AFP

Acute accid paralysis

weakness in one or more limbs,or the
respiratory or bulbar muscles, resulting from
damaged lower motor neurones.
Signs
there is weakness with reduced tone
(accidweakness)
and reduced or absent reexes
D/d
Polio
Enterovirus 71
Gullian barre syndrome
Injection neuritis
Tick bite
Botulinum toxicity
Diptheritic neuropathy
Rabies
differences of AFP
Direct viral damage to
anterior horn cells eg
polio
Immune medicated
damage to peripheral
nevers
Paralysis onset

During(or straight after)
febrile illness
Several weeks after
febrile illness
Pattern of
paralysis
Asymmetrical Symmetrical
Time to reach
maximum weakness
Short(e.g.23days) Long (e.g.714days)
Sensory involvement No Often (depending on
exact disease)
CSF
Increased lymphocytes increased
protein(e.g.100mg/dLes
peciallylate in the
disease)
Pain
Often limb muscle pain Often back pain
polio- mobin
historical background
First recorded case of polio is a
hieroglyph from Memphis, drawn
in approximately 1400BC, which
depicts a temple priest called
Siptah showing typical clinical
signs of paralytic poliomyelitis
was recorded in the late 1700s
with the first epidemic in the late
1800s.
The cases that were reported in
1979 where mild and self-limited
and do not result in paralysis
modern history
1789 - British physician Michael Underwood provides the
first clinical description of polio, referring to it as "debility of
the lower extremities."
1840 - German physician Jacob von Heine publishes a 78-
page monograph in 1840 which not only describes the
clinical features of the disease, but also notes that its
symptoms suggest the involvement of the spinal cord.
1908- Austrian physicians Karl Landsteiner and Erwin Popper
make the first hypothesis that polio may be caused by a
virus.
Treatment history
Polio patients whose
muscles were paralysed
faced months, perhaps
years, of arduous physical
therapy to strengthen
weakened muscles

Patients were often placed
in iron lungs to help with
breathing regulation
Bacteriological history
Poliovirus was first identified in
1909 by inoculation of specimens
into monkeys. The virus was first
grown in cell culture in 1949 which
became the basis for vaccines
vaccine history
1955 Inactivated vaccine

1961 Types 1 and 2 monovalent OPV

1962 Type 3 monovalent OPV

1963 Trivalent OPV

1987 Enhanced IPV (IPV)
Enterovirus
Serotypes
polio= gray matter
Myelitis= inflammation
of the spinal cord
Poliovirus

Enterovirus (RNA)(Picornavirus)
Three serotypes: 1, 2, 3
Rapidly inactivated by heat, formaldehyde,
chlorine, ultraviolet light
no cross immunization
Transmitted by oronasal route
By water and milk
Poliomyelitis Pathogenesis

Entry into mouth
Replication in pharynx, GI tract,
local lymphatics
Hematologic spread to lymphatics and central
nervous system
Viral spread along nerve fibers
Destruction of motor neurons

Outcomes of poliovirus infection
Prognosis
Epidemiology
Reservoir Human

Transmission Fecal-oral Oral-oral
possible

Communicability 7-10 days before onset

Virus present in stool 3-6 weeks
Epidemiology
Most affects children under the age of 5 years in
developing tropical countries.
Incubation period ranges from 6 to 20 days
risk factors
infants and elderly
living with infected person
compromised immune system
lack of immunization
extreme stress or strenuous activity
travel to an area that has experienced polio outbreak
incubation period
The incubation period for poliomyelitis is
commonly 6 to 20 days with a range from
3 to 35 days. The response to poliovirus
infection is highly variable and has been
categorized based on the severity of
clinical presentation.

symptoms
Acute stage: generally lasts 7 to 10
days.
May include fever, pharyngitis, headache,
anorexia, nausea, and vomiting.
Illness may progress to aseptic meningitis and
menigoencephalitis in 1% to 4% of patients.
These patients develop a higher fever & sever
headache with stiffness of the neck and back
symptoms
Paralytic disease occurs 0.1% to 1% of those who
become infected with the polio virus.

Paralysis of the respiratory muscles or from cardiac
arrest if the neurons in the medulla oblongata are
destroyed.
signs
In cases with paralysis superficial reflexes
usually are absent first, and deep tendon
reflexes disappear when the muscle
group is paralyzed.

Recovery
Patients have some or full recovery from
paralysis, most clinical recovery occurs during
the 1 month and almost complete within 6
months

.
Limited recovery may occur for about 2 years.

fate
Among children who are paralysed by polio:
30% make a full recovery
30% are left with mild paralysis
30% have medium to severe paralysis
10% die
paralytic polio-3 types
Spinal polio - the most common, and accounted for
79% of paralytic cases from 1969-1979. It is
characterized by asymmetric paralysis that most
often involves the legs.
Bulbar polio - accounts for 2% of cases and leads to
weakness of muscles innervated by cranial nerves.
Bulbospinal polio - it accounts for 19% of cases and
is a combination of bulbar and spinal paralysis
diagnostic studies
Virus Culture
The laboratory diagnosis of polio is confirmed by isolation of virus by cultures,
from the stool or throat swab or cerebrospinal fluid (rare). In an infected person,
the virus is most likely to be cultured in stool cultures.

Serologic test
Acute and convalescent serum sample may be tested for rise in antibody titer
(antibodies to the poliovirus), but the report can be difficult to interpret as in
many cases, the rise in titer may occur prior to paralysis.

Cerebrospinal fluid test
Infection with polio virus may cause an increased number of white blood cells
and a mildly elevated protein level in cerebrospinal fluid

Treatment-acute stage
Bed rest, analgesics, hot packs, and
anatomical positioning of the limbs
gentle passive ROM exercises of all joints
treatment-acute stage
close monitoring of respiratory and cardiovascular
functioning is essential during the acute stage of
poliomyelitis along with fever control and pain relievers for
muscle spasms.
Mechanical ventilation, respiratory therapy may be
needed depending of the severity of patients.
Convalescent stage
From 2 days after the temperature return to normal and
continues for 2 years
Muscle power improves
Physical therapy is recommended for full recovery.
Passive stretching exercises and wedging casts can be
used for mild to moderate contractures.
convalescent stage
Surgical release of tight fascia and muscle
aponeuroses and lengthening of tendons may be
necessary for contractures persisting longer than 6
months.

Orthoses should be used until no further recovery
is anticipated.
chronic stage
Static joint instability can be controlled by
Orthoses.
Dynamic joint instability result in a fixed
deformity that cannot be controlled by
Orthoses.
chronic stage
Soft tissue surgery, such as tendon transfers, should be
done in young children before the development of any
fixed bony changes.
Bony procedures for correcting a deformity can be
delayed until skeletal growth is near completion.
prevention
The best preventive measure for poliomyelitis is
ensuring hygiene and encouraging good sanitation
practices. But, polio prevention begins with polio
vaccination. Polio vaccine has been developed
against all 3 subtypes of the poliovirus and is very
effective in producing protective antibodies that
induces immunity against the poliovirus and
provides protection from paralytic polio.
vaccine
Two types of vaccine are available:

an inactivated (killed) polio vaccine (IPV) and
a live attenuated (weakened) oral polio vaccine (OPV
schedule
epi
"I wont ever forget the
feeling in my legs when I
lost the use of them.
It was just such a weird
feeling.
It was just like it went
through me,
just a surge went through
my body.
I can feel it right now just
thinking about it.
It was very frightening for
a little 14-year-old girl to
think,
gosh, my lifes gone, you
know?
Addie Flowers Vance, Charlotte,
Mecklenburg County, 1996