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Poliomyelitis

Disease Details

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Description: Poliomyelitis is a highly infectious viral disease that primarily affects the nervous system, leading to potential paralysis or muscle weakness.
Type: Poliomyelitis is an infectious disease caused by the poliovirus. There is no genetic transmission involved; it is primarily transmitted via the fecal-oral route, typically through contaminated water or food.
Signs And Symptoms: The term "poliomyelitis" is used to identify the disease caused by any of the three serotypes of poliovirus. Two basic patterns of polio infection are described: a minor illness which does not involve the central nervous system (CNS), sometimes called abortive poliomyelitis, and a major illness involving the CNS, which may be paralytic or nonparalytic. Adults are more likely to develop symptoms, including severe symptoms, than children.In most people with a normal immune system, a poliovirus infection is asymptomatic. In about 25% of cases, the infection produces minor symptoms which may include sore throat and low fever. These symptoms are temporary and full recovery occurs within one or two weeks.In about 1 percent of infections the virus can migrate from the gastrointestinal tract into the central nervous system (CNS). Most patients with CNS involvement develop nonparalytic aseptic meningitis, with symptoms of headache, neck, back, abdominal and extremity pain, fever, vomiting, stomach pain, lethargy, and irritability. About one to five in 1000 cases progress to paralytic disease, in which the muscles become weak, floppy and poorly controlled, and, finally, completely paralyzed; this condition is known as acute flaccid paralysis. The weakness most often involves the legs, but may less commonly involve the muscles of the head, neck, and diaphragm. Depending on the site of paralysis, paralytic poliomyelitis is classified as spinal, bulbar, or bulbospinal. In those who develop paralysis, between 2 and 10 percent die as the paralysis affects the breathing muscles.Encephalitis, an infection of the brain tissue itself, can occur in rare cases, and is usually restricted to infants. It is characterized by confusion, changes in mental status, headaches, fever, and, less commonly, seizures and spastic paralysis.
Prognosis: Patients with abortive polio infections recover completely. In those who develop only aseptic meningitis, the symptoms can be expected to persist for two to ten days, followed by complete recovery. In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed, but lose function temporarily, may recover within four to six weeks after onset. Half the patients with spinal polio recover fully; one-quarter recover with mild disability, and the remaining quarter are left with severe disability. The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. Spinal polio is rarely fatal.Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions. Overall, 5 to 10 percent of patients with paralytic polio die due to the paralysis of muscles used for breathing. The case fatality rate (CFR) varies by age: 2 to 5 percent of children and up to 15 to 30 percent of adults die. Bulbar polio often causes death if respiratory support is not provided; with support, its CFR ranges from 25 to 75 percent, depending on the age of the patient. When intermittent positive pressure ventilation is available, the fatalities can be reduced to 15 percent.
Onset: The onset of poliomyelitis, also known as polio, typically begins with nonspecific symptoms such as fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. These symptoms usually appear between 6 to 20 days after infection but can range from 3 to 35 days. The acute phase may last about 2 to 5 days before either resolution or progression to more severe symptoms, including paralysis.
Prevalence: The global prevalence of poliomyelitis has significantly decreased due to widespread vaccination efforts. In 1988, there were an estimated 350,000 cases worldwide. By 2022, the number of cases had been reduced to just a few dozen, primarily in Afghanistan and Pakistan. The disease remains a critical public health issue in these regions, but global initiatives continue to work toward complete eradication.
Epidemiology: **Epidemiology of Poliomyelitis:**
Poliomyelitis, commonly known as polio, is caused by the poliovirus. The virus primarily affects children under the age of 5. Its transmission occurs through the fecal-oral route, often through contaminated water or food. The Global Polio Eradication Initiative (GPEI) has significantly reduced the incidence of polio since its launch in 1988, decreasing cases by over 99%. Most remaining cases are found in a few countries, primarily Afghanistan and Pakistan. Sporadic outbreaks can occur in non-endemic countries due to imported cases.

**Nanoparticles and Poliomyelitis:**
There is ongoing research into the use of nanoparticles in the context of polio, particularly in vaccine delivery. Nanoparticles can potentially enhance the efficacy and stability of vaccines, offering new routes for oral and intranasal delivery. These advancements aim to improve immunogenicity and ease of administration, especially in challenging environments.

(Note: If "nan" was intended differently, please clarify.)
Intractability: Poliomyelitis, or polio, is generally not considered intractable, as effective vaccines have been developed that can prevent the disease. Vaccination programs have significantly reduced the number of polio cases worldwide. However, once polio has caused paralysis, there is no cure for the paralysis, and management focuses on supportive care and rehabilitation. Prevention through vaccination remains the most effective strategy against polio.
Disease Severity: Poliomyelitis, often referred to as polio, is a highly infectious viral disease that primarily affects young children. It can cause:

- **Asymptomatic infection:** Most people (about 72%) will not show any symptoms.
- **Minor illness:** Around 24% experience minor, flu-like symptoms.
- **Non-paralytic aseptic meningitis:** Approximately 1-5% develop symptoms of meningitis without paralysis.
- **Paralytic poliomyelitis:** Less than 1% of infections lead to severe symptoms, including paralysis, which can be permanent. This can involve the spinal cord (spinal polio), the brainstem (bulbar polio), or both (bulbospinal polio).

In severe cases, complications can lead to respiratory difficulties and death.
Healthcare Professionals: Disease Ontology ID - DOID:4953
Pathophysiology: Poliovirus enters the body through the mouth, infecting the first cells with which it comes in contact – the pharynx and intestinal mucosa. It gains entry by binding to an immunoglobulin-like receptor, known as the poliovirus receptor or CD155, on the cell membrane. The virus then hijacks the host cell's own machinery, and begins to replicate. Poliovirus divides within gastrointestinal cells for about a week, from where it spreads to the tonsils (specifically the follicular dendritic cells residing within the tonsilar germinal centers), the intestinal lymphoid tissue including the M cells of Peyer's patches, and the deep cervical and mesenteric lymph nodes, where it multiplies abundantly. The virus is subsequently absorbed into the bloodstream.Known as viremia, the presence of a virus in the bloodstream enables it to be widely distributed throughout the body. Poliovirus can survive and multiply within the blood and lymphatics for long periods of time, sometimes as long as 17 weeks. In a small percentage of cases, it can spread and replicate in other sites, such as brown fat, the reticuloendothelial tissues, and muscle. This sustained replication causes a major viremia, and leads to the development of minor influenza-like symptoms. Rarely, this may progress and the virus may invade the central nervous system, provoking a local inflammatory response. In most cases, this causes a self-limiting inflammation of the meninges, the layers of tissue surrounding the brain, which is known as nonparalytic aseptic meningitis. Penetration of the CNS provides no known benefit to the virus, and is quite possibly an incidental deviation of a normal gastrointestinal infection. The mechanisms by which poliovirus spreads to the CNS are poorly understood, but it appears to be primarily a chance event – largely independent of the age, gender, or socioeconomic position of the individual.
Carrier Status: Carrier status for poliomyelitis refers to the ability of an individual to carry and potentially spread the poliovirus without showing symptoms themselves. Although asymptomatic carriers do not display signs of the disease, they can still excrete the virus in their feces, contributing to its transmission. Regular vaccination is crucial to prevent the spread of poliomyelitis, including by asymptomatic carriers.
Mechanism: Poliomyelitis, commonly known as polio, is a highly contagious viral disease caused by the poliovirus.

**Mechanism:**
1. **Transmission:** The virus typically spreads through the fecal-oral route, often due to ingestion of contaminated water or food.
2. **Initial Infection:** After entering the body, the virus multiplies in the oropharynx and gastrointestinal tract.
3. **Viremia:** Poliovirus then enters the bloodstream, a phase known as viremia, allowing it to spread throughout the body.
4. **Neurological Involvement:** In some cases, the virus invades the central nervous system (CNS), where it primarily infects motor neurons in the spinal cord, brainstem, or motor cortex. This leads to the characteristic motor deficits of poliomyelitis.

**Molecular Mechanisms:**
1. **Viral Entry and Replication:** Poliovirus attaches to its receptor, the poliovirus receptor (PVR or CD155) on host cells, facilitating viral entry. Once inside the cell, the viral RNA is released and hijacks the host's cellular machinery for replication.
2. **Translation and Polyprotein Processing:** The viral RNA acts as a direct template for protein synthesis, producing a large polyprotein that is subsequently cleaved into functional viral components by viral proteases.
3. **Assembly and Release:** New viral particles are assembled in the host cell and released, often lysing the host cell in the process, which contributes to tissue damage.
4. **Neurovirulence:** The virus can cross the blood-brain barrier or migrate along peripheral nerves to reach the CNS. Inside the CNS, it primarily targets motor neurons, leading to their destruction. This neuronal damage is the primary cause of the muscle weakness and paralysis associated with polio.

Understanding these mechanisms has been crucial in developing effective vaccines and treatment strategies to combat poliomyelitis.
Treatment: There is no cure for polio, but there are treatments. The focus of modern treatment has been on providing relief of symptoms, speeding recovery and preventing complications. Supportive measures include antibiotics to prevent infections in weakened muscles, analgesics for pain, moderate exercise and a nutritious diet. Treatment of polio often requires long-term rehabilitation, including occupational therapy, physical therapy, braces, corrective shoes and, in some cases, orthopedic surgery.Portable ventilators may be required to support breathing. Historically, a noninvasive, negative-pressure ventilator, more commonly called an iron lung, was used to artificially maintain respiration during an acute polio infection until a person could breathe independently (generally about one to two weeks). Today, many polio survivors with permanent respiratory paralysis use modern jacket-type negative-pressure ventilators worn over the chest and abdomen.Other historical treatments for polio include hydrotherapy, electrotherapy, massage and passive motion exercises, and surgical treatments, such as tendon lengthening and nerve grafting.Sister Elizabeth Kenny's Kenny regimen is now the hallmark for the treatment of paralytic polio.
Compassionate Use Treatment: For poliomyelitis, there are no specific compassionate use treatments or well-established off-label or experimental treatments currently available. The primary means of combating polio are through prevention, via vaccination. Frontline therapies for those who contract polio focus on supportive care, which may include pain management, physical therapy, and mechanical ventilation if respiratory muscles are affected. Research is ongoing in various aspects of polio treatment and management, but no experimental treatments have gained significant traction as of now.
Lifestyle Recommendations: For poliomyelitis, lifestyle recommendations to prevent infection and its spread include:

1. **Vaccination:** Ensure complete immunization with the polio vaccine, as it is the most effective way to prevent the disease.

2. **Hygiene Practices:** Maintain good personal hygiene, including regular handwashing with soap and clean water, especially before eating and after using the restroom.

3. **Safe Water and Sanitation:** Use clean, safe drinking water and avoid consuming contaminated food and water. Proper disposal of sewage and the use of toilets can prevent the spread of the virus.

4. **Avoiding Crowded Areas:** In areas where polio is endemic or during outbreaks, avoid crowded places to reduce the risk of exposure.

5. **Travel Precautions:** If traveling to areas where polio is present, ensure your vaccinations are up to date. Follow any additional travel health recommendations provided by health authorities.

These measures significantly contribute to preventing the transmission and occurrence of poliomyelitis.
Medication: There is no specific antiviral medication to cure poliomyelitis. Instead, treatment focuses on supportive care to alleviate symptoms and prevent complications. This can include pain relievers, physical therapy to recover muscle strength, and the use of ventilators if respiratory muscles are affected. Preventative measures are crucial, primarily through the administration of the polio vaccine.
Repurposable Drugs: Repurposable drugs for poliomyelitis have been explored to address the challenge of limited antiviral treatments. Some candidates include:

1. **Pleconaril**: Originally developed for enterovirus infections, it has shown activity against poliovirus in laboratory settings.
2. **Ribavirin**: An antiviral drug with broad-spectrum activity, explored for use against various RNA viruses, including poliovirus.
3. **Favipiravir**: Another broad-spectrum antiviral that has shown potential efficacy against several RNA viruses, including poliovirus.
4. **Interferon (IFN)**: Immunomodulatory treatments like IFN-α have been considered for their potential antiviral effects.

Further clinical studies are necessary to confirm the safety and efficacy of these drugs specifically against poliomyelitis.
Metabolites: Poliomyelitis, caused by the poliovirus, primarily affects the nervous system and can result in paralysis. The disease itself does not have distinct metabolites that are measured for diagnostic purposes. Diagnostic tests typically involve detecting the presence of the virus or its RNA in bodily fluids like stool, throat swabs, or cerebrospinal fluid through methods such as PCR (polymerase chain reaction).
Nutraceuticals: For poliomyelitis, there are no nutraceuticals or nanotechnology-based treatments that are currently proven effective. The primary prevention method is vaccination, typically with the inactivated poliovirus vaccine (IPV) or the oral poliovirus vaccine (OPV). Standard medical care focuses on supportive treatments, including physical therapy and pain management, to alleviate symptoms and aid recovery.
Peptides: Poliomyelitis, also known as polio, is a highly infectious viral disease caused by the poliovirus. It primarily affects the nervous system, leading to partial or full paralysis in severe cases. When discussing peptides in relation to poliomyelitis, it generally pertains to segments of viral proteins used for diagnostic assays or the development of vaccines. These peptides can stimulate an immune response without causing the disease.

The term "nan" in this context is unclear. If you meant "nanotechnology," it involves using nanoparticles for vaccine delivery or drug delivery systems designed to target poliovirus more effectively, potentially enhancing treatment and vaccination strategies.