Poliomyelitis: symptoms, treatment and prevention

Polio(from the Greek polios gray, myelos brain), or Heine-Medina disease is an infectious viral disease characterized by defeat mainly gray matter of the spinal cord with the development of a sharp muscle weakness. Although, to date, thanks to mass vaccination, in Russia this disease is rare, there is a certain risk. Outbreaks are observed in Afghanistan, Nigeria, Pakistan and up to the present, which means that the pathogen can be imported to any country in the world. Postponed poliomyelitis leaves behind severe motor disabilities, deformities of the limbs, which causes disability.

In this article, let's talk about the symptoms of this ailment, about treatment, and also talk about the importance of quality prevention in order to avoid infection.

Historical facts

The disease affects people since the days of Ancient Egypt. In addition to humans, monkeys are sensitive to the pathogen. Poliomyelitis was the cause of epidemics in the twentieth century, took thousands of lives. Since the 50-ies of the last century, thanks to the vaccine, the world has been able to successfully combat the disease. The vaccine against poliomyelitis is still the only effective preventive measure today. The beginning of mass application of vaccination caused a sharp decrease in the incidence of poliomyelitis, which allowed to virtually defeat the disease.

Causes

The causative agent of the disease is the poliovirus (poliovirus).
It belongs to the family of intestinal viruses. In total, there are three types of virus (, ,3), the first of which occurs most often. It reproduces only within the body, but it is very stable in the external environment. At temperatures below zero, it persists for many years, at 4-5 ° C for several months, at room temperature for several days, it is not inactivated by gastric juice, and it lasts up to three months in dairy products. Effective in fighting the virus are boiling, ultraviolet radiation, treatment with chlorine lime, chloramine, hydrogen peroxide, formaldehyde.

The source of infection is always the infected person. It is the infected, not only the patient, as there are cases of carrier of the virus without clinical symptoms. A person begins to isolate the virus in 2-4 days from the time of infection. "Catch" an infection can be done in two ways:

• fecal-oral: through dirty hands, food, general things, dishes, towels, water. Insects (flies) can become carriers of the disease. This way of transmission of infection is possible due to the isolation of the virus with feces. If the rules of personal hygiene are not observed, the pathogen spreads in the environment. It is believed that with feces the virus is released up to 7 weeks;
• air-drop: when sneezing and coughing. The virus enters the exhaled air from the human nasopharynx, in which it multiplies in the lymphoid tissue. Virus isolation in this way takes about a week.

The spread of infection contributes to staying in a small room with a significant number of people, a violation of the sanitary and hygienic regime, reduced immunity. Children's groups are in the zone of greatest risk.

The peak incidence falls on the summer-autumn period. The disease is more likely to affect children from one year to seven years.

After the virus enters the gastrointestinal tract or into the nasopharynx, the virus multiplies in the lymphatic structures of these parts of the body. After that, it penetrates into the blood. With blood flow spread throughout the body, continues its multiplication in other lymphatic structures (liver, spleen, lymph nodes). In most cases at this stage, the spread of the virus through the body ends. In this case, the patient transfers the disease in mild form (signs of intestinal infection or catarrh of the upper respiratory pathways without the development of muscle manifestations) or the carrier of the poliomyelitis virus develops in general. How effective the organism will withstand the further spread of the pathogen depends on the immune state of the organism, the amount of the virus that has got into the body.

In some cases, the virus enters the brain and spinal cord from the bloodstream. Here he selectively affects motor neurons of gray matter. The death of neurons is clinically accompanied by the development of muscle weakness in different muscle groups - paralysis develops.

Symptoms

From the moment of getting the virus into the body before the development of the disease can pass from 2 to 35 days (this is called the incubation period). After this, further development of the situation is possible in the form of:

• virus-carrying (inapparant form) - the clinical symptoms are completely absent. Identify the virus can only be a laboratory test or detect antibodies in the blood. Thus the person is contagious, allocates in an environment a virus and can become a source of disease for other people;
• small (abortive, visceral) form of the disease;
• lesions of the nervous system.

Abortive form of poliomyelitis

According to statistics, this form of the disease develops in almost 80% of all cases of poliomyelitis. To guess by clinical signs, that it is poliomyelitis, it is practically impossible. The disease begins sharply with a temperature increase of 38-39 ° C, headache, general malaise, sweating. Against the background of weakness and lethargy there may be catarrhal phenomena: a small cold, red eyes, reddening of the pharyngeal mucosa, unpleasant sensations in the throat, coughing. This situation in most cases is perceived as an acute respiratory viral disease.

Instead of catarrhal phenomena from the upper respiratory tract may appear intestinal symptoms: nausea, vomiting, abdominal pain, loosening of the stool. These symptoms resemble a banal intestinal infection or are regarded as food poisoning.

After 5-7 days the body copes with the disease and recovers. Confirm the diagnosis of poliomyelitis in this case also possible only with the help of additional methods of investigation (search for pathogens in the nasopharynx, feces or the detection of antibodies in the blood).

In the case of the abortive form of the disease, a person is also a source of infection for others (even after recovery, while continuing to isolate the virus with feces).

The defeat of the nervous system

This variant of the development of the disease is much less common than the abortive form. The defeat of the nervous system can be nonparalytic and paralytic.

Non-paralytic poliomyelitisis a serous form of meningitis. Against the background of an increase in temperature to 39-40 ° C there is a severe headache, vomiting that does not bring relief, photophobia, back and limb pain. On day 2-3 of the disease, meningeal symptoms appear: Brudzinsky, Kerniga, rigidity of the occipital muscles, etc. (although they can be expressed slightly). Patients are sluggish, sleepy. Since there are suspicions of meningitis if there are such symptoms, the patient is given a spinal puncture. Likvor (cerebrospinal fluid) thus obtained a clear, with normal or slightly increased pressure. The number of cellular elements of the blood was increased to 1000 (if the puncture was performed in the first days of the disease, then it is predominantly neutrophils, and then lymphocytes are detected), the protein increases to 1 g / l. There are no poliomyelitis-specific symptoms in a routine survey. Confirm the diagnosis of poliomyelitis is possible only if the virus is detected in swabs from the nasopharynx or in the feces or when antibodies are detected. Non-paralytic poliomyelitis has a favorable course without consequences. After 2-3 weeks from the onset of the disease, all symptoms disappear, a little later the composition of the CSF is normalized.

Paralytic poliomyelitis- the most formidable form of the disease, because of which a person can remain disabled for life. It develops in 2-3% of cases of poliomyelitis. It can be divided into several periods in time:

• The preparative stage begins with a rise in temperature to 39 ° C, the onset of headache, vomiting, catarrhal phenomena or signs of intestinal infection. Against this background, there are meningeal symptoms, pain in the muscles, pain along the nerve trunks (with pressure). The duration of this stage is about a week (4-7 days). During this time, the temperature may drop slightly or even normalize, and then rise again (wave-like temperature rise). If spinal puncture is performed during this period, an increase in the number of neutrophils to 100-500, a normal or slightly elevated protein content, is detected in the cerebrospinal fluid;
• the paralytic stage - occurs by the time the temperature drops the second time, when the condition seems to have improved somewhat. Often, patients wake up in the morning with a sudden weakness in the muscles, up to the complete absence of even a stir. This stage coincides in time with the penetration of the virus into the nerve cells of the gray matter of the brain and spinal cord. Paralysis develops within one to a maximum of several days. Reflexes decline or completely disappear, muscle tone falls, with the palpation of the muscles there is pain (sometimes so pronounced that it is impossible to examine the affected area). After a few days in the muscle tissue starts atrophic process - gradually the muscles begin to decrease in volume, as if "dry up". Depending on which parts of the brain are affected by the virus, such muscle massifs will become immobilized. Any muscle can be affected, but more often it is the muscles of the lower limbs. If the muscles of the abdominal press, the diaphragm are involved in the process, this leads to a violation of the act of breathing. When the neurons of the brain stem are damaged, weakness develops in the facial muscles, the angle of the mouth drops, the eye does not close, the food pours out of the mouth, the face looks distorted. If the cells of the nuclei of the vagus nerve suffer, salivation develops, the amount of mucus in the bronchi increases (it overlaps lumen of the bronchi), speech and swallowing (food can get into the respiratory tract) is disrupted, central regulation of respiration is disturbed. This can all be so pronounced that the patient will need artificial ventilation. In parallel, violations in the activity of the cardiovascular system (also due to damage to the nuclei of the vagus nerve) develop. Impaired breathing and cardiac activity can cause death. A characteristic feature of poliomyelitis is the development of only motor disorders, the sensitive sphere does not suffer. Liquor in the paralytic stage contains an increased amount of protein, and the number of cells decreases to 10 in 1 μl. The duration of the period of paralysis is from several days to two weeks;
• restorative stage: it begins immediately, as soon as the paralysis ceases to grow. This stage is quite long. The most active recovery occurs the first 3 months, then the pace slows down, but still the recovery continues. The maximum period is 3 years (at the end of this period there is no need to improve). The pain in the muscles disappears, there are reflexes and small movements. Gradually, the amplitude of movements and muscle strength increases. If the virus has harmed a large number of neurons, the paralysis may not recover;
• residual stage - the stage of residual phenomena. It is characterized by the presence of atrophic changes in muscles, the formation of contractures (restriction of mobility in the joints), dislocations, deformities of the joints and spine. If polio carries a child, then the affected limbs lag behind in development, the bones grow poorly. It is these residual effects that are the cause of disability after a history of poliomyelitis.

Diagnostics

The virus-carrying, abortive form and non-paralytic poliomyelitis are very difficult to suspect, and it can only be proved using laboratory methods of research to prove that it is poliomyelitis. Paralytic form is easier to diagnose because of typical symptoms (development of paralysis after temperature increase and signs of an infection of the upper respiratory tract or intestines), but this occurs at the second week of the disease. To accurately confirm the diagnosis, laboratory methods of investigation are also needed.

Thus, in all cases suspected of poliomyelitis, the patient is taken from the nasopharynx and feces (take into account that the virus contains the first week of the disease in the nasopharynx, and in the feces up to 7 weeks). These materials search for the polio virus. In addition, serological methods are used: in the patient's blood, the concentration (titer) of antibodies to poliomyelitis is determined at the time of admission to the hospital and after 2-4 weeks. This method was called - the method of paired sera. The increase in the antibody titer is no less than 4 times, confirming the diagnosis of poliomyelitis.

Treatment

To date, there is no specific effective polio medication. All methods of helping a patient are, in fact, symptomatic.

If you suspect poliomyelitis patient should be hospitalized. During the first two weeks, it is necessary to observe bed rest (until paralysis is possible). The smaller the motor activity during this period, the less the risk of paralysis.

From medicinal preparations are used:

• non-steroidal anti-inflammatory drugs andantipyretic: Ibuprofen, Diclofenac, Movalis (Revmoxicam), paracetamol, etc .;
• with a pain reliever - analgesia, Spasmalgon, tranquilizers (Diazepam), and antidepressants (fluoxetine, paroxetine, sertraline);
• with meningeal symptoms - diuretics (Lasix, Diacarb), magnesium sulfate (magnesia);
• vitamins of group B and vitamin C.

Previously, the serum of people who had suffered poliomyelitis and gamma globulin was tested. However, these drugs do not reduce the degree of paralysis and do not affect the course of the disease.

In order to reduce pain in the muscles, thermal procedures are used: ozocerite, paraffin, a lamp of solux. In the paralytic period, the proper placement of the affected limbs plays a very important role. Such measures prevent the formation of contractures and deformities: the legs are located parallel to each other with a slight bending in the knees and hip joints (using rollers with sand), the feet rest on a pillow or a thick roller so that there is a right angle between them and the shin, hands bend at the elbows at a right angle and away from the trunk. In the future, the correct position of the limbs is determined by the orthopedist (individually, depending on which limbs are affected).

It should be noted that injections into the affected limbs are not carried out, as this increases the risk of more severe muscle damage and reduces the chances of recovery.

When the symptoms of respiratory failure increase, the patient is transferred to the intensive care unit, where an artificial ventilation of the lungs, as well as correction of cardiovascular disorders that can endanger life.

In the recovery period, a patient with poliomyelitis should receive drugs that promote the fastest recovery of muscles. For this purpose, apply:

• drugs that improve neuromuscular conduction:Prozerin, Neurromidine, Galantamine, Dibasol;
• drugs that improve metabolic processes in muscles: Glutamic acid, Cerebrolysin, ATP;
• anabolic steroids: Retabolil, Methandrostenolone;
• vitamins of group B: Milgamma, Neurorubin and others.

Very good effect is physiotherapy. To restore muscle strength apply mud and paraffin applications, electrophoresis, muscle electrical stimulation, UHF, diathermy. Massage courses, exercise therapy on an individual program, shower-massage, swimming - all this is used throughout the recovery period by courses. In 6 months after the transferred poliomyelitis the patient is shown sanatorium treatment (Evpatoria, Saki, Anapa). Mud and sea bathing contribute to the normalization of trophic processes in the muscles.

To prevent contractures and deformations of joints use special longes, cuffs, tires, tutors (products for fixing joints), orthopedic footwear. In the residual stage, orthopedic care can be conservative (using special devices for movement) and operative (removal of the formed defects surgically). All these activities are aimed at facilitating the movement, self-service, professional activities.

Prevention

Poliomyelitis refers to diseases that are much easier to prevent than treat. Since 1959 In Russia, a live vaccine containing a weakened virus is used to prevent poliomyelitis. There is also an inactivated vaccine. Mass immunization of children of the first years of life allowed to practically eradicate this disease. With the procedure of vaccination, the peculiarities of vaccination can be found in a separate article.

In the outbreak, where a patient with poliomyelitis is identified, sanitary and hygienic measures are taken to prevent the spread of the disease. Illnesses are hospitalized in infectious departments (boxes). All that was in contact with the patient, is disinfected (clothes, shoes, dishes, toys, toilet, which the patient used, etc.). Persons who communicate with the patient are subject to medical supervision for 3 weeks (with a daily temperature measurement). When there are signs of possible polio, hospitalization is shown in the box until the diagnosis is clarified. If the disease is detected in the kindergarten, then the quarantine is applied for 21 days. If the child had contact with a patient with poliomyelitis outside the walls of a children's institution, he is forbidden to visit the kindergarten for 3 weeks.

Poliomyelitis today is a very rare infection due to vaccination. Despite this, some cases of the disease are still registered on the planet. Therefore, knowledge of the basic symptoms and methods of prevention is simply necessary. Forewarned is forearmed!

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