Poliomielite e síndrome pós-pólio

A cirurgia, agressiva, por vezes abusiva, em pleno inverno paulistano, predispunha à polioencefalite, à perda da consciência! Não bastante, identificavam-se mais fatores desencadeantes: injeções intramusculares, apendicectomias, insolação, exposição ao frio... A carga dos vírus selvagens em circulação na população era fora do comum. Iceberg, o melhor exemplo para estimativa de sua densidade; a ponta, as ocorrências paralíticas; a base, submersa, a imensidade das formas inaparentes.Denominação paralisia infantil? Impropriedade. Adultos ? populares ou famosos ? padeceram da enfermidade.A raiva muda ? forma clínica paralítica da raiva humana ?, figurava entre opções na discussão de casos. Nada simples distinguir enfermidades com sintomas afins.Trata-se agora de rediscutir a estratégia para assegurar de vez a erradicação.A modalidade atual de queixas,retroativas,é a "síndrome pós-pólio".

Síndrome pós-poliomielite / Post-poliomyelitis syndrome

A poliomielite é uma doença erradicada no Brasil, desde os anos 80, mas atualmente estão aparecendo novos sintomas relacionados a essa patologia, a síndrome pós-polio, que é caracterizada por uma nova desordem neurológica. Esses sintomas aparecem 30 a 40 anos após a infecção aguda da poliomielite e, como é uma patologia recente, há poucos estudos e casos diagnosticados. O objetivo deste estudo é descrever o aparecimento do caso dessa síndrome, através do relato de caso de uma paciente que realiza tratamento fisioterapêutico na clínica de Fisioterapia do Hospital Regional de Araranguá, localizado na cidade de Araranguá/SC, em agosto de 2006. Conforme a literatura, os sinais e sintomas que foram relatados pelo estudo são considerados como uma conseqüência tardia da infecção aguda da poliomielite, devido à degeneração dos brotamentos dos axônios atingidos pela poliomielite há 40 anos.

The poliomyelitis disease was eradicated in Brazil in the eighties, but now new symptoms related to this pathology are rising, like the post-polio syndrome, which is characterized by a new neurological disorder. These symptoms rise 30 to 40 years after the acute poliomyelitis infection and, as it is a recent pathology, studies and diagnosed cases are scarce. The objective of this study was to describe the onset of this syndrome, through the case of a patient attended in a Physical Therapy Clinic of a Regional Hospital of Araranguá, located in the city of Araranguá/SC, Brazil, in August 2006. According to literature, signs and symptoms reported in the study are considered as the consequence of acute poliomyelitis infection, due to degeneration of budding axons damaged by the poliomyelitis 40 years ago.

Casos de poliomielitis paralítica asociada a la vacuna oral antipoliomielítica en Cuba (1963-2006) / Cases of paralytic poliomyelitis associated with oral antipoliomielytis vaccine in Cuba (1963-2006)

Objetivo: divulgar los indicadores de poliomielitis paralítica asociada encontrados en 44 años en niños vacunados con oral antipoliomielítica, suministrada exclusivamente en campañas masivas de vacunación durante el período de 1963 a 2006 y reportar el riesgo de poliomielitis paralítica asociada a la vacuna con relación a diferentes aspectos epidemiológicos. Métodos: se realizó un estudio retrospectivo en 596 casos de parálisis fláccida aguda en niños ingresados en hospitales pediátricos, basado en investigaciones virológicas y detección de diferentes variables epidemiológicas. Resultados: de 113 pacientes estudiados se aislaron 120 agentes virales y 30 fueron identificados como poliovirus. Los datos clínicos y epidemiológicos en 596 casos de parálisis fláccida aguda permitieron categorizar a 20 niños afectados con poliomielitis paralítica asociada a la vacuna. Todos los casos se presentaron en niños menores de un año, vacunados con oral antipoliomielítica con estrategias de campañas masivas de vacunación exclusivamente y 19 fueron producidos por la primera dosis. El riesgo global en los niños vacunados con primera dosis de 1963 a 2006 fue 1 en 379 888 (7 217 866 dosis administradas/19 casos con poliomielitis paralítica asociada a la vacuna). Los casos de poliomielitis paralítica asociada a la vacuna se han presentado esporádicos o en un grupo de 8 casos en el período 1989-1992. El riesgo de primera dosis en casos esporádicos fue 1 en 612 864 y en el grupo de 1 en 84 670. El riesgo en casos agrupados es 7,2 veces mayor que los ocurridos en casos aislados. Particularmente en el año 1992, que coincidió con una epidemia de neuropatía epidémica, el riesgo fue de 1 en 52 140, lo que representó un incremento de 11,8 veces a lo ocurrido en casos esporádicos. Los niños de 4-7 meses de edad también tuvieron un riesgo mayor que fue 1 en 132 812. Conclusiones: se identificaron aspectos epidemiológicos que incrementaron el riesgo de poliomielitis paralítica asociada a la vacuna, en los cuales coinciden aspectos de deficiencias nutricionales.

Aim: to disseminate the indicators of associated paralytic poliomyelitis found during 44 years in children that received the oral antipoliomyelitis vaccine, which was only administered in massive vaccination campaigns from 1963 to 2006, and to report the risk of vaccine-associated paralytic poliomyelitis as regards different epidemiological aspects. Methods: a retrospective study was undertaken in 596 cases of acute flaccid paralysis in children admitted in pediatric hospitals, based on virology researches, and on the detection of different epidemiological variables. Results: 120 viral agents were isolated from 113 studied patients. 30 were identified as poliovirus. The clinical and epidemiological data from 596 cases of acute flaccid paralysis allowed to categorize 20 children affected with vaccine-associated paralytic poliomyelitis. All the cases were children under one that were exclusively administered the oral antipoliomyelitis vaccine through the strategy of the massive vaccination campaigns. 19 of them were caused by the first dose. Global risk in children vaccinated with the first dose from 1963-2006 was of one in 379 888 (7 217 866 doses administered/19 cases with vaccine-associated paralytic poliomyelitis). Cases of vaccine-associated paralytic poliomyelitis have been sporadic or in a group of 8 cases during 1989-1992. The risk of first dose in sporadic cases was of one in 612 864, and in the group of 1 in 84 670. The risk of grouped cases is 7.2 times higher than those occurred in isolated cases. Particularly, in 1992, coinciding with an outbreak of epidemic neuropathy, the risk was of one in 52 140, which represented an increase of 11.8 times compared with sporadic cases. Children aged 4-7 months old also had a higher risk of 1 in 132 812. Conclusions: there were identified epidemiological aspects that augmented the risk of vaccine-associated paralytic poliomyelitis, in which the aspects of nutritional deficiencies coincided.

Cytoskeletal changes during poliovirus infection in an intestinal cell line.

BACKGROUND & OBJECTIVES: Although polioviral replication has been extensively studied, cytoskeletal changes in the host cell during poliovirus replication have not been extensively investigated. We studied the ultrastructural and cytoskeletal changes in host cells during poliovirus infection. METHODS: Fluorescence staining of filamentous actin with a fluorescein-isothiocynate labelled mycotoxin, in the absence and presence of microfilament inhibitors cytochalasins B and D, and electron microscopy were used to investigate the role and fate of actin microfilaments during poliovirus infection, morphogenesis and release in an intestinal cell line, HRT-18. RESULTS: At 10 h post-infection, fluorescence staining of actin showed focal areas of fluorescence in the cytoplasm. By 16 h, these became more prominent and increased in number, and by 18-22 h they coalesced to enclose areas of the cytoplasm. These changes in the actin profile were confirmed by electron microscopy, where small actin bundles appeared in association with vesicles, increased in size, number and thickness, enclosed areas of cytoplasm with numerous vesicles and were finally seen in association with crystalline arrays of virus near the periphery of the cells. The addition of microfilament inhibitors cytochalasins B and D, after the initial period of adsorption resulted in complete inhibition of changes in the actin profile and of viral release, indicating that microfilament inhibitors prevented both polymerization of actin and movement of the virus within the cell. INTERPRETATION & CONCLUSION: In poliovirus infection, both intracellular movement and release of virus appear to be related to cytoskeletal changes, particularly involving actin microfilaments.

Inmunoprofilaxia de la poliomielitis / Inmunoprophilaxis of poliomielitis

La poliomielitis es una enfermedad viral, generalizada y aguda, que afecta al sistema nervioso central con severidad variable, y a veces se complica con parálisis. Si ocurre esto último, se trata de una parálisis fláccida, generalmente asimétrica, de diversos músculos estriados que a veces se acompaña de trastornos respiratorios y vasomotores. La poliomielitis solamente afecta al ser humano y al no haberse demostrado que en la naturaleza existen reservorios animales, se trata de una enfermedad que puede ser erradicada si se consigue inmunizar el número adecuado de sujetos como para interrumpir definitivamente la cadena de transmisión. Los subtítulos en que se divide el trabajo son: Historia, Agente, Patogenia, Diagnóstico, Inmunología, Epidemiología, Vacunas disponibles, Vacunas inactivadas, Vacuna atenuada, Reacciones diversas, Otros esquemas de inmunización, y Nuevas vacunas

Poliomyelitis in Malawi

The article discusses the work of Malawi Against Polio; and its findings are consistent with what is know of the pathology and epidemiology of poliomyelitis which suggests that MAP is adequately monitoring the disease in Malawi