What Is Pilonidal Disease?

Poliomyelitis is an acute infectious disease caused by polio virus which seriously endangers children's health. Poliomyelitis virus is a neurotropic virus that mainly invades motor nerve cells of the central nervous system and mainly damages motor neurons in the anterior horn of the spinal cord. Patients are mostly children aged 1 to 6 years. The main symptoms are fever, general discomfort, severe limb pain, flaccid paralysis with irregular distribution and varying severity, commonly known as polio. Poliomyelitis has a variety of clinical manifestations, including mild nonspecific lesions, aseptic meningitis (non-paralytic poliomyelitis) and flaccid weakness of various muscle groups (paralytic poliomyelitis). In polio patients, motor neurons in the anterior horn of the spinal cord are damaged, and the muscles associated with them lose their neuromodulation and atrophy. At the same time, subcutaneous fat, tendons and bones also shrink, making the entire body thinner.

Basic Information

nickname: Polio
English name: Poliomyelitis
Visiting department: Infectious Diseases, Pediatrics

Multiple groups: 1 to 6 years old
Common causes: Caused by polio virus
Common symptoms: Fever, general malaise, severe limb pain and flaccid paralysis

Clinical manifestations of polio

The incubation period of this disease is 8 to 12 days, which can be divided into many types clinically: recessive infection; frustrated type; non-paralytic type; paralyzed type.

1. Prodromal stage < br The main symptoms are fever, loss of appetite, sweating, irritability, and general hypersensitivity; nausea, vomiting, headache, sore throat, constipation, diffuse abdominal pain, rhinitis, cough, and exudate of throat , Diarrhea, etc., last for 1 to 4 days. If the disease does not develop, it is frustrated.

2. Early paralysis

Most patients enter the current period from the prodromal period, and a few enter the current period with fever again after a few days after the disappearance of the prodromal symptoms, or they can start without this period. The child developed high fever and headache. Pain in the back of the neck and extremities, worsening when moving or changing positions. At the same time, there are excitement states such as sweating, redness of the skin, irritability and nervous system signs such as positive meningeal irritation. Small infants refuse to hug, older infants can see the physical examination: Tripod sign means that the patient needs to support with two hands on the bed such as a tripod to support the posture when sitting up; Positive knee-knee test means that the patient cannot sit and bend the lips when the neck is bent Touch the knee; The drooping head is about to be placed under the patient's shoulder. When the trunk is raised, the head of the normal person is parallel to the trunk. At this time, the cerebrospinal fluid appeared abnormal, showing the phenomenon of cell protein separation. If the condition ends here, it will be non-paralyzed after 3 to 5 days of heat regression. If the condition continues to develop, tendon reflex changes will usually occur 12 to 24 hours before the paralysis. The initial is shallow reflex, then deep tendon reflex inhibition, Therefore, early detection of reflex changes has important clinical diagnostic value.

3. Paralysis period

Clinically, this period cannot be completely separated from the pre-paralysis period. Generally, asymmetric muscle weakness or flaccid paralysis occurs 2 to 7 days after the onset or 1 to 2 days after the second fever, which increases with fever and heat regression. After paralysis no longer progressed. There is no sensory disturbance, and dysfunction of urination is rare. According to the lesion site, it can be divided into the following types.

(1) Spinal type This type is the most common. Presented as flaccid paralysis, asymmetry, disappearance of tendon reflexes, decreased muscle tone, lower limbs and large muscle groups are more susceptible than upper limbs and small muscle groups, but only single muscle groups may be involved or limbs may be paralyzed, such as involving the neck Muscles, diaphragm muscles, intercostal muscles, combing and sitting up difficulties, respiratory movement disorders, paradoxical breathing and other manifestations.

(2) The medulla oblongata, also known as the bulbar type, is caused by violations of the cranial nerve's motor nucleus and the medulla's breathing and circulation centers. This type is rare. Irregular breathing and apnea occur when the respiratory center is damaged; changes in blood pressure and pulse rate can occur when the vascular motor center is damaged, both of which are fatal. When the cranial nerve is damaged, the corresponding symptoms and signs of neural palsy appear. The facial nerve and the Xth injury to the cranial nerve are more common.

(3) Brain type This type is rare. Presented with high fever, restlessness, convulsions, or lethargic coma, with spastic paralysis of upper motor neurons.

(4) The performance of mixed types and above.

4. Recovery period

Generally, the paralysis recovers from the distal end of the limb for 1 to 2 weeks after the paralysis, which lasts for several weeks to several months. The general case can be completely recovered within 8 months, and the severe case takes 6 to 18 months or longer.

5. Sequelae

In severe cases, the affected muscles atrophy and nerve function cannot be restored, causing deformities of the affected limbs. Partial paralytic cases have progressive neuromuscular weakness and pain for several decades after infection, and the paralysis of the affected limbs has become worse, known as "post polio muscular atrophy syndrome". The cause is unknown.

Polio examination

Blood routine

The total number of white blood cells and the percentage of neutrophils are mostly normal.

2. Cerebrospinal fluid examination

In the early and early stages of paralysis, the number of cells was increased (mainly lymphocytes), the increase in protein was not obvious, and the phenomenon of cell protein separation was seen, which has certain reference value for diagnosis. By the third week of paralysis, the number of cells had returned to normal, while the protein continued to increase, and it returned to normal after 4 to 6 weeks.

3. Virus isolation

Virus isolation is the most important confirmatory test for this disease. The virus can be isolated from the pharynx and feces within one week of onset of disease. Specimens can be collected with swabs of the throat and anus: two specimens (weight> 5g) are collected at intervals of 24-48 hours, and refrigerated below 4 ° C in time for multiple inspections. Concord test can increase the positive rate. Within 1 week after onset, the virus can also be isolated from nasopharynx, blood, and cerebrospinal fluid of children.

4. Serology

In patients who have not taken polio vaccine recently, the anti-poliomyelitis virus-specific immunoglobulin M (IgM) antibodies in the blood and cerebrospinal fluid of patients are detected by enzyme-linked immunosorbent assay (ELISA method) within 1 month after onset. It helps early diagnosis; the serum specific immunoglobulin G (IgG) antibody titer of patients in the recovery stage is more than 4 times higher than that in the acute stage, which is of diagnostic significance.

Differential diagnosis of polio

The diagnosis is not difficult when polio shows typical symptoms of paralysis. It is not easy to diagnose before the onset of paralysis, and serology and stool virus isolation can be confirmed. It needs to be distinguished from other acute flaccid paralysis (AFP): Gilambare syndrome, familial paralysis, peripheral neuritis, and pseudoparalysis.

Poliomyelitis treatment

At present, there are no drugs to control the occurrence and development of paralysis, mainly symptomatic treatment and supportive treatment.

The principle of treatment is to reduce fear, reduce bone deformity, prevent and manage comorbidities, and rehabilitation.

Bed rest

The patient stayed in bed until 1 week of heat withdrawal, isolated for 40 days, and avoided physical activity for at least 2 weeks. When using a bed, use a footboard to make the feet and calves at the correct angle to facilitate functional recovery.

Symptomatic treatment

Antipyretic analgesics and sedatives can be used to relieve systemic muscle spasms, discomfort and pain; moist and hot compresses every 2 to 4 hours, 15 to 30 minutes each; hot water bath is also effective, especially for young children, and sedative The combination of pain medicine has a synergistic effect; if possible, intravenous infusion of gamma globulin 400mg / (kg · day) can be used for 2 to 3 days, which can reduce the disease. Interferon can be applied in the early stage, 1 million U / d, intramuscular injection, 14 days as a course of treatment; slight passive movement can avoid deformity.

3. Paralysis period

(1) Correct posture When the patient is in bed, the knees are slightly bent, and the hips and spine can be straightened with boards or sandbags, and the ankles are at 90 °. Immediately after the pain disappears, take active and passive exercises to avoid bone deformities.

(2) Proper nutrition A nutrient-rich diet and a lot of water should be given. If sweating is caused by high ambient temperature or hot compresses, sodium salts should be added. Anorexia can be used to ensure the intake of food and water.

(3) Drug treatment Drugs that promote nerve conduction functions, such as dobazole, galantamine, vitamin B _12, etc .; those with secondary infections should be treated with appropriate antibiotics.

(4) Medullary paralysis Keep the airway unobstructed: use low head position (bed feet raised to 20 ° -25 °) to avoid inhalation of saliva, food, vomit, etc., avoid gastric tube feeding for the first few days, and use intravenous route to supplement nutrition Measure blood pressure twice a day. If there is hypertensive encephalopathy, it should be handled in time. Patients with vocal cord paralysis and respiratory muscle paralysis need tracheotomy, and those with impaired ventilation need mechanical assisted breathing.

4. Recovery and sequelae

Start active and passive exercise early to prevent muscle atrophy. Acupuncture, massage, and physical therapy can also be used to promote functional recovery. Severe limb deformities can be corrected surgically.

Poliomyelitis prevention

Active immunity

All children should be actively immunized with a live attenuated polio vaccine. The basic immunization started in February after birth, and three doses were taken at intervals of 1 month, and the immunization was strengthened once at the age of 4 years. Currently, internationally, polio-inactivated vaccines are gradually being used to replace oral polio attenuated live vaccines for active immunization, and trials have also been conducted in China.

2. Passive immunity

Children less than 5 years old and children with congenital immunodeficiency who are in close contact with patients without the vaccine should be injected with immunoglobulin as early as 0.3 ~ 0.5ml / Kg once a day for 2 days in a row, which can prevent disease or reduce symptom.