Acute Paralytic Polio


INTRODUCTION:
  • 2nd phase of the illness
  • Spotty paralysis
  • Asymmetric flaccid paralysis
  • One leg most common followed by one arm
  • Absent DTRs
  • In Paralytic poliomyelitis Anterior horn cell & Autonomous nervous system are affected 
  • Paralytic poliomyelitis develops in about 1% patients causing 3 clinically recognizable syndromes which are
  1. Spinal paralytic poliomyelitis
  2. Bulbar poliomyelitis
  3. Polioencephalitis
RISK FACTORS:
  • The risk factors found to precipitate an attack of paralytic polio in individuals infected with polio include:
  1. Physical activity immediately following onset of paralysis
  2. Skeletal muscle injury due to injection of vaccines or therapeutic agents
  3. Pregnancy
  4. Vaccine associated paralytic poliomyelitis is suspected if AFP develops within45 days of receipt of OPV
  5. Malnutrition
  6. Immune deficiency
  7. Tonsillectomy

FEATURES:
  • Spinal: 
  1. Absent DTRs 
  2. No sensory deficits 
  3. Full picture by 3 days. Usually no further progression 
  4. Bowel and bladder dysfunction 
  5. Older age and provocation paralysis the biphasic illness is not seen 
  6. Recovery is slow starting after several weeks of the disease, but usually within 6 months 
  7. If not then residual paralysis 
  8. Recovery may continue for as long as 18 months 
  9. Atrophy, deformity and failure to grow
  • Bulbar 
  1. Inability to swallow and pooling of oral secretions 
  2. Palatal and tongue involvement 
  3. Vocal cord palsy 
  4. Vital centers in medulla being involved 
  5. Ascending paralysis 
  6. Autonomic disturbances 
  7. Recovery is variable
  • Paralytic poliomyelitis-Encephalitis 
  1. Involvement of higher centers 
  2. Seizures,coma,spastic paralysis 
  3. Peripheral & cranial nerve palsies 
  4. Respiratory paralysis-due to variety of possibilities
TREATMENT:
  • Care of bowel & bladder
  • Increased fluid intake
  • Care of airway & secretions
  • Monitor vital signs
  • Ventilation
  • Tracheostomy
  • Paralytic polio is under surveillance by WHO for notification by National health Authorities  
Exam Question
  • IM injections and increased muscular activity increases the risk of paralytic polio
  • Vaccine associated paralytic poliomyelitis is suspected if AFP develops within45 days of receipt of OPV
  •  In Paralytic poliomyelitis Anterior horn cell & Autonomous nervous system are affected 
  • Paralytic polio is under surveillance by WHO for notification by National health Authorities 
  • Anterior horn cells  is affected in spinal paralytic polio
Don't Forget to Solve all the previous Year Question asked on Acute paralytic polio