Poliomyelitis is an acute viral disease that affects the central nervous system, primarily the spinal cord, and sometimes causes paralysis. The main method of distribution is considered to be direct or indirect contact with the patient (through hands, handkerchiefs, clothing, etc.). Also spreads through food, water, air.
What it is? Poliomyelitis is caused by poliovirus (poliovirus hominis) of the Picornaviridae family of the Enterovirus genus. There are three serotypes of the virus (type I prevails): I - Brunhilde (isolated from a sick monkey with the same name), II - Lansing (isolated in the town of Lansing) and III-Leon (isolated from a sick boy Macleon).
In some cases, the disease proceeds in an erased or asymptomatic form. A person can be a carrier of the virus, releasing it into the external environment along with feces and nasal secretions, and at the same time feel completely healthy. Meanwhile, the susceptibility to poliomyelitis is quite high, which is fraught with a rapid spread of the disease among the child population.
How is polio transmitted and what is it?
Poliomyelitis (from ancient Greek πολιός - gray and µυελός - spinal cord) - infantile spinal paralysis, an acute, highly contagious infectious disease caused by the lesion of the gray matter of the spinal cord by poliovirus and characterized mainly by the pathology of the nervous system.
Mostly it occurs in an asymptomatic or erased form. Sometimes it happens that the poliovirus enters the central nervous system, multiplies in motor neurons, which leads to their death, irreversible paresis or paralysis of the muscles they innervate.
Infection occurs in several ways:
- Airborne droplet - realized by inhalation of air with viruses suspended in it.
- Alimentary transmission - contamination occurs when eating contaminated food.
- Contact-household way - possible when using one dish for eating by different people.
- Waterway - the virus enters the body with water.
Particularly dangerous in terms of infectiousness are persons who are asymptomatic (in the form of an apparatus) or with nonspecific manifestations (slight fever, general weakness, increased fatigue, headache, nausea, vomiting) without signs of CNS damage. Such people can infect a large number of people in contact with them, because It is very difficult to diagnose a sick person, and, therefore, these persons are practically not isolated.
Polio vaccine
Specific prevention is polio vaccination. There are 2 types of polio vaccines:
- sebin live vaccine (OPV - contains live attenuated viruses)
- inactivated (IPV - contains poliovirus of all three serotypes killed by formalin).
Currently, the only manufacturer of poliomyelitis vaccine in Russia is the Federal State Unitary Enterprise “Enterprise for the Production of Bacterial and Viral Preparations of the Institute of Poliomyelitis and Viral Encephalitis. M.P. Chumakov ”produces only live vaccines against poliomyelitis.
Other drugs for vaccination are traditionally purchased abroad. However, in February 2015, the company presented the first samples of its own inactivated vaccine. The start of its use is scheduled for 2017.
Polio Symptoms
According to the WHO, poliomyelitis affects mainly children under the age of 5. The incubation period lasts from 5 to 35 days, the symptoms depend on the form of polio. According to statistics, most often the disease proceeds without impairment of motor functions - ten non-paralytic cases per one paralytic case. The initial form of the disease is the preparative form (non-paralytic poliomyelitis). It has the following symptoms:
- General malaise;
- Temperature rise up to 40 ° C;
- Decreased appetite;
- Nausea;
- Vomiting;
- Muscle pain;
- Sore throat;
- Headaches.
The listed symptoms gradually disappear within one to two weeks, but in some cases they can last longer. As a result of headache and fever, symptoms occur that indicate damage to the nervous system.
In this case, the patient becomes more irritable and restless, emotional lability is observed (instability of mood, its constant change). Muscle rigidity (that is, their numbness) also occurs in the back and neck, and Kernig-Brudzinsky signs indicating the active development of meningitis appear. In the future, the listed symptoms of the preparative form can develop into a paralytic form.
Abortive poliomyelitis
With the abortive form of poliomyelitis, sick children complain of an increase in body temperature up to 38 ° C. Against the background of the temperature, observe:
- malaise;
- weakness;
- lethargy;
- mild headache;
- cough;
- runny nose;
- abdominal pain;
- vomiting.
In addition, redness of the throat, enterocolitis, gastroenteritis or catarrhal sore throat are observed as concomitant diagnoses. The duration of the manifestation of these symptoms is about 3-7 days. Poliomyelitis in this form is characterized by pronounced intestinal toxicosis, in general, there is a significant similarity in manifestations with dysentery, the course of the disease can also be cholera-like.
Meningeal poliomyelitis
This form is characterized by its own severity, while symptoms similar to the previous form are noted:
- temperature;
- general weakness;
- malaise;
- stomach ache;
- headaches of varying intensity;
- runny nose and cough;
- decreased appetite;
- vomiting.
On examination, the throat is red, there may be plaque on the palatine arches and tonsils. This state lasts 2 days. Then the body temperature is normalized, catarrhal phenomena decrease, the child looks healthy for 2-3 days. After this, the second period of increase in body temperature begins. Complaints become more distinct:
- a sharp deterioration in the condition;
- strong headache;
- vomiting;
- pain in the back and limbs, usually in the legs.
An objective examination diagnoses the symptoms characteristic of meningism (positive symptom Kernig and Brudzinsky, rigidity in the back and occipital muscles). Improvement is achieved by the second week.
Paralytic poliomyelitis
It develops quite rarely, but, as a rule, leads to a violation of many body functions and, accordingly, to disability:
- Bulbar. The development of bulbar paralysis is of particular severity. The entire group of caudal nerves is affected. Selective damage to one or two nerves is not typical for poliomyelitis. With the defeat of the reticular formation, respiratory and vascular centers, consciousness, respiratory disorders of central genesis can be impaired.
- Pontinnaya. This type of poliomyelitis is characterized by the development of paresis and paralysis of the facial nerve, in which there is a partial or complete loss of facial movements.
- Encephalitic. The brain substance and subcortical nuclei are affected (very rarely). Central paresis, convulsive syndrome, aphasia, hyperkinesis develop.
- Spinal. Weakness and pain in the muscles are gradually replaced by paralysis, both general and partial. Muscle damage in this form of poliomyelitis can be symmetrical, but paralysis of individual muscle groups occurs throughout the body.
During the course of the disease, 4 periods are distinguished:
- preparative;
- paralytic;
- restorative;
- residual.
Preparalytic stage
Differs in a rather acute onset, high body temperature, general malaise, headache, gastrointestinal disorders, rhinitis, pharyngitis. This clinical picture persists for 3 days, then the condition is normalized for 2-4 days. After a sharp deterioration occurs with the same symptoms, but more pronounced intensity. The following signs join:
- pain in the legs, arms, back;
- decreased reflexes;
- increased sensitivity;
- decreased muscle strength;
- convulsions;
- confusion of consciousness;
- excessive sweating;
- spots on the skin;
- "goose-flesh".
Paralytic stage
This is the stage when the patient suddenly breaks down with paralysis (in a couple of hours). This stage lasts from 2-3 to 10-14 days. Patients during this period often die from severe respiratory and circulatory disorders. He has the following symptoms:
- flaccid paralysis;
- disorders of the act of defecation;
- decreased muscle tone;
- limitation or complete absence of active movements in the limbs, body;
- damage mainly to the muscles of the arms and legs, but the muscles of the neck and trunk may also be affected;
- spontaneous muscle pain syndrome;
- damage to the medulla oblongata;
- disorders of urination;
- damage and paralysis of the diaphragm and respiratory muscles.
In the recovery period of poliomyelitis, which lasts up to 1 year, there is a gradual activation of tendon reflexes, and movements in individual muscle groups are restored. Mosaicity of the lesion and uneven recovery cause the development of atrophy and muscle contractures, lagging of the affected limb in growth, the formation of osteoporosis and atrophy of bone tissue.
The residual period, or the period of residual effects, is characterized by the presence of persistent paresis and paralysis, accompanied by muscle atrophy and trophic disorders, the development of contractures and deformation in the affected limbs and body parts.
Post-polio syndrome
After the postponed poliomyelitis, some patients for many years (on average 35 years) remain limited and a number of manifestations, the most frequent of which are:
- progressive muscle weakness and pain;
- general weakness and fatigue after minimal exertion;
- amyotrophy;
- breathing and swallowing disorders;
- breathing disorders during sleep, especially sleep apnea;
- poor tolerance to low temperatures;
- cognitive impairment - such as decreased concentration and difficulty remembering;
- depression or mood swings.
Diagnostics
In the case of poliomyelitis, the diagnosis is based on laboratory tests. In the first week of illness, the poliomyelitis virus can be isolated from the secretion of the nasopharynx, and starting from the second - from the feces. Unlike other enteroviruses, the causative agent of poliomyelitis is rarely isolated from the cerebrospinal fluid.
If it is impossible to isolate and study the virus, a serological analysis is carried out, which is based on the isolation of specific antibodies. This method is quite sensitive, but it does not distinguish between post-vaccination and natural infections.
Treatment
Polio interventions require compulsory hospitalization. Bed rest, taking painkillers and sedatives, as well as thermal procedures are prescribed.
In case of paralysis, comprehensive rehabilitation treatment is carried out, and then supportive treatment in sanatorium-resort areas. Such complications of poliomyelitis as respiratory failure require urgent measures to restore breathing and resuscitate the patient. The focus of the disease is subject to disinfection.
Forecast for life
Mild forms of poliomyelitis (occurring without damage to the central nervous system and meningeal) disappear without a trace. Severe paralytic forms can lead to permanent disability and death.
Thanks to long-term targeted vaccine prophylaxis of poliomyelitis, mild inapparent and abortive forms of infection prevail in the structure of the disease; paralytic forms occur only in unvaccinated individuals.
Prevention
Non-specific is aimed at general strengthening of the body, increasing its resistance to various infectious agents (hardening, proper nutrition, timely sanitation of chronic foci of infection, regular physical activity, optimization of the sleep-wake cycle, etc.), combating insects that are carriers of pathogenic microorganisms ( various types of disinfestation), adherence to the rules of personal hygiene (first of all, washing hands after the street and after using the toilet), thorough processing of vegetables, fruits and other products before eating them.
To prevent the development of poliomyelitis, vaccination is used, which is carried out with the help of live weakened viruses - they cannot cause the development of the disease, but cause a specific immune response of the body with the formation of long-term stable immunity. To this end, in most countries of the world, polio vaccination is included in the mandatory vaccination schedule. Modern vaccines are multivalent - they contain all 3 serological groups of the poliomyelitis virus.
Poliomyelitis today is a very rare infection due to the use of vaccinations. Despite this, isolated cases of the disease are still being recorded on the planet. Therefore, knowledge of the main symptoms and methods of prevention is simply necessary. Forewarned is forearmed!
Global number of cases
Since 1988, the number of polio cases has decreased by more than 99%. It is estimated that from 350,000 cases in more than 125 endemic countries to 359 cases reported in 2014. Today, only separate territories of the two countries of the world with the smallest area in history remain endemic for this disease.
Of the 3 wild poliovirus strains (type 1, type 2 and type 3), wild poliovirus type 2 was eradicated in 1999, and the number of cases of wild poliovirus type 3 fell to the lowest level on record since November 2012 in Nigeria. new cases have been reported.
Good day, dear readers!
In today's article we will consider with you such an infectious and neurological disease as poliomyelitis, as well as its symptoms, causes, types, diagnosis, treatment, medicines, folk remedies and prevention. So…
What is polio?
Polio - acute, viral nature, characterized by predominant damage to the nervous system, brain and spinal cord, gastrointestinal tract. One of the most popular outcomes of polio is paralysis and muscle tissue atrophy. The disease poliomyelitis in most cases is diagnosed in children under the age of 5 years.
Other names for poliomyelitis - Heine-Medine disease, infantile paralysis.
The causative agent of poliomyelitis - poliovirus (poliovirus hominis), belonging to the group of enteroviruses (Latin Enterovirus). The source of infection is the carrier of the pathogen.
The main symptoms of polio - general malaise, headaches, redness of the pharynx, increased sweating. In fact, poliovirus infection is associated with symptoms similar to acute respiratory infections (ARI). Moreover, even the entry of the virus into the body usually occurs by airborne droplets.
The main measure for the prevention of poliomyelitis is vaccination of the population.
Development of poliomyelitis
The routes of transmission of the poliomyelitis virus are airborne and oral-fecal.
The entry gates for poliovirus, where it settles and begins to multiply actively, are the nasopharynx and intestines, which depends on the path of infection of the body.
The incubation period for poliomyelitis is from 5 to 14 days (rarely, the incubation period can last up to 35 days).
At the initial stage, during, the viral infection begins to multiply in the lymphoid formations of the nasopharynx or intestines. Further, the poliovirus enters the circulatory system and spreads along with the blood stream throughout the body. However, Poliovirus hominis has one feature, it loves to "eat" the cells of the nervous system, therefore, the target organs for poliomyelitis are mainly 2 parts - the brain and spinal cord. Doctors have established that if the poliovirus leads to the death of 25-33% of the cells of the spinal cord, a person develops paresis (partial loss of motor function), but if the dead cells are about 75%, complete paralysis develops.
Dead nerve cells are replaced by another tissue, and due to the fact that the motor function is impaired due to the innervation of certain tissues, those muscles lose their tone and begin to atrophy. One of the main signs of muscle atrophy is a significant decrease in volume.
Nevertheless, the course of poliomyelitis and its nature depends on the state of human health, the reactivity of the immune system, and the presence of the polio vaccine.
In this regard, the course of poliomyelitis after the incubation period can occur according to the following options:
1. Abortive form of poliomyelitis - a relatively mild form of the course of the disease with predominantly catarrhal symptoms, general weakness, a slight increase in temperature, nausea, digestive disorders, as well as the absence of damage to the cells of the nervous system. In addition, this form of the disease is the source of the spread of infection.
2. Non-paralytic form of poliomyelitis - accompanied by symptoms characteristic of inflammatory infectious diseases - fever, runny nose, nausea, diarrhea. It can also proceed as meningitis (inflammation of the meninges) in a mild form, with periodic back pain (sciatica), Kernig's, Neri's, Lasegue's symptoms.
3. Paralytic form of poliomyelitis - accompanied by damage to the cells of the spinal cord and brain in combination with symptoms characteristic of inflammatory infectious diseases.
The initial manifestations of paralysis are considered harbingers of the transition of the disease from a non-paralytic form to a paralytic one. The development of the paralytic form occurs in 4 stages:
Poliomyelitis stage 1 (preparative stage) - characterized by an acute onset lasting 3-5 days, fever, headaches, runny nose, pharyngitis and digestive disorders. After 2-4 days, a secondary wave of fever appears with an increase in temperature to 40 ° C and an increase in symptoms. The patient begins to be bothered by pain in the back and limbs, sometimes there is confusion, there is periodic muscle weakness, muscle cramps and some limited motor functions.
Poliomyelitis stage 2 (paralytic stage) - characterized by a weakening of tendon reflexes, a decrease in muscle tone, limitation of motor functions and a sharp development of paralysis. Most often, this phenomenon is present in the upper body - arms, neck, torso. Danger to life is the bulbar form of paralytic poliomyelitis, which is accompanied by paralysis of the respiratory system and disturbances in the work of the heart, which ultimately leads to suffocation of the patient. The duration of the paralytic stage ranges from several days to two weeks.
Poliomyelitis stage 3 (recovery stage) - characterized by a gradual restoration of the functioning of the paralyzed muscles over a long period - from several months to 3 years, and, at the beginning, this process is quite fast, and then slows down.
Poliomyelitis stage 4 (residual or residual stage) - characterized by atrophy of some muscles, flaccid paralysis, the presence of contractures and deformities in the limbs and trunk.
The functions of deeply affected muscles are usually not fully restored, therefore, various deformities often remain in children after poliomyelitis.
The pathogenesis of poliomyelitis
When the poliovirus is infected and the disease progresses, the spinal cord becomes inflamed, soft and edematous, and hemorrhagic areas are present in the gray matter. With the help of histology, the most pronounced changes are noted in the gray matter of the medulla oblongata and spinal cord. Diagnostics also shows various changes in the ganglion cells of the anterior horns - from a mild degree of chromatolysis to their complete destruction, accompanied by neuronophagy. The main essence of pathogenesis is expressed in the formation of perivascular couplings, consisting mainly of lymphocytes, as well as diffuse infiltration by lymphocytes and neuroglial cells of the gray matter. Not deeply affected ganglion cells, in the recovery stage, gradually return to their normal state.
Polio statistics
Poliomyelitis in children from 6 months to 5 years old was recorded most often. The incidence usually peaks in the summer and autumn. At an earlier age, the disease is practically not diagnosed, which is associated with the presence of maternal immunity in newborn infants, which is transmitted transplacentally - from mother to child.
Poliomyelitis, like guinea worm, is part of the global eradication program, which is led by WHO, UNICEF and Rotary International (Rotary International).
In general, the spread of poliomyelitis was halted by mass vaccination of people. For example, in 1988, there were about 350,000 recorded cases of the disease, and in 2001, only 483 cases were recorded. Since 2001, an average of about 1000 patients have been recorded annually, a significant part of whom live in the territories of South Asia (Afghanistan, Pakistan and the countries surrounding them) and in Nigeria.
The most frequent increases in morbidity were recorded in summer and autumn.
Poliomyelitis - ICD
ICD-10: A80, B91;
ICD-9: 045, 138.
Poliomyelitis - symptoms
Symptoms and their severity depend on the age and health of the patient, as well as the type of inflammatory process. In some cases, the disease can be asymptomatic or with minimal manifestations.
The first signs of poliomyelitis:
- Sometimes digestive disorders may be present in the form of or.
- Increased body temperature.
The main symptoms of poliomyelitis appear 2-4 days after the first signs of the disease, while the patient's condition deteriorates sharply.
The main symptoms of polio
- , soreness;
- Headaches;
- (up to 40 ° C);
- Increased sweating;
- Redness () and sore throat;
- Increased sleepiness or;
- Gastrointestinal disorders - nausea, diarrhea, constipation, rapid weight loss;
- There is a decrease or loss of tendon and skin reflexes;
- Tension in the neck muscles;
- Paresis, muscle atrophy, paralysis (in rare cases);
- It is also possible the appearance, nystagmus, incontinence or retention of urine and feces.
Complications of poliomyelitis
- Paralysis;
- Respiratory failure;
- Violation of the cardiovascular system;
- Interstitial,;
- Acute expansion of the stomach;
- Formation of ulcers, perforations and internal bleeding in the digestive tract;
- Lung atelectasis;
- Death.
The causative agent of poliomyelitis - poliovirus (Poliovirus hominis, poliomyelitis virus), belonging to the Enterovirus genus, of the Picornaviridae family.
In total, there are three strains of poliovirus - types I, II, III, and most people are diagnosed with type I poliovirus.
Source of infection - a sick person in whom at the initial stage the virus is excreted in saliva and is transmitted by airborne droplets, but as the disease progresses, the poliovirus settles in the intestines and is excreted into the external environment through feces, due to which people become infected through non-compliance, as well as with eating contaminated food. Flies can also transmit the infection, which first crawled through infected feces, and then through food.
Poliovirus is quite stable in the external environment - it can retain its activity in feces for up to 6 months, in the open air for up to 3-4 months, tolerates freezing, does not break down when exposed to digestive juices. The virus can be inactivated by drying, ultraviolet rays, boiling, chlorine treatment, heating to 50 ° C.
Once in the body, poliovirus spreads through the body through the lymphatic and circulatory systems, reaching and ultimately affecting the nervous system. Especially the infection loves to affect the motor cells of the anterior horns of the spinal cord, as well as the nuclei of the cranial nerves.
Types of poliomyelitis
The classification of poliomyelitis is as follows:
Type:
Typical forms - with damage to the central nervous system. The disease can develop in the following ways:
- Nonparalytic - accompanied mainly by symptoms characteristic of acute respiratory diseases (ARI) and the development of serous meningitis or meningoradiculitis, in which the presence of radiculitis is often noted.
- Paralytic - accompanied by the appearance of paresis, muscle atrophy and paralysis in the patient. Depending on the localization of the inflammatory process, there are:
- Spinal poliomyelitis - is accompanied by damage to the spinal cord, mainly in the area of \u200b\u200bthe lumbar thickening and is characterized by impaired motor function (flexion, extension) of various muscle groups on the legs and arms. Paralysis is usually asymmetrical. The most dangerous is the paralysis of the thoracic and cervical spinal cord, as this often leads to the appearance of paralysis of the muscles of the respiratory system and, accordingly, impaired respiratory function.
- Bulbar poliomyelitis - is accompanied by damage to the bulbar cranial nerves and is characterized by disorders of swallowing, impaired activity of the respiratory and cardiovascular systems. Particular attention is paid to breathing performance, since paralysis of the diaphragm with further suffocation is sometimes fatal. The defeat of the respiratory system can be divided into two main forms - "dry" (the airways are free) and "wet" (the airways are clogged with saliva, mucus, and sometimes vomit).
- Pontine poliomyelitis - is accompanied by damage to the pons and is characterized by damage to the facial nerve (paresis and other manifestations), which can be the main, and sometimes a single sign of the disease;
- Mixed form - accompanied by simultaneous damage to several areas of the spinal cord and brain.
Atypical forms - characterized by the absence of damage to the central nervous system. It can pass in the following types:
- Inapparent form - there is no symptomatology, but the patient is a carrier of infection (virus carrier);
- Abortive form - there are minimal manifestations of the disease in the form of catarrhal symptoms, general weakness, nausea, fever, while there are no signs of damage to the nervous system. Nevertheless, despite the ease of the disease, such a patient is an active carrier of viruses and a source of spread of infection.
With the flow:
- Smooth;
- Unsmooth, which can be:
- With complications;
- With the advent of secondary infections;
- With the appearance of exacerbations of chronic diseases.
By severity:
- Light form;
- Medium form;
- Severe form.
Poliomyelitis diagnostics
Polio diagnostics includes:
- General examination, anamnesis;
- Research for the presence of a virus of nasopharyngeal mucus and feces;
- Studies using ELISA methods (IgM detection is carried out) and RSK;
- Polymerase chain reaction (PCR diagnostics);
- Electromyography;
- Lumbar puncture and further examination of cerebrospinal fluid.
Poliomyelitis in adults must be differentiated from Guillain-Barré syndrome, myelitis, botulism, and serous meningitis.
Poliomyelitis - treatment
How is polio treated? Poliomyelitis treatment is carried out after a thorough diagnosis and includes the following points:
1. Hospitalization and bed rest;
2. Medical treatment;
3. Physiotherapy procedures.
1. Hospitalization and bed rest
A patient with suspected poliomyelitis is delivered for treatment to a medical institution on a hospital basis. Moreover, in case of detection of poliovirus, the patient is placed in the infectious diseases department, in a special box for 40 days.
Bed rest is aimed at preventing the development of complications in the form of contractures and deformities of the limbs, so the patient needs to restrict movement in the first 2-3 weeks. If necessary, the damaged areas are immobilized using special devices - splints, etc.
The affected areas of the body must be wrapped in a warm scarf or blanket. The patient should lie on a hard mattress.
In addition, the isolation of the patient is important for epidemiological purposes - to prevent the spread of infection to surrounding people.
2. Medication
2.1. Anti-infective therapy
Special sera for stopping the polio virus in the patient's body have not yet been invented as of the beginning of 2018, at least no official information has been revealed about this.
In this regard, anti-infective therapy is aimed at strengthening the immune system so that the body can fight the poliovirus.
To do this, the patient is injected intramuscularly with gamma globulin, with a dosage of 0.5-1 ml per 1 kg of body weight, but not more than 20 ml in total. A total of 3 to 5 of these injections are made. Interferon preparations are also administered.
Hemotherapy is also carried out (according to the method of M.A.Khazanov) - the child is injected intramuscularly with 10-20 injections of 5-30 ml of blood taken from the vein of the father or mother. Serum for injection is taken from parents who have recovered from polio or from adults who have been in contact with sick children (convalescent serum).
Antibiotics for poliomyelitis are prescribed only if there is a threat of a secondary infection of bacterial origin in order to prevent the development of pneumonia and other bacterial diseases. Antibiotics are not effective against viral infections.
2.2. Anti-inflammatory therapy
To remove the inflammatory process from the membranes of the brain and spinal cord, dehydration therapy is used, using saluretics - Furosemide, Indapamide, Hydrochlorothiazide.
Ribonuclease is used to dilute sputum and relieve the inflammatory process, in the absence of respiratory disorders.
Also, to relieve the inflammatory process, they can prescribe - "", "", "Afida".
2.3. Symptomatic treatment
To normalize the patient's condition and maintain the general condition of the body, from the first days it is necessary to introduce vitamins, amino acids.
For disorders of the respiratory system, artificial lung ventilation (ALV) is used.
After the end of new paralysis, in order to normalize the work of the nervous system, anticholinesterase drugs are used that stimulate myoneural and interneuronal conduction - "Nivalin", "Proserin", "Dibazol".
Analgesics are used to relieve muscle pain.
To calm and relax the patient, sedatives are used - Diazepam, Tenoten, Persen, Valerian.
If swallowing is impaired, feeding is carried out using a nasogastric tube.
2.4. Recovery
In the initial recovery period (from about 14 to 20 days), appoint:
- - , AT 6;
- anticholinesterase drugs - "Nivalin", "Proserin";
- nootropic drugs - "Glycine", "Piracetam", "Cavinton", "Bifren";
- anabolic hormones.
3. Physiotherapy treatment
Physiotherapy procedures are aimed at restoring physical activity and restoring muscles, internal organs and systems, and restoring nerve cells.
So, for the treatment of poliomyelitis and rehabilitation after it, the following procedures are used:
- Electromyostimulation;
- Perefinotherapy;
- UHF therapy;
- Healing baths;
- Orthopedic massage and physical therapy (exercise therapy) - are aimed at restoring muscle tone and motor activity of damaged areas on the patient's body.
Rehabilitation in a sanatorium-resort environment has a very beneficial effect on the body.
Spa treatment is carried out in the interval from 6 months to 3-5 years, not earlier and not later.
Important!
Before using folk remedies for poliomyelitis, be sure to consult with your doctor!
The following folk remedies are used mainly during the recovery period of the disease.
Rosehip. Pour half a glass of fruits into a thermos, pour 1 liter of boiling water over them and set overnight to infuse. You need to take the rosehip infusion in a warm form, half a glass 3 times a day. Rosehip contains a large amount of ascorbic acid (vitamin C), which is a natural stimulant of the immune system. Due to this, rosehip helps in the fight against many infectious diseases.
Celandine. Pour 1 tbsp. a spoonful of dry herbs 300 ml of boiling water, cover the container with a lid and leave the product for 1 hour to infuse. After that, strain the infusion, and take it warm for 2 teaspoons 3 times a day.
Aloe. In pharmacy kiosks, you can purchase an extract for injection, which is injected subcutaneously in 1 ml for 30 days, once a day. After the injection, a rest of 20 minutes is required.
Prevention of poliomyelitis
Prevention of poliomyelitis includes:
- Isolation of the patient during treatment in the infectious diseases department of a medical institution;
- Disinfection in places where the source of infection is detected;
- Compliance with the rules of personal hygiene;
- Processing food before eating it;
- Vaccination.
Polio vaccination
Polio vaccination is today considered the main preventive measure against this disease. Vaccination promotes the development of immunity to poliovirus, after which, if a person gets sick (which is extremely rare), then the course of the disease passes mildly with no complications.
As of 2018, there are 3 main types of polio vaccine:
Seibin vaccine (Seibin live vaccine, OPV, OPV) - oral polio vaccine, which is given to the child in 1-2 drops on a piece of sugar. Immunity against poliovirus is created for 3 years or more. Replicated in the gastrointestinal tract without spreading to nerve fibers. To achieve the desired result, the OPV vaccine must be injected 2-3 times. Effective against all 3 types of poliovirus - PV1, PV2 and PV3. There are also rare cases of a weakened virus returning to its normal form and causing paralytic poliomyelitis, which has prompted many countries to switch to immunizing the population with Salk vaccines (IPV).
Infectionist
Polio video
Poliomyelitis is an acute infectious disease in which the Poliovirus hominis virus attacks the spinal cord and causes paralysis of the muscles in the body. The disease most often affects children from 1 to 5 years old.
How you can get polio
The causative agent of poliomyelitis is the enterovirus Poliovirus hominis. The virus is well adapted to survive in hostile environments. He lives up to 30 days in sunlight, is not afraid of the cold, household chemicals. At room temperature, the death of the virus occurs only after 90 days. All this explains its ability to mass infection and the ease of transmission from a sick person to a healthy person.
Poliomyelitis is transmitted primarily in two ways:
- through direct contact (through touch, common items, food);
- through the air from sick people and carriers.
There are cases when the disease was transmitted through flies and other insects.
Epidemics often begin in summer and autumn. The most widespread method of infection is airborne. The virus enters the throat with a stream of air, settles on the lymph nodes and begins to reproduce itself. Further, the pathogen passes to other lymph nodes on the body, enters the intestines, then into the blood. Further damage to the central nervous system - spinal cord and brain is possible.
The penetration of the virus into the body does not always cause the disease in its full form. The disease is often asymptomatic or mild. Most of the sick are children from one to 5 years old.
What are the forms of poliomyelitis?
Polio can develop differently depending on the child's immunity. There are several forms of the course of the disease.
- Atypical inapparent form- absence of any symptoms of the virus. The body manages to defeat the virus even before it begins to have a significant impact on it. Those who have had poliomyelitis in an inapparent form often do not even know what the disease was. Only a blood test for antibodies can confirm the fact of the disease.
- Atypical abortive form - the absence of specific polio syndromes, but the manifestation of general symptoms of infection. Headache, runny nose, weakness, a slight increase in temperature resemble a common cold. There is no lesion of the central nervous system. Symptoms disappear after a week without special treatment. This is the most common form of poliomyelitis.
- Typical non-paralytic form- manifestation of symptoms of poliomyelitis with damage to the central nervous system, but in the absence of paralysis. Serous meningitis is diagnosed.
- Typical paralytic form- manifestation of symptoms of the polio virus with damage to the central nervous system and paralysis. The virus can cause paralysis of various muscle groups: muscles of the legs, arms, trunk, diaphragm, face.
What are the symptoms of polio
The symptoms of poliomyelitis are different in different forms of the disease. The incubation period lasts from 6 to 12 days.
In an atypical form, the main symptoms are:
- weakness;
- headache;
- temperature increase;
- sweating;
- runny nose;
- abdominal pain;
- vomiting;
- diarrhea;
- rash.
In a typical form, the following symptoms appear:
- muscle pain;
- backache;
- decreased muscle tone;
- labored breathing;
- difficulty swallowing
- speech disorder;
- confusion of consciousness;
- paralysis;
- paralytic edema;
- meningeal syndrome;
- uncontrolled urination;
- cold hands and feet;
- pressure instability;
- violation of reflexes.
How does polio proceed?
In atypical forms without paralysis, poliomyelitis proceeds without consequences for the body, the symptoms disappear in a week, the patient fully recovers and acquires immunity to polio.
In typical forms, the course of the disease is more severe. The paralytic form is especially dangerous. Spinal cord cells gradually die off, causing muscle paralysis. Without movement, the muscles die off and no longer recover. When cells of the medulla oblongata die, the patient dies. Lethal cases also occur as a result of diaphragm paralysis: the patient dies of suffocation. The likelihood of patient death increases if a bacterial infection joins the viral infection.
Mortality among adults is higher than among children. Although polio is considered primarily a childhood disease, it is dangerous for adults as well. Adults should not neglect polio prevention.
What are the complications after poliomyelitis
Mild poliomyelitis does not cause complications.
In severe forms of the disease, complications are possible. Among them:
- paralysis of the legs, arms, trunk, neck and face;
- violation of breathing, speech, swallowing;
- brain damage;
- lag in the development of bones of the affected limbs;
- bone atrophy;
- deformation of the hands and feet;
- rachiocampsis.
The degree and severity of complications is influenced by the state of immunity, the quality of treatment and rehabilitation. So, deformation of joints and bones can be avoided if the patient is immediately provided with bed rest with fixation of the trunk and limbs. Timely diagnosis and treatment reduces the risk of irreversible paralysis and nervous disorders.
How to detect polio
Accurate diagnosis is essential for the successful treatment of polio. The disease often has blurred symptoms, reminiscent of the common cold or SARS, which makes it difficult to detect the pathogen in a timely manner.
A pediatrician and an infectious disease specialist are involved in the diagnosis of poliomyelitis in children. An analysis of blood, urine, feces, mucus from the nose, and, if necessary, cerebrospinal fluid is performed.
If poliomyelitis is suspected, the patient is immediately sent to the infectious diseases hospital. It is important to closely monitor the patient to distinguish polio from other illnesses and to ensure adequate treatment.
How to treat polio
An effective cure for poliomyelitis has not yet been found. All patients are hospitalized. This is necessary to protect the people around and prevent complications in the patient in an acute period. The hospitalization period lasts from 40 days.
Treatment consists of rapid relief of acute symptoms. For severe pain, pain relief is performed. The high temperature is removed with antipyretic drugs. Additionally, the patient receives vitamins. In the acute period, which lasts up to 6 weeks, strict bed rest is recommended. Medical personnel use pillows and rollers to ensure the correct position of the torso and limbs, this reduces the risk of bone deformation. Pressure sores are being prevented. In case of damage to the diaphragm and intercostal muscles and insufficient breathing, resuscitation is necessary. If swallowing is impaired, liquid food is supplied through a tube.
After the acute period ends, the patient's rehabilitation begins. The condition of the muscles and the central nervous system after an illness depends on the quality of rehabilitation. Muscles that have not completely lost their activity are restored by gymnastics, massage, acupuncture, swimming. With complete paralysis, electrical muscle stimulation, massage, baths, acupuncture, paraffin therapy and other thermal procedures are prescribed. Sanatorium treatment in specialized institutions is recommended.
Medication is also helpful during the rehabilitation period. Drugs are prescribed to improve blood supply to the brain, stimulate nerve impulses, hormonal drugs.
For the prevention of contractures, wearing orthopedic shoes, splints, bandages is indicated. They protect weakened legs from deformation, correct the shape and position of the feet and joints.
It is possible to correct the complications after the postponed poliomyelitis by surgery. Surgeons perform plastic surgery of muscles and tendons, resection and osteotomy of bones, resection and prosthetics of joints.
A wide range of specialists are involved in the treatment of poliomyelitis - pediatricians, therapists, neurologists, surgeons, infectious disease specialists, immunologists, orthopedists, and rehabilitation specialists.
How to prevent polio
The main way to prevent poliomyelitis is vaccination, which has significantly reduced the incidence of poliomyelitis. It is difficult to treat poliomyelitis, after severe forms there is a high risk of disability, so it is better to vaccinate and protect yourself and your children from this terrible disease.
There are 2 types of vaccine: inactivated vaccine for injection and live vaccine for oral administration in the form of pills or solutions. In the first case, the killed virus enters the body, in the second - alive, but weakened.
According to the number of diseases that vaccines fight, they distinguish between monovaccines and polyvaccines. Monovaccines prevent only poliomyelitis, polio vaccines combine the prevention of poliomyelitis and pertussis, tetanus, diphtheria, Haemophilus influenzae and hepatitis B in various combinations.
In Russia, polio vaccination is mandatory, it is carried out free of charge, from infancy to 14 years old. They use mainly live vaccine.
The live vaccine schedule is as follows:
- 3 months;
- 4 months;
- 5 months;
- 18 months;
- 3 years
- 6 years;
- 14 years old.
After the introduction of the vaccine, a sparing regimen is required: good rest and sleep, light nutrition rich in vitamins. It is necessary to protect the child from hypothermia and communication with possible carriers of bacteria and viruses, since the fight against the virus temporarily reduces immunity, and the infection can seize the weakened body of the baby.
Adults are vaccinated in two cases: if they were not routinely vaccinated in childhood or when traveling to areas of high risk of polio. These are mainly the countries of Asia and Africa. Health organizations monitor epidemic situations in the world and recommend vaccination against certain diseases. Re-vaccinations of adults against polio are carried out every 5-10 years, while maintaining the risk of infection.
The vaccine is generally well tolerated. There may be a slight rise in temperature, indigestion, swelling and weakness. In rare cases, urticaria, shortness of breath, convulsions, extensive edema are possible. If this happens, you must immediately consult a doctor.
For some people, polio vaccination is contraindicated. Absolute contraindications are immunodeficiency, allergy to vaccine components. Temporary contraindications are bacterial or viral diseases, pregnancy, breastfeeding, acclimatization after a trip to another climatic zone.
Poliomyelitis (spinal infantile paralysis) is an acute viral disease that affects the nervous system (mainly the gray matter of the spinal cord). In addition, inflammation may occur in the intestinal mucosa and nasopharynx. Poliomyelitis is considered a childhood disease, but adults can also get sick, and their disease is very difficult.
The source of infection is a sick person. Polio is most common in children under the age of 10, with more than half of the cases occurring in children under 4. The peak incidence is recorded between August and October. The infection is usually transmitted by the fecal-oral route, less often by airborne droplets.
Polio Symptoms
Poliomyelitis is a viral disease transmitted mainly by the fecal-oral route.The incubation period can last from 2 to 35 days, on average it lasts 5-12 days.
There are two forms of the disease: paralytic and non-paralytic.
The paralytic form of the disease proceeds in 4 stages: preparative, paralytic, the recovery period and the stage of residual effects.
- Preparalytic stage (3-5 days). The disease begins acutely, with a sharp increase in body temperature. The first 3 days of illness, patients complain of headache, nausea, runny nose, sore throat, sometimes digestive disorders (constipation or diarrhea). Such signs can be regarded as an acute viral disease, patients do not go to the doctor, not even suspecting that it may be poliomyelitis. Symptoms may subside for several days, after which deterioration occurs again, headache intensifies, pains in the limbs and back occur, and the consciousness of patients may be confused.
- Paralytic stage. Paralysis develops very quickly, usually within a few hours. In the limbs there is a decrease in muscle tone, active movements are limited or completely absent. Most often, the muscles of the lower extremities are affected, but sometimes paralysis of the muscles of the neck and trunk can develop. With the onset of paralysis, muscle pain also appears. The paralytic stage can last from a few days to 2 weeks.
- The recovery period lasts from several months to 2-3 years. Initially, the restoration of movement in the paralyzed muscles proceeds at a rapid pace, but then slows down.
- The residual stage is characterized by muscle atrophy, persistent flaccid paralysis of the limbs, and deformity of the trunk.
Nonparalytic (abortive, erased) form of poliomyelitis occurs with the appearance of a short fever, catarrhal phenomena (cough, sore throat, runny nose) and dyspeptic disorders (nausea, vomiting,). These symptoms usually disappear within a few days.
Polio treatment
There are no antiviral drugs for specific treatment of the disease. Patients are placed in an infectious hospital box, isolation lasts 40 days. Patients are shown adherence to bed rest for 2-3 weeks. Symptomatic therapy is carried out: antipyretic (nurofen, paracetamol), vitamin therapy (B vitamins, ascorbic acid). If the respiratory muscles are affected, artificial ventilation may be required.
The procedures performed during the recovery period are very important. A large role is given to physiotherapy exercises, massage, physiotherapy, water procedures, electrical stimulation. Very useful sanatorium treatment in the resorts of Evpatoria, Anapa, Odessa.
In the period of residual effects, orthopedic treatment is indicated, if necessary, in order to correct the developed deformities and contractures of the limbs and trunk.
Prevention of poliomyelitis
In the focus of infection, sanitary and hygienic measures are carried out: disinfection of the room, dishes, toys, bedding and other items that may be contaminated. Children who have been in contact with the sick are in quarantine from 15 days to 3 weeks.
To date, the only effective method of preventing this dangerous disease is vaccination. Vaccination is performed in several stages. According to the national vaccination schedule, the vaccine is administered at 3, 4.5 and 6 months. The first revaccination is performed at 18 months, and the second at 20 months. The third and final dose of vaccine is given to a child at age 14.
Many parents refuse to vaccinate against polio for fear of complications in their child. Before signing a waiver of vaccination, it is necessary to weigh the pros and cons, since by refusing vaccination, the parents leave the child without protection from the most dangerous disease.
Currently, modern vaccines are used to immunize children, the use of which reduces the risk of complications to a minimum. In rare cases, after vaccination against polio, a child may experience mild malaise, a slight fever, and diarrhea. This complication does not require treatment and goes away on its own. The first two vaccinations are carried out using an inactivated vaccine, so polio infection is not possible.
In the future, vaccination is performed using a vaccine containing live weakened poliviruses. There is a risk of contracting poliomyelitis (1 case per 2.5 million people), but the disease can occur only if the vaccinated person has severe immune system disorders.
Polio vaccination, like any medication, can cause a dangerous allergic reaction. It is contraindicated if you are allergic to antibiotics (kanamycin, streptomycin and neomycin). Vaccination is also interrupted if there was a strong reaction to the previous vaccination.
Considering the above, it can be concluded that vaccination against polio is practically safe, and its role in protecting against a serious disease can hardly be overestimated. Before each vaccination, it is necessary to conduct an examination and undergo additional consultation with a neurologist. A healthy child is usually vaccinated without any complications.
Which doctor to contact
The only effective method of preventing polio is vaccination. if signs of an infectious disease appear, accompanied by progressive weakness in the extremities, it is necessary to urgently contact an infectious disease specialist. In the recovery period, which lasts a long time, the role of a physiotherapist, a specialist in physiotherapy exercises and massage is important.
- Non-paralytic poliomyelitis:
- symptoms of intoxication (signs of poisoning the body with toxins of the pathogen) - low body temperature 37.5 - 38.5 ° C, headache, malaise;
- signs of a cold - cough, sore throat, runny nose;
- dyspeptic symptoms - abdominal pain, nausea, vomiting, loose stools;
- proceeds easily and ends in 3-7 days.
- Meningeal form:
- begins acutely - with a rise in body temperature to 38-39 ° C, which decreases after 1-3 days, and then rises again to high values;
- cold symptoms - coughing, mucous discharge from the nose;
- signs of damage to the nervous system appear on the 2-3 day of illness - drowsiness, lethargy, headaches, vomiting;
- positive meningeal symptoms: rigidity of the occipital muscles (the inability to lie on the back with the chin to touch the chest due to increased muscle tone), Kernig's symptom (a patient who is lying on his back bends his leg at the knee and hip joints at an angle of 90 °, and then try to straighten it in the knee joint - this cannot be done due to muscle tension).
- Paralytic poliomyelitis -there are 4 periods of the disease: preparative, paralytic, restorative and residual.
- Preparalytic period:
- high body temperature 38.5 - 39.5 ° C;
- weakness, malaise;
- headaches;
- runny nose;
- a sore throat;
- there may be vomiting, loose stools, or constipation;
- then for 2-3 days the body temperature returns to normal - and again a sharp deterioration in the condition. The second wave of rise in body temperature to 39-40 ° C;
- severe headaches, pain in the back, arms, legs, twitching and twitching of muscles, impaired consciousness;
- the duration of the period is 4-5 days.
- Paralytic period:characterized by the sudden development of paralysis (lack of active movements) of the muscles of the limbs, more often the legs, sometimes paralysis of the muscles of the neck and trunk develops, sudden pain in the muscles, sensitivity is not disturbed. Paralysis of the diaphragm and respiratory muscles are dangerous by impaired breathing and blood circulation, such patients die from respiratory arrest. The duration of the period is up to 1-2 weeks.
- Recovery period: at the beginning of the period, the paralyzed muscles are actively restored, then the pace slows down. The period lasts up to 1-3 years.
- Period of residual effects (residual):
- muscle atrophy (reduction in muscle size), contractures (limitation of mobility) develop;
- deformities of the trunk and limbs.
- Preparalytic period:
Incubation period
3 to 35 days (average 7-12 days).
Forms
- Non-paralytic (a form of poliomyelitis without damage to the nervous system):
- carriage of viruses - there are no signs of the disease, but the virus is detected by the virological method in feces or nasopharyngeal swabs;
- abortive (minor illness) - proceeds without damage to the nervous system;
- meningeal form - appears with signs of damage to the membranes of the brain and spinal cord (headaches, positive meningeal symptoms), but proceeds without muscle paralysis.
- Paralytic (a form of poliomyelitis with damage to the nervous system):
- spinal (paralysis of the arms, legs, trunk, neck);
- bulbar (violation of swallowing, breathing, speech, heart function);
- pontine (violation of the sensitivity of the muscles of the face);
- encephalitic (brain damage);
- mixed (combination of several forms, for example, ponto-spinal).
The reasons
- The virus enters the external environment with feces and mucus from the patient's nasopharynx.
- The source of infection can only be a sick person or a virus carrier.
- The virus is transmitted from person to person through alimentary (through dirty hands, contaminated food, water) and airborne droplets (when talking, sneezing, coughing) routes.
Polio treatment
- There is no specific treatment.
- Hospitalization of the patient.
- Providing the patient with physical and mental rest.
- Pain relievers and diuretics.
- In case of respiratory failure - artificial ventilation.
- If swallowing is impaired, tube feeding.
- According to indications - corticosteroid drugs, which have an anti-inflammatory effect.
- In the preparative stage, immunoglobulin is used.
- During the recovery period:
- physiotherapy exercises, massage;
- b vitamins (B12, B6);
- nootropic agents for improving metabolic processes in the brain and spinal cord;
- physiotherapy - paraffin, UHF;
- spa treatment.
Complications and consequences
- Damage to the respiratory system - pneumonia (inflammation of the lungs), atelectasis of the lungs (a condition of the lung when it cannot fully expand, this leads to the collapse of all or part of the lung, which causes respiratory failure).
- Lesion of the gastrointestinal tract (gastrointestinal bleeding, mucosal ulcers).
- Vaccine-associated poliomyelitis is caused by strains of the virus from the vaccine. Very rare. Typical symptoms of vaccine-associated poliomyelitis:
- flaccid paralysis (lack of active movements) or paresis (weakening of active movements), but sensitivity is not impaired;
- 2 months after the onset of the disease, residual effects occur: muscle atrophy (reduction in muscle size), contractures (limitation of mobility) develop;
- the disease does not progress, that is, if paralysis of the muscles of the foot has developed, then the paralysis will not spread to other parts of the leg;
- the virological method allows you to identify the vaccine strain of the virus;
- serological method: determination by ELISA (enzyme-linked immunosorbent assay) of an increase in antibody titer by 4 or more times.
Prevention of poliomyelitis
- Vaccine prophylaxis:
- at 3 months, the first vaccination is given to all children with an inactivated vaccine;
- at 4.5 months, a second vaccination with an inactivated vaccine is carried out;
- at 6 months, the third live vaccination is given. Children from closed preschool institutions, as well as children with congenital immunodeficiency diseases and malformations of the gastrointestinal tract, receive an inactivated vaccine;
- at 18 months, the first revaccination with a live vaccine is carried out. Children from closed preschool institutions, as well as children with congenital immunodeficiency diseases and malformations of the gastrointestinal tract, receive an inactivated vaccine;
- at 20 months, a second revaccination with a live vaccine is carried out. Children from closed preschool institutions, as well as children with congenital immunodeficiency diseases and malformations of the gastrointestinal tract, receive an inactivated vaccine;
- at the age of 14, the third revaccination with a live vaccine is carried out. Children from closed preschool institutions, as well as children with congenital immunodeficiency diseases and malformations of the gastrointestinal tract, receive an inactivated vaccine.
- Isolation of the patient.
- In the children's institution where there was a polio patient, quarantine is established for three weeks.
- Wet cleaning of premises with disinfectants. Compliance with the rules of personal hygiene (wash your hands more often, drink only boiled water).
