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Clinical Manifestation of Polio

The following phases of the virus infection:
A. Acute Stage
That phase since the clinical symptoms up to 2 weeks. Characterized by increased body temperature. Sometimes accompanied by headache and vomiting. Paralysis caused by damage to the motor neuron cells in the spinal cord (spinal cord) due to a virus invasion. This paralysis is asymmetrical so it tends to cause a disturbance in body shape (deformity) that persist or even become more severe. Paralysis that occurs mostly in the legs (78.6%), whereas 41.4% in arm. Gradual paralysis lasted until about 2 months after the initial illness.

B. Subacute Stage
That phase of 2 weeks to 2 months. Characterized by the disappearance of fever within 24 hours. Sometimes accompanied by muscle stiffness and mild muscle aches. Paralysis of limbs paralyzed and usually one side only.

Stadium Konvalescent
the phase at 2 months to 2 years. Characterized by the recovery of a previously weak muscle strength. Approximately 50-70 percent of muscle function to recover within 6-9 months after the acute phase. Furthermore, after 2 years is not expected to occur again in muscle strength recovery.

D. Chronic Stadium
That is more than 2 years. Muscle paralysis that occurs is permanent.

Clinical picture which occur very varied ranging from the lightest to the heaviest, among other things: 
a. Infection without symptoms. 
 Incidence of asymptomatic infection, is difficult to know, but it is usually quite high, especially in areas that are poor cleanliness standards. At an endemic polio are estimated at 9-95% of the population and lead to immunity against polio. Newborns protected at first because of maternal antibodies which then would disappear after the age of 6 months. The disease is only known by a virus found in feces or elevated antibody titers.
 b. Abortive infection It was estimated 4-8% of the population in a region where the incidence is quite high. Not present the typical symptoms of poliomyelitis. Begins suddenly and lasts 1-3 days with symptoms of minor illness such as fever may reach 39.5 ° C, malaise, headache, sore throat, anorexia, vomiting, muscle pain and abdominal pain and sometimes diarrhea. The disease is difficult to distinguish from other viral diseases, only to be expected in case of polio epidemic in the region. Definitive diagnosis only by finding the virus in tissue culture. Differential diagnosis is influenza or other throat infections.

Non-paralytic poliomyelitis        
This disease occurs in about 1% of all infections. Clinical symptoms similar to abortive infection that lasts 1-2 days. After the temperature became normal, but then increases again (dromarychart), accompanied by symptoms of headache, nausea and vomiting is more severe, and found the back muscle stiffness in the neck, back and legs. Kernig's sign and positive brudzinsky. Another sign is when the child tried to sit down with sleeping position, then he would bend his knees up, while two support arms back on the bed. Head drop is established when the patient's body by pulling on both armpits, will cause the head fall back. Tendon reflexes are usually normal. When the tendon reflex changes, it is likely to occur paralytic poliomyelitis. The differential diagnosis of serous meningitis and meningismus are.

Paralytic poliomyelitis       
Clinical picture similar to paralytic poliomyelitis is accompanied by non weaknesses in one or more of the collection or the cranial skeletal muscles. These symptoms may disappear for several days and then comes back accompanied by paralysis (paralytic) is a flaccid paralysis' which is usually unilateral and symmetrical that is most often affected are the limbs. This may be accompanied by paralysis of the urinary vesicles, intestinal atony and sometimes paralytic ileus. In case of severe respiratory muscle paralysis can occur.

Clinically can be divided into four forms according to the height of lesions in the central nervous system are:
 a. Form of spinal muscular neck with symptoms of weakness, stomach, back, diaphragm, there is a limb where the majority of the lower limb. Common is the large muscles, quadriceps femoral in the leg, the arm of the deltoid. The nature of this paralysis is asymmetrical. Tendon reflexes decreases until it disappears and no disturbance of sensibility.
b. Bulbospinal form of a mixture of symptoms found between spinal and bulbar form. 
c. Bulbar form characterized by motor weakness of one or more cranial nerves with or without disruption of vital centers such as breathing, circulation and body temperature. If the weakness involves cranial nerves IX, X and XII, it will cause paralysis of the pharynx, tongue and fangs with the consequences of airway obstruction occurs.
d. Encephalytic form is characterized by a decreased consciousness, tremors and sometimes convulsions

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