Poliovirus infection

Last reviewed: June 2019

Last updated: March 2019

Summary

Usually asymptomatic. When symptomatic, the most common presentation is a minor gastrointestinal illness.

Acute flaccid paralysis (AFP), or paralytic poliomyelitis, is the hallmark of the major illness. A minority of affected cases with AFP progress to life-threatening bulbar paralysis and respiratory compromise.

Post-poliomyelitis syndrome may occur many years after the initial illness, and consists of weakness and fatigue in muscle groups previously affected in the acute illness.

There is no cure for poliovirus infection or post-poliomyelitis syndrome, and treatment is mainly supportive.

Early physiotherapy is key to maximising and restoring limb function in paralytic poliomyelitis and in post-poliomyelitis syndrome.

The cornerstones of poliomyelitis eradication initiatives are oral vaccines containing attenuated poliovirus (OPV) (Sabin) in disease-endemic, outbreak-affected areas and recently polio-free countries of the world, and inactivated poliovirus vaccine (IPV) (Salk) in the rest of the world, in countries where the risk of vaccination-associated paralytic polio is considered greater than the risk of naturally occurring infection.

Definition

Poliomyelitis is contracted through transmission of poliovirus, an enterovirus, usually through gastrointestinal-oral transmission. [1] The condition may manifest as the minor illness, which is usually gastrointestinal, or as the major illness, characterised by acute flaccid paralysis (AFP). Ninety-five percent of poliovirus infections are asymptomatic. The classic clinical syndrome of poliomyelitis involves asymmetrical paralysis of the affected limb (usually the lower extremities). There is no specific treatment, nor reservoir in nature, making vaccination and global eradication a major priority for the World Health Organization (WHO). [2]

History and exam

Key diagnostic factors

unimmunised status
residence or travel in endemic area
decreased tone and motor function of affected limb
decreased tendon reflexes of affected limb
muscle atrophy of affected limb

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Other diagnostic factors

age <36 months
gastrointestinal prodrome
fever
malaise
respiratory muscle atrophy and respiratory distress

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Risk factors

lack of vaccination
poor sanitation
poverty
area of endemic infection
immunosuppression

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Diagnostic investigations

Investigations to consider

virus culture from stool, CSF, or pharynx
CSF analysis
serum antibodies to poliovirus
MRI of spinal cord
electromyelogram (EMG) of affected limb

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Treatment algorithm

INITIAL

Contributors

Authors VIEW ALL 

Omar A. Khan, MD, MHS, FAAFP

President and CEO

Delaware Health Sciences Alliance

Physician Leader, Partnerships & Academic Programs

Christiana Care Health System

Associate Professor

Department of Family & Community Medicine

Sidney Kimmel Medical College of Thomas Jefferson University

Newark

Disclosures

OAK is an author of a number of references cited in this monograph.

David L. Heymann, MD, DTM&H

Professor of Infectious Disease Epidemiology

London School of Hygiene and Tropical Medicine

University of London

Head

Centre on Global Health Security - Chatham House

London

Disclosures

DLH is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL 

Javed M. Gilani, MD, FRCP, FACP

Assistant Clinical Professor

Jefferson Medical College

Philadelphia

Disclosures

JMG declares that he has no competing interests.

Gregory Pappas, MD, PhD

The Nordin M. Thobani Professor and Chairman

Department of Community Health Sciences

Aga Khan University

Karachi

Pakistan

Disclosures

GP declares that he has no competing interests.

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Poliovirus infection

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

Investigations to consider

Treatment algorithm

gastrointestinal illness: poliovirus suspected

paralytic poliomyelitis (acute flaccid paralysis)

post-poliomyelitis syndrome (PPS)

Contributors

Authors VIEW ALL 

Omar A. Khan, MD, MHS, FAAFP

Disclosures

David L. Heymann, MD, DTM&H

Disclosures

Peer reviewers VIEW ALL 

Javed M. Gilani, MD, FRCP, FACP

Disclosures

Gregory Pappas, MD, PhD

Disclosures

Differentials

Guidelines

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