Polio

Symptoms Of Polio 

The effects range from asymptomatic (most common) to the most severe forms of debilitating paralysis. Various symptoms are discussed below:

1. Non-Paralytic Polio
About 95% of people who get infected with polio won't have any symptoms. They are able to fight off the infection without even realizing they are infected. 

In approximately a few cases, 4%–8% of polio infections result in a minor illness without any evidence of central nervous system invasion. This is known as abortive poliomyelitis. Complete recovery usually occurs in less than a week.

Few people experience a flu-like illness for 3 to 21 days after they are infected. The symptoms observed in this type of infection are: 

• High temperature (fever) of 100.4F or above

• Headache

• Abdominal pain

• Sore throat 

• Gastrointestinal disturbances (nausea and vomiting)

2. Paralytic Polio 
Around 1 percent of cases can lead to paralytic polio. Paralytic polio causes paralysis of the spinal cord, brainstem, or both. The early symptoms are related to nonparalytic polio. But after a week, severe symptoms appear like 

• Muscle weakness 

• Tight joints (contractures)

• Shrinking of the muscles (atrophy)

• Deformities, such as twisted hips, feet, or legs

• Loss of reflexes 

• Sudden paralysis (temporary or permanent)

Many people with paralytic poliomyelitis recover completely, and muscle function returns to some degree in several cases. 

3. Post-Polio syndrome (PPS)
Polio can return even after 15 to 40 years of recovery. Some common symptoms of Post Polio syndrome include

• Easily exhausted or fatigued

• Low tolerance to cold temperatures

• Worse muscle pain

• Muscle atrophy

• Trouble with concentration and memory

It has been estimated that 25-50 percent of people who survive polio will get PPS. 

Causes Of Polio 

Polio is a highly infectious disease caused by the poliovirus.

Poliovirus only infects people. An infected individual can spread the virus to others before or up to 2 weeks after symptoms appear. An asymptomatic carrier can also infect others.

The poliovirus can survive in an infected person's intestines for many weeks. This can lead to the contamination of food and water in an unclean environment. Transmission can occur in the following ways:

• Contact with the feces of an infected person

• Droplets from a sneeze or cough of an infected person

• Touching contaminated surfaces.

• Close contact with an infected person.

Risk Factors For Polio 

Polio tends to affect the most vulnerable members of the population. This includes pregnant, young children, and those with weakened immune systems. 

Various risk factors for contracting the infection are as follows:

• Not vaccinated against polio

• Travel to countries where polio is widespread or endemic, like Pakistan or Afghanistan. 

• A weakened immune system

• Tonsillectomy or having tonsils removed

• Handling of a laboratory specimen of the virus

Diagnosis Of Polio 

A general practitioner diagnoses polio by a detailed medical history, performing a physical exam, and testing samples of body fluids.

Medical history 

This includes taking information like any travel to an area where polio is endemic or any contact with a person infected with polio.

Physical examination 

This involves a complete body check-up. The function of respiratory muscles is examined as polio affects the spinal cord and the brain stem, which may infect the respiratory muscles. The muscle reflexes are also evaluated as there may be stiff neck and back muscles or difficulty lifting the head or legs while lying flat on the back.

Laboratory diagnosis 

The following tests help in the diagnosis and confirmation of polio infection:  

Virus isolation and detection 

Virus isolation in culture is the most reliable method for diagnosing poliovirus infection. Poliovirus is usually isolated from stool specimens or throat swabs. Two samples are collected at least 24 hours apart from patients with suspected poliomyelitis to increase the chances of isolating poliovirus.

Cerebrospinal fluid analysis 

The cerebrospinal fluid (CSF) can also be used for diagnostic testing of the virus. CSF is collected using a lumbar puncture (also called a spinal tap), in which a needle is inserted into the spinal canal to collect CSF.

Blood tests 

Blood is tested for antibodies for poliovirus, produced by the body in defense against an invading virus or bacteria.

Electromyogram (EMG) 

EMG measures electrical activity in response to a nerve's muscle stimulation. This test is used to help detect any neuromuscular abnormalities and differential diagnosis of muscle weakness in post-polio syndrome.

Fingerprinting the polio virus 

Poliovirus is isolated and tested by a particular test called oligonucleotide mapping (fingerprinting) or genomic sequencing. This test helps look at the virus's genetic sequence to screen if the virus's origin is wild-type or vaccine-like. Wild-type viruses naturally occur in the environment, whereas a vaccine-like virus is derived after a spontaneous mutation of the virus's genes. 

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Specialist To Visit

There's currently no cure for polio, so treatment focuses on managing symptoms and improving the quality of life. A team often treats patients with different healthcare professionals. This is called a multidisciplinary team (MDT) of doctors.

The multidisciplinary team of doctors includes

• General physician: Diagnoses polio by taking a detailed medical history, performing a physical exam, and advising necessary diagnostic tests.

• Neurologists: Specialize in the treatment of problems affecting the nervous system. 

• Mobility specialist: Advice about mobility aids, such as walking sticks and wheelchairs.

• Physiotherapist: Help patients improve their range of movement and coordination

• Respiratory consultant: Deal with problems affecting breathing

• Rehabilitation consultant: A specialist in managing complex disabilities

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Prevention Of Polio 

There is currently no treatment for polio. However, it is a vaccine-preventable disease. 

Vaccination is usually done in childhood. If you are not vaccinated as a child, ask your healthcare provider about your vaccination. 

A healthcare professional will recommend four polio shots in childhood:

1. First shot at 2 months

2. Second shot at 4 months

3. Third shot between 6 and 18 months

4. Booster shot between 4 and 6 years

If a person is not vaccinated in childhood and is recommended to get vaccinated as an adult, that person will get three shots:

1. Two doses 1-2 months apart

2. A third dose is 6-12 months after the second

There are two types of vaccines: 

1. Inactivated polio vaccine (IPV): The IPV contains poliovirus that is treated ("killed") so that it cannot multiply anymore. It has an inactive version of polio strains types 1, 2, and 3. IPV is administered as a series of shots (injections). 

2. Oral polio vaccine (OPV): This is also known as the live attenuated polio vaccine. It uses a live virus that has been weakened (attenuated) and cannot make you sick. However, it creates an immune response in the intestines called mucosal immunity, which protects from polio infection. It is given in a liquid form orally.

Treatment Of Polio 

There is no cure for polio. The management of this condition focuses on increasing comfort, speedy recovery, and preventing complications. Supportive treatments include:

Pain relief medications

Over-the-counter medication such as aspirin, paracetamol, or ibuprofen, and stronger NSAIDs and opiates can be prescribed by the doctor to help relieve pain. But these medications should not be taken for a long time as they can cause side effects, such as stomach ulcers. If these medications don't work, the physician may prescribe medicines like gabapentin for pain.

Rest and exercise 

Staying active is beneficial for most people with post-polio syndrome, as it may slow down progressive muscle weakness. However, patients may find it challenging to stay active as symptoms may worsen over some time. 

To overcome this issue, "pacing" techniques may be recommended. This involves

1. Prioritizing tasks 

2. Taking regular breaks and rest during the day

3. Doing regular gentle exercise 

Physical or occupational therapy 

Physical therapy aims to ease pain and helps to function, move, and live better. This can help alleviate arm or leg weakness caused by polio and improve long-term outcomes, primarily if implemented early in the illness. 

Mobility aids 

Mobility aids are designed to assist in walking or improve the mobility of people with a mobility impairment. These include

1. Wheelchairs

2. Walking sticks 

3. Braces to support weakened muscles or joints

Shoe inserts 

The physical deformities with polio tend to affect the extremities and limbs. The physical effects of polio can lead to changes in gait and bone structure, and shoe inserts help move around without causing pain. 

Using cold and heat compression 

Alternate applications of heat and cold can help to relieve muscle pain and tension.

Managing the psychological impact 

PPS can lead to a significant psychological impact as it can trigger anxiety, isolation, stress, and depression. Therefore, managing the symptoms and improving the quality of life is essential. 

Healthy eating and managing weight 

Being overweight can further strain weakened muscles and hurt energy levels and general health. A well-balanced and nutritious diet will help control weight and improve your overall health. 

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Complications Of Polio 

• The most significant complications of polio infection include paralysis, fatal respiratory and cardiovascular collapse, and Post-polio syndrome (PPS). 

• It has been estimated that up to 30 to 40% of the 15 to 20 million known polio survivors worldwide develop some form of PPS. It has been characterized by new-onset or progressive muscle weakness in a patient previously diagnosed with poliomyelitis.

• The other symptoms include myalgias, respiratory distress, joint pain, atrophy, dysphagia, and generalized fatigue.

• Paralysis can often cause problems with breathing, swallowing, and bowel and bladder functioning. 

Alternative Therapies of Polio

Massage Therapy

Massage under medical supervision can help a great deal to relieve muscle aches and pains. Targeting the right muscle areas for a perfect massage to relieve the symptoms is imperative. Applying herbal oils can also help enhance the effects of a massage and add to the relaxing effect.

Hydrotherapy 

Hydrotherapy can do wonders for polio survivors due to reduced gravity and buoyancy,  especially when the body is undergoing a lot of strain. A few hours in a swimming pool or tub for sore and aching joints relieve the muscles.

Living With Polio 

Polio can have various adverse effects on the patient's lifestyle, depending on the severity of the symptoms. The challenge or ease of living with polio varies for each survivor, subject to the availability of medical care and rehabilitation opportunities and their family and social support. Various forms of rehabilitation and support include:

• Polio patients often require assistive devices for movements, such as braces, canes, orthotics, and wheelchairs, so they can individually also take care of the daily chores of life. 

• Physical or occupational therapy can also help ease pain and enable them to function, move, and live better.

• Emotional and caretaking are also required by the person dealing with polio. As this ailment can also lead to lifelong impairment, a helping hand or support from the family on the emotional ground can do wonders in recovery.