Poliomyelitis

- aka Infantile paralysis, Heine-Medin disease

- infectious disease characterized by changes in the CNS which may result in pathologic
reflexes, muscle spasm, and paresis or paralysis
- disease of the lower motor neurons with anterior horn involvement
- Not hereditary
- Mainly affects young children
- Virus is neurotropic - high affinity with the CNS
- As it multiplies, the virus destroys nerve cells (motor neurons) which activate muscles.
- These cells are responsible for helping people make movements such as walking or eating.
The motor neurons (nerve cells or anterior horn cells), therefore, control the voluntary
"movements in the arms, legs, chest, face, throat, and tongue." These nerve cells cannot be
regenerated and the affected muscles no longer function.
- The muscles of the legs are affected more often than the arm muscles.
- The limb becomes floppy and lifeless - a condition known as acute flaccid paralysis (AFP).

Causative Agent
- Polio virus, Legio debilitans
- Strains
Type I: Brunhilde – most frequent
Type II: Lansing
Type III: Leon – least frequent

INCUBATION PERIOD: 7-21 days

Period of Communicability
- first 3 days to first three months of the illness
- MOST COMMUNICABLE: first few days of the disease and possibly 3-4 days before that

Mode of Transmission
 Primary mode: ingestion of water contaminated with the virus
 Direct contact with infected oropharyngeal secretions
 Indirectly through contaminated articles and flies, contaminated water, food and utensils
 Primary mode: ingestion of water contaminated with the virus

Signs and symptoms

 Abortive type
 Does not invade the CNS – 95% of all cases
 Duration of illness usually less than 5 days and recovers within 72 hours
 Virus is ingested: accounts for GI symptoms
 Headache and sore throat
 Slight or moderate fever
 Abdominal pain
 Nausea and vomiting

  Non-paralytic
 Duration of illness usually less than 5 days
 Meningeal irritation persists for two weeks
 All the above signs
 Transient paresis
 Meningeal irritation
 Pandy’s sign (increased CHON in CSF)
 Paralytic
 All the above signs
 Hoyne’s sign (head lag)
 Amoss’s sign
 Kernig’s sign
 Brudzinski’s sign
 Less tendon reflex
 Paralysis occurs
 Recovery is still possible
 There is usually urine retention, constipation and abdominal distention
 One in 200 cases of polio progress to paralytic
Under Paralytic
o Spinal
 paralysis occurs in the area innervated by motor neurons of the spinal cord
 Flaccid paralysis on one or both lower extremities
 asymmetry
 autonomic involvement manifested by excessive sweating
 respiratory difficulty
o Bulbar
 develops rapidly and more serious
 respiratory failure and cardiac irregularity
 Motor neuron in the brainstem is attacked and affects the medulla, CN IX, X
 The medulla affects cardiac rate, blood pressure, respiration and swallowing
 More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result
in quadriplegia.
 Hypothalamic involvement: impaired temperature regulation
 Bulbospinal – neurons in both the brainstem and spinal cord

Diagnostic Procedures
 Isolation of the virus from throat
 Stool culture throughout the disease
 Culture from CSF

Treatment
- Because no drug developed so far has proven effective, treatment is entirely symptomatic.
- Bed rest
o Provide firm, non-sagging bed
o PLYWOOD bed to help align posture
- Moist heat application
o Done with physical therapy
 o Moist heat application for muscle spasm and pain
o Antispasmodics
- Analgesics
o Analgesics to ease headache, back pain and spasm. Morphine is contraindicated
because it causes respiratory depression
- Mechanical ventilator, as necessary
o While this can improve mobility, it cannot reverse permanent polio paralysis.

Nursing Management
 Carry out enteric precaution (because the Primary mode of transmission is the ingestion of
contaminated water)
 Perform neurologic assessment OD (but don’t demand any vigorous muscular activity)
 Check blood pressure BP (specially for bulbar poliomyelitis  brain stem/medulla  HR, BP)
 Provide a diet rich in fiber (Paralysis  prone to constipation)
 Watch for signs of fecal impaction (This is due to dehydration and immobility)
 Prevent pressure sores (Frequent position changes, every 2 hours)
 Dispose excreta and vomitus properly
 Provide emotional support

Complications
 Bed sore
 Pneumonia
 Renal calculi
 Constipation
 Muscular atrophy
 Respiratory failure
 Circulatory collapse

DO WE HAVE A VACCINE FOR THIS DISEASE?

- YES
- Oral Polio Vaccine (OPV) - Given by mouth The dropper should not touch the tongue)
- Inactivated Polio Vaccine (IPV) - IPV is a shot, given in the leg or arm
- Polio vaccine requires freezing PM
- Given by mouth

OPV IPV
Sabin Salk
Attenuated Killed virus
Cost-effective Expensive
Induces mucosal immunity Does not induce mucosal immunity
VAPP Does not cause VAPP
6, 10, 14 weeks 2, 4, 6-18 months and 4 years