Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jul 31 2022

Polio

Images
https://upload.medbullets.com/topic/121823/images/dwe00209g01.jpg
https://upload.medbullets.com/topic/121823/images/anterior-horn.jpg
https://upload.medbullets.com/topic/121823/images/polio_sequelle.jpg
  • 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
Card
1 of 0
Private Note