Updated: 7/31/2022

Polio

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  • Snapshot
    • A 2-month-old girl is brought to the pediatrician for a routine well-baby visit. She is due for multiple vaccines, including the polio vaccine. Her mother is concerned about potential post-vaccine poliomyelitis, something she has heard about from her friends abroad. The pediatrician reassures her that the vaccine responsible for that is a live-attenuated vaccine. The vaccine they will administer to the baby today is inactivated and safe.
  • Introduction
    • Classification
      • poliovirus
        • a single-stranded (+) RNA virus
        • a picornavirus and enterovirus
      • transmission
        • fecal-oral
    • Associated conditions
      • poliomyelitis
      • meningitis
    • Prevention
      • vaccines
        • live-attenuated oral polio vaccine (OPV)
          • developed by Sabin
          • may be associated with vaccine-associated paralytic poliomyelitis and thus, no longer offered in the United States and most high-income countries
        • inactivated polio vaccine (IPV)
          • developed by Jonas Salk
          • 4 doses for infants from 2 months of age to 4-6 years of age
  • Epidemiology
    • Incidence
      • endemic in areas of Asia and Africa
    • Demographics
      • affects children
  • ETIOLOGY
    • Pathogenesis
      • replicates in oropharynx and small intestines and spreads to the central nervous system via bloodstream
      • destroys the anterior horn of the spinal cord, causing lower motor neuron cell death
  • Presentation
    • Symptoms
      • poliomyelitis
      • meningitis
        • headache
        • vomiting
        • stiff neck
        • myalgias
    • Physical exam
      • systemic signs of infection
        • fever and malaise
      • lower motor neuron lesion
        • asymmetric weakness
        • asymmetric hypotonia
        • flaccid paralysis
          • legs > arms
        • fasciculations
        • decreased or absent reflexes
        • muscle atrophy
        • normal sensory exam
  • Studies
    • Labs
      • cerebral spinal fluid
        • ↑ white blood cells
        • ↑ protein
        • normal glucose
        • presence of viral RNA
      • viral isolation
        • stool
        • throat
    • Making the diagnosis
      • based on clinical presentation and laboratory studies
  • Differential
    • Werdnig-Hoffmann disease
      • distinguishing factor
        • both affect the anterior horns of the spinal cord but Werdnig-Hoffmann presents with symmetric weakness
    • Guillain-Barré syndrome
      • distinguishing factor
        • symmetric weakness
  • Treatment
    • Management approach
      • mainstay of treatment is supportive care
      • management is focused on vaccine and prevention
    • Conservative
      • physical therapy and occupational therapy
        • indication
          • all patients
      • respiratory support
        • indication
          • disease progression to respiratory system
  • Complications
    • Progression to respiratory failure
    • Permanent deformity
  • Prognosis
    • Disease starts with preceding aseptic meningitis and progresses to flaccid paralysis
    • Two-thirds of patients do not recover their strength
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