Poliomyelitis By: Dr. Masoud Shayesteh Azar Associate Professor, Orthopaedic Department, Mazandaran University
Feb 25, 2016
Poliomyelitis
By: Dr. Masoud Shayesteh Azar
Associate Professor, Orthopaedic Department, Mazandaran University
Poliomyelitis
polio= gray matterMyelitis= inflammation of the spinal cord
PoliomyelitisPoliomyelitis
First described by Michael Underwood in 1789First described by Michael Underwood in 1789First outbreak described in U.S. in 1843First outbreak described in U.S. in 1843
21,00021,000 paralytic cases reported in the U. S. in 1952paralytic cases reported in the U. S. in 1952Global eradication in near futureGlobal eradication in near future
Poliomyelitis
Poliomyelitis, literally meaning “gray spinal cord inflammationIt is a viral infectionThere are three types of poliovirus and many strains of each type
It is contagious: usually spread from person to person.
Only harmful to humans
The Poliovirus
Virus localized in the anterior horn cells of the spinal cord and certain brain steam motor nuclei.
Poliovirus
Enterovirus (RNA)Three serotypes: 1, 2, 3Minimal heterotypic immunity between serotypesRapidly inactivated by heat, formaldehyde, chlorine, ultraviolet light
Poliomyelitis Pathogenesis
Entry into mouthReplication in pharynx, GI tract, local lymphaticsHematologic spread to lymphatics and central nervous systemViral spread along nerve fibersDestruction of motor neurons
Poliomyelitis Pathogenesis
The ant. Horn motor cells may be damaged by viral multiplication or toxic byproducts of the virus or indirectly by ischemia, edema,
and hemorrhage in the glial tissues .Destruction of the spinal cord occurs focally and within 3 days wallerian degeneration is evident.
poliomyelitis
Most affects children under the age of 5 years in developing tropical countries.
Incubation period ranges from 6 to 20 days
What are the symptoms?
Acute stage: generally lasts 7 to 10 days.Many include fever, pharyngitis, headache, anorexia, nausea, and vomiting. Illness may progress to aseptic meningitis and menigoencephalitis in 1% to 4% of patients. These patients develop a higher fever & sever headache with stiffness of the neck
and back .
What are the symptoms?
Paralytic disease occurs 0.1% to 1% of those who become infected with the polio virus.
Paralysis of the respiratory muscles or from cardiac arrest if the neurons in the medulla oblongata are destroyed.
Clinical course
Symptoms range :from mild malaise to generalized encephalomyelitis with widespread paralysis.
Hyperesthesia or paresthesia in the extremities and muscular pain is common.Muscles are tender even to gentle palpation .
Poliomyelitis
According to Sharrard, weakness is clinically detectable only when more than 60% of the nerve cells supplying the muscle have been destroyed.
Paralysis occurs twice as often in the lower extremity as in upper extremity.
Poliomyelitis
The most commonly affected muscles are theQuadriceps, glutei, tibialis anterior, medial hamstrings, and hip flexors.Deltoid, triceps, and pectoralis major .
Poliomyelitis
Patients have some or full recovery from paralysis, most clinical recovery occurs during the 1 month and almost complete within 6 months.
Limited recovery may occur for about 2 years.
Poliomyelitis
In cases with paralysis superficial reflexes usually are absent first, and deep tendon reflexes disappear when the muscle group
is paralyzed .DDX.: Guillain-Barre syndrome, and other
forms of encephalomyelitis
Treatment in the acute stage
Bed rest, analgesics, hot packs, and anatomical positioning of the limbs
gentle passive ROM exercises of all joints
Treatment in the acute stageclose monitoring of respiratory and cardiovascular functioning is essential during the acute stage of poliomyelitis along with fever control and pain relievers for muscle spasms.
Mechanical ventilation, respiratory therapy may be needed depending of the severity of patients.
Convalescent stage From 2 days after the temperature return to normal and continues for 2 years Muscle power improves
Physical therapy is recommended for full recovery.
Passive stretching exercises and wedging casts can be used for mild to moderate contractures.
Convalescent stage
Surgical release of tight fascia and muscle aponeuroses and lengthening of tendons may be necessary for contractures persisting longer than 6 months.
Orthoses should be used until no further recovery is anticipated.
Chronic stage
24 months after the active illness:
The goals of treatment include correcting any significant muscle imbalance and preventing or correcting soft tissue or bony
deformities .
Chronic stage
Static joint instability can be controlled by Orthoses.
Dynamic joint instability result in a fixed deformity that cannot be controlled by Orthoses.
Chronic stage
Soft tissue surgery, such as tendon transfers, should be done in young children before the development of any fixed bony
changes .Bony procedures for correcting a deformity can be delayed until skeletal growth is near
completion .
Global eradication in near futureGlobal eradication in near future
PreventionPreventionPreventionImmunization of the young continues
Wild Poliovirus 1988
National Immunization ProgramCenters for Disease Control and Prevention
Wild Poliovirus 2004
National Immunization ProgramCenters for Disease Control and
PreventionNational Immunization Program
Centers for Disease Control and Prevention
National Immunization ProgramCenters for Disease Control and Prevention
Study
We study 246 patient with polio in Sari Male:156 cases (63/4%)
female: 90 cases (36/6%) age :22 to 63 years old main age 46/3
One lower limb: 164 cases (66/6%) Both lower limb: 62 cases (25/2 %)
Both lower limb together with upper limb 10 cases (4/1% )
Result:
From 246 patients ;108 used brace 56 patients needs brace but not used 187 operation has down for these patients 97 patients more than one operation has down 82 patients have mild symptoms and don’t need To any operation or brace.
Result:
From 187 operation: 53 cases; ankle triple arthrodesis
81 cases; tendon transfer EHL to dorsum foot
10 cases; other kind of tendon transfers11 cases; ATL
8 cases; lower limb lengthening
Result:
2 cases; Ephypisodesis 1 case; ankle fusion
23 cases; toe deformity correction53 cases; soft tissue release for knee and hip
flexion contracture 37 cases; osteotomy around knee
Result:
Very important pointNo any new case in last 10 years reported.