(Polio, acute anterior poliomyelitis; polio)

Poliomyelitis is an acute infection that is caused by a poliovirus (an enterovirus). Manifestations include nonspecific mild disease (abortive poliomyelitis), sometimes aseptic meningitis without paralysis (poliomyelitis nichtparalytische) and rarely flaccid paralysis of various muscle groups (paralytic poliomyelitis). The diagnosis is clinically detected, although a clinical laboratory confirmation is possible. Treatment is supportive.

Polio viruses occur with three serotypes. The type 1 leads most commonly to paralysis and was the most frequent cause of epidemics. Humans are the only natural reservoir. The infection is highly contagious and is transmitted by direct contact. Asymptomatic or mild courses (abortive poliomyelitis) exceed curves with and without symptoms of paralysis in the ratio ? 60: 1, and represent the main cause of the spread.

Poliomyelitis is an acute infection that is caused by a poliovirus (an enterovirus). Manifestations include nonspecific mild disease (abortive poliomyelitis), sometimes aseptic meningitis without paralysis (poliomyelitis nichtparalytische) and rarely flaccid paralysis of various muscle groups (paralytic poliomyelitis). The diagnosis is clinically detected, although a clinical laboratory confirmation is possible. Treatment is supportive. Polio viruses occur with three serotypes. The type 1 leads most commonly to paralysis and was the most frequent cause of epidemics. Humans are the only natural reservoir. The infection is highly contagious and is transmitted by direct contact. Asymptomatic or mild courses (abortive poliomyelitis) exceed curves with and without symptoms of paralysis in the ratio ? 60: 1, and represent the main cause of the spread through extensive vaccination the disease could be eradicated almost worldwide.. However, in areas with inadequate immunization coverage continues to occur cases such. B. in Africa (sub-Saharan) and South Asia. Pathophysiology The virus occurs via the fecal-oral route of infection or the airways, and then passes into the lymphoid tissue of the gastrointestinal tract. The following is a primary viremia with spread of the virus to the reticuloendothelial system. At this point, there can be an infection or virus can continue to multiply and lasting several days, causing pronounced secondary viremia, which has culminated in the development of symptoms and antibodies. In infections with paralysis poliovirus into the cerebrospinal a-about whether secondary viremia or migration to peripheral nerves is unclear occurs. Significant damage occurs only in the spinal cord and brain, especially in the nerves that control motor function and autonomic functions. By the primary viral invasion damaging inflammatory products are formed. Among the predisposing factors for severe neurological damage include With age (throughout life) Current tonsillectomy or intramuscular injection pregnancy reduction in B cell function Physical exertion simultaneously with the start of the CNS Phase The polio virus during the incubation period in the throat and chair exists and persists after the onset of symptoms 1-2 weeks in the throat and ? 3-6 weeks in the stool. Tips and risks Most infections caused by the poliovirus does not affect the central nervous system and cause paralysis. Symptoms and signs Most (70-75%) infections cause no symptoms. Symptomatic disease is divided into Abortive poliomyelitis Paralytic poliomyelitis or nichtparalytische abortive course Most symptomatic infections, especially in young children, running in the minor form, with 1-3 days slight fever, malaise, headache, sore throat and vomiting 3-5 occur days after exposure. There are no neurological symptoms or signs and physical examination is up to fever unauffällig.Paralytischer and nichtparalytischer course of a paralytic poliomyelitis occurs all infections in <1%. You usually develops without a previous minor form, especially in older children and adults. The incubation period is usually 7-21 days. Common manifestations include aseptic meningitis, deep muscle pain, hyperesthesia, paresthesia and, during the active meningitis, a urinary retention and muscle spasms. Asymmetric flaccid paralysis can develop and persist for more than 2-3 days. Occasionally dominate encephalitic symptoms. Dysphagia, nasal regurgitation and nasal voice are usually the first signs of bulbar involvement, but some patients suffering from a swallowing disorder and there is aspiration for their own secretions from the nose and throat. As with skeletal muscle paralysis, a bulbar involvement for 2-3 days can deteriorate and in some patients lead to a central disorder of breathing and circulatory regulation, the central respiratory failure is usually in the foreground. Rarely has a respiratory arrest develops when the diaphragm or intercostal muscles are affected. Some patients develop post-polio syndrome for years or decades after paralytic poliomyelitis. This syndrome is characterized by muscle fatigue and decreased endurance, often characterized by weakness, fasciculations and atrophy. Diagnostic lumbar puncture Viral Culture (chair, throat and liquor) RT-PCR of blood or CSF Serological tests for poliovirus serotypes, enteroviruses and West Nile Virus If there is no central nervous system manifestations, similar symptomatic polio other systemic viral infection and is in not considered generally or diagnosed, except during an epidemic. A nichtparalytische poliomyelitis is similar to other viral meningitis. In these patients, usually a Lubalpunktion is performed. In the CSF are found mostly unobtrusive glucose levels, only a slight increase protein and pleocytosis of 10-500 / ul (mainly lymphocytes). The detection of the virus in a throat swab, stool or CSF or the detection of an increase in specific antibody titers confirmed infection with the polio virus, but is not usually needed in patients with uncomplicated aseptic meningitis. Paralytic poliomyelitis may be suspected in unimmunized children or young adults with no sensory loss have asymmetric flaccid limb paralysis or bulbar paralysis during acute febrile illness. However, certain of the coxsackieviruses groups A and B (particularly A7), a plurality of echo virus and enterovirus type 71 cause similar symptoms. Cases of focal limb weakness or paralysis were identified after infection with enterovirus D68. Infection with West Nile virus can also lead to acute flaccid paralysis, which is clinically indistinguishable from one caused by poliovirus paralytic poliomyelitis. Guillain-Barre syndrome causes flaccid paralysis, but can be distinguished on the basis of the following: It usually causes no fever. Muscle weakness is symmetric. Sensory deficits occur in 70% of patients CSF protein is usually increased and CSF cell count is normal. Epidemiological evidence (eg. As past immunization recent trip, age, season) can help find the cause. Since the identification of the polio virus or enterovirus other as a cause of acute flaccid paralysis is important to protect public health, a viral culture of throat swab, stool and cerebrospinal fluid and a reverse transcriptase PCR of cerebrospinal fluid and blood should be performed in all cases , Also, specific serological tests for poliovirus, other enteroviruses and the West Nile virus should be carried out. Forecast In nichtparalytischen poliomyelitis it comes to a complete remission. In paralytic polio occurs in about two thirds of patients in persistent permanent muscle weakness. Bulbar paralysis disappear again rather than peripheral paralysis. The mortality rate is 4-6%, but increases in adults and bulbar paralysis of 10-20%. Therapy Supportive treatment The standard therapy of poliomyelitis is supportive and consists u. a. of bed rest, analgesics and antipyretics when needed. A specific antiviral therapy is not available. During an active myelitis measures may be required, which serve to prevent complications of bed rest (eg. As deep vein thrombosis, atelectasis, urinary tract infections) and the prolonged immobility (z. B. contractures). A respiratory insufficiency can make mechanical ventilation required. Mechanical ventilation or bulbar paralysis require intensive measures to prevent pulmonary complications. Prevention All infants and children should be immunized with polio vaccine. The STIKO recommends three vaccinations in childhood: a vaccination with up to 4 basic immunizations with 2 months (3 months depending on the recommendation of the vaccine manufacturer), 4 months and 11-14 months and a booster dose of 9-17 years (see table: recommended vaccination schedule for the age of 0-6 years. (reference: STIKO recommendations, August 2013 www.rki.de) a childhood vaccination leads to an immunity instead of the live attenuated oral polio vaccine in live> 95% of subjects. Sabin (OPV) is now the inactivated poliovirus vaccine according Salk (IPV) is used because OPV in approximately 1 case per 2,400,000 vaccination leads to a paralytic poliomyelitis and unintended proliferation of the temporarily excreted in the feces Impfpoliovirus in immunocompromised in household contacts is possible. no serious side effects have been associated with IPV. As part of the Global polio Eradication initiative, all countries should d implement ie routine IPV immunization programs by the end of the 2016th Vaccination is currently not routinely recommended for adults. Here, however, the current global situation must be noticed, especially by changing migration flows from countries where polio is not yet eradicated. Not Immunized adults traveling in Endemie- or epidemic areas should receive primary immunization with IPV, which consists of two injections with an interval of 4-8 weeks and a third dose 6-12 months later. At least one vaccination which should be administered before the trip. Immunized adults traveling in Endemie- or epidemic areas should receive a dose of IPV. Immunocompromised patients and their roommates should not be given OPV. Conclusion Most infections caused by poliovirus are asymptomatic or cause nonspecific mild illness or aseptic meningitis without paralysis; <1% of patients develop the classic syndrome of flaccid paralysis (paralytic poliomyelitis). The occurrence of asymmetric flaccid limb paralysis or bulbar paralysis without sensory deficits during an acute febrile disease in a non-immunized child or young adult may be an indication of a paralytic poliomyelitis. Viral cultures of throat swabs, stool and cerebrospinal fluid and reverse transcriptase-PCR from CSF or blood should be conducted in clinically justified suspicion. In paralytic forms of poliomyelitis occurs in about two thirds of patients in persistent permanent muscle weakness. All infants and children should be vaccinated, but adults are currently not routinely vaccinated, unless they are at increased risk (eg. As a result of travel or because of the profession).

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