Poliomyelitis Clinical Review Essay

Introduction

Poliomyelitis is a highly contagious disease that can debilitate an individual into paralysis and long lasting muscle weakness. Although the last polio epidemics occurred in Australia in the early 1960’s, there are tens of thousands of polio survivors (Gandevia, Allen & Middleton, 2000). Eradication of the virus through vaccines such as IPV (inactivated poliovirus vaccine) and OPV (oral poliovirus vaccine) was essential to ensure this epidemic could be ceased, which in developed counties it has been, underdeveloped countries however are still under the threat of the virus due living conditions. In ALS ambulance there is no direct treatment for the poliomyelitis disease be that as it may hospitals would be equipped to treat such patients.

Pathophysiology of Poliomyelitis

Poliomyelitis is an infectious disease of the neuromuscular system caused by the Enterovirus. Only about 5% of cases show signs or symptoms of the disease, depending on which form of the person acquires (Gandevia et al., 2000). There are three categories of the virus that may affect individuals which are mild polio, nonparalytic polio and paralytic polio. Mild polio exhibits similar symptoms to that of a typical intestinal infection such as nausea, vomiting and a minor fever for approximately three days. Following these few days the individual will recover as the virus is defeated by the immune system before in can further develop into a more serious form (Hecht, 2008). In nonparalytic polio the individual will have similar symptoms of mild polio with the increase of fever, muscle pain and fatigue; no paralysis occurs in this form. It can also be referred to as aseptic meningitis (Hecht, 2008). The paralytic form of polio firstly causes the person to develop a stiff neck and back that can also incorporate muscle spasms, high fever, irritability and headaches. Muscle weakness has the ability to come on very quickly and can develop into paralysis as the virus spreads throughout the bloodstream and lymph system, it then affects the central nervous system through the anterior portion of the spinal cord which innervates muscle movements such as contraction and relaxation. The extent of the damage determines the extent of paralysis. If the cells are simply damaged then paralysis may only be temporary and the person may developing long or short lasting muscle weakness or can possibly recover full use of muscle function, however if the nerves are completely destroyed the paralysis is permanent as nerve cells are unable to be regenerated (Wilson, 2009). Approximately 1% of cases are the severe paralytic form of polio (Hecht, 2008).  In severe cases the virus may paralyse muscles that innervate urination, swallowing and respiratory function. If the virus affects the medulla oblongata, the structure that controls the breathing, a person develops bulbar polio which without the help of the ‘Iron lung’ – a large metal machine that covers the patient head to toe sealing around the neck regulating air pressure surrounding a patients chest, therefore allowing air to be pulled into the lungs of a person who cannot breathe on their own – the patient wouldn’t be able to breathe and death would occur (Hecht, 2008). The progression of paralysis usually stops in less than a week, after which there is a period of stability followed by some degree of gradual recovery of function (Stibrant Sunnerhagen & Grimby, 2001), which involves the reinnervation of muscles by the muscle fibres from motor neurons which survived the initial virus.

The disease spreads from person to person through infected mucus and contaminated faeces. In less developed countries with poor sanitation, contaminated sewerage comes into contact with drinking water and food which then causes the virus to spread. The virus can also spread through human contact, although most common in children both adolescents and adults can contract the disease (Wilson, 2009). A common avenue of exposure to the virus was not washing your hands after using the bathroom.

The virus enters by the means of the nose and mouth, but the initial infection occurs in the throat and intestinal tract. Once there the cells replicate making thousands, then passing through the intestinal tract into the blood and lymph were it then target the spinal cord and brain stem attacking motor neurons, then eventually passing into faeces. Afterward leading into sewerage where the process starts again affecting more of the population (Hecht, 2008). Humans are the only host bodies for the virus.

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