Poliomyelitis - Causes, symptoms and treatment. MF.

Poliomyelitis, spinal pediatric paralysis, Heine-Medina disease are the names of a serious infectious disease. The causative agent of the disease is a filtering virus, the smallest of enteroviruses, affecting the gray matter of the anterior horns of the spinal cord, the motor nuclei of the brain stem and causing paralysis.

Polio virus

The pathogen was discovered by Landsteiner and Popper, the disease was described back in the 80s of the 19th century by J. Heine, A. Ya. Kozhevnikov and O. Medina. The virus is stable in the external environment, it breaks down at a temperature of 56º for 30 minutes, with ultraviolet irradiation and in disinfectants - chloramine, bleach, potassium permanganate, formalin. Durable in milk and dairy products( up to 3 months), in water( up to 4 months), in stool( up to 6 months).Three types of the virus were found: 1-Brunhild's virus, 2 Lansing virus, 3-virus Leon.

In the middle of the 20th century, the increase in the incidence of poliomyelitis took the form of an epidemic in Europe and North America. Currently, there are isolated, sporadic cases of polio, the incidence is decreasing in countries where the population is vaccinated. In 2010, only Afghanistan, India, Nigeria, Pakistan remained endemic for poliomyelitis, in 1988, there were 125 countries. In 1988, the World Health Assembly adopted a resolution on the eradication of poliomyelitis in the world. The global initiative to eradicate poliomyelitis over the years has reduced the incidence by 99%.And this is due to the active immunization of children. There remains the risk of importing the virus from "dysfunctional" countries.

Now they talk a lot about the advisability and harm of vaccination to children. Before deciding whether to vaccinate your child or not - read - what is "poliomyelitis".Here are terrible photos of polio-born children in countries where vaccination is not carried out:

Photo of an adult who has transferred polio:

A virus is isolated from the mucous membrane of the nasopharynx and the patient's feces in the acute period and in healthy virus carriers. The source of the disease can be a patient with erased, atypical, abortive forms, without a paralytic stage, when poliomyelitis occurs as a normal ARI and is not diagnosed. The virus is excreted with feces in the first 2 weeks of the disease, fecal carriage can last up to 3 - 5 months. From the nasopharynx virus is released in the first 3 - 7 days.

Susceptibility is low - 0.2 - 1%.Mostly children under 7 years old are ill.

The path of infection is through the gastrointestinal tract, unwashed hands, water, food. Through the lymphatic system, blood, along the axial cylinders of vegetative fibers and peripheral nerves, the virus enters the central nervous system, causing dystrophic and necrotic changes, which causes the development of motor disorders - paresis and paralysis.

The seasonality of the disease with a maximum in the summer-autumn period is noted.

Symptoms of poliomyelitis

The incubation period( the period before the appearance of clinical signs of the disease) is 7-14 days.
There are paralytic poliomyelitis - spinal, bulbar, pontine, encephalitic, mixed and nonparalytic - asymptomatic, visceral, meningeal.
The flow varies from very light erased forms to heavy ones.

The initial stage of the disease - the preparative one - is characterized by acute onset, fever, catarrhal symptoms and disorders of the gastrointestinal tract. From the side of the nervous system are possible - headache, vomiting, lethargy, lack of mobility, fatigue, drowsiness or insomnia, muscle twitching, trembling, convulsions, irritation symptoms of the roots and meninges - pain in the spine, limbs. Lasts for up to 5 days. In the best case( if vaccination was performed) the disease does not go to the next stage and the patient recovers.

The next stage is paralytic - the temperature drops, the pains in the muscles pass, the paresis and paralysis appear. Most often affected are the lower limbs, the deltoid muscle, less often the muscles of the trunk, neck, abdominal press, respiratory musculature. With the trunk form, the muscles of the face, tongue, throat, larynx are affected. The paralysis is asymmetrical, sluggish. The muscle tone is reduced, the tendon reflexes are reduced, after 1 - 2 weeks, muscle atrophies develop, dislocations in the joints.

Restorative stage - lasts 4 - 6 months, then the rate of recovery decreases - there are muscle atrophies, contractures.

Residual phenomena - residual stage is a stage of persistent flaccid paralysis, atrophy, contractures, deformations and shortening of limbs, curvatures of the spine.

Spinal deformity - kyphoscoliosis as a result of poliomyelitis .

The mortality rate for poliomyelitis epidemics is 5 to 25%, mainly due to respiratory disorders in respiratory muscle paralysis.

The remaining deformities of the spine, limbs can cause disability for life.

Diagnosis of poliomyelitis

Diagnostically significant symptoms - acute fever, rapid development of flaccid paralysis, asymmetry of paralysis, with a large lesion of the proximal parts. To confirm the diagnosis, a lumbar puncture is done, laboratory diagnosis is serological and virologic.

Paired blood sera collected at an interval of 3-4 weeks are examined. A "color" test is used - based on the indicator's ability( phenol red) to change color in the altered pH of the cell culture contaminated with the polio virus. Result within 48 hours.

Differential diagnosis is performed with meningitis, myelitis, Guillain-Bar, encephalitis, polio-like diseases.

Treatment of poliomyelitis

Specific antiviral treatment of poliomyelitis does not exist .

Treatment is carried out in a hospital - boxing infectious hospital. Isolation of the patient for 40 days. Use symptomatic therapy, gamma globulin, vitamin C, B1, B6, B12, amino acids. If the respiratory muscle is affected, it is artificial ventilation of the lungs. Bed rest is obligatory for 2 - 3 weeks.

Great care must be taken to care for paralyzed limbs. All movements should be cautious, slow, the feet should not hang, the limb and spine should be correct. The patient lies on the bed on a hard mattress, legs are laid parallel, slightly bent at the knee and hip joints with the help of rollers. The feet are laid at right angles to the lower leg, a dense cushion is placed under the sole for the abutment. Hands are sideways and bent at the elbow joints at a right angle. To normalize the neuromuscular conductivity, use is made of proserine, neuromidine, dibasol.

During the recovery period, the priority role is assigned to physical therapy, exercises with an orthopedist, massage, water procedures, physiotherapy - UHF, paraffin applications, electrostimulation. Spa treatment - Evpatoria, Odessa, Anapa, Saki is shown. Used sea baths, sulfuric, mud baths.

In the residual period, orthopedic treatment is performed - conservative, operative with the aim of correcting developed contractures and deformations.

The whole world united in the fight against the virus. In the world there should not be a single child infected with polio. In the meantime, is at risk for children in any country .For Russia, the risk of importation of a wild virus in connection with migration from Tajikistan is actual. In this regard, increased surveillance for the implementation of sanitary regulations and the prevention of poliomyelitis. It is planned at the checkpoints across the state border of the Russian Federation who arrived from Tajikistan to vaccinate once and inform about the need for a second and third vaccination. Keep this in mind when deciding to vaccinate your child!

Prevention of poliomyelitis

Prevention of poliomyelitis - vaccination of live attenuated vaccine Sebina( Chumakov, Smorodintsev) at 3 months three times a month - droplets in the mouth on the lymphoid tissue, the surface of the tonsils, revaccination at 18 months, 3 years, 6 years, 14 years.

Intramuscularly injected inactivated vaccine containing killed wild polioviruses.

Produced in a syringe - dispenser of 0.5 ml. Introduced to children subcutaneously in the scapular area( less often in the shoulder), older children in the shoulder. Do 2-3 injections with an interval of 1.5 - 2 months, a year later the first revaccination, after 5 years the second. In the future, revaccination is not required. Both vaccines contain all three types of poliovirus.

In the hearth of the disease, sanitary and hygienic measures are carried out - disinfection of dishes, clothes, all items that could be contaminated. Contact children are in quarantine up to 15 - 20 days.

Consultation of a neurologist in poliomyelitis:

Question: Can an adult who is not vaccinated be ill?
Answer: Any adult with immunocompromised vaccine-associated poliomyelitis can become ill. Parents who have AIDS, who take medications that suppress the immune system, can get infected from the child. To avoid this, you need to observe personal hygiene, wash your hands, do not kiss the baby on the lips.

Question: What is the difference between the vaccines used?
Answer: The inactivated vaccine has a number of advantages over the vaccine that is administered through the mouth: the possibility of complications such as vaccine-associated poliomyelitis is completely excluded, there are no intestinal disorders, it gives 100% immunity. After drops, the child emits a live vaccine virus within two months, which is a danger to others.
Puncture painless. The droplets are saline-bitter, the baby can vomit, tear out and the vaccine will go away.

Question: complications of vaccination against poliomyelitis?
Answer: Vaccine-associated poliomyelitis may develop if a live vaccine( oral drops) is applied to a weakened child, allergic reactions are urticaria, Quincke's edema, intestinal dysfunction.

The doctor neurologist Kobzeva S.V.