DISEASES OF THE NERVOUS SYSTEM : POLIO ACUTE (EPIDEMIC INFANTILE PARALYSIS) (POLYOMYELITIS ACUTA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology, epidemiology. The disease is caused by a filterable virus. Occurs as epidemics in autumn (August - October). During the year marked sporadic cases. Most often occurs in childhood (2 to 7 years); during periods of epidemics occurs in older children and adults. The main spread of infection occurs by intestinal; possible transfer and droplet infections. The disease may be sick and in the presence of abortive its manifestations, as well as healthy virus carriers. The virus of poliomyelitis may be detected in the stool of patients, nasal mucus, in some food products (milk), wastewater; stored up to 5 - 6 months. In areas where the epidemic had been new outbreaks do not reach large sizes.
The pathogenesis. Changes observed mainly in the anterior horns of the spinal cord in the acute period in the form of inflammatory phenomena, later there is a destruction of the ganglion cells. There have been changes in other parts of the nervous system. The infection takes root in the Central nervous system from the intestinal tract and nasopharynx perineurally lymphatic ducts.
Symptoms. The disease always occurs acutely, at a temperature of 39 - 40º. First, there is a headache, often vomiting, increased sweating, especially of the head, gastrointestinal disorders, pharyngitis. In the early period there is a meningeal syndrome, pain, hyperesthesia. Very early appear flaccid paralysis of the arms and legs with areflexia and atrophy of the muscles of the proximal parts. In accordance with the main localization process may yield different symptoms:
There is also infantile paralysis (polio) with a predominantly bulbar symptoms; in such cases, the disease sometimes occurs on the type of ascending paralysis of the legs and arms. Often abortive forms; some epidemics are characterized by predominantly these forms. Children often (up to 12 - 15) the main and predominant symptom is paralysis of the facial nerve in the peripheral type.
Recognition in typical cases in the acute stages is fairly easy. Unlike meningitis polio spinal fluid is clear, with a small limfotsitoz. From polyneuritis polio different proximal distribution of the paralysis, the asymmetry of their location, the absence of objective disorders of sensitivity. In chronic stages should be excluded myopathy, always progressive.
The patient must be hospitalized and to stay in the hospital for at least 40 days. Of the sick should be sent card emergency notification. Disinfection is carried out, as in the case of intestinal infections during periods of epidemics should be quarantined against children who had close contact with the patient and daycare settings. Children under 4 years of direct contact with patients, it is recommended to enter the serum parents (30 - 60 ml). During epidemics careful observation of children with acute catarray of the upper respiratory tract and unclear bowel disease to identify the possible presence of polio.
For disinfection use a solution of bleach, formalin, potassium permanganate, hydrogen peroxide, in which the virus dies in a short time.
The main method of treatment is the use of serum recover, injected intramuscularly for 10 - 20 ml for 8 - 10 days in a row, only 80 - 100 ml you Can also enter the serum combined method:, 5 to 10 ml vnutrispinalnaya to 10 - 15 ml intramuscularly. It is recommended that radiotherapy. The sooner it is applied radiotherapy and serotherapy, the greater the effect you would expect. Good influence of a warm bath (38 - 39º). Successfully used hypertonic solutions (glucose, sodium chloride), which reduces the swelling of the spinal cord and reduce intracranial and spinal pressure, intravenous infusion of 40% solution of urotropine (5 ml), vitamin C. When bulbar phenomena - injection of 0.2 - 0.5 ml of adrenaline (1 : 1 000); oseltamivir, due to the possible occurrence of pneumonia, was appointed penicillinate or sulfonamides. In stage residual paralysis - videoarchives treatment; if necessary - surgery. Diabetol 0,003 - 0,006 every other day for 10 days.