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==Overview==
==Overview==
Only treatment for symptoms is available, ranging from [[pain]] and [[fever]] relief to [[intubation]] and [[mechanical ventilation]] for patients with respiratory insufficiency.
There is no treatment for neither form of poliomyelitis.  Current management of these patients is based on supportive care towards [[symptom]] relief and prevention of [[complications]].  Supportive treatment may include: application of hot moist patches to affected [[muscles]]; [[mechanical ventilation]] with tank respirators, or positive pressure ventilators; drainage and suction of [[secretions]]; [[bladder]] [[catheterization]]; physical and psychological therapy.<ref name=mend>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
 
== Medical Therapy==
== Medical Therapy==
There is no antiviral drug, or other kind of treatment for neither form poliomyelitis.  Current management of these patients is based on supportive care towards symptom relief.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
===Supportive Care===
===Supportive Care===
Hospitalization is indicated for acute cases of paralytic poliomyelitis, since bed rest prevents extension of paralysis.  Pain and spasms may be relieved by application of host moist packs to the affected muscles.  Once extension of paralysis has stopped, physical therapy should be initiated.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
Hospitalization is indicated for acute cases of paralytic poliomyelitis, since bed rest and proper care help prevent extension of the [[paralysis]][[Pain]] and [[spasms]] may be relieved by application of hot moist packs to the affected [[muscles]].  Once progression of [[paralysis]] has stopped, [[physical therapy]] should be initiated.<ref name=mend>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> [[Mechanical ventilation]] is indicated when [[paralysis]] of the [[respiratory]] [[muscles]] occurs, before development of [[hypoxia]].  It is often started once [[vital capacity]] is below 50%. Endotracheal intubation, often with subsequent tracheostomy may be required in these patients. Previous methods of ventilation included negative pressure ventilator chambers that are no longer used in modern medical practiceFor patients with bulbar poliomyelitis without [[respiratory]] [[muscle]] [[paralysis]], drainage of [[secretions]] may be accomplished by [[suction]] and postural drainage.  For severe cases of this form of the disease, tracheal intubation may be required.<ref name=mend>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
 
[[Mechanical ventilation]] is indicated when [[paralysis]] of the [[respiratory]] muscles occurs, before development of [[hypoxia]].  It is often started once vital capacity is below 50%.  Two respiratory machines are available for this purpose:<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
* Tank Respirators - although not commonly used, some institutions use these respirators, that were used in the past to treat the same type of patients, in order to avoid tracheal intubation and the complications that may occur from it.
 
* Positive-pressure Ventilators - Although they tracheal intubation, these machines are replacing tank respirators, allowing better access to the patient.
 
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Pooling of secre- tions in the pharynx in mild bulbar poliomyelitis, if unaccompanied by spinal respiratory paralysis, can be managed with postural drainage and suction. Severe bulbar paralysis necessitates tracheal intubation. Weak- ness or paralysis of the bladder may necessitate catheterization.
 
Management of long-term physical and psychiatric sequelae of paralytic poliomyelitis is beyond the scope of this text. The reader is referred to excellent older references on these topics.54,55
->
 
No cure for polio exists, and the focus of modern polio treatment has been on increasing comfort, 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 also often requires long-term rehabilitation including 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 [[ventilator]]s that are worn over the chest and abdomen.
In spinal poliomyelitis with paralysis or weakness of the bladder muscle, [[catheterization]] may be indicated.<ref name=mend>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>  Psychological management of the disease should also be provided to the patient, in order to facilitate dealing with the disease and accompanying disabilities.<ref name=mend>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
 
Other historical treatments for polio have included [[hydrotherapy]], [[electrotherapy]] and surgical treatments such as tendon lengthening and nerve grafting. The use of devices such as rigid braces and body casts—which tended to cause muscle atrophy due to the limited movement of the user—were also touted as effective treatments. Massage, passive motion exercises, and vitamin C were also used to treat polio victims, with varying degrees of success.


==References==
==References==
{{Reflist|2}}
{{Reflist|1}}
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[[Category:Primary care]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
{{WH}}
{{WS}}

Latest revision as of 23:46, 29 July 2020

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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

There is no treatment for neither form of poliomyelitis. Current management of these patients is based on supportive care towards symptom relief and prevention of complications. Supportive treatment may include: application of hot moist patches to affected muscles; mechanical ventilation with tank respirators, or positive pressure ventilators; drainage and suction of secretions; bladder catheterization; physical and psychological therapy.[1]

Medical Therapy

Supportive Care

Hospitalization is indicated for acute cases of paralytic poliomyelitis, since bed rest and proper care help prevent extension of the paralysis. Pain and spasms may be relieved by application of hot moist packs to the affected muscles. Once progression of paralysis has stopped, physical therapy should be initiated.[1] Mechanical ventilation is indicated when paralysis of the respiratory muscles occurs, before development of hypoxia. It is often started once vital capacity is below 50%. Endotracheal intubation, often with subsequent tracheostomy may be required in these patients. Previous methods of ventilation included negative pressure ventilator chambers that are no longer used in modern medical practice. For patients with bulbar poliomyelitis without respiratory muscle paralysis, drainage of secretions may be accomplished by suction and postural drainage. For severe cases of this form of the disease, tracheal intubation may be required.[1]

In spinal poliomyelitis with paralysis or weakness of the bladder muscle, catheterization may be indicated.[1] Psychological management of the disease should also be provided to the patient, in order to facilitate dealing with the disease and accompanying disabilities.[1]

References

  1. 1.0 1.1 1.2 1.3 1.4 Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.

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