Polio physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Most patients with a normal immune system will not be symptomatic and will have a normal physical exam. 4 to 8% of patients may develop abortive poliomyelitis, that may only show [[fever]] on the physical exam. 1 to 2% of patients will manifest non-paralytic poliomyelitis that may present with findings of [[nuchal rigidity]], and positive [[Kernig's sign|Kernig's]] and [[Brudzinski's sign|Brudzinski's]] signs. Less than 1% of patients will have paralytic poliomyelitis. This form of the disease may manifest as: spinal paralytic poliomyelitis or bulbar paralytic paralysis. The spinal form may present with: [[fever]]; [[meningeal signs]]; weakness of the extremities; and asymmetrical flaccid paralysis, most frequently of the lower limbs. The bulbar form may present with: pharyngeal paralysis, with accumulation of secretions, inability to swallow and sometimes respiratory arrest. When poliencephalitis occurs, seizures and spastic paralysis may be present. | |||
==Physical Examination== | ==Physical Examination== | ||
About 95% of patients with an healthy [[immune system]] are asymptomatic and have a normal physical examination.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html }}</ref> | About 95% of patients with an healthy [[immune system]] are asymptomatic and have a normal physical examination.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html }}</ref> | ||
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[[Meningeal signs]] may be present on physical exam, such as:<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | [[Meningeal signs]] may be present on physical exam, such as:<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | ||
* [[Nuchal rigidity]] | * [[Nuchal rigidity]] | ||
* [[Kernig's sign]] | * Positive [[Kernig's sign]] | ||
* [[Brudzinski's sign]] | * Positive [[Brudzinski's sign]] | ||
==Paralytic Poliomyelitis== | ==Paralytic Poliomyelitis== | ||
Revision as of 16:21, 3 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Most patients with a normal immune system will not be symptomatic and will have a normal physical exam. 4 to 8% of patients may develop abortive poliomyelitis, that may only show fever on the physical exam. 1 to 2% of patients will manifest non-paralytic poliomyelitis that may present with findings of nuchal rigidity, and positive Kernig's and Brudzinski's signs. Less than 1% of patients will have paralytic poliomyelitis. This form of the disease may manifest as: spinal paralytic poliomyelitis or bulbar paralytic paralysis. The spinal form may present with: fever; meningeal signs; weakness of the extremities; and asymmetrical flaccid paralysis, most frequently of the lower limbs. The bulbar form may present with: pharyngeal paralysis, with accumulation of secretions, inability to swallow and sometimes respiratory arrest. When poliencephalitis occurs, seizures and spastic paralysis may be present.
Physical Examination
About 95% of patients with an healthy immune system are asymptomatic and have a normal physical examination.[1]
4 to 8% of poliovirus infection may lead abortive poliomyelitis, a mild symptomatic disease with little findings on physical exam. 2 to 3 days of fever may be the only finding.[2]
Poliovirus infection may cause non-paralytic (1-2%) or paralytic (<1%) forms of the disease. Physical findings in these forms of the disease may include:
Non-Paralytic Poliomyelitis
Meningeal signs may be present on physical exam, such as:[3]
- Nuchal rigidity
- Positive Kernig's sign
- Positive Brudzinski's sign
Paralytic Poliomyelitis
Spinal Paralytic Poliomyelitis
Temperature
- A fever is often present
Extremities
- Weakness of the extremities, predominantly of the proximal muscles, is characteristic of this form of the disease. Lower extremities are more often involved.
- Asymmetrical flaccid paralysis, predominantly of the proximal muscles, is characteristic of this form of the disease. Lower extremities are more often involved.
Neurologic
- Meningeal signs may be present on physical exam, such as:[4]
- Initially hyperactive deep tendon reflexes, that later become absent.
- Common combinations of limb involvement include:
- One lower limb, followed by one upper limb
- Both lower limbs, followed by both upper limbs
- Quadriplegia is a rare finding in infants.
Bulbar Paralytic Poliomyelitis
Neurologic
- Pharyngeal paralysis, evidenced by accumulation of secretions is often present in this form of the disease.[5]
- Inability to swallow[6]
- In rare severe cases, respiratory centers may be affected, leading to inability to breathe.[7]
Polioencephalitis
Neurologic
- Seizures are often present
- Spastic paralysis may be present
References
- ↑ "Poliomyelitis".
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.