Polio Health Article

Definition

Poliomyelitis, also called polio or infantile paralysis, is a highly infectious viral disease that may attack the central nervous system and is characterized by symptoms that range from a mild nonparalytic infection to total paralysis in a matter of hours.

Description

There are three known types of polioviruses (called 1,2, and 3), each causing a different strain of the disease and all are members of the viral family of enteroviruses (viruses that infect the gastrointestinal tract). Type 1 is the cause of epidemics and many cases of paralysis, which is the most severe manifestation of the infection. The virus is usually a harmless parasite of human beings. Some statistics quote one in 200 infections as leading to paralysis while others state that one in 1,000 cases reach the central nervous system (CNS). When it does reach the CNS, inflammation and destruction of the spinal cord motor cells (anterior horn cells) occurs, which prevents them from sending out impulses to muscles. This causes the muscles to become limp or soft and they cannot contract. This is referred to as flaccid paralysis and is the type found in polio. The extent of the paralysis depends on where the virus strikes and the number of cells that it destroys. Usually, some of the limb muscles are paralyzed; the abdominal muscles or muscles of the back may be paralyzed, affecting posture. The neck muscles may become too weak for the head to be lifted. Paralysis of the face muscles may cause the mouth to twist or the eyelids to droop. Life may be threatened if paralysis of the throat or of the breathing muscles occurs.

Man is the only natural host for polioviruses and it most commonly infects younger children, although older children and adults can be infected. Crowded living conditions and poor hygiene encourage the spread of poliovirus. Risk factors for this paralytic illness include older age, pregnancy, abnormalities of the immune system, recent tonsillectomy, and a recent episode of excessively strenuous exercise concurrent with the onset of the CNS phase.

Causes and symptoms

Poliovirus can be spread by direct exposure to an infected individual, and more rarely, by eating foods contaminated with waste products from the intestines (feces) and/or droplets of moisture (saliva) from an infected person. Thus, the major route of transmission is fecal-oral, which occurs primarily with poor sanitary conditions. The virus is believed to enter the body through the mouth with primary multiplication occurring in the lymphoid tissues in the throat, where it can persist for about one week. During this time, it is absorbed into the blood and lymphatics from the gastrointestinal tract where it can reside and multiply, sometimes for as long as 17 weeks. Once absorbed, it is widely distributed throughout the body until it ultimately reaches the CNS (the brain and spinal cord). The infection is passed on to others when poor handwashing allows the virus to remain on the hands after eating or using the bathroom. Transmission remains possible while the virus is being excreted and it can be transmitted for as long as the virus remains in the throat or feces. The incubation period ranges from three to 21 days, but cases are most infectious from seven to 10 days before and after the onset of symptoms.

There are two basic patterns to the virus: the minor illness (abortive type) and the major illness (which may be paralytic or nonparalytic). The minor illness accounts for 80–90% of clinical infections and is found mostly in young children. It is mild and does not involve the CNS. Symptoms include a slight fever, fatigue, headache, sore throat, and vomiting, which generally develop three to five days after exposure. Recovery from the minor illness occurs within 24–72 hours. Symptoms of the major illness usually appear without a previous minor illness and generally affect older children and adults.

About 10% of people infected with poliovirus develop severe headache and pain and stiffness of the neck and back. This is due to an inflammation of the meninges (tissues which cover the spinal cord and brain). This syndrome is called "aseptic meningitis." The term "aseptic" is used to differentiate this type of meningitis from those caused by bacteria. The patient usually recovers completely from this illness within several days.

About 1% of people infected with poliovirus develop the most severe form. Some of these patients may have two to three symptom-free days between the minor illness and the major illness but the symptoms often appear without any previous minor illness. Symptoms again include headache and back and neck pain. The major symptoms, however, are due to invasion of the motor nerves, which are responsible for movement of the muscles. This viral invasion causes inflammation, and then destruction of these nerves. The muscles, therefore, no longer receive any messages from the brain or spinal cord. The muscles become weak, floppy, and then totally paralyzed. All muscle tone is lost in the affected limb and the muscle becomes soft (flaccid). Within a few days, the muscle will begin to decrease in size (atrophy). The affected muscles may be on both sides of the body (symmetric paralysis), but are often on unbalanced parts of the body (asymmetric paralysis). Sensation or the ability to feel is not affected in these paralyzed limbs.

When poliovirus invades the brainstem (the stalk of brain which connects the two cerebral hemispheres with the spinal cord; called bulbar polio), a person may begin to have trouble breathing and swallowing. If the brainstem is severely affected, the brain's control of such vital functions as heart rate and blood pressure may be disturbed. This can lead to death.

The maximum state of paralysis is usually reached within just a few days. The remaining, unaffected nerves then begin the process of attempting to grow branches which can compensate for the destroyed nerves. Fortunately, the nerve cells are not always completely destroyed. By the end of a month, the nerve impulses start to return to the apparently paralyzed muscle and by the end of six months, recovery is almost complete. If the nerve cells are completely destroyed, however, paralysis is permanent.