2/15/2017

Crippling disease on the verge of worldwide eradication


Virus invades nervous system and destroys nerve cells that control muscles, especially in legs
Children with polio doing physiotherapy exercises at Wingfield Nuffield Orthopaedic Hospital in Oxfordshire Rex
A passage in Philip Roth’s novel Nemesis describes the horror of catching polio in the US town of Newark in 1944, when outbreaks of the disease were common and each summer was spent in fear of infection.
“Finally the cataclysm began – the monstrous headache, the enfeebling exhaustion, the severe nausea, the raging fever, the unbearable muscle ache, followed in another forty-eight hours by the paralysis,” it says.
Polio, or poliomyelitis, has existed for millennia. There is ancient Egyptian art which depicts a victim of the disease with a frail, deformed limb, using a staff for support.
While the paralysing effects of polio have always been devastating, outbreaks of the disease were relatively rare in the West until the late 19th century, when major epidemics swept Europe and the US.
In Roth’s story, everyone knows what polio is but no one knows where it comes from or how it spreads, with everything from flies to fast food blamed for its rapid transmission.
In fact it is passed on through contact with faecal matter, by drinking contaminated water and eating food that has been touched by the unclean hands, and sometimes through coughs and sneezes.
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A polio patient in an iron lung in 1938 (Getty)
Once infected, the virus invades the nervous system and begins to destroy nerve cells which control the muscles, especially in the legs. If someone is paralysed by polio, there is a five to 10 per cent chance they will die when the disease reaches their respiratory system. There is no cure.
“He was there for three weeks before he no longer needed catheterisation and enemas, and they moved him upstairs and began treatment with steamed woollen hot packs wrapped around his arms and legs, all of which were initially stricken,” writes Roth, of one character’s experience.

“He underwent four torturous sessions of the hot packs a day, together lasting as long as four to six hours. Fortunately his respiratory muscles hadn’t been affected, so he never had to be moved inside an iron lung to assist with his breathing, a prospect that he dreaded more than any other.” 
The iron lung was invented in 1928 by American physiologists Philip Drinker and Louis Shaw. 
The huge ventilator, which left only the head visible, kept polio victims alive for a number of weeks while they recovered from the illness – but those left permanently paralysed could spend their whole lives encased in one.
Dawn Varma, a 20-year-old who was paralysed by polio when she was 10 weeks’ pregnant, even gave birth while she was in an iron lung.
A photograph from 1959 shows Ms Varma, the wife of an Indian scientist, inside the ventilator with a nurse tending to her healthy newborn baby, called Dilip.
In 1952, Jonas Salk developed an injectable polio vaccine and in 1961 Albert Sabin pioneered the oral vaccine drops, which had the advantage of spreading immunity through communities. These vaccines were highly effective, and cases in the US fell from 35,000 in 1953 to 5,300 in 1957. 
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Dawn Varma, who gave birth while inside an iron lung at the age of 20 (Rex)
The new oral vaccine was approved for emergency use in Hull in 1961 when an epidemic hit the city, with parents taking their children to improvised immunisation centres in their thousands to be given sugar lumps with the vaccine.
The success of mass polio vaccination in the developed world led doctors and international humanitarian organisation Rotary International to consider its potential elsewhere.
John Sever, head of the infectious disease branch at the US National Institutes of Health and a Rotary member, in 1979 proposed the idea to the group’s president, who wanted to develop a new project for Rotary that would involve the entire organisation.
“He asked my opinion of what we could do, and I wrote him: ‘If a single vaccine were to be selected, I would recommend poliomyelitis’. At the time, less than half the children in the world were receiving any vaccine,” Dr Sever told National Geographic.
“At the time, there had just been the last cases of polio to occur in the United States, and smallpox had just been declared to be eradicated. So people felt it was possible, that we could aim to eradicate polio.”
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Dr Jonas Salk, who developed the injectable polio vaccine, in the lab with his assistant (Rex)
He said soon afterwards, “the legislative body that represents all Rotarians voted that we would make immunisation for the eradication of polio our number one priority throughout the world”.
That same year, Dr Sever and several fellow Rotary members travelled to the Philippines, where with the support of the government and health industry, they immunised around six million children.
Soon, the virus had been eradicated across the Americas – a remarkable feat that led Rotary International and the World Health Organisation to announce the goal of worldwide Polio eradication in 1988.
Now the disease is only endemic in three countries, Pakistan, Afghanistan and Nigeria, and there were just 37 cases last year. Optimistic health workers and organisations such as Rotary International say 2017 could be the year in which the world sees the last case of polio.
Serious challenges, including violent attacks on vaccinators by Islamists and poor routine immunisation coverage, remain.
But one day taking children to the doctor for polio vaccination drops may be a distant memory, and the long list of famous Polio survivors including Francis Ford Coppola, David Starkey and Mary Berry will fade into history.
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National Polio Immunisation Day in New Delhi, India
The hope generated by this possibility is summed up in Roth’s novel when the protagonist listens to his grandmother reminisce about diseases of the past.
“His grandmother was remembering when whooping cough victims were required to wear armbands and how, before a vaccine was developed, the most dreaded disease in the city was diphtheria,” it says. 
“She remembered getting one of the first smallpox vaccinations. The site of the injection had become seriously infected, and she had a large, uneven circle of scarred flesh on her upper right arm as a result. She pushed up the half-sleeve of her housedress and extended her arm to show it to everyone.” 


































Post Polio Litaff, Association A.C _APPLAC Mexico

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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movie

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here