Polio-About Polio:
Polio is caused by the polio virus, an acute infectious disease. Clinical manifestations of polio-bed fever, sore throat and body pain, some patients with flaccid paralysis may occur. Prevalence of infection and when to conceal non-paralyzed for many, the high morbidity in children than in adults, particularly before general vaccination of infants and young children more sick.
Polio - Data
Alias disease: polio, polio current sexual activity
Respective parts: the body
Treatment sections: Pediatric Infectious Diseases
Signs and symptoms: diarrhea, fever, cough, cyanosis, coma, paralysis of abdominal pain, nausea and vomiting
Polio - Overview
Polio (poliomyelitis hereinafter referred to as polio), also known as poliomyelitis, is caused by the polio virus, an acute infectious disease. The main clinical manifestations are fever, sore throat and body pain, some patients may occur flaccid paralysis. Prevalence of infection and when to conceal non-paralyzed for many, the high morbidity in children than in adults, particularly before general vaccination of infants and young children sick more, it is also called poliomyelitis (Infantile paralysis), the main lesions in the spinal cord gray matter, damage can have serious paralysis sequelae.
Polio - causes
Polio virus, polio virus from the oropharynx or intestinal mucosa into the human body can be reached within one day of local lymphoid tissue such as tonsils, pharyngeal wall lymphoid tissue, intestinal growth and reproduction of a collection of lymphoid tissue, etc., to the partial discharge of the virus, If this time the body produces large amounts of specific antibodies, the virus can be controlled locally. The formation of latent infection; otherwise the virus further invade the bloodstream (the first viremia) throughout the first 3 days to reach non-neural tissues, such as respiratory, intestinal, skin and mucous membranes, heart, kidney, liver, pancreas, adrenal, etc. breeding In particular, multi-systemic lymphoid tissues, and in the first 4 to 7, again poured into the blood circulation (second viremia) If the time-specific antibodies in the blood circulation is adequate and the virus, the development of the disease at this point to form a frustrated type polio. Only the upper respiratory and intestinal symptoms, without neurological disease, some patients may be less toxic due to strong virus or antibodies in the blood and not the one, the virus can be violated with the blood-brain barrier via the central nervous system, a serious disease paralysis may occur, and occasionally the virus can spread along peripheral nerves to the central nervous system, specific neutralizing antibodies is not easy to reach the central nervous system and gut, so the virus within the cerebrospinal fluid and feces retained longer. Therefore, if blood circulation in the body-specific antibodies appear sooner or later and their number is to determine whether the violation of the virus an important factor in the central nervous system.
A variety of factors can affect the disease outcome, such as cold, fatigue, local irritation, injury, surgery (such as vaccination, tonsils amputated patients, dial teeth, etc.) and the immunocompromised, etc., are likely to promote the occurrence of paralysis, pregnant women such as disease prone to paralysis, older children and adults with serious condition, the occurrence of paralysis and more. Children susceptible to severe in boys than girls, more common in paralysis.
The most prominent pathological changes of polio in the central nervous system (the virus with neurotropic toxic) scattered lesions and multiple asymmetrical features may involve the brain, midbrain, medulla oblongata, cerebellum and spinal cord, the main damage to the spinal cord, brain dry times, especially in the motor nerve cells in the lesions of the most significant. Cervical and lumbar segments of the spinal cord to anterior horn cell damage is more gray matter, it is a common clinical quadriplegic. Most of central and brain stem motor nucleus can be damaged to the network structure, vestibular nuclei and cerebellar nuclear lesions is more common cover, the cerebral cortex are rare lesions, even if the motor area lesions were mostly minor. Occasionally sympathetic ganglia and peripheral ganglia lesions, scattered on the leptomeningeal inflammatory lesions, arachnoid little affected, inflammatory changes appear in cerebrospinal fluid. No paralysis type of nervous system lesions are mostly minor. Polio virus enters the body through the mouth, throat and intestinal tract that invade lymphatic tissue, the formation of latent infection; antibodies into the blood circulation is low virus caused viremia, if the body's lack of immunity, the virus with blood blood brain barrier to invade the central nervous system, and spread along the nerve fibers, causing paralysis period without symptoms; if badly damaged motor neurons, the muscle paralysis, causing paralysis of symptoms.
Polio - symptoms
Polio patients season if susceptible patients after exposure to excessive sweating, irritability, hypersensitivity, sore throat, neck and back limb pain, stiffness, tendon reflexes, and so on, and the disease should be suspected. Prodromal period should be the general upper respiratory infection, influenza, gastroenteritis and other identification. Patients should be a variety of pre-paralysis virus encephalitis, purulent meningitis, tuberculous meningitis and encephalitis phase identification. Flaccid paralysis occurs in the diagnosis.
3 to 35 day incubation period, usually 7 to 14, according to the severity of symptoms and the presence of paralysis can be divided into latent infection, frustrated type, no type of paralysis and paralysis type.
Polio incubation period is 5 to 14 days, clinically manifested a variety of types: ① latent infection; ② frustrated type; ③ no paralysis type; ④ paralysis type.
(A) the precursor of the main symptoms are fever, loss of appetite, sweating, irritability and systemic hypersensitivity; also visible nausea. Vomiting, headache, sore throat, constipation, diffuse abdominal pain, rhinitis, cough, pharyngeal exudate, diarrhea, 1 to 4 days. If the condition does not develop, is frustrated type.
(B) the period of paralysis early prodromal symptoms disappeared after the l ~ 6 days, the temperature rose again, headache, nausea, severe vomiting, skin redness, transient bladder sphincter disorders, neck muscles, trunk and limb rigidity burning, often constipation. Examination shows that: ① tripod sign: the need to use both hands when the patient sat up in bed after a support such as tripod, to support the position; ② kiss knee test positive, that is, patients sit, bend the neck when the lips can not touch the knee; ③ appear head drooping levy, set about to hand under the patient shoulder, lift the torso, the head and torso parallel to the normal. So far, such as illness, 3 to 5 days after the heat back, is no paralysis type, such as the disease continues to develop, is often paralysis appeared 12 to 24 hours before the key reflex, light reflex initially, after the suppression of deep tendon reflexes Therefore early detection of reflex has important diagnostic value.
(C) paralysis paralysis of the early period from the third and fourth day, the temperature started to decline in most of paralysis, and gradually increased, when the body temperature normal to retreat, to stop the development of paralysis, no sensory disturbances. Can be divided into the following types:
1, the spinal cord of this type is most common. Showed flaccid paralysis, asymmetry, tendon reflexes, muscle hypotonia, lower limbs and large muscles and small muscles more than upper limb involvement, but there may be only a single muscle group involved, or are paralyzed limbs, such as involving the neck muscle, diaphragm, intercostal muscles, then a vertical head and sat up difficulties, breathing movement disorders, breathing contradiction performance.
2, also known as medullary type ball, Department of cranial nerve motor nucleus and the medullary respiratory, circulatory center due to violations. This type accounts for 5% ~ paralysis type 10%, damage to the respiratory center when irregular breathing, apnea; impaired vasomotor center may have changes in blood pressure and pulse rate, both of which are fatal diseases. Cranial nerve damage occurs when the corresponding nerve palsy symptoms and signs, to the facial nerve and Part X of the cranial nerve injury common.
3, this type of rare brain-type; high fever, irritability, convulsions, coma or lethargy, with upper motor neuron spastic paralysis performance.
4, mixed over the performance of several types exist.
(D) recovery from paralysis of the distal limbs began to recover, for several weeks to several months, usually within 8 months of cases can be fully restored, serious need 6 to 18 months or longer.
(E) sequelae of severe involvement of muscle contraction, nerve function can not be restored, resulting in affected limb deformities. Part of the paralysis-type cases for decades after infection, the occurrence of progressive neuromuscular weakness, pain, paralysis of limbs increased involvement, known as the "post-polio muscular atrophy syndrome." Of unknown etiology.
Complications: As of peripheral or central respiratory paralysis may be secondary to aspiration pneumonia, atelectasis, purulent bronchitis, and respiratory failure caused by severe bleeding; prolonged bed rest can lead to bedsores and nitrogen, calcium negative balance, the performance of osteoporosis , urinary tract stones and renal failure.
1, the latent infection (asymptomatic): 90 total infections to 95%, symptoms appear after infection, virus propagation only stay in the digestive tract, does not produce viremia, not immersed in the central nervous system, but the pharyngeal separable from the Ministry and feces can be found in vivo virus-specific neutralizing antibodies.
2, frustrated type (light): about 4 ~ 8% of virus attacks the body non-neural tissues, the lack of specificity of clinical symptoms can appear ① symptoms of upper respiratory tract inflammation, such as varying degrees of fever, throat discomfort, pharyngeal congestion and pharyngeal lymphoid tissue, tonsils, etc.; ② gastrointestinal symptoms, nausea, vomiting, diarrhea or constipation, abdominal discomfort; ③ flu-like symptoms, joint, muscle pain and other symptoms for 1 to 3, self-healing.
3, no paralysis type: polio virus invades the central nervous system and nerve fibers spread systemic circulation, can occur at the beginning of this period, the incidence of symptoms, but most patients in the prodromal period of 1 to 6 days after symptom or symptom relief , then enter this period.
4, paralysis type: about infection of 1 to 2%, characterized by paralysis in the absence of clinical manifestations, based on the combined gray matter involving the anterior horn of the spinal cord, brain and brain lesions, resulting in muscle paralysis.
Polio - Check
1, brain fluid: Most abnormalities in paralysis before. Slightly turbid appearance, the pressure increased slightly, the number of cells increased slightly (25 ~ 500/mm3), early in neutrophils as many places after the single-core-based, rapid heat back to normal, may be a slight increase in sugar, most of the normal chloride, protein slightly increased, and last longer, a small number of patients with spinal cord fluid can be always normal.
2, peripheral blood: the majority of normal white blood cells in early and secondary infection can be increased, mainly by neutrophils, acute phase ESR.
3, virus isolation or antigen detection: onset 1 week, and from the nasopharynx to isolate the virus in feces, feces can hold 2 to 3 weeks following the positive, early blood or cerebrospinal fluid from the isolated virus even greater significance, general separation method using tissue culture, in recent years, the use of PCR, detection of enterovirus RNA than the tissue culture and rapid sensitive.
4 polio patients, serological tests: type-specific antibody titers reached a peak in the first week can be, especially in specific IgM rose faster than IgG, and testing available in the complement fixation test and ELISA methods such as detection of specific antibodies, and experiments in which the more commonly used, because of persistent positive longer, double titer four times and 4 times more growth can be confirmed by the complement fixation test was negative and rapid, while in the negative on schedule and test positive, and often prompts past infection; both of which are positive, you are prompted recent infection, recent detection of antigen by immunofluorescence and specific IgM monoclonal antibody ELISA method for detecting early diagnosis.
Poliomyelitis - diagnosis
Whether the child is infected with polio, the need for testing stool taken, because the virus will appear in the human excrement of two to three weeks long, so samples from feces, easier to isolate the virus.
Prodromal period should be the general upper respiratory infection, influenza, gastroenteritis and other identification. Patients should be a variety of pre-paralysis virus encephalitis, purulent meningitis, tuberculous meningitis and encephalitis phase identification. Flaccid paralysis occurs in the diagnosis. Need to identify patients with the following:
(A) infection or inflammation of multiple nerve root known as Green - Bell Composite (Guillain-Barre's syndrome) more common in older children, distribution of onset, no heat or fever, with mild symptoms of upper respiratory tract inflammation, the gradual emergence of flaccid paralysis, goes to the line, symmetry, often accompanied by sensory disturbances. Increased cerebrospinal fluid protein and cells have less of its features. Recovered rapidly and completely paralyzed, with few side effects.
(B) rare familial periodic paralysis, no heat, sudden paralysis, symmetry, the rapid, throughout the body. Attack of low blood potassium, potassium quickly restored, but can recur. Often a family history.
(C) by peripheral neuritis neuritis after diphtheria, intramuscular injection injury, lead poisoning, vitamin B1 deficiency, caused by herpes zoster infection. History, physical examination can be identified, no change in cerebrospinal fluid.
(D) caused by paresis of other viral infections such as Coxsackie, ECHO virus infection, clinical difficult to identify, such as chest pain, rash and other typical symptoms, help to identify. Diagnosis depends on virus isolation and serology.
(E) encephalitis should be identified with this type of brain disease. Encephalitis occurs mainly in summer and autumn, rapid onset, often accompanied by consciousness disorder. Peripheral blood and cerebrospinal fluid are mainly an increase in neutrophils.
(F) pseudo-paralysis of infants and young children because of injuries, fractures, arthritis, vitamin C deficiency subperiosteal hematoma, physical activity may be limited, should be carefully examined to identify.
Polio - treatment:
Treatment of patients with acute polio
1, the general treatment: bed rest, isolation, at least until 40 days after onset, to avoid fatigue, muscle pain can be localized at the moist heat to relieve pain, paralysis of limb function should be placed in position to prevent hand, foot drop and other deformities. Attention to nutrition and fluid balance, can be taken orally a lot of vitamin C and B group, high fever, poisoning symptoms and patients with early, consider intramuscular injection of gamma globulin preparations, 3 ~ 6ml per day for 2 to 3 days, critically ill patients may be strong The loose oral or intravenous hydrocortisone. Usually with 3 to 5 days, secondary infection plus antibiotics.
2, respiratory disorders treatment: patients often severe respiratory disorders, caused by lack of oxygen and carbon dioxide retention, the main cause of death is often caused, we must first distinguish the cause of respiratory disorders, active rescue, to keep the airway open, hypoxia and irritability sedatives with caution, so as not to increase the breathing and swallowing difficulties early use of antimicrobial drugs to prevent secondary infection of the lungs, blood gas changes and close attention to the dielectric disorder, at any time be corrected.
Promote the recovery of paralysis
1, the patient should be lying on a hard mattress Banchuang, pay attention to paralyzed limbs of care, to avoid injury pressure, in a comfortable position functions, to prevent the pedal produces the phenomenon of vertical wrist, constipation and urinary retention, to provide appropriate enema and catheterization.
2, Chinese medicine treatment, the choice of DUHUOJISHENG Decoction.
3, difficulty breathing and swallowing disorders treatment, prevention and treatment of circulatory failure.
4, to promote the recovery of nerve conduction
Promote the function of nerve conduction drugs such as methimazole, such as the blue he was sensitive, the effect is not significant, now rarely used, in the heat back to do, when no longer paralyzed, early selection of the following treatments.
(1) acupuncture treatment: for younger age, short duration, body atrophy were not obvious. According to the paralyzed parts of the acupoints, neck and upper limb often take Jiaji, shoulder Chen, Ojo, hand three years, a small sea, the customs, Hegu, after the river, 2 to 3 points each election, the lower limbs often choose to open next lumbar 1 inch at, jump ring, rank edge, jumping, Yu Shu, thigh clearance, Yin Lian, the semi-finals, V rabbit, Cheng Fu, Yin gate, season, Yanglingquan, Zusanli, Xie River, the river too, must bone, the wind market, Cheng-shan, paralysis of limbs under the floor and other major muscle groups involved in the election for three or four points, each can be replaced alternately, 1 day, 10 to 15 times for a course, two courses are between 3 to 5 days, starting treatment after treatment with a strong stimulation to achieve change in the stimulus, the consolidation effect with weak stimulation, the needle can be electric or water needle, every election 1 to 2 point injection of vitamin B1 γ or blood of GABA Angelica fluid stasis of Chinese herbal compound (angelica, safflower, Chuanxiong preparation) per hole 0.5 ~ 1.0ml.
(2) Massage Therapy: The paralysis of limbs on the rolling method to roll back 8 to 10 minutes, rubbing loose joints 3 to 5 minutes, rub the spine and limbs 5 to 6 times, and local laws to rub rub hot day or every other day, families can be taught at home.
(3) functional exercise: weight is not in paralyzed limbs can be the first massage, massage, promote limb blood circulation, improve muscular and neural regulation, and enhance muscle strength, limb movement and muscle strength can be very poor for a minor who can help its for flexion, abduction, adduction and so passive action, physical activity and muscle strength has been able to remain poor, encourage patients to make automatic movement, the physical therapy, physical therapy tool training with muscle strength and correct deformities.
(4) therapy: to use hydrotherapy, electrotherapy, paraffin, light therapy, contributing to the disease, muscle relaxation, improve blood flow and absorption of inflammation.
(5) Other: Available cupping (cupping tank cylinders) and herbal fumigation, external application to promote the recovery of paralyzed limbs, and another reported application of acupuncture to stimulate the ligation therapy for longer paralyzed limbs to enhance muscle strength, limb deformities of wood can be used or cast immobilization, as well as with surgical correction.
Poliomyelitis - prevention measures
Polio patients
1, taking the polio vaccine.
2, the patient has been disease, isolated from the date of onset less than 40 days. At the same time, the patient excretions, secretions and contaminated equipment should be promptly disinfected.
