Poliomyelitis: symptoms, treatment, prevention, causative agent

What is it - polio is called infectious pathology caused by a virus that affects mainly children and provokes the emergence of various forms, the most serious of which is the defeat of the nervous system with the development of flaccid paralysis.

The causative agent of the disease is the poliovirus from the enterovirus group;can be transmitted either by drip, or through water or dirty hands.

In countries where polio vaccination is compulsory, the disease occurs in isolated cases, not reaching epidemic proportions.

The causative agent of poliomyelitis

The disease is caused by a poliovirus from the genus of enteroviruses. The danger for humans is I, II and III types of the virus. Only type I causes 85% of all cases of development of flaccid paralysis in poliomyelitis.

Polioviruses have a particular pathogenicity with respect to motor neurons located in the gray matter of the spinal cord, which led to their name( polyo-"gray", myelon-"brain").

The virus is stable in the environment: up to a week lives in feces, in water - up to 100 days, does not degrade in gastric juice, safely tolerates drying. Bends only when boiled, treated with disinfectants or ultraviolet radiation.

The only source of infection for a person is only a person who can tolerate the infection in any form. Especially dangerous are people who carry poliomyelitis in an erased or mild form: they continue to go to work or to children's institutions, actively spreading the virus into the environment.


The virus spreads in two ways:

1. 1) Drip: the pharynx of the nasopharynx of the patient contains viruses, which for infection must reach the mucous membrane of the nasopharynx of a healthy person. The patient is contagious 3-4 days before the first temperature increase( that is, when he does not yet know that he is sick).The infectious period lasts about a week from the time of the development of the first symptoms;
   
2. 2) Through the excrement of the patient, with which the poliovirus enters the water, and with it( when watering) - on vegetables and berries;on their hands, and from them - on everyday objects. Poliomyelitis can develop in children with congenital or acquired immunodeficiency, who have been vaccinated with live polio vaccine.

Only in 1-5% of people, to whom a virus has fallen on the nasal or pharyngeal mucosa, develop a disease manifested by flaccid paralysis. The rest of the people recover spontaneously after 5-7 days.

Symptoms of poliomyelitis

The incubation period, that is, the time when a person has already contracted, but the disease has not yet shown any symptoms, with the disease 2-35 days( on average, 1-2 weeks).Then the symptoms develop, depending on which one speaks about one form or another of poliomyelitis.

Abortion form is the most common course of poliomyelitis. It starts with raising the temperature to high figures, which lasts 2-4 days. The following symptoms also develop:

• headache;
  
• weakness;
  
• fatigue;
  
• sore throat;
  
• slight cough;
  
• abdominal pain without specific localization;
  
• nausea;
  
• diarrhea or constipation;
  
• vomiting;
  
• may be weakness of the muscular musculature or slight lameness.

The meningeal form manifests itself as:

• of high body temperature, which lasts 2-5 days;
  
• of other symptoms that are described for the abortive form;
  
• after 1-3 days develops headache, vomiting, nausea, muscle weakness.

Spinal poliomyelitis begins with the same symptoms as the meningeal or abortive form. After a 2-4 day drop in temperature, no signs are observed. Then the preparative stage develops. It is characterized by:

• muscle pain;
  
• sensation of goosebumps on the skin of the extremities.

This stage lasts several hours - a few days. Then, against the background of severe muscle pain, weakness and decreased appetite, the volume of movements in the limbs decreases. This is a paralytic stage. The process can have an ascending character, that is, first the legs move, then the conscious control of acts of urination and defecation is violated. Then paralysis can reach the respiratory musculature, making it difficult, if not impossible, to act as a respiratory system. The neck muscles and muscles of the upper extremities also suffer. Bulbar poliomyelitis is typical for adults. This is a life-threatening form of the disease, requiring treatment only in a hospital. In the beginning the nasal voice develops, swallowing is disturbed. After a few hours or 2-3 days, you can observe this symptomatology:

• nasal and hoarseness of the voice, then it can disappear completely;
  
• inability to swallow( even swallowing saliva is difficult);
  
• difficulty breathing;
  
• heart rhythm disorder;
  
• sensation of "hot flashes" with reddening of the skin.

The form with the defeat of the bridge of the brain often develops without any preliminary symptoms, is characterized by paralysis of facial muscles, which is manifested by some degree of asymmetry in the face.

Encephalic form manifests itself as a violation of consciousness, convulsions, focal symptomatology.

Diagnosis

The diagnosis of "poliomyelitis" is based on:

• of the symptoms of the disease;
  
• isolation of the virus from the patient's feces obtained without enema by serological methods, PCR;
  
• isolation of the virus from cerebrospinal fluid;
  
• increase in antibody titer in sera taken after a time;
  
• electromyography.

Treatment of poliomyelitis

Treatment of poliomyelitis is carried out in an infectious hospital. The patient is assigned bed rest, since any active movements increase the chance of developing paralytic forms.

It is important to ensure this position of the patient in bed, so that contractures develop in his muscles, as well as antagonistic muscles.

Specific drugs not developed. Neither interferons nor gamma globulins are effective in poliomyelitis. Antibiotics are prescribed in order to prevent the development of bacterial complications of a stagnant nature.

Oxygen therapy is performed;the patient is fed with a spoon( if there are no swallowing disorders), or through a probe. When recovered, rehabilitation measures are carried out, which consist in performing physical exercises with a gradual build-up of muscle strength, massage, physiotherapy.

Prevention of poliomyelitis

Specific prevention is the mandatory vaccination of children up to a year.

A live attenuated vaccine is used( it is available in the form of droplets taken through the mouth) and the vaccine is killed. Preference is given to the preparation from the living culture of the virus. Three times introduced to the child such a drug provides 80-85% protection.

If a child has polio, it needs isolation. For everyone who has been in contact with him, they establish medical supervision for 15-20 days, immunize living vaccine outside the schedule.

To non-specific prevention include:

• wash hands;
  
• to avoid communication with sick people, the disease of which occurs with a high temperature;
  
• wash fruit and berries;
  
• Do not swallow water while bathing.

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