infectious diseases
Poliomyelitis
Key Points
Most poliovirus infections are asymptomatic or cause nonspecific minor illness or aseptic meningitis without paralysis; < 1% of patients develop the classic syndrome of flaccid weakness (paralytic poliomyelitis). Asymmetric flaccid limb paralysis or bulbar palsies without sensory loss during an acute febrile illness in a nonimmunized child or young adult may indicate paralytic poliomyelitis. Local and state health departments should be notified of suspected cases immediately. Viral culture of throat swabs, stool, and cerebrospinal fluid and reverse transcriptase–polymerase chain reaction of cerebrospinal fluid and blood should be done in coordination with health departments. In paralytic poliomyelitis, about two thirds of patients have residual permanent weakness. All infants and children should be immunized, but adults are not routinely vaccinated unless they are at increased risk (eg, because of travel, occupation, or local outbreak). 