PolioPoliomyelimyeli

tistisA report of…A report of…

Ø Abarca, Mark Abarca, Mark

Ø Nerza, Lourelie Nerza, Lourelie

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Ø polio= gray matterØ Myelitis=

inflammation of the spinal cord

Ø This disease result in the destruction of motor neurons caused by the poliovirus.

Ø Polio is caused by a virus that attacks the nerve cells of the brain& spinal cord althoughnot all infections resultin severe injuries and paralysis.

ØPoliomyelitis, often called polio or infantile paralysis, is an infectious disease caused by a virus.

ØAn infectious diseasecaused by one of the three polioviruses.

ØPoliovirus

ØThis virus is a memberof the enterovirus subgroup of the Picornaviridae family and has three serotypes: PV1, PV2 and PV3.

ØImmunity to one serotype of the virus does not provide significant protection against the other serotypes.

ØThe principal mode of transmission is from person to person, by the fecal-oral route.

ØTransmission via oral secretions, such as saliva is possible and may account for some cases.

ØEnter through Mouth,ØMultiplies in

Oropharynx tonsils and Intestines,

ØExcreted in Stool.

ØEnters the CNS from Blood.

ØSpread along the Axons of peripheral nerves to CNS.

ØProgress along the fibers of the lower motor neurons spinal cord or brain.

ØDestroy the Anterior horn cells of the SpinalCord

ØDo not Multiply in Muscles only muscles manifest with weakness and flaccid paralysis result is secondary.

ØOccasionally produce - Myocarditis, - Lymphatic

hyperplasia.

ØParalytic Poliomyelitis

ØNonparalytic Poliomyelitis (Abortive Poliomyelitis)

Ø Spinal polio is the most common form of paralytic polio; it results from viral invasion of the motor neurons of the anterior horn cells, or the ventral (front) gray matter section in the spinalcolumn responsible for movement of the muscles, including those of the trunk, limbs and the intercostal muscles. Virus invasion causes inflammation of the nerve cells, leadingto damage or destruction of motor neuron ganglia.

Ø Making up about 2% of cases of paralytic polio, bulbar polio occurs when poliovirus invades and destroys nerves within the bulbar region of the brain stem. The bulbar region is a white matter pathway that connects the cerebral cortex to the brain stem. The destruction of these nerves weakens the muscles supplied by the cranial nerves, producing symptoms of encephalitis.

Nonparalytic polio Some people who develop symptoms

from the poliovirus contract nonparalytic polio — a type of polio that doesn't lead to paralysis (abortive poliomyelitis). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.

Signs and symptoms, which generally last two to 10 days, include:

- Fever - Back pain or stiffness

- Sore throat - Headache

- Vomiting - Fatigue

- Neck pain or stiffness

- Pain or stiffness in the arms or legs

- Muscle spasms or tenderness

- Meningitis

Paralytic PoliomyelitisFewer than 1 percent of people

infected with poliovirus develop paralytic polio, the most serious form of the disease. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio.

Between one and 10 days laterhowever, signs and symptomsspecific to paralytic polio appear,including:

Ø Loss of reflexes

Ø Severe muscle aches or spasms

Ø Loose and floppy limbs (acuteflaccid paralysis), often worseon one side of the body

Ø Viral isolation from Throat swabs, Rectal swabs, Stool specimens, andCSF.

Ø If poliovirus is isolated from a patient experiencing acute flaccid paralysis, it is further tested through oligonucleotide mapping(genetic fingerprinting),or more recently by PCR amplification, to determine whether it is “wild type" (that is, the virus encountered in nature) or "vaccine type" (derived from a strain of poliovirus used to produce polio vaccine).

Ø It is important to determine the source of the virus because for each reported case of paralytic polio causedby wild poliovirus, an estimated another 200 to 3,000 contagious asymptomatic carriers exist.

Ø Estimation of AntibodiesIgM

Ø There is no cure for polio. The focus of modern treatment has been on providing relief of symptoms, speeding recovery and preventing complications. Supportive measures include antibiotics to prevent infections in weakened muscles, analgesics for pain, moderate exercise and anutritious diet. Treatment of polio often requires long-term rehabilitation, including physicaltherapy, braces, corrective shoes and, in some cases, orthopedic surgery

Ø Diet: Because patients with poliomyelitis are prone to develop constipation, a diet rich in fiber is usually indicated.

Ø Orthotic treatment (AFO/KAFO)

Ø Surgical Care: Total hip arthroplasty is a surgical therapeutic options for patients with paralytic sequelae of poliomyelitis who develop of hip dysplasia and degenerative disease.

Ø Bladder involvement may require catheterization

Ø respiratory muscle involvement may require mechanical ventilation

Ø Postural drainage & suction may be sufficient to manage pooling of secretions in patients with nonparalytic polio.

Ø Paralytic polio can lead to temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles and feet. Although many deformities can be corrected with surgery and physical therapy, these treatments may not be options in developing nations where polio is still endemic. As a result, children who survive polio may spend their lives with severe disabilities.

Ø You're at greatest risk of polio if you haven't been immunized against the disease. In areas with poor sanitation and sporadic or nonexistent immunization programs, the most vulnerable members of the population — pregnant women, the very young and those with weakened immune systems — are especially susceptible to poliovirus.

Ø These factors also increase your risk if you haven't been vaccinated:

Ø Travel to an area where poliois common or that has recently experienced an outbreak

Ø Living with or caring for someone who may be shedding poliovirus

Ø Handling laboratory specimens that contain live poliovirus

Ø A compromised immune system, such as occurs with HIV infection

Ø Having had your tonsils removed (tonsillectomy)

Ø Extreme stress or strenuous physical activity after being exposed to poliovirus, both of which can depress your immune system

Ø Paralytic polio can lead to temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles and feet. Although many deformities can be corrected with surgery and physical therapy, these treatments may not be options in developing nations where polio is still endemic. As a result, children who survive polio may spend their lives with severe disabilities.

Ø Two types of vaccine are used throughout the world to combat polio. Both types induce immunity to polio, efficiently blocking person-to-person transmission of wild poliovirus, thereby protecting both individual vaccine recipients and the wider community (so-called herd immunity).

ØAlbert Sabin (Virologist)

ØTwo types of vaccines used in the prevention of poliomyelitis:

Ø inactivated poliovirus vaccine “IPV” administered through IM (Salk Vaccine – given by injection)

Ø oral attenuated poliovirus vaccine “OPV”. (Sabin Vaccine)

ØIPV was the first polio vaccine available on the market, and its widespread administration began in the 1950s.

ØAn enhanced inactivated poliovirus vaccine (eIPV) formulation is now available.

ØNonenhanced early formulations had the disadvantages of not being as immunogenic as OPV, not being able to induce mucosal immunity, and having to be administered parenterally, which increased costs and decreased compliance.

ØOne of the major advantages of IPV is that it contains an inactivated virus;

Ø for that reason, IPV is notassociated with the development of vaccine-associated poliomyelitis and can be given to immunocompromised patients.

ØThis vaccine is administered when individuals are aged 2 months, 4 months, and 6-12 months and before school entry, which is usually at age 4 years.

ØTrivalent OPV has been used since the early 1960s.

ØImmunization with this formulation was responsible for the significant decrease in the prevalence of disease throughout the world.

ØThis formulation has the advantages of inducing mucosal immunity,

Øproviding appropriate herd immunity, and increasing vaccine uptakebecause of oral administration.

ØAdditionally, it is cost-effective, especially in countries in the developing world.

ØThe major disadvantage of trivalent OPV is its association with

Øvaccine-associated paralytic poliomyelitis (VAPP). Although the virus contained in this formulation is attenuated, it may occasionally become neurotropic and be able to produce disease similar to wild-type virus.

ØTrivalent OPV is being administered in developing countries when individuals are aged 2 months, 4 months, and 6

Ømonths and with a booster at age 4 years.

ØVAPP occurs most frequently after the first dose of OPV but may alsooccur after administration of the second or third doses.

ØAdministration of OPV is contraindicated in children who are immunocompromised and in children whose caretakers are immunocompromised.

ØA risk for development ofpoliomyelitis is present inthose individuals who receive this vaccine and are immunocompromised

Children

ØChildren are recommended a primary course of 3 doses of an IPV-containing vaccine at2, 4 and 6 months of age and a booster dose at 4 years of age.

ØThe recommended interval between 2 doses is 2 months, but, for catch-up, the minimum interval can be 1 month

Adults

ØThe schedule for unvaccinated adults is 3doses administered at intervals of 1–2 months.

Booster doses ØA booster dose is not

required for fully vaccinated children or adults unless they are atincreased risk of infection,

such as:

Ø Travelling to areas or countries where poliomyelitis is epidemic or endemic.

Ø Healthcare workers, including laboratory workers, in possible contact with poliomyelitis cases.

ØFor those exposed to a continuing risk of infection, booster doses are desirable every 10 years.

Ø Inactivated poliomyelitis vaccines can be safely administered to either persons with impaired immunity or to persons living with someone with impaired immunity.

Ø IPV vaccines may cause erythema, pain, and induration at the injection site. Other symptoms reported following administration of IPV vaccines in young babies include fever, crying and decreased appetite.

Ø Imbalanced Nutrition: Less Than Body Requirements r/t anorexia, nausea and vomiting

Ø Ineffective Thermoregulation r/t theinfection process

Ø Ineffective Airway Clearance r/t muscle paralysis

Ø Ineffective Breathing Pattern r/t muscle paralysis

Ø Acute Pain r/t the infectionthat attacks the nerve

Ø Impaired Physical Mobility r/t paralysis

Ø Anxiety: in children and families related to disease conditions

Ø Maintain a patent airway, and keep a tracheotomy tray at the patient’s bed side.

Ø Encourage a return to mild activity as soon as possible.

Ø Prevent fecal impaction by giving enough fluids to ensure an adequate daily urine output of low specific gravity.

Ø Provide tube feedings when needed.

Ø Provide good skin care, reposition the patient often, and keep bed linens dry.

Ø To alleviate discomforts, use foam rubber pads and sandbags or light splint as ordered.

Ø Wash hands thoroughly after contact with patient or any of his secretions and excretions

Ø Frequently check blood pressure, especially if the patient has bulbar poliomyelitis

Ø Assess bladder retention that cause muscle paralysis.

Ø Have the patient wear high-top sneakers or use of footboard to prevent foot drop

Ø Provide emotional support to the patient and his family.

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