ICD-10-code Poliomyelitis
A80.0 Acute paralytic Poliomyelitis by virus
A80.1 Acute paralytic poliomyelitis by imported wild virus
A80.2 Acute paralytic poliomyelitis by indigenous wild virus
A80.3 Other and unspecified acute paralytic Poliomyelitis
A80.4 Acute poliomyelitis nichtparalytische
A80.9 Acute poliomyelitis, unspecified

The poliomyelitis (anterior acute epidemica) (older, taught Greek πολιομυελιτις, new πολιομυελιτιδα “inflammation of the gray Marks”, by πολιος “gray” and μυελος “the Mark”), short polio, polio or German Heine-Medin disease; Polio is a virus-induced infectious disease which in the unvaccinated muskelsteuernden neurons of the spinal cord and infect permanent paralysis to death.

Most are children aged three to eight years, sometimes-older patients until adulthood affected. Since it is a viral disease, there is no causal treatment. Through consistent polio vaccination in Some parts of the world was completely eliminated.

Excitation

The pathogen of this disease, is the poliovirus. It is an unbehülltes single-stranded RNA virus with positive polarity (ss (+) RNA) of approximately 30 nanometers in diameter to the enterovirus genus of the family Picornaviridae heard. There are three known serotypes: type I (Brunhilde), as most lähmungsauslösend and is prone to epidemic spread, along with Type II (Leon) and type III (Lansing). Between the three types of pathogens, there is no cross-immunity. This means that an infection with one of the three types does not protect against further infection with one of the other two guys! Besides the people are also infected monkeys.

Epidemiology

The pathogen is except in the Polar Regions around the world to be. Through consistent implementation of vaccination is the frequent occurrence of the disease to areas in Africa and Asia have been pushed back. In Some parts of the world, the last polio infection with the 1990th the last introduced infections registered in 1992. In the U.S. there were in 1979 in the states of Iowa, Wisconsin, Missouri and Pennsylvania, an outbreak only under the strictly devout Amish. Another outbreak was in October 2005, only trailers for this faith community in Minnesota reported. In Western Europe occurred in 1992 in the Netherlands, the last polio epidemic. There were members of fundamentalist Calvinist communities affected which like most Amish also vaccinations for religious reasons refused and still do it.

Worldwide there are approximately 1,000 new cases of the wild per year, up to date, especially in Nigeria, India, Somalia, Pakistan and Afghanistan, but also particularly because of rising Impfskepsis again sporadically in the developed nations. The World Health Organization (WHO) wants in the next few decades, the polio virus, similar to that in the 1970s, smallpox, eradicated worldwide, the pathogen appears to be adequate as it is practically not changed and in fact only the people has as a reservoir. Essential for the success of this project is not, however, a slowdown in the world’s vaccinations because the virus is environmentally stable and quasi-”starved” to be, so that it will no longer host. A high immunization rate worldwide over the years is mandatory.

The virus is under poor hygienic condition stuhlverschmutzte by hands or objects, and the digestive tract (fecal-oral contact or smear infection). But it is also spreading through droplet infection. The ability of infection is obviously only a few hours after infection of A. In the throat (droplet infection) where it considers, in the chair three to six weeks. The incubation period is 7-14 (3-35) days.

Pathogenesis

The virus is usually through the mouth into the body and then multiplies in the intestine. From there, initially infects local lymph nodes and spread after propagating through the blood (viraemia). It arrives as a neurotropic virus preferentially in those neurons in the front horn of the spinal cord (α-motoneurons), and their survival rates, the striated muscles, and control. In response to the infection migrate body’s own immune cells (leukocytes) into the spinal cord, with an inflammation which ultimately destroys nerve cells. The consequences are more or less distinct, unevenly distributed, tired paralysis, mainly on the legs. The sense of touch remains intact.

In addition to the infestation of the spinal cord is in the paralytic form is almost always also affected the brain itself, so that exakterweise by a Poliomyeloencephalitis be spoken. Especially in the area of the cerebellum, the bridge and the extended Marks occur regularly immigration of inflammatory cells (inflammatory infiltrates), and nerve cell sunsets on. These rarely lead to there own symptoms. Only the front horn cells of spinal neurons in the analog cranial nerve nuclei of the IX. And X. Cranial nerves are more frequently affected. Due to the infestation of these cell leads to the dreaded Bulba form, in which the laryngeal functions (speaking and breathing), or swallowing may be affected.

Such paralysis may be even within a few hours after infection of the nervous system occurs.

Disease, symptoms

In 90 to about 95 percent of cases the infection is completely asymptomatic (without symptoms), so that no disease can be spoken. Instead, it is – from infected unnoticed – to the formation of antibodies, thus leading to a so-called silent Feiung.

Abortive Poliomyelitis

After an incubation period of 7-14 days there is a roughly three-illness with fever, sore throat, fatigue diarrhea and often vomiting. For a good three-quarters of these patients healed abortive poliomyelitis (abortive for “abbreviated, has lost”) consequences from. The cells of the central nervous system (CNS) are not infected.

Infection with CNS involvement

Approximately 5-10 percent of those infected it may be a participation of the central nervous system, in which the above symptoms Prodromalstadium the (preliminary) of the disease present. After a frenetic and beschwerdfreien period of about a week, these patients develop nichteitrige meningitis (aseptic meningitis), the paralysis (paralysis) of the muscles are missing (nichtparalytischen poliomyelitis). This form of meningitis is characterized by a recurrence of fever rise to 39-° C, headache and neck stiffness characterized. If the spinal fluid (water the nerve, the cerebrospinal fluid) were analyzed, the doctor finds that an increase in cell number and a slight increase in protein concentration.

Only about 1 percent of infected people is on the development of paralytic poliomyelitis, the most serious form of the disease, referred to, as “classic polio” is feared. This may include a fever and symptom-free latency of approximately 2-12 days to happen, in which the symptoms of meningitis initially improve, leading to a two-phase (biphasichen) History comes (end of the disease can be divided into two phases will be). Characterized by the sudden start of the paralytic form of phase is a “morning paralysis” on the eve of the still healthy child. The paralysis is flaccid (as opposed to spastic paralysis with damage to the motor cortex or pyramidal tract), asymmetrically distributed, prefers the muscles of the thighs and is often associated with significant pain. If the corresponding segments of the spinal cord are involved, but also the muscles of the torso, between rib spaces, bladder, rectum or even the diaphragm affected. Much rarer are the areas of origin of the cranial nerves (cranial nerve nuclei) are affected. In this form Bulba is at a high temperature to swallowing or respiratory and circulatory regulation disorders. This serious form has a high mortality burden. Any additional burden, for example, in the form of physical exertion or banal interventions such as injections into a muscle or tonsillectomy, especially in the early stages of the disease increases the risk for subsequent paralysis. For all of the patients with paralysis occurs, the mortality (death) at around 2-20%.

Late

Usually the symptoms are formed within a year back, but can be paralysis; circulatory and skin disorders as a diet duration damage left behind. Also joint damage due to the paralysis and the changing static’s of the spine such as scholiasts and foot deformities are permanent impairment dar. Braked A linear growth of individual limbs can be affected in the growth of the child to make disability. After initially Entfieberung is no further progression of paralysis to be expected. Partially until years or decades after the infection occurs but the post-polio syndrome as late on. Its symptoms are extreme tiredness, muscle pain and muscular atrophy in new and previously affected muscles, breathing and swallowing. These late seem more the rule than the exception to be.

Diagnostic

Clinically doppelgipfelige directs the course of a fever at the latest, at the onset of paralysis on suspicion of the existence of poliomyelitis. The virus can be removed from the chair, from Rachenspülwasser and water from the brain (cerebrospinal fluid cerbrospinalis) angezüchtet is. Also, the molecular biological detection of viral genetic information (RNA) using polymerase chain reaction (PCR) is possible. In the absence of pathogen detection in serum may be specific antibodies against the polio virus diagnosis secure.

Differential Diagnosis

During the first phase of the disease poliomyelitis against all feverish infections by other pathogens should be delineated. Symptoms of meningitis, also occur with paralysis, can also by other agents of the group of enteroviruses like Coxsackie and echo-viruses and Frühsommermeningoenzephalitis caused. When Bulba is the form in our latitudes also rare Diphtheria is an important differential diagnosis; Whereas the Guillain-Barré syndrome is in contrast to the symmetric of poliomyelitis by the feet ever ascending paralysis marked. Nackensteife as fever and signs of meningitis are lacking.

Therapy

Since no causal antiviral therapy exists, the treatment is limited to symptomatic measures. This includes bed rest to ensure a careful maintenance, proper storage and physical therapies. The pain can occur except by painkillers (analgesics) and anti-inflammatory agents (anti) with warm moist packs to the affected lots will be soothed. At the slightest suspicion of the existence of the threatening Bulba phenotype with onset of swallowing or respiratory disorders should be an early intensive medical monitoring and treatment must be ensured. For post-treatment addition of appropriate physiotherapy and, where appropriate, the supply of orthopedic appliances (orthotics). This can be up to two years after the acute disease, improving the mobility can be achieved.

Prevention

Vaccination

To prevent a possible prophylactic vaccination and by the STIKO generally recommended. In the year 1962 (already in the GDR from 1960) was the first sip of poliomyelitis vaccination with attenuated organisms (live attenuated vaccine) in Some parts of the world as in other European countries. As early as 1965, only four years after the first vaccination campaigns, had the number of federal territory covered illness to less than 50 new cases reduced, in comparison to the 4,670 new cases reported in 1961 was a decrease of 99%. The last two diseases caused by indigenous wild poliovirus occurred in Some parts of the world in the years 1986 and 1990, the last imported cases recorded in 1992.

Vaccination with the attenuated, but viable and REPRODUCTIVE viruses, however, poses the risk that those with the chair of the so-vaccinated persons expelled again. This will allow unvaccinated contact persons on a smear infection or contact infection infect (Impfpoliomyelitis). Also through improper and reckless handling of the live vaccine is a possible infection. Since the polio from Europe is now largely disappeared, this risk of infection is no longer considered acceptable. Since 1998 is, therefore, vaccination against poliomyelitis with inactivated vaccine, which is no longer swallowed, but is injected. The transfer of the pathogen is no longer possible.

Isolation

Patients with poliomyelitis are ill or are liable to elimination of polio virus is suspected, should be to protect other patients and staff will be isolated. The staff should be in the care and protection gown gloves.

History

Already in ancient times was the polio known as typical representations of the deformed limbs paralyzed from ancient Egypt shows? 1838 Jacob von Heine reported on the nature of Freiburg researchers Assembly of acute paralysis of the legs in children. Two years later he described the clinical picture under the name of Spinal polio in a monograph and limited than it did first from their own. Other authors described it as a major consequence of the paralysis or atrophic polio. Jean Louis Prevost and Vulpian Edmé 1865 described the pathological-anatomical changes in the front horn cells. Adolf Kussmaul underlined the anatomical localization of the disease in the gray matter of the spinal cord and suggested the name of the first 1874 poliomyelitis acuta anterior before. Adolf Strumpet of 1884 recognized the disease as infectious disease. When it Stockholm area in 1887 to an accumulation of disease cases, was the poliomyelitis by Karl Oskar Median as an epidemic disease. Later, by the name of Ivan Wickmann Heine-Medin disease, which does not enforce. 1909 succeeded Karl Landsteiner and Popper Hugo, monkeys poliomyelitis einzuimpfen and they described the neurotropic filterable virus. A year later came the discovery that the serum of convalescent from large epidemics of poliomyelitis in Scandinavia and the United States can neutralize this virus (Neutralisationsreaktion). It lasted until 1939, from Armstrong to the differentiation of three different types has been confirmed. 1952 enabled the introduction of viral culture by JF Enders, not just the end of animal testing, but eventually the development of inactivated vaccine by Jonas Salk in 1954 and the attenuated live vaccine by Albert Sabin 1960th

While it has previously usually isolated cases had acted, the spread of polio until the turn of the century range from threatening and remained in the first half of the 20th Century, a dreaded disease. In Europe and the United States were regional epidemics in a cycle of about 5-6 years, while in the intervals repeatedly came to sporadic cases. Major outbreaks, for example, in 1932 in Some parts of the world (3,700 cases), 1934 in Denmark (4,500 cases) or 1916 in the State of New York (more than 13,000 cases), where only the paralytic forms have been registered.

In the area of treatment, the development of measures for artificial respiration, initially in the form of the iron lung, a Thinning of the mortality of the dreaded poliomyelitis. The equally frequent permanent paralysis can still barely affect therapeutically, so that until the widespread introduction of vaccination led to the polio begins an historic illness to be.