abnormal sensations (but not loss of sensation) in an area
- Bloated feeling in abdomen
- Breathing difficulty
- Constipation
- Difficulty beginning to urinate
- Drooling
- Headache
- Irritability or poor temper control
- Muscle contractions or muscle spasms in the calf, neck, or back
- Muscle pain
- Muscle weakness, asymmetrical (only on one side or worse on one side)
- Comes on quickly
- Location depends on where the spinal cord is affected
- Worsens into paralysis
- Sensitivity to touch; mild touch may be painful
- Stiff neck and back
- Swallowing difficulty
What causes Polio?
Poliomyelitis is a disease caused by infection with the poliovirus. The virus spreads by direct person-to-person contact, by contact with infected mucus or phlegm from the nose or mouth, or by contact with infected feces.
The virus enters through the mouth and nose, multiplies in the throat and intestinal tract, and then is absorbed and spread through the blood and lymphatic system. The time from being infected with the virus to developing symptoms of disease (incubation) ranges from 5 - 35 days (average 7 - 14 days).
Who is at highest risk?
Person's at higher risk include those who:
- Lack immunization against polio and are exposed to the virus
- Travel to an area that has experienced a polio outbreak
In areas where there is an outbreak, those most likely to get the disease include children, pregnant women, and the elderly. The disease is more common in the summer and fall. Between 1840 and the 1950s, polio was a worldwide epidemic. Since the development of polio vaccines, the incidence of the disease has been greatly reduced. Polio has been wiped out in a number of countries. There have been very few cases of polio in the Western hemisphere since the late 1970s. Children in the United States are now routinely vaccinated against the disease. Outbreaks still occur in the developed world, usually in groups of people who have not been vaccinated. Polio often occurs after someone travels to a region where the disease is common. Thanks to a massive, global, vaccination campaign over the past 20 years, polio exists only in a few countries in Africa and Asia.
When to seek urgent medical care?
Call your health care provider if:
- Someone close to you has developed poliomyelitis and you haven't been vaccinated
- You develop symptoms of poliomyelitis
- Your child's polio immunization (vaccine) is not up to date
Diagnosis
The health care provider may find signs of meningeal irritation (similar to meningitis), such as stiff neck or back stiffness with difficulty bending the neck. The person also might have difficulty lifting the head or lifting the legs when lying flat on the back, and their reflexes might be abnormal. Tests include:
- Routine CSF examination
- Test for levels of antibodies to the polio virus
- Viral cultures of throat washings, stools, or cerebrospinal fluid (CSF)
Treatment options
The goal of treatment is to control symptoms while the infection runs its course. People with severe cases may need lifesaving measures, especially breathing help. Symptoms are treated based on how severe they are. Treatments include:
- Antibiotics for urinary tract infections
- Medications (such as bethanechol) for urinary retention
- Moist heat (heating pads, warm towels) to reduce muscle pain and spasms
- Pain killers to reduce headache, muscle pain, and spasms (narcotics are not usually given because they increase the risk of breathing difficulty)
- Physical therapy, braces or corrective shoes, or orthopedic surgery to help recover muscle strength and function
Where to find medical care for Polio?
Directions to Hospitals Treating Polio
What to expect (Outlook/Prognosis)?
What to expect depends on the form of the disease (subclinical, nonparalytic, or paralytic) and the site affected. If the spinal cord and brain are not involved, which is the case more than 90% of the time, complete recovery is likely. Brain or spinal cord involvement is a medical emergency that may result in paralysis or death (usually from respiratory difficulties). Disability is more common than death. Infection high in the spinal cord or in the brain increases the risk of breathing problems.
Possible complications
- Aspiration pneumonia
- Cor pulmonale
- High blood pressure
- Kidney stones
- Lack of movement
- Lung problems
- Myocarditis
- Paralytic ileus (loss of intestinal function)
- Permanent muscle paralysis, disability, deformity
- Pulmonary edema
- Shock
- Urinary tract infections
Post-polio syndrome is a complication that develops in some patients, usually 30 or more years after their initial infection. Weakness may get worse in muscles that were previously weakened. Weakness may also develop in muscles that previously were thought not to be affected.
Prevention
Polio immunization (vaccine) effectively prevents poliomyelitis in most people (immunization is over 90% effective)
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/001402.htm Template:WS Template:WH