Polio classification: Difference between revisions
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== Classification == | == Classification == | ||
In most people with a [[immunocompetent|normal immune system]], | ===Subclinical Poliomyelitis=== | ||
In most people with a [[immunocompetent|normal immune system]], poliovirus infection is [[asymptomatic]]. Patients with subclinical poliomyelitis often gain active [[immunity]] against future [[infection]]s with the same viral strain. | |||
===Abortive Poliomyelitis=== | ===Abortive Poliomyelitis=== | ||
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Approximately 1 in 200 to 1 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 [[Flaccid paralysis|acute flaccid paralysis]].<ref>Frauenthal HWA, Manning JVV (1914). Manual of infantile paralysis, with modern methods of treatment.. Philadelphia Davis, 79–101. OCLC 2078290</ref> Depending on the site of paralysis, paralytic poliomyelitis is classified as ''spinal'', ''bulbar'', or ''bulbospinal''. [[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 [[seizure]]s and [[spastic paralysis]].<ref name= Encephalitis>{{cite book |author=Wood, Lawrence D. H.; Hall, Jesse B.; Schmidt, Gregory D. |title=Principles of Critical Care, Third Edition |publisher=McGraw-Hill Professional |location= |year=2005 |pages=870 |isbn=0-07-141640-4 |oclc= |doi=}}</ref> | Approximately 1 in 200 to 1 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 [[Flaccid paralysis|acute flaccid paralysis]].<ref>Frauenthal HWA, Manning JVV (1914). Manual of infantile paralysis, with modern methods of treatment.. Philadelphia Davis, 79–101. OCLC 2078290</ref> Depending on the site of paralysis, paralytic poliomyelitis is classified as ''spinal'', ''bulbar'', or ''bulbospinal''. [[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 [[seizure]]s and [[spastic paralysis]].<ref name= Encephalitis>{{cite book |author=Wood, Lawrence D. H.; Hall, Jesse B.; Schmidt, Gregory D. |title=Principles of Critical Care, Third Edition |publisher=McGraw-Hill Professional |location= |year=2005 |pages=870 |isbn=0-07-141640-4 |oclc= |doi=}}</ref> | ||
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Nonparalytic Polio. Symptoms are "headache, neck, back, and limb pain; fever, vomiting, abdominal pain, lethargy, and irritability. Muscle spasm... is always present in... the neck and back, usually present in hamstring muscles, and variably present in other muscles. Muscles may be tender to palpation."1 | |||
Paralytic Polio. "In addition to symptoms of nonparalytic poliomyelitis, tremors and muscle weakness appear.... Paralytic poliomyelitis may be divided into two forms that may coexist: (1) Spinal poliomyelitis, with weakness of the muscles supplied by the spinal nerves and (2) Bulbar poliomyelitis, with weakness of the muscles supplied by the cranial nerves, and variable “encephalitis„ symptoms.... Deep tendon reflexes are diminished or lost, often asymmetrically, in areas of involvement. | |||
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==ECPPC and ELCPPC Classifications== | ==ECPPC and ELCPPC Classifications== | ||
Until 1976, ''paralytic poliomyelitis'' was classified according only to epidemiological data. The '''ECPPC''', or Epidemiologic Classication of Paralytic Poliomyelitis Cases, distributed these cases into 1 of 4 categories:<ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811 }} </ref> | Until 1976, ''paralytic poliomyelitis'' was classified according only to epidemiological data. The '''ECPPC''', or Epidemiologic Classication of Paralytic Poliomyelitis Cases, distributed these cases into 1 of 4 categories:<ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811 }} </ref> | ||
Revision as of 20:28, 1 September 2014
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Polio classification On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
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 non-paralytic.[1]
Classification
Subclinical Poliomyelitis
In most people with a normal immune system, poliovirus infection is asymptomatic. Patients with subclinical poliomyelitis often gain active immunity against future infections with the same viral strain.
Abortive Poliomyelitis
Rarely the infection produces minor symptoms; these may include upper respiratory tract infection (sore throat and fever), gastrointestinal disturbances (nausea, vomiting, abdominal pain, constipation or, rarely, diarrhea), and influenza-like illnesses.
CNS Involvement
The virus enters the central nervous system in about 3% of infections.
Non-Paralytic Poliomyelitis
Most patients with CNS involvement develop non-paralytic aseptic meningitis, with symptoms of headache, neck, back, abdominal and extremity pain, fever, vomiting, lethargy and irritability.[2]
Paralytic Poliomyelitis
Approximately 1 in 200 to 1 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.[3] Depending on the site of paralysis, paralytic poliomyelitis is classified as spinal, bulbar, or bulbospinal. 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.[4]
ECPPC and ELCPPC Classifications
Until 1976, paralytic poliomyelitis was classified according only to epidemiological data. The ECPPC, or Epidemiologic Classication of Paralytic Poliomyelitis Cases, distributed these cases into 1 of 4 categories:[5]
In 1985, a new classification was proposed, in order to incorporate not only epidemiological information but also viral isolation, and characterization of the viral strain. This new classification was named ELCPPC, or Epidemiologic and Laboratory Classification of Paralytic Poliomyelitis Cases, and it classifies paralytic poliomyelitis according to the following classes:[5]
Sporadic
Any case of poliomyelitis that is not epidemiological related to another, and that may be caused by either the wild form of the virus, or by the virus in the vaccine.
Epidemic
When a case of the disease is epidemiologically linked to a similar case. It may, or may not be related to the virus in the vaccine.
Immunologically abnormal
Any presumed or confirmed case of poliomyelitis that may be caused by either the wild form of the virus, or by the virus in the vaccine, irrespectively to the origin of the host's immunological deficiency.
Imported
Any new case of poliomyelitis in a person who has entered the US (either foreign or US resident), and that has been symptomatic for the previous 30 days of entrance, or that develops symptoms during the initial 30 days in the country.
References
- ↑ Falconer M, Bollenbach E (2000). "Late functional loss in nonparalytic polio". American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 79 (1): 19–23. PMID 10678598.
- ↑ name=Late>Leboeuf C (1992). The late effects of Polio: Information For Health Care Providers (PDF). Commonwealth Department of Community Services and Health. ISBN 1-875412-05-0. Retrieved 2007-11-10.
- ↑ Frauenthal HWA, Manning JVV (1914). Manual of infantile paralysis, with modern methods of treatment.. Philadelphia Davis, 79–101. OCLC 2078290
- ↑ Wood, Lawrence D. H.; Hall, Jesse B.; Schmidt, Gregory D. (2005). Principles of Critical Care, Third Edition. McGraw-Hill Professional. p. 870. ISBN 0-07-141640-4.
- ↑ 5.0 5.1 Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ; et al. (1989). "A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases". Am J Public Health. 79 (4): 495–8. PMC 1349984. PMID 2929811.