Poliovirus infection is 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.
Postpoliomyelitis 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 postpoliomyelitis syndrome, and treatment is mainly supportive.
Early physical therapy is key to maximizing and restoring limb function in paralytic poliomyelitis and in postpoliomyelitis 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.
Poliomyelitis is contracted through transmission of poliovirus, an enterovirus, usually through gastrointestinal-oral transmission. The condition may manifest as the minor illness, which is usually gastrointestinal, or as the major illness, characterized by acute flaccid paralysis (AFP). Ninety-five percent of poliovirus infections are asymptomatic. The classic clinical syndrome of poliomyelitis involves asymmetric 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). World Health Organization: poliomyelitis Opens in new window
History and exam
Key diagnostic factors
- unimmunized 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
Other diagnostic factors
- age <36 months
- gastrointestinal prodrome
- respiratory muscle atrophy and respiratory distress
- lack of vaccination
- poor sanitation
- area of endemic infection
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
gastrointestinal illness: poliovirus suspected
paralytic poliomyelitis (acute flaccid paralysis)
postpoliomyelitis syndrome (PPS)
Omar A. Khan, MD, MHS, FAAFP
President and CEO
Delaware Health Sciences Alliance
Physician Leader, Partnerships & Academic Programs
Christiana Care Health System
Department of Family & Community Medicine
Sidney Kimmel Medical College of Thomas Jefferson University
OAK is an author of a number of references cited in this topic.
David L. Heymann, MD, DTM&H
Professor of Infectious Disease Epidemiology
London School of Hygiene and Tropical Medicine
University of London
Centre on Global Health Security - Chatham House
DLH is an author of a number of references cited in this topic.
Javed M. Gilani, MD, FRCP, FACP
Assistant Clinical Professor
Jefferson Medical College
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
GP declares that he has no competing interests.
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