Poliomyelitis and Post Polio Syndrome

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Poliomyelitis and Post Polio Syndrome

• Mazloumi MD
• Qaem,s Hospital

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What is Poliomyelitis?

• polio gray matter
• Myelitis inflammation of the spinal cord
• This disease result in the destruction of motor
  neurons caused by the poliovirus.
• Polio is causes by a virus that attacks the nerve
  cells of the brain spinal cord although not all
  infections result in sever injuries and paralysis.

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POLIOMYELITIS

• Picornavirus
• 3 types Poliovirus 1,2,3
• Ingested, spread by faeco-oral route Commoner in
  areas of poor sanitation
• Infants protected by maternal antibodies

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History

• Associated with man since ancient times
• Egyptian hieroglyph indicates presence since 1400
  BC
• 1840 - Heinle characterizes poliomyelitis
• Poliomyelitis grey marrow in Greek
• 1954 - Salk vaccine
• 1960 - Sabin vaccine
• 1991 Molla produces polio in vitro from virus
  RNA
• 2002 completele synthetic production

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Polio EradicationStatus in 1988
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Polio Eradication Status in 1998
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Epidemiology

• Silent circulation Many hundreds may be
  infected prior to the development of a single
  case of paralysis
• WHO considers a single confirmed case of polio in
  an area of low occurrence an epidemic

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How is polio transmitted?

• Poliovirus is transmitted through both oral and
  fical routes with implantation and replication
  occurring in either the orapgaryngeal and or in
  the intestine of mucosa. Polio cases are most
  infected for 7-10 days before and after clinical
  symptoms begin.

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The unique stages of infection and pathogenesis
of poliomyelitis.
Poliovirus, an Enterovirus has an icosahedral
capsid shell that protects it from digestion.
GI Tract ? Blood ? Cord
? CNS Paralysis of motor neurons
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Provocative Poliomyelitis

• Provocative poliomyelitis occurs when a person
  having polio virus circulating in blood
  (viraemia) receives any intra-muscular injection.
• Reason is increased susceptibility of the
  relevant anterior horn cells resulting in
  settling of the circulating polio virus there and
  consequential paralysis.

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What are the symptoms?

• Many include fever, pharyngitis, headache,
  anorexia, nausea, and vomiting. Illness may
  progress to aseptic meningitis and
  menigoencephalitis in 1 to 4 of patients. These
  patients develop a higher fever, myalia and sever
  headache with stiffness of the neck and back.

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Clinical Pattern of Polio
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Virus travels through blood and the nerves
And each place in the cord that nerve cells
are destroyed causes paralysis of that part of
the body controlled by those motor neurons.
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POLIO ATTACKS MOTOR NEURONES
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PoliomyelitisClinical Features

• In 1 of cases virus invades CNS
• Multiples and destroys anterior horn cells.
• In severe cases, poliovirus may attacks motor
  neurones in brainstem, leading to difficulty in
  swallowing, speaking and breathing

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Equanous deformity

• Tibialis anterior muscle paralysis (most common)
• Heel elevated
• Toe gait
• Achill tendon contracture

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Calcaneous deformity

• Gastrosoleous muscle paralysis
• (Cavous foot)

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Varous deformity

• Peroneal muscle paralysis ,associate with
  equanuse deformity
• (paralytic equano varous )

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Planovalgus deformity

• Tibialis posterior paralysis
• ( Flat foot )

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Paralytic Scoliosis

• Paravertebral muscleparalysis
• ( Pelvic title )

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Knee deformities

• Hamstring muscle paralysis(Geno recurvatum )
• Quadriceps muscle paralysis ( knee flection
  contracture )

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Treatment

• Intensive physiotherapy

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Treatment

• Orthosis

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treatment
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Inactivated Vaccine

• Immunity to Poliovirus 1,2,3
• Safe, effective
• Injection
• No gastrointestinal immunity Risks of continued
  circulation of virus in endemic areas
• Expensive

Jonas Salk
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Live Vaccine

• Live attenuated oral vaccine (Sabin, 1961)
• Risks of viral mutation, leading to potential
  regain of virulence
• Excretion of live virus thru faeces
• Live vaccine cheaper, and suitable for mass
  vaccination programmes

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PoliomyelitisCurrent Status

• Eradicated from developed world in 1960s
• Remains endemic in 7 countries
• Eradication plan by WHO by year 2000 not yet
  achieved, but progress is being made

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THANKS