Polio is caused by poliovirus, spread mainly by the fecal-oral route, and most infections cause no or mild symptoms. In a small number of people the virus attacks the motor nerves of the spinal cord and causes sudden, lasting paralysis, which the inactivated polio vaccine prevents.
Key symptoms
- Fever, sore throat, headache and vomiting
- Neck and back stiffness and muscle pain
- Sudden weakness of one or more limbs, often uneven
- Trouble swallowing or breathing in severe cases
What you find on exam
- Floppy, asymmetric weakness, legs more often than arms
- Reduced or absent reflexes in weak limbs
- Normal sensation
- Signs of meningitis; check breathing and swallowing
Tests
- Two stool samples 24 hours apart and a throat swab for poliovirus
- Lumbar puncture: raised white cells with normal glucose
- Spine MRI showing changes in the anterior horn
- Report to public health right away
Treatment basics
- No antiviral treatment; supportive care
- Monitor breathing and swallowing; ventilator support if needed
- Pain control and rest early, then physical therapy
- Vaccinate contacts and check community vaccine coverage
Red flags
- Shallow breathing or weak cough
- Trouble swallowing or handling saliva
- Weakness spreading quickly over hours
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.