Disease condition

What do you know about POLIOMYELITIS?

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DEFINITION

It is defined as “An acute viral disease that cause destruction of anterior cells in spinal cord and cranial nerve, causing paralysis.

CAUSATIVE AGENT: polio virus

MODE OF TRANSMISSION:  oropharyngeal route and fecal oral route

INCUBATION PERIOD:  For 7-10 days.

PERIOD OF COMMUNICABILITY: unknown. It’s infectious for upto several weeks before symptoms develop..

 PATHOGENESIS

Poliovirus is excreted in stool of patient, 2 weeks before and 6-8 weeks after onset of illness.

The virus may also be water borne, resulting from contamination of water with sewage

CLINICAL FEATURES:

Most infections are asymptomatic.

1.ASYMPTOMATIC(SILENT) POLIO

2.ABORTIVE: In this condition the virus invaded the blood stream, causing a sort of viremia, manifested with body pain, fever , sore throat,s anorexia, etc.

SYMPTOMS ARE MODERATE INCLUDING:

  • fever
  • headache
  • sorethroat
  • nausea
  • vomiting
  • loss of appetite
  • vague  abdominal pain
  • neurological manifestations are absent.

NON PARALYTIC POLIO

The poliovirus enters the nervous system without destroying the cells. The febrile illness is then followed by meningeal irritation in the form of neck stiffness, headache, pain in neck, back muscles, vomiting etc.

No paralysis occurs in this condition. 

Kiss the knee sign:  consists in directing the child to sit up and kiss his/her knees. The test is positive if he fails to do so without bending the knee. This is owing to nuchal rigidity.

Tripod sign is elicited by asking the child to sit up. The test is positive if he assumes a tripod position while doing so.

PARALYTIC POLIO:

1.SPINAL FORM: It involves extremities, neck, abdomen, diaphragm and intercoastals. Its major manifestations are:

a.fever and other constitutional symptoms

b.muscle pain and tenderness

c.flaccid paralysis

 large muscles are more often involved than small muscles.

Maximum paralysis occurs on second to third day, with no sensory loss.

bladder and bowel involvements are common.

2.BULBAR FORM 

It’s very rare, but is most severe because of the involvement of vital medullary centres.

 It is characterized by paralysis of muscles supplied by cranial nerves(dysphagia, nasal speech and dyspnea due to involvement of soft palate and pharynx and facial paralysis).

Mild hypertension may accompany.

3.BULBOSPINAL FORM: it is the combination of both spinal and bulbar forms.

4.ENCEPHALY FORM it is relatively uncommon.. It may occur as an isolated entity.

COMPLICATIONS:

GASTROINTESTINAL : bleeding, perforation, dialatation

CVS: hypertension, tachycardia, congestive cardiac failure, myocarditis  and cardiac arrest etc..

Pulmonary: respiratory distress, pneumonia, collapse, pulmonary edemaetc.

Urinary tract: paralysis of bladder, calculi,infection.

PRECAUTIONS:

DIAGNOSTIC EVALUATION:

  • History collection
  • Physical examination
  • Lumbar puncture
  • Stool and throat swab.

MANAGEMENT:

  • Hospitalization
  • CBR
  • Minimum handling of affected part.
  • Analgesics and mild sedatives for pain relief
  • Attention to solving problem like retention of urine and constipation
  • Maintenance of adequate fluid and dietary intake.
  • Suction to remove secretions
  • Physiotherapy
  • Watch for respiratory distress.

NURSING MANAGEMENT

  • Isolation
  • report about the case to the health authorities
  • bed rest upto 3 to 4 weeks
  • vital signs
  • hot packs may be used to relieve muscle shortening, pain and tenderness.

VACCINATION:

vaccine of poliomyelitis-source internet

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