POLIOMYELITIS

An acute viral infection characterised by acute onset of flaccid paralysis of skeletal muscles. It is transmitted from person to person through the faecal-oral route.
Poliomyelitis is a notifiable disease.

Cause

  • Polio virus (enterovirus) types I, II, and III

Clinical features

  • Majority of cases are asymptomatic, only 1% result in flaccid paralysis
  • Non paralytic form: minor illness of fever, malaise, headache, and vomiting, muscle pains, spontaneous recovery in 10 days
  • Paralytic form: after the aspecific symptoms, rapid onset (from morning to evening) of asymmetric flaccid paralysis, predominantly of the lower limbs, with ascending progression
  • Paralysis of respiratory muscles is life threatening (bulbar polio)
  • Aseptic meningitis may occur as a complication

Differential diagnosis

  • Guillain-Barré syndrome
  • Traumatic neuritis
  • Transverse myelitis
  • Pesticides and food poisoning

Consider all cass of Acute Flaccid Paralysis as possible Poliomyelitis: alert the district focal person for epidemic control, and send 2 stool samples (refrigerated).

Investigations

  • Isolation of the virus from stool samples
  • Viral culture

Management

Acute stage
Poliomyelitis in this stage without paralysis is difficult to diagnose

Paralytic form

  • If paralysis is recent, rest the patient completely Note: Do not give IM injections as they make the paralysis worse
  • Refer the patient to a hospital for supportive care
  • After recovery (if partially/not immunised), complete recommended immunisation schedule

Chronic stage

  • Encourage active use of the limb to restore muscle function/physiotherapy
  • In event of severe contractures, refer for corrective surgery

Prevention

  • Isolate patient for nursing and treatment, applying contact and droplets precautions
  • Immunise all children below 5 years from the area of the suspected case
  • If case is confirmed, organize mass immunisation campaign
  • Proper disposal of children’s faeces
  • Immunisation (see chapter 18)
  • Proper hygiene and sanitation