Polio - is an infectious viral disease, which is a danger that its activator able to destroy the structure of the central nervous system. The destruction of these tissues causes paralysis and muscle atrophy. Basically polio are children, but, thanks to vaccination, it was possible to reduce the morbidity, and in many countries and fully defeat the disease.
GENERAL
At the moment, there are isolated cases of poliomyelitis development, whereas in the past, prior to mass vaccination, the epidemic of the disease were observed. In the early twentieth century in Europe and Africa on the growth of the incidence of polio had the character of a national disaster.
In 50-ies of the last century, after the active introduction of polio vaccine indicators diagnosed outbreaks of infection fell by 99%, but still marked endemic areas of the disease in Nigeria and South Asia.
Polio is seasonal increase in incidence occurs in summer and autumn. Particularly susceptible children from six months old to 5 years old, but adults are also cases of infection recorded.
The causative agent of poliomyelitis - poliovirus from the group of intestinal Enterobacteriaceae family Picornaviridae (Picornaviridae). There are 3 types of the pathogen. In 85% of cases diagnosed paralysis poliovirus first type.
The virus is highly resistant in the environment: it is stored in water for over 100 days, while in feces - six months. The impact of digestive juices, freezing and drying is not reflected on his life. Death occurs when poliovirus prolonged boiling under the influence of ultraviolet and low concentrations of disinfectant solutions (chlorhexidineBleach, furatsilin, hydrogen peroxide).
CAUSES
The source of infection is infected person is showing signs of disease, and the media, who are asymptomatic pathology.
In the human body the causative agent penetrates through the mucous membranes of the upper respiratory tract and intestine. Basically there is fecal-oral route of transmission through contaminated food, water, hand. Much less is the spread of disease by airborne droplets. Also recorded cases of infection while swimming in polluted waters.
Phases of development:
- Enteral. Initial replication of the virus in tonsils with airborne infection or in the lymphoid follicles of the intestine with fecal-oral infection.
- Lymph node. From the localization of viral particles are distributed in the lymphoid tissue, then in the mesenteric and cervical limfauzly, where they continue the process of replication.
- Viremia. Poliovirus occurs out of the lymphatic system into the bloodstream and spread throughout the body. Secondary replication of viral particles is carried out already from the internal organs.
- Neural. This phase of development is possible only in the absence of neutralizing the virus by mononuclear phagocytes. The causative agent of the blood migrates into neurons of the anterior horn of the spinal cord and motor nuclei of the brain. Damage and death of neurocytes provokes inflammation, at this point the nerve tissue is replaced by connective.
Of particular danger to others are people with erased symptoms or mild polio. They continue their usual life and spread the virus among others, becoming a source of infection. In addition, another 3-4 days before the development of the first polio symptoms as fever, people are contagious.
Despite the severity of the disease, only 1% of people after penetration through the mucous membranes of poliovirus shell and viremia develops a severe form of polio, which is accompanied by sluggish paralysis.
CLASSIFICATION
Poliomyelitis is classified according to the severity of the CNS damage, by outward appearance, the nature of the flow.
Forms of the disease, depending on the symptoms:
- Polio flowing without damage to the nervous system cells - inapparent (of virus) and visceral (abortive) form.
- Polio flowing with damage to neurons, or typical - meningeal, paralytic and non-paralytic form.
By gravity poliovirus nervous system damage:
- Spinal - paralysis of the trunk muscles, diaphragm, neck and limbs.
- Bulbar - suppression of swallowing function, breathing, changes in speech and decreased cardiac function.
- Pontina accompanied by a partial change in facial expressions with distortion corner of the mouth from one side face and incomplete by closing lids.
- Encephalitic - signs of focal brain damage.
- Mixed
By the nature of the flow:
- smooth over - without complications; •
- nonsmooth for - the development of complications in the form of a secondary infection or aggravation of pathological processes smoldering).
Symptoms of polio in adults
The latent period polio lasts from 2 to 35 days, but mainly it lasts 1-2 weeks. In 95-99% of adult patients, the disease occurs without paralysis.
Symptoms according to the forms of the disease:
- Inapparent. In other words means carrier of the virus. Symptoms of infection are absent, to confirm the presence of the pathogen in the body is possible only with the help of laboratory tests.
- Visceral (abortive). It occurs in 80% of cases diagnosing poliovirus infection. Most often, the clinical manifestations occur in the form of fever, headache, intoxication, there may be catarrhal phenomena, abdominal pain, nausea, vomiting and diarrhea. Sometimes there may be muscle weakness and lameness. Symptoms are non-specific, the disease ends after 3-7 days of complete recovery.
- Meningeal. There have been two waves of fever for 2-5 days, followed by headache appears 1-3 days, muscle weakness, nausea and vomiting. in its course of the disease resembles serous meningitis. Recovery occurs after 3-4 days.
- Paralytic (spinal). This form of polio is characterized by the most severe and unpredictable outcome. At first the patient has symptoms and meningeal abortive form. Repeated increase in body temperature observed pain in the spine and muscles, confusion, and seizures. Paralytic phase manifests itself in adults for 3-6 days after onset of symptoms. It is characterized by sudden development of paralysis of the limbs (usually the legs) without loss of sensitivity. Less commonly, the disease is rising in nature, in which there comes paresis of the hands, face and body, often in violation of defecation and urination function. Spinal cord lesions of cervical-thoracic accompanied by paralysis of the diaphragm and respiratory muscles, which can cause the death of a patient due to acute respiratory failure. The severity of paralysis increases during the week, then half of the patients there is a gradual restoration of normal motor skills. A quarter of patients with paralytic polio in the future become disabled.
DIAGNOSTICS
Identification of the causative agent is of great practical importance, since similar symptoms can cause other types of enteroviruses and gerpevirusov. The differential diagnosis is carried out in order to exclude or confirm the tick encephalitis, Guillain-Barre syndrome, myelitis, serous meningitis and other enterovirus infections.
polio Identify nonparalytic form or in step preparaliticheskoy flowing to the lack of damage to the nervous system, it is difficult. Often during this period is commonly misdiagnosed as acute respiratory viral disease, intestinal infections or aseptic meningitis. Therefore, the clinical picture at this point is not decisive. The main role is played by laboratory diagnosis.
Diagnostic Methods
- Polymerase chain reaction (PCR) allows you to identify the virus in feces and the patient's cerebrospinal fluid.
- Linked immunosorbent assay (ELISA) helps to highlight the poliovirus RNA.
- Serological analysis of the plasma determines antibodies to poliovirus.
- Clinical analysis of cerebrospinal fluid, EEG, CT and MRI - as additional methods detect changes in the structure of the motor centers spinal cord and brain.
When taking lumbar puncture, CSF noted its high pressure. The content therein of leucocytes and proteins than normal.
TREATMENT
Patients with suspected polio and identify cases of infection being treated in a hospital infectious disease ward. Therapy involves isolation strict bed rest with restriction active movements and nutrition.
Specific treatment polio no effective antiviral drugs currently do not exist. All activities are reduced to the holding of symptomatic therapy.
For the treatment of the disease designate:
- analgesics;
- fever;
- sedatives;
- anti-inflammatory;
- antihistamines;
- intravenous infusion for the purpose of detoxification.
Also, possible use of diuretics, antibiotics, immunoglobulins, and antihypoxic agents to improve the neuromuscular conduction.
It is important to follow the correct position of the patient's body. With the development of paralysis of his stack on a hard bed without a pillow. Slightly legs bent at the knees and hip joints are disposed in parallel, the foot is fixed rail in the normal physiological state. Hand plant in hand and bend them at the elbows at right angles.
Resuscitation conducted in disorders of respiration. For this purpose the apparatus lung forced ventilation with simultaneous suction of mucus from the airways.
The recovery period begins at a hospital immediately after treatment and continues in outpatient conditions.
The recovery period includes:
- water treatment;
- exercise therapy;
- physical therapy (electrostimulation, UHF, hot compresses on the affected muscles).
COMPLICATIONS
When polio likely to develop paralysis of the respiratory muscles, which triggers an acute cardiac and respiratory failure. These serious conditions can be fatal, so patients should be monitored in a hospital.
Other complications of polio could be: interstitial myocarditis, pneumonia and pulmonary atelectasis. Bulbar form of the disease sometimes lead to severe disorders of the gastrointestinal tract that are accompanied by ulcers, bleeding, and perforation.
One of the rather rare complications of vaccination is the development of a live polio vaccine-associated poliomyelitis.
PREVENTION
The only effective measure for prevention of polio is vaccination. It provides active lifelong immunity against the disease. Routine vaccination of children is usually performed inactivated, and then the live vaccine. Inactivated vaccine is administered intramuscularly by injection, but a living produced in the form of drops for oral administration. Charts the introduction of the vaccine against polio are different in different countries in terms of vaccination and revaccination.
Another measure to prevent the spread of disease is to isolate patients to specialized hospitals to complete recovery and hygiene standards.
FORECAST FOR RECOVERY
When non-paralytic forms prognosis is favorable, the disease is often not accompanied by the appearance of any complications.
When paralytic development are more likely to appear the defects of different severity (contracture, paresis, muscle atrophy) and increased likelihood of death.
In the event of a disability lasting proper treatment and rehabilitation period led to a significant recovery of lost functions. After the defeat of the respiratory center prognosis significantly worse.
According to statistics, the structure identified polio predominate mild forms of the disease. Usually, severe damage observed in non-vaccinated patients.
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