POLIOMYELITIS – Stages,
Treatment, Management
and Prevention
POLIOMYELITIS – Stages, Treatment, Management and Prevention
Poliomyelitis is highly contagious disease, caused by polio virus type I, II, III (type 1 is common). These viruses are resistant to drying, cooling, and digestive juices. These are destroyed at 50 degree celcius for 30 minutes. It is spread through the oral-fecal route and droplet infection. It is common July and August.
Poliovirus multiplies in the lymph nodes and enters the blood stream along the lymphatic. Viremia causes viruses to enter the nerve cell (anterior hom cells), specially in the cervical and lumbar segment of the spinal cord. This causes destructive changes in the nerve cells. It may affect the motor cells of medulla oblongata, pons and vestibular nuclei. The death of the motor neurons leads to the faccid (loss of tone) paralysis of skeletal muscles. After eight days of the disease, regeneration and restoration period begins. The musculatrophy may develop due to infection of the corresponding neurons.
Incubation period is 5 to 35 days
STAGES
- Symptomatic stage: in this stage, no symptoms are seen
- Abortive: the children may get sore throat, moderate fever, vomiting and low headache
- Nonparalytic: the children may get headache, fever, stiff neck in the extremities, hypersensitivity of the skin; children look drowsy but can be easily aroused. Children may get constipated and may retain urine for more than 16 hours and cry excessively.
- Paralytic stage: in this stage; the paralysis is seen in relation to the destruction of the nerve cells. If the anterior horn cells of the spinal cord are destroyed, legs, arms, and diaphragm may be paralyzed. This is flaccid paralysis with the reduced muscle tone and restriction or absence of the movement.
Bulbar polio: nuclei are affected. It can cause facial and pharyngeal paralysis. The speech and respiratory may get affected.
Due to irregular involvement of different groups of muscles, contractures may develop and affect muscles may get retarded.
Investigations: nasopharyngeal swab and stool examination is done
TREATMENT
- The treatment depends on the severity of the symptoms
- Ventilator may be required for respiratory paralysis
- Retention of urine may be treated by indwelling catheter
- Analgesics may help to reduce fever
- Laxatives may be prescribed for the constipation
- Antibiotics may be prescribed for some cases with the secondary infections
MANAGEMENT
- Isolation is advisable and concurrent disinfection should be carried out to control the spread of infection
- Organized nursing care helps in minimizing disturbance to the patient. Bed rest should be provided for three or four weeks. The bed on the firm mattress with the foot board is helpful
- Painful and tender limbs should be immobilized. In preparalytic stage, any type of trauma should be prevented because it may cause further damage
- Observation of vital signs should be accurate. Respiration may be affected if the diaphragm is paralyzed and the patient may require assistance with the ventilator. Therefore, the abdominal respiration should be notified. The cyanosis can be treated with the oxygen. The symptoms such as irritability, severe pain, absence of gag reflex should be attended promptly. Any changes in the vital signs should be notified.
- Application of heat: hot packs may be used to relieve the muscle shortening, pain and tenderness. This should be applied three to four times a day for 15 to 20 minutes. These are applied on the painful affected limbs and affected spinal region on the back
- Diet should consist of the nourishing food but free from the gas producing foods
Complication: bronchitis, pneumonia, atelectasis
PREVENTION
- Vaccination: polio vaccine is of two types – sabin vaccine is administered orally and salk vaccine is administered by injection
- Children should be vaccinated at the age of six weeks to nine months with the three doses with the interval of one month
- The orofecal infection should be prevented
- Abortive symptoms should be treated promptly in the early stage
- Even children with history of poliomyelitis should be advised to get immunized with the polio vaccine because they might get infected with the virus other than they have suffered from