Poliomyelitis: Symptoms
Last reviewed: 23.04.2024
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The inpatient form of poliomyelitis, which develops in almost 90% of cases, is a healthy virus carrier, with no symptoms of poliomyelitis, and the virus does not go beyond the lymph glotopharynx and the intestine. About the transferred infection judged by the results of virological and serological studies.
Distinguish the following clinical forms of poliomyelitis: abortive (without CNS), meningeal and paralytic (most typical). Depending on the localization of the process, spinal, bulbar, contact, encephalitic and mixed (combined) variants of the paralytic form are isolated.
The incubation period of poliomyelitis lasts from 3 to 35 days, more often - 7-12 days.
For the abortive (catarrhal) form of poliomyelitis (the so-called "small disease") is characterized by an acute onset and symptoms of poliomyelitis: a brief increase in body temperature, moderate intoxication, headache, slight catarrh of the upper respiratory tract, abdominal pains, sometimes accompanied by vomiting and loose stools without pathological impurities. It is benign and ends in recovery after 3-7 days. The diagnosis is based on epidemiological and laboratory data.
When the meningeal form of the disease begins with an acute rise in body temperature to 39-40 ° C, there is severe headache, vomiting, back pain, neck, limbs. Meningeal symptoms of poliomyelitis are moderately expressed, but may be absent, despite changes in the cerebrospinal fluid. Typically, the presence of symptoms of tension of nerve trunks (Neri, Lasega, Wasserman) and tenderness during palpation along the nerve trunks. Often there is a horizontal nystagmus. Perhaps the two-wave course of the disease. The first wave proceeds as an abortive form of the disease, and then after a remission lasting from one to five days, a pattern of serous meningitis develops. With lumbar puncture, the transparent spinal fluid flows out under increased pressure. Pleocytosis ranges from several dozen cells to 300 in 1 μl. In the first 2-3 days neutrophils can prevail, in the future - lymphocytes. The protein concentration and glucose level are within normal limits or slightly elevated. Sometimes inflammatory changes in the spinal cord may appear 2-3 days after the onset of meningeal syndrome. The course of the disease is benign: by the beginning of the second week of the illness, the temperature normalizes, the meningeal syndrome regresses, and by the third week the spinal cord fluid normalizes.
The spinal (paralytic) form of poliomyelitis is observed in less than one in 1000 infected. The development of paralytic forms of poliomyelitis can provoke immunodeficiency, malnutrition, pregnancy, tonsillectomy, subcutaneous and intravenous injections, high physical activity in the early stages of the disease. In the clinical picture, four periods are distinguished: preparative, paralytic, restorative, residual (period of residual phenomena).
Preparalytic period lasts 3-6 days. Poliomyelitis begins acutely, with general intoxication, fever (sometimes - two-wave). In the first days of the disease catarrhal symptoms of poliomyelitis are noted: rhinitis, tracheitis, tonsillitis, bronchitis. Dyspepsia is more common in younger children. On the 2nd-3rd day, symptoms of CNS involvement are added. With a two-wave temperature curve, neurologic symptoms appear on the second wave after a 1-2-day period of apyrexia. There is a headache, pain in the limbs and back along the nerve trunks, "brain" vomiting, hyperesthesia, meningeal symptoms, as well as the symptoms of tension of nerve trunks and roots of the spinal nerves. Patients are sluggish, sleepy, capricious. Changes in the autonomic nervous system are manifested by sweating. Possible fibrillation of muscles, delay urination. By the end of the first period, the general condition improves, intoxication decreases, the temperature decreases, but the pain syndrome increases and the disease passes into the paralytic period. Paralysis occurs on the 2-6th day of the disease, less often (in the absence of a preparative period) - on the first day ("morning paralysis"). Typically the rapid development of sluggish asymmetric paresis and paralysis of the muscles of the trunk and extremities, the disruption of the function of the pelvic organs for a short time - from a few hours to 1-3 days. Muscular hypotension, hypo- or areflexia, proximal localization of lesions and their mosaic character (in connection with death of a part of nerve cells of the anterior horns of the spinal cord with preservation of others) are characteristic. Symptoms of poliomyelitis depend on the localization of the lesion of the nervous system. The lumbar spinal cord is more often affected with the development of paresis and paralysis of the muscles of the pelvic girdle and lower limbs. In the thoracic localization of the process, paralysis, spreading to the intercostal muscles and diaphragm, causes respiratory distress. The defeat of the cervical and thoracic parts of the spinal cord is manifested by paralysis and paresis of the muscles of the neck and arms (spinal paralytic poliomyelitis). Depending on the number of affected segments of the spinal cord, the spinal form may be limited (monoparesis) or common. Isolated damage to individual muscles while preserving the functions of others leads to disruption of interaction between them, the development of contractures, the appearance of joint deformities. The paralytic period lasts from several days to 2 weeks. After which the recovery period begins. The most noticeable restoration of impaired functions, the return of muscle strength occurs in the first 3-6 months. In the future, the pace slows down, but the recovery lasts for up to a year, sometimes up to two years. First of all, the movements in the least affected muscles are restored, mainly due to the surviving neurons, in the future the recovery occurs as a result of compensatory hypertrophy of the muscle fibers that retain innervation. In the absence of positive dynamics for six months, the remaining paralysis and paresis are considered residual. Residual period is characterized by muscular atrophy. Development of joint contractures, osteoporosis. Deformity of the bones, in children - lagging the affected limbs in growth, with the defeat of the long back muscles - curvature of the spine, with the defeat of abdominal muscles - deformation of the abdomen. More often residual phenomena are observed in the lower extremities.
The bulbar form of poliomyelitis is characterized by high fever, marked intoxication. Vomiting, severe condition of patients. Preparalytic period is short or absent. This form of the disease is accompanied by the defeat of the nuclei of the motor cranial nerves involving the vital centers controlling respiration, blood circulation, thermoregulation. The defeat of the nuclei of IX and X pairs of cranial nerves leads to hypersecretion of mucus, swallowing disorders. And, as a result, to obstruction of the respiratory tract, disturbance of ventilation of the lungs, hypoxia, development of aspiration pneumonia. With the defeat of the respiratory and vasomotor centers, the normal respiratory rhythm (pauses and pathological rhythms) is disrupted, cyanosis is increasing, the rhythm of the cardiac activity (tachy- or bradyarrhythmia) is disturbed, as well as the increase and subsequent drop in blood pressure. There are symptoms of poliomyelitis, such as: psychomotor agitation, confusion, and then - sopor and coma. In stem forms with damage to the nuclei of III, VI and VII pairs of cranial nerves, oculomotor disorders and facial asymmetry due to paresis of facial muscles are revealed. Often the bulbar form ends with a fatal outcome. If death does not occur, then in the next 2-3 days the process stabilizes, and from the 2-3th week of the disease the condition of the patients improves and the full restoration of the lost functions occurs.
With an isolated lesion of the nucleus of the facial nerve located in the region of the brain's brainstem, a less severe pontine form develops. Preparalytic period, fever, general intoxication, meningeal symptoms can often be absent. When examining the patient, paresis or paralysis of the facial muscles of the half of the face is revealed, the unobstruction of the eye gap (lagophthalmus), the lowering of the angle of the mouth. The course of benign, but possibly persistent preservation of paresis of the facial nerve.
A number of authors describe the encephalitic form of poliomyelitis, in which the general symptoms of poliomyelitis prevail and scattered symptoms of prolapse are present. When lesions of different parts of the brain, mixed (combined) forms of the disease - bulbospinal and pontospinal - are also isolated.
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