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Poliomyelitis diagnosis and treatment

Video transcript

diagnosis of polio myelitis is really based off of two things so first of all you're going to want to think about what symptoms the patient is having and the symptoms should paint a clear picture of polio so it should be like oh okay these are the symptoms this should get you thinking about polio to confirm the diagnosis the next step you'll take a look at is the lab values or specific lab tests I should say that will determine that there is actually polio or an active polio infection in the body so first of all before we talk about the active polio infection what are the symptoms we can see well the buzzword that you're going to encounter for polio is acute asymmetric asymmetric flaccid paralysis so a patient is having a cue infection it's a sudden onset the the patient and usually we're thinking of a child in fact the term floppy baby is often associated with a polio diagnosis or really any other flaccid paralysis so impala oh it's children less than six months old that are the most commonly affected really anybody can be affected adults children but they are the most commonly affected and they'll appear they'll appear floppy because as you remember in polio it's the motor neurons that are being affected so you've got a motor neuron that innervates a muscle so it provides energy to a muscle and these motor neurons are damaged and they may be damaged in an asymmetric pattern so you might have this motor neuron getting shut down by the polio virus but this other motor neuron being completely active so you'll see in asymmetric pattern so we've got acute sudden onset asymmetric and flaccid so there's really no innervation to that muscle so the patient is weak the baby is weak and appears flaccid so you get this floppy baby syndrome I'm not really great at drawing babies so just I just want you to picture in your mind's eye a baby that's just flopping on one side of the body like their arm isn't able to move and that should alert you to this asymmetric paralysis now once these symptoms have been identified lab tests should be underway and there are actually several lab tests that you can really think about for this asymmetric paralysis and all of them relate to the pathway that the virus the polio virus is going to take in the body so the polio virus gets into the mouth gets to the throat and can replicate here it can also travel into the intestines into the stomach and the intestines and replicate in the small intestines so has two sites of replication then the virus can actually spread to the spinal cord to the central nervous system so now it's there's three locations in which you can find the poliovirus so there are actually three lab tests that you can perform to diagnose polio till one let's go ahead and erase some of this here reveal this you can isolate the virus from throat culture you can also isolate the virus from a stool culture and the virus can also be isolated from the spinal fluid so let me write that down remember you can get a throat culture you can get a stool culture and you can get it from the cerebrospinal fluid CSF and this is usually done with a spinal tap where the doctor inserts a needle into the spine and withdrawal some of this fluid that can be found this fluid surrounds all of the central nervous system it surrounds the brain and it encodes the spinal nerve as well so these are the lab tests three different tests that can be performed and any of them will work the cerebral spinal fluid is the most accurate if you can find the polio virus isolated in this fluid that confirms diagnosis of polio myelitis in fact remind as a reminder myelitis means inflammation in the spine so right there that shows if you can isolate the virus in this CSF cerebrospinal fluid then that confirms your diagnosis but also because the virus can be shed through the mouth and in the feces you can collect stool cultures or throat cultures as well and stool cultures are one of the cheapest methods and fairly accurate more accurate than throat cultures in determining if a person is infected by the polio virus so stool cultures are fairly commonly used now once diagnosis is made we need to progress to treatment and unfortunately treatment is well there is really no treatment for a person who has polio it's really symptomatic support if a patient for example has their respiratory muscles like the muscles like the diaphragm if that is dysfunctional and they can't breathe then they might need support through a breathing tube put a breathing tube into the mouth to support the lungs in fact in the old days let's go ahead and scroll down and I'll show you this in the old days there was this thing called an iron lung and here's a view of it right here you can also see a patient sitting inside the iron lung in this picture they have their head poking out and this essentially allows pressure changes to expand the chest cavity and allow breathing and this was before the time of having ventilators this hasn't been long retired but it still provides you an idea of how serious the condition can be and sometimes warrants respiratory support now though there is no treatment currently for polio virus there is a way to prevent it and that's through a polio vaccine through vaccination and through the efforts of the World Health Organization and many other organizations that have contributed eradication of polio is very real the entire western hemisphere including the United States North America Europe are completely polio free now there are still cases in the world where polio exists but the widespread eradication because of these vaccines has been considered one of the world's greatest medical achievements hopefully in the future polio can be completely eliminated by the widespread use of vaccination