DEDICATION

This work is dedicated to our respective parents who have been there to support us

financially and morally and who have been our constant source of inspiration. We also

offer this work to our Almighty God who have been our source of strength and knowledge

for us to be able to finish this case presentation. To our Instructor, Mr. Rogelio Villena,

who have been helping and guiding us in doing this research. And lastly, to the people who

have been with us through ups and downs while doing this output.

Ruth Cañaveral

Bryan Vince Cordero

Marge Ysabelle De Guzman
Irene Dimaya
Kimberly Dimaya
Regie Mae Dionaldo

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 TABLE OF CONTENTS

I: TITLE PAGE………………………………………………………………………i
II: DEDICATION………………………………………………………………..…...ii
III: TABLE OF CONTENTS………………………………………………………...iii
IV: BACKGROUND OF THE STUDY……………………………………………...
V: REVIEW OF THE RELATED STUDY…………………………………………..
VI: ANATOMY AND PHYSIOLOGY………………………………………………..
VII: PATHOPHYSIOLOGY…………………………………………………………….
VIII: SIGN AND SYMPTOMS WITH DESCRIPTION
OF THE CAUSE……………………………………………………………………..
IX: PHARMACOLOGIC INTERVENTIONS……………………………………….
X: MEDICAL MANAGEMENT…………………………………………………….
XI: SURGICAL MANAGEMENT…………………………………………………….
XII: MIDWIFERY MANAGEMENT…………………………………………………..
XIII: NUTRITIONAL MANAGEMENT……………………………………………….
XIV: BIBLIOGRAPHY/REFERENCES……………………………………………
IV. BACKGROUND OF THE STUDY

Poliomyelitis, often called Polio, or Infantile Paralysis, is a highly contagious

disease caused by a virus that attacks the nervous system. The virus is transmitted by

person-to-person spread mainly through the fecal-hand-oral route or, less frequently, by a

common vehicle and multiplies in the intestine, from where it can invade the nervous

system and can cause paralysis.

Those who are infected may spread the disease for up to six weeks even if no

symptoms are present. The disease may be diagnosed by finding the virus in the feces or

detecting antibodies against it in the blood. The disease mainly affects young children.

Before the 20th century, polio infections were rarely seen in infants before six months of

age, most cases occurring in children six months to four years of age. Poorer sanitation of

the time resulted in a constant exposure to the virus, which enhanced a natural immunity

within the population. In developed countries during the late 19th and early 20th centuries,

improvements were made in community sanitation, including better sewage disposal and

clean water supplies. These changes drastically increased the proportion of children and

adults at risk of paralytic polio infection, by reducing childhood exposure and immunity to

the disease. However, any person who is not immune to poliovirus, regardless of age, can

become infected.

The virus enters the central nervous system in about 1% of infections. About one

to five in 1000 cases progress to paralytic disease in which the muscles become weak,

floppy and poorly controlled, and, finally, completely paralyzed; this condition is known
as acute flaccid paralysis. Depending on the site of paralysis, paralytic poliomyelitis is

classified as spinal, bulbar, or bulbo-spinal, and represents approximately 19% of all cases.

Three serotypes of poliovirus have been identified—poliovirus type 1 (PV1), type

2 (PV2), and type 3 (PV3). All three are extremely virulent and produce the same disease

symptoms. PV1 is the most commonly encountered form, and the one most closely

associated with paralysis.

Poliomyelitis, has no cure. The disease is preventable with the polio vaccine;

however, multiple doses are required for it to be effective. The virus lives in an infected

person’s throat and intestines. It enters the body through the mouth and spreads through

contact with the feces (poop) of an infected person and, though less common, through

droplets from a sneeze or cough. You can get infected with poliovirus if you have feces on

your hands and you touch your mouth. Also, you can get infected if you put in your mouth

objects like toys that are contaminated with feces (poop).

An infected person may spread the virus to others immediately before and about 1

to 2 weeks after symptoms appear. The virus can live in an infected person’s feces for many

weeks. It can contaminate food and water in unsanitary conditions. People who don’t have

symptoms can still pass the virus to others and make them sick. The US Centers for Disease

Control and Prevention recommends polio vaccination boosters for travelers and those who

live in countries where the disease is occurring. Once infected there is no specific treatment.

In 2018, there were 33 cases of wild polio and 104 cases of vaccine-derived polio.
 This photo depicts the symptoms of Poliomyelitis.

V. REVIEW OF RELATED STUDY AND LITERATURE

A number of related articles were used by the researchers to gain further

understanding of the topic being studied.

VI. ANATOMY & PHYSIOLOGY

VII. PATHOPHYSIOLOGY

 Cribriform plate defect

 Group B streptococcus
 Otitis media
 Streptococcus Pneumonia
 Sinusitis
 Neisseria meningitis
 Mastoiditis
 Gram-bacilli
 Basal skull fracture
 Haemophilus Influenza  Pneumonia

CAUSATIVE AGENT SOURCE OF INFECTION

MENINGOCOCCEMIA

Bacteria enters through the

nose & mouth

Bacteria in bloodstream

Purplish rush is a telltale

symptoms
VIII. SIGNS AND SYMPTOMS WITH ANALYSIS

XI. MEDICAL MANAGEMENT

XI. SURGICAL MANAGEMENT

Because mortality may be reduced with early antibiotic therapy, patients with a

meningococcal rash should receive parenteral antibiotics by means of an intravenous (IV)

or intramuscular (IM) route as soon as the diagnosis is suspected. In the United Kingdom,

prehospital treatment with benzylpenicillin is recommended.

Intramuscular antibiotic injections may be less effective in a patient with shock and

poor tissue perfusion.

Tests can confirm a diagnosis of meningococcal meningitis. The doctor may start

antibiotics, such as penicillin or ceftriaxone, by an IV, or intravenous line. You or your

child may also need other medication to treat problems related to increased spinal fluid

pressure. Doctors sometimes prescribe steroids.

Meningococcal meningitis is a serious disease -- even with treatment. That's why

prevention is a far better approach. The meningococcal vaccinecan prevent meningitis

infection. In the U.S., three types of meningococcal vaccines are used:

Meningococcal conjugate vaccine (MCV4)-- One of these vaccines, Menactra, is

approved for people ages 9 months to 55. The other, Menveo, is used in those ages 2

through 55.Meningococcal polysaccharide vaccine (MPSV4) -- This vaccine was approved

in the 1970s and protects against most forms of meningococcal disease. This vaccine used
is for people as young as 9 months and older than age 55.Serogroup B Meningococcal B -

There are two MenB vaccines. Trumenba (MenB-FHbp) and Bexsero (MenB-4C). Both

are licensed for ages 10-24 but can be used in older patients.

Doctors recommend a dose of MCV4, which is given as a shot, for children at age

11, and then a booster shot at age 16. If the first dose is missed, the MCV4 can be

administered between ages 13 and 15, followed by a booster dose between ages 16 and 18.

The Serogroup B Meningococcal B vaccine is recommended for ages 16 to 18.

XII. MIDWIFERY MANAGEMENT

Diet and activity

Patients with meningitis or fulminant meningococcemia are at risk of vomiting and

should be prevented from taking anything by mouth prior to substantial clinical

improvement with antimicrobial therapy.

The level of patient activity is determined by the severity of the presentation. Bed

rest is recommended for patients suspected of having meningococcal disease. In most

severe cases, patients are bed bound.

Transfer

Once the patient is stabilized, attempt to transfer him or her to a tertiary care center

because meningococcal sepsis frequently produces multisystem organ dysfunction.

Transfer to a PICU is necessary in approximately 20% of pediatric cases of meningococcal

infection.

Pericarditis can occur while patients are recuperating from meningococcemia.

Consider pericarditis in patients with fever and shortness of breath upon minimal exertion

during the recovery period.

 Late skeletal deformities are rare, but epiphyseal avascular necrosis and epiphyseal-

metaphyseal defects have been described. These usually occur in the lower extremities and

result in angular deformity and inequality of leg length.

Observe patients for any late neurologic sequelae. Abnormal findings on

electroencephalography or cerebral computed tomography (CT) scanning, as well as

epileptogenic activity, sensorineural hearing loss, impaired vestibular function, and

neuropsychological impairment, have been found in up to 30% of survivors 1 year after an

episode of meningococcal disease. The frequency of serious neurologic sequelae in

individuals who survive an episode is 3%.

Follow-up care at least 6 weeks after meningococcal infection should include the

following:

 Ongoing management of specific complications such as amputations, skin grafting,

or renal failure

 Full physical examination

 Assessment of plasma complement levels - Eg, total hemolytic complement, C3,

and C4, with or without properdin

 Serologic confirmation of the diagnosis if no diagnosis was made at the time of

presentation

 Audiologic function testing

 Basic assessment of psychological status after intensive care, if relevant

 Possible vaccination of contacts if an outbreak of group A, C, Y, or W-135 disease

occurs
XIII. NUTRITIONAL MANAGEMENT

Practicing healthy hygiene can decrease the risk of infection. This includes washing

hands thoroughly and covering your mouth and nose when sneezing and coughing.

You can also help reduce your risk of infection by avoiding people who are

coughing, sneezing, or showing other signs of illness. Also, don’t share personal items with

people who are sick. This means not sharing anything that comes into contact with the

mouth unless it’s been washed after it was last used.

If you’ve been exposed to a person who is infected, your doctor may recommend

preventive antibiotics. This will reduce your chances of getting the disease.

Your doctor may recommend that you get a vaccination. Vaccination is

recommended for those at increased risk for infection, such as teenagers, college students,

or people about to move into a group living situation for the first time. Talk to your doctor

about possible vaccination options.