Polio

The effects range from asymptomatic (most common) to the most severe forms of debilitating paralysis. Various symptoms are discussed below:

1. Non-Paralytic Polio

About 95% of people who get infected with polio won't have any symptoms. They are able to fight off the infection without even realizing they are infected. In approximately 4%–8% of polio infections, a minor illness occurs without any evidence of central nervous system invasion, known as abortive poliomyelitis. Complete recovery usually occurs in less than a week. Few people experience a flu-like illness for 3 to 21 days after infection. The symptoms observed in this type of infection include:

• High temperature (fever) of 100.4°F or above
• Headache
• Abdominal pain
• Sore throat
• Gastrointestinal disturbances (nausea and vomiting)

2. Paralytic Polio

Around 1% of cases can lead to paralytic polio, which causes paralysis of the spinal cord, brainstem, or both. The early symptoms are related to non-paralytic polio. However, after a week, severe symptoms appear, including:

• Muscle weakness
• Tight joints (contractures)
• Shrinking of the muscles (atrophy)
• Deformities, such as twisted hips, feet, or legs
• Loss of reflexes
• Sudden paralysis (temporary or permanent)

Many people with paralytic poliomyelitis recover completely, and muscle function returns to some degree in several cases.

3. Post-Polio Syndrome (PPS)

Polio can return even after 15 to 40 years of recovery. Some common symptoms of Post-Polio Syndrome include:

• Easily exhausted or fatigued
• Low tolerance to cold temperatures
• Worse muscle pain
• Muscle atrophy
• Trouble with concentration and memory

It has been estimated that 25%–50% of people who survive polio will develop PPS.

Polio is a highly infectious disease caused by the poliovirus. Poliovirus only infects people. An infected individual can spread the virus to others before or up to 2 weeks after symptoms appear. An asymptomatic carrier can also infect others.

The poliovirus can survive in an infected person's intestines for many weeks. This can lead to the contamination of food and water in an unclean environment. Transmission can occur in the following ways:

• Contact with the feces of an infected person
• Droplets from a sneeze or cough of an infected person
• Touching contaminated surfaces
• Close contact with an infected person

• Not vaccinated against polio
• Travel to countries where polio is widespread or endemic, such as Pakistan or Afghanistan
• A weakened immune system
• Tonsillectomy or having tonsils removed
• Handling a laboratory specimen of the virus

A general practitioner diagnoses polio by a detailed medical history, performing a physical exam, and testing samples of body fluids.

Medical History

This includes taking information about any travel to an area where polio is endemic or any contact with a person infected with polio.

Physical Examination

This involves a complete body check-up. The function of respiratory muscles is examined as polio affects the spinal cord and the brain stem, which may impact the respiratory muscles. Muscle reflexes are also evaluated, as there may be stiff neck and back muscles or difficulty lifting the head or legs while lying flat on the back.

Laboratory Diagnosis

The following tests help in the diagnosis and confirmation of polio infection:

• Virus Isolation and Detection: Virus isolation in culture is the most reliable method for diagnosing poliovirus infection. Poliovirus is usually isolated from stool specimens or throat swabs. Two samples are collected at least 24 hours apart from patients with suspected poliomyelitis to increase the chances of isolating poliovirus.
• Cerebrospinal Fluid Analysis: The cerebrospinal fluid (CSF) can also be used for diagnostic testing of the virus. CSF is collected using a lumbar puncture (also called a spinal tap), in which a needle is inserted into the spinal canal to collect CSF.
• Blood Tests: Blood is tested for antibodies to poliovirus, produced by the body in defense against an invading virus or bacteria.
• Electromyogram (EMG): EMG measures electrical activity in response to a nerve's muscle stimulation. This test is used to help detect any neuromuscular abnormalities and for the differential diagnosis of muscle weakness in post-polio syndrome.
• Fingerprinting the Polio Virus: Poliovirus is isolated and tested using a specific test called oligonucleotide mapping (fingerprinting) or genomic sequencing. This test examines the virus's genetic sequence to determine if the virus's origin is wild-type or vaccine-like. Wild-type viruses naturally occur in the environment, whereas a vaccine-like virus is derived from a spontaneous mutation of the virus's genes.

There is currently no treatment for polio. However, it is a vaccine-preventable disease.

Vaccination is usually done in childhood. If you are not vaccinated as a child, ask your healthcare provider about your vaccination.

A healthcare professional will recommend four polio shots in childhood:

• First shot at 2 months
• Second shot at 4 months
• Third shot between 6 and 18 months
• Booster shot between 4 and 6 years

If a person is not vaccinated in childhood and is recommended to get vaccinated as an adult, that person will receive three shots:

• Two doses 1-2 months apart
• A third dose 6-12 months after the second

There are two types of vaccines:

• Inactivated polio vaccine (IPV): The IPV contains poliovirus that is treated ("killed") so that it cannot multiply anymore. It includes inactive versions of polio strains types 1, 2, and 3. IPV is administered as a series of shots (injections).
• Oral polio vaccine (OPV): This is also known as the live attenuated polio vaccine. It uses a live virus that has been weakened (attenuated) and cannot make you sick. However, it creates an immune response in the intestines called mucosal immunity, which protects against polio infection. It is given in a liquid form orally.

Treatment of Polio

There is no cure for polio. The management of this condition focuses on increasing comfort, speeding recovery, and preventing complications. Supportive treatments include:

• Pain relief medications: Over-the-counter medications such as aspirin, paracetamol, or ibuprofen, as well as stronger NSAIDs and opioids, can be prescribed by a doctor to help relieve pain. However, these medications should not be taken for extended periods, as they can cause side effects, such as stomach ulcers. If these medications are ineffective, the physician may prescribe alternatives like gabapentin for pain relief.
• Rest and exercise: Staying active is beneficial for most people with post-polio syndrome, as it may slow down progressive muscle weakness. However, patients may find it challenging to remain active as symptoms may worsen over time. To address this, "pacing" techniques may be recommended, which involve:
  • Prioritizing tasks
  • Taking regular breaks and resting throughout the day
  • Engaging in regular gentle exercise
• Physical or occupational therapy: Physical therapy aims to alleviate pain and improve function, mobility, and overall quality of life. This can help reduce arm or leg weakness caused by polio and enhance long-term outcomes, particularly when implemented early in the illness.
• Mobility aids: Mobility aids are designed to assist with walking or improve the mobility of individuals with impairments. These include:
  • Wheelchairs
  • Walking sticks
  • Braces to support weakened muscles or joints
  • Shoe inserts
• Shoe inserts: The physical deformities associated with polio tend to affect the extremities and limbs. These effects can lead to changes in gait and bone structure, and shoe inserts can help individuals move around without causing pain.
• Using cold and heat compression: Alternating applications of heat and cold can help relieve muscle pain and tension.
• Managing the psychological impact: Post-polio syndrome can lead to significant psychological effects, including anxiety, isolation, stress, and depression. Therefore, it is essential to manage these symptoms and improve quality of life.
• Healthy eating and managing weight: Being overweight can further strain weakened muscles and negatively impact energy levels and overall health. A well-balanced and nutritious diet can help control weight and enhance general health.

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The most significant complications of polio infection include:

• Paralysis
• Fatal respiratory and cardiovascular collapse
• Post-polio syndrome (PPS)

It is estimated that up to 30% to 40% of the 15 to 20 million known polio survivors worldwide develop some form of PPS. This condition is characterized by new-onset or progressive muscle weakness in patients previously diagnosed with poliomyelitis.

Other symptoms may include:

• Myalgias
• Respiratory distress
• Joint pain
• Atrophy
• Dysphagia
• Generalized fatigue

Paralysis can often lead to complications with:

• Breathing
• Swallowing
• Bowel and bladder functioning

Massage Therapy

Massage under medical supervision can significantly relieve muscle aches and pains. Targeting the appropriate muscle areas is essential for effective symptom relief. The application of herbal oils can enhance the effects of the massage and contribute to relaxation.

Hydrotherapy

Hydrotherapy can be beneficial for polio survivors due to reduced gravity and buoyancy, especially during periods of physical strain. Spending a few hours in a swimming pool or tub can alleviate soreness in aching joints and relieve muscle tension.

Polio can have various adverse effects on a patient's lifestyle, depending on the severity of the symptoms. The challenge or ease of living with polio varies for each survivor, subject to the availability of medical care, rehabilitation opportunities, and family and social support. Various forms of rehabilitation and support include:

• Assistive devices for movement, such as braces, canes, orthotics, and wheelchairs, which enable patients to manage daily chores independently.
• Physical or occupational therapy to help ease pain and improve functionality, mobility, and overall quality of life.
• Emotional support and caretaking, as polio can lead to lifelong impairment. Support from family members can significantly aid in recovery.