Polio is an acute viral disease characterized by damage to the spinal cord or brain. The most common complications of the development of this disease in children under the age of 5 years are atrophy, as well as muscle paralysis. It is very important to know the epidemiology, clinic, diagnosis and prevention of poliomyelitis. After all, this knowledge will help protect yourself from the disease. The main causative agent is poliovirus, which is part of the group of enteroviruses.
For more information about the prevention, treatment, diagnosis and clinic of polio, see our article.
General information about the disease
Polio was ill in Ancient Greece and Egypt of the times of the pharaohs. This is confirmed by the found remains of people with limb deformities characteristic of the disease.
Even at the beginning of the 20th century, polio was a real scourge that affected thousands of children around the world.the world. The situation changed with the invention of the vaccine. Now in developed countries, including Russia, poliomyelitis is registered in isolated cases, but it is still too early to completely exclude it from the list of diseases dangerous to he alth and life.
It is caused by the poliovirus, which mainly affects children under the age of 7. Among older citizens, the disease practically does not occur or is asymptomatic. Those who have recovered develop strong immunity, that is, you can get sick with polio only once.
Children under the age of 3 months also do not get sick, as their body protects the immunity received from their mother.
How can you get infected
The poliovirus enters the body through the oral-fecal or airborne route. You can catch it from someone who is already sick, if he has symptoms of a cold (coughing, sneezing), through close contact with him, for example, through kisses, when using common household items, dishes, towels, toys (applies to children) with the carrier of the infection.
In addition, the fecal-oral route of infection involves infection through dirty hands, eating contaminated with the virus and unwashed food. Flies are often carriers of infection. That is why outbreaks of the disease are observed in summer and autumn.
Poliovirus is very hardy. In feces, it lasts up to 6 months, and on objects - up to 3 months. He is not afraid of frost, he is not destroyed by gastric juice. However, when boiled, it dies almost instantly. It is also killed by the treatment of objects with chlorine solutions (even in minimalquantities). The virus cannot survive temperatures above 50 degrees Celsius.
Symptomatics
Once in the oral cavity, viruses begin to multiply in the intestines, tonsils or in the lymphatic pharyngeal ring. The incubation period can last from 3 to 35 days, but most often it takes 9-11 days. Viruses penetrate into the blood, and with its current into the central nervous system, causing damage to the nuclear cranial nerves and horns of the spinal cord. In cases of asymptomatic course, the disease can only be detected by chance when performing any research on the patient.
Polio can come in several forms:
- Bulbarnaya.
- Spinal.
- Pontine.
- Mixed.
Each has its own characteristics. In general, patients may experience:
- Fever.
- Breach of stool.
- Rash.
- Catarrhal phenomena.
- HELL jumps.
- General weakness, muscle pain.
- Urinary disorder.
- Cyanosis.
- Shortness of breath and choking.
- Swallowing disorder.
- Pareses.
- Paralysis.
When contacting a medical institution, the patient is given:
- History taking and general examination of the child.
- Collection of tests for the diagnosis of polio.
- Detection of mucus in stool and nasopharynx.
- Study of biomaterial using RSC and ELISA methods.
- Electromyography.
- Performing a lumbar puncture, a thorough examination of the cerebrospinal fluid.
Methods for determining the disease
The diagnosis is finally made after receiving the results of laboratory diagnosis of poliomyelitis, that is, virological and serological studies, obtaining electromyography indicators, which allows you to determine the level of severity of the lesion, the location of the pathological process.
Blood, cerebrospinal fluid, as well as swabs from the inside of the nasopharynx and feces are suitable materials for performing effective studies at the earliest possible time for the onset of the disease.
Laboratory diagnosis of poliomyelitis makes it possible to isolate the virus. The performed serodiagnosis makes it possible to identify antibodies that are directed against the developing virus of this disease, and the use to determine RSK makes it possible to determine the dynamic increase in titer.
Diagnosis of polio can be difficult in the visceral and meningeal form. In this case, the small patient's motor activity should be carefully examined and observed in order to be able to identify symptoms of minimal muscle weakness, as well as subtle weakening of reflexes.
Differential diagnosis of poliomyelitis
At the very beginning of the onset of signs of polio, it is quite difficult to distinguish it from tonsillitis and SARS, as well as in cases where the child has dyspeptic symptoms of dysentery and gastroenterocolitis.
It is also difficult to differentiate the disease we are considering from polio-like diseases,which can cause coxsackieviruses and ECHO. In such a situation, in addition to indicators of serological and virological studies, it is necessary to take into account certain features of the course of ailments of diseases: the ephemeral nature of paresis, fever-free course, and the absence of a changed composition of the cerebrospinal fluid, which occurs with poliomyelitis and its complications. In such cases, PCR is used to diagnose polio.
The meningeal form must be differentiated from serous meningitis, tuberculous, and mumps etiology. In this case, seasonality, epidemiological history, and features of the course of the disease should be taken into account.
Mumps meningitis has a more pronounced pleocytosis, which in almost every case has a gradual onset, a significant increase in temperature, a progressive course, as well as the presence of a small amount of fibrin film in the cerebrospinal fluid, a minimum content of sugars
Symptoms of enteroviral meningitis are herpetic eruptions. The pontine variety of this disease can be compared with the development of neuritis of the facial nerve. It should be borne in mind that it is mainly accompanied by lacrimation, impaired sensitivity, and pain. The disease develops more often in children under the age of 7.
When a patient is diagnosed with a bulbar form of poliomyelitis, it is extremely important to exclude the presence of stem encephalitis, which manifests itself as cerebral lesions, convulsions, impaired consciousness.
Diagnosis of epidemic poliomyelitis is needed in order to clarify the causethe he alth status of the child. The characteristics of the clinical course, indications of electromyographic and laboratory studies, as well as available endemiological data must be taken into account.
Treatment
Therapy of this disease is carried out after a qualitative diagnosis. This procedure includes the following items:
- Compulsory hospitalization, bed rest.
- Optimal and appropriate drug therapy.
- Performing physiotherapy.
A child with symptoms of polio must be taken to hospital as soon as possible for inpatient treatment. If a patient is diagnosed with poliovirus, they are placed in a closed box for a period of 40 days. This is done to prevent further spread of the infection.
Bed rest is required to prevent the development of deformities and contractures of the legs and arms, so the patient's movements should be limited for 2 weeks or more.
In the presence of damage, it is recommended to immobilize the areas using splints. Also, the affected areas should be well wrapped with a blanket or scarf. The child should be placed on a hard mattress.
In our time, there is still no special serum that would make it possible to stop the development of the polio virus. The patient is usually prescribed complex therapy, which helps to strengthen the immune system so that the body has the ability to successfully and quickly overcome poliovirus.
First of all, gamma globulin is administered intramuscularly to the patient,the dose of which is a maximum of 20 ml per day. In total, 3-5 injections are made. In addition, it is necessary to administer Interferon preparations, carry out hemotherapy - intramuscularly the child is injected with 5-30 ml of venous blood of one of the parents, 10-20 injections. The serum of convalescents is taken from adults who have been in contact with sick people, as well as people who have recovered from polio.
In this disease, antibiotics are prescribed only in a situation where there is a threat of infection with a secondary infection in order to further prevent the occurrence of pneumonia and bacterial diseases. With a viral infection, antibiotics will not have the desired effect.
Anti-inflammatory therapy
To remove a possible inflammatory process of the spinal cord and brain, doctors usually use dehydration therapy, for which they use saluretics - Hydrochlorothiazide, Indapamide and Furosemide. In order to alleviate the patient's condition as quickly as possible and thin the sputum, if there are no respiratory disorders, the use of ribonuclease is allowed. Also, to eliminate the inflammatory process, non-steroidal drugs are prescribed, such as Afida, Nurofen and Nimesil.
Symptomatic treatment
To normalize the patient's condition, as well as to maintain the general condition of the body, vitamins B1 (thiamine chloride), ascorbic acid, amino acids, vitamin B12 (cyanocobalamin) and B6 (pyridoxine) are administered on the first day. If there are disorders in the functioning of organsbreathing, the use of mechanical ventilation is indicated.
When new paralysis is ruled out, anticholinesterase agents are used to normalize the functioning of the nervous system, which maximally and effectively stimulate the interneuronal and myoneural conduction of the body - Dibazol, Prozerin and Nivalin.
To relieve pain in the muscle system, analgesics are used. To calm the child, the use of sedatives such as Valerian, Persen, Tenoten and Diazepam is shown. If the patient has difficulty swallowing, they can be fed using a nasogastric tube.
Recovery period
The first 3 weeks of the recovery period for a child is usually prescribed:
- Vitamins, especially group B.
- Nootropics Piracetam, Bifren, Glycine, Cavinton.
- Anticholinesterase drugs Prozerin and Nivalin.
- Anabolic-type hormones.
Physiotherapy treatments
These methods allow you to effectively restore movement, and contribute to the rapid recovery of internal systems, nerve cells, and muscles. For the treatment of poliomyelitis and further rehabilitation, the patient is recommended to perform the following procedures:
- Paraffin therapy.
- Electromyostimulation.
- Healing showers and baths.
- UHF therapy.
- Therapeutic exercise and orthopedic massage.
The above methods help restore muscle tone and movement of the patient's limbs. For a polio survivorrehabilitation performed in a sanatorium or resort will have a very beneficial effect.
Great attention is paid to the care of human limbs, which may have been paralyzed or deformed. The movements must be slow and careful. It is necessary to ensure that the person has the correct position of the spine, arms and legs.
The patient is placed on a rather hard mattress, the legs are placed parallel to the body, they need to be slightly bent at the hip and knee joints using special rollers. Under the sole for additional emphasis, you need to place a dense pillow, the feet should be located at right angles to the shins. Hands need to be taken to the sides, and bent at the elbows.
Prevention
To avoid the diagnosis and treatment of polio, prevention can be done. This process includes the following steps:
- The main method of prevention is vaccination.
- Carry out thorough disinfection where the source of infection has been found.
- Following the rules of personal hygiene.
- Processing food before cooking and eating.
Performing vaccination
In our time, routine vaccination against polio is considered the main measure for the prevention of this disease. The vaccine helps to develop immunity to the virus. Even if a person becomes ill with poliomyelitis after some time, which happens very rarely, the course of the disease does not cause dangerous complications and passes in the mildform.
In 2018, 3 types of drugs were used:
- Koprowski's vaccine. It is the world's first polio vaccine, which has been successfully used since the 1950s. This drug is used against polioviruses PV1 and PV3 type.
- The Salk vaccine (IPV, IPV) allows the body to develop immunity to three varieties of poliovirus. To achieve the desired result, the Salk vaccination is required to be given 3 times according to a special vaccination schedule.
- Sabin Vaccine (OPV) is an oral-type treatment for polio. It is given to the child in the mouth on a small piece of sugar, 2 drops each.
In a child, immunity against this poliovirus is created at about 3 years of age. To achieve maximum results, the OPV vaccine should be given three times.
In very rare situations, a weakened virus can become normal, causing paralytic polio. Based on this, many countries began to implement mandatory immunization using the Salk vaccine.
Also other types of polio drugs are used in the world:
- Chumakov's vaccine.
- "Tetracoccus" is a combined vaccine that protects children from polio, tetanus, diphtheria and whooping cough at the same time.
The inactivated vaccine used contains the virus of this disease, which was previously killed by formalin. It is administered three times, which allows you to develop a special humoral immunity. The live vaccine contains an attenuated virus thatis administered orally. It stimulates the humoral and tissue immunity of the child's body.
Conclusion
Polio is a rather serious disease that requires urgent medical attention. In order to protect your child as much as possible, it is necessary to timely vaccinate and revaccinate with effective and high-quality drugs. It is equally important to know the treatment, prevention, clinic and diagnosis of poliomyelitis. This information will help protect you from the disease. Poliomyelitis can cause pathological changes in the limbs, and in cases where the respiratory center is affected, suffocation can occur. Therefore, it is impossible to refuse vaccination.
