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Poliomyelitis (the disease is called also children's paralysis, Heine-Medina's illness) is an acute disease of infectious character which provokes the virus possessing a tropnost to motor neurons in front horns of a spinal cord and also to motor neurons of a brainstem. Owing to destruction of these neurons there is paralysis of muscles and the subsequent their atrophy.
Epidemics of a disease occurred in the world up to the middle of the last century. But today owing to mass immunization of children specially developed poliomyelitis vaccine observes exclusively sporadic cases. The poliomyelitis inoculation allowed to stop distribution of poliomyelitis. However the quantity of healthy carriers of poliomyelitis, and also number of abortal cases (the person recovers before paralysis develops) significantly exceeds the number of people in a paralytic stage. They are also the chief distributors of poliomyelitis though it happens that infection occurs also from the patient in a paralysis stage.
The infection is transferred in the basic through personal contacts, and also by fecal pollution of food stuffs. The last circumstance explains why the illness often develops seasonally: the peak of distribution of a disease is the share of the end of flying and an early autumn. The incubation interval at poliomyelitis to last from one to two weeks. Children aged from six months till five years get sick with poliomyelitis, as a rule. Today the disease meets worldwide.
Causative agent of poliomyelitis
There are three virus strains, causing poliomyelitis: I, II and III type. In the course of diagnosis of a disease the virus is allocated from a mucous membrane of a nasopharynx at patients with an acute stage of a disease, at virus carriers and the recovering patients. Most often the person catches a virus through a digestive tract. The virus gets to a nervous system on vegetative fibers and perinevralno. Today there is an opinion that the virus can extend through lymphatic and circulatory systems. Is implemented into an organism through a throat. Features of a virus following: he is very sensitive to heat and dryness, however steadily perceives chemical agengena.
There are four different types of reaction to a poliomyelitis virus:
- immunity can develop when symptoms are not shown (a so-called subclinical or implicit infection);
- symptoms are shown in a viremiya stage. They are similar to symptoms at systemic infection, at the same time the nervous system is not involved in process of a disease a nervous system (so-called abortal cases);
- many diseased has a feeling of an indisposition, fever, headaches; perhaps also manifestation of the meningeal phenomena, developments of paralysis does not happen;
- at the patient paralysis (exceptional cases) develops.
So, if at the patient the subclinical form of a disease is observed, then symptoms in general are absent. If the abortal form of poliomyelitis takes place, then symptoms are identical to signs of systemic infection. At the same time serological tests are positive, at the patient the virus is allocated. At a preparalytic stage two phases of a disease are allocated. At the first phase the person has a number of symptoms: weakness, indisposition, gastrointestinal disturbances, headache, perspiration, etc. This stage can proceed one or two days. In certain cases further improvement of a state for some time follows, or there comes the second phase of an illness. As symptoms in this case the expressed headache, feeling of a pain syndrome in a back, legs, hands, the high level of fatigue takes place. All symptoms are very similar to manifestation of other forms of viral meningitis. If sick has no paralysis, then he recovers. At the patient increase of level of proteins and globulins is observed, on the second week of an illness protein level increases in liquor. Duration of a preparalytic stage – from one to two weeks.
At patients in a paralytic stage the spinal form of an illness at which paralysis does not develop owing to existence of the expressed fastsikulyation is allocated. The patient complains of morbidity of extremities and high sensitivity of muscles to pressure. Distinguish the extended or localized paralyzes. If the illness passes hard, then the patient can not move at all. Are possible unless very weak movements – in a trunk, a neck, extremities. If the course of a disease less heavy, then paralyzes can asymmetrically be shown. Damage of muscles on the one hand bodies and lack of that on other party is possible. As a rule, paralysis is shown in the first days of a course of a disease. Also "ascending" paralysis option when it extends up is possible, threatening human life in view of in parallel the shown disorder of breath. The descending option of display of paralysis is possible.
As a rule, improvement of a condition of the patient with poliomyelitis comes approximately by the end of the first week from time of development of paralyzes. At paralysis decrease in cutaneous and deep reflexes is observed. Sensitivity is also not broken.
At a paralytic stage of a disease also the trunk form (polioencephalitis) is possible. In this case at the patient there comes the glossolysis, throats, throats, mimic muscles. In more exceptional cases paralysis of oculomotor muscles is possible. At the patient dizziness is sometimes shown. Also the vital centers can be involved in process.
Diagnosis of poliomyelitis
At sporadic cases a disease of poliomyelitis it is very important to carry out differentiation of an illness from myelites of other etiology. At diagnosis of an illness at adult patients poliomyelitis is differentiated with a syndrome of Giyena-Barret-Shtrolya and an acute cross myelitis. By allocation of a virus and carrying out serological tests the bulbar form of poliomyelitis is differentiated.
In the course of diagnosis of acute poliomyelitis the doctor conducts survey and survey of the patient. At statement of the diagnosis its characteristic beginning which is followed by fever, all-infectious symptoms, manifestation and intensive increase of sluggish paresis and paralyzes is considered. The diagnosis by virologic research is confirmed. Also in pair blood sera the caption of specific antibodies is defined. The analysis is taken with an interval which has to make about 10 — 14 days.
Treatment of poliomyelitis
Methods of treatment of poliomyelitis directly depend on that how heavy stage of an illness takes place at the patient and what form of poliomyelitis was diagnosed. If there is a suspicion on existence at the person of poliomyelitis, it is necessary to create at once to it a condition of absolute rest. At physical activity the possibility of display of heavy paralyzes considerably increases in a preparalytic stage of poliomyelitis. If paralysis takes place, then the doctor defines therapy tactics individually, being guided by prevalence of paralysis on respiratory and boulevard muscles. If at the patient respiratory disturbances are not observed, then ribonuclease and serum of convalescents is intramusculary entered. At an acute stage of an illness of the patient shall use a lot of liquid. To specify the diagnosis, and also to reduce pain in spin and a headache, the lumbar puncture is carried out. For the purpose of reduction of concern of the patient and simplification of pain sedatives and analgetics are appointed.
The person who receives medical treatment poliomyelitis can make only very easy passive movements. Treatment by means of antibiotics is carried out only if the patient has a respiratory frustration and, as a result, prevention of pneumonia is necessary.
After development in the patient with paralysis poliomyelitis treatment of an illness can be carried out in three steps. At an acute stage of an illness when the person feels an acute pain, and his muscles have high sensitivity, it is very important to protect the affected muscles from stretching. For this purpose the patient has to lie on a soft mattress, at the same time situation has to be such that muscles which were paralyzed stayed in the weakened state. For improvement of comfort it is possible to use special bags with sand or pillows.
In the course of recovery it is regularly very important to carry out the physical exercises which are specially developed for accumulation of force of muscles of the patient. Such exercises should be carried out by means of other people, on special devices, in a bathtub.
If the residual stage of an illness takes place, carrying out a tenotomy or other surgeries is possible. At treatment Dibazolum, metabolic means, vitamins is used prozerin. The physical therapy – carrying out UVCh, novocaine ionophoresis is also effective in this case.
If bulbar paralysis is diagnosed for the patient, then there is a danger of hit of liquid in a throat. In that case the patient has to lie on one side, and time in several hours it needs to be turned on other side. The secret is removed by means of a suction. Receives food of the patient through a nazogastralny probe.
Earlier during poliomyelitis epidemics mortality of the diseased made from 5% to 25%. The death at poliomyelitis occurs owing to respiratory frustration at bulbar forms or the ascending paralyzes. Today mortality considerably decreased. If in time to stop progress of paralysis, the patient recovers. At the patient autokinesias, deep reflexes and reductions of muscles which are shown after paralysis owing to stimulation of a nerve are considered as a good sign. Recovery process sometimes to last year and more.
Prevention of poliomyelitis
In view of the maintenance of a virus activator of poliomyelitis in Calais, saliva, the patient's urine, it should be isolated, at least, for six weeks. Children who contacted to sick poliomyelitis are isolated for three weeks from other children.
Will be applied to the prevention of distribution of an illness mass timely immunization. The poliomyelitis inoculation with use of an attenuirovanny poliomyelitic vaccine provides the person with immunity for three years. Today the poliomyelitis inoculation is considered the most effective measure of prevention of distribution of a disease.
As general measures of prevention of an illness various actions from which it is necessary to distinguish work on identification of all cases of developing of a disease, tracking of circulation of viruses of poliomyelitis in external environment, the full vaccination which is carried out to precisely established periods, control over quality of a vaccine from poliomyelitis and also behind vaccination process are applied.