Poliomyelitis: diagnosis
Last reviewed: 23.04.2024
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Diagnosis of poliomyelitis is based on a characteristic clinical picture (acute onset of the disease with fever, development of meningoradicular syndrome, peripheral paresis, paralysis with hypotension, hypo- or areflexia, hypo- or atrophy without sensitivity disturbance) and epidemiological data: contact with patients or newly vaccinated. Consideration is also given to the association with vaccination and the absence or incomplete vaccination. Confirm the diagnosis by determining the increase in the titer of virus neutralizing antibodies 4 times or more in the DSC or PH in paired sera taken at intervals of 14-21 days. Also used are virological studies. The virus can be isolated from stool, less often from nasopharyngeal mucus, spinal fluid. Isolation of the virus in the absence of clinical manifestations of the disease is not a reason for making a diagnosis of poliomyelitis, especially in areas where vaccination is constantly carried out. PCR is used to determine whether an isolated virus belongs to a vaccine or wild strain.
When studying the cerebrospinal fluid, lymphocytic pleocytosis is found in several tens of hundreds of cells in 1 μl (sometimes in the first days of the disease it can be neutrophilic). In the acute stage of the disease, the concentration of protein and glucose is usually within normal limits. The paralytic form of poliomyelitis is characterized by a change in cell-protein dissociation at the onset of the disease to protein-cell (decrease in pleocytosis, increase in protein concentration) after 1-2 weeks.
Changes in peripheral blood are not characteristic. Sometimes there is moderate leukocytosis.
To identify the level and severity of motor neuron damage, ENMG is used. In the paralytic period of poliomyelitis, a change in bioelectrical activity is observed, characteristic of an anterrhoeic lesion: in the paralyzed muscles with an early developed atrophy on the electromyogram, the total absence of bioelectrical activity is determined. When removing the electromyogram from less affected muscles, there are clear rare fluctuations in the potential (the "rhythm of the stockade").
[Differential diagnosis of poliomyelitis
Differential diagnosis of poliomyelitis is determined by its clinical form.
The abortive form of the disease is clinically indistinguishable from many ARVIs or diarrheas caused by Coxsackie-ECHO enteroviruses, rotaviruses and other viral agents.
When the meningeal form is differential diagnosis of polio treatment with other serous meningitis (enterovirus, mumps, tuberculosis), and in the early stages of the disease with neutrophilic pleocytosis in the cerebrospinal fluid, it is necessary to exclude bacterial purulent meningitis. For the meningeal form of poliomyelitis is characterized by the severity of the pain syndrome, the presence of symptoms of tension of the nerve trunks and roots of the spinal nerves, the soreness of the nerve trunks during palpation, but the final diagnosis is possible only with the use of laboratory methods.
The spinal form of paralytic poliomyelitis differentiates from diseases of the musculoskeletal system, which is characterized not by a paretic but gentle gait, pain with passive movements in the joints, the preservation of the muscle tone, and the preservation or enhancement of deep reflexes. Spinal-cerebral fluid is normal when tested, and inflammatory changes are noted in the blood. Also, the spinal form of the disease must be differentiated with myelitis, poliomyelitis form of tick-borne encephalitis, diphtheria polyneuropathy, polyradiculoneuritis, spinal amyotrophy of Verdnig-Hoffmann.
Paralysis in myelitis is central: high muscle tone, animated reflexes, the presence of pyramidal signs, sensitivity disorders, pelvic organs, trophic disorders with the formation of pressure sores.
In poliomyelitic form of tick-borne encephalitis, unlike poliomyelitis, the pathological process is localized mainly in the cervical segments and is manifested by flaccid paresis and paralysis of the muscles of the neck and shoulder girdle. There is no mosaic defeat. In the cerebrospinal fluid there is a slight lymphocytic pleocytosis (40-60 cells) and an elevated protein level (up to 0.66-1.0 g / l). When making a diagnosis, an epidemiological anamnesis is taken into account (tick bite, use of raw milk in endemic areas).
Diphtheria polyneuropathy is characterized by a relationship with the diphtheria transferred 1.5-2 months before the defeat of the peripheral nervous system, the symmetry of lesions, the gradual increase of pareses within a few weeks, the detection of electroeuromyography of violations of bioelectrical activity mainly in demyelinating or axonal-demyelinating type.
In polyradiculoneuritis, slow (sometimes undulating) development and growth of symmetrical paresis with a predominant lesion of the distal parts of the limbs, a sensitivity disorder along the polyneuric and rootlets, a rise in the protein content in the cerebrospinal fluid with normal cytosis are noted.
Spinal amyotrophy of Verdnig-Hoffmann is a hereditary disease. Which is characterized by the defeat of spinal cord motoneurons. The first symptoms of the disease appear at the age of up to 1.5 years. Paralysis develops gradually and symmetrically: at the beginning of the legs. Then hands. Muscles of the trunk, neck. Deep reflexes disappear, there is no pain syndrome. With a well-expressed subcutaneous fat layer it is often difficult to detect muscle atrophy, the cerebrospinal fluid is not changed. Death occurs at the age of 4-5 years due to bulbar disorders and paralysis of the respiratory musculature.
In the pontine form of the disease, differential diagnosis of poliomyelitis treatment is performed with the neuritis of the facial nerve, for which the common infectious symptomatology is not characteristic and at least one of the following symptoms is observed: lacrimation on the side of the lesion, a decrease in taste sensitivity to sweet and salty in the anterior 2/3 of the tongue with the patient side, soreness of trigeminal points during palpation, spontaneous pain and impaired sensation on the face.
The bulbar form is differentiated with stem encephalitis, in which deep disorders of consciousness and convulsive syndrome dominate.
In contrast to poliomyelitis, the lesion of the motor cranial nerves in polyradiculoneuritis usually has a bilateral symmetrical character: facial muscle diplegia, bilateral defeat of the oculomotor nerve.
Lesions of the nervous system that are clinically indistinguishable from poliomyelitis can cause enteroviruses of the Coxsackie-ECHO group, less often other viral agents. In these cases it is necessary to use the whole complex of virologic, serological diagnostic methods, as well as PCR.