clinical features

Last reviewed 01/2018

Although the infection rate is extremely high, majority (95%) of infections are inapparent or asymptomatic (1).

  • The ratio of inapparent to paralytic infections may be as high as 1,000:1 in children and 75:1 in adults (2)

After the incubation period of three to twenty one days, poliomyelitis symptoms may manifest from a fever to aseptic meningitis or paralysis.

  • abortive poliomyelitis
    • patient may present with upper respiratory tract infection (sore throat and fever), gastrointestinal disturbances (nausea, vomiting, abdominal pain, constipation) and influenza like illness
    • complete recovery occurs in less than one week
  • nonparalytic aseptic meningitis
    • stiffness of the neck, back, and/or legs is seen several days after a prodrome similar to that of minor illness
    • complete recovery occurs after 2 to 10 days 
  • paralytic infection
    • occurs in less than 1% of all infections (3)
    • a biphasic prodrome may be observed (specially in children) where  initial minor symptoms is separated by a 1- to 7-day period from more major symptoms (1)
    • generally classified into spinal, bulbar and bulbospinal types
      • spinal poliomyelitis 
        • most common form
        • begins with symptoms of meningitis
        • this is followed by severe myalgia and motor (spasms, fasciculations) symptoms.
        • weakness and paralysis sets in after 1-2 days and is classically an asymmetrical, flaccid paralysis that peaks at 48 hours after onset
          • proximal muscle groups are involved more than the distal muscle groups
          • lower limbs are mainly affected
      • bulbar poliomyelitis
        • patient may present with vasomotor disturbances such as hypertension, hypotension and circulatory collapse, autonomic dysfunction, dysphagia, dysphonia, and respiratory failure (4) 
      • bulbospinal poliomyelitis 
        • a combination of bulbar and spinal forms
    • sensation is unaffected by this condition
  • rarely polio virus may cause an acute encephalitis which is clinically similar to other viral encephalitis (3,4)

When a badly- paralysed limb is picked up it has a floppy feel which, in the presence of normal sensation, is characteristic of the residual paralysis from poliomyelitis.

Reference:

Related pages:

headache in children

pyrexia in children

vomiting in children

muscle pain

fasciculation

photograph of wasted legs in patient with old polio