Acute anterior poliomyelitis meaning
It is caused by poliomyelitis virus, three serotypes 1,2,3 which invade the nervous system and attack the motor neurons of anterior horn cells of spinal cord and of the brain stem.
Causation and spread
- Infection is transmitted from healthy, usually carries by droplet infection, entering through nasopharynx.
- It also spreads by milk, food, water and enters through gastrointestinal tract.
Types of Acute anterior poliomyelitis
- Spinal and bulbar
- Minor and major
Symptoms / Signs and Clinical features of acute anterior poliomyelitis
Minor illness
Incubating period 7 to 14 days.
Initially malaise, headache, fever, gastrointestinal disturbances lasting for few days. After 3 to 7 days, the patient develops major illness.
Non-paralytic polio, along with signs and symptoms of minor illness. There are signs of meningeal involvement, but paralysis does not occur.
Major illness: This is divided into 3 stages:
Per paralytic stage:
Temperature rises to 39 to 40℃ with severe headache.
A sign of meningeal irritation develops, preventing flexion of the spine.
Malaise, diarrhea, vomiting and anorexia.
Restlessness may amount to delirium.
Patient may improve without further development.
CSF shows increased cell count, mostly poly morphs; proteins may be high.
Paralytic stage:
In others, temperature and general symptoms improve in 24 to 48 hours, but paralysis appears.
Pain and tenderness in muscles persists.
Paralysis starts anywhere and is often patchy and asymmetrical in distribution.
Lower limbs are more affected.
Paralysis completes its course in 24 hours, but may continue for several days.
Paralysis of respiratory muscles may cause death due to respiratory failure.
Bulbar paralysis: Impairs swallowing, coughing, making voice weak and nasal.
Leads to regurgitation of fluids and food through nose.
CSF shows increased tension, increased cells, increased proteins.
Stage of residual disability:
There is complete muscular wasting, leading to contracture and deformities.
The distribution is usually symmetrical and patchy, talipses, equino-varus, shortening of limbs, scoliosis may develop.
Retardation of bone growth, shortening of limbs, coldness and cyanosis may also develop due to trophic changes.
Fasciculations are seen in partially paralyzed muscles for a long time.
Laboratory investigations
- WBC may be increased.
- CSF pressure raised.
- Virus isolation from throat.
Prevention
Use of oral polio vaccine can prevent polio. It is a part of UIP. During the period of epidemic, injections, vaccination, operation, heavy exercised should be avoided. Persons who have been exposed to infection may be protected by immediate injection of Gamma globulin.
Differential diagnosis
Meningitis: There is no lower motor neuron lesion in lower limb, neck rigidity is marked, muscle pain is absent, patient may be unconscious, CSF findings are diagnostic.
Rheumatic fever.
Guillain Barre Syndrome: Sensations are involved, symmetrical and painless.
Infantile scurvy.
Osteomyelitis is also to be differentiated.
Treatment
- Rest in bed.
- Orthopedic procedures to correct the talipes etc., May be used.
- Physiotherapy and rehabilitation.
Homeopathic medicines
Aconite: Sudden paraplegia with tingling and numbness in limb s, fever with great physical and mental restlessness. Hip joint and thigh feel lame.
Belladonna: Cold extremities, tottering gait, shooting pains also limbs, jerking and involuntary limping. All complaints start with high feverish state with no thirst. Throbbing headache and vertigo, twitching and convulsions.
Gelsemium: Loss of power of muscular control, motor paralysis, patient initially is very dull and drowsy with generalized trembling. Paralysis of various group of muscles, lack of muscular coordination. Bad effects of fear.
Lathyrus: Affects the lateral and anterior columns of spinal cord. All reflexes are increased, paralysis of lower limbs, infantile paralysis.
Kali. phos: This medicine indicates a paralytic lameness in back and limbs.
Physostigma: Anterior poliomyelitis
[Reference: Practice of Medicine Kamal Kansal and Rakesh Kaushal]
Post a Comment