POLIOMIYELITOPODOBNY DISEASES — group of the diseases clinically similar to paralytic forms of acute epidemic poliomyelitis, but etiologically connected with other, not poliomyelitic viruses.
The concept «poliomiyelitopodobny diseases» appeared after carrying out mass inoculations against acute epidemic poliomyelitis (see) and elimination of this disease as epidemic. These inoculations allowed to establish that there is a certain group of diseases which, as well as acute epidemic poliomyelitis, are characterized by defeat of front horns of a spinal cord and motive kernels craniocereberal (cranial, T.) nerves, but etiologically are not connected with viruses of poliomyelitis. In some cases P.'s etiology z. it is reliable it is not possible to establish, however developing of these diseases is connected with Koksaki's enteroviruses (see. Koksaki-virusnye of a disease, etiology ; Enteroviral diseases ) and ECHO (see. Intestinal viruses ), viruses of parotitis (see. Parotitis epidemic, etiology ), measles (see. Measles, etiology ), etc.
Sporadic cases of P. z. years can be observed at different times. A certain seasonality in their emergence usually is not noted. In most cases these sporadic diseases have no accurate epidemiol, patterns and visible communication among themselves. Sometimes P. z. are observed in the form of small, local flashes. Only one large epidemic flash of P. z is known., observed in Bulgaria in 1975 and captured apprx. 700 people. Clinically these diseases almost completely corresponded to the known forms of poliomyelitis, but etiologically were connected with the enterovirus 71 which caused this flash. Item z. are usually observed at children under 2 years. However during epidemic flash of P. z. in Bulgaria, in addition to children of early age, also children of other age groups and adults were ill.
Patomorfologiya is characterized by development of inflammatory reaction of various degree of manifestation caused by influence of viruses (Koksaki, ECHO, etc.). At the same time note diffusion and focal changes preferential in a zone of motor-neurons of a spinal cord. In rare instances P. z., caused by Koksaki's viruses B 3, B 5, B 1, ECHO and an enterovirus 71, proceed as encephalomyelitis with a lethal outcome. Macroscopically in such cases find a plethora of vessels and hypostasis of an arachnoid membrane and substance of a head and spinal cord. At microscopic examination, in addition to sharply expressed hyperemia of vessels, reveal diapedetic hemorrhages, staz and blood clots in small vessels and capillaries, infiltration of an arachnoid membrane kruglokletochny elements, perivascular infiltrates (fig., a), diffusion and focal accumulations of monocytes and neutrocytes in substance of a head and spinal cord (fig., b). The infiltrates consisting of these cells are especially characteristic of P. z.; they most often meet in front horns of a spinal cord, the lower olive kernels of a myelencephalon, kernels of cranial nerves and a reticular formation of a brain trunk, is more rare in gear kernels of a cerebellum, a cerebral cortex and other departments of c. N of page. In the neurons located on border with infiltrates define a chromatolysis and a hyperchromatosis of cytoplasm, a hyperchromatosis of kernels (see. Nervous cell, patomorfologiya ), edematous change of neurons and their cytolysis is quite often observed, in capillaries often reveal hypostasis of endotheliocytes (fig., b). Neyronofagiya (see) find seldom, only single nervous cells are exposed to it. In a spinal cord loss of a large number of neurons is observed, sites of a full necrosis of front horns in places meet. In a head and spinal cord reveal also moderately expressed hypertrophy of astrocytes, their klazmatodend-roses (fragmentation of shoots), proliferation of glial macrophages with formation of their rod forms, a hyperplasia and edematous change of oligodendroglyocites. All this complex of changes, according to B. A. Ehrman et al. (1965), is regarded as the most acute encephalomyelitis. Morfol, the changes developing in c. N of page at P. z., differ from the changes observed at poliomyelitis, bigger sharpness patol, process and heavier circulatory disturbances.
Item z. on the manifestations in most cases do not differ from paralytic poliomyelitis and are, as a rule, characterized by sluggish paresis or paralyzes of muscles, preferential proximal departments of extremities, with development mono-or parapareses (see. Paralyses, paresis ). On a paretichny extremity note decrease or lack of tendon jerks, decrease in a muscle tone and an atrophy of muscles, but without disturbances of sensitivity. In most cases paresis develops against the background of a satisfactory general condition and standard temperature of a body. In nek-ry cases development of paresis is preceded short-term (1 — 4 day) by the period of the prodromal phenomena (an indisposition, the general weakness, lack of appetite) with the subsequent emergence of unsharply expressed all-infectious syndrome which is followed by fervescence (sometimes on type one - or a two-wave curve), the phenomena of the general intoxication, occasionally radicular pains and symptoms meningism (see). Motive disturbances can arise on 2 — the 5th day of fever and accrue usually within 2 — 3 days, more rare longer. Sometimes P. z. can proceed as a pontinny form of poliomyelitis with symptoms of defeat of motive kernels of skull-but-brain nerves; thus is more often than others peripheral paresis of the muscles innervated is observed facial nerve (see). In nek-ry cases of P. z. proceed with symptoms of widespread defeat back, a myelencephalon and other departments of c. N of page are also followed by heavy paralyzes and bulbar frustration (see. Myelencephalon, pathology ; Bulbar paralysis ).
Cerebrospinal liquid (see) at P. z. to a thicket it is not changed, but sometimes in it note a lymphocytic pleocytosis (to several honeycombs elements in 1 mkl) and increase in protein (usually no more than 1%0) - Sanitation of cerebrospinal liquid occurs quickly enough.
The diagnosis is based on data of the anamnesis, a wedge, pictures, results of virologic and serological researches. Differential diagnosis is carried out first of all with acute epidemic poliomyelitis (see), at the same time data virusol, and immunol have crucial importance. researches. Item z. differentiate also with a polyradiculoneuritis (see. Polyneuritis ), focal myelitis (see) and other diseases. Unlike P. z. existence of symmetric defeats of a peripheral nervous system with disturbance of sensitivity in distal departments of extremities of radicular type is characteristic of a polyradiculoneuritis. The focal myelitis differs from P. z. conduction disorders of sensitivity and movements at safety or increase in tendon, periosteal jerks and a tone of muscles, existence of permanent dysfunctions of pelvic bodies. Sometimes P. z. differentiate with myopathies (see) and nek-ry other hereditary diseases of nervous and muscular system, and also with traumatic injuries of extremities and flat-footedness (see).
Treatment complex, in the acute period same, as well as at poliomyelitis. Carry out medicamentous therapy using the pharmaceuticals improving neuromuscular conductivity (a prozerin, etc.), biostimulators (a vitreous, an aloe, FIBS, etc.), vitamins of group B, ascorbic to - you.
Appoint LFK, massage; carry out the correct functional laying of the paralyzed extremities; the fiziobalneoterapiya is widely used.
Forecast at sporadic the arising P. z. more favorable, than at acute epidemic poliomyelitis. In most cases these diseases come to an end with an absolute recovery within two months. Sometimes, as well as at epidemic poliomyelitis, there can be resistant phenomena in the form of sluggish paresis or paralyzes. In separate exceptional cases, when P. z. are followed by the widespread phenomena of encephalomyelitis, the lethal outcome is possible.
During the holding preventive actions consider polietiol P.'s ogichnost z. Uniform specific prevention of P. z. does not exist since they are caused by various viruses.
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