polio

Polio: description

Polio (poliomyelitis, polio) used to be a dreaded childhood disease because it can cause paralysis or even respiratory paralysis. In 1988, the World Health Organization launched a worldwide program to eradicate polio. In Germany, there was no case of polio after 1990 (only a few infections introduced).

After America (1994) and the Western Pacific (2000), WHO Europe was declared polio-free in 2002. Meanwhile, Southeast Asia has this “status”. In the other regions such as Africa, however, there are always outbreaks when the polio vaccinations are suspended, for example, for political-religious reasons. Unvaccinated travelers can become infected there and lure the disease to Europe.

Polio: symptoms

The incubation period, ie the time between infection and onset of the disease, is about three to 35 days. In more than 95 percent of those infected, the infection proceeds without symptoms (asymptomatic) with the formation of antibodies.

In the remaining cases, different courses of disease are possible: Four to eight percent of the infected develop a polio disease without involvement of the central nervous system (CNS), the so-called abortive polio. The CNS is also less involved: either a non-paralytic (two to four percent of the cases) or a paralytic poliomyelitis (0.1 to 1 percent) is present.

Abortive poliomyelitis

About six to nine days after infection with the polio virus, patients briefly develop nonspecific symptoms such as nausea, diarrhea, fever, gastric, cervical, head and muscle pains.

Non-paralytic poliomyelitis (aseptic meningitis)

Here patients get fever, muscle cramps, back pain and a stiff neck about three to seven days after the abortive poliomyelitis.

Paralytic poliomyelitis

In some patients with non-paralytic polio, the symptoms initially improve, followed by a recurrence of fever after two to three days, and rapid or gradual onset paralysis. These are usually asymmetrical and affect the leg, arm, abdomen, ribcage or eye muscles. As a rule, the paralysis is partly back, but not complete. Rarely, there are also speech, chewing or swallowing disorders with damage to the cranial nerve cells and central respiratory paralysis (imminent danger to life!). Sometimes it also develops a heart muscle inflammation that causes a heart failure.

Polio vaccine

Only a complete vaccine can protect against polio. Learn more about the polio vaccine.

Polio: causes and risk factors

Polio virus causes polio, of which there are three types of immunological disorders (types 1, 2, 3). They belong to the enteroviruses, which means they live and multiply in the gastrointestinal tract, more specifically in the intestinal mucosa and the lymphatic tissue of the intestinal wall. Man is the only natural host of polioviruses.

In the early phase of infection, the polio pathogens can be transmitted via the saliva (for example, when coughing or sneezing). First and foremost, however, the transmission is fecal-oral: The patients excrete the pathogen massively with the chair. Other people then tend to sting over the consumption of food and drink that had contact with the infectious stool. Poor hygienic conditions favor this propagation of polio viruses.

Polio: duration of infectivity

A patient is contagious as long as he excretes the virus. In saliva, the virus is detectable at the earliest 36 hours after infection and can remain there for about a week. Fecal excretion begins two to three days after infection and usually lasts for up to six weeks. People with weakened immune systems can even retire the virus for months and years.

Infants born to mothers with antibodies to polio are protected from infection in the first few months of life because the antibodies are also transmitted to the child via the placenta during pregnancy.

Polio: examinations and diagnosis

If there is any suspicion of polio, a patient must be taken to the hospital immediately and housed there isolated from other patients.

To diagnose a poliomyelitis, the doctor will ask exactly the course of the disease and the past medical history – the patient himself or (in children) the parents. Possible questions are:

• When did the first symptoms appear and which ones?
• Was it nausea, abdominal pain, diarrhea, muscle aches or headache?
• Did you experience any other symptoms such as neck stiffness, numbness, back, neck and muscle pain?
• Have you / your child been abroad recently?

In pronounced cases, the doctor can determine the polio by the symptoms alone. Characteristic of the paralytic poliomyelitis is the biphasic course of the fever curve.

Polio: laboratory tests

To ensure the diagnosis of polio, the doctor performs additional laboratory tests:

The polio virus can be detected directly in the pharynx or stool. From a stool sample succeeds in the first two weeks of the disease to about 80 percent. To determine the exact nature of the pathogen, a polymerase chain reaction (PCR) is performed (the genome of the detected germs is thereby multiplied so that it can be analyzed more accurately).

The polio pathogen can also be detected indirectly if one finds specific antibodies against the virus in the blood of a patient.

To find out if polio has spread to the brain, the doctor performs a lumbar puncture: he takes a small sample of cerebrospinal fluid (cerebrospinal fluid) around the lumbar spine and sends it to the laboratory for analysis. In the case of infection with polio, virus components of the pathogen (viral RNA) can usually be detected in the CSF.

Polio: differential diagnosis

Sudden flaccid paralysis can also be caused by Guillain-Barré syndrome, but is usually symmetrical and can regress within ten days. Also often missing accompanying symptoms such as fever, headache, nausea and vomiting.

In disease progression without paralysis always a meningitis or encephalitis (meningitis or encephalitis) should be excluded as a cause.

Infectious polio and “cerebral palsy” (infantile cerebral palsy) should not be confused. The latter is a disorder of movement and posture in children due to damage to the developing brain before, during or shortly after birth.

Polio: treatment

If there is a suspicion of polio, you must immediately report this to the responsible health department and bring the patient to a hospital. He is there isolated in a single room with its own toilet and provided under strict hygiene measures. Isolation remains in place until laboratory tests at the National Reference Center for Poliomyelitis and Enteroviruses (NRZ PE) have been able to rule out polio infection.

If someone actually suffers from polio, they have to comply with bed rest and get anti-inflammatory painkillers for the ailments. The cause of the polio itself can not be treated until today – no matter in which stage of the disease the patient is. The treatment is therefore only symptomatic (so only the symptoms can be alleviated).

In the reparative stage, when the acute inflammatory symptoms gradually regress, the patient should be cared for by physiotherapy. If symptoms of meningitis occur, the patient should be treated in an intensive care unit. If necessary, the patient can be ventilated there. In addition, other complications such as high blood pressure, cardiac arrhythmias and bladder emptying disorders can be optimally treated there. In the first few days, the failures improve. However, the degree of permanent failure can only be assessed after several months.

Polio: hygiene measures

Consistent hygiene contributes to the fact that poliomyelitis does not spread. This includes above all to avoid a fecal-oral lubrication infection by hand washing and disinfection. Regardless of vaccination status, contact persons should be vaccinated against polio as early as possible.

Polio: Disease course and prognosis

Most forms of polio have a good prognosis.

Paralysis can recede spontaneously up to two years after infection if the patient is given intensive physiotherapy. In about a quarter of all patients with paralytic poliomyelitis slight damage remains, in another quarter severe damage. Joint deformities, leg and arm length differences, spinal displacements and osteoporosis (bone loss) can be late effects of polio.

If cranial nerves are affected by the disease, the prognosis is poor. The death rate is two to twenty percent.

Polio with CNS involvement: post-polio syndrome

Years or decades after a paralytic polio, a post-polio syndrome (PPS) can occur: existing paralysis worsens, chronic muscle wasting occurs. Accompanying symptoms are pain and fatigue. The post-polioSyndrome can manifest not only to those muscles that were originally affected by the infection, but also to new muscle groups.