Polio natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Poliovirus initially colonizes the cells of the [[gastrointestinal]] tract.  When [[symptoms]] occur, these usually follow an [[incubation period]] of 7 to 14 days.  The disease may be manifested as abortive poliomyelitis, lasting for 2-3 days, with nonspecific [[symptoms]]; non-paralytic poliomyelitis, lasting about 2-10 days, which presents with the previously described [[symptoms]], along with [[meningeal signs]]; and paralytic disease, presenting with [[symptoms]] such as [[hyperesthesia]], [[paresthesia]], [[myalgia]], [[muscle spasms]], [[meningeal]] symptoms, and [[paralysis]].  [[Complications]] of poliomyelitis may include: [[respiratory]] compromise, [[gastrointestinal]] symptoms, [[musculoskeletal]] deformities and postpoliomyelitis syndrome.  The [[prognosis]] of poliomyelitis depends on the form of the disease: patients with abortive poliomyelitis often have a full recovery; while patients with severe form of disease, who require [[mechanical ventilation]] have less probability to recover.  [[Paralysis]] of the [[respiratory]] muscles is a sign of bad [[prognosis]] and these patients have an higher probability of a fatal outcome.
Poliovirus initially colonizes the cells of the [[gastrointestinal]] tract.  When [[symptoms]] occur, these usually follow an [[incubation period]] of 7 to 14 days.  The disease may manifest as ''abortive poliomyelitis'', lasting for 2-3 days with nonspecific [[symptoms]] of fatigue, nausea, and sore throat, ''non-paralytic poliomyelitis'', lasting about 2-10 days which with signs of meningeal irritation, and ''paralytic poliomyelitis'' with [[symptoms]] such as [[hyperesthesia]], [[paresthesia]], and [[paralysis]].  [[Complications]] of poliomyelitis may include [[respiratory]] compromise, [[gastrointestinal]] symptoms, [[musculoskeletal]] deformities, and post-poliomyelitis syndrome.  The [[prognosis]] of poliomyelitis depends on the form of the disease: patients with abortive poliomyelitis often have a full recovery; while patients with severe form of disease have poorer outcome.  [[Paralysis]] of the [[respiratory]] muscles is a sign of bad [[prognosis]] and these patients have higher mortality.


==Natural History==
==Natural History==
[[Poliovirus]] enters the body through the [[mouth]], infecting nearby cells, such as those of the [[oral mucosa]], nose and throat.  The [[incubation period]] often ranges from 7 to 14 days, however,  it may vary from 5 to 35 days.<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840  }} </ref><ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
[[Poliovirus]] enters the body through the oral cavity, infecting nearby cells, such as those of the [[oral mucosa]], nose and throat.  The [[incubation period]] often ranges from 7 to 14 days, however,  it may vary from 5 to 35 days.<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840  }} </ref><ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>


Typical manifestations of poliomyelitis may range from [[asymptomatic]] disease, to death.  95% of infections with poliovirus are [[asymptomatic]].  4 to 8% of the cases present as abortive poliomyelitis.  In about 1 to 2% of of infections, the disease manifests as non-paralytic poliomyelitis. Less than 1% of infected patients develop [[paralytic]] disease.
Typical manifestations of poliomyelitis may range from [[asymptomatic]] disease, to death.  95% of infections with poliovirus are [[asymptomatic]].  4 to 8% of the cases present as abortive poliomyelitis.  In about 1 to 2% of infections, the disease manifests as non-paralytic poliomyelitis. Less than 1% of infected patients develop [[paralytic]] disease.


===Abortive Poliomyelitis===
===Abortive Poliomyelitis===
Abortive poliomyelitis often presents with 2 to 3 days of [[fever]].  [[Neurological exam]] is normal in this form of the disease, and common [[symptoms]] may include: [[sore throat]]; [[headache]]; [[anorexia]]; [[nausea]]; [[vomiting]] and [[abdominal pain]].<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
Abortive poliomyelitis often presents with 2 to 3 days of [[fever]].  [[Neurological exam]] is normal in this form of the disease, and common [[symptoms]] may include [[sore throat]], [[headache]], [[anorexia]], [[nausea]], [[vomiting]], and [[abdominal pain]].<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
===Non-Paralytic Poliomyelitis===
===Non-Paralytic Poliomyelitis===
This form of the disease presents with the symptoms of abortive poliomyelitis, however, these are often more severe, and signs of [[meningeal]] irritation are present.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>  Typically these [[symptoms]] last for 2 to 10 days, followed by complete recovery.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf }}</ref>
This form of the disease presents with symptoms of abortive poliomyelitis; however, these are often more severe, and signs of [[meningeal]] irritation are present.<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>  Typically [[symptoms]] in non-paralytic polio last for 2 to 10 days, and patients are expected to achieve complete recovery.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf }}</ref>
 
===Paralytic Poliomyelitis===
===Paralytic Poliomyelitis===
Paralytic symptoms generally begin 1 to 10 days after [[prodromal]] symptoms, and evolve during 2 to 3 days. The [[prodrome]] may be biphasic, especially in children, with initial minor [[symptoms]] separated from major symptoms, by 1 to 7 days.  Adults commonly present with a single phase of [[symptoms]], with prolongation of [[prodrome]] until onset of [[paralysis]].<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf }}</ref><ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref><ref name="pmid18126001">{{cite journal| author=HORSTMANN DM| title=Clinical aspects of acute poliomyelitis. | journal=Am J Med | year= 1949 | volume= 6 | issue= 5 | pages= 592-605 | pmid=18126001 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18126001  }} </ref>
Paralytic symptoms generally begin 1 to 10 days after [[prodromal]] symptoms, and evolve during 2 to 3 days. The [[prodrome]] may be biphasic, especially in children, with initial minor [[symptoms]] separated from major symptoms, by 1 to 7 days.  Adults commonly present with a single phase of [[symptoms]], with prolongation of the [[prodrome]] until onset of [[paralysis]].<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf }}</ref><ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref><ref name="pmid18126001">{{cite journal| author=HORSTMANN DM| title=Clinical aspects of acute poliomyelitis. | journal=Am J Med | year= 1949 | volume= 6 | issue= 5 | pages= 592-605 | pmid=18126001 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18126001  }} </ref>
====Spinal Paralytic Poliomyelitis====
====Spinal Paralytic Poliomyelitis====
Severe paralysis occurs in about 0.1% of the cases.  Initial minor symptoms are similar to those of abortive poliomyelitis, lasting 1 to 3 days.  After this initial period, the patient recovers during 2 to 5 days, until severe symptoms develop.  The severe phase of this form of poliomyelitis is characterized by signs and symptoms of aseptic meningitis. These include: [[malaise]]; [[fever]]; [[chills]]; [[nausea]]; [[vomiting]]; and [[neck stiffness]].<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
Severe paralysis occurs in about 0.1% of the cases.  Initial minor symptoms are similar to those of abortive poliomyelitis, lasting 1 to 3 days.  After this initial period, the patient recovers over 2 to 5 days, until severe symptoms develop.  The severe phase of this form of poliomyelitis is characterized by signs and symptoms of [[aseptic meningitis]]. These include [[fever]], [[chills]], [[nausea]], [[vomiting]], [[photophobia]], and [[neck stiffness]].<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>


The more severe phase of this pause begins with [[hyperesthesia]], [[paresthesia]], [[myalgia]], and [[muscle spasms]].  [[Meningeal]] symptoms start 2 days before the onset of [[paralysis]].  [[Muscular]] symptoms are often asymmetrical and may vary from mild weakness to quadriplegia.  Lower limbs tend to be more affected than the upper limbs, and symptoms may occur in different combinations of limbs.  [[Paralysis]] usually lasts 2 to 3 days, and its progression stops when [[fever]] decreases. 25% of adults also experience bladder muscle paralysis.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
The more severe phase begins with [[hyperesthesia]], [[paresthesia]], [[myalgia]], and [[muscle spasms]].  [[Meningeal]] symptoms start 2 days before the onset of [[paralysis]].  [[Muscular]] symptoms are often asymmetrical and may vary from mild weakness to quadriplegia.  Lower limbs tend to be more affected than the upper limbs, and symptoms may occur in different combinations of limbs.  [[Paralysis]] usually lasts 2 to 3 days, and its progression stops when [[fever]] decreases. Twenty five percent of adults also experience [[bladder]] muscle paralysis.<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>


====Bulbar Paralytic Poliomyelitis====
====Bulbar Paralytic Poliomyelitis====
In this form of the disease the patient often experiences difficulty swallowing and dyspnea.  It occurs in about 5-35% of the cases where paralysis occurs.  The most common sign is accumulation of pharyngeal secretions.<ref name="pmid18126002">{{cite journal| author=BAKER AB| title=Bulbar poliomyelitis; its mechanism and treatment. | journal=Am J Med | year= 1949 | volume= 6 | issue= 5 | pages= 614-9 | pmid=18126002 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18126002  }} </ref>
Patients with bulbar paralytic poliomyelitis often experience difficulty swallowing and breathing.  This form occurs in about 5-35% of the cases where paralysis occurs.  The most common sign is accumulation of [[pharyngeal]] secretions.<ref name="pmid18126002">{{cite journal| author=BAKER AB| title=Bulbar poliomyelitis; its mechanism and treatment. | journal=Am J Med | year= 1949 | volume= 6 | issue= 5 | pages= 614-9 | pmid=18126002 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18126002  }} </ref>
 
====Polioencephalitis====
====Polioencephalitis====
Occurrence of [[encephalitis]] in a patient with poliomyelitis is uncommon and occurs more frequently in infants.  [[Confusion]] is commonly the first [[symptom]] of polioencephalitis.  It may also be accompanied by [[spastic]] [[paralysis]] and [[seizures]].<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
Occurrence of [[encephalitis]] in a patient with poliomyelitis is uncommon and occurs more frequently in infants.  [[Confusion]] is commonly the first [[symptom]] of polioencephalitis.  It may also be accompanied by [[spastic]] [[paralysis]] and [[seizures]].<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>


== Complications==
== Complications==
Potential [[complications]] of poliomyelitis may include:<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref><ref name="pmid13427128">{{cite journal| author=WEINSTEIN L| title=Cardiovascular disturbances in poliomyelitis. | journal=Circulation | year= 1957 | volume= 15 | issue= 5 | pages= 735-56 | pmid=13427128 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13427128  }} </ref><ref name="pmid13826196">{{cite journal| author=GALPINE JF, WILSON WC| title=Occurrence of myocarditis in paralytic poliomyelitis. | journal=Br Med J | year= 1959 | volume= 2 | issue= 5163 | pages= 1379-81 | pmid=13826196 | doi= | pmc=PMC1990933 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13826196  }} </ref><ref name=MayoComps>{{cite web |author = Mayo Clinic Staff | date=[[2005-05-19]] | url = http://www.mayoclinic.com/health/polio/DS00572/DSECTION=7  | title = Polio: Complications| publisher = Mayo Foundation for Medical Education and Research (MFMER)| accessdate=2007-02-26}}</ref><ref name="pmid1442743">{{cite journal| author=Ramlow J, Alexander M, LaPorte R, Kaufmann C, Kuller L| title=Epidemiology of the post-polio syndrome. | journal=Am J Epidemiol | year= 1992 | volume= 136 | issue= 7 | pages= 769-86 | pmid=1442743 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1442743  }} </ref><ref name="pmid6330854">{{cite journal| author=Dalakas MC, Sever JL, Madden DL, Papadopoulos NM, Shekarchi IC, Albrecht P et al.| title=Late postpoliomyelitis muscular atrophy: clinical, virologic, and immunologic studies. | journal=Rev Infect Dis | year= 1984 | volume= 6 Suppl 2 | issue=  | pages= S562-7 | pmid=6330854 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6330854  }} </ref><ref name="pmid3007983">{{cite journal| author=Dalakas MC, Elder G, Hallett M, Ravits J, Baker M, Papadopoulos N et al.| title=A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 15 | pages= 959-63 | pmid=3007983 | doi=10.1056/NEJM198604103141505 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3007983  }} </ref><ref name="pmid6330855">{{cite journal| author=Johnson RT| title=Late progression of poliomyelitis paralysis: discussion of pathogenesis. | journal=Rev Infect Dis | year= 1984 | volume= 6 Suppl 2 | issue=  | pages= S568-70 | pmid=6330855 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6330855  }} </ref>
Potential [[complications]] of poliomyelitis may include:<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref><ref name="pmid13427128">{{cite journal| author=WEINSTEIN L| title=Cardiovascular disturbances in poliomyelitis. | journal=Circulation | year= 1957 | volume= 15 | issue= 5 | pages= 735-56 | pmid=13427128 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13427128  }} </ref><ref name="pmid13826196">{{cite journal| author=GALPINE JF, WILSON WC| title=Occurrence of myocarditis in paralytic poliomyelitis. | journal=Br Med J | year= 1959 | volume= 2 | issue= 5163 | pages= 1379-81 | pmid=13826196 | doi= | pmc=PMC1990933 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13826196  }} </ref><ref name=MayoComps>{{cite web |author = Mayo Clinic Staff | date=[[2005-05-19]] | url = http://www.mayoclinic.com/health/polio/DS00572/DSECTION=7  | title = Polio: Complications| publisher = Mayo Foundation for Medical Education and Research (MFMER)| accessdate=2007-02-26}}</ref><ref name="pmid1442743">{{cite journal| author=Ramlow J, Alexander M, LaPorte R, Kaufmann C, Kuller L| title=Epidemiology of the post-polio syndrome. | journal=Am J Epidemiol | year= 1992 | volume= 136 | issue= 7 | pages= 769-86 | pmid=1442743 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1442743  }} </ref><ref name="pmid6330854">{{cite journal| author=Dalakas MC, Sever JL, Madden DL, Papadopoulos NM, Shekarchi IC, Albrecht P et al.| title=Late postpoliomyelitis muscular atrophy: clinical, virologic, and immunologic studies. | journal=Rev Infect Dis | year= 1984 | volume= 6 Suppl 2 | issue=  | pages= S562-7 | pmid=6330854 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6330854  }} </ref><ref name="pmid3007983">{{cite journal| author=Dalakas MC, Elder G, Hallett M, Ravits J, Baker M, Papadopoulos N et al.| title=A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 15 | pages= 959-63 | pmid=3007983 | doi=10.1056/NEJM198604103141505 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3007983  }} </ref><ref name="pmid6330855">{{cite journal| author=Johnson RT| title=Late progression of poliomyelitis paralysis: discussion of pathogenesis. | journal=Rev Infect Dis | year= 1984 | volume= 6 Suppl 2 | issue=  | pages= S568-70 | pmid=6330855 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6330855  }} </ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Respiratory compromise'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Respiratory'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Resulting from paralysis of [[respiratory]] muscles (diaphragm and intercostal muscles)
* Respiratory compromise resulting from paralysis of [[respiratory]] muscles (diaphragm and intercostal muscles)
* [[Airway obstruction]]
* [[Airway obstruction]]
* Lesions in:
* Occurs due to lesions in the [[cranial nerve nuclei]] and [[medulla]]
:* [[Cranial nerve nuclei]]
:* [[Medullary]] [[respiratory center]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Myocarditis'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cardiac'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Inflammatory infiltration in cardiac muscle
* Myocarditis
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Gastrointestinal'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Gastrointestinal'''
Line 65: Line 65:
* Occurs in 20-30% of patients with history of paralytic poliomyelitis (25-35 years before), who have made a partial or full recovery
* Occurs in 20-30% of patients with history of paralytic poliomyelitis (25-35 years before), who have made a partial or full recovery
* Commonly involves previously affected muscles
* Commonly involves previously affected muscles
* Possible cause is attrition of motor nerves that innervate previously affected muscles
* New onset of:
* New onset of:
:*[[Fatigue]]
:*[[Fatigue]]
Line 71: Line 72:
:*[[Muscle atrophy]]
:*[[Muscle atrophy]]
* Gradual symptom progression
* Gradual symptom progression
* Possible cause:
:* Attrition of motor nerves that innervate previously affected muscles
|-
|-
|}
|}


==Prognosis==
==Prognosis==
* The [[mortality rate]] from poliomyelitis is referred to the period during which the disease was [[epidemic]].  During that period, acute paralytic poliomyelitis had a [[mortality rate]] of 5-10%, however, this number was higher in the case of bulbar poliomyelitis.<ref name="pmid13822503">{{cite journal| author=FERRIS BG, AULD PA, CRONKHITE L, KAUFMANN HJ, KEARSLEY RB, PRIZER M et al.| title=Life-threatening poliomyelitis, Boston, 1955. | journal=N Engl J Med | year= 1960 | volume= 262 | issue=  | pages= 371-80 | pmid=13822503 | doi=10.1056/NEJM196002252620801 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13822503  }} </ref>
* The [[mortality rate]] from acute paralytic poliomyelitis during its [[epidemic]] stage was approximately 5-10% of symptomatic individuals; higher  mortality was noted in cases of bulbar poliomyelitis.<ref name="pmid13822503">{{cite journal| author=FERRIS BG, AULD PA, CRONKHITE L, KAUFMANN HJ, KEARSLEY RB, PRIZER M et al.| title=Life-threatening poliomyelitis, Boston, 1955. | journal=N Engl J Med | year= 1960 | volume= 262 | issue=  | pages= 371-80 | pmid=13822503 | doi=10.1056/NEJM196002252620801 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13822503  }} </ref>
* Patients with abortive poliomyelitis often have a full recovery.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
* Patients with abortive poliomyelitis often have a full recovery.<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
* Patients who develop [[aseptic meningitis]], can expect [[symptoms]] to persist for 2-10 days, followed by complete recovery.<ref name=Neumann>{{cite journal |author=Neumann D |title=Polio: its impact on the people of the United States and the emerging profession of physical therapy |url= http://www.post-polio.org/edu/hpros/Aug04HistPersNeumann.pdf | format = PDF | journal=The Journal of orthopaedic and sports physical therapy |volume=34 |issue=8 |pages=479–92 |year=2004 |pmid=15373011}} Reproduced online with permission by Post-Polio Health International; retrieved on [[2007-11-10]].</ref>
* Patients who develop [[aseptic meningitis]] can have [[symptoms]] for 2-10 days and often recover fully.<ref name=Neumann>{{cite journal |author=Neumann D |title=Polio: its impact on the people of the United States and the emerging profession of physical therapy |url= http://www.post-polio.org/edu/hpros/Aug04HistPersNeumann.pdf | format = PDF | journal=The Journal of orthopaedic and sports physical therapy |volume=34 |issue=8 |pages=479–92 |year=2004 |pmid=15373011}} Reproduced online with permission by Post-Polio Health International; retrieved on [[2007-11-10]].</ref>
* Spinal poliomyelitis is rarely fatal.<ref>Silverstein A, Silverstein V, Nunn LS (2001). Polio, Diseases and People. Berkeley Heights, NJ: Enslow Publishers, 12. ISBN 0-7660-1592-0.</ref>
* In paralytic  poliomyelitis, [[muscle]] [[paralysis]] usually lasts 1-3 days, and in some cases up to 1 week.<ref name="Ritchie RussellFischer-Williams1954">{{cite journal|last1=Ritchie Russell|first1=W.|last2=Fischer-Williams|first2=M.|title=RECOVERY OF MUSCULAR STRENGTH AFTER POLIOMYELITIS|journal=The Lancet|volume=263|issue=6807|year=1954|pages=330–333|issn=01406736|doi=10.1016/S0140-6736(54)91084-3}}</ref>  Persistent weakness occurs in two thirds of patients.  
* [[Muscle]] [[paralysis]] usually lasts 1-3 days, and in some cases up to 1 week.<ref name="Ritchie RussellFischer-Williams1954">{{cite journal|last1=Ritchie Russell|first1=W.|last2=Fischer-Williams|first2=M.|title=RECOVERY OF MUSCULAR STRENGTH AFTER POLIOMYELITIS|journal=The Lancet|volume=263|issue=6807|year=1954|pages=330–333|issn=01406736|doi=10.1016/S0140-6736(54)91084-3}}</ref>  Persistent weakness occurs in two thirds of patients with the paralytic form of the disease.
* Patients with severe form of paralytic poliomyelitis, and those who require [[mechanical ventilation]] have lower probability of achieving recovery.<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
* Patients with severe form of paralytic poliomyelitis, and those who require [[mechanical ventilation]] have less probability to recover.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
* 5- 10% of patients with paralytic poliomyelitis die of[[respiratory]] [[muscles]] paralysis. The [[mortality rate]] varies with age: 2-5% in children, 15-30% in adults.  
* 5 to 10% of patients with paralytic poliomyelitis die due to the [[paralysis]] of [[respiratory]] [[muscles]]. The [[mortality rate]] varies with age: 2-5% in children, 15-30% in adult. In the presence of support, bulbar poliomyelitis has a [[mortality rate]] of 25-75%, depending on the patient's age.<ref>{{cite journal |author=Miller AH, Buck LS |title=Tracheotomy in bulbar poliomyelitis |url= http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1520308&pageindex=1#page |journal=California medicine |volume=72 |issue=1 |pages=34–6 |year=1950 |pmid=15398892 |doi=}}</ref> When positive pressure [[ventilator]]s are available, the [[mortality]] can be reduced to 15%.<ref name=Wackers>{{cite paper| author = Wackers, G.| title = Constructivist Medicine| version = PhD-thesis| publisher = Maastricht: Universitaire Pers Maastricht| date = 1994| url = http://www.fdcw.unimaas.nl/personal/WebSitesMWT/Wackers/proefschrift.html#h4| format = [[web]]| accessdate = 2008-01-04 }}</ref>
* In the absence of support, bulbar poliomyelitis has a [[mortality rate]] of 25-75%, depending on the patient's age.<ref>{{cite journal |author=Miller AH, Buck LS |title=Tracheotomy in bulbar poliomyelitis |url= http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1520308&pageindex=1#page |journal=California medicine |volume=72 |issue=1 |pages=34–6 |year=1950 |pmid=15398892 |doi=}}</ref> With adequate positive pressure [[ventilation]], the [[mortality]] can be reduced to 15%.<ref name=Wackers>{{cite paper| author = Wackers, G.| title = Constructivist Medicine| version = PhD-thesis| publisher = Maastricht: Universitaire Pers Maastricht| date = 1994| url = http://www.fdcw.unimaas.nl/personal/WebSitesMWT/Wackers/proefschrift.html#h4| format = [[web]]| accessdate = 2008-01-04 }}</ref>
* Permanent sequelae is uncommon in patients who have survived bulbar poliomyelitis.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
* Permanent sequelae are uncommon in patients who have survived bulbar poliomyelitis.<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>


==References==
==References==
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[[Category:Primary care]]
[[Category:Disease]]
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Poliovirus initially colonizes the cells of the gastrointestinal tract. When symptoms occur, these usually follow an incubation period of 7 to 14 days. The disease may manifest as abortive poliomyelitis, lasting for 2-3 days with nonspecific symptoms of fatigue, nausea, and sore throat, non-paralytic poliomyelitis, lasting about 2-10 days which with signs of meningeal irritation, and paralytic poliomyelitis with symptoms such as hyperesthesia, paresthesia, and paralysis. Complications of poliomyelitis may include respiratory compromise, gastrointestinal symptoms, musculoskeletal deformities, and post-poliomyelitis syndrome. The prognosis of poliomyelitis depends on the form of the disease: patients with abortive poliomyelitis often have a full recovery; while patients with severe form of disease have poorer outcome. Paralysis of the respiratory muscles is a sign of bad prognosis and these patients have higher mortality.

Natural History

Poliovirus enters the body through the oral cavity, infecting nearby cells, such as those of the oral mucosa, nose and throat. The incubation period often ranges from 7 to 14 days, however, it may vary from 5 to 35 days.[1][2]

Typical manifestations of poliomyelitis may range from asymptomatic disease, to death. 95% of infections with poliovirus are asymptomatic. 4 to 8% of the cases present as abortive poliomyelitis. In about 1 to 2% of infections, the disease manifests as non-paralytic poliomyelitis. Less than 1% of infected patients develop paralytic disease.

Abortive Poliomyelitis

Abortive poliomyelitis often presents with 2 to 3 days of fever. Neurological exam is normal in this form of the disease, and common symptoms may include sore throat, headache, anorexia, nausea, vomiting, and abdominal pain.[2]

Non-Paralytic Poliomyelitis

This form of the disease presents with symptoms of abortive poliomyelitis; however, these are often more severe, and signs of meningeal irritation are present.[2] Typically symptoms in non-paralytic polio last for 2 to 10 days, and patients are expected to achieve complete recovery.[3]

Paralytic Poliomyelitis

Paralytic symptoms generally begin 1 to 10 days after prodromal symptoms, and evolve during 2 to 3 days. The prodrome may be biphasic, especially in children, with initial minor symptoms separated from major symptoms, by 1 to 7 days. Adults commonly present with a single phase of symptoms, with prolongation of the prodrome until onset of paralysis.[3][2][4]

Spinal Paralytic Poliomyelitis

Severe paralysis occurs in about 0.1% of the cases. Initial minor symptoms are similar to those of abortive poliomyelitis, lasting 1 to 3 days. After this initial period, the patient recovers over 2 to 5 days, until severe symptoms develop. The severe phase of this form of poliomyelitis is characterized by signs and symptoms of aseptic meningitis. These include fever, chills, nausea, vomiting, photophobia, and neck stiffness.[2]

The more severe phase begins with hyperesthesia, paresthesia, myalgia, and muscle spasms. Meningeal symptoms start 2 days before the onset of paralysis. Muscular symptoms are often asymmetrical and may vary from mild weakness to quadriplegia. Lower limbs tend to be more affected than the upper limbs, and symptoms may occur in different combinations of limbs. Paralysis usually lasts 2 to 3 days, and its progression stops when fever decreases. Twenty five percent of adults also experience bladder muscle paralysis.[2]

Bulbar Paralytic Poliomyelitis

Patients with bulbar paralytic poliomyelitis often experience difficulty swallowing and breathing. This form occurs in about 5-35% of the cases where paralysis occurs. The most common sign is accumulation of pharyngeal secretions.[5]

Polioencephalitis

Occurrence of encephalitis in a patient with poliomyelitis is uncommon and occurs more frequently in infants. Confusion is commonly the first symptom of polioencephalitis. It may also be accompanied by spastic paralysis and seizures.[2]

Complications

Potential complications of poliomyelitis may include:[2][6][7][8][9][10][11][12]

Complications Description
Respiratory
Cardiac
  • Myocarditis
Gastrointestinal
Musculoskeletal
Postpoliomyelitis Syndrome
  • Occurs in 20-30% of patients with history of paralytic poliomyelitis (25-35 years before), who have made a partial or full recovery
  • Commonly involves previously affected muscles
  • Possible cause is attrition of motor nerves that innervate previously affected muscles
  • New onset of:
  • Gradual symptom progression

Prognosis

  • The mortality rate from acute paralytic poliomyelitis during its epidemic stage was approximately 5-10% of symptomatic individuals; higher mortality was noted in cases of bulbar poliomyelitis.[13]
  • Patients with abortive poliomyelitis often have a full recovery.[2]
  • Patients who develop aseptic meningitis can have symptoms for 2-10 days and often recover fully.[14]
  • In paralytic poliomyelitis, muscle paralysis usually lasts 1-3 days, and in some cases up to 1 week.[15] Persistent weakness occurs in two thirds of patients.
  • Patients with severe form of paralytic poliomyelitis, and those who require mechanical ventilation have lower probability of achieving recovery.[2]
  • 5- 10% of patients with paralytic poliomyelitis die ofrespiratory muscles paralysis. The mortality rate varies with age: 2-5% in children, 15-30% in adults.
  • In the absence of support, bulbar poliomyelitis has a mortality rate of 25-75%, depending on the patient's age.[16] With adequate positive pressure ventilation, the mortality can be reduced to 15%.[17]
  • Permanent sequelae are uncommon in patients who have survived bulbar poliomyelitis.[2]

References

  1. ↑ Mueller S, Wimmer E, Cello J (2005). "Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event". Virus Res. 111 (2): 175–93. doi:10.1016/j.virusres.2005.04.008. PMID 15885840.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  3. ↑ 3.0 3.1 "Poliomyelitis" (PDF).
  4. ↑ HORSTMANN DM (1949). "Clinical aspects of acute poliomyelitis". Am J Med. 6 (5): 592–605. PMID 18126001.
  5. ↑ BAKER AB (1949). "Bulbar poliomyelitis; its mechanism and treatment". Am J Med. 6 (5): 614–9. PMID 18126002.
  6. ↑ WEINSTEIN L (1957). "Cardiovascular disturbances in poliomyelitis". Circulation. 15 (5): 735–56. PMID 13427128.
  7. ↑ GALPINE JF, WILSON WC (1959). "Occurrence of myocarditis in paralytic poliomyelitis". Br Med J. 2 (5163): 1379–81. PMC 1990933. PMID 13826196.
  8. ↑ Mayo Clinic Staff (2005-05-19). "Polio: Complications". Mayo Foundation for Medical Education and Research (MFMER). Retrieved 2007-02-26. Check date values in: |date= (help)
  9. ↑ Ramlow J, Alexander M, LaPorte R, Kaufmann C, Kuller L (1992). "Epidemiology of the post-polio syndrome". Am J Epidemiol. 136 (7): 769–86. PMID 1442743.
  10. ↑ Dalakas MC, Sever JL, Madden DL, Papadopoulos NM, Shekarchi IC, Albrecht P; et al. (1984). "Late postpoliomyelitis muscular atrophy: clinical, virologic, and immunologic studies". Rev Infect Dis. 6 Suppl 2: S562–7. PMID 6330854.
  11. ↑ Dalakas MC, Elder G, Hallett M, Ravits J, Baker M, Papadopoulos N; et al. (1986). "A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms". N Engl J Med. 314 (15): 959–63. doi:10.1056/NEJM198604103141505. PMID 3007983.
  12. ↑ Johnson RT (1984). "Late progression of poliomyelitis paralysis: discussion of pathogenesis". Rev Infect Dis. 6 Suppl 2: S568–70. PMID 6330855.
  13. ↑ FERRIS BG, AULD PA, CRONKHITE L, KAUFMANN HJ, KEARSLEY RB, PRIZER M; et al. (1960). "Life-threatening poliomyelitis, Boston, 1955". N Engl J Med. 262: 371–80. doi:10.1056/NEJM196002252620801. PMID 13822503.
  14. ↑ Neumann D (2004). "Polio: its impact on the people of the United States and the emerging profession of physical therapy" (PDF). The Journal of orthopaedic and sports physical therapy. 34 (8): 479–92. PMID 15373011. Reproduced online with permission by Post-Polio Health International; retrieved on 2007-11-10.
  15. ↑ Ritchie Russell, W.; Fischer-Williams, M. (1954). "RECOVERY OF MUSCULAR STRENGTH AFTER POLIOMYELITIS". The Lancet. 263 (6807): 330–333. doi:10.1016/S0140-6736(54)91084-3. ISSN 0140-6736.
  16. ↑ Miller AH, Buck LS (1950). "Tracheotomy in bulbar poliomyelitis". California medicine. 72 (1): 34–6. PMID 15398892.
  17. ↑ Template:Cite paper

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