definition Infectivity Clinical picture clinical picture Complications Diagnosis treatment
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Respiratory system:-
Otitis media: Is the most common complication in small children. Usually is caused by a bacterial agent as
Forms of measles: 🔹
the pneumococcus, Streptococcus pyogenes etc.
Croup: As a feature of measles usually disappears within few days of rash. If persists complication is likely.
Measles has three clinical stages:
1. An incubation period: Usualy 8-11days; may be longer The classical measles has already been described in the anterior section. Other forms of presentation 🔹
Mostly is viral in origin but may be bacterial.
🔹 Tracheitis and bronchiolitis: are common and may be due to the virus alone.
Pneumonia: The bacterial pneumonia is a major killer of measles cases may be cause by pneumococcus,
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are:
2. Prodromal period (catarrhal, pre eruptive, enthemathic): Staphylococcus aureus, and Haemophiles influenzae among others. Pneumonia can be complicated by Treatment:
measles is a viral disease caused by an RNA virus of the genus Morbillivirus in PURPURIC measles:
the family Paramyxoviridae. 🔹
Lasts 3-5 days; mainly characterized by congestion of many mucous membranes Is not common. Characterized by a rash that instead of fading becomes deeper purple an looks
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pneumothorax, pneumomediastinum, subcutaneous emphysema and pleural effusion.
Giant cell pneumonia (interstitial pneumonitis): 🔹
(1) Symptomatic: This is the main part of treatment.
-There is only one antigen to type of this virus. 🔹
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Conjunctivitis with injected eyes, tearing and photophobie.
Runningnose (coryza).
purpuric especially on the face. May persist for a week or two.
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common in immunocompromised patients, caused by measles virus and characterized by severe prolong course.
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Fever is to be lowered by use of antipyretics and tiped (not cold)
sponges.
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There is no serious complications to this form but it needs some observation.
Tuberculosis: Patients suffering of (TB), even in a latent form , may have activation of TB, for around 2-6
🔻 Epidemiology
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Stomatitis: darked congestion of the mouth.
Congested throat and larynx with dry iritating cough that may become croupy.
HEMORRHAGJC measles (black):
This is a serious form characterized by hemorrhage into the skin and bleeding from any body orifices.
weeks.
Measles infection is known to suppress skin test responsiveness to purified tuberculin antigen. 🔹
Also frequent meals, mainly consisting of fluids are advisable; IV
fluids may be needed
-In developing countries, measles is still an important cause of childhood 🔹
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A few patients may have gastroenteritis
It is also characterized by fever which is around 38C
In this form the rashis poorly developed. Vit. A 50,000 -100,000 IU start IM is advisable, or orally. There is no
antiviral agent that can treat measles.
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The course is almost always fatal.).
morbidity and morality
🔹 General malaise prostration, and anorexia.
Koplik's spots: The pathognomonic sign of measles, appear by the end of the prodromal period and are MODIFIED measles: 🔹
Gastrointestinal system:-
Stomatitis: its most severe form is the CANCRUM ORIS [NOMA] (gangrenous sloughing of muscles, mucosa. Diagnosis:
(2) Preventive:
(i) Isolation :
MEASLES
- 90% of children acquirng the infection before 15 years of age. A mild form with few features as for example no fever with-few Koplik spots or mild conjunctivitis
- It is rarely subclinical.
probably, last 24-48hrs Are few hundreds of gayish White dots surounded by a wet background of
congestion, usualy as small as grains of sand. and coryza without anything more. This form may develop among:
(i) cases vaccinated with some immunity
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and skin from inside the mouth to the exterior showing theteeth through thisopening).
Enteritis:
History of contact in the previous few weeks is important clue plus
theclinical presentation.
Once suspected measles cases must beisolated to protect them from
other infections and to prevent measles spread.
-Occurs in all seasons more in winter and spring Most infectious stage mainly in the prodomal period Within 24-48 hrs of rash
They tend tooccur opposite the molars butmayspread irregularly over the rest of the buccal mucosa.
(ii) cases who have received immunoglobulins during the incubation period, or even, 🔹
May be afeature of measles in some cases. It is especially serious in malnourished patients.
Appendicitis : May be apart of mucosal congestion. Observation is necessary in presence of a surgeon for
Serological and/or virological tests may be needed for difficult
presentations as modified, atypical, black measles ect.
(ii) Use of gammaglobulins ;
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They appear and disappear rapidly, they begin to fade as rash comes out. within 5-6 days or less of exposure in incubation period, can eb given
(RUBEOLA)
-Measles is highly contagious ; approximatly 90% of susceptible household By the end of this stage the fever becomes higher and the manifestations become severe (iii) those having some immunity from the mother. any eventuality Differential diagnosis: in a dose of 0.25ml/kg start (or 0.5 ml/kg in immune-compromised
contacs acquire the disease. Measles must be differentiated from other exanthematic illnesses: cases) IM as single dose.
Atypical measles:
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3. Eruptive (exanthematic) period:
cases vaccinated with a killed measles vaccine who some years later are exposed to wild virus may 🔹
Central Nervous System (CNS):
Encephalitis: It is a serious frequent complication especially in unimmunized small children.
rubella measles, roseola infantum, scalet fever,
enterovitus,infectious mononucleosis allergic rash, etc.
(iii)Vaccination:
spread
-mainy by direct conact with respiatory droplet(Air borne transmission).
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Lasts 3-5 days.
🔹 As fever rises some children may have febrile convulsions
Rash starts, usually behind the ears, along the hairline, and spreads over the face and down to the trunk
have an unusual form of measles characterized by a petechial rash on distal extremities.
Frequently they have pneumonia often complicated with pleural effusion. 🔹
The case-fatality is around 10-40%. The incidence was reported to range from 1-2/1000 cases.
Subacute sclerosis° pan-enceplaitis (SSPE): {Dawson's encephalitis). is a chronic complication of measles
is live attenuated vaccine given at 9 months and 18 months and a
booster dose at the time of entrance to school, combined with the
rubella vaccine (MR) according to Yemen schedule of vaccinationOther
This is the atypical measleswhich is especially life-threatening with frequent fatal outcome. with a delayed onset and an outcome that is nearly always fatal. After 7-10 yr the virus apparently regains
-Natural infection results in almost life long immunity. -Transplacental and limbs and involves palms and soles. It is maculopapular that may become coalescent. It is minimally
This form is attributed to inappropriate immune response to the killed virus vaccine.
type of vaccination
pruritic. virulence and attacks the cells .in the CNS that offered the virus protection. it is a demyelinating disorder that Measles-mumps-rubella(MMR) vaccine or the MMRV (with varicella) in
antibodies give a transient immunity lasting for around 6-7 months after birth.
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In 2-3 days the whole body is covered, reaching the feet on the 3rd day. The fever is high > 39°C, the MEASLES and MALNUTRlTION: leads to death. a 2-dosees regimen at 12-15 months and 4-7 years of age
🔻 reservoir 🔹
manifestations are intense (cough, anorexia, malaise etc).
The rash fades downward in the same sequence in which it appeared. Some darkening of rash, especially
Among undernourished cases: measles can present ؟severe form:
characterized by a deeply desquamated largely confluent rash without hemorrhage.
Other: multiple sclerosis, retrobulbar neuritis. Contraindication to measles vaccination: the main contraindication
for the application of any live-attenuated vaccine is the immune-
measles is a human disease. on the trunk, may occur and takes 7-10 days or more to disappear. Frequently, occur a fine branny Frequently is complicated by bronchopneumonia and gastroenteritis, that usually lead to aggravation
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Eyes:
Purulent conjunctivitis. Keratitis Corneal ulceration: This is a senous complication risking vision. Is common in
deficiency states including high dose corticosteroid therapy
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desquamation that usually spares the hands and soles.
The uncomplicated cases usually become well in 2-3 days. Fever disappears by crisis (rapidly) and the
manifestations improve dramatically
of the malnutrition and frequently lead to death.
cases with marginal vitamin A deficiency.For this reason is advisable to give a prophylactic dose of vit.A for
cases with measles in developing countries.
Factors that predispose to severe measles are:
Undernutrition, Vit A deficiency, and Immunodeficiency states
Malnutrition:
Measles is an extremely catabolic and there is significant weightloss.
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The acquired form:
The incubation period is 2-3 week Nearly always acquired rubella, is a mild infection. in older children and Treatment:
🔹 In the acquired rubella
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adults severe forms were described.
The prodromal period is of 1-2 days or more charcterized by: 🔹
There is no specific treatment for acquired or congenital rubella.
🔹 It is wholly symptomatic.
viruses are shed from the throat from one week-before the onset of rash to one week after its
disappearance.
-mild catarrhal manifestations that may go unnoticed.
-A mild conjunctivitis without photophobia neither tearing is one frequent feature .
-The mucus membranes of the cheeks internally are invariably clean and pale.
🔹 Fluids are advisable especially with fever and decreased appetite.
If congenital rubella is diagnosed during pregnancy, may be decided
the inturruption of pregnancy provided the approval of parents.
Rubella a is characterized by in constant skin rash with a potentially serious Patients are likely to be infectious for around 10 days around rash time, mostly before its onset. -The tonsils ana soft palate rather are red with slight sore throat. Prevention:
Diagnosis: Acquired rubella can be suspected by
congenital form Is caused by RNA virus of Togavirdae family, genus Rubivirus. 🔹 In congenital form
An enanthem appears in 20% of patients just before the onset of the skin rash consists of discrete rose-
colored spots on the soft palate (Forchheimer spots) that may coalesce into a red blush and extend over the
Congenital form:
Clinically ranges from a subclinical to the severe form with multiple congenital malformations.
(i) H/O recent contact,
(ii) mild picture in children. and
1) Passive immunization is of questionable efficacy.
May be tried especially in pregnant women at risk of congenital
🔻Epidemiology: Rubella: is less contagious than measles.
Complications:
RUBELLA the virus may be shed from the newly born infant for a long time, ranging from 6 months to around
two years which constitutes a very important source of infection for other children and susceptible
fauces. Fetuses may be aborted, stillborn, premature, lowbirth weight, or even apparently perfectly normal.
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The major congenital malformations that may be present in cases affected are: Acquired rubella is not as complicated an illness as is measles. One such complication may be the congenital (iii) the presence of important posterior cervical adenopathy. infection.
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adult. 🔹
-There is mild fever and slight malaise.
🔹 In the eves: Cataract, retinal lesions and glaucoma.
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form. Otherwise, among the few complications detected after rubella is mentioned: Paraclinical diagnosis is not warranted except with pregnant If pregnant woman exposed to rubella, a Hemagglutination Inhibition
(GERMAN OR 🔻Reservoir: Man is considered the only Natural host
The main diagnostic feature of the prodromal period is the presence of characteristic cervical lymph Arthritis: Frequently presenting in small joints. May simulate a rheumatic migratory polyarthritis. This women and in an epidemic of exanthematic disease of unidentified Test is performed immediately to determine the presence of antibodies
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Also patients with subclinical (inapparent) form are contagious. nodes enlargement These are retroauricular ,posterior cervical, and suboccipital nodes that are enlarged In the cardiovascular system: Any defect as PDA, VSD, pulmonary stenosis. against rubella. If immune reassure her.
Before the application of the rubella vaccine, it was reported to occur in epidemics every 6-9 years
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usuall at least 24 hr before the rash appears and may remain for 1 wk or more. In the ear: Sensori-neural deafness.
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complication was reported mostly in females.
🔹 Encephalitis: Rare. may occur in 1:6000 cases.
origin.
Serologically diagnosis is likely with a single positive IgM specific If not immune and therapeutic abortion is not accepted, passive
THREE-DAY MEASLES) 🔻It isSpread:
with the peak age of incidence from 5 to 14 years. It is to be highlighted that many infections are The exanthem (rash) is more variable than that of rubeola. Other features: immunization with immunoglobulins (immune-serum globulin [ISG]) is
subclinical, with a ratio of the subclinical to the apparent (clinical) of 2:1. Immunity after natural it appears first on the face at roots of the hair, around the mouth and behind the ear Are small, pale Purpura either thrombocytopenic or non-thrombocytopenic, usually transient for weeks; may persist
🔹 Thrombocytopenia, in about 1:3000 cases.
Congenital rubella syndrome.
test or paired sera (IgG) samples.
Differential diagnosis: measles must be differentiated from other given 0.25-0.50 ml/ kg within 5-7 days of exposure.
spread by oral .droplet mainly (the acquired) and transplacental (the 🔹
infection appear to be long-lasting, possibly life-long.
🔹 Maternal antibodies are protective for around 6 months after birth.
maculopapular, pinkish incolor.On be trunk the rash is discrete.Rapidly rash progress to the trunk, hands and
feet.
for months, anemia, microcephaly, mental retardation. Jaundice and hepatomegaly, an diabetes
mellitus.
exanthematic ilinesses: measies. roseola infantum, scalet fever,
enterovirus, infectious mononucleosis, allergic rash, etc.
(2) Active immunization:
Is most valuable preventive measure. With a live attenuated rubella
congenital form) from infected mother to fetus If a susceptible mother contract Rubella early in pregnancy (≤8 wks) the risk of infecting the This rash is more variable than measles. It spreads quickly. It may be fading the face by the time it appears virus vaccine is usually administered in combination with measles (MR),
product of conception would be around 50-80%, while infection during the second trimester the risk on the trunk. with measles and mumps (MMR) or also with varicella (MMRV).
is no more than 10-20%. In the third trimester, rarely there is risk infecting fetuses. During the second day the rash may assume a pinpoint appearance especially over the trunk, resembling that Vaccine should not be administered to severely immunocompromised
On the other hand, it is to be assured that congenital rubella case may also be subclinical of scarlet fever The duration of the rash is generally 3 days, and it usually resolve without Desquamation patients or during pregnancy.
Communicabl 🔹
Subclinical infection is common, and 25-40%of children may not have a rash
🔹 Mild fever or no fever appears during the illness.
Slight spleen enlargement may be detected.
It is especially important for girls to have immunity to rubella before
they reach childbearing age.
e Diseases 1
Incubation period: Around 2-3 weeks.
Prodromal features: These are rare in children. More frequently found in adults and the immunodeficient 🔹
Plenty are the complications of mumps. Both clinical and subclinical cases may have complications.
🔹 CNS complications: Meningoencephilitis, aseptic meningitis, encephalitis.
🔻 Etiology: An RNA virus of the Paramyxoviridae family. Only one serotype
Infectivity:
Mumps is infective in the apparent cases possibly from 6 days before to 9 days after the appearance
patients. May begin with general malaise, fever, pain or spasm in the neck muscles, headache, and malaise.
Characteristics of the parotid swelling: Parotid is the most common presentation for clinical mumps. Is 🔹 Other less common complications: Guillain-Barre syndrome, optic neuritis and transient fascial palsy.
Orchitis and or epididymitis: Are the most common complications among adoescents. Often is unilateral but
Diagnosis: The clinical picture contact diagnosis. Subclinical cases
Treatment:
exists. of the salivary gland (s) swelling.
On the other hand, inapparent cases are also infectious. It is to be noted that around 30-40% of
characterized by noticeable swelling of one or both parotids. It fills, firstly, the space between the posterior
border of the mandible and mastoid process. It is limited above by the zygomatic process. 🔹
may be bilateral. It lasts 3-4 days.
Pancreatitis: In its mild form pancreatitis is quite common. Is characterized by upper abdominal pain, vomiting lab diagnosis (serology or virology).
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Is wholly symptomatic.
Bed rest should be guided by the patient's needs, but no evidence
🔻Epidemiology: Mumps is not a highly contagious disease as is measles.
Differential diagnosis:
MUMPS 🔹 🔹 🔹
infections are inapparent (subclinical). There is edema of the skin and soft tissues overlying the swelling. Swelling may proceed very quickly but etc. Severe attacks are rare. Usually it settles in a day or two. indicates that it prevents complications.
Other viral causes of parotitis (HIV infection, influenza,
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The most affected age group, around 85% of cases, is under 15 years (mainly between 5 and 9 yrs) usually it peaks in 1-3 days and is subsiding within 3-7 days later. One gland may swell one or two days after -------------- Oophoritis: Pelvic pain and tenderness are noted in about 7% of postpubertal female patients. There is no Antipyretics are indicated for fever.
parainfluenza viruses 1 and 3, cytomegalovirus, and
🔻 Spread: It spreads by by direct contact, airborne droplets, fomites
but any age can be affected.
Epidemics occur at all seasons but are slightly more frequent in late winter and spring. After natural
the other (in about 75%).
The swollen area is tender and painful. 🔹
evidence of impairment of fertility.
🔹 Deafness: Is a rare complication. May be transient or permanent, uni or bilateral. coxsackieviruses).
Acute suppurative parotitis is a bacterial infection (Staphylococcus
🔹 The diet should be adjusted to the patient's ability to chew.
Orchitis should be treated with local support and bed rest.
contaminated by saliva, and possibly by urine.
infection a life-long immunity develops even after subclinical infections, although reinfections have
been documented.
Transplacental antibodies may protect infant during 6-8 months after delivery.
The opening (s) of Stenson's duct may be congested. Sour beverages may elicit pain in the gland when taken
orally. The edema over the mandible and upper chest wall may occur. Moderate fever is common. 🔹 Acute labyrinthitis: Manifested by tinnitus, vertigo, vomiting, and nystagmus. It occurs occasionally.
Ocular complications: Dacryoadenitis may occur with painful swelling, usually bilateral, of the lacrimal
glands. Optic neuritis (papillitis) may occur; symptoms vary from loss of vision to mild blurring, with recovery in
aureus). A salivary calculus. Parotitis, tumors.
Preventive treatment: As a combined MMR (or MMRV)
Rarely there is no fever or it is high.
It is to be noted that the swelling of parotid may be so trivial to escape inspection.
Other salivery glands (submandibular, sublingual) may be involved with or without the parotid glands. 🔹
10-20 days
Others: Thyroiditis; arthritis; myocarditis; thrombocytopenia, diabetes mellitus
Clinical manifestations:
The incubation period of poliovirus from contact to initial clinical symptomsis usually considered to be 8-12
days, with a range of 5-35 days.
The forms of presentations of poliomyelitis are as follows:
🔻 Etiology:
Polioviruses are non-enveloped, positive-stranded RNA viruses belonging to the
A. Inapparent infection: which occurs in 90-95% of cases and causes no disease and no sequelae.
B. Abortive poliomyelitis (minor illness): In about 5% of patients, a nonspecific influenza-like syndrome
occurs 1-2 weeks after infection. Fever, malaise, anorexia, and headache are prominent features, and there
Picornaviridae family, in the genus Enterovirus. There are three antigenic may be sore throat and abdominal or muscular pain. Vomiting occurs irregularly.
serotypes 1, 2, and 3. No cross-immunity occurs between them. Second attacks The physical examination may be normal or may reveal nonspecific pharyngitis, abdominal or muscular
tenderness, and weakness.
may occur. Recovery is complete, and no neurologic signs or sequelae develop
The virus is highly selective for nervous tissue. C. Non-paralytic (Pre-paralytic) form: Both preparalytic and paralytic constitute the major illness. Complications:
Poliomyelitis can be complicated both in the acute phase and in the residual form. Some of the acute Diagnosis:
🔻Entry 🔹
The non-paralytic (meningitic): In about 1% of all infected patients presented into:
complications are: Poliomyelitis should be considered in any unimmunized or
Pathogenesis:
of the virus is via the oral route. Multiplication occurs in the throat and infectivity
🔹 1st phase (minor illness) symptoms and signs of abortive poliomyelitis are more intense.
The 2nd phase (CNS disease or major illness) more intense headache, nausea, and vomiting, as well as
soreness and stiffness of the posterior muscles of the neck, trunk, and limbs.
Respiratory:-
Respiratory paralysis due to spinal and/or bulbar involvement respiratory failure shock and death if not well
incompletely immunized child with nonspecific febrile illness,
aseptic meningitis, or paralytic disease. Treatment:
In polio cases, infectivity in the pharyngeal foci is around one week. attended by ventilation therapy. - Isolation of the virus: Poliovirus isolation is highest from stool Is symptomatic. Severe cases may need ICU for ventilation, etc. Are to
gastrointestinal tract. Poliovirus has been isolated from feces more than 2 wks before paralysis to several weeks after the
Fleeting paralysis of the bladder and constipation are frequent. Nuchal rigidity and spinal rigidity are the
specimens, intermediate frompharyngeal swabs and low from blood
basis for the diagnosis of nonparalytic poliomyelitis during the 2nd phase. - Pulmonary: pneumonia and atlectasis. be avoided in suspected cases the IM injections, exhausting physical
Within 1-3 days virus migrates to the regional lymph nodes. onset of symptoms. Physical examination reveals nuchal-spinal signs and changes in superficial and deep reflexes.Sensory Cardiovascular: or CSF. To increase the probability of poliovirus isolation, at least exploration, exercise, etc.
Viremia then occurs with selective invasion of nervous tissue The poliovirus Fecal transfer is seemingly easier where poor hygiene prevails and in places where many young defects do not occur in poliomyelitis. - Hyperpyrexia due to dysfunction of the central thermo regulatory areas. two stool specimens should be obtained 24 hours apart from Physiotherapy as soon as possible in recovery phase.Interdisciplinary
primarily infects motor neuron cells in the spinal cord (the anterior horn cells) children are grouped. - Hypertension usually is an acute complication caused by dysregulation of the vasomotor center. In some patients with suspected poliomyelitis as early in the course of (Orthopedic, rheumatologic, rehabilitationist, etc.)
disease as possible (ideally within 14 days after onset).
POLIOMYELITIS
Infants acquire immunity transplacentally from their mothers; the immunity disappears at a variable D. Paralytic poliomyelitis: Is the least manifestation, develops in about <1% of persons infected cases it may become sustained (chronic).
and the medulla oblongata (the cranial nerve nuclei). rate during the first 4-6 months of life. ------------ - Arrhythmias, myocarditis, and acute cardiac failure. - Cerebrospinal fluid: In poliovirus infection, the CSF usually Prevention Vaccination:
withpoliovirus. Rarely it starts directly without any preceding manifestations, causing four clinically
Virus disappears from the throat around 1 week after the major illness though Active immunity after natural infection is probably life long but protects against the infecting recognizable syndromes that represent a continuum of infection differentiated only by the portions of the Gastrointestinal: contains an increased number of white blood cells (20-300 Vaccination is the only effective method of preventing poliomyelitis.
the intestinal excretion continues for 2-3 weeks or more. serotype only; CNS most severely affected. - Acute gastric dilatation. cells/mm3, primarily lymphocytes) and a mildly elevated proteinat Hygienic measures help limit the spread of the infection among young
infections with other serotypes are possible. Melena: may be severe. The cause is obscure, possibly related to superficial intestinal erosions. onset of the of CNS disease but usually rises to between 50-100 children. Oral poliomyelitis vaccine (OPV) is the standard vaccine in
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These are:
Predisposing factors: Renal: mg/dL by the second weekof illness. many countries, and is given in multiple doses.
Epidemiology: (1) spinal paralytic poliomyelitis, (2) bulbar poliomyelitis, (3) Bulbo-spinal ،(4) encephalitis. - Serologic testing demonstrates seroconversion or a fourfold or
Tonsillectomy, adenoectomy, and tooth extraction predispose the child to paralysis during the - Renal calculi: This complication may occur in convalescence especially in cases attended by artificial
Humans are the only known reservoir of poliovirus. epidemics. Strenuous physical exercise, intramuscular injections. may be associated with an increased ventilation with alkalosis that may predispose to stone- formation in the kidneys compounded with the urine greater increase in antibody titers, when measured during the acute The inactivated poliomyelitis vaccine (IPV) is given parenterally, at
risk of paralytic poliomyelitis 1. Spinal paralytic poliomyelitis: Is usually the main, and most common form of paralytic poliomyelitis. Is stasis of chronic bed ridden state. phase of illness and 3-6 wk later. the age of 3½ months and 9 months of age.
Poliomyelitis is highly contagious. characterized by a lower-motor neuron paralysis (flaccid with hypo- or areflexia). In the worst of the cases, Chronic: The main complication is the so-called POST-POLIO-RESIDUAL PARALYSIS (PPRP). This Differential diagnosis: Any acute flaccid paralysis must be
The majority of the infections are subclinical. The ratio of paralytic to infected nearly every skeletal muscle may be paralyzed, even bilaterally but usually not in a symmetrical form, which complication is secondary to the spinal form. Some cases paralysis is self-limited reversible within a time that included in the differential diagnosis of the paralytic cases: Guillain-
polio cases of 1 out of 200 (more than 90% of the infected are subclinical). distinguishes it from the Guillain-barre' syndrome In its mildest form may be limited to a part of a muscle. In may range from few weeks to several months. In another number of casesit is irreversible muscles become Barre syndrome, transverse myelitis, traumatic neuritis, etc.
most cases the paralysis reaches its peak within 48 hours or certainly within 72 hours. After that time it atrophied affecting the growth of that part.
In temperate climates occurs in summer months mainly, while in tropical areas is progresses no more, and remains confined to the affected part (s). It may be reversible within few months.
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found throughout the year.
Spread:
Person-to-person spread of poliovirus via the fecal-oral route is the most
2. Bulbar: Manifestations by dysfunctions of the cranial nerves and medullary centers. The main
characteristics of this form are the inability to swallow and the pharyngeal pooling of secretions. So patients
are afraid of breathing that becomes shallow with or without involvement of other cranial nerves (facial
important route of transmission, although the oral-oral route may account for palsy.... etc.)
some cases.
3. Bulbo-spinal form: This form combines the features of the above mentioned forms (bulbar and spinal).
4. Encephalitic form: Is a rare form of the disease in which higher centers of the brain are severely involved
(upper motor neuron). It is common in children below 3 years of age. Seizures, coma, and spastic paralysis
with hyperreflexia, may be observed. The outlook is grave and is life-threatening.
by fatema okoff
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Respiratory system:-
Otitis media: Is the most common complication in small children. Usually is caused by a bacterial agent as
Forms of measles: 🔹
the pneumococcus, Streptococcus pyogenes etc.
Croup: As a feature of measles usually disappears within few days of rash. If persists complication is likely.
Measles has three clinical stages:
1. An incubation period: Usualy 8-11days; may be longer The classical measles has already been described in the anterior section. Other forms of presentation 🔹
Mostly is viral in origin but may be bacterial.
🔹 Tracheitis and bronchiolitis: are common and may be due to the virus alone.
Pneumonia: The bacterial pneumonia is a major killer of measles cases may be cause by pneumococcus,
🔸
are:
2. Prodromal period (catarrhal, pre eruptive, enthemathic): Staphylococcus aureus, and Haemophiles influenzae among others. Pneumonia can be complicated by Treatment:
measles is a viral disease caused by an RNA virus of the genus Morbillivirus in PURPURIC measles:
the family Paramyxoviridae. 🔹
Lasts 3-5 days; mainly characterized by congestion of many mucous membranes Is not common. Characterized by a rash that instead of fading becomes deeper purple an looks
🔹
pneumothorax, pneumomediastinum, subcutaneous emphysema and pleural effusion.
Giant cell pneumonia (interstitial pneumonitis): 🔹
(1) Symptomatic: This is the main part of treatment.
-There is only one antigen to type of this virus. 🔹
🔹
Conjunctivitis with injected eyes, tearing and photophobie.
Runningnose (coryza).
purpuric especially on the face. May persist for a week or two.
🔹
common in immunocompromised patients, caused by measles virus and characterized by severe prolong course.
🔹
Fever is to be lowered by use of antipyretics and tiped (not cold)
sponges.
🔸
There is no serious complications to this form but it needs some observation.
Tuberculosis: Patients suffering of (TB), even in a latent form , may have activation of TB, for around 2-6
🔻 Epidemiology
🔹
🔹
Stomatitis: darked congestion of the mouth.
Congested throat and larynx with dry iritating cough that may become croupy.
HEMORRHAGJC measles (black):
This is a serious form characterized by hemorrhage into the skin and bleeding from any body orifices.
weeks.
Measles infection is known to suppress skin test responsiveness to purified tuberculin antigen. 🔹
Also frequent meals, mainly consisting of fluids are advisable; IV
fluids may be needed
-In developing countries, measles is still an important cause of childhood 🔹
🔹
A few patients may have gastroenteritis
It is also characterized by fever which is around 38C
In this form the rashis poorly developed. Vit. A 50,000 -100,000 IU start IM is advisable, or orally. There is no
antiviral agent that can treat measles.
🔸
The course is almost always fatal.).
morbidity and morality
🔹 General malaise prostration, and anorexia.
Koplik's spots: The pathognomonic sign of measles, appear by the end of the prodromal period and are MODIFIED measles: 🔹
Gastrointestinal system:-
Stomatitis: its most severe form is the CANCRUM ORIS [NOMA] (gangrenous sloughing of muscles, mucosa. Diagnosis:
(2) Preventive:
(i) Isolation :
MEASLES
- 90% of children acquirng the infection before 15 years of age. A mild form with few features as for example no fever with-few Koplik spots or mild conjunctivitis
- It is rarely subclinical.
probably, last 24-48hrs Are few hundreds of gayish White dots surounded by a wet background of
congestion, usualy as small as grains of sand. and coryza without anything more. This form may develop among:
(i) cases vaccinated with some immunity
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and skin from inside the mouth to the exterior showing theteeth through thisopening).
Enteritis:
History of contact in the previous few weeks is important clue plus
theclinical presentation.
Once suspected measles cases must beisolated to protect them from
other infections and to prevent measles spread.
-Occurs in all seasons more in winter and spring Most infectious stage mainly in the prodomal period Within 24-48 hrs of rash
They tend tooccur opposite the molars butmayspread irregularly over the rest of the buccal mucosa.
(ii) cases who have received immunoglobulins during the incubation period, or even, 🔹
May be afeature of measles in some cases. It is especially serious in malnourished patients.
Appendicitis : May be apart of mucosal congestion. Observation is necessary in presence of a surgeon for
Serological and/or virological tests may be needed for difficult
presentations as modified, atypical, black measles ect.
(ii) Use of gammaglobulins ;
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They appear and disappear rapidly, they begin to fade as rash comes out. within 5-6 days or less of exposure in incubation period, can eb given
(RUBEOLA)
-Measles is highly contagious ; approximatly 90% of susceptible household By the end of this stage the fever becomes higher and the manifestations become severe (iii) those having some immunity from the mother. any eventuality Differential diagnosis: in a dose of 0.25ml/kg start (or 0.5 ml/kg in immune-compromised
contacs acquire the disease. Measles must be differentiated from other exanthematic illnesses: cases) IM as single dose.
Atypical measles:
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3. Eruptive (exanthematic) period:
cases vaccinated with a killed measles vaccine who some years later are exposed to wild virus may 🔹
Central Nervous System (CNS):
Encephalitis: It is a serious frequent complication especially in unimmunized small children.
rubella measles, roseola infantum, scalet fever,
enterovitus,infectious mononucleosis allergic rash, etc.
(iii)Vaccination:
spread
-mainy by direct conact with respiatory droplet(Air borne transmission).
🔹
Lasts 3-5 days.
🔹 As fever rises some children may have febrile convulsions
Rash starts, usually behind the ears, along the hairline, and spreads over the face and down to the trunk
have an unusual form of measles characterized by a petechial rash on distal extremities.
Frequently they have pneumonia often complicated with pleural effusion. 🔹
The case-fatality is around 10-40%. The incidence was reported to range from 1-2/1000 cases.
Subacute sclerosis° pan-enceplaitis (SSPE): {Dawson's encephalitis). is a chronic complication of measles
is live attenuated vaccine given at 9 months and 18 months and a
booster dose at the time of entrance to school, combined with the
rubella vaccine (MR) according to Yemen schedule of vaccinationOther
This is the atypical measleswhich is especially life-threatening with frequent fatal outcome. with a delayed onset and an outcome that is nearly always fatal. After 7-10 yr the virus apparently regains
-Natural infection results in almost life long immunity. -Transplacental and limbs and involves palms and soles. It is maculopapular that may become coalescent. It is minimally
This form is attributed to inappropriate immune response to the killed virus vaccine.
type of vaccination
pruritic. virulence and attacks the cells .in the CNS that offered the virus protection. it is a demyelinating disorder that Measles-mumps-rubella(MMR) vaccine or the MMRV (with varicella) in
antibodies give a transient immunity lasting for around 6-7 months after birth.
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In 2-3 days the whole body is covered, reaching the feet on the 3rd day. The fever is high > 39°C, the MEASLES and MALNUTRlTION: leads to death. a 2-dosees regimen at 12-15 months and 4-7 years of age
🔻 reservoir 🔹
manifestations are intense (cough, anorexia, malaise etc).
The rash fades downward in the same sequence in which it appeared. Some darkening of rash, especially
Among undernourished cases: measles can present ؟severe form:
characterized by a deeply desquamated largely confluent rash without hemorrhage.
Other: multiple sclerosis, retrobulbar neuritis. Contraindication to measles vaccination: the main contraindication
for the application of any live-attenuated vaccine is the immune-
measles is a human disease. on the trunk, may occur and takes 7-10 days or more to disappear. Frequently, occur a fine branny Frequently is complicated by bronchopneumonia and gastroenteritis, that usually lead to aggravation
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Eyes:
Purulent conjunctivitis. Keratitis Corneal ulceration: This is a senous complication risking vision. Is common in
deficiency states including high dose corticosteroid therapy
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desquamation that usually spares the hands and soles.
The uncomplicated cases usually become well in 2-3 days. Fever disappears by crisis (rapidly) and the
manifestations improve dramatically
of the malnutrition and frequently lead to death.
cases with marginal vitamin A deficiency.For this reason is advisable to give a prophylactic dose of vit.A for
cases with measles in developing countries.
Factors that predispose to severe measles are:
Undernutrition, Vit A deficiency, and Immunodeficiency states
Malnutrition:
Measles is an extremely catabolic and there is significant weightloss.
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The acquired form:
The incubation period is 2-3 week Nearly always acquired rubella, is a mild infection. in older children and Treatment:
🔹 In the acquired rubella
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adults severe forms were described.
The prodromal period is of 1-2 days or more charcterized by: 🔹
There is no specific treatment for acquired or congenital rubella.
🔹 It is wholly symptomatic.
viruses are shed from the throat from one week-before the onset of rash to one week after its
disappearance.
-mild catarrhal manifestations that may go unnoticed.
-A mild conjunctivitis without photophobia neither tearing is one frequent feature .
-The mucus membranes of the cheeks internally are invariably clean and pale.
🔹 Fluids are advisable especially with fever and decreased appetite.
If congenital rubella is diagnosed during pregnancy, may be decided
the inturruption of pregnancy provided the approval of parents.
Rubella a is characterized by in constant skin rash with a potentially serious Patients are likely to be infectious for around 10 days around rash time, mostly before its onset. -The tonsils ana soft palate rather are red with slight sore throat. Prevention:
Diagnosis: Acquired rubella can be suspected by
congenital form Is caused by RNA virus of Togavirdae family, genus Rubivirus. 🔹 In congenital form
An enanthem appears in 20% of patients just before the onset of the skin rash consists of discrete rose-
colored spots on the soft palate (Forchheimer spots) that may coalesce into a red blush and extend over the
Congenital form:
Clinically ranges from a subclinical to the severe form with multiple congenital malformations.
(i) H/O recent contact,
(ii) mild picture in children. and
1) Passive immunization is of questionable efficacy.
May be tried especially in pregnant women at risk of congenital
🔻Epidemiology: Rubella: is less contagious than measles.
Complications:
RUBELLA the virus may be shed from the newly born infant for a long time, ranging from 6 months to around
two years which constitutes a very important source of infection for other children and susceptible
fauces. Fetuses may be aborted, stillborn, premature, lowbirth weight, or even apparently perfectly normal.
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The major congenital malformations that may be present in cases affected are: Acquired rubella is not as complicated an illness as is measles. One such complication may be the congenital (iii) the presence of important posterior cervical adenopathy. infection.
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adult. 🔹
-There is mild fever and slight malaise.
🔹 In the eves: Cataract, retinal lesions and glaucoma.
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form. Otherwise, among the few complications detected after rubella is mentioned: Paraclinical diagnosis is not warranted except with pregnant If pregnant woman exposed to rubella, a Hemagglutination Inhibition
(GERMAN OR 🔻Reservoir: Man is considered the only Natural host
The main diagnostic feature of the prodromal period is the presence of characteristic cervical lymph Arthritis: Frequently presenting in small joints. May simulate a rheumatic migratory polyarthritis. This women and in an epidemic of exanthematic disease of unidentified Test is performed immediately to determine the presence of antibodies
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Also patients with subclinical (inapparent) form are contagious. nodes enlargement These are retroauricular ,posterior cervical, and suboccipital nodes that are enlarged In the cardiovascular system: Any defect as PDA, VSD, pulmonary stenosis. against rubella. If immune reassure her.
Before the application of the rubella vaccine, it was reported to occur in epidemics every 6-9 years
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usuall at least 24 hr before the rash appears and may remain for 1 wk or more. In the ear: Sensori-neural deafness.
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complication was reported mostly in females.
🔹 Encephalitis: Rare. may occur in 1:6000 cases.
origin.
Serologically diagnosis is likely with a single positive IgM specific If not immune and therapeutic abortion is not accepted, passive
THREE-DAY MEASLES) 🔻It isSpread:
with the peak age of incidence from 5 to 14 years. It is to be highlighted that many infections are The exanthem (rash) is more variable than that of rubeola. Other features: immunization with immunoglobulins (immune-serum globulin [ISG]) is
subclinical, with a ratio of the subclinical to the apparent (clinical) of 2:1. Immunity after natural it appears first on the face at roots of the hair, around the mouth and behind the ear Are small, pale Purpura either thrombocytopenic or non-thrombocytopenic, usually transient for weeks; may persist
🔹 Thrombocytopenia, in about 1:3000 cases.
Congenital rubella syndrome.
test or paired sera (IgG) samples.
Differential diagnosis: measles must be differentiated from other given 0.25-0.50 ml/ kg within 5-7 days of exposure.
spread by oral .droplet mainly (the acquired) and transplacental (the 🔹
infection appear to be long-lasting, possibly life-long.
🔹 Maternal antibodies are protective for around 6 months after birth.
maculopapular, pinkish incolor.On be trunk the rash is discrete.Rapidly rash progress to the trunk, hands and
feet.
for months, anemia, microcephaly, mental retardation. Jaundice and hepatomegaly, an diabetes
mellitus.
exanthematic ilinesses: measies. roseola infantum, scalet fever,
enterovirus, infectious mononucleosis, allergic rash, etc.
(2) Active immunization:
Is most valuable preventive measure. With a live attenuated rubella
congenital form) from infected mother to fetus If a susceptible mother contract Rubella early in pregnancy (≤8 wks) the risk of infecting the This rash is more variable than measles. It spreads quickly. It may be fading the face by the time it appears virus vaccine is usually administered in combination with measles (MR),
product of conception would be around 50-80%, while infection during the second trimester the risk on the trunk. with measles and mumps (MMR) or also with varicella (MMRV).
is no more than 10-20%. In the third trimester, rarely there is risk infecting fetuses. During the second day the rash may assume a pinpoint appearance especially over the trunk, resembling that Vaccine should not be administered to severely immunocompromised
On the other hand, it is to be assured that congenital rubella case may also be subclinical of scarlet fever The duration of the rash is generally 3 days, and it usually resolve without Desquamation patients or during pregnancy.
Communicabl 🔹
Subclinical infection is common, and 25-40%of children may not have a rash
🔹 Mild fever or no fever appears during the illness.
Slight spleen enlargement may be detected.
It is especially important for girls to have immunity to rubella before
they reach childbearing age.
e Diseases 1
Incubation period: Around 2-3 weeks.
Prodromal features: These are rare in children. More frequently found in adults and the immunodeficient 🔹
Plenty are the complications of mumps. Both clinical and subclinical cases may have complications.
🔹 CNS complications: Meningoencephilitis, aseptic meningitis, encephalitis.
🔻 Etiology: An RNA virus of the Paramyxoviridae family. Only one serotype
Infectivity:
Mumps is infective in the apparent cases possibly from 6 days before to 9 days after the appearance
patients. May begin with general malaise, fever, pain or spasm in the neck muscles, headache, and malaise.
Characteristics of the parotid swelling: Parotid is the most common presentation for clinical mumps. Is 🔹 Other less common complications: Guillain-Barre syndrome, optic neuritis and transient fascial palsy.
Orchitis and or epididymitis: Are the most common complications among adoescents. Often is unilateral but
Diagnosis: The clinical picture contact diagnosis. Subclinical cases
Treatment:
exists. of the salivary gland (s) swelling.
On the other hand, inapparent cases are also infectious. It is to be noted that around 30-40% of
characterized by noticeable swelling of one or both parotids. It fills, firstly, the space between the posterior
border of the mandible and mastoid process. It is limited above by the zygomatic process. 🔹
may be bilateral. It lasts 3-4 days.
Pancreatitis: In its mild form pancreatitis is quite common. Is characterized by upper abdominal pain, vomiting lab diagnosis (serology or virology).
🔹
Is wholly symptomatic.
Bed rest should be guided by the patient's needs, but no evidence
🔻Epidemiology: Mumps is not a highly contagious disease as is measles.
Differential diagnosis:
MUMPS 🔹 🔹 🔹
infections are inapparent (subclinical). There is edema of the skin and soft tissues overlying the swelling. Swelling may proceed very quickly but etc. Severe attacks are rare. Usually it settles in a day or two. indicates that it prevents complications.
Other viral causes of parotitis (HIV infection, influenza,
🔹
The most affected age group, around 85% of cases, is under 15 years (mainly between 5 and 9 yrs) usually it peaks in 1-3 days and is subsiding within 3-7 days later. One gland may swell one or two days after -------------- Oophoritis: Pelvic pain and tenderness are noted in about 7% of postpubertal female patients. There is no Antipyretics are indicated for fever.
parainfluenza viruses 1 and 3, cytomegalovirus, and
🔻 Spread: It spreads by by direct contact, airborne droplets, fomites
but any age can be affected.
Epidemics occur at all seasons but are slightly more frequent in late winter and spring. After natural
the other (in about 75%).
The swollen area is tender and painful. 🔹
evidence of impairment of fertility.
🔹 Deafness: Is a rare complication. May be transient or permanent, uni or bilateral. coxsackieviruses).
Acute suppurative parotitis is a bacterial infection (Staphylococcus
🔹 The diet should be adjusted to the patient's ability to chew.
Orchitis should be treated with local support and bed rest.
contaminated by saliva, and possibly by urine.
infection a life-long immunity develops even after subclinical infections, although reinfections have
been documented.
Transplacental antibodies may protect infant during 6-8 months after delivery.
The opening (s) of Stenson's duct may be congested. Sour beverages may elicit pain in the gland when taken
orally. The edema over the mandible and upper chest wall may occur. Moderate fever is common. 🔹 Acute labyrinthitis: Manifested by tinnitus, vertigo, vomiting, and nystagmus. It occurs occasionally.
Ocular complications: Dacryoadenitis may occur with painful swelling, usually bilateral, of the lacrimal
glands. Optic neuritis (papillitis) may occur; symptoms vary from loss of vision to mild blurring, with recovery in
aureus). A salivary calculus. Parotitis, tumors.
Preventive treatment: As a combined MMR (or MMRV)
Rarely there is no fever or it is high.
It is to be noted that the swelling of parotid may be so trivial to escape inspection.
Other salivery glands (submandibular, sublingual) may be involved with or without the parotid glands. 🔹
10-20 days
Others: Thyroiditis; arthritis; myocarditis; thrombocytopenia, diabetes mellitus
Clinical manifestations:
The incubation period of poliovirus from contact to initial clinical symptomsis usually considered to be 8-12
days, with a range of 5-35 days.
The forms of presentations of poliomyelitis are as follows:
🔻 Etiology:
Polioviruses are non-enveloped, positive-stranded RNA viruses belonging to the
A. Inapparent infection: which occurs in 90-95% of cases and causes no disease and no sequelae.
B. Abortive poliomyelitis (minor illness): In about 5% of patients, a nonspecific influenza-like syndrome
occurs 1-2 weeks after infection. Fever, malaise, anorexia, and headache are prominent features, and there
Picornaviridae family, in the genus Enterovirus. There are three antigenic may be sore throat and abdominal or muscular pain. Vomiting occurs irregularly.
serotypes 1, 2, and 3. No cross-immunity occurs between them. Second attacks The physical examination may be normal or may reveal nonspecific pharyngitis, abdominal or muscular
tenderness, and weakness.
may occur. Recovery is complete, and no neurologic signs or sequelae develop
The virus is highly selective for nervous tissue. C. Non-paralytic (Pre-paralytic) form: Both preparalytic and paralytic constitute the major illness. Complications:
Poliomyelitis can be complicated both in the acute phase and in the residual form. Some of the acute Diagnosis:
🔻Entry 🔹
The non-paralytic (meningitic): In about 1% of all infected patients presented into:
complications are: Poliomyelitis should be considered in any unimmunized or
Pathogenesis:
of the virus is via the oral route. Multiplication occurs in the throat and infectivity
🔹 1st phase (minor illness) symptoms and signs of abortive poliomyelitis are more intense.
The 2nd phase (CNS disease or major illness) more intense headache, nausea, and vomiting, as well as
soreness and stiffness of the posterior muscles of the neck, trunk, and limbs.
Respiratory:-
Respiratory paralysis due to spinal and/or bulbar involvement respiratory failure shock and death if not well
incompletely immunized child with nonspecific febrile illness,
aseptic meningitis, or paralytic disease. Treatment:
In polio cases, infectivity in the pharyngeal foci is around one week. attended by ventilation therapy. - Isolation of the virus: Poliovirus isolation is highest from stool Is symptomatic. Severe cases may need ICU for ventilation, etc. Are to
gastrointestinal tract. Poliovirus has been isolated from feces more than 2 wks before paralysis to several weeks after the
Fleeting paralysis of the bladder and constipation are frequent. Nuchal rigidity and spinal rigidity are the
specimens, intermediate frompharyngeal swabs and low from blood
basis for the diagnosis of nonparalytic poliomyelitis during the 2nd phase. - Pulmonary: pneumonia and atlectasis. be avoided in suspected cases the IM injections, exhausting physical
Within 1-3 days virus migrates to the regional lymph nodes. onset of symptoms. Physical examination reveals nuchal-spinal signs and changes in superficial and deep reflexes.Sensory Cardiovascular: or CSF. To increase the probability of poliovirus isolation, at least exploration, exercise, etc.
Viremia then occurs with selective invasion of nervous tissue The poliovirus Fecal transfer is seemingly easier where poor hygiene prevails and in places where many young defects do not occur in poliomyelitis. - Hyperpyrexia due to dysfunction of the central thermo regulatory areas. two stool specimens should be obtained 24 hours apart from Physiotherapy as soon as possible in recovery phase.Interdisciplinary
primarily infects motor neuron cells in the spinal cord (the anterior horn cells) children are grouped. - Hypertension usually is an acute complication caused by dysregulation of the vasomotor center. In some patients with suspected poliomyelitis as early in the course of (Orthopedic, rheumatologic, rehabilitationist, etc.)
disease as possible (ideally within 14 days after onset).
POLIOMYELITIS
Infants acquire immunity transplacentally from their mothers; the immunity disappears at a variable D. Paralytic poliomyelitis: Is the least manifestation, develops in about <1% of persons infected cases it may become sustained (chronic).
and the medulla oblongata (the cranial nerve nuclei). rate during the first 4-6 months of life. ------------ - Arrhythmias, myocarditis, and acute cardiac failure. - Cerebrospinal fluid: In poliovirus infection, the CSF usually Prevention Vaccination:
withpoliovirus. Rarely it starts directly without any preceding manifestations, causing four clinically
Virus disappears from the throat around 1 week after the major illness though Active immunity after natural infection is probably life long but protects against the infecting recognizable syndromes that represent a continuum of infection differentiated only by the portions of the Gastrointestinal: contains an increased number of white blood cells (20-300 Vaccination is the only effective method of preventing poliomyelitis.
the intestinal excretion continues for 2-3 weeks or more. serotype only; CNS most severely affected. - Acute gastric dilatation. cells/mm3, primarily lymphocytes) and a mildly elevated proteinat Hygienic measures help limit the spread of the infection among young
infections with other serotypes are possible. Melena: may be severe. The cause is obscure, possibly related to superficial intestinal erosions. onset of the of CNS disease but usually rises to between 50-100 children. Oral poliomyelitis vaccine (OPV) is the standard vaccine in
🔻
These are:
Predisposing factors: Renal: mg/dL by the second weekof illness. many countries, and is given in multiple doses.
Epidemiology: (1) spinal paralytic poliomyelitis, (2) bulbar poliomyelitis, (3) Bulbo-spinal ،(4) encephalitis. - Serologic testing demonstrates seroconversion or a fourfold or
Tonsillectomy, adenoectomy, and tooth extraction predispose the child to paralysis during the - Renal calculi: This complication may occur in convalescence especially in cases attended by artificial
Humans are the only known reservoir of poliovirus. epidemics. Strenuous physical exercise, intramuscular injections. may be associated with an increased ventilation with alkalosis that may predispose to stone- formation in the kidneys compounded with the urine greater increase in antibody titers, when measured during the acute The inactivated poliomyelitis vaccine (IPV) is given parenterally, at
risk of paralytic poliomyelitis 1. Spinal paralytic poliomyelitis: Is usually the main, and most common form of paralytic poliomyelitis. Is stasis of chronic bed ridden state. phase of illness and 3-6 wk later. the age of 3½ months and 9 months of age.
Poliomyelitis is highly contagious. characterized by a lower-motor neuron paralysis (flaccid with hypo- or areflexia). In the worst of the cases, Chronic: The main complication is the so-called POST-POLIO-RESIDUAL PARALYSIS (PPRP). This Differential diagnosis: Any acute flaccid paralysis must be
The majority of the infections are subclinical. The ratio of paralytic to infected nearly every skeletal muscle may be paralyzed, even bilaterally but usually not in a symmetrical form, which complication is secondary to the spinal form. Some cases paralysis is self-limited reversible within a time that included in the differential diagnosis of the paralytic cases: Guillain-
polio cases of 1 out of 200 (more than 90% of the infected are subclinical). distinguishes it from the Guillain-barre' syndrome In its mildest form may be limited to a part of a muscle. In may range from few weeks to several months. In another number of casesit is irreversible muscles become Barre syndrome, transverse myelitis, traumatic neuritis, etc.
most cases the paralysis reaches its peak within 48 hours or certainly within 72 hours. After that time it atrophied affecting the growth of that part.
In temperate climates occurs in summer months mainly, while in tropical areas is progresses no more, and remains confined to the affected part (s). It may be reversible within few months.
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found throughout the year.
Spread:
Person-to-person spread of poliovirus via the fecal-oral route is the most
2. Bulbar: Manifestations by dysfunctions of the cranial nerves and medullary centers. The main
characteristics of this form are the inability to swallow and the pharyngeal pooling of secretions. So patients
are afraid of breathing that becomes shallow with or without involvement of other cranial nerves (facial
important route of transmission, although the oral-oral route may account for palsy.... etc.)
some cases.
3. Bulbo-spinal form: This form combines the features of the above mentioned forms (bulbar and spinal).
4. Encephalitic form: Is a rare form of the disease in which higher centers of the brain are severely involved
(upper motor neuron). It is common in children below 3 years of age. Seizures, coma, and spastic paralysis
with hyperreflexia, may be observed. The outlook is grave and is life-threatening.
by fatema okoff
