Pediatric Poliomyelitis Clinical Presentation

Updated: Jun 29, 2017
  • Author: Benjamin Estrada, MD; Chief Editor: Russell W Steele, MD  more...
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Presentation

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. [14, 6, 15]

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Physical

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.
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Causes

Polioviruses are enteroviruses within the Picornaviridae family. These viruses are resistant to ether and chloroform but can be inactivated by formaldehyde. They multiply in the GI tract but are particularly neurotropic.

Documentation suggests that infections with polioviruses can be potentiated by factors such as exercise and tonsillectomy. Additionally, patients who are immunocompromised, such as those with human immunodeficiency virus (HIV) infection, B-cell disfunction, immunoglobulin A (IgA) deficiency, or severe combined immunodeficiency, are particularly at high risk of developing poliomyelitis when exposed to both wild-type polioviruses and vaccine-attenuated viruses present in the oral poliovirus vaccine.

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