Snapshot A 3-year-old girl presents to a local hospital in rural Asia for sudden-onset weakness of the lower extremities over the past 2 days. Her parents report that it seems to affect the right leg more. She has not had any immunizations due to lack of access to hospitals. On physical exam, there is notable muscular atrophy of the right leg and absent reflexes on the right. Reflexes are weak on the left side. Sensation is normal bilaterally. Introduction Classification poliovirus a non-enveloped single-stranded (+) RNA virus a picornavirus and enterovirus transmission fecal-oral Epidemiology incidence endemic in areas of Asia and Africa demographics affects children Pathogenesis replicates in oropharynx and small intestines and spreads to the central nervous system via bloodstream destroys the anterior horn of the spinal cord, causing lower motor neuron cell death Associated conditions poliomyelitis meningitis Prevention vaccines live attenuated oral polio vaccine (OPV) developed by Sabin may be associated with vaccine-associated paralytic poliomyelitis no longer offered inactivated polio vaccine (IPV) developed by Jonas Salk 4 doses for infants 2 months to 4-6 years Prognosis disease starts with preceding aseptic meningitis and progresses to flaccid paralysis two-thirds of patients do not recover their strength Presentation Symptoms meningitis headache vomiting stiff neck myalgias Physical exam systemic signs of infection fever and malaise lower motor neuron lesion asymmetric weakness asymmetric hypotonia flaccid paralysis legs > arms fasciculations decreased or absent reflexes muscle atrophy normal sensory exam Studies Labs cerebral spinal fluid ↑ white blood cells ↑ protein normal glucose presence of viral RNA viral isolation stool throat Making the diagnosis based on clinical presentation and laboratory studies Differential Werdnig-Hoffmann disease distinguishing factor both affect the anterior horns of the spinal cord but Werdnig-Hoffmann presents with symmetric weakness Guillain-Barre syndrome distinguishing factor symmetric weakness Treatment Management approach mainstay of treatment is supportive care management is focused on vaccine and prevention Conservative physical therapy and occupational therapy indication all patients respiratory support indication disease progression to respiratory system Complications Progression to respiratory failure Permanent deformity