Poliomyelitis is an acute viral disease that is characterized by damage to the spinal cord or brain. The most common complications of the development of this disease in children under the age of 5 years are atrophy, as well as muscle paralysis. It is very important to know the epidemiology, clinic, diagnosis and prevention of poliomyelitis. After all, this knowledge will help protect yourself from the disease. The main causative agent is poliovirus, which is part of the enterovirus group.
For more information about the prevention, treatment, diagnosis and clinic of poliomyelitis, see our article.
General information about the disease
Polio was ill in ancient Greece and Egypt since the time of the Pharaohs. This is confirmed by the found remains of people with characteristic deformities of the limbs.
Even at the beginning of the 20th century, poliomyelitis was a real disaster, which affected thousands of children around the world. The situation has changed with the invention of the vaccine. Now in developed countries, including Russia, polio is registered in isolated cases, but it is too early to completely exclude it from the list of diseases dangerous to health and life.
It causes poliovirus, which affects mainly children under the age of 7 years. Among older citizens, the disease practically does not occur or is asymptomatic. The survivors have a stable immunity, that is, you can get polio only once.
Children under the age of 3 months also do not get sick, as their body protects the immunity received from the mother.
How can you get infected
Poliovirus enters the body by oral-fecal or airborne droplets. You can catch it from an already sick person if he has symptoms of a cold (coughing, sneezing), in close contact with him, for example, through kisses, when using common objects, utensils, a towel, toys with the carrier of infection (applies to children).
In addition, the fecal-oral route of infection involves infection through dirty hands, eating contaminated virus and not washed food. Spreaders often become flies. That is why outbreaks of the disease are observed in the summer and autumn.
Poliovirus is very tenacious. In feces it lasts up to 6 months, and on objects - up to 3 months. He is not afraid of frost, gastric juice does not destroy him. However, when boiled, it dies almost instantly. It also kills the processing of objects with solutions with chlorine (even in minimal quantities). The virus cannot survive heating above 50 degrees Celsius.
Symptomatology
Once in the oral cavity, viruses begin to multiply in the intestines, tonsils or in the lymphatic pharyngeal ring. The incubation period can last from 3 to 35 days, but most often it takes 9-11 days. Viruses penetrate the bloodstream, and with its current into the central nervous system, causing damage to the nuclear cranial nerves and horns of the spinal cord. In cases of asymptomatic progression, the ailment can be detected only by chance when performing any patient studies.
Poliomyelitis can occur in several forms:
- Bulbar.
- Spinal.
- Pontina.
- Mixed.
Each has its own characteristic features. In general, patients may experience:
- Fever.
- Violation of the stool.
- Rash.
- Catarrhal phenomena.
- Horse Racing.
- General weakness, muscle pain.
- Urination disorder.
- Cyanosis.
- Shortness of breath and choking.
- Violation of swallowing.
- Paresis.
- Paralysis.
When contacting a medical institution, the patient is carried out:
- Medical history and general examination of the child.
- Collection of tests for the diagnosis of poliomyelitis.
- Detection of mucus in the feces and nasopharynx.
- The study of biomaterial using the methods of DSC and ELISA.
- Electromyography.
- Performing lumbar puncture, a thorough study of cerebrospinal fluid.
Methods for determining the disease
The diagnosis is finally made after obtaining the results of laboratory diagnostics of poliomyelitis, that is, virological and serological studies, obtaining electromyography indicators, which allows you to determine the severity of the lesion, the location of the pathological process.
Blood, cerebrospinal fluid, as well as swabs from the inside of the nasopharynx and feces, are suitable materials for performing effective studies as early as possible when the disease appears.
Laboratory diagnosis of poliomyelitis makes it possible to isolate the virus. Performed serodiagnosis allows you to identify antibodies that are directed against the developing virus of a given disease, and use for the determination of CSC makes it possible to determine the dynamic increase in titer.
Diagnosis of poliomyelitis can be difficult with visceral and meningeal forms. In this case, it is necessary to carefully examine and observe the motor activity of a small patient in order to be able to identify symptoms of minimal muscle weakness, as well as subtle weakening of reflexes.
Differential diagnosis of poliomyelitis
At the very beginning of the appearance of signs of polio, it is quite difficult to distinguish it from a sore throat and SARS, as well as in cases where the child has dyspeptic symptoms of dysentery and gastroenterocolitis.
It is also difficult to differentiate the disease under consideration from polio-like diseases that can cause Coxsackie and ECHO viruses. In such a situation, in addition to indicators of serological and virological studies, it is necessary to take into account certain features of the course of illnesses: ephemeral paresis, febrile course, as well as the absence of an altered composition of the cerebrospinal cerebrospinal fluid, which occurs with poliomyelitis and its complications. In such cases, PCR is used to diagnose poliomyelitis.
The meningeal form should be differentiated from serous meningitis, tuberculous, as well as mumps etiology. In this case, seasonality, epidemiological history, and features of the disease should be taken into account.
Mumps meningitis has a more pronounced pleocytosis, which in almost every case has a gradual onset, a significant increase in temperature, a progressive course, as well as the presence of a small amount of fibrin film in the cerebrospinal fluid, and a minimum sugar content
Symptoms of enteroviral meningitis are herpetic eruptions. The pontine variety of this disease can be compared with the development of facial neuritis. It should be borne in mind that it is mainly accompanied by lacrimation, impaired sensitivity, as well as pain. The disease develops more often in children under the age of 7 years.
If a patient has a bulbar form of polio, it is extremely important to exclude the presence of stem encephalitis, which manifests itself as cerebral lesions, seizures, impaired consciousness.
Diagnosis of epidemic polio is necessary in order to clarify the cause of the child’s health status. It is necessary to take into account the characteristics of the clinical course, indications of electromyographic and laboratory studies, as well as available endemiological data.
Treatment
Therapy of this disease is carried out after a qualitatively performed diagnosis. This procedure includes the following items:
- Mandatory hospitalization, bed rest.
- Optimal and appropriate drug therapy.
- Performing physiotherapeutic procedures.
A child who has poliomyelitis symptoms should be taken to the hospital as quickly as possible for inpatient treatment. If a patient is diagnosed with poliovirus, they are placed in a closed box for a period of 40 days. This is done to prevent the further spread of infection.
Bed rest is required to prevent the development of deformities and contractures of the legs and arms, so you should limit the patient's movement for 2 weeks or more.
If there is damage, it is recommended to immobilize the sites through the use of protractors. Also, the affected areas should be well wrapped with a plaid or scarf. The child needs to be put on a hard mattress.
In our time, there is still no special serum that would make it possible to stop the development of the polio virus. The patient is usually prescribed complex therapy, which helps to strengthen the immune system, so that the body has the ability to successfully and quickly overcome the poliovirus.
First of all, gamma globulin is administered intramuscularly to the patient, the dose of which is a maximum of 20 ml per day. A total of 3-5 injections are made. In addition, the introduction of “Interferon” preparations is necessary, hemotherapy is carried out - 5-30 ml of venous blood of one of the parents of 10-20 injections is administered intramuscularly to the child. Convalescence serum is taken from adults who have been in contact with patients, as well as people who have recovered from polio disease.
With this disease, antibiotics are prescribed exclusively in a situation if a threat of infection with a secondary infection is identified in order to prevent the occurrence of pneumonia and bacterial diseases in the future. With viral infection, antibiotics will not have the desired effect.
Anti-inflammatory therapy
To remove a possible inflammatory process of the spinal cord and brain, doctors usually use dehydration therapy, for which they use saluretics - Hydrochlorothiazide, Indapamide and Furosemide. In order to alleviate the patient’s condition as quickly as possible and to dilute sputum, if no respiratory disorders are noted, the use of ribonuclease is allowed. Also, to eliminate the inflammatory process, non-steroidal type drugs are prescribed, such as Afida, Nurofen and Nimesil.
Symptomatic treatment
To normalize the patient’s condition, as well as maintain the general condition of the body, vitamins B1 (thiamine chloride), ascorbic acid, amino acids, vitamin B12 (cyanocobalamin) and B6 (pyridoxine) are administered on the first day. If there are disorders of the functioning of the respiratory system, the use of mechanical ventilation is indicated.
When new paralysis is ruled out, anticholinesterase agents are used to normalize the functioning of the nervous system, which stimulate the interneuronal and myoneural conduction of the body as effectively and efficiently as Dibazol, Proserin and Nivalin.
To relieve pain in the muscle system, analgesics are used. To reassure the child, the use of sedatives such as "Valerian", "Persen", "Tenoten" and "Diazepam" is indicated. If the patient has impaired swallowing function, they can feed him using a nasogastric tube.
Recovery period
The first 3 weeks of the recovery period, the child is usually prescribed:
- Vitamins, especially Group B.
- Nootropic drugs "Piracetam", "Bifren", "Glycine", "Cavinton".
- Anticholinesterase drugs Prozerin and Nivalin.
- Anabolic hormones.
Physiotherapeutic treatments
These methods allow you to effectively restore movement, and contribute to the rapid restoration of internal systems, nerve cells, as well as muscles. The patient is advised to perform the following procedures for polio therapy and further rehabilitation:
- Paraffin therapy.
- Electromyostimulation.
- Healing showers and baths.
- UHF therapy.
- Physiotherapy exercises and orthopedic massage.
The above methods help restore muscle tone and movement of the limbs of the patient. Polio survivors will be very beneficially affected by rehabilitation performed in a sanatorium or resort.
Much attention is paid to the care of human limbs, which may have been paralyzed or deformed. It is necessary that the movements are slow and careful. It is necessary to provide a person with the correct position of the spine, arms and legs.
The patient is laid on a rather rigid mattress, the legs are laid parallel to the body, they need to be slightly bent at the hip and knee joints using special rollers. Under the sole for additional emphasis you need to place a dense pillow, the feet should be located at right angles to the legs. Hands should be taken to the sides, and bent at the elbows.
Prevention
In order not to resort to the diagnosis and treatment of polio, prevention can be performed. This process includes the following measures:
- The main method of prevention is vaccination.
- Thoroughly disinfect where the source of infection was detected.
- Following the rules of personal hygiene.
- Processing foods before cooking and eating.
Vaccination
Nowadays, a planned vaccine against polio is considered the main measure for the prevention of this disease. The vaccine helps to develop immunity to the virus. If even a person after some time becomes ill with polio, which happens very rarely, the course of the disease does not cause dangerous complications and passes in a mild form.
In 2018, 3 types of drugs were used:
- Koprovsky vaccine. It is the first polio vaccine in the world that has been used successfully since the 50s of the last century. This drug is used against polioviruses of type PV1 and PV3.
- Salk Vaccine (IPV, IPV) enables the body to develop immunity to three varieties of poliovirus. To achieve the desired result, the Salk vaccine must be given 3 times according to a special vaccination schedule.
- Seibin vaccine (OPV, OPV) is an oral type of anti-polio vaccine. It is given to the child in the mouth on a small piece of sugar, 2 drops each.
In a child, immunity against this poliovirus is created at about 3 years of age. To achieve maximum results, the OPV vaccine must be administered three times.
In very rare situations, a weakened virus can go into a normal course, causing the occurrence of paralytic poliomyelitis. Based on this, in many countries began to carry out mandatory immunization using the Salk vaccine.
Also in the world apply other varieties of polio preparations:
- Chumakova vaccine.
- Tetracock is a combination vaccine that protects children at the same time from poliomyelitis, tetanus, diphtheria and whooping cough.
The inactivated vaccine used contains the virus of the disease, which was previously killed by formalin. It is administered three times, which allows you to develop a special humoral immunity. The live vaccine has an attenuated virus that is administered orally. It stimulates the humoral and tissue immunity of the child's body.
Conclusion
Polio is a fairly serious disease that requires immediate medical attention. In order to maximally protect your child, it is necessary to timely vaccinate and revaccinate with effective and high-quality drugs. It is equally important to know the treatment, prevention, clinic and diagnosis of poliomyelitis. This information will help protect you from illness. Polio can cause pathological changes in the limbs, and in cases where the respiratory center is affected, choking may occur. Therefore, you can not refuse vaccination.