Transcript Cholera Definition

Poliomyelitis
Dept. Of Infectious Disease
2nd Affiliated Hospital
CMU
Definition
Poliomyelitis is acute infectious
disease caused by poliovirus.
Infantile paralysis.
Pathologic lesions: motor neurons in the
gray matter in the anterior horn of the spinal
cord..
Clinical feature:
Definition
Clinical feature: fever
sore throat
muscle pain
paralysis
Etiology
Causative agent: poliovirus

family Picornaviridae, genus Enterovirus

single strain RNA
Resistance: Sensitive to heat, oxidant
ultraviolet rays
Etiology
Serotype:
on the basis of neutralization tests.
 Type I
 Type II
 Type III
 no cross immunity
Epidemiology
Source of infection
patients and carriers:
inapparent inf. & non-paralytic inf.
Route of transmission
air-borne, respiratory tract:
fecal-oral route:
Epidemiology
Susceptibility:
universal susceptible to polio
covert infection >90%
paralytic patients<1%
lifelong immunity to same type virus
Epidemiologic features
children under 5yrs, 6m~5yrs
summer & fall
Pathogenesis
poliovirus
air
oral
epithelial cells (in pharynx, intestine)
regional lymphatics Ab covert infection
blood stream
first viremia Ab
second viremia
abortive infection
blood-brain barrier
CNS
non-paralytic type
paralytic type
Pathology
Place of lesion:
all of CNS
spinal cord, brain stem
motor neurons in anterior horns of
cervical & lumbar enlargement of
spinal cord.
Pathology
Pathologic features
neuron necrosis
inflammatory infiltrate of
leukocyte,lymphocyte.
Clinical manifestation
Incubation period: 5~14 days
Clinical types
Covert infection: >90%
Abortive poliomyelitis: 4~8%
Non-paralytic poliomyelitis:
Paralytic poliomyelitis: 1%~2%
Clinical manifestation
Paralytic poliomyelitis
Prodromal period
preparalytic period
paralytic period
convalescent period
sequela period
Clinical manifestation
Prodromal period:(1~4d)
upper
respiratory tact infection:
fever, fatigue, sore throat,
headache
intestinal tract infection:
vomiting, diarrhea, constipation
abortive poliomyelitis
Clinical manifestation
Preparalytic period
progressing this phase without
prodromal phase
1~6days after symptoms of
prodromal phase
without prodromal phase
Clinical manifestation
Preparalytic period
fever: two-hump fever(10~30%)
symptoms & signs of CNS
severe headache & vomiting
dysphoria or lethargy
muscle pain
Clinical manifestation
Preparalytic period
symptoms & signs of CNS
 cutaneous hyperesthesia
 hyperhidrosis
 meningeal irritations (neck
stiffness Kernigs & Brudzinskis
signs positive) 3~6d ,
nonparalytic poliomyelitis
Clinical manifestation
Paralytic period
paralysis types
 spinal type
 brain stem type
 mixed type
 brain type
Clinical manifestation
Paralytic period
Spinal type: most common
paralysis features:
 flaccid (hypomyotonia ,tendon reflexes
are weak or absent)
 asymmetric distribution:
 without sensory loss
Clinical manifestation
Paralytic period
Spinal type: most common
paralysis muscles
paralysis of extremities: leg >arm; proximal
> distal
 paralysis of diaphragmatic & intercostal
muscles affects respiratory movement
 paralysis of abdominal muscle -- stubborn
constipation

Clinical manifestation
Paralytic period
 Brain stem type
cranial nerve paralysis: 7&10, then 9&12,
 facial paresis
 dysphagia, high-pitched voice
 respiratory center paralysis:

central
respiratory failure:
 cacorhythmic breathing ect.

vasomotor center paralysis:
Clinical manifestation
Paralytic period
brain type - polio-encephalitis
high fever, convulsion,
disturbance of consciousness,
tonic paralysis
mixed type
spinal type + brain stem type
Clinical manifestation
Convalescent period
 paralytic muscles begin to
recover
distal > proximal,
at first 3~4 month quick recovery,
6 month later recovery slowly,the
recovery process reaches its limit
around 18 months
Clinical manifestation
Sequela period
 persistent paralysis
muscular atrophies
deformities of limbs
Laboratory Findings
Cerebrospinal fluid
aseptic menigitis
pleocytosis: 50~500×109/L
 protein: normal or slightly increase

albuminocytologic dissociation
 glucose and chloride; normal

virus isolation:
pharynx, feces, blood or CSF,brain.
Laboratory Findings
Serological test:
Specific IgM Ab (blood & CSF)
Neutralized Ab
Complement combining Ab
four fold rise
Diagnosis
Epidemiological data:
Clinical manifestation:
Laboratory findings:
Abortive or non-paralytic polio isolation of virus or serological test
paralytic polio - clinical diagnosis
Differential Diagnosis
Guillain-Barre Syndrome
symmetric, ascending paralysis with loss
of sensation
CSF: protein elevate with absent or
minimal pleocytosis,
albuminocytologic dissociation
rapid and complete recovery
Differential Diagnosis
Paralysis caused by other enterovirus
Coxsackie or ECHO viruses:
no epidemic no sequelae
Treatment
Prodromal & preparalytic P
isolation & rest in bed:
not accept muscular injection &
operation
 hot moist pack to muscles
50%GS&VitC 1~2g iv, IFN
 hydrocortison
Treatment
Paralytic period:
limb paralysis
nursing for paralytic limbs
Put the limbs on function position
Vit C ATP ivdrop
Galanthamin or Prostipmin iM
Treatment
treatment for respiratory obstacle
 bulbar paralysis
dysphgia
 keep air way clear (sputum aspiration
postural drainage )
 tracheal intubation
 tracheotomy
tank respirator
Treatment
treatment for respiratory obstacle
respiratory center paralysis
 respiratory stimulant
 tracheotomy
tank respirator
 respiratory muscle paralysis
 mild
observation
 tank respirator
Treatment
Convalescent & sequela period
acupuncture
massage
Prevention
control of source of infection:
 isolation: 40 days after the onset of
illness
protection of susceptible
population :
attenuated live vaccine by oral
 killed virus vaccine
