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Key Features

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  • Poliovirus infection is asymptomatic in 90–95% of cases

  • Presents as acute febrile illness in about 5% of cases, and aseptic meningitis, with or without paralysis in 1–3%

  • Has been eliminated with the use of oral polio vaccines (OPV) in > 99% of the population with the only endemic areas now in Nigeria, Pakistan, and Afghanistan

  • Occasional cases in the United States have occurred in unprotected travelers to foreign countries or in populations with low polio vaccine coverage who come in contact with visitors from endemic areas

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Clinical Findings

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  • Fever, myalgia, sore throat, and headache for 2–6 days are presenting symptoms

  • In less than 5% of infected children, several symptom-free days are followed by recurrent fever and signs of aseptic meningitis: headache, stiff neck, nuchal rigidity, and nausea

  • Mild cases resolve completely

  • In only 1–2% of those infected, high fever, severe myalgia, and anxiety herald progression to loss of reflexes and subsequent flaccid paralysis

  • Sensation remains intact, although hyperesthesia of skin overlying paralyzed muscles is common and pathognomonic

  • Paralysis is usually asymmetrical

  • Bulbar involvement affects swallowing, speech, and cardiorespiratory function and accounts for most deaths

  • Bladder distention and marked constipation characteristically accompany lower limb paralysis

  • Paralysis is usually complete by the time the temperature normalizes

  • Atrophy is usually apparent by 4–8 weeks

  • Most improvement of muscle paralysis occurs within 6 months

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Diagnosis

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  • PCR is now the method of choice for detection

  • In patients with meningeal symptoms, cerebrospinal fluid shows a lymphocytic pleocytosis and a normal glucose with mildly elevated protein concentration

  • Poliovirus is easy to grow in cell culture

  • Rarely isolated from spinal fluid but is often present in the throat and stool for several weeks following infection

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Treatment

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  • Supportive

  • Bed rest, fever and pain control (heat therapy is helpful), and careful attention to progression of weakness (particularly of respiratory muscles) are important

  • No intramuscular injections should be given during the acute phase

  • Intubation or tracheostomy for secretion control and ventilation, enteral feeding and catheter drainage of the bladder may be needed

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