POLIOMIELITIS

Erny
FK UWKS
TIU
Setelah mengikuti kuliah mahasiswa mampu
mendiagnosis dengan anamnesa, pemeriksaan
fisik dan merujuk penderita ke pusat
kesehatan terpadu
Pendahuluan
Poliomyelitis adalah infeksi enterovirus yang
menyebabkan 4 manifestasi klinis :
infeksi subklinis
Abortive disesase
Poliomyelitis non-paralitik
Poliomyelitis paralisis
Epidemiologi
Sebelum abad 19 : insiden sporadis
Abad 19-20 : epidemi >> dengan puncak
pertengahan 1950
Vaksin polio (1952) (Jonas Salk) : insiden secara
bermakna
Mortalitas : banyak terjadi pada tipe
paralytic poliomyelitis akibat
komplikasi respirasi
Frekuensi : Insiden L = P
Golongan usia : terutama pada anak / individu
dengan gangguan sistim imun
Eradikasi polio hingga dekade terakhir merupakan
prioritas WHO


Virus Polio
(RNA Virus)
fecal-oral route
nasofaring & GIT
invasi
jaringan limfoid
hematoviremia
Neurotropik pada
cornu anterior & medula spinalis
destruksi motor neuron Paralisis
Periode
inkubasi 5-35
hari
Diagnosis
Riwayat penyakit :
1. Tipe asimptomatik : sebagian besar kasus
2. Tipe abortive (5-10%) :
Anorexia
Vomiting
Nyeri perut
Lama sakit <5 hari
3. Tipe non-paralitik : serupa tipe abortive +gejala iritasi
meningeal
4. Tipe paralitik : serupa tipe non-paralitik + manifestasi
sistemik (gagal nafas)

Pemeriksaan fisik neurologis
Pemeriksaan penunjang diagnostik
Pemeriksaan fisik

Physical
The spectrum of disease varies from inapparent infection to paralytic disease.
In mild cases, the following nonspecific signs and symptoms are observed and
usually resolve within a few days:
Fever
Headache
Nausea
Vomiting
Abdominal pain
Oropharyngeal hyperemia
Nonparalytic poliomyelitis is characterized by the symptoms described above in
addition to the following:
Nuchal rigidity
More severe headache
Back and lower extremity pain
Meningitis with lymphocytic pleocytosis (usually)
Paralytic poliomyelitis occurs in fewer than 5% of affected patients and is
characterized by the following:
Compromise of the motor neurons may be localized or widespread.
More frequently, asymmetric loss of muscle function is observed with involvement of major
muscle groups.
Muscle atrophy is generally observed several weeks after the beginning of symptoms.
Recovery may be complete, partial, or absent.

Causes
Polioviruses are enteroviruses within the Picornaviridae family.
These viruses are resistant to ether and chloroform but can be
inactivated by formaldehyde. They multiply in the GI tract but are
particularly neurotropic.
Documentation suggests that infections with polioviruses can be
potentiated by factors such as exercise and tonsillectomy.
Additionally, patients who are immunocompromised, such as those
with human immunodeficiency virus (HIV) infection, B-cell
disfunction, immunoglobulin A (IgA) deficiency, orsevere combined
immunodeficiency, are particularly at high risk of developing
poliomyelitis when exposed to both wild-type polioviruses and
vaccine-attenuated viruses present in the oral poliovirus vaccine.

Laboratory Studies
Obtain specimens from the cerebrospinal fluid
(CSF), stool, and throat for viral cultures in
patients with suspected poliomyelitis infection.
Obtain acute and convalescent serum for
antibody concentrations against the 3
polioviruses.
A 4-fold increase in the immunoglobulin G (IgG)
antibody titers or a positive anti-immunoglobulin
M (IgM) titer during the acute stage is diagnostic.

Medical Care
No antivirals are effective against polioviruses. The treatment of
poliomyelitis is mainly supportive.
Analgesia is indicated in cases of myalgias or headache.
Mechanical ventilation is often needed in patients with bulbar paralysis.
Tracheostomy care is often needed in patients who require long-term
ventilatory support.
Physical therapy is indicated in cases of paralytic disease.
In paralytic disease, provide frequent mobilization to avoid development of
chronic decubitus ulcerations.
Active and passive motion exercises are indicated during the convalescent
stage.
Fecal impaction is frequent in cases of paralytic disease and can be treated
with laxatives as soon as it develops.
Surgical Care
Total hip arthroplasty is a surgical therapeutic options for patients
with paralytic sequelae of poliomyelitis who develop of hip
dysplasia and degenerative disease.
[6]

Consultations
Physical therapist and rehabilitation therapist
Pulmonologist
Neurologist
Immunologist
Infectious diseases specialist
Diet
Because patients with poliomyelitis are prone to develop
constipation, a diet rich in fiber is usually indicated.
Prognosis
Bulbar paralytic poliomyelitis has been associated with
the highest rate of complications and a mortality rate
as high as 60%; spinal poliomyelitis follows. Patients
with inapparent or abortive poliomyelitis recover
without significant sequelae.
Patients who have recovered from poliomyelitis
occasionally develop a postpoliomyelitis syndrome, in
which recurrences of weakness or fatigue are observed
and which usually involve groups of muscles that were
initially affected. This postpolio syndrome may develop
20-40 years after infection with poliovirus.
[5]