History

Most patients infected with poliovirus develop inapparent infections and are frequently asymptomatic.

In cases of abortive poliomyelitis (5-10%), a history of the following is found with normal neurologic examination findings:

Anorexia
Vomiting
Abdominal pain
Duration of illness usually less than 5 days

When nonparalytic poliomyelitis develops, symptoms are usually those observed in abortive disease in addition to meningeal irritation.

Paralytic poliomyelitis involves systemic manifestation, such as respiratory failure, in addition to symptoms observed in nonparalytic poliomyelitis.

Patients who have recovered from poliomyelitis occasionally develop a post-poliomyelitis syndrome, in which recurrences of weakness or fatigue are observed and which usually involve groups of muscles that were initially affected. This postpolio syndrome may develop 20-40 years after infection with poliovirus and constitutes a persistent healthcare problem, even in countries in which poliomyelitis has been eradicated.^{[17, 7, 18]}

Physical Examination

The spectrum of disease varies from inapparent infection to paralytic disease.

In mild cases, the following nonspecific signs and symptoms are observed and usually resolve within a few days:

Fever
Headache
Nausea
Vomiting
Abdominal pain
Oropharyngeal hyperemia

Nonparalytic poliomyelitis is characterized by the symptoms described above in addition to the following:

Nuchal rigidity
More severe headache
Back and lower extremity pain
Meningitis with lymphocytic pleocytosis (usually)

Paralytic poliomyelitis occurs in fewer than 5% of affected patients and is characterized by the following:

Compromise of the motor neurons may be localized or widespread.
More frequently, asymmetric loss of muscle function is observed with involvement of major muscle groups.
Muscle atrophy is generally observed several weeks after the beginning of symptoms.
Recovery may be complete, partial, or absent.

Differential Diagnoses

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Poliovirus. Pediatrics. 2011 Oct. 128(4):805-8. [QxMD MEDLINE Link].
Link-Gelles R, Lutterloh E, Schnabel Ruppert P, et al. Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022. MMWR Morb Mortal Wkly Rep. 2022 Aug 19. 71 (33):1065-68. [QxMD MEDLINE Link]. [Full Text].
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Stewardson AJ, Roberts JA, Beckett CL, et al. Imported case of poliomyelitis, Melbourne, Australia, 2007. Emerg Infect Dis. 2009 Jan. 15(1):63-5. [QxMD MEDLINE Link].
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Polio Outbreak in Syria Poses Vaccination Dilemma for WHO. Medscape. Available at http://www.medscape.com/viewarticle/881378. June 09, 2017; Accessed: June 16, 2017.
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Media Gallery

The typical contractures of postpolio residual paralysis.

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Author

Benjamin Estrada, MD Professor, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine, University of South Alabama Children's and Women's Hospital

Benjamin Estrada, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD, FACP Editor-in-Chief, ID Cases; Moderator, Program for Monitoring Emerging Diseases; Adjunct Professor of Medicine, State University of New York Downstate College of Medicine

Larry I Lutwick, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American Association for the Study of Liver Diseases, American College of Physicians, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, Infectious Diseases Society of New York, International Society for Infectious Diseases, New York Academy of Sciences, Veterans Affairs Society of Practitioners in Infectious Diseases

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Winthrop University Hospital; Professor of Pediatrics, Stony Brook University School of Medicine

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Pediatric Poliomyelitis Clinical Presentation

History

Physical Examination

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