Polimaltosny disease

Polimaltosny disease is a group of infectious diseases, similar clinical manifestations of different forms of polio.
Polimaltosny diseases are caused, as a rule, neurotropic intestinal viruses, Coxsackie and ECHO. Polimaltosny disease differ from polio (see) easier for and a favorable outcome. There are, however, severe cases of paralysis and residual phenomena.
The clinical picture. Sick and more children of preschool and younger school age. May occur as sporadic cases and epidemic outbreaks. More common spinal form with lesions of the spinal cord and the form with the defeat of the various divisions of the brain stem - pontina, at least - polyradiculoneuritis and other forms polimaltosny diseases. Paralytic period of the disease is usually absent or expressed slightly. In the latter case against the General satisfactory condition of the child, having motor disorders, which often develop in the proximal parts of the lower extremities. Pain syndrome of often poorly defined. As a result of paresis of the legs is marked change of gait, limping, weakness in the legs. Sometimes there peripheral paresis of the facial nerve. The nature of flaccid paralysis, peripheral (see Paralysis, paresis), with a decrease in muscle tone, weight loss muscle, but in some cases there is increasing tendon reflexes on paretic limbs with the presence of pathological reflexes.
Inflammatory changes in the cerebrospinal fluid may be missing, in other cases, increasing the number of cellular elements
and the protein content. Often one can distinguish viruses from the cerebrospinal fluid.
As a rule, all forms polimaltosny diseases are characterized by a benign course with a fairly rapid recovery of the disturbed functions (for 1-1,5 months), but may occur severe paralytic form, after which there is persistent residual effects.
The differential diagnosis is carried out with polio. At the same time have the value of epidemiological data, the nature of the clinical picture, benign disease. Great diagnostic significance of laboratory research methods: virus isolation from stool, blood, cerebrospinal fluid of patients. Along with increase of the titer of specific antibodies and the absence of serological changes to the polio virus is observed weak expression of inflammatory changes in the spinal fluid when polimaltosny diseases.
Treatment polimaltosny disease is recommended in the hospital (see Polio, treatment): a combination of drugs with exercise therapy and massage the affected muscles, physiotherapeutic procedures (diathermy, UHF, warm baths, paraffin). To prevent contractures necessary correct record of the affected muscles. As a rule, these therapeutic measures give a good therapeutic effect. Paralytic form polimaltosny diseases with residual effects of the patients are treated the same way as with poliomyelitis consequences.
In the preventive purposes is of particular importance early compulsory hospitalization of the patient and the establishment of quarantine.

Polimaltosny diseases, clinical manifestations are similar to various forms of polio, but etiological with polio viruses are not related.
Methods virological laboratory diagnosis was established: 1) serous meningitis, it is difficult to discern from meningeal form of polio is caused by various types of intestinal viruses, Coxsackie and ECHO; 2) the defeat of the cells of peripheral motoneuron, clinically expressed flaccid paralysis, can be caused not only by the three types of polio virus, but also by various other viruses. On this basis, it was designated paralytic polimaltosny diseases.
Viral serous meningitis have been studied in more detail. Describes many outbreaks of serous meningitis, observed since the early 50-ies abroad and in the Soviet Union. Initially, these flashes were erroneously regarded as nephrolithiasis polio (meningeal form). But by 1956 it was conclusively proved etiological significance of different types of viruses, Coxsackie and ECHO the origin of serous meningitis. These viruses can cause sporadic cases and outbreaks large scale. Described epidemic serous meningitis disease tens of thousands of people.
Mass diseases, expressed focality, highly contagious and is spreading speed suggest that the infection is transmitted by airborne droplets. Flash enteroviral meningitis occur mostly the same type that distinguishes them from clinically polymorphic outbreaks of polio. Clinical features of enteroviral meningitis and their difference from polio - see Meningitis (sero).
Paralytic polimaltosny diseases can be caused by different viruses. Currently, when conducted a mass vaccination of the population against polio cases are rare and require laboratory confirmation (see Polio). To eliminate polio and attributed the disease to P. C., you need to get a negative laboratory data for all three types of polio virus.
The origin of the paralytic P. C. most reliably established role of Coxsackie virus A7. This was first demonstrated in 1952, the Soviet scientists. During the polio outbreak of the brain-two patients who died when events bulbospinal defeat, were allocated to the virus, originally named the fourth type of polio virus, but who are immunologically identical with Coxsackie virus A7 (M. P. Chumakov, M. K. Voroshilov, V. I., Zhevandrova, L. L. Mironov, I. A. Robinson). Paralytic properties Coxsackie virus A7 received a confirmation in further studies. Coxsackie virus A7 has miotroponogo and neurotropic properties and is therefore regarded as a transition between a virus polio and Coxsackie.
Pathogens paralytic polimaltosny diseases may be other types of enteroviruses - all types Coxsackie group; Coxsackie A4, a10; ECHO 2, 4, 6,7, 9,11, the virus Frater. However etiological significance of these types of enteroviruses proved only in respect of sporadic cases of P. C., and Coxsackie virus A7 can play a role in the origin of the outbreak of paralytic P. C.
There is evidence that P. C. can be caused by various non-intestinal viruses (virus mumps, herpes, lymphocytic choriomeningitis, perhaps, others).
Many cases of P. C. remain etiological not solved, despite thorough laboratory tests.

Pathological anatomy. For polimaltosny diseases characteristic expressed circulatory disorders of the organs in the form of hyperemia and dystrophic changes in the nerve cells of different departments of the brain and spinal cord. Thus lack of the electoral defeat of motor ganglia is the main distinguishing feature of P. C. polio. The children killed in 2-4 days of illness, the histological examination of the brain and spinal cord are expressed plethora of vascular stasis in capillaries of the meninges and the brain, thrombosis and angioneurosis. In the nerve cells of the cortex and brain stem note hypoxic changes in the form of cytolysis, spraying substances Nissle, pignose nuclei and moderate atrophy ganglion cells.
In different areas of the cerebral cortex {bridge, the medulla, bark different departments) is the focal proliferation elements glia, sometimes around the small veins. In some fields of view among clusters of elements glia marked deeper dystrophic changes in nerve cells with the phenomenon of Tyrolese and neuronophagia. Kibrick and Benirschke (S. Kibrick, K. Benirschke) discovered these changes in nerve cells back and horns lateral spinal cord without the inflammatory response.
P. C., as a rule, occurs with myocardial damage in the form of interstitial myocarditis, stromal edema and infiltration her macrophage cells. Muscle fibers razvelecheny, some of them are lysed. Newborns are documented cases of encephalomyelitis in combination with myocarditis. From brain and heart of the dead newborns allocated virus Coxsackie B4 or B5.
P. C. been reproduced in the experiment when infected monkeys different groups of the Coxsackie virus. Noting changes in the cortex of the brain in those departments, which, as a rule, are not affected by polio. Along with degenerative changes in the nerve cells of cerebral cortex, subcortical knots and other parts of the brain were determined lymphoid-gistiotitarnaya infiltrates around vessels and single nevrologicheskoe knots. In the spinal cord similar changes took place mainly in the rear horns. The combination of damage to the brain and heart that allows etiological link P. C. with the Coxsackie virus.
Spring-summer meningoencephalitis have similar morphological picture of polio, but localization process when them other than polio.
The clinical picture. Paralytic polimaltosny diseases, as a rule, are easily pronounced limp spinal paralysis. In most patients paralysis developing on the background of normal temperature and satisfactory General condition. Paresis most often localized in one limb (usually in the leg) or only in any one group of muscles, muscle tone reduced tendon reflexes are not changed or reduced. For some patients muscle tone slightly elevated; even more rarely tendon reflexes somewhat increased and called on one or both symptom Babinsky. Gait paretic, with a slight bowing of the knee and rotate it outward. Spinal fluid, usually normal; some patients may be light inflammatory changes. The disease is favorable, with full recovery of functions within 4-8 weeks.
Approximately 1/3 of patients develop a small muscle atrophy with good functional capacity. Except spinal localization, polimaltosny diseases are signs of defeat of motor nuclei of craniocerebral nerves, often VII pair. In some very rare cases develop severe paralysis bulbospinal localization, when it can occur death. Possible and recovery with a defect.
Paralytic P. C. hospitalization for 6 weeks, when polio, not mandatory.
Treatment of paralytic P. C. in the acute stage of the disease is the same as in case of poliomyelitis. For most patients do not require lengthy and sanatorium treatment.