POLIOMYELITIS

(INFANTILE PARALYSIS/HEINE-MEDEN DISEASE)

Definition

 Anacute infectious disease characterized

by changes in the CNS which may result in
pathologic reflexes, muscle spasms, and
paresis or paralysis.
 Disease of the lower motor neurons
 Anterior
horn involvement, such that it is
named anterior poliomyelitis.
Etiologic Agent

 Caused by filterable virus, the polio virus (Legio

dibilitans)
3 strains of this virus:
BRUNHILDE
LANSING
LEON
Incubation period

7 to 21 days for paralytic causes, with a repeated

range of 3 to 35 days.
Period of Communicability

 Pt is capable of transmitting the disease during the

first three days to three months of illness.
 The disease is most contagious during the first few
days of active disease, and possibly from 3 to 4
days before the onset of symptoms.
Mode of Transmission

 Transmitted from person to person by:

Direct contact with infected oropharyngeal
secretions and feces;
Person to person transmission through healthy
carriers; and
Indirectly, through flies and contaminated water,
food, utensils and other articles.
Types of Poliomyelitis

 The abortive
Does not invade the central nervous system.
Headache and sore throat
Slight or moderate fever
Occasional vomiting
Low lumbar pain
The pt usually recovers within 72 hours
Accts. For about 4 to 8%
 Non-paralytic
All the signs of the abortive type are observed
Types and spasm of the muscles of the hamstring
Changes in deep and superficial reflexes
Pain in the neck, back, arms, legs and abdomen.
Inability to place the head in between the knees
Positive Pandy’s test
Transient paresis may occur
Usually lasts for about a week, with meningeal
irritation persisting for about two weeks.
 Paralytic
The S/Sx listed under the abortive and non-
paralytic types are observed are present.
Positive (+) Hoyne’s sign
Paralysis occurs
Less tendon reflexes
Positive (+) Kernig and Brudzinski tests
Weakness of the muscles
Hypersensitivity to touch
 there usually is urine retention, constipation and
abdominal distension
Spinal Paralytic
Paralysis occurs in muscles innervated by
the motor neurons of the spinal cord.
Itis characterized by asymmetry and
scattered flaccid paralysis on one or both
lower extremities.
There is respiratory difficulty.
Bulbar
This type of paralysis usually develops rapidly
and is more serious.
Motor neurons in the brainstem are attacked,
affecting the medulla. This weakens the muscles
supplied by the cranial nerves, especially the 9th (
Glossopharyngeal) and the 10th (vagus)
Facial,pharyngeal and ocular muscles are
paralyzed.
There are cardiac irregularities and respiratory
failure
There is hypothalamic dysfunction, as manifested
by impaired temperature regulation.
Encephalitis manifestations, such as facial
weakness, dysphagia, difficulty in chewing,
inability to swallow or expel saliva, regurgitation
of food through the nasal passages and dyspnea,
are observed in about 30% of patients.
Bulbospinal
There is an involvement of the neurons
both in the brainstem, and the spinal cord.
Pathology

 The organism usually enters the body through the

alimentary tract and multiplies in the oropharynx
and lower intestinal tract.
 The organisms spread to the regional lymph nodes
and the blood.
 In the spinal type, there is evidence of gross
inflammation in the anterior horns of the gray
matter in the cord that often extends into the
arachnoid membrane of the nerve roots.
 In the cerebral type, the lesions are
indistinguishable from other brain inflammations,
although there seems to be predilection for the
medulla and basal ganglia.
 There seem to be subsequent congestion, edema
and necrosis in the area.
 There seem to be subsequent congestion, edema
and necrosis in the area.
 The lesions are found mainly in the anterior horn cells at the
following sites:
 The spinal cord
 The vestibular nuclei of the medulla and the cranial nerves
 The roof and dermis of the cerebrum
 Gray matter of the midbrain
 The motor cortex
Complications

 Respiratory failure
 Circulatory collapse
 Electrolyte infection
 Bacterial infection
 Urinary problems related to retention or paralysis
of the urinary bladder
 Abdominal distention
Diagnostic Procedures

 Isolation of the virus from throat washings or swab

early in the disease
 Stool culture throughout the course of the disease
 Culture from the cerebrospinal fluid (CSF)
Modalities of treatment

 Analgesics are helpful in easing headaches, back pain, and

leg spasms. Morphine is contraindicated because of the
danger of additional respiratory suppression.
 Moist heat application may reduce muscle spasms and
pain.
 Bed rest is necessary.
 Paralytic polio requires rehabilitation using physical
therapy, brace, corrective shoes and, in some cases,
orthopedic surgery.
Nursing Management

 Carry out enteric isolation

 Observe the patient closely for signs of paralysis
and other neurologic damage.
 Perform neurologic assessment at least once a day,
but don’t demand any vigorous muscular activity.
 Check blood pressure regularly, especially in
bulbar poliomyelitis.
 Watch for signs of fecal impaction due to
dehydration and immobility. To prevent this, give
sufficient fluid to ensure adequate daily output.
 Prevent the occurrence of pressure sores. Provide
good skin care. Reposition the patient frequently
and keep the bed dry.
 To prevent the spread of the disease, wash hands
after ever contact with the patient
 Apply how packs on the affected limb to relieve
pain and muscle shortening
 Dispose excreta and vomitus properly
 Provide emotional support both to the patient and
his/her family
 Maintain good personal hygiene. Particularly oral
care and skin care.
Prevention and control

 Immunization: oral polio vaccine (OPV)

 Proper disposal of GIT secretions
 Isolation
 Implementation of standard precaution
 Sanitationof the premises and proper food
handling should be strictly observed to avoid
contamination by flies.
FIN.