Symptoms of poliomyelitis in children and adults

Poliomyelitis is an acute viral infection that occurs with a primary lesion of the gray matter of the brain, which causes the development of paresis and paralysis. Signs of poliomyelitis can be found in children under 7 years of age, but the risk of contracting them, under certain circumstances, is also maintained for adults.

A bit of history

Poliomyelitis is characterized by acute infectious lesions of the spinal cord and brain stem resulting in the development of paresis and paralysis, bulbar disorders. The disease of poliomyelitis, the signs of which had been known for a very long time, spread widely in the 19th and early 20th centuries. During this period, massive epidemics of this infection were recorded in the countries of America and Europe. The causative agent of poliomyelitis was discovered in 1908 by Vienna E. Popper and K. Landstein, and the inactivated vaccine, created by A. Sabin and allowed by the 50s of the last century to significantly reduce the incidence of poliomyelitis in children.

Positive dynamics in the fight against this infection continues due to active immunization, frequent signs of the disease are preserved only in some countries - Pakistan, Afghanistan, Nigeria, India, Syria - while in 1988 their number reached 125. The number of cases fell during this period from 350 thousand cases (17,5 thousand of them with a lethal outcome) to 406 cases detected in 2013. The countries of Western Europe, Russia and North America are today considered to be territories free of this disease and signs of polio are only revealed here as sporadic cases.

Causal agent

Poliomyelitis is a viral disease. The reason for it is poliovirus, which belongs to enteroviruses. Three types of the virus are identified (I, II, III). For humans and monkeys, pathogens I and III are types. II can affect some rodents. The virus contains RNA, its size is 12 mk. It is stable in the environment - in water it can persist up to 100 days, in milk - up to 3 months, up to 6 months - in the discharge of the patient. Ordinary des. The drugs are ineffective, but the virus is quickly neutralized by autoclaving, boiling, exposure to ultraviolet. When heated to 50 ° C, the virus dies within 30 minutes. When infected during the incubation period, it can be found in the blood, the first 10 days of the disease - in swabs from the pharynx and very rarely - in the cerebrospinal fluid.

Transmission mechanism

The source of infection in poliomyelitis can be either a sick person or an asymptomatic virus carrier (in some cases, the carrier can persist for three to five months after recovery). The virus is secreted into the external environment with the patient's feces and nasopharyngeal mucus. The following transmission routes are relevant for poliomyelitis:

• contact;

• Air-drip;

• Fecal-oral.

The most common route of transmission is fecal-oral - the virus enters the body through contaminated hands, cutlery, food, water. Also the danger is mucus secreted by the patient from the nasopharynx from 2 days of the disease during the first 2 weeks.

The susceptibility of the virus is 0.2-1%, most of the cases are children under 7 years old. The peak incidence falls on summer and autumn.

Risk factors

Factors contributing to the spread of infection include:

• Insufficiency of the child's hygiene skills;

• Crowding;

• Poor sanitary and hygienic conditions, including violation of the sanitary regime in children's institutions;

• Frequent diseases (more than 4 times a year) in a child;

• Immunodeficiency states;

• Low level of vaccination of the population.

Classification

Poliomyelitis is classified by the nature of the lesion of the nervous system:

• Non-paralytic forms - proceeding without pronounced lesions of the nervous system - meningeal, abortive (visceral), andapparatus (occurs asymptomatically and is a virus carrier, which can only be determined by laboratory methods) forms;

• Paralytic form.

In turn, the paralytic form is classified by the localization of the lesion. Allocate:

• Spinal form - characterized by flaccid paralysis of the limbs, trunk, diaphragm, neck;

• Pontine form - proceeds with full or partial loss of facial expressions, hanging of the corner of the mouth on the face half, lagophthalmic;

• Bulbar - characterized by speech disorders, swallowing, breathing disorders and cardiac activity;

• Encephalitis - focal and general cerebral symptoms;

• Mixed form - pontospinal, bulbospinal, bulbopontospinal.

On a stream distinguish easy, average gravity, heavy and subclinical forms.

The incubation period

The incubation period, when the first signs of poliomyelitis are not yet manifest, lasts from 2 to 35 days. Most often, its duration is 10-12 days, depending on the individual characteristics of the child's body. At this time, through the entrance gate (they are the pharynx and digestive tract), the virus enters the lymph nodes of the intestine, where it multiplies. After that, it penetrates into the bloodstream and the stage of viremia begins, during which the infection spreads throughout the body and affects the most vulnerable parts for it. In the case of polio, these are the anterior horns of the spinal cord and the cells of the myocardium.

Symptoms of meningeal form

Meningeal and abortive forms refer to non-paralytic forms of poliomyelitis. The first signs of poliomyelitis in children with meningeal form always appear acutely. The temperature rises to 38-39 ° within several hours. There are symptoms characteristic of the common cold - coughing, serous or mucous discharge from the nose. When examining the throat, hyperemia is noted, on tonsils and palatine arches there may be a plaque. At a temperature, nausea and vomiting are possible. Later the temperature decreases and for two or three days the child's condition stabilizes.

Then there is a repeated increase in temperature, and signs of poliomyelitis become more distinct - there are drowsiness, inhibition, lethargy, headaches, vomiting. There are meningeal symptoms: a positive Kerning symptom (lying on the back of the patient bend the leg in the knee and hip joint at an angle of 90 °, after which due to muscle strain it becomes impossible to unbend the knee joint), stiff neck muscles (impossibility of lying on your back to reach your chin up to your chest ).

Abortive form

The signs of poliomyelitis in children with abortive form also begin to be acute. Against the background of high fever (37.5-38 °), malaise, lethargy, mild headaches are noted. There are small catarrhal phenomena - cough, runny nose, redness of the throat, there may be abdominal pain, vomiting. In the future, can develop catarrhal angina, enterocolitis or gastroenteritis. It is the intestinal manifestations that distinguish abortive poliomyelitis. Symptoms of the disease in children in this case are most often expressed in a pronounced intestinal toxicosis according to the type of dysentery or cholera. Neurological manifestations with this form of poliomyelitis are absent.

Paralytic form of poliomyelitis

This form of poliomyelitis is much heavier than the forms described above and is much more difficult to treat. The first neurological signs of poliomyelitis begin to appear on 4-10 days from the moment of contact with the virus, in some cases this period can increase up to 5 weeks.

The following stages are distinguished in the development of the disease.

• Preparalytic. Characteristic rise in temperature to 38.5-39.5 °, headaches, cough, runny nose, diarrhea, nausea, vomiting. On 2-3 days the condition is normalized, but then a new temperature rise begins to 39-40 °. On its background there are strong headaches and muscle pains, convulsive twitching of the muscles, which can be seen even visually, impaired consciousness. This period lasts 4-5 days.

• The paralytic stage is characterized by the development of paralysis. They develop suddenly and are expressed in the absence of active movements. Depending on the form, paralysis of the limbs (more often legs), torso, neck, develops, however, sensitivity, as a rule, is not violated. The duration of the paralytic stage varies from 1 to 2 weeks.

• The stage of recovery with successful therapy is characterized by the restoration of the functions of paralyzed muscles. At first this process is very intense, but then the pace slows down. This period can last from one to three years.

• At the stage of residual phenomena, the affected muscles atrophy, contractures are formed and various deformations of limbs and trunks that are so widely known as signs of poliomyelitis in children develop. The photos presented in our review clearly illustrate this stage.

Spinal form

It is characterized by an acute onset (the temperature rises to 40 ° and, unlike other forms, has a permanent character). The child is sluggish, adynamic, drowsy, but hyperexcitability is also possible (as a rule, its symptoms are more pronounced in very young children), a convulsive syndrome. There are spontaneous pains in the lower extremities, worse with a change in the position of the body, pain in the dorsal and occipital muscles. When examined, the symptoms of bronchitis, pharyngitis, rhinitis are revealed. There are general cerebral symptoms, hyperesthesia (increased reaction to various pathogens). When you press the spine or the site of the projection of the nerve trunks, a sharp pain syndrome arises.

At 2-4 days from the onset of the disease, paralysis occurs. In poliomyelitis, they have the following features:

• Asymmetry - the lesion passes by the type of the left arm - the right leg;

• Mosaic - not all muscles of the limb are affected;

• Decrease or absence of tendon reflexes;

• Decrease in muscle tone right up to atony, but the sensitivity is not disturbed.

The affected limbs are pale, cyanotic, cold to the touch. Pain syndrome leads to the fact that the child takes a forced position, which, in turn, causes the early contractures.

Restoration of motor functions begins with 2 weeks of the disease, but this process continues for a long time and unevenly. Developed violations of tissue trophism, lag in the growth of limbs, deformation of the joints, atrophy of bone tissue develop. The disease lasts 2-3 years.

Bulbar form

Bulbar shape is characterized by a very sharp beginning. Preparalytic stage is almost absent. Against the background of sore throat and suddenly rising to high figures (39-49 °) there are neurological symptoms:

• Laryngeal paralysis - violation of swallowing and phonation;

• Respiratory distress;

• Disturbances of movements of eyeballs - nystagmus rotary and horizontal.

The course of the disease can be complicated by pneumonia, atelectasis, myocarditis. It is also possible the development of gastrointestinal bleeding, intestinal obstruction.

Pontine form

The pontine form arises from the defeat of the poliomyelitis virus of the facial, diverting, and sometimes trigeminal nerves (V, VI, VII, pairs of cranial nerves). This leads to paralysis of muscles responsible for facial expressions, and in some cases, masticatory muscles. Clinically, this is expressed in the asymmetry of the facial muscles, the smoothness of the nasolabial fold, the absence of horizontal wrinkles on the forehead, the ptosis (lowering) of the corner of the mouth or eyelid, its incomplete closure. Symptoms become more distinct when you try to smile, close your eyes, or inflate your cheeks.

Treatment

There is no specific treatment for poliomyelitis. When the diagnosis is made, the patient is hospitalized in an infectious hospital, where he is provided with physical and mental rest. In the preparative and paralytic periods, painkillers and diuretics are used, according to indications, anti-inflammatory drugs or corticosteroids are given. When the function of swallowing is disturbed - feeding through the probe, with violation of breathing - ventilation. In the recovery period, exercise therapy, massage, physiotherapy, vitamins and nootropic drugs, and sanatorium treatment are shown.

Prevention

Poliomyelitis refers to those diseases that are easier to avoid than to treat. This can be done by vaccination. In Russia, all newborn children are given this vaccination. Vaccination is carried out in several stages - at 3 and 4.5 months the baby is vaccinated with an inactivated vaccine. At 6, 18, 20 months the procedure is repeated using a live vaccine. The last vaccination is carried out at 14 years. And do not miss it, because, despite the fact that it is believed that polio is dangerous only for babies, it is not, and in case of disease, signs of poliomyelitis in adults are very pronounced and dangerous.

When an illness is identified, an important element of prevention will be timely isolation of the patient, quarantine and observation for 3 weeks for the contact group, observance of personal hygiene.

Thus, we examined in sufficient detail what signs of poliomyelitis exist, and what needs to be done to avoid this serious disease.