Updated: 5/31/2018

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
  • Epidemiology
    • incidence
      • endemic in areas of Asia and Africa
    • demographics
      • affects children
  • 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
  • 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
      • inactivated polio vaccine (IPV)
        • developed by Jonas Salk
        • 4 doses for infants from 2 months of age to 4-6 years of age
  • Prognosis
    • disease starts with preceding aseptic meningitis and progresses to flaccid paralysis
    • two-thirds of patients do not recover their strength
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

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