Materiały źródłowe

• #1 Polio – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polio/diagnosis-treatment/drc-20376517

  Health care providers often recognize polio by symptoms, such as neck and back stiffness or abnormal reflexes or muscle weakness. To confirm the diagnosis, a lab test of a stool sample can detect the poliovirus. The virus can be found in a throat sample only during the first week of illness. So a throat sample is a less reliable source for testing. […] A test of the fluid surrounding the brain and spinal cord, or cerebrospinal fluid, may be used to rule out other diseases of the nervous system.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-Polio.aspx

  Polio is caused by a viral infection. In most cases (95% infections) there are no clinical symptoms and these infections do not need treatment. […] Diagnosis of polio involves medical history, physical examination and so forth. […] Medical history of the patient includes enquiry about exposure to a case of polio. This includes travelling to an area where polio in endemic, direct contact with nasal or mucus secretions of an individual with polio infection. […] History or polio vaccination is also important. Inactivated injectable polio vaccine or IPV for example has an effectiveness of around 90% protection from the infection. Individuals who are vaccinated are usually protected from the infection. […] This involves a complete check up of the systems. The respiratory muscles are examined for function as polio affecting spinal cord and brain stem may affect respiratory muscles.

• #1 Poliomyelitis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/enteroviruses/poliomyelitis

  Poliovirus poliomyelitis is an acute neurologic infection leading to acute flaccid paralysis caused by poliovirus (an enterovirus). […] Diagnosis of acute flaccid paralysis is clinical, although laboratory diagnosis is necessary to confirm poliovirus, a nonpolio enterovirus, or other virus as the cause of disease. […] When there are no central nervous system manifestations, mildly symptomatic polio resembles other systemic viral infections and is typically not considered or diagnosed except during an epidemic. […] Detection of the virus in a throat swab, feces, or cerebrospinal fluid can confirm infection with poliovirus. […] Epidemiologic clues (eg, immunization history, recent travel, age, season) can help raise suspicion for poliovirus infection. […] Because identification of poliovirus or another enterovirus as the cause of acute flaccid paralysis is important for public health reasons, suspected cases should be reported to the local or state health department immediately to assist with diagnostic testing. […] Specific testing for polioviruses, other enteroviruses, and West Nile virus should be conducted on these specimens in conjunction with public health departments.

• #1 Laboratory Testing for Poliovirus | Polio | CDC

  https://www.cdc.gov/polio/php/laboratories/index.html

  There are several ways diagnostic testing can detect poliovirus, and CDC laboratories conduct some of these tests. […] Diagnostic testing can detect poliovirus in specimens from the throat, feces (stool), and occasionally cerebrospinal fluid (CSF). Testing works by isolating the virus in cell culture or by detecting the virus by polymerase chain reaction (PCR). […] CDC laboratories conduct testing for poliovirus, including: Culture, Intratypic differentiation, Genome sequencing, Serology. […] Virus isolation in culture is the most sensitive method to diagnose poliovirus infection. […] To increase the probability of isolating poliovirus, collect at least 2 stool specimens 24 hours apart from patients with suspected poliomyelitis. […] Real-time reverse transcription PCR is used to differentiate possible wild strains from vaccine-like strains („intratypic differentiation”).

• #1 Laboratory Testing for Poliovirus | Polio | CDC

  https://www.cdc.gov/polio/php/laboratories/index.html

  Partial genome sequencing is used to confirm the poliovirus genotype and determine its likely geographic origin. […] Serology may be helpful in supporting the diagnosis of paralytic poliomyelitis; particularly if a patient is known or suspected to not be vaccinated. […] An acute serum specimen should be obtained as early in the course of disease as possible. A convalescent specimen should be obtained at least 3 weeks later. […] Detection of poliovirus in CSF is uncommon. […] CDC’s Infectious Disease Laboratories provide guidance for various specimen collection, storage, and shipment, including for polio. […] You must request pre-approval for all submission to CDC for diagnostic testing.

• #1

  https://www.gov.uk/government/publications/poliomyelitis-indications-for-serological-testing/poliomyelitis-indications-for-serological-testing

  The Virus Reference Department (VRD) houses the World Health Organization (WHO) National Polio Laboratory for the UK. In addition to the molecular detection and isolation of poliovirus, the laboratory performs serological assays to detect anti-poliovirus neutralising antibodies. This document provides clarification for service users on the indications for polio serological testing. Since June 2017, VRD has only processed referred samples that meet the approved indications for testing. […] Approved indications for polio serological testing are: diagnosis of poliovirus infection when the diagnosis cannot be established by molecular or culture-based methods, by comparing titres in acute and convalescent sera […] serological confirmation of poliovirus infection following detection of poliovirus using molecular and/or culture-based assays

• #1 Acute Poliomyelitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/967950-overview

  Acute poliomyelitis is a disease of the anterior horn motor neurons of the spinal cord and brain stem caused by poliovirus. Flaccid asymmetrical weakness and muscle atrophy are the hallmarks of its clinical manifestations, due to loss of motor neurons and denervation of their associated skeletal muscles. […] Lab tests in the workup of acute poliomyelitis include a lumbar puncture test; a complete blood count (CBC); virus recovery via throat washing, stool culture, blood culture, and cerebrospinal fluid (CSF) culture; and a polymerase chain reaction (PCR) assay (to differentiate wild-type strains from vaccine strains). […] With regard to imaging studies, magnetic resonance imaging (MRI) may show localization of inflammation to the spinal cord anterior horns. […] In electromyographic evaluation, the earliest finding is a reduction in the recruitment pattern and a diminished interference pattern due to acute motor axon fiber involvement. Fibrillations develop in 2-4 weeks and persist indefinitely; fasciculations also may be observed.

• #1 Polio differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Polio_differential_diagnosis

  Abortive poliomyelitis must be differentiated from other diseases that cause fever, nausea, vomiting, diarrhea, headache, and sore throat, such as gastroenteritis or acute respiratory infection. […] Paralytic poliomyelitis must be differentiated from other diseases that cause headache, muscle pain, lethargy, muscle weakness, spams, and tremors, such as Guillain-Barr syndrome, traumatic neuritis of the sciatic nerve, transverse myelitis, and West Nile Virus. […] The table below summarizes the findings that differentiate poliomyelitis from other conditions that cause headache, muscle pain; nausea and vomiting. […] The following table differentiates poliomyelitis from other diseases that cause muscle weakness, hypotonia, and flaccid paralysis. […] Poliomyelitis presents with asymmetric paralysis following a flu-like syndrome.

• #1 Post-polio syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-polio-syndrome/diagnosis-treatment/drc-20355674

  There’s no specific test to diagnose post-polio syndrome. Diagnosis is based on a medical history and physical exam, and exclusion of other conditions that could cause the signs and symptoms. […] For a diagnosis of post-polio syndrome, doctors look for three indicators: Previous diagnosis of polio. This might require finding old medical records or getting information from older family members. Long interval after recovery. People who recover from the initial attack of polio often live for years without further signs or symptoms. The onset of late effects varies widely but typically begins at least 15 years after the initial diagnosis. Gradual onset. The later onset weakness typically occurs in muscles that were affected at the time of the initial polio illness. Weakness often isn’t noticeable until it interferes with daily activities.

• #1 Post-polio syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-polio-syndrome/diagnosis-treatment/drc-20355674

  Because there are no tests that confirm a post-polio syndrome diagnosis, your doctor may use certain tests to rule out other conditions, including: Electromyography (EMG) and nerve conduction studies. Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles to be studied. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. […] A noninvasive test that shows promise for evaluating the severity of post-polio syndrome and monitoring its progression is muscle ultrasound, which uses sound waves to create images of muscles. More study is needed.

• #1 Diagnosis – Post Polio

  https://post-polio.org/living_with_polio/diagnosis/

  The criteria for diagnosing post-polio syndrome include: a prior episode of paralytic polio confirmed by medical history, neurologic examination, and, if needed, an electrodiagnostic exam to show changes consistent with prior anterior horn cell disease (exam is not required for limbs with obvious polio paralysis); a period of neurologic recovery followed by an extended interval of neurologic and functional stability, usually 15 years or more, preceding the onset of new weakness; the gradual or abrupt onset of new weakness and/or abnormal muscle fatiguability (decreased endurance), with or without generalized fatigue, muscle atrophy, and/or pain; and exclusion of medical, orthopedic, and neurologic conditions that may be causing the health problems listed above. New weakness (usually accompanied by diminished function) is the cardinal symptom of post-polio syndrome. […] Without a clear history of new weakness, the diagnosis cannot be made. In addition, the diagnosis cannot be made without excluding other likely causes of new weakness and other new health problems. For this reason, post-polio syndrome is called a diagnosis by exclusion.

• #1 Poliomyelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558944/

  Poliomyelitis is a highly transmissible infection nearing global eradication. […] Clinicians must remain vigilant for polio, especially in countries with low vaccination rates. […] Early recognition of symptoms, timely reporting to public health authorities, and reinforcing vaccination remain critical for patient outcomes and global eradication efforts. […] This activity provides healthcare professionals with a comprehensive overview of polio identification, management, and control. […] Compare clinical manifestations and apply diagnostic testing to differentiate poliomyelitis from similar infections as possible causes of acute flaccid paralysis. […] Healthcare professionals must maintain a high index of suspicion to diagnose acute poliomyelitis in patients who present with new-onset paralysis following a viral prodrome and are living in an endemic region or under-vaccinated population.

• #2 Poliomyelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558944/

  Poliomyelitis is a highly transmissible infection nearing global eradication. […] Clinicians must remain vigilant for polio, especially in countries with low vaccination rates. […] Early recognition of symptoms, timely reporting to public health authorities, and reinforcing vaccination remain critical for patient outcomes and global eradication efforts. […] This activity provides healthcare professionals with a comprehensive overview of polio identification, management, and control. […] Compare clinical manifestations and apply diagnostic testing to differentiate poliomyelitis from similar infections as possible causes of acute flaccid paralysis. […] Healthcare professionals must maintain a high index of suspicion to diagnose acute poliomyelitis in patients who present with new-onset paralysis following a viral prodrome and are living in an endemic region or under-vaccinated population.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-Polio.aspx

  Acute flaccid paralysis (AFP) is a common clinical manifestation of poliomyelitis. AFP is defined as the sudden onset of flaccid paralysis in one or more limbs. […] Laboratory diagnosis includes routine blood tests. There may be raised white blood cells. […] The Cerebrospinal fluid bathes the spinal cord and the brain. This CSF is tested using a lumbar puncture. […] Throat washing is taken and assessed for the virus. […] Blood is tested for antibodies for polio virus. […] When a person is infected with polio virus, special tests can detect the levels of polio virus specific antibodies and confirm the diagnosis. […] Once the polio virus is isolated it is tested by a special test called oligonucleotide mapping (fingerprinting) or genomic sequencing.

• #2 Poliovirus infection – Symptoms, diagnosis and treatment | BMJ Best Practice

  http://bestpractice.bmj.com/topics/en-gb/902?locale=ar&

  Key diagnostic factors include unimmunised status, residence or travel in endemic area, decreased tone and motor function of affected limb, decreased tendon reflexes of affected limb, and muscle atrophy of affected limb. […] Investigations to consider include virus culture from stool, CSF, or pharynx, PCR plus sequencing, CSF analysis, serum antibodies to poliovirus, MRI of spinal cord, and electromyelogram (EMG) of affected limb.

• #2 Clinical Overview of Poliomyelitis | Polio | CDC

  https://www.cdc.gov/polio/hcp/clinical-overview/index.html

  Many patients with AFP will have a lumbar puncture and analysis of cerebrospinal fluid (CSF) performed as part of their evaluation. Detection of poliovirus in CSF from confirmed polio cases is uncommon. A negative CSF test result cannot be used to rule out polio. […] Consider polio in patients with polio-like symptoms, especially if the person is unvaccinated, incompletely vaccinated, recently traveled abroad to a place where polio still occurs, or was exposed to a person who recently traveled to one of these areas.

• #2 Poliomyelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558944/

  Poliovirus infection is assessed through viral cultures or detection of viral ribonucleic acid in stool or throat irrigation or swabs. […] The CDC recommends 2 specimens taken at least 24 hours apart during the first 14 days after the onset of paralysis. […] Clinical confirmation of polio requires 1 of the following: Poliovirus detected by sequencing of the capsid region of the genome by the CDC Poliovirus Laboratory. […] Polioviruses undergo reverse transcriptase polymerase chain reaction testing following culture to differentiate between WPV and VDPVs. […] Rapid investigation of acute flaccid paralysis is critical to identifying a possible polio infection and implementing control measures.

• #2 Poliovirus – Isolation and Characterization | Public Health Ontario

  https://www.publichealthontario.ca/en/Laboratory-Services/Test-Information-Index/Poliovirus

  It is recommended to submit 2 stool samples taken at least 48 hours apart for patients with suspected poliomyelitis or acute flaccid paralysis. […] To increase the probability of poliovirus isolation, obtain two stool specimens at least 48 hours apart from patients with suspected poliomyelitis. […] Rectal swab, respiratory/oropharyngeal, serum and CSF specimen types are not recommended for polio testing. […] Specimens should be frozen at -20C following collection and shipped to PHOs laboratory on dry ice. […] When poliomyelitis is suspected in persons of all ages, or acute flaccid paralysis (AFP) occurs in children less than 15 years of age, PHOs laboratory will conduct Enterovirus testing by Enterovirus PCR, and Enterovirus molecular serotyping on Enterovirus-positive specimens. […] For additional information on the test methodologies and algorithms used to at NML, please refer to NML Poliovirus Isolation and Molecular Characterization.

• #2 Polio – Infections – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/infections/enteroviruses/polio

  Polio is a highly contagious, sometimes fatal enterovirus infection that affects nerves and can cause permanent muscle weakness, paralysis, and other symptoms. […] The diagnosis is based on symptoms and the results of a stool culture. […] The diagnosis of nonparalytic poliomyelitis or paralytic poliomyelitis is confirmed by identifying poliovirus in a stool sample or throat swab or by detecting high levels of antibodies to the virus in the blood. […] Paralytic poliomyelitis is suspected in people who have muscle or limb paralysis or weakness. […] The diagnosis of nonparalytic poliomyelitis or paralytic poliomyelitis is confirmed by identifying poliovirus in a stool sample or throat swab or by detecting high levels of antibodies to the virus in the blood. […] Doctors usually also do a spinal tap (lumbar puncture) to look for other disorders that affect the brain and/or spinal cord and to test the spinal fluid for poliovirus.

• #2 Laboratory Testing for Poliovirus | Polio | CDC

  https://www.cdc.gov/polio/php/laboratories/index.html

  Partial genome sequencing is used to confirm the poliovirus genotype and determine its likely geographic origin. […] Serology may be helpful in supporting the diagnosis of paralytic poliomyelitis; particularly if a patient is known or suspected to not be vaccinated. […] An acute serum specimen should be obtained as early in the course of disease as possible. A convalescent specimen should be obtained at least 3 weeks later. […] Detection of poliovirus in CSF is uncommon. […] CDC’s Infectious Disease Laboratories provide guidance for various specimen collection, storage, and shipment, including for polio. […] You must request pre-approval for all submission to CDC for diagnostic testing.

• #2 Polio Resurgence: Guidance for Health Care Workers | NETEC

  https://netec.org/2023/02/06/polio-resurgence-guidance-for-health-care-workers/

  Diagnosis typically occurs 15 years or more after recovery and a period of stable neuromuscular function. Diagnostic tests include MRI and CT scans of the spinal cord; and electrophysiological studies and spinal fluid analysis to exclude other, possibly treatable, conditions that mimic PPS. […] Specimen collection, storage, and shipping to the CDC for polio isolation and genotyping requires that you first contact your state health department. […] Antibody testing for poliovirus types 1 and 3 can be performed in a biosafety level 2 laboratory to assess an individual’s protection from the virus. […] The lab performs Semi-Quantitative Serum Neutralization and can turn around test results in 6-12 days. […] CDC laboratories use several methods for testing for poliovirus, including: […] Culture: Virus isolation in culture is the most sensitive method of detecting poliovirus. The best samples come from stool two samples collected 24 hours apart as early as possible after the onset of illness.

• #2 Poliovirus: Characteristics, Pathogenesis and Lab Diagnosis • Microbe Online

  https://microbeonline.com/poliovirus-poliomyelitis/

  Poliovirus can be detected in specimens from the throat, feces (stool), and occasionally blood or cerebrospinal fluid (CSF). […] Virus isolation from stool specimens is the most sensitive method to diagnose poliovirus infection. Collecting at least two stool specimens 24 hours apart from suspected poliomyelitis patients is recommended to increase the probability of isolating poliovirus. […] Poliovirus may also be isolated from pharyngeal swabs. Isolation is less likely from blood or CSF. Samples should be collected early during the disease (ideally within 14 days after onset). […] For the patients who did not receive polio vaccination, the serological test may help support the diagnosis of paralytic poliomyelitis. An acute serum specimen should be obtained early in the course of the disease, and a convalescent specimen should be obtained at least three weeks later. […] A four-fold rise in antibody titer in paired sera confirms the diagnosis. Neutralization and complement fixation tests can be useful to measure the concentration of antibodies.

• #2

  https://www.gov.uk/government/publications/poliomyelitis-indications-for-serological-testing/poliomyelitis-indications-for-serological-testing

  quantifying antibody levels in individuals who work in laboratories where there is deliberate handling of poliovirus. […] Note that requests for testing for any indications not mentioned here should be discussed with VRD before samples are submitted. […] Excluded indications, meaning that samples will not be processed, include: demonstrating an antibody response to polio vaccination to assist in the diagnosis of immunodeficiency states including, but not limited to, primary humoral immunodeficiencies […] detecting antibodies or quantifying antibody levels in individuals travelling to an overseas area that has an active polio outbreak.

• #2 Post-polio syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-polio-syndrome/diagnosis-treatment/drc-20355674

  Because there are no tests that confirm a post-polio syndrome diagnosis, your doctor may use certain tests to rule out other conditions, including: Electromyography (EMG) and nerve conduction studies. Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles to be studied. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. […] A noninvasive test that shows promise for evaluating the severity of post-polio syndrome and monitoring its progression is muscle ultrasound, which uses sound waves to create images of muscles. More study is needed.

• #2 Poliovirus infection – Symptoms, diagnosis and treatment | BMJ Best Practice

  http://bestpractice.bmj.com/topics/en-gb/902?locale=ar&

  Poliovirus infection is usually asymptomatic. When symptomatic, the most common presentation is a minor gastrointestinal illness. […] Acute flaccid paralysis (AFP), or paralytic poliomyelitis, is the hallmark of the major illness. A minority of affected cases with AFP progress to life-threatening bulbar paralysis and respiratory compromise. […] There is no cure for poliovirus infection or post-poliomyelitis syndrome, and treatment is mainly supportive. […] Early physiotherapy is key to maximising and restoring limb function in paralytic poliomyelitis and in post-poliomyelitis syndrome. […] The classic clinical syndrome of poliomyelitis involves asymmetrical paralysis of the affected limb (usually the lower extremities). […] There is no specific treatment, nor reservoir in nature, making vaccination and global eradication a major priority for the World Health Organization (WHO).

• #2 Diagnosis – Post Polio

  https://post-polio.org/living_with_polio/diagnosis/

  The criteria for diagnosing post-polio syndrome include: a prior episode of paralytic polio confirmed by medical history, neurologic examination, and, if needed, an electrodiagnostic exam to show changes consistent with prior anterior horn cell disease (exam is not required for limbs with obvious polio paralysis); a period of neurologic recovery followed by an extended interval of neurologic and functional stability, usually 15 years or more, preceding the onset of new weakness; the gradual or abrupt onset of new weakness and/or abnormal muscle fatiguability (decreased endurance), with or without generalized fatigue, muscle atrophy, and/or pain; and exclusion of medical, orthopedic, and neurologic conditions that may be causing the health problems listed above. New weakness (usually accompanied by diminished function) is the cardinal symptom of post-polio syndrome. […] Without a clear history of new weakness, the diagnosis cannot be made. In addition, the diagnosis cannot be made without excluding other likely causes of new weakness and other new health problems. For this reason, post-polio syndrome is called a diagnosis by exclusion.

• #2

  https://www.nhs.uk/conditions/post-polio-syndrome/diagnosis/

  Post-polio syndrome (PPS) can be difficult to diagnose because there are no specific tests for it and symptoms can be mistaken for other conditions. […] Your GP may suspect post-polio syndrome based on your medical history and the results of a physical examination. […] As the symptoms of post-polio syndrome can be similar to those of several other conditions, such as arthritis, some tests may be needed to rule out any other possible causes of your problems. […] If your GP is unsure whether you have post-polio syndrome, you may be referred to a hospital consultant for further testing. […] To rule out other conditions, or confirm whether you have post-polio syndrome, tests you might have can include: electromyography (EMG) tests to measure the electrical activity in your muscles and nerves and find out whether they’re damaged. […] It’s possible to have post-polio syndrome alongside other conditions, so not every health problem or symptom you experience may be related to PPS.

• #2 Diagnosis | Post Polio: Polio Place

  https://www.polioplace.org/living-with-polio/diagnosis-0

  Without a clear history of new weakness, the diagnosis cannot be made. In addition, the diagnosis cannot be made without excluding other likely causes of new weakness and other new health problems. For this reason, post-polio syndrome is called a diagnosis by exclusion. […] Sin una historia clara de nuevas debilidades, el diagnstico no se puede realizar. Adicionalmente, es imposible hacer el diagnstico sin la exclusin de otras probables causas de nuevas debilidades as como de otros nuevos problemas de salud. Por esta razn, al tipo de diagnstico del sndrome post polio se le conoce como diagnstico por exclusin.

• #2 Clinical Overview of Poliomyelitis | Polio | CDC

  https://www.cdc.gov/polio/hcp/clinical-overview/index.html

  If you suspect polio, you should work with your state and local health department to order diagnostic testing. […] Rapidly investigating suspected polio cases is critical to identifying possible poliovirus transmission and implementing proper control measures. […] The Manual for the Surveillance of Vaccine-Preventable Diseases provides current guidelines for those involved in VPD surveillance and response. Learn more about epidemiologic, clinical, and laboratory investigations of AFP to rule out poliovirus infection. […] Although poliovirus is no longer endemic in the United States, healthcare professionals should rule out poliovirus infection in cases of unexplained AFP that are clinically compatible with polio (particularly those with anterior myelitis). This ensures that any importation of poliovirus is quickly identified and investigated.

• #2 The history of Polio – from eradication to re-emergence – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/stories/history-polio-eradication-re-emergence

  Dr. Rey said that, at this time, the recommendation of the Technical Advisory Group (TAG) on Immunizations is to use both the injected and oral vaccines to generate optimal immunity. […] As part of the primary vaccination schedule during the first year of life, a baby should receive two doses of the injectable vaccine (IPV) and one dose of the oral polio vaccine (OPV), as well as two boosters at 18 months and 5 years old. This scheme provides life-long protection. […] The 2022 detection of the vaccine-derived polio case in New York, however, raised the alarm among public health authorities across the world, and a renewed call to improve immunization rates. […] Polio vaccination coverage in the region is at 79 percent, the lowest since 1994, Dr. Rey warned. […] The recommended vaccination coverage to prevent the reintroduction of the virus is 95 percent.

• #3 Acute Poliomyelitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/967950-overview

  Acute poliomyelitis is a disease of the anterior horn motor neurons of the spinal cord and brain stem caused by poliovirus. Flaccid asymmetrical weakness and muscle atrophy are the hallmarks of its clinical manifestations, due to loss of motor neurons and denervation of their associated skeletal muscles. […] Lab tests in the workup of acute poliomyelitis include a lumbar puncture test; a complete blood count (CBC); virus recovery via throat washing, stool culture, blood culture, and cerebrospinal fluid (CSF) culture; and a polymerase chain reaction (PCR) assay (to differentiate wild-type strains from vaccine strains). […] With regard to imaging studies, magnetic resonance imaging (MRI) may show localization of inflammation to the spinal cord anterior horns. […] In electromyographic evaluation, the earliest finding is a reduction in the recruitment pattern and a diminished interference pattern due to acute motor axon fiber involvement. Fibrillations develop in 2-4 weeks and persist indefinitely; fasciculations also may be observed.

• #3 Poliovirus infection – Symptoms, diagnosis and treatment | BMJ Best Practice

  http://bestpractice.bmj.com/topics/en-gb/902?locale=ar&

  Poliovirus infection is usually asymptomatic. When symptomatic, the most common presentation is a minor gastrointestinal illness. […] Acute flaccid paralysis (AFP), or paralytic poliomyelitis, is the hallmark of the major illness. A minority of affected cases with AFP progress to life-threatening bulbar paralysis and respiratory compromise. […] There is no cure for poliovirus infection or post-poliomyelitis syndrome, and treatment is mainly supportive. […] Early physiotherapy is key to maximising and restoring limb function in paralytic poliomyelitis and in post-poliomyelitis syndrome. […] The classic clinical syndrome of poliomyelitis involves asymmetrical paralysis of the affected limb (usually the lower extremities). […] There is no specific treatment, nor reservoir in nature, making vaccination and global eradication a major priority for the World Health Organization (WHO).

• #3 Polio – Causes, Symptoms, Treatment, New vaccines | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/polio

  Polio is a severe acute infectious disease caused by the poliovirus, which can spread from person to person, damaging the central nervous system and motor neurons, resulting in flaccid paralysis. […] The doctor will arrive at a polio diagnosis by taking your medical history, performing a physical examination, and ordering laboratory tests to rule out or confirm the disease, particularly for unvaccinated persons, travelers to an endemic area, or persons presenting with acute flaccid paralysis (AFP). […] Physical examination: test for abnormal reflexes by tapping with a rubber mallet to gauge the knee and ankle reflexes, checking for stiff neck, muscle weakness, urinary incontinence, constipation, difficulty swallowing, or difficulty speaking. […] Lab testing for enteroviruses: Oropharyngeal swab to collect a secretion sample and run tests in a laboratory to check for enterovirus material during the first week of suspected infection.

• #3 Poliovirus infection – Symptoms, diagnosis and treatment | BMJ Best Practice

  http://bestpractice.bmj.com/topics/en-gb/902?locale=ar&

  Key diagnostic factors include unimmunised status, residence or travel in endemic area, decreased tone and motor function of affected limb, decreased tendon reflexes of affected limb, and muscle atrophy of affected limb. […] Investigations to consider include virus culture from stool, CSF, or pharynx, PCR plus sequencing, CSF analysis, serum antibodies to poliovirus, MRI of spinal cord, and electromyelogram (EMG) of affected limb.

• #3 Poliomyelitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4212416/

  Poliomyelitis is a highly infectious disease caused by a virus belonging to the Picornaviridae family. The clinical features are varied ranging from mild cases of respiratory illness, gastroenteritis, and malaise to severe forms of paralysis. This disease has been associated with crippling deformities affecting thousands of lives throughout the world. The current method of diagnosis is polymerase chain reaction (PCR) for detection of poliovirus, which can be isolated from samples of stool, throat swabs, blood, and cerebrospinal fluid (CSF). Stool samples of the infected person are the primary sample source. The virus is excreted intermittently for a long period of 1 to 2 months after infection. In all, 80% of exposed people excrete the virus in the first 2 weeks, which declines to around 25% in the third week. Therefore, 2 samples of stool must be collected ideally at an interval of 24 hours within 2 weeks time for maximizing the chances of isolation of virus. The virus can rarely be isolated from CSF in cases of aseptic meningitis. The poliovirus enters the oropharynx and multiplies locally in the tonsils, lymph nodes of the neck, and then subsequently in Peyer patches and small intestine. The incubation period ranges from 2 to 35 days. The spread of the disease is through the fecal-oral route. The dissemination of the virus in the feces is the reason of it being a highly communicable disease. Clinical features have been classified according to the severity of symptoms. The majority of exposed patients (around 95%) are asymptomatic. During this period, there is shedding of the virus in stool and it can be isolated from throat swabs also. The ratio of asymptomatic to paralytic cases ranges from 50:1 to 1000:1. The most severe form, paralytic poliomyelitis, which is seen in less than 1% of patients, presents as excruciating episodes of pain in back and lower limbs. In children, the disease may present in biphasic form a period of prodrome followed by a brief symptom-free period of 7 to 10 days and then appearance of asymmetrical paralysis of limbs. The current method of diagnosis is polymerase chain reaction (PCR) for detection of poliovirus, which can be isolated from samples of stool, throat swabs, blood, and cerebrospinal fluid (CSF). Genetic sequencing of the virus is essential to determine its origin and mode of transmission in cases of outbreak. When the world today stands on the brink of polio eradication, immediate identification of the genome of the outbreak isolate is imperative.

• #3 Poliovirus – Isolation and Characterization | Public Health Ontario

  https://www.publichealthontario.ca/en/Laboratory-Services/Test-Information-Index/Poliovirus

  It is recommended to submit 2 stool samples taken at least 48 hours apart for patients with suspected poliomyelitis or acute flaccid paralysis. […] To increase the probability of poliovirus isolation, obtain two stool specimens at least 48 hours apart from patients with suspected poliomyelitis. […] Rectal swab, respiratory/oropharyngeal, serum and CSF specimen types are not recommended for polio testing. […] Specimens should be frozen at -20C following collection and shipped to PHOs laboratory on dry ice. […] When poliomyelitis is suspected in persons of all ages, or acute flaccid paralysis (AFP) occurs in children less than 15 years of age, PHOs laboratory will conduct Enterovirus testing by Enterovirus PCR, and Enterovirus molecular serotyping on Enterovirus-positive specimens. […] For additional information on the test methodologies and algorithms used to at NML, please refer to NML Poliovirus Isolation and Molecular Characterization.

• #3 Clinical Overview of Poliomyelitis | Polio | CDC

  https://www.cdc.gov/polio/hcp/clinical-overview/index.html

  Many patients with AFP will have a lumbar puncture and analysis of cerebrospinal fluid (CSF) performed as part of their evaluation. Detection of poliovirus in CSF from confirmed polio cases is uncommon. A negative CSF test result cannot be used to rule out polio. […] Consider polio in patients with polio-like symptoms, especially if the person is unvaccinated, incompletely vaccinated, recently traveled abroad to a place where polio still occurs, or was exposed to a person who recently traveled to one of these areas.

• #3 Poliovirus: Characteristics, Pathogenesis and Lab Diagnosis • Microbe Online

  https://microbeonline.com/poliovirus-poliomyelitis/

  Poliovirus can be detected in specimens from the throat, feces (stool), and occasionally blood or cerebrospinal fluid (CSF). […] Virus isolation from stool specimens is the most sensitive method to diagnose poliovirus infection. Collecting at least two stool specimens 24 hours apart from suspected poliomyelitis patients is recommended to increase the probability of isolating poliovirus. […] Poliovirus may also be isolated from pharyngeal swabs. Isolation is less likely from blood or CSF. Samples should be collected early during the disease (ideally within 14 days after onset). […] For the patients who did not receive polio vaccination, the serological test may help support the diagnosis of paralytic poliomyelitis. An acute serum specimen should be obtained early in the course of the disease, and a convalescent specimen should be obtained at least three weeks later. […] A four-fold rise in antibody titer in paired sera confirms the diagnosis. Neutralization and complement fixation tests can be useful to measure the concentration of antibodies.

• #3 The Pathologist | Polio’s Past, Present, and Future

  https://thepathologist.com/issues/2024/articles/aug/polio-s-past-present-and-future

  Various studies have shown that certain enterovirus types might present a challenge, which increases demand for fast and reliable enterovirus differentiation and type identification. Looking ahead, The European Non-Polio Enterovirus Network (ENPEN) network has already taken the first step towards improved diagnostic accuracy and is writing an up-to-date guideline on diagnostic and characterisation of enteroviruses. This guideline reflects the shift from slow, labor-intensive virus-culture methods to innovative molecular techniques. […] The next step involves implementing high-throughput (complete) genome sequencing to quickly identify any enterovirus type. Many university hospitals are equipped for next-generation sequencing, allowing them to detect and characterize enterovirus strains from diagnostic samples.

• #3 FPOLO – Overview: Poliovirus (Types 1, 3) Antibodies, Neutralization

  https://www.mayocliniclabs.com/test-catalog/overview/75165

  Poliovirus (Types 1, 3) Antibodies, Neutralization […] This sensitive procedure is recommended for vaccine response testing and type-specific serodiagnosis of recent poliovirus infection. It can also serve as an aid for diagnosing immune deficiency disorders. […] The presence of neutralizing serum antibodies (titers 1:8 up to >1:128) against polioviruses implies lifelong immunity. Some persons without detectable titers (<1:8) may also be immune as demonstrated by elicitation of a secondary-type serum antibody response upon rechallenge with live polio vaccine. [...] This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

• #3 Polio – Causes, Symptoms, Treatment, New vaccines | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/polio

  Stool examination: collecting stool samples to test for poliovirus. Throat secretions are usable only during the first week of illness. The virus is thus more likely detectable with a fecal examination. […] Cerebrospinal fluid examination is beneficial in ruling out poliovirus and other neurological diseases. […] Neuroimaging/Electrodiagnostic testing is a diagnostic test for peripheral nervous system disorders and muscle weakness. […] The antibody test checks for specific antibodies against the virus following an infection. […] Polymerase chain reaction (PCR) is a test to detect poliovirus genetic material in the body. […] Culture: taking bodily secretions to incubate in a culture medium to confirm or rule out the disease.

• #3 Clinical Overview of Poliomyelitis | Polio | CDC

  https://www.cdc.gov/polio/hcp/clinical-overview/index.html

  If you suspect polio, you should work with your state and local health department to order diagnostic testing. […] Rapidly investigating suspected polio cases is critical to identifying possible poliovirus transmission and implementing proper control measures. […] The Manual for the Surveillance of Vaccine-Preventable Diseases provides current guidelines for those involved in VPD surveillance and response. Learn more about epidemiologic, clinical, and laboratory investigations of AFP to rule out poliovirus infection. […] Although poliovirus is no longer endemic in the United States, healthcare professionals should rule out poliovirus infection in cases of unexplained AFP that are clinically compatible with polio (particularly those with anterior myelitis). This ensures that any importation of poliovirus is quickly identified and investigated.

• #3 Diagnosis | Post Polio: Polio Place

  https://www.polioplace.org/living-with-polio/diagnosis-0

  The criteria for diagnosing post-polio syndrome include: a prior episode of paralytic polio confirmed by medical history, neurologic examination, and, if needed, an electrodiagnostic exam to show changes consistent with prior anterior horn cell disease (exam is not required for limbs with obvious polio paralysis); a period of neurologic recovery followed by an extended interval of neurologic and functional stability, usually 15 years or more, preceding the onset of new weakness; the gradual or abrupt onset of new weakness and/or abnormal muscle fatiguability (decreased endurance), with or without generalized fatigue, muscle atrophy, and/or pain; and exclusion of medical, orthopedic, and neurologic conditions that may be causing the health problems listed above. New weakness (usually accompanied by diminished function) is the cardinal symptom of post-polio syndrome.

• #3 Polio and the late effects of polio | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/polio-and-post-polio-syndrome

  Polio (referred to medically as poliomyelitis) is a serious disease caused by infection with any of the 3 strains of poliovirus. […] To diagnose polio, a doctor will: take a medical history, perform a physical examination for symptoms such as: neck and back stiffness, abnormal reflexes, swallowing and breathing problems, rule out other possible explanations for symptoms, test for the poliovirus in a sample of: throat secretions, faeces, cerebrospinal fluid (the fluid surrounding the brain and spinal cord). […] Post-polio syndrome (PPS) is a sub-category of LEoP. It is a diagnosable condition, however there is no test that will definitely show that you have it. PPS is diagnosed on the basis of: new symptoms of pain and weakness, continuing for at least a year, medical history having had a polio infection in the past, with or without paralysis, no other clinical explanations for the symptoms (known as diagnosis of exclusion).

• #3 Post-Polio Syndrome – Harvard Health

  https://www.health.harvard.edu/a_to_z/post-polio-syndrome-a-to-z

  Post-polio syndrome is an illness defined by a collection of symptoms that generally occur at least 10-20 years after infection with the polio virus. […] There is no specific test that diagnoses post-polio syndrome. Instead, the diagnosis is made by confirming an old history of polio (based on history, physical examination and a muscle test called an electromyogram, or EMG). […] Your doctor will ask about your medical history, especially your history of polio. A neurological exam can identify muscle weakness and atrophy. An EMG can help to diagnose this disease. […] Post-polio syndrome usually worsens slowly. With a combination of multi-disciplinary rehabilitation approaches and lifestyle modifications, people often can return to or approach their previous level of functioning.

• #3 Polio: For health professionals – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/poliomyelitis-polio/health-professionals.html

  To learn about best practices to help prepare for, detect and control poliovirus, and roles and responsibilities for a coordinated response across Canada, consult the: […] Investigate all confirmed, probable, and suspected cases of polio as soon as possible according to provincial and territorial guidelines. […] Stool is the required clinical specimen for the laboratory investigation and diagnosis of polio. For clinical cases, ensure the collection of at least 2 stool samples (taken at least 24 hours apart and minimum 2 grams per sample) within 2 weeks after symptom onset for viral studies. […] Polio is nationally notifiable in Canada, and all countries globally. Any confirmed or probable polio case (if the respective case definitions presented above are met) must be reported immediately to the Public Health Agency of Canada (PHAC).

• #3 The history of Polio – from eradication to re-emergence – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/stories/history-polio-eradication-re-emergence

  When vaccination levels are low, the unvaccinated in a community are more susceptible to the disease, increasing the likelihood that the weakened poliovirus mutates and reverts to a strain that is able to infect and cause paralysis, Dr. Rey added. […] The key to eradication is to keep up vaccination rates and to improve communication. […] Low vaccination rates, limited surveillance of acute flaccid paralysis, coupled with stretched human resources can contribute to a high risk of polio reintroduction not just in Peru, but across the region, she explained. […] We need to do our best effort to vaccinate children and reach more than 95 percent vaccination coverage to guarantee that our region remains polio-free.

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