Poliomyelitis

Description:

Poliomyelitis (children's paralysis, Heine-Medina's disease) - the acute infectious disease caused by the virus possessing a tropnost to motor neurons of front horns of a spinal cord and motor neurons of a brainstem (a kernel of cranial nerves) which destruction leads to paralysis of muscles and their atrophy.
Healthy carriers and abortal cases - the main distributors of a disease though it is possible to catch also from the patient in a paralytic stage. The main ways of transmission of infection - personal contacts and fecal pollution of food. Seasonality has a talk with the maximum incidence of late summer and in the early fall it. At the age of 5 years the susceptibility sharply decreases. The incubation interval of 7-14 days, but can last also 5 weeks.

Poliomyelitis symptoms:

4 types of reaction to a poliomyelitis virus are observed:

    * development of immunity in the absence of disease symptoms (a subclinical or implicit infection);
    * symptoms in the viremiya stages having character of the systemic moderate infection without involvement in process of a nervous system (abortal cases);
    * existence at many patients (to 75% in the period of epidemic) fevers, a headache, an indisposition; there can be meningeal phenomena, a pleocytosis in liquor. Paralyzes do not develop;
    * development of paralyzes (in rare instances).

At a subclinical form symptoms are absent. At an abortal form of manifestation are indistinguishable from any systemic infection. Serological tests are positive, it is possible to allocate a virus. At other patients it is possible to allocate two stages of a clinical picture: preparalytic and paralytic.

Preparalytic stage. During this stage distinguish two phases. In the first phase fever, an indisposition, a headache, drowsiness or sleeplessness, perspiration, a throat hyperemia, gastrointestinal disturbances (anorexia, vomiting, diarrhea) are observed. This phase of "a small disease" lasts 1-2 days. Sometimes after it there steps temporary improvement with decrease in temperature on 48 h or the disease passes into the second phase - "a big disease" at which the headache is more expressed and is followed by dorsodynias, extremities, increased fatigue of muscles. Symptoms remind other forms of viral meningitis. In the absence of paralyzes of the patient recovers. In cerebrospinal liquid pressure is increased, a pleocytosis (50-250 in 1 мкл). In the beginning there are both polimorfonukleara, and lymphocytes, but after the 1st week - only lymphocytes. Moderately the level of proteins and globulins increases. Content of glucose is normal. Within the 2nd week protein level in liquor increases. The preparalytic stage lasts 1-2 weeks.

Paralytic stage. Spinal form. Development of paralysis is preceded by the expressed fastsikulyation. Extremity pains, hypersensitivity of muscles to pressure are noted. Paralyzes can be widespread or localized. In hard cases the movements, except for very weak are impossible (in a neck, a trunk, extremities). In less hard cases draw attention asymmetry of paralyzes: muscles can be strongly affected on one side of a body and are kept on another. Usually paralyzes reach a maximum during the first 24 h, less often the disease progresses. At "ascending" option paralyzes from legs extend up and threaten life because of accession of disorder of breath. Also the descending options of development of paralyzes meet. It is necessary to monitor function of intercostal muscles and diaphragms. The test for detection of respiratory paresis - the loud account on one breath. If the patient is not capable to count till 12-15, there is an expressed respiratory insufficiency and it is necessary to measure the forced breath volume for clarification of need of an assisted breast.

Improvement usually begins by the end of the 1st week from the moment of development of paralyzes. As well as at other defeats of peripheral motor-neurons, loss or decrease in deep and cutaneous reflexes is noted. There are no disturbances of sensitivity, function of sphincters of pelvic bodies seldom falls apart.

Trunk form (polioencephalitis). Paralyzes of mimic muscles, language, a throat, throat less often - oculomotor muscles are observed. Dizziness, a nystagmus are possible. Danger of involvement in process of the vital centers is big (respiratory, cardiovascular). It is very important to distinguish respiratory disturbances owing to accumulation of saliva and slime at paralysis of pharyngeal muscles from true paralyzes of respiratory muscles.

Poliomyelitis reasons:

Three virus strains are allocated: types I, II and III. The virus can be allocated from a mucous membrane of a nasopharynx of patients in an acute stage, the healthy virus carriers recovering and also from excrements. The person has the most widespread way of infection - through a digestive tract. The virus reaches a nervous system on vegetative fibers and perinevralno along axial cylinders in peripheral nerves and in the central nervous system. Consider that its distribution through blood and lymphatic system is possible. The throat, especially a bed of almonds after a tonzillekgomiya can be the place of implementation of a virus. The virus is steady against chemical agengena, but is sensitive to heat and drying. It can be grown up in culture of cells of a kidney of monkeys. Specific serological tests, including the test of complement deflection and neutralization of antibodies are applied.

Treatment of Poliomyelitis:

At suspicion of poliomyelitis the patient needs to create immediately absolute rest as physical activity in a preparalytic stage increases risk of development of heavy paralyzes. In the presence of paralyzes medical tactics depends on their prevalence on respiratory and boulevard muscles. At treatment of patients without respiratory disturbances intramuscular administration of ribonuclease, and also serum of convalescents is shown. In an acute stage give enough liquid. The lumbar puncture is necessary for the diagnostic purposes, and also can reduce a headache and dorsodynias. Analgetics and sedative drugs (diazepam) are used for pain relief and reduction of concern.
Only an admissible form of activity - the easy passive movements. Antibiotics are appointed only for prevention of pneumonia at patients with respiratory frustration. Immunoglobulins are useless as the virus after connection with nervous tissue is unattainable for antibodies.

Treatment after development of paralyzes is subdivided into stages.

In an acute stage at pains and hypersensitivity of muscles (3-4 weeks) it is important not to allow stretchings of the affected muscles and a contracture of antagonists that can demand more prolonged treatment. The patient has to lie in a soft bed, extremities have to be in such situation that the paralyzed muscles were relaxed (but are not stretched). For this purpose use small pillows and sacks with sand.

In a recovery stage at the continuing accumulation of muscle strength (6 months - 2 years) physical exercises which the patient carries out with assistance, in a bathtub or in devices with support by straps and belts are important.

In a residual stage in the presence of contractures make a tenotomy or other surgical intervention. Appoint прозерин, Dibazolum, vitamins, metabolic means, physical therapy.

At threat of respiratory insufficiency sometimes within weeks and even months IVL when normal concentration of PCO2 and PO2 can be maintained only by the excessive, exhausting efforts of the patient is necessary.

At bulbar paralysis the main danger hit of liquid and a secret in a throat, their suction at a breath. Difficulties of feeding of patients are aggravated with a dysphagy. The correct position of the patient is important (on one side), and each several hours it should be turned on other side; the foot end of a bed is lifted on 15 °. This pose can be changed for leaving or other purposes, but for a while. The secret is deleted with a suction. In 24 h starvation it is necessary to feed the patient via the nazogastralny probe.