Poliomyelitis is a dreaded communicable disease that is caused by a virus, which brings about the inflammation of the nerve cell of the brain and spinal cord. It has been prevalent for centuries and has been recorded in ancient Egypt.
Not long ago the world was paralysed by polio which affected more than 125 countries, killing or crippling 1,000 people a day, most of them children. In Bangalore 33-year-old Lalita working as a physiotherapist for the NGO APD contracted polio as a 9-month-old baby. Similarly, Eldrade 42 years, was struck by polio at age 6. These cases show the destructive reach of the disease.
According to Mr HS Kapinaiah, of polio plus committee, Rotary Intl, Bangalore District, India recorded 559 cases of wild polio in 2008 and 19 cases of wild polio thus far for 2009.
An interview with Dr Sudipta Sen, Director & Consulting Paediatrician, The Apollo Clinic, Fraser Town, Bangalore, threw light on the disease and its prevention and management.
The polio disease can vary between mild flu-like illness or a major paralytic type. It is caused by a RNA virus with 3 subtypes.They are. Type 1 or Brunhilde virus, Type 2 or Lansing virus, Type 3 or Leon virus.
Type 1 is associated with major epidemics and has got the highest affinity to cause paralytic forms. Type 2 causes small outbreaks with less paralytic forms. Type 3 occupies an intermediate position.
The disease is spread by direct contact with infected persons through pharyngeal secretions and faeces. Apart from the oro-oral and faeco-oral route, rarely oral vaccines can cause clinical polio, especially in persons with low immunity.
The disease affects mostly non-immunised children (especially under 5) and adults with low immunity are particularly susceptible. Clinical severity can be affected by age, pregnancy, recent tonsillectomy and steroid drugs.
Description
In its mildest forms(abortive polio), it is characterised by flu-like features like fever, headache, nausea, pain and muscle cramps and gastrointestinal problems. Most people will have no further illness and will recover thereafter.
However, some people will have pain and stiffness of neck and back. They will improve over 7-10 days and thereafter make a recovery (non paralytic poliomyelitis).
A few will unfortunately proceed from the above pre-paralytic stage to paralysis 2-3 days later. In particular virulent types of disease, onset of paralysis can take place within hours of flu-like symptoms.
Post-polio syndrome
This is a cluster of disabling signs and symptoms affecting people who have recovered from polio about 10-40 years after the initial attack. It is characterised by new muscle weakness in limbs that may or may not have been affected in the first instance; muscle and joint pain; fatigue and exhaustion after minimal activity; breathing or swallowing difficulty; sleep related disorders including sleep apnea and intolerance to cold temperatures.
Treatment
For flaccid paralysis of limb muscles — Physiotherapy, passive movement, hydrotherapy, orthopaedic device for support and splinting of paralytic limbs.
Spinal paralysis — Ventilators, Drinker tank respirator and tracheostomy.
Bulbar paralysis — Nasogastric tube feed, suction of secretions, may need tracheostomy. Spontaneous recovery within 2-3 weeks.