A viral disease that is usually mild but can cause paralysis is polio. Rare in developed countries, it still remains main problem for the health of children in the developing world. The disease can cause meningitis or even paralysis. In this article we will look at the main forms of the disease.

Classification of polio

Forms of polio by type:

Typical - with damage to the central nervous system:

• Non-paralytic (meningeal).
• Paralytic (spinal, bulbar, pontine, combined).

Atypical - without damage to the central nervous system (virus carriage):

• The erased form is characterized by an acute onset, a general infectious syndrome (increased body temperature up to 38 ° C, headache, malaise, decreased appetite), symptoms of gastrointestinal intestinal tract(moderate abdominal pain, intestinal dysfunction), catarrhal symptoms (short-term rhinitis with scanty discharge, hyperemia of the pharynx, coughing), autonomic disorders(sweating, pallor, weakness). The duration of the disease is 3-5 days, which pathogenetically corresponds to the phase of primary viremia. Diagnosis is carried out on the basis of epidemiological and laboratory data.
• Asymptomatic form - there are no clinical manifestations of the disease. The diagnosis is established in foci of infection based on laboratory examination(virological and serological).

Forms of polio by severity:

The mild form of acute paralytic poliomyelitis is estimated at 4 points based on the degree of muscle damage. Monoparesis occurs, more often than one leg; complete restoration of the functions of the affected limb is possible.

Moderate form - muscle damage is assessed as 3 points (mono-, paraparesis). Recovery is quite active, but without complete normalization.

Severe form - reduction in muscle function to 1-2 points or complete paralysis. Recovery is significantly reduced, atrophy and contractures form.

Severity criteria:

• severity of intoxication syndrome;
• depth and prevalence of paresis and paralysis;
• severity of motor disorders.

Criteria for the depth of paresis are determined using a 6-point scoring system functional state muscles:

Normal muscle function;

Active movements in full, but the resistance force is reduced;

Active movements in the vertical plane (weight of the limb) are possible, but it is impossible to provide resistance;

Movement is possible only in the horizontal plane (friction force);

Movement in the horizontal plane while eliminating friction (the limb is suspended); 0 - no movement.

Forms of polio according to the course (by nature):

Unsmooth:

• with complications;
• with a layer of secondary infection;
• with exacerbation of chronic diseases.

In approximately 90–95% of cases, asymptomatic poliomyelitis develops.

Periods of the disease in a typical form:

• incubation from 2 to 21 days (usually 5 to 14 days);
• preparalytic (from 1 to 6 days);
• paralytic;
• restorative;
• residual phenomena.

The classification of polio provides variants of the disease as without damage to the nervous system (abortive or visceral form), and with its defeat.

The variant that occurs with damage to the nervous system is, in turn, divided into non-paralytic (meningeal form) and paralytic poliomyelitis.

What are the clinical forms of polio?

Non-paralytic poliomyelitis (meningeal form)

The disease begins acutely, with the following symptoms: increased body temperature to 38° C or higher, severe headache, repeated vomiting. The temperature curve may have a two-wave character: the first wave occurs with general infectious symptoms, and after 1-3 days normal temperature a second wave of fever occurs with clinical signs of damage to the meninges. Meningeal syndrome is the leading one in this form of the disease: stiff neck, Kernig's, Brudzinski's symptoms I, II, III are detected. There is hyperesthesia and increased sensitivity to auditory and visual stimuli - hyperacusis and photophobia. Adynamia, short-term neuromyalgic syndrome, and autonomic disorders may be observed.

To resolve the issue of the presence of meningitis, a lumbar puncture is performed: the cerebrospinal fluid is clear, colorless, flows out under increased pressure, pleocytosis is 100-300 cells in 1 μl, usually has a lymphocytic character, but in the first 1-2 days of the disease neutrophils may predominate, protein content normal or slightly increased.

The course of the meningeal form is favorable. At the beginning of the 2nd week. the disease, the general condition improves, the temperature normalizes, in the 3rd week. the composition of the cerebrospinal fluid is normalized.

Paralytic polio

During this form, in addition to the incubation period, the following periods are distinguished:

• preparalytic - from 1 to 6 days;
• paralytic - up to 1-2 weeks;
• restorative - up to 2 years;
• residual - after 2 years.

The preparalytic period is from the onset of the first clinical manifestations until the appearance of paralysis. It is characterized by an acute onset with a rise in body temperature to 38 °C and above, catarrhal syndrome, abdominal pain, diarrhea, general cerebral symptoms (vomiting, headache), autonomic disorders (dystonia, sweating, red persistent dermographism). By the end of the period, the body temperature returns to normal, but the patient’s well-being worsens. Pain syndrome appears and increases:

• spontaneous muscle pain in the limbs and back;
• a child suffering from polio takes a forced position - the “tripod” position (sitting, leaning on his hands behind the buttocks) and the “potty” position (painful reaction when sitting on the potty);
• symptoms of tension in the roots and nerve trunks are revealed - Neri's symptom (bending the head forward causes pain in the lower back), Lassegue's symptom (when trying to bend in hip joint straightened leg, pain occurs along the way sciatic nerve, when the leg is bent at the knee joint, the pain stops);
• pain appears along the nerve trunks and at the exit points of the nerves.

The paralytic period of poliomyelitis begins with the appearance of paresis (paralysis) and continues until the first signs of improvement in motor functions.

Characterized by the sudden appearance of paralysis and paresis, more often in the morning, against the background of normal body temperature or during the second wave of fever. Their increase occurs quickly - within 24-36 hours. Paralysis and paresis are sluggish (peripheral) in nature and are manifested by hypotension, (a-) hyporeflexia and hypotrophy (early development of atrophy is characteristic - by 7-10 days).

Depending on the predominant localization of damage to the nervous system, several forms of poliomyelitis are distinguished.

In addition, taking into account the main localization of the damage to the nervous system according to the characteristic clinical signs, the following clinical forms of poliomyelitis are distinguished:

• Spinal, most characteristic of paralytic poliomyelitis, characterized by flaccid paresis and skeletal paralysis, diaphragmatic muscles and abdominals;
• Bulbar, accompanied by dysfunction of vital organs, and therefore the most severe;
• Pontine, limited to damage to the facial nerve located in the area of ​​the medullary pons, which is manifested by paresis and paralysis of the facial muscles;
• Encephalitic, occurring with signs of focal brain damage.

There may be mixed forms, such as bulbospinal, pontinospinal. Depending on the clinical picture, paralytic poliomyelitis in children can be mild, moderate or severe.

Visceral form of polio

Usually it is limited to the clinical picture of the initial period of the disease without further addition of its specific symptoms. Fever appears headache, general condition and sleep are disturbed. Marked pathological symptoms from the upper respiratory tract, most often in the form of pharyngitis or catarrhal tonsillitis. In combination with the above or only against the background of general intoxication, dyspeptic disorders such as gastroenteritis or enterocolitis with stool resembling that of dysentery may be observed. Changes in cerebrospinal fluid No. Recovery occurs in 3 to 7 days.

Meningeal form of polio

This form is also characterized by symptoms of intoxication and the predominance in the clinical picture of signs of inflammation of the meninges (headache, vomiting, stiff neck, positive symptoms Kernig, Brudzinsky) with corresponding deviations in the composition of the cerebrospinal fluid in the absence of paresis and paralysis. Pain in the back and limbs, general hyperesthesia, positive symptoms of root tension are detected spinal nerves(Lasegue’s symptom, etc.) The patients’ condition improves in the 2nd week, and later the composition of the cerebrospinal fluid normalizes.

Spinal form of polio

With this form, the motor cells of the anterior horns of the spinal cord, mainly the lumbar, and less commonly the cervical enlargement, are affected. Mono-, para-, tri- or tetraparesis may develop. The proximal limbs are most often affected. An asymmetrical and mosaic distribution of paresis is characteristic: on the lower extremities the quadriceps and adductor muscles of the thigh are most often affected, on the upper extremities - the deltoid and triceps. Possible damage to the distal extremities. In antagonistic groups, a reflex “spasm” develops, which contributes to the formation of first physiological and then organic contractures. There are no sensory disturbances or dysfunctions of the pelvic organs. Due to a violation of innervation, trophic changes occur in the tissues: the affected limbs are pale, microcirculation is impaired - they are cold to the touch.

When the thoracic region is affected, paresis and paralysis of the intercostal muscles and diaphragm occur, and respiratory disorders. Patients experience shortness of breath, paradoxical movements of the chest, retraction of the epigastric region, and participation of auxiliary muscles in the act of breathing are noted.

When the abdominal muscles are affected, the following symptoms are observed: a “bubble” symptom (one half of the abdomen bulges), a “frog” belly (with bilateral damage).

Bulbar form of polio

This form is one of the most severe forms polio progresses rapidly, often without a pre-paralytic period. Accompanied by decreased mobility soft palate, nasal voice, choking when drinking and leakage of liquid through the nose, disappearance of the pharyngeal and cough reflexes, accumulation of mucus with obstruction of the respiratory tract, hoarseness of the voice, decrease in its volume. The clinical picture is caused by damage to the nuclei of the IX, X, XII pairs of cranial nerves. There is a pathological breathing rhythm, agitation followed by stupor and coma, hyperthermia due to damage to the respiratory and cardiovascular centers. Possible death on the 1st-2nd day of the disease. From the outside cardiovascular system are developing following changes: myocardial dystrophy, rhythm disturbance, interstitial myocarditis, increased blood pressure; from the gastrointestinal tract - bleeding, distension of the stomach.

Pontine form of polio

This form is caused by an isolated lesion of the nucleus of the facial nerve. It is characterized by peripheral paresis or paralysis of the facial muscles on the same side (asymmetry of the face, incomplete closure of the eyelids, smoothness of the nasolabial fold, lag in the corner of the mouth). Features of this form: no sensitivity or taste disorders, no lacrimation or hyperacusis.

The prognosis for the meningeal form of poliomyelitis is favorable, without consequences. In spinal cases, recovery depends on the depth of the paresis (in 20-40% of cases, motor functions are restored; with deep paresis, residual effects are likely). In bulbar and spinal forms, accompanied by respiratory failure, death is possible.

Combined forms of polio

Combined forms (bulbo-spinal, pontospinal, ponto-bulbospinal) are caused by damage to the nuclei of the cranial nerves and motor cells of the anterior horns of the spinal cord. The clinical picture is characterized by a combination of symptoms of isolated forms of polio.

The recovery period is characterized by the appearance of motor functions in the affected muscles, a decrease pain syndrome and autonomic disorders. Restoration of movements in the affected muscles occurs in the reverse order of their occurrence. When motor neurons die, complete recovery does not occur in the affected areas, and therefore residual effects are characteristic.

The residual period of polio is characterized by the presence of severe contractures, deformation of the spine, hands and feet, and growth retardation of the affected limbs. Characterized by a variety of neurological disorders - persistent flaccid paralysis, post-polio muscle atrophy, liquor circulation disorders, segmental autonomic disorders. Possible saving arterial hypertension and cardiopathy.

The syndrome of general intoxication has a two-phase temperature curve (the first rise in the preparalytic period, the second in the paralytic period). Catarrhal syndrome is represented by rhinitis, tracheitis, bronchitis. Dyspeptic syndrome is detected in the form of vomiting, loose stools, constipation, which are accompanied by abdominal pain.

Syndrome neurological disorders manifested by adynamia, skin hyperesthesia, meningeal symptoms, peripheral paresis and paralysis, tremor, nystagmus, convulsions, bulbar disorders, facial expression disorders. The frequency of aseptic meningitis with nasopharyngitis is 1–5%, the paralytic form is 0.1–0.2%, the residual paralytic form with damage to motor neurons is 1:250 patients. Adults who in childhood were in contact with patients with the paralytic form of poliomyelitis, at the age of 30–40 years, may develop post-polio syndrome, which is characterized by muscle pain, weakness or weakness, and the appearance of new paralysis.

Poliomyelitis in vaccinated children occurs in the form of mild paresis ending full recovery. However, in some children, significant residual organic changes in the central nervous system may persist. In rare cases, flaccid paralysis may occur after vaccination with the live Sabin vaccine. They are interpreted as vaccine-associated poliomyelitis when a vaccine strain of polio virus is isolated and the titer of type-specific antibodies to it increases by 4 times. The course of this form of polio is favorable, followed by complete recovery.

Poliomyelitis is an acute viral highly contagious disease. When the disease affects motor neurons spinal cord and cranial nerve nucleus of the medulla oblongata. The forms and symptoms of polio are varied and depend on the degree immune defense the infected body and the location of the nervous system lesion. With the development of the spinal form of the disease, patients develop flaccid paralysis of the peripheral type.

In some cases, when paralysis develops, the function of the affected muscles is not fully restored and the defect persists for life. But most often the pathological process is limited to a “minor form” of the disease, which occurs without damage to the nervous system. The most dangerous of them in epidemiological terms is the asymptomatic form of polio, which occurs easily and without clinical symptoms. The absence of clinical manifestations makes it possible to infect others with polioviruses. The best protection against polio is vaccination. In countries where 95% or more of the child population is vaccinated against polio, polio has been eradicated.

Rice. 1. In economically backward countries, in the absence of universal vaccination and the inability of the body to resist poliovirus due to chronic diarrhea and malnutrition, a large number of cases of polio are still recorded in children.

Pathogenesis of polio (how the disease develops)

The development of poliomyelitis, its course and outcome, the absence or presence of damage to the nervous system depend on biological properties the virus and its genetic characteristics on the one hand and the immunological reactions of the body (local and general immunity) on the other hand.

Initially, the polio virus penetrates the cells of the mucous membranes of the nasopharynx and small intestine where it begins to reproduce. With sufficient accumulation, pathogens further penetrate into regional lymphoid tissue: tonsils, Peyer's patches of the intestine, solitary follicles and regional lymph nodes, where they continue to multiply intensively. 3-5 days after infection, viruses penetrate into the blood (primary short-term viremia). With the bloodstream, pathogens spread throughout the body and settle in the liver, spleen, lungs and bone marrow, where their further reproduction and accumulation occurs. After re-release into the blood, secondary (major) viremia is observed, which is manifested by general toxic symptoms.

The reproduction of polioviruses stimulates defensive reactions the body - macrophages (cellular immunity) and the production of immunoglobulins (humoral immunity). Poliomyelitis at this time occurs in the form of a “minor disease” - in abortive, asymptomatic or meningeal forms. In most cases, under the influence immune system The viruses die and recovery occurs. After past illness persistent type-specific immunity remains.

Rice. 2. Photo of polio viruses (view under an electron microscope).

Damage to nerve cells

Massive viremia lasts from several hours to several days and in some cases causes the development of the most severe form of the disease - paralytic. It is believed that polioviruses penetrate the spinal cord and brain through peripheral nerve endings from the muscles, where they enter during viremia. Defeat nerve cells is already registered on early stage diseases. The process of virus reproduction ends with the destruction of some neurons and the release of pathogens into the interstitial substance. Further, the viruses not only infect neighboring neurons, but also spread across the diameter of the spinal cord.

The destruction (destruction) of neurons develops rapidly. Disorders of nucleoprotein metabolism and their disappearance from the cytoplasm of neurons develop especially quickly, which is distinctive feature polio from other viral infections, such as rabies. When the metabolism of ribonucleic acid is disrupted in the cytoplasm of neurons, tigrolysis is observed - damage to the cytoplasm of the infected cell and crystal-like accumulations of pathogens.

Nerve cells in polio are affected unevenly. Most often, motor neurons of the anterior horns of the spinal cord are damaged, slightly less often - cells of the medulla oblongata and subcortical nuclei of the cerebellum, and very rarely - motor neurons of the cerebral cortex and posterior horns spinal cord. There is a mild reaction meninges in the form of hyperemia, edema and cellular infiltration.

Polioviruses are present in nervous tissue only for a few days.

However, further inflammatory reaction lasts up to several months, causing further damage to neurons. This is explained by the active migration and accumulation of immune cells that secrete biologically active substances, which negatively affects the neurons of the central nervous system.

Rice. 3. Photo of neurons.

Consequences of viral damage to neurons

The death of 25 - 30% of nerve cells leads to the development of paresis and paralysis. Dead neurons are replaced by glial and then scar tissue. The volume of the spinal cord decreases. The defeat is asymmetrical. Neurons with minor damage are restored. In the affected muscles, neurogenic atrophy is observed, followed by the replacement of these areas by fatty and connective tissue. Internal organs change slightly. Most often, patients develop a picture of interstitial myocarditis.

Rice. 4. Consequences of polio in children.

Immunity in polio

After the illness, persistent (lifelong) type-specific immunity remains. Antibodies in the blood remain only to the serotype of the virus that caused the disease. Antibodies appear in the blood serum even before the development of paralysis, but they do not prevent the development of paralysis if the virus has already penetrated into the body. nervous system. Local secretory antibodies of the intestinal and pharyngeal mucosa play an important role in the development of immunity.

For one and a half months after birth, the child is protected by the mother’s antibodies (passive immunity) and does not suffer from polio.

Rice. 5. Consequences of the spinal form of polio in an adult. Paralysis right limb. The leg is shortened. The muscles are atrophied.

Classification of polio

By type of disease

• Based on the type of disease, polio is divided into typical form (with damage to the central nervous system) and atypical (without damage to the central nervous system).
• The typical form of polio is divided into non-paralytic - meningeal and paralytic - spinal, bulbar, pontine and mixed.
• The atypical form of polio is divided into inapparatus (virus carriage) and abortive (“minor disease”).

According to severity

Poliomyelitis can occur in mild form, moderate and heavy. Criteria for the severity of the disease are the severity of the intoxication syndrome and movement disorders.

According to the nature of the flow

Poliomyelitis can have a smooth or complicated course.

Rice. 6. Consequences of polio: the lower limbs are deformed, paresis and muscle atrophy are noted.

Incubation period for polio

The latent or incubation period for the non-paralytic form of polio lasts 3-6 days, for the paralytic form - 7-14 days (rarely 4-6 days). On average, for all forms of polio, the incubation period lasts from 8 to 12 days. The possible range of latent period duration is from 3 to 35 days.

Signs and symptoms of non-paralytic polio

Non-paralytic poliomyelitis occurs in subclinical (asymptomatic), abortive and meningeal forms. The largest number of cases of polio are asymptomatic and the disease can only be detected using laboratory diagnostics.

Inactive (asymptomatic) form of polio

The non-hardware (asymptomatic) form of the disease occurs without any clinical manifestations. An essentially asymptomatic form of polio is a healthy carrier. An infected person develops specific immunity and specific antibodies appear in the blood. The asymptomatic form of polio is the most dangerous form of the disease, since the absence of clinical manifestations makes it possible to infect others with polio.

Signs and symptoms of abortive polio

The abortive (asymptomatic) form of polio occurs in 25–80% of cases. The disease occurs with symptoms of acute respiratory infections, elevated body temperature, disruption of the intestinal tract, without signs of central nervous system damage.

• With viremia, body temperature rises significantly.
• Intoxication is accompanied by severe weakness, sweating, malaise, aches throughout the body, headache, and the child becomes lethargic.
• Virus infection of the epithelial cells of the respiratory tract and lymphatic system is the cause of the development of catarrhal phenomena.
• Hyperesthesia, excessive sweating and pink dermographism indicate the development of autonomic disorders.
• Replication of polioviruses in the cells of the mucous membrane and lymphatic system of the small intestine causes abdominal pain, nausea, and loose stools.

Diagnosis of this form of the disease is difficult and is based only on laboratory data (serological tests) and epidemiological investigation data.

The course of the abortive form of polio is benign and always ends within 3-7 days with complete recovery.

Signs and symptoms of meningeal polio

The meningeal (non-paralytic) form of polio occurs in the form of aseptic serous meningitis with all the symptoms inherent in the abortive form of the disease. Meningeal symptoms appear on the 2nd - 3rd day of the disease: repeated vomiting, severe headache, tremor, twitching of individual muscles of the limbs, pain in the arms, legs and back, stiff neck, horizontal nystagmus. Signs of irritation of the meninges are indicated by positive Brudzinsky and Kernig symptoms. Positive symptoms of tension in the nerve trunks and roots are recorded - the symptoms of Lasegue, Neri and Wasserman.

Meningoradicular syndrome is a variant of the course of the disease when radicular pain and positive Kernig and Lasegue symptoms are simultaneously recorded.

With the meningeal form of polio, paralysis does not develop. In some cases, patients complain of fleeting fatigue when walking and fleeting weakness in the limbs.

There is an increased number of lymphocytes in the cerebrospinal fluid. Total quantity cells (cytosis) increases to 200 - 300 per 1 mm 3. Sugar and protein are slightly increased. Cerebrospinal fluid flows out during puncture slight pressure, transparent and colorless.

The disease progresses favorably and ends with recovery after 3-4 weeks. Serous meningitis in polio has great similarities with serous meningitis caused by the mumps virus, Coxsackie virus and ECHO virus.

Rice. 7. In countries where vaccine prevention is not fully implemented, polio outbreaks are currently being recorded. Unsanitary conditions, malnutrition and chronic diarrhea.

Paralytic form of polio

Most cases of polio are asymptomatic; infection can only be detected using laboratory testing methods. But in a number of cases, after incubation period develops dangerous form diseases - paralytic poliomyelitis (acute flaccid peripheral paresis/ paralysis). From 95 to 99% of cases of polio in adults occurs without paralysis.

• Pre-paralytic, acute form The disease develops after an incubation period and lasts from 3 to 6 days. Characterized by an increase in body temperature to high numbers, vomiting, severe sweating, headaches and muscle pain. Before its appearance, a prodromal period is recorded, occurring with symptoms of catarrh of the upper respiratory tract and autonomic disorders.
• Next comes a period of development of peripheral paralysis, affecting the proximal muscles, most often the lower, less often the upper limbs, neck and torso (spinal form). Paresis is asymmetrical, appears suddenly, in the first 2 - 3 days and then increases in severity until paralysis. The larger the affected area, the more severe the disease. When the nucleus of the facial nerve is damaged, the pontine form of poliomyelitis develops; the nuclei of the IX, X, XII cranial nerves develop - the bulbar form. Paralysis of the respiratory muscles and respiratory center leads to the death of the patient. The paralytic phase lasts about 2 weeks.
• After the stage of paralysis, a recovery period begins. Sometimes there is a restoration of the function of the affected muscles, but often the defect is not completely restored and the patient remains disabled for life.

Rice. 8. Consequences of polio in a child.

Forms of paralytic poliomyelitis

There are several forms of paralytic polio. They depend on the level of damage to the central nervous system:

• The spinal form of polio develops when the spinal cord is damaged.
• The bulbar form of the disease develops when the nuclei of the IX, X, XII cranial nerves are damaged.
• The pontine form of polio develops when the nucleus of the facial nerve is damaged.
• There are mixed forms - pontospinal, bulbospinal, pontobulbospinal.
• The encephalic form of polio develops with the development of general cerebral symptoms and symptoms of focal brain damage.

Signs and symptoms of spinal polio

The degree of damage in the spinal form of poliomyelitis depends on the extent of damage to motor neurons. Lesions are most often located in the anterior horns of the spinal cord. Paresis and paralysis in polio are characterized by random localization, which is explained by the uneven distribution of polioviruses in the nervous structures. Most often, paresis and paralysis develop in the lower extremities, less often in the upper extremities, muscles of the trunk, neck and diaphragm. Paralysis can spread upward (“ascending” form) or downward (“descending” form). The danger is represented by paralysis of the respiratory muscles - intercostal muscles and the diaphragm, leading to severe breathing problems. During the recovery period, the function of the affected muscles is restored. With an unfavorable course of the disease, persistent flaccid peripheral paralysis which remain with the patient throughout his life. The affected muscles atrophy, contractures develop, limbs become shortened and deformed, and osteoporosis develops in the bones. The patient remains deeply disabled for life.

Rice. 9. Poliomyelitis in a child, spinal form. Paresis of the left lower limb. Skin folds smoothed out.

Rice. 10. Consequences of polio. The muscles of the shoulder girdle on the left are affected.

Rice. 11. Consequences of polio in children. Paresis of both arms and intercostal muscles (photo on the left). Paresis of the lower limbs and right arm (photo on the right).

Signs and symptoms of bulbar polio

This form of paralytic poliomyelitis develops as a result of damage to the motor nuclei of the IX, X and XII pairs of cranial nerves of the medulla oblongata. The disease is acute, the preparalytic period is short, and occurs with high fever, repeated vomiting and severe headache. Facial hyperemia and cherry-red lip coloring are early symptoms bulbar forms s polio.

When the nuclei of the IX, X and XII pairs of cranial nerves are damaged, the following symptoms develop:

• Children often experience dizziness and headaches. Nystagmus is noted.
• The act of swallowing is disrupted, pathological secretion of saliva and mucus appears, which accumulate in the upper respiratory tract. The child is choking. Liquid food gets into the nose when eaten.
• Damage to the ligaments and muscles of the larynx leads to impaired phonation. The voice becomes dull, hoarse and quiet, the cough becomes silent.
• Paralysis of the tongue, larynx, pharynx develops, and less often - paralysis of the external eye muscles.
• Damage to the respiratory center is characterized by the appearance of intermittent, arrhythmic, bubbling breathing with pauses. Shortness of breath and cyanosis increase. Atelectasis develops in the lungs.
• Damage to the cardiovascular center is manifested by arrhythmias and instability of blood pressure.
• In some cases, patients develop delirium, which turns into coma.
• Paralysis of the vasomotor and respiratory centers leads to the death of the child.

If the course is favorable, stabilization occurs after 2–3 days pathological process. After 2 - 3 weeks, the recovery process begins.

In the bulbospinal form of polio, the spinal cord and medulla oblongata are affected.

Signs and symptoms of pontine polio

When the nuclei of the VII pair of cranial nerves (facial nerve) are damaged, the pontine form of poliomyelitis develops. Paralysis of facial muscles occurs without impairment of pain sensitivity and lacrimation. Facial movements are disrupted on one half of the face, the corner of the mouth drops, the palpebral fissure does not close, the nasolabial fold is smoothed out, the mouth is pulled into healthy side, the child cannot wrinkle his forehead and puff out his cheeks. Less commonly, bilateral lesions develop. The disease occurs without fever. The cerebrospinal fluid has a normal composition.

The pontospinal form develops with simultaneous damage to the motor neurons of the nuclei of the facial nerve and spinal cord.

Rice. 12. The photo shows polio in a child, pontine form. Facial nerve paresis (photo on the left). Subtle signs of the disease become obvious when crying and laughing (photo on the right).

Rice. 13. Pontine form of the disease. Paralysis of facial muscles.

Signs and symptoms of encephalic polio

The development of the encephalic form of polio is characterized by the appearance of general cerebral symptoms and symptoms of focal brain damage.

Signs and symptoms of paralytic poliomyelitis in children and adults during different periods of the disease

Paralytic poliomyelitis in its development goes through 4 stages: pre-paralytic, paralytic, recovery period and residual period (residual changes).

Signs and symptoms of polio in the preparalytic period

With the paralytic form of polio, the incubation period lasts 7–14 days (rarely 4–6 days). After it, a prodromal period begins, characterized by the appearance of symptoms of catarrh of the upper respiratory tract, intestinal dysfunction and autonomic disorders. The child develops headache, lethargy and drowsiness. This phase lasts 1 - 2 days and is called the “minor illness”.

After 2 - 4 days (often after temporary improvement), symptoms of a “big illness” appear: body temperature suddenly rises to 38 - 39 o C, patients experience severe headache and repeated vomiting, increased sweating (especially of the head), severe lethargy and drowsiness . The skin becomes hyperemic and moist. Some children develop goose bumps and red spots. The pulse increases, blood pressure decreases.

Muscle pain, tremors of the limbs, twitching of individual muscle groups, hyperesthesia, pain along the nerve roots and trunks appear, meningeal phenomena, horizontal nystagmus, and confusion are often recorded. Children take a forced pose. Tendon reflexes are reduced. Their asymmetry is noted.

In the cerebrospinal fluid, the number of lymphocytes increases to 250 in 1 μl. During puncture, cerebrospinal fluid flows out under pressure. Protein levels are slightly increased.

The preparalytic stage lasts 3 - 5 days.

Rice. 14. In the preparalytic period, the child does not stand, but when sitting, leans on the bed with his hands (tripod symptom).

Signs and symptoms of polio during the paralytic period

The paralytic phase develops suddenly, over several hours.

• The most common form of the disease is the spinal one. Initially, paresis, and then flaccid paralysis, develops in the muscles of the lower extremities, less often in the upper extremities, muscles of the neck and torso. In the spinal form of poliomyelitis, paralysis can be “ascending” and “descending”, local and widespread. The most dangerous are respiratory paresis.
• When the nuclei of the IX, X, XII pairs of cranial nerves are damaged, paralysis of the muscles of the tongue, larynx, and pharynx develops, and, less commonly, paralysis of the external ocular muscles (eye muscles).
• When the nuclei of the VII pair of cranial nerves (facial nerve) are damaged, paralysis of the facial muscles develops.
• Mixed forms of the disease are often found. With simultaneous damage to the brain and spinal cord, polio ends in the death of the patient.

Initially, asymmetric paresis develops, which transforms into paralysis within 2–3 days. The development of paresis is preceded by muscle pain and paresthesia. The randomness of paresis and paralysis is due to the uneven distribution of polioviruses in the nervous structures. For a short time, movements are limited and then become impossible, muscle tone decreases, up to atony, tendon and skin reflexes disappear. Sensitivity is not impaired. Following this, paralysis develops. The limbs become pale and cold, with a cyanotic tint.

In some cases, improvement occurs from the end of the first week. If the course of the disease is unfavorable, paralysis remains for life, and patients develop muscle atrophy and osteoporosis.

The duration of the paralytic phase is from 1 to 2 weeks.

Rice. 15. Spinal form of poliomyelitis in children. Flaccid paresis of the left lower limb. Skin folds are smoothed (photo on the left). Paralysis of the lower limbs and muscle atrophy in a child (photo on the right).

Signs and symptoms of polio in recovery

A few days after the development of paralysis, the recovery stage begins. The patient's headache and sweating disappear, separate groups muscle movements are restored, pain in the limbs and spine disappears. During the first two months, recovery occurs at a rapid pace, but then the process slows down.

Muscle function is restored unevenly. The recovery period can last up to 3 years.

Rice. 16. Consequences of polio in a child. Atrophic paralysis of the right arm.

Residual period (consequences of polio)

In some cases, when paralysis develops, the function of the affected muscles is not fully restored and the defect persists for life. This is associated with massive death of motor neurons and degeneration of axial cylinders. Damaged muscles atrophy, contractures, curvatures and deformities of the limbs develop. The affected limb is stunted and lameness occurs.

Rice. 19. Left paresis upper limb due to polio. The arm is shortened. The muscles are atrophied.

The incubation period of the disease is on average 5-14 days, less often it is shortened to 2-4 days or prolonged to 25 days.

The course of the disease can be divided into four stages:

I - initial, or preparalytic;

II - paralytic;

III - restorative;

IV - stage of residual effects, or residual.

The initial stage (preparalytic) of the disease lasts, as a rule, 2-5 days.

The onset of the disease is rapid: there is a significant increase in temperature. In some cases, from the very first days of the disease, patients experience nasal congestion, runny nose, cough, redness and soreness in the throat, in others - gastrointestinal tract disorders in the form of diarrhea or constipation. In terms of the child’s general well-being, pronounced disturbances are also noted: headache, blackouts, drowsiness or insomnia, lethargy (up to adynamia); in rare cases, delirium, twitching and trembling, and convulsions are recorded. Most often, convulsive syndrome occurs in children in the first year of life. Due to irritation various departments nervous system, pain occurs in the limbs, pain when pressing on the spine, pain when bending the head and back. Sometimes meningeal phenomena are detected: stiff neck, Kernig's and Brudzinski's symptoms. Children with polio often experience excessive sweating.

Typical of polio is a “spinal symptom”, which occurs due to the characteristic pain of the spine when bending over: in a sitting position, a sick child cannot touch his knees with his lips. In addition, patients with poliomyelitis exhibit the so-called tripod symptom: in a sitting position, the patient leans on both hands to unload and maintain immobility of the spine.

In some cases, the disease occurs in two phases. The first phase is manifested by a rise in temperature, with symptoms of a runny nose, cough, sore throat or intestinal upset. Then the patient’s condition stabilizes for a short time, after which an increase in temperature is observed again, accompanied by a violation of the general condition, functional disorders nervous system, sometimes meningeal phenomena.

The paralytic stage of the disease lasts several days, 1-2 weeks, less often longer.

At the end of the preparalytic or at the beginning of the paralytic stage, the patient’s body temperature drops, followed by paresis and paralysis. Less often, their development is recorded at the height of fever. Typically, paralysis occurs before the 5th day of the disease, less often later - up to the 14th day from the onset of the disease, and gives the impression of a sudden appearance. However, this impression is only apparent, and upon careful observation of the child, it becomes clear that already a few days before paralysis, muscle weakness and lack of reflexes are detected.

Most often, paralysis is detected after a child has slept at night, but the day before there were no obvious signs of impaired motor functions. They are called morning paralysis.

Most often, with polio, the lower extremities are affected by paralysis; less often, the muscles of the trunk, neck, and abdominals are affected. Paralysis of the facial muscles is also possible, occurring both in isolation and in combination with paralysis of other parts of the body. The most dangerous phenomenon is considered to be paralysis of the respiratory muscles and muscles involved in the act of swallowing. Often, paralysis with poliomyelitis spreads asymmetrically in relation to the right and left halves of the human body, with predominant damage to the right or left half of the face, one of the legs, etc. With poliomyelitis, flaccid paralysis develops with a decrease in muscle tone, delimitation or complete absence active movements, with partial or complete reactions of pathological degeneration, absence of tendon reflexes. The affected limbs become cold to the touch, their skin takes on a bluish tint. The reaction of pathological muscle degeneration becomes noticeable after 1-3 weeks.

The recovery stage of the disease can last 1-3 years.

As a rule, in certain muscle groups, movements begin to be restored within a few days after the onset of paralysis. Already at the beginning of this stage, headaches, excessive sweating and, in most cases, pain in the spine and limbs disappear.

At first, the restoration of the functions of paralyzed muscles occurs at a very rapid pace. As active movements are restored, tendon reflexes reappear or intensify. After 4-6 days from the beginning of this stage, the rate of recovery slows down. Muscles whose function is not restored by the end of this stage are deformed: the limbs may seem to freeze in a bent position, they may become shorter than their normal length, etc.

The stage of residual effects (residual) of the disease is caused by persistent flaccid paralysis, atrophy of some muscle groups, deformities of the limbs and torso, etc.

Poliomyelitis can occur in four clinical forms: paralytic, abortive (visceral), meningeal and aparalytic.

Paralytic form of polio

This clinical form The disease, in turn, is also divided into several clinical forms.

Based on the location of the main lesions, the following forms of paralytic poliomyelitis are distinguished: spinal, bulbar, pontine, encephalitic and mixed.

Spinal shape paralytic poliomyelitis occurs most often and is the most typical for of this disease. It is manifested by the development of flaccid paralysis of the limbs, trunk, neck, and diaphragm.

Bulbar form paralytic poliomyelitis is the most dangerous and is characterized by impaired swallowing, breathing and speech.

Pontine form paralytic poliomyelitis manifests itself in the form of paralysis and paresis of the facial muscles, sometimes one-sided. As a result of the latter, the child’s face seems to skew to one side.

Encephalitic form paralytic poliomyelitis is caused by general cerebral signs and clinical manifestations of focal brain damage.

Mixed form of paralytic poliomyelitis occurs when there are two or more lesions in the nervous system. An example is the bulbospinal form of poliomyelitis. Current and clinical features each mixed form reflects its name to a certain extent.

Based on the severity of the disease and the severity of clinical symptoms, 4 forms of paralytic poliomyelitis are distinguished: erased (very mild), mild, moderate and severe.

Abortive, or visceral, form of polio

This clinical form occurs very often: approximately 40-60% or more of all cases of polio. It manifests itself with clinical symptoms initial stage polio: increased body temperature, nausea, vomiting, diarrhea are observed or occurs with symptoms of a runny nose, cough, redness and soreness in the throat. Violated general health in the form of headaches, mental disorders, pain in the back muscles, lethargy (even to the point of immobility). With abortive form of poliomyelitis
Cerebrospinal fluid examination often does not show changes typical for the disease.

Meningeal form of polio

This clinical form of the disease is clinical manifestations similar to abortive, but differs from the latter in the development of the complex meningeal symptoms: more severe headache and vomiting, neck stiffness, Kernig’s, Brudzinski’s symptoms, etc.

Aparalytic form of polio

This clinical form of the disease is extremely rare in vaccinated children. It occurs in a very mild form and usually ends with recovery without residual effects.

Is acutely infectious viral disease, affecting the nervous system. The main impact of polio occurs on the gray matter of the spinal cord. In addition, the polio virus causes inflammatory damage to the intestinal mucosa and nasopharynx, similar to an intestinal infection or acute respiratory infection. This infectious disease causes poliovirus of three antigenic types: I, II and III types.

Outbreaks of polio epidemics are usually associated with type I virus. The source of infection with polio can be a patient, regardless of the form of the disease, as well as an asymptomatic carrier of the virus. The polio virus is transmitted through contaminated hands, food, water, and household items. It is also possible to become infected with polio by swimming in a polluted body of water.

Reasons

Viruses remain viable in water, milk, and feces for a long time—up to 4 months. Polio most often affects young children (usually under six years of age), but adults can also get it. Transmission of the polio virus usually occurs through the fecal-oral route due to the high concentration of the pathogen in the feces of an infected person. In addition, an airborne mechanism of infection cannot be ruled out. The polio virus enters the human body through the intestinal mucosa or nasopharynx.

In the case of fecal-oral infection, the virus is localized in the lymphoid follicles of the intestinal wall; in the case of airborne infection, the virus is localized in the tonsil area.

Manifestations and symptoms

The first signs of polio are most often a sore throat, cough and runny nose, accompanied by nausea, vomiting and loose stools. In addition, a sharp increase in body temperature is very often observed. The person feels unwell and tired. In addition to the general toxic signs of the disease, muscle paralysis is a characteristic symptom of polio. Paralysis of the diaphragm can lead to serious respiratory problems, which can cause death in a person from polio.

Clinical picture of polio

The incubation period of polio ranges from 5 to 12 days, less often – from 2 to 35 days. Poliomyelitis is known in two forms: non-paralytic and paralytic.

Non-paralytic form of polio

The non-paralytic form (otherwise visceral, or abortive) is characterized by catarrhal manifestations (sore throat, runny nose, cough), short-term fever, as well as symptoms of dyspepsia ( loose stool, vomiting, nausea). All symptoms of the disease usually disappear after a few days. Another variant of non-paralytic poliomyelitis is also possible in the form of serous meningitis, characterized by a mild course. Poliomyelitis in the non-paralytic form is most dangerous for others, since the patient may not be aware of the cause of his illness, but the pathogen is eliminated into the environment with the same intensity as in the case of paralytic poliomyelitis.

Paralytic form of polio

Paralytic poliomyelitis is divided into four stages:

• preparalytic;
• paralytic;
• restorative;
• stage of residual effects.

Preparalytic stage of polio

The duration of the preparalytic stage of polio is from 3 to 5 days. The onset of the disease is acute. The temperature rises sharply. In the first days of the disease (about three days), headache, pharyngitis, runny nose, and general malaise are noted. This is followed by a period of apyrexia, lasting from two to four days. In some cases, apyrexia may be absent. Following the period of apyrexia, the next feverish wave occurs.

Rigidity of the muscles of the lower back and neck appears. In addition, soreness occurs in the muscles, which will later be paralyzed. The patient's condition rapidly deteriorates, the headache intensifies, hyperesthesia appears, and consciousness is confused. Possibly decreased tendon reflexes muscle strength, twitching of individual muscles, convulsive shudders, autonomic disorders (goose bumps, red spots, etc.)

Paralytic stage of polio

The paralytic stage of polio manifests itself in the form of flaccid paralysis with decreased tone of the affected muscles, partial limitation or complete impossibility of active movements, and absence of tendon reflexes. The development of paralysis is accompanied by muscle pain without loss of sensitivity.

Paralytic polio comes in several forms:

• spinal (paralysis of the neck, torso, diaphragm, limbs);
• bulbar (disorders of cardiac activity, speech, breathing, swallowing);
• encephalitic (focal brain damage);
• pontine (damage to the nucleus of the facial nerve, paresis of facial muscles);
• mixed - characterized by a multiplicity of lesions.

The consequence of paralysis of the diaphragm and respiratory muscles, as well as damage to the medulla oblongata, is severe breathing disorders that pose a serious danger to the lives of patients. The mortality rate for polio is 14%. In surviving patients, the paralytic stage lasts up to fifteen days.

Recovery stage and stage of residual effects

The recovery period for polio lasts until three years, but may take several months. Recovery of muscle functions is rapid at first, then slows down. At the stage of residual effects of poliomyelitis, persistent flaccid paralysis, contractures and deformations of the trunk and limbs, and muscle atrophy are observed. It is known that a quarter of patients with paralytic polio become disabled.

Diagnostics

The diagnosis of poliomyelitis is established based on the clinical picture, epidemiological prerequisites (contact with patients with poliomyelitis, summer time) and laboratory data. Diagnosis of non-paralytic forms of polio and its pre-paralytic stage, before the appearance movement disorders, is very difficult. If polio is suspected, feces and blood should be tested for the presence of the virus.

Laboratory tests for poliomyelitis consist of determining the antibody titer in paired sera. Serum collection interval: three to four weeks. Preferred methods: RSC, as well as neutralization reaction (in the form of a modified color test). The causative agent of polio is isolated on tissue cultures from the feces of patients and from nasopharyngeal swabs.

Treatment

There are no specific treatments for polio. Patients with suspected polio are hospitalized. During the preparalytic and paralytic period of the disease, patients require strict bed rest. To reduce deformations, paralyzed muscles are protected with splints. A damp, hot cloth is applied to the affected muscles.

In case of paralysis of the pharyngeal muscles, timely suction of secretions from the pharynx is necessary. Paralysis of the muscles involved in the respiratory process requires artificial ventilation lungs. For symptomatic treatment polio, analgesics and sedatives are used. Upon completion of the acute stage of polio, physical therapy is used; exercises are very effective under water.

It is recommended to conduct classes in special orthopedic clinics. Complications of polio can include interstitial myocarditis, pulmonary atelectasis, and pneumonia. In the bulbar form it is possible acute dilatation stomach, severe gastrointestinal disorders, accompanied by ulcers, bleeding, ileus, perforation.

Prevention

To protect yourself from polio, you should not swim in polluted waters. Milk must be consumed only in boiled or pasteurized form, kill flies and reliably protect food products from them. Huge value Poliomyelitis can be prevented by vaccination, which provides lifelong immunity. The effectiveness of the oral polio vaccine is 50% when administered once.

Three-time administration of this vaccine allows you to get a 95% effect. The effectiveness of OPV in hot countries may be reduced due to the vaccine's sensitivity to heat. As a rule, it is recommended to use OPV - live oral vaccine (otherwise: Sabin vaccine) for immunization, due to better immunity which she gives. The vaccine is considered quite safe, but rare cases (one in several million) of paralytic polio have been observed, most often associated with the first or, much less often, the second OPV vaccination.

In most cases, this occurred during the first dose of the vaccine in people with immunocompromise. In this regard, they are currently switching to IPV - the inactivated polyvalent Salk vaccine. This vaccine provides much less protection for the body, but avoids the paralytic stage of the disease. Data about serious complications after using IPV there is no, slight swelling and pain at the injection site are possible. Both polio vaccines contain all three existing types virus, which provides protection against all possible variations of the disease.

Modern society actively promotes refusal to vaccinate. Allegedly, such measures only weaken and poison the child’s body. Meanwhile, childhood diseases have existed and still threaten unvaccinated children. Poliomyelitis in children is most often recorded in preschool age, just at a time when its prevention is advisable. We’ll talk further about what kind of illness this is, what signs should alert parents, where to go, how to treat and protect the baby from polio.

Poliomyelitis is a disease caused by poliovirus that affects the nervous system and is localized in the gray matter of the spinal cord. The disease is contagious, dangerous and can lead to paralysis or even death.

Until the 20th century, the disease was an epidemic, the fight against which became possible only with the advent of a vaccine. Until then, the mortality rate was very high. Even those children who managed to recover remained disabled for the rest of their lives.

Young children are especially sensitive to all strains of this virus, although cases of infection in adults have occurred. “Infantile spinal palsy” is another name for the disease because motor neurons are affected as the infection progresses. Today, only vaccination provides lasting immunity from polio, so the possibility of becoming infected has decreased. In some Asian countries, vaccination is not carried out, and this fact threatens the modern world with outbreaks of infection.

Characteristics of the virus

The infection's resistance to chemical and physical influences is very high. The virus remains viable at a temperature of 37° for two months, and a low temperature (3-4°) maintains its activity for more than long term. The poliovirus can be destroyed using high temperature and disinfectant solutions. The infection cannot develop in the body if the child is vaccinated.

The habitat of poliovirus is liquids, objects, soil and feces. Children can become infected through shared utensils, toys, and by eating unwashed fruits and vegetables (especially from Central Asia). But direct contact with a sick child poses an even greater threat. For example, droplets of saliva or the touch of an infected baby’s dirty hands after visiting the toilet - and the enemy has entered the body. A vaccinated child cannot become infected, just as such a baby is not at risk of infection.

But children have different susceptibility to the virus. According to statistics, 95% of babies can get sick without specific symptoms. 5% are affected by the respiratory system and gastrointestinal tract. And paralysis occurs in only 1% of patients.

Risk group

There are factors that increase the likelihood of poliovirus entering the body. Individual susceptibility and severity of the disease also depend on the following points:

• availability surgical interventions, especially for tonsil removal;
• babies with blood types 1 and 2 are more at risk;
• the presence of endocrine abnormalities in the baby’s body;
• children exposed to constant stress and living in unfavorable conditions;
• uncontrolled consumption of sweets and easily digestible carbohydrates increases the likelihood of infection;
• pesticides and insecticides that come into contact with the child’s body.

Path of the virus in the body and consequences

Symptoms and forms

The virus enters the child’s body through the mouth, and from there into the intestines, where it actively multiplies. Together with the blood, the infection from the intestines spreads further, causing disorders in the brain and spinal cord. Signs of a child becoming infected with polio differ depending on the form of the disease. There are two of them: paralytic and non-paralytic.

The non-paralytic form is divided into 3 types.

1. Asymptomatic (in-hardware) the form does not show any clinical signals. Babies with this type of disease release infection into the external environment and are dangerous for healthy children. When examining the blood of an infected child, a significant concentration of characteristic antibodies is observed. The asymptomatic form is very common.
2. The abortive type of polio is detected using laboratory and epidemiological studies. The symptoms are similar to simple childhood diseases and manifest themselves in increased body temperature, weakness, and malaise. Diarrhea and abdominal pain may also be present. At usual treatment recovery occurs within a week.
3. The meningeal form is similar to serous meningitis, hence the name. Immediately after infection, a high temperature rises, the child has a headache, and vomiting occurs. Then Kernig's and Brudzinski's symptoms appear. Feeling the nerve trunks causes pain, and certain muscle groups may contract involuntarily. With adequate therapy, treatment ends within a few weeks.

There are 4 types of paralytic polio.

1. Spinal shape goes through 4 stages. Signs of the disease do not appear immediately, but only after 10-12 days of the incubation period. However, the virus at this stage is already detected in the stool. When the first signs appear, children have a high temperature for 6-7 days. An infected baby often vomits, there is pain in the limbs and back, and the child sweats profusely. When the fever subsides, paralysis begins. It can affect the lower back, chest, neck. In this case, the muscles gradually atrophy, joint contracture and osteoporosis are possible, and the affected limbs may have stunted growth. The rehabilitation period after spinal poliomyelitis lasts about a year.
2. Pontine form affects facial nerve, resulting in muscle paralysis. The child cannot make any facial movements.
3. The bulbar type of the disease affects the cranial nerves. Respiratory distress and phonation occur, and the baby cannot swallow. The disease is aggravated by abnormalities in the functioning of vital organs. If everything ends well and death does not occur, then within 3 days the process will stabilize. The rehabilitation period in this case begins from the 15th day.
4. Bulbospinal form especially dangerous. It contains mixed symptoms spinal and bulbar forms, when paralysis of the body occurs simultaneously with paralysis of the facial muscles, impaired breathing, swallowing, etc.

A separate type of polio - vaccine-associative. It occurs after the introduction of a vaccine and is characterized by mild symptoms. If more than 30-35 days have passed after the injection or drops and no suspicious changes are observed in the child’s condition, he is healthy. This type of disease is rare, with a probability of 1 case in 200 thousand.

Stages of the paralytic form

The paralytic form is divided into several stages that determine the course of the disease.

1. Preparalytic the stage lasts up to six days, accompanied by signs of intoxication and fever.
2. The paralytic stage is characterized by the appearance of the first paresis. On average, its duration is 2 days.
3. Recovery stage characterized by relief of symptoms, active recovery lasts six months, final completion is delayed for several years.
4. In the residual phase Residual reactions are observed, as a rule, they last more than three years.

Diagnostics

To make a correct diagnosis, it is not enough to have data on the presence of specific symptoms. The final conclusion is formulated only after special analyzes.

There are two main methods of research conducted in the laboratory: virological and serological.

• The first type involves detecting an infection in the patient’s biological material, the second is checking the blood for the presence of antigens or antibodies. The infection can be isolated from feces and the nasopharyngeal cavity (through washings) in the first 7 days of illness.
• Serological tests are prescribed several times, each subsequent analysis is done no earlier than 14 days after the previous one. At the same time, it is important to know about the fundamental differences between the post-vaccination reaction and the infection itself.

Differential diagnosis is also used based on patient complaints, comparing symptoms in children with a specific clinical form.

Treatment

After the final diagnosis of polio is made, the sick baby is isolated from healthy children. Basic therapeutic procedures are performed in a medical facility. Special drug, capable of curing the disease, has not yet been developed, so treatment of polio in children comes down to symptom relief and supportive therapy.

Any form of illness requires bed rest, and when paralysis begins to increase, the child needs absolute rest. What drugs treat the disease?

1. At elevated temperatures and headaches, dehydration therapy is carried out using Paracetamol, Ibuprofen, and Aspirin.
2. Gastrointestinal disorders are treated with drugs that regulate the water-salt balance (“Hidrovit” or “Regidron”).
3. For normalization intestinal motility laxatives are used. These include castor oil and the drug Lactulose.
4. To restore nerve conduction and muscle response, use “Dibazol”, “Proserin”.
5. Diazepam is prescribed as a drug that relaxes muscles and reduces anxiety, and Paroxetine is prescribed as a sedative and antidepressant.
6. For speedy recovery and maintenance of the body, as well as for meningoradicular syndrome, B vitamins are prescribed, but more important role plays vitamin B 12.

For polio, Diacarb is often prescribed. The medicine has a positive diuretic, decongestant, antiepileptic effect, and can also have a beneficial effect on the ventricular plexuses in the neurons of the brain.

In addition to taking medications, specialists pay considerable attention to caring for the baby’s atrophied limbs. When the recovery phase begins, damaged limbs need regular massage, physiotherapy, hydrotherapy, electrical stimulation, and UHF. Doctors prescribe physical therapy, the action of which is designed not only to develop an atrophied muscle group, but also to restore the physical functions of the body as a whole. After recovery, work begins on correcting the deformed limbs.

The paralytic form requires special care, since the correct position of the spine and limbs determines the presence or absence of complications. Problem joints are sometimes fixed with splints or orthoses, and bolsters are placed under them.

Identify signs of polio in children, diagnose the disease, prescribe therapeutic measures and restorative therapy can only be performed by a neurologist.

Folk remedies

A child with polio, along with traditional treatment recommended to use folk recipes. However, all your actions must be coordinated with your doctor. If he does not advise doing this now, then it is better to wait.

The most popular folk recipes.

1. At severe pain in the back, neck, shoulders, as well as persistent headaches, a bath is recommended for children. To do this, you need the child to sit in the bath with the usual water temperature (37°). After a short adaptation, the water is gradually, over 10 - 15 minutes, brought to 41°. The baby should be in hot water for no more than five minutes, after which he is laid on the bed, covered with a warm blanket and allowed to sweat for half an hour. For a more noticeable effect, you can give your baby linden tea before bathing.
2. If a child has a sore throat and the upper respiratory tract, rinse with medicinal sage. To do this, you need to chop the dry herb (1 tbsp) well, add a glass of water and boil in a water bath for 10 - 15 minutes. Then strain the solution, squeeze it out and let it cool a little. Gargle 2-3 times a day, an hour before meals.
3. Has a good influence fresh juice seed lettuce. It is squeezed out of the plant and given to the child to drink, adding a spoonful of honey. The norm is 50 - 100 ml per day.
4. If the child sleeps poorly and restlessly, prepare a decoction of oregano. A teaspoon of herb is poured with boiling water and infused for an hour. Strain. Children under 5 years old are given 1 tsp. 5-6 times a day; children after five years old should be given the same amount of infusion 8-9 times a day.
5. Relaxing pine baths will help relieve symptoms of polio in children associated with muscle tension. To do this, pine needles (250 g) are poured with 1.5 liters of water and allowed to stand in a water bath for 15 minutes. After this, the broth is removed from the stove and allowed to brew for an hour. Strain and add to bathing water.

We remind you that the use of all means traditional medicine Be sure to check with your doctor! Poliomyelitis is serious illness, during which all your actions must be coordinated by a specialist!

Prevention

Is it possible to protect a child from polio? Currently, the only way to prevent the disease is vaccination. The first time it is carried out at two months, it is repeated two more times - at 3 and 5 months. Revaccination of children occurs at the ages of two and seven years. For this, oral drops containing a weakened virus are used, which are dropped into the baby's mouth, or an intramuscular vaccine with a killed virus.

In domestic medical practice Three vaccines have been officially tested, registered and used:

1. Oral. Three types are used: I, II, III. Produced in Russia.
2. The drug "Imovax", made in France.
3. "Tetracoccus". The second and third vaccines are from the same French manufacturer (Sapofi Pasteur).

As a result of the introduction of a weak or killed virus, the baby’s body begins to actively produce antibodies, which will subsequently provide immunity for life.

Vaccinated children, as a rule, do not get polio. The only exceptions can be those whose immunity is extremely weakened.

People who had contact with infected child, 21 days are under observation. All items and personal belongings of the baby must be disinfected.

To reduce the risk of infection, you need to:

• avoid contact with a sick child;
• follow the rules of personal hygiene;
• carry out correct heat treatment food;
• help improve the baby's immunity.

About the vaccine

Most babies tolerate the injection of a killed or weakened virus well. Children can be vaccinated on the same day as DTP. The injection sites for one and the second vaccine should be different, as well as the syringes.

However, sometimes the vaccine may cause minor side effects:

• redness around the injection site;
• increased body temperature;
• painful sensation at the injection site, possibly in the abdomen;
• weakness.

It is unknown whether your child will have any reaction to the vaccine. It all depends on the individual characteristics and general condition of the body.

Consequences

The most dangerous consequences carries a paralytic form of polio. Atrophied limbs and spine are not always restored. In this case, this threatens:

• underdevelopment of one or two limbs;
• visible kyphosis;
• deformation of bone tissue;
• blocking motor function limbs;
• problems with speech, swallowing.

Poliomyelitis in children, which occurs in mild forms, after recovery can remind of itself:

• flaccid, weak muscles;
• respiratory and heart failure;
• increased fatigue;
• shortness of breath;
• periodic muscle pain.

The insidiousness of the disease is that sometimes childhood polio causes complications in adolescence and adulthood. This is due to the fact that nerve tissue still contains the virus (albeit in a latent state), and all this time there was a process of gradual destruction of neurons.

Many scientists in laboratories worked to create a vaccine that could prevent polio, a disease that, if it did not kill, then crippled small patients for the rest of their lives. Currently, the prevention of polio in children consists of vaccination. Pediatricians insist on this not because it is customary, but for the reason that it will really protect the child. I am glad that most parents still bring their children for vaccination. Whereas those who write a refusal simply do not understand the seriousness of the consequences of their action. After all, no one knows what a child will do when he grows up, what countries he will have to visit and what people he will communicate with. But in some countries children are not vaccinated at all! Therefore, it is better to ensure lifelong immunity from polio by getting vaccinated in childhood.

Resume

Poliomyelitis is a severe childhood infection that attacks the nervous system and can lead to disability. The advent of a vaccine is a breakthrough in the field of healthcare and the only opportunity to protect a child from the disease. Timely visits to the doctor and compliance with the vaccination schedule are the key to peace of mind for parents and the baby. No matter what they say about the dangers of vaccinations, it is thanks to them that since 1997 not a single strain of the polio virus has been identified in the country.