Paralytic Poliomyelitis

Infectious Disease MONDO:0000341 Pathograph 10 Show in embeddings browser Motor Neuron Disease Viral infectious disease Central nervous system disorder

Paralytic poliomyelitis is an acute lower-motor-neuron disease caused by poliovirus, an enterovirus of the family Picornaviridae. The virus is spread by the fecal-oral (and oral-oral) route, undergoes primary replication in the alimentary mucosa and gut-associated lymphoid tissue, and produces a viremia through which it can invade the central nervous system. Poliovirus enters cells via its receptor CD155 (PVR) and shows marked tropism for, and lytic destruction of, the anterior horn lower motor neurons of the spinal cord (and brainstem motor nuclei in bulbar polio), producing acute asymmetric flaccid paralysis, areflexia, and muscle atrophy with intact sensation. Most infections are asymptomatic or abortive and fewer than 1% progress to paralytic disease. Bulbar involvement threatens respiratory and swallowing centers and can be fatal. The disease is vaccine-preventable with the inactivated (IPV) and oral (OPV) poliovirus vaccines. It is mechanistically related to the polio-like syndrome acute flaccid myelitis (caused chiefly by non-polio enteroviruses) and to the late sequela post-polio syndrome.

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6
Pathophys.
8
Phenotypes
10
Pathograph
3
Medical Actions
2
Differentials
9
References
⚙

Pathophysiology

6
Poliovirus Entry via CD155 Receptor
Poliovirus is a non-enveloped, positive-strand RNA enterovirus (Picornaviridae). Host-cell entry is governed by the poliovirus receptor CD155 (PVR), an immunoglobulin-superfamily membrane protein. CD155 binding determines species and cell-type susceptibility, and its expression in structures giving rise to anterior horn motor neurons helps explain the restrictive neuronal tropism of poliovirus.
motor neuron CL:0000100 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves motor neuron (CL:0000100). CL:0000100 is a cell type from the Cell Ontology.
PVR (CD155, poliovirus receptor) hgnc:9705 HUGO Gene Nomenclature Committee (hgnc) Relation: this pathophysiological event involves this gene This pathophysiological event involves PVR (CD155, poliovirus receptor), annotated with PVR (hgnc:9705). hgnc:9705 is a gene from the HUGO Gene Nomenclature Committee.
poliovirus entry into host cell via CD155 GO:0046718 ↑ INCREASED Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves increased poliovirus entry into host cell via CD155, annotated with symbiont entry into host cell (GO:0046718). GO:0046718 is a biological process from the Gene Ontology.
Downstream
Viremia and CNS Invasion CD155-mediated cell entry and replication in the alimentary mucosa seed the viremia that delivers poliovirus to the central nervous system.
Show evidence (3 references)
PMID:33490061 SUPPORT In Vitro
"Poliomyelitis is caused by poliovirus (PV), a positive strand non-enveloped virus"
The engineered neural tissue model confirms poliovirus as a non-enveloped positive-strand virus that is the cause of poliomyelitis.
PMID:10915595 SUPPORT Model Organism
"Expression of CD155 within embryonic structures giving rise to spinal cord anterior horn motor neurons may explain the"
CD155 reporter-expression mapping links receptor distribution to the anterior horn motor neuron compartment targeted by poliovirus.
PMID:10915595 SUPPORT Model Organism
"restrictive host cell tropism of poliovirus for this cellular compartment of the"
The same study attributes the restrictive cellular tropism of poliovirus to CD155-defined neuronal compartments.
Viremia and CNS Invasion
After fecal-oral acquisition, poliovirus multiplies in the alimentary mucosa and gut-associated lymphoid tissue, then enters the bloodstream. The resulting viremia delivers virus to the central nervous system by permeation of the blood-brain barrier and, alternatively, by retrograde axonal transport along peripheral motor neurons from muscle to the spinal cord.
response to virus GO:0009615 ↑ INCREASED Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves increased response to virus (GO:0009615). GO:0009615 is a biological process from the Gene Ontology.
central nervous system UBERON:0001017 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in central nervous system (UBERON:0001017). UBERON:0001017 is an anatomical location from the Uberon multi-species anatomy ontology. spinal cord UBERON:0002240 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in spinal cord (UBERON:0002240). UBERON:0002240 is an anatomical location from the Uberon multi-species anatomy ontology.
Downstream
Anterior Horn Motor Neuron Tropism and Lysis Virus reaching the CNS replicates preferentially in spinal and brainstem motor neurons, where its lytic replication destroys the cells.
Show evidence (3 references)
PMID:22529845 SUPPORT Model Organism
"the virus multiplies in the alimentary mucosa"
The trafficking review describes primary poliovirus replication in the alimentary mucosa before bloodstream entry.
PMID:22529845 SUPPORT Model Organism
"paralytic poliomyelitis results from the invasion of the central nervous system"
The review frames paralytic poliomyelitis as the consequence of CNS invasion by circulating poliovirus.
PMID:24367151 SUPPORT Model Organism
"the mechanisms for viral permeation through the blood-brain barrier and retrograde axonal transport of the virus"
The transgenic-mouse dissemination work supports both blood-brain barrier permeation and retrograde axonal transport as CNS-invasion routes.
Anterior Horn Motor Neuron Tropism and Lysis
Within the CNS poliovirus replicates preferentially in motor neurons, especially the lower motor neurons of the anterior (ventral) horn of the spinal cord gray matter and, in bulbar disease, brainstem motor nuclei. Lytic viral replication kills these neurons; the replicating capacity of the virus within the CNS is the principal determinant of neurovirulence.
anterior horn motor neuron CL:2000048 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves anterior horn motor neuron (CL:2000048). CL:2000048 is a cell type from the Cell Ontology.
poliovirus-induced motor neuron death GO:0052150 ↑ INCREASED Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves increased poliovirus-induced motor neuron death, annotated with symbiont-mediated perturbation of host apoptosis (GO:0052150). GO:0052150 is a biological process from the Gene Ontology.
ventral horn of spinal cord UBERON:0002257 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in ventral horn of spinal cord (UBERON:0002257). UBERON:0002257 is an anatomical location from the Uberon multi-species anatomy ontology. gray matter UBERON:0002020 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in gray matter (UBERON:0002020). UBERON:0002020 is an anatomical location from the Uberon multi-species anatomy ontology.
Downstream
Acute Flaccid Paralysis Destruction of lower motor neurons denervates skeletal muscle, producing flaccid weakness, areflexia, and subsequent atrophy.
Show evidence (3 references)
PMID:22529845 SUPPORT Model Organism
"it replicates in neurons, especially in motor neurons, inducing the cell death that causes paralytic poliomyelitis"
The review directly states that motor neuron replication and cell death cause paralytic poliomyelitis.
PMID:24367151 SUPPORT Model Organism
"strain-specific neurovirulence levels are shown to depend mainly on the replicating capacity of the virus in the central nervous system"
Neurovirulence is attributed primarily to viral replicating capacity within the CNS, supporting the lytic motor-neuron-destruction model.
PMID:33490061 SUPPORT In Vitro
"motor neurons are responsible for the permissiveness of poliovirus within the MN ENTs"
In motor-neuron-enriched human neural tissue, motor neurons are the permissive cell type for poliovirus, supporting selective tropism.
Retrograde Axonal Transport Neural Route
Beyond hematogenous spread, poliovirus can reach the CNS by a neural route: after intramuscular uptake by endocytosis at the neuromuscular synapse, the virus is carried retrogradely along motor axons, a CD155-dependent fast axonal transport process, to the motor neuron cell body where uncoating and replication occur.
motor neuron CL:0000100 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves motor neuron (CL:0000100). CL:0000100 is a cell type from the Cell Ontology.
PVR (CD155, poliovirus receptor) hgnc:9705 HUGO Gene Nomenclature Committee (hgnc) Relation: this pathophysiological event involves this gene This pathophysiological event involves PVR (CD155, poliovirus receptor), annotated with PVR (hgnc:9705). hgnc:9705 is a gene from the HUGO Gene Nomenclature Committee.
spinal cord UBERON:0002240 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in spinal cord (UBERON:0002240). UBERON:0002240 is an anatomical location from the Uberon multi-species anatomy ontology.
Downstream
Anterior Horn Motor Neuron Tropism and Lysis Retrograde axonal transport delivers poliovirus to anterior horn motor neuron cell bodies, complementing the hematogenous CNS-invasion route.
Show evidence (2 references)
PMID:22529845 SUPPORT Model Organism
"PV is taken up by endocytosis at synapses"
Intramuscularly inoculated poliovirus is taken up at synapses, the entry step of the neural dissemination route.
PMID:22529845 SUPPORT Model Organism
"a fast retrograde axonal transport process is required for PV dissemination"
Fast retrograde axonal transport is required for poliovirus dissemination through peripheral nerve to the CNS.
Acute Flaccid Paralysis
Loss of lower motor neurons denervates the muscles they innervate, producing the hallmark acute, asymmetric, flaccid weakness with diminished or absent reflexes and preserved sensation, followed by muscle atrophy. Most infections, however, are inapparent or abortive, with only a small minority progressing to paralytic disease.
motor neuron CL:0000100 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves motor neuron (CL:0000100). CL:0000100 is a cell type from the Cell Ontology.
Downstream
Bulbar Involvement and Respiratory Failure When motor neuron destruction extends to brainstem motor nuclei, bulbar and respiratory muscle failure can follow.
Show evidence (3 references)
PMID:32644370 SUPPORT Other
"acute-onset flaccid paralysis, decreased or absent tendon reflexes, and without sensory or cognitive deficits"
The clinical review captures the defining flaccid paralysis with areflexia and preserved sensation that follows motor neuron loss.
PMID:32644370 SUPPORT Other
"most infections are asymptomatic"
Most poliovirus infections are asymptomatic, with paralysis occurring in only a small minority.
PMID:25360208 SUPPORT Other
"inapparent infection without symptoms, mild illness (abortive poliomyelitis), aseptic meningitis (nonparalytic"
The review describes the clinical spectrum from inapparent and abortive infection through nonparalytic to paralytic poliomyelitis.
Bulbar Involvement and Respiratory Failure
In bulbar poliomyelitis, motor neuron destruction involves the brainstem motor nuclei controlling swallowing and respiration. This can cause dysphagia, airway compromise, and respiratory failure, the most life-threatening manifestation of the disease.
motor neuron CL:0000100 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves motor neuron (CL:0000100). CL:0000100 is a cell type from the Cell Ontology.
brainstem UBERON:0002298 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in brainstem (UBERON:0002298). UBERON:0002298 is an anatomical location from the Uberon multi-species anatomy ontology.
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"ranging from asymptomatic to a transient flu-like viral illness to paralysis, quadriplegia, and even respiratory failure and death"
Severe poliomyelitis can progress to respiratory failure and death, reflecting bulbar and respiratory muscle involvement.
⬡

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Paralytic Poliomyelitis Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.
●

Phenotypes

8
Immune 1
Meningitis HP:0001287 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is aseptic meningitis, annotated with Meningitis (HP:0001287). HP:0001287 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:25360208 SUPPORT Other
"inapparent infection without symptoms, mild illness (abortive poliomyelitis), aseptic meningitis (nonparalytic"
The review lists aseptic meningitis (nonparalytic poliomyelitis) as part of the clinical spectrum.
Metabolism 1
Fever HP:0001945 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Fever (HP:0001945). HP:0001945 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"ranging from asymptomatic to a transient flu-like viral illness to paralysis"
The clinical review describes a transient flu-like illness phase that includes febrile symptoms.
Musculoskeletal 2
Skeletal muscle atrophy HP:0003202 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Skeletal muscle atrophy (HP:0003202). HP:0003202 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"Paralytic deficits are often permanent"
Permanent paralytic deficits reflect the irreversible denervation and muscle wasting that follow motor neuron destruction.
Respiratory insufficiency due to muscle weakness HP:0002747 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Respiratory insufficiency due to muscle weakness (HP:0002747). HP:0002747 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"ranging from asymptomatic to a transient flu-like viral illness to paralysis, quadriplegia, and even respiratory failure and death"
Respiratory failure is part of the severe end of the polio clinical spectrum.
Nervous System 3
Motor neuron destruction Abnormal lower motor neuron morphology HP:0002366 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Abnormal lower motor neuron morphology (HP:0002366). HP:0002366 is a phenotype from the Human Phenotype Ontology.
Show evidence (2 references)
PMID:32644370 SUPPORT Human Clinical
"Clinicians should suspect polio in patients with acute-onset flaccid paralysis, decreased or absent tendon reflexes, and without sensory or cognitive deficits."
The diagnostic clinical picture — acute flaccid paralysis with reduced or absent reflexes and preserved sensation — localizes the lesion to the lower motor neuron.
PMID:22529845 SUPPORT Other
"After the virus enters the CNS, it replicates in neurons, especially in motor neurons, inducing the cell death that causes paralytic poliomyelitis."
States that motor neuron cell death is what causes paralytic poliomyelitis. Cited as a pathogenesis study, not a clinical series.
Acute flaccid paralysis VERY_FREQUENT HP:0003470 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is acute flaccid paralysis, annotated with Paralysis (HP:0003470), qualified as temporality acute. HP:0003470 is a phenotype from the Human Phenotype Ontology.
Temporal: ACUTE
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"acute-onset flaccid paralysis, decreased or absent tendon reflexes, and without sensory or cognitive deficits"
The clinical review lists acute-onset flaccid paralysis as the cardinal sign prompting suspicion of polio.
Areflexia VERY_FREQUENT HP:0001284 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Areflexia (HP:0001284). HP:0001284 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"acute-onset flaccid paralysis, decreased or absent tendon reflexes, and without sensory or cognitive deficits"
Decreased or absent tendon reflexes accompany the flaccid paralysis of polio.
Other 1
Preserved sensation
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"without sensory or cognitive deficits"
The clinical review notes absence of sensory deficits, supporting preserved sensation in polio.
💊

Medical Actions

3
Poliovirus vaccination (IPV/OPV)
Action: vaccinationNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is vaccination (NCIT:C15346). NCIT:C15346 is a clinical intervention from the NCI Thesaurus. Ontology label: Vaccination NCIT:C15346
Platform: Vaccine
Vaccination with inactivated poliovirus vaccine (IPV) or oral poliovirus vaccine (OPV) is the cornerstone of prevention. IPV was the first vaccine used against poliomyelitis and its immunogenicity to prevent paralytic disease is well established; there is no specific antiviral therapy for established acute poliomyelitis.
Target Phenotypes: acute flaccid paralysis HP:0003470 Human Phenotype Ontology (HP) Relation: this treatment targets this phenotype This treatment targets acute flaccid paralysis, annotated with Paralysis (HP:0003470). HP:0003470 is a phenotype from the Human Phenotype Ontology.
Show evidence (3 references)
PMID:38535567 SUPPORT Other
"became the first vaccine to be used to protect against poliomyelitis"
IPV was the first poliomyelitis vaccine, supporting vaccination as the central preventive intervention.
PMID:38535567 SUPPORT Other
"the immunogenicity of IPV to prevent paralytic poliomyelitis continues to be irrefutable"
The review affirms the established immunogenicity of IPV against paralytic poliomyelitis.
PMID:25360208 SUPPORT Other
"Contribution of Salk and Sabin in the form of vaccines"
The historical review credits the Salk (IPV) and Sabin (OPV) vaccines as the basis of polio prevention.
Supportive care
Action: Supportive CareNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is Supportive Care (NCIT:C15747). NCIT:C15747 is a clinical intervention from the NCI Thesaurus. NCIT:C15747
Because no antiviral treatment exists for acute poliomyelitis, management is supportive, including monitoring for bulbar and respiratory compromise, pain control, and prevention of complications.
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"As no antiviral treatment for acute poliomyelitis exists, prevention is critical"
The absence of antiviral therapy makes supportive care and prevention the mainstays of management.
Mechanical ventilatory support
Action: artificial respirationNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is artificial respiration, annotated with Mechanical Ventilation (NCIT:C70909). NCIT:C70909 is a clinical intervention from the NCI Thesaurus. Ontology label: Mechanical Ventilation NCIT:C70909
Patients with bulbar or respiratory muscle weakness may require mechanical ventilation, historically the iron lung and now invasive or noninvasive respiratory support.
Target Phenotypes: Respiratory insufficiency due to muscle weakness HP:0002747 Human Phenotype Ontology (HP) Relation: this treatment targets this phenotype This treatment targets Respiratory insufficiency due to muscle weakness (HP:0002747). HP:0002747 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"ranging from asymptomatic to a transient flu-like viral illness to paralysis, quadriplegia, and even respiratory failure and death"
Respiratory failure in severe polio necessitates ventilatory support.
🔬

Diagnosis

2
Stool RT-PCR and Sequencing (Positive for poliovirus RNA (stool))
Reverse transcription-PCR and genomic sequencing of a stool specimen is the primary laboratory method for confirming poliovirus infection and determining serotype and WPV-versus-VDPV status; cerebrospinal fluid and nasopharyngeal/oropharyngeal specimens can be negative even in confirmed paralytic cases, making stool the higher-yield specimen.
stool nucleic acid amplification testing NCIT:C20055 NCI Thesaurus (NCIT)
Show evidence (3 references)
PMID:35980868 SUPPORT Human Clinical
"RT-PCR and sequencing of a stool specimen by the NYSDOH laboratory identified poliovirus type 2."
Documents stool RT-PCR and sequencing as the method that identified and typed poliovirus in a confirmed paralytic case. Establishes the serotype half of this entry's claim; the VDPV-origin half is evidenced by the following item.
PMID:35980868 SUPPORT Human Clinical
"Additional sequencing identified the virus as VDPV2 (4), differing from the Sabin 2 vaccine strain by 10 nucleotide changes in the region encoding the viral capsid protein, VP1"
Supports the WPV-versus-VDPV half of this entry's claim: sequencing resolved the isolate's origin as vaccine-derived, and names VP1 divergence from the parent Sabin strain as the discriminator that distinguishes a VDPV from wild poliovirus.
PMID:35980868 SUPPORT Human Clinical
"A combined nasopharyngeal/oropharyngeal swab and cerebrospinal fluid sample were negative by reverse transcription–polymerase chain reaction (RT-PCR) testing for enteroviruses and human parechovirus"
Shows that CSF and nasopharyngeal/oropharyngeal RT-PCR were negative in the same confirmed case, underscoring stool as the higher-yield specimen for poliovirus diagnosis.
Wastewater Surveillance (Positive for poliovirus RNA (wastewater))
RT-PCR and partial genome sequencing of municipal wastewater (sewage) detects poliovirus shed by infected people in a catchment area. Because only a small minority of poliovirus infections become paralytic, environmental surveillance detects community transmission that clinical surveillance misses, and can do so before and after any paralytic case presents. Sequencing links wastewater isolates genetically to a known case and distinguishes vaccine-derived from wild virus on the same VP1 criterion used for clinical specimens.
wastewater nucleic acid amplification testing NCIT:C20055 NCI Thesaurus (NCIT)
Show evidence (2 references)
PMID:35980868 SUPPORT Human Clinical
"Among these samples, 21 (8%) yielded positive poliovirus test results using RT-PCR and partial genome sequencing, including 13 from Rockland County and eight from Orange County."
Documents RT-PCR plus partial genome sequencing of wastewater as the assay, and reports its yield across a real surveillance program.
PMID:35980868 SUPPORT Human Clinical
"Twenty specimens from wastewater samples collected during May, June, and July were genetically linked to virus from the patient's stool samples"
Shows that sequencing of wastewater isolates establishes genetic linkage to a clinical case, which is what makes environmental surveillance diagnostically informative rather than merely a positive signal.
🦠

Infectious Agent

1
Poliovirus
Poliovirus circulates as two epidemiologically distinct forms relevant to global eradication. Wild poliovirus (WPV, serotypes 1-3) is the naturally circulating virus targeted for eradication. Vaccine-derived poliovirus (VDPV) instead arises when the live attenuated oral poliovirus vaccine (OPV) replicates for a prolonged period in an under-vaccinated community and reverts toward wild-type neurovirulence and transmissibility, producing paralytic disease clinically indistinguishable from WPV infection. VDPVs are further divided by the setting in which that reversion occurred: circulating VDPV (cVDPV) sustains person-to-person transmission in an under-vaccinated community, immunodeficiency-associated VDPV (iVDPV) arises from prolonged replication in a person with a B-cell immunodeficiency, and ambiguous VDPV (aVDPV) covers isolates that fit neither. cVDPV is the form that drives outbreaks and is the target of monovalent OPV2 response campaigns.
Poliovirus
WPV VDPV
Show evidence (3 references)
PMID:35980868 SUPPORT Human Clinical
"VDPVs can emerge when live, attenuated OPV is administered in a community with low vaccination coverage. Replication of OPV in a person who was recently vaccinated can result in viral reversion to neurovirulence, which can cause paralytic poliomyelitis in unvaccinated persons who are exposed to..."
Describes the mechanism by which vaccine-derived poliovirus (VDPV) emerges from OPV and causes paralytic disease, distinguishing it from wild poliovirus.
PMID:35980868 SUPPORT Human Clinical
"Until poliovirus eradication is achieved worldwide, importations of both wild polioviruses and VDPVs into the United States are possible."
States the current global eradication status: both WPV and VDPV remain importation risks until eradication is complete.
PMID:32644370 SUPPORT Other
"Delays in detecting circulating wild poliovirus (WPV) and VDPVs pose a significant risk to eradication efforts."
A 2026 clinical review confirms that both WPV and VDPV circulation remain active threats to eradication.
↔️

Transmission

1
Faecal-oral and oral-oral spread
Poliovirus is shed in stool and pharyngeal secretions and passes between people by the faecal-oral route, with oral-oral spread also recognised. Transmission is therefore highest where water, sanitation and hygiene infrastructure is poor. Most transmission is from people with no symptoms, since only a small minority of infections become paralytic.
Show evidence (3 references)
PMID:32644370 SUPPORT REVIEW SYNTHESIS Other
"Poliomyelitis, or polio, is an infection transmitted via the fecal-oral and oral-oral routes by the poliovirus."
States both routes of person-to-person transmission.
PMID:32644370 SUPPORT REVIEW SYNTHESIS Other
"Today, polio primarily affects children younger than 5 in countries with poor water, sanitation, and hygiene infrastructure."
Ties the burden to the water and sanitation conditions that a faecal-oral route depends on.
PMID:32644370 SUPPORT INDIRECT REVIEW SYNTHESIS Other
"most infections are asymptomatic, and the characteristic paralysis occurs in a small minority of those it infects"
Supports the point that most onward transmission comes from people who never develop paralytic disease.
🔀

Differential Diagnoses

2

Conditions with similar clinical presentations that must be differentiated from Paralytic Poliomyelitis:

Acute flaccid myelitis
Overlapping Features Acute flaccid myelitis is a polio-like syndrome caused chiefly by non-polio enteroviruses (especially enterovirus D68) and is the leading contemporary mimic of paralytic poliomyelitis.
Show evidence (1 reference)
PMID:32644370 SUPPORT Other
"acute flaccid myelitis"
The clinical review names acute flaccid myelitis as the principal polio-like syndrome to be distinguished from poliomyelitis.
Guillain-Barre syndrome
Overlapping Features Guillain-Barre syndrome causes acute flaccid paralysis but is typically symmetric with sensory involvement and albuminocytologic dissociation, contrasting with the asymmetric, sensation-sparing pattern of polio.
{ }

Source YAML

click to show 
name: Paralytic Poliomyelitis
creation_date: "2026-06-26T00:00:00Z"
category: Infectious Disease
disease_term:
  preferred_term: paralytic poliomyelitis
  term:
    id: MONDO:0000341
    label: paralytic poliomyelitis
parents:
- Motor Neuron Disease
- Viral infectious disease
- Central nervous system disorder
description: >-
  Paralytic poliomyelitis is an acute lower-motor-neuron disease caused by
  poliovirus, an enterovirus of the family Picornaviridae. The virus is spread
  by the fecal-oral (and oral-oral) route, undergoes primary replication in the
  alimentary mucosa and gut-associated lymphoid tissue, and produces a viremia
  through which it can invade the central nervous system. Poliovirus enters
  cells via its receptor CD155 (PVR) and shows marked tropism for, and lytic
  destruction of, the anterior horn lower motor neurons of the spinal cord (and
  brainstem motor nuclei in bulbar polio), producing acute asymmetric flaccid
  paralysis, areflexia, and muscle atrophy with intact sensation. Most
  infections are asymptomatic or abortive and fewer than 1% progress to
  paralytic disease. Bulbar involvement threatens respiratory and swallowing
  centers and can be fatal. The disease is vaccine-preventable with the
  inactivated (IPV) and oral (OPV) poliovirus vaccines. It is mechanistically
  related to the polio-like syndrome acute flaccid myelitis (caused chiefly by
  non-polio enteroviruses) and to the late sequela post-polio syndrome.
infectious_agent:
- name: Poliovirus
  infectious_agent_term:
    preferred_term: Poliovirus
    description: >-
      Left unbound deliberately. NCBITaxon has no species-level "Poliovirus"
      node: it carries only serotype terms (NCBITaxon:12080 Poliovirus 1,
      NCBITaxon:12083 Poliovirus 2, NCBITaxon:12086 Poliovirus 3) plus
      strain-level descendants, and the species-level parent NCBITaxon:138950
      "Enterovirus C" also contains the coxsackie A viruses and is therefore
      too broad. Because paralytic poliomyelitis is caused by all three
      serotypes, no single serotype term fits either. The has_subtypes entries
      below divide the agent on the WPV-versus-VDPV origin axis rather than by
      serotype, so the serotype terms do not fit there either and are
      deliberately left unbound throughout.
  description: >-
    Poliovirus circulates as two epidemiologically distinct forms relevant to
    global eradication. Wild poliovirus (WPV, serotypes 1-3) is the naturally
    circulating virus targeted for eradication. Vaccine-derived poliovirus
    (VDPV) instead arises when the live attenuated oral poliovirus vaccine
    (OPV) replicates for a prolonged period in an under-vaccinated community
    and reverts toward wild-type neurovirulence and transmissibility,
    producing paralytic disease clinically indistinguishable from WPV
    infection. VDPVs are further divided by the setting in which that
    reversion occurred: circulating VDPV (cVDPV) sustains person-to-person
    transmission in an under-vaccinated community, immunodeficiency-associated
    VDPV (iVDPV) arises from prolonged replication in a person with a B-cell
    immunodeficiency, and ambiguous VDPV (aVDPV) covers isolates that fit
    neither. cVDPV is the form that drives outbreaks and is the target of
    monovalent OPV2 response campaigns.
  has_subtypes:
  - name: WPV
    display_name: Wild poliovirus (WPV, serotypes 1-3)
    description: >-
      The naturally circulating, non-vaccine-derived virus targeted for global
      eradication. Wild serotypes 2 and 3 have been certified eradicated; WPV1
      remains endemic in Afghanistan and Pakistan.
    evidence:
    - reference: PMID:32941411
      reference_title: "Progress Toward Poliovirus Containment Implementation - Worldwide, 2019-2020."
      supports: SUPPORT
      evidence_source: OTHER
      quote_role: BACKGROUND
      snippet: "The Global Commission for the Certification of Poliomyelitis Eradication (GCC) declared two of the three WPV types, type 2 (WPV2) and type 3 (WPV3), eradicated globally in 2015 and 2019, respectively"
      explanation: >-
        Sources the certification half of this subtype's description, naming
        the certifying body and both certified serotypes with their dates.
        Graded OTHER because a certification of eradication is a determination
        by an expert commission rather than a study result; this
        containment-progress report restates the declarations rather than
        issuing them.
    - reference: PMID:32941411
      reference_title: "Progress Toward Poliovirus Containment Implementation - Worldwide, 2019-2020."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      quote_role: BACKGROUND
      snippet: "Wild poliovirus type 1 (WPV1) remains endemic in Afghanistan and Pakistan"
      explanation: >-
        Sources the endemicity half of the description, naming both remaining
        WPV1-endemic countries. Graded HUMAN_CLINICAL because endemic status is
        a conclusion drawn from global acute-flaccid-paralysis surveillance in
        human populations.
  - name: VDPV
    display_name: Vaccine-derived poliovirus (VDPV), including circulating VDPV (cVDPV)
    description: >-
      Virus descended from the live attenuated OPV strains that has reverted
      toward wild-type neurovirulence and transmissibility during prolonged
      replication. Genetically identified by divergence from the parent Sabin
      strain in the VP1 capsid-coding region. The circulating subform (cVDPV)
      is the outbreak-driving form; VDPV2 is the serotype responsible for the
      majority of contemporary cVDPV outbreaks.
    evidence:
    - reference: PMID:35980868
      reference_title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Globally, type 2-containing vaccine (OPV2) has not been used in routine immunization since 2016, although monovalent OPV2 is used for specific vaccination campaigns to control circulating VDPV2 outbreaks (7)."
      explanation: >-
        Names the circulating subform (circulating VDPV2) specifically and
        establishes that it is the form outbreak-response campaigns target,
        distinguishing cVDPV from the broader VDPV category.
  evidence:
  - reference: PMID:35980868
    reference_title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "VDPVs can emerge when live, attenuated OPV is administered in a community with low vaccination coverage. Replication of OPV in a person who was recently vaccinated can result in viral reversion to neurovirulence, which can cause paralytic poliomyelitis in unvaccinated persons who are exposed to the vaccine-derived virus."
    explanation: >-
      Describes the mechanism by which vaccine-derived poliovirus (VDPV)
      emerges from OPV and causes paralytic disease, distinguishing it from
      wild poliovirus.
  - reference: PMID:35980868
    reference_title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Until poliovirus eradication is achieved worldwide, importations of both wild polioviruses and VDPVs into the United States are possible."
    explanation: >-
      States the current global eradication status: both WPV and VDPV remain
      importation risks until eradication is complete.
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Delays in detecting circulating wild poliovirus (WPV) and VDPVs pose a significant risk to eradication efforts."
    explanation: >-
      A 2026 clinical review confirms that both WPV and VDPV circulation
      remain active threats to eradication.
transmission:
- name: Faecal-oral and oral-oral spread
  description: >-
    Poliovirus is shed in stool and pharyngeal secretions and passes between people
    by the faecal-oral route, with oral-oral spread also recognised. Transmission
    is therefore highest where water, sanitation and hygiene infrastructure is poor.
    Most transmission is from people with no symptoms, since only a small minority
    of infections become paralytic.
  evidence:
  - reference: PMID:32644370
    reference_title: Poliomyelitis.
    supports: SUPPORT
    evidence_source: OTHER
    quote_role: REVIEW_SYNTHESIS
    snippet: "Poliomyelitis, or polio, is an infection transmitted via the fecal-oral and oral-oral routes by the poliovirus."
    explanation: States both routes of person-to-person transmission.
  - reference: PMID:32644370
    reference_title: Poliomyelitis.
    supports: SUPPORT
    evidence_source: OTHER
    quote_role: REVIEW_SYNTHESIS
    snippet: "Today, polio primarily affects children younger than 5 in countries with poor water, sanitation, and hygiene infrastructure."
    explanation: Ties the burden to the water and sanitation conditions that a faecal-oral route depends on.
  - reference: PMID:32644370
    reference_title: Poliomyelitis.
    supports: SUPPORT
    directness: INDIRECT
    evidence_source: OTHER
    quote_role: REVIEW_SYNTHESIS
    snippet: "most infections are asymptomatic, and the characteristic paralysis occurs in a small minority of those it infects"
    explanation: Supports the point that most onward transmission comes from people who never develop paralytic disease.
pathophysiology:
- name: Poliovirus Entry via CD155 Receptor
  description: >-
    Poliovirus is a non-enveloped, positive-strand RNA enterovirus
    (Picornaviridae). Host-cell entry is governed by the poliovirus receptor
    CD155 (PVR), an immunoglobulin-superfamily membrane protein. CD155 binding
    determines species and cell-type susceptibility, and its expression in
    structures giving rise to anterior horn motor neurons helps explain the
    restrictive neuronal tropism of poliovirus.
  cell_types:
  - preferred_term: motor neuron
    term:
      id: CL:0000100
      label: motor neuron
  genes:
  - preferred_term: PVR (CD155, poliovirus receptor)
    term:
      id: hgnc:9705
      label: PVR
  biological_processes:
  - preferred_term: poliovirus entry into host cell via CD155
    modifier: INCREASED
    term:
      id: GO:0046718
      label: symbiont entry into host cell
  downstream:
  - target: Viremia and CNS Invasion
    description: >-
      CD155-mediated cell entry and replication in the alimentary mucosa seed
      the viremia that delivers poliovirus to the central nervous system.
  evidence:
  - reference: PMID:33490061
    reference_title: "Modeling Poliovirus Infection Using Human Engineered Neural Tissue Enriched With Motor Neuron Derived From Embryonic Stem Cells"
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: "Poliomyelitis is caused by poliovirus (PV), a positive strand non-enveloped virus"
    explanation: >-
      The engineered neural tissue model confirms poliovirus as a non-enveloped
      positive-strand virus that is the cause of poliomyelitis.
  - reference: PMID:10915595
    reference_title: "Expression of the human poliovirus receptor/CD155 gene during development of the central nervous system: implications for the pathogenesis of poliomyelitis."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Expression of CD155 within embryonic structures giving rise to spinal cord anterior horn motor neurons may explain the"
    explanation: >-
      CD155 reporter-expression mapping links receptor distribution to the
      anterior horn motor neuron compartment targeted by poliovirus.
  - reference: PMID:10915595
    reference_title: "Expression of the human poliovirus receptor/CD155 gene during development of the central nervous system: implications for the pathogenesis of poliomyelitis."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "restrictive host cell tropism of poliovirus for this cellular compartment of the"
    explanation: >-
      The same study attributes the restrictive cellular tropism of poliovirus
      to CD155-defined neuronal compartments.
- name: Viremia and CNS Invasion
  description: >-
    After fecal-oral acquisition, poliovirus multiplies in the alimentary mucosa
    and gut-associated lymphoid tissue, then enters the bloodstream. The
    resulting viremia delivers virus to the central nervous system by permeation
    of the blood-brain barrier and, alternatively, by retrograde axonal
    transport along peripheral motor neurons from muscle to the spinal cord.
  locations:
  - preferred_term: central nervous system
    term:
      id: UBERON:0001017
      label: central nervous system
  - preferred_term: spinal cord
    term:
      id: UBERON:0002240
      label: spinal cord
  biological_processes:
  - preferred_term: response to virus
    modifier: INCREASED
    term:
      id: GO:0009615
      label: response to virus
  downstream:
  - target: Anterior Horn Motor Neuron Tropism and Lysis
    description: >-
      Virus reaching the CNS replicates preferentially in spinal and brainstem
      motor neurons, where its lytic replication destroys the cells.
  evidence:
  - reference: PMID:22529845
    reference_title: "Poliovirus trafficking toward central nervous system via human poliovirus receptor-dependent and -independent pathway."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "the virus multiplies in the alimentary mucosa"
    explanation: >-
      The trafficking review describes primary poliovirus replication in the
      alimentary mucosa before bloodstream entry.
  - reference: PMID:22529845
    reference_title: "Poliovirus trafficking toward central nervous system via human poliovirus receptor-dependent and -independent pathway."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "paralytic poliomyelitis results from the invasion of the central nervous system"
    explanation: >-
      The review frames paralytic poliomyelitis as the consequence of CNS
      invasion by circulating poliovirus.
  - reference: PMID:24367151
    reference_title: "Molecular aspects of poliovirus pathogenesis."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "the mechanisms for viral permeation through the blood-brain barrier and retrograde axonal transport of the virus"
    explanation: >-
      The transgenic-mouse dissemination work supports both blood-brain barrier
      permeation and retrograde axonal transport as CNS-invasion routes.
- name: Anterior Horn Motor Neuron Tropism and Lysis
  description: >-
    Within the CNS poliovirus replicates preferentially in motor neurons,
    especially the lower motor neurons of the anterior (ventral) horn of the
    spinal cord gray matter and, in bulbar disease, brainstem motor nuclei.
    Lytic viral replication kills these neurons; the replicating capacity of the
    virus within the CNS is the principal determinant of neurovirulence.
  locations:
  - preferred_term: ventral horn of spinal cord
    term:
      id: UBERON:0002257
      label: ventral horn of spinal cord
  - preferred_term: gray matter
    term:
      id: UBERON:0002020
      label: gray matter
  cell_types:
  - preferred_term: anterior horn motor neuron
    term:
      id: CL:2000048
      label: anterior horn motor neuron
  biological_processes:
  - preferred_term: poliovirus-induced motor neuron death
    modifier: INCREASED
    term:
      id: GO:0052150
      label: symbiont-mediated perturbation of host apoptosis
  downstream:
  - target: Acute Flaccid Paralysis
    description: >-
      Destruction of lower motor neurons denervates skeletal muscle, producing
      flaccid weakness, areflexia, and subsequent atrophy.
  evidence:
  - reference: PMID:22529845
    reference_title: "Poliovirus trafficking toward central nervous system via human poliovirus receptor-dependent and -independent pathway."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "it replicates in neurons, especially in motor neurons, inducing the cell death that causes paralytic poliomyelitis"
    explanation: >-
      The review directly states that motor neuron replication and cell death
      cause paralytic poliomyelitis.
  - reference: PMID:24367151
    reference_title: "Molecular aspects of poliovirus pathogenesis."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "strain-specific neurovirulence levels are shown to depend mainly on the replicating capacity of the virus in the central nervous system"
    explanation: >-
      Neurovirulence is attributed primarily to viral replicating capacity
      within the CNS, supporting the lytic motor-neuron-destruction model.
  - reference: PMID:33490061
    reference_title: "Modeling Poliovirus Infection Using Human Engineered Neural Tissue Enriched With Motor Neuron Derived From Embryonic Stem Cells"
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: "motor neurons are responsible for the permissiveness of poliovirus within the MN ENTs"
    explanation: >-
      In motor-neuron-enriched human neural tissue, motor neurons are the
      permissive cell type for poliovirus, supporting selective tropism.
- name: Retrograde Axonal Transport Neural Route
  description: >-
    Beyond hematogenous spread, poliovirus can reach the CNS by a neural route:
    after intramuscular uptake by endocytosis at the neuromuscular synapse, the
    virus is carried retrogradely along motor axons, a CD155-dependent fast
    axonal transport process, to the motor neuron cell body where uncoating and
    replication occur.
  locations:
  - preferred_term: spinal cord
    term:
      id: UBERON:0002240
      label: spinal cord
  cell_types:
  - preferred_term: motor neuron
    term:
      id: CL:0000100
      label: motor neuron
  genes:
  - preferred_term: PVR (CD155, poliovirus receptor)
    term:
      id: hgnc:9705
      label: PVR
  downstream:
  - target: Anterior Horn Motor Neuron Tropism and Lysis
    description: >-
      Retrograde axonal transport delivers poliovirus to anterior horn motor
      neuron cell bodies, complementing the hematogenous CNS-invasion route.
  evidence:
  - reference: PMID:22529845
    reference_title: "Poliovirus trafficking toward central nervous system via human poliovirus receptor-dependent and -independent pathway."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "PV is taken up by endocytosis at synapses"
    explanation: >-
      Intramuscularly inoculated poliovirus is taken up at synapses, the entry
      step of the neural dissemination route.
  - reference: PMID:22529845
    reference_title: "Poliovirus trafficking toward central nervous system via human poliovirus receptor-dependent and -independent pathway."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "a fast retrograde axonal transport process is required for PV dissemination"
    explanation: >-
      Fast retrograde axonal transport is required for poliovirus dissemination
      through peripheral nerve to the CNS.
- name: Acute Flaccid Paralysis
  description: >-
    Loss of lower motor neurons denervates the muscles they innervate,
    producing the hallmark acute, asymmetric, flaccid weakness with diminished
    or absent reflexes and preserved sensation, followed by muscle atrophy.
    Most infections, however, are inapparent or abortive, with only a small
    minority progressing to paralytic disease.
  cell_types:
  - preferred_term: motor neuron
    term:
      id: CL:0000100
      label: motor neuron
  downstream:
  - target: Bulbar Involvement and Respiratory Failure
    description: >-
      When motor neuron destruction extends to brainstem motor nuclei, bulbar
      and respiratory muscle failure can follow.
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "acute-onset flaccid paralysis, decreased or absent tendon reflexes, and without sensory or cognitive deficits"
    explanation: >-
      The clinical review captures the defining flaccid paralysis with
      areflexia and preserved sensation that follows motor neuron loss.
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "most infections are asymptomatic"
    explanation: >-
      Most poliovirus infections are asymptomatic, with paralysis occurring in
      only a small minority.
  - reference: PMID:25360208
    reference_title: "Poliomyelitis: historical facts, epidemiology, and current challenges in eradication."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "inapparent infection without symptoms, mild illness (abortive poliomyelitis), aseptic meningitis (nonparalytic"
    explanation: >-
      The review describes the clinical spectrum from inapparent and abortive
      infection through nonparalytic to paralytic poliomyelitis.
- name: Bulbar Involvement and Respiratory Failure
  description: >-
    In bulbar poliomyelitis, motor neuron destruction involves the brainstem
    motor nuclei controlling swallowing and respiration. This can cause
    dysphagia, airway compromise, and respiratory failure, the most
    life-threatening manifestation of the disease.
  locations:
  - preferred_term: brainstem
    term:
      id: UBERON:0002298
      label: brainstem
  cell_types:
  - preferred_term: motor neuron
    term:
      id: CL:0000100
      label: motor neuron
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "ranging from asymptomatic to a transient flu-like viral illness to paralysis, quadriplegia, and even respiratory failure and death"
    explanation: >-
      Severe poliomyelitis can progress to respiratory failure and death,
      reflecting bulbar and respiratory muscle involvement.
phenotypes:
- name: Motor neuron destruction
  category: Neurologic
  description: >-
    Poliovirus replicates in and lytically destroys motor neurons after invading the
    CNS; the anterior horn is the target compartment, which is why paralysis is flaccid
    and sensation is preserved.
  phenotype_term:
    preferred_term: Abnormal lower motor neuron morphology
    term:
      id: HP:0002366
      label: Abnormal lower motor neuron morphology
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Clinicians should suspect polio in patients with acute-onset flaccid paralysis, decreased or absent tendon reflexes, and without sensory or cognitive deficits."
    explanation: >-
      The diagnostic clinical picture — acute flaccid paralysis with reduced or absent
      reflexes and preserved sensation — localizes the lesion to the lower motor neuron.
  - reference: PMID:22529845
    reference_title: "Poliovirus trafficking toward central nervous system via human poliovirus receptor-dependent and -independent pathway."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "After the virus enters the CNS, it replicates in neurons, especially in motor neurons, inducing the cell death that causes paralytic poliomyelitis."
    explanation: >-
      States that motor neuron cell death is what causes paralytic poliomyelitis. Cited
      as a pathogenesis study, not a clinical series.
- name: Acute flaccid paralysis
  category: Neurologic
  frequency: VERY_FREQUENT
  description: >-
    Acute-onset asymmetric flaccid paralysis is the defining feature of
    paralytic poliomyelitis.
  phenotype_term:
    preferred_term: acute flaccid paralysis
    term:
      id: HP:0003470
      label: Paralysis
    temporality: ACUTE
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "acute-onset flaccid paralysis, decreased or absent tendon reflexes, and without sensory or cognitive deficits"
    explanation: >-
      The clinical review lists acute-onset flaccid paralysis as the cardinal
      sign prompting suspicion of polio.
- name: Areflexia
  category: Neurologic
  frequency: VERY_FREQUENT
  description: >-
    Deep tendon reflexes are decreased or absent in affected limbs, consistent
    with lower motor neuron injury.
  phenotype_term:
    preferred_term: Areflexia
    term:
      id: HP:0001284
      label: Areflexia
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "acute-onset flaccid paralysis, decreased or absent tendon reflexes, and without sensory or cognitive deficits"
    explanation: >-
      Decreased or absent tendon reflexes accompany the flaccid paralysis of
      polio.
- name: Preserved sensation
  category: Neurologic
  description: >-
    Despite profound motor deficits, sensation is preserved, reflecting the
    pure lower-motor-neuron localization of poliovirus injury and distinguishing
    polio from sensory or sensorimotor neuropathies. Recorded as a descriptive
    clinical observation without an ontology binding, since preserved (normal)
    sensation has no positive HP term and HPO does not assert normal findings.
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "without sensory or cognitive deficits"
    explanation: >-
      The clinical review notes absence of sensory deficits, supporting
      preserved sensation in polio.
- name: Skeletal muscle atrophy
  category: Musculoskeletal
  description: >-
    Denervation of skeletal muscle following motor neuron loss leads to muscle
    wasting and permanent deficits.
  phenotype_term:
    preferred_term: Skeletal muscle atrophy
    term:
      id: HP:0003202
      label: Skeletal muscle atrophy
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Paralytic deficits are often permanent"
    explanation: >-
      Permanent paralytic deficits reflect the irreversible denervation and
      muscle wasting that follow motor neuron destruction.
- name: Respiratory insufficiency due to muscle weakness
  category: Respiratory
  description: >-
    Bulbar and respiratory muscle involvement can cause respiratory failure, the
    most dangerous complication of paralytic poliomyelitis.
  phenotype_term:
    preferred_term: Respiratory insufficiency due to muscle weakness
    term:
      id: HP:0002747
      label: Respiratory insufficiency due to muscle weakness
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "ranging from asymptomatic to a transient flu-like viral illness to paralysis, quadriplegia, and even respiratory failure and death"
    explanation: >-
      Respiratory failure is part of the severe end of the polio clinical
      spectrum.
- name: Meningitis
  category: Neurologic
  description: >-
    Nonparalytic poliomyelitis can present as aseptic meningitis with febrile
    meningitic features preceding or without paralysis.
  phenotype_term:
    preferred_term: aseptic meningitis
    term:
      id: HP:0001287
      label: Meningitis
  evidence:
  - reference: PMID:25360208
    reference_title: "Poliomyelitis: historical facts, epidemiology, and current challenges in eradication."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "inapparent infection without symptoms, mild illness (abortive poliomyelitis), aseptic meningitis (nonparalytic"
    explanation: >-
      The review lists aseptic meningitis (nonparalytic poliomyelitis) as part
      of the clinical spectrum.
- name: Fever
  category: Constitutional
  description: >-
    A febrile, flu-like prodrome commonly precedes neurologic involvement.
  phenotype_term:
    preferred_term: Fever
    term:
      id: HP:0001945
      label: Fever
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "ranging from asymptomatic to a transient flu-like viral illness to paralysis"
    explanation: >-
      The clinical review describes a transient flu-like illness phase that
      includes febrile symptoms.
diagnosis:
- name: Stool RT-PCR and Sequencing
  description: >-
    Reverse transcription-PCR and genomic sequencing of a stool specimen is
    the primary laboratory method for confirming poliovirus infection and
    determining serotype and WPV-versus-VDPV status; cerebrospinal fluid and
    nasopharyngeal/oropharyngeal specimens can be negative even in confirmed
    paralytic cases, making stool the higher-yield specimen.
  diagnosis_term:
    preferred_term: stool nucleic acid amplification testing
    term:
      id: NCIT:C20055
      label: Nucleic Acid Amplification Test
  presence: Positive for poliovirus RNA (stool)
  evidence:
  - reference: PMID:35980868
    reference_title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "RT-PCR and sequencing of a stool specimen by the NYSDOH laboratory identified poliovirus type 2."
    explanation: >-
      Documents stool RT-PCR and sequencing as the method that identified and
      typed poliovirus in a confirmed paralytic case. Establishes the serotype
      half of this entry's claim; the VDPV-origin half is evidenced by the
      following item.
  - reference: PMID:35980868
    reference_title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Additional sequencing identified the virus as VDPV2 (4), differing from the Sabin 2 vaccine strain by 10 nucleotide changes in the region encoding the viral capsid protein, VP1"
    explanation: >-
      Supports the WPV-versus-VDPV half of this entry's claim: sequencing
      resolved the isolate's origin as vaccine-derived, and names VP1
      divergence from the parent Sabin strain as the discriminator that
      distinguishes a VDPV from wild poliovirus.
  - reference: PMID:35980868
    reference_title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A combined nasopharyngeal/oropharyngeal swab and cerebrospinal fluid sample were negative by reverse transcription–polymerase chain reaction (RT-PCR) testing for enteroviruses and human parechovirus"
    explanation: >-
      Shows that CSF and nasopharyngeal/oropharyngeal RT-PCR were negative in
      the same confirmed case, underscoring stool as the higher-yield
      specimen for poliovirus diagnosis.
- name: Wastewater Surveillance
  description: >-
    RT-PCR and partial genome sequencing of municipal wastewater (sewage)
    detects poliovirus shed by infected people in a catchment area. Because
    only a small minority of poliovirus infections become paralytic,
    environmental surveillance detects community transmission that clinical
    surveillance misses, and can do so before and after any paralytic case
    presents. Sequencing links wastewater isolates genetically to a known case
    and distinguishes vaccine-derived from wild virus on the same VP1
    criterion used for clinical specimens.
  diagnosis_term:
    preferred_term: wastewater nucleic acid amplification testing
    term:
      id: NCIT:C20055
      label: Nucleic Acid Amplification Test
  presence: Positive for poliovirus RNA (wastewater)
  evidence:
  - reference: PMID:35980868
    reference_title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Among these samples, 21 (8%) yielded positive poliovirus test results using RT-PCR and partial genome sequencing, including 13 from Rockland County and eight from Orange County."
    explanation: >-
      Documents RT-PCR plus partial genome sequencing of wastewater as the
      assay, and reports its yield across a real surveillance program.
  - reference: PMID:35980868
    reference_title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Twenty specimens from wastewater samples collected during May, June, and July were genetically linked to virus from the patient's stool samples"
    explanation: >-
      Shows that sequencing of wastewater isolates establishes genetic linkage
      to a clinical case, which is what makes environmental surveillance
      diagnostically informative rather than merely a positive signal.
treatments:
- name: Poliovirus vaccination (IPV/OPV)
  description: >-
    Vaccination with inactivated poliovirus vaccine (IPV) or oral poliovirus
    vaccine (OPV) is the cornerstone of prevention. IPV was the first vaccine
    used against poliomyelitis and its immunogenicity to prevent paralytic
    disease is well established; there is no specific antiviral therapy for
    established acute poliomyelitis.
  therapeutic_modality: VACCINE
  treatment_term:
    preferred_term: vaccination
    term:
      id: NCIT:C15346
      label: Vaccination
  target_phenotypes:
  - preferred_term: acute flaccid paralysis
    term:
      id: HP:0003470
      label: Paralysis
  evidence:
  - reference: PMID:38535567
    reference_title: "Inactivated Poliovirus Vaccine: Recent Developments and the Tortuous Path to Global Acceptance."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "became the first vaccine to be used to protect against poliomyelitis"
    explanation: >-
      IPV was the first poliomyelitis vaccine, supporting vaccination as the
      central preventive intervention.
  - reference: PMID:38535567
    reference_title: "Inactivated Poliovirus Vaccine: Recent Developments and the Tortuous Path to Global Acceptance."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "the immunogenicity of IPV to prevent paralytic poliomyelitis continues to be irrefutable"
    explanation: >-
      The review affirms the established immunogenicity of IPV against
      paralytic poliomyelitis.
  - reference: PMID:25360208
    reference_title: "Poliomyelitis: historical facts, epidemiology, and current challenges in eradication."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Contribution of Salk and Sabin in the form of vaccines"
    explanation: >-
      The historical review credits the Salk (IPV) and Sabin (OPV) vaccines as
      the basis of polio prevention.
- name: Supportive care
  description: >-
    Because no antiviral treatment exists for acute poliomyelitis, management is
    supportive, including monitoring for bulbar and respiratory compromise, pain
    control, and prevention of complications.
  treatment_term:
    preferred_term: Supportive Care
    term:
      id: NCIT:C15747
      label: Supportive Care
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "As no antiviral treatment for acute poliomyelitis exists, prevention is critical"
    explanation: >-
      The absence of antiviral therapy makes supportive care and prevention the
      mainstays of management.
- name: Mechanical ventilatory support
  description: >-
    Patients with bulbar or respiratory muscle weakness may require mechanical
    ventilation, historically the iron lung and now invasive or noninvasive
    respiratory support.
  treatment_term:
    preferred_term: artificial respiration
    term:
      id: NCIT:C70909
      label: Mechanical Ventilation
  target_phenotypes:
  - preferred_term: Respiratory insufficiency due to muscle weakness
    term:
      id: HP:0002747
      label: Respiratory insufficiency due to muscle weakness
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "ranging from asymptomatic to a transient flu-like viral illness to paralysis, quadriplegia, and even respiratory failure and death"
    explanation: >-
      Respiratory failure in severe polio necessitates ventilatory support.
differential_diagnoses:
- name: Acute flaccid myelitis
  description: >-
    Acute flaccid myelitis is a polio-like syndrome caused chiefly by non-polio
    enteroviruses (especially enterovirus D68) and is the leading contemporary
    mimic of paralytic poliomyelitis.
  evidence:
  - reference: PMID:32644370
    reference_title: "Poliomyelitis."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "acute flaccid myelitis"
    explanation: >-
      The clinical review names acute flaccid myelitis as the principal
      polio-like syndrome to be distinguished from poliomyelitis.
- name: Guillain-Barre syndrome
  description: >-
    Guillain-Barre syndrome causes acute flaccid paralysis but is typically
    symmetric with sensory involvement and albuminocytologic dissociation,
    contrasting with the asymmetric, sensation-sparing pattern of polio.
  notes: >-
    Distinguished from polio by symmetric weakness and sensory involvement;
    no quotable abstract snippet is asserted for this differential.
references:
- reference: PMID:10915595
  title: "Expression of the human poliovirus receptor/CD155 gene during development of the central nervous system: implications for the pathogenesis of poliomyelitis."
- reference: PMID:22529845
  title: "Poliovirus trafficking toward central nervous system via human poliovirus receptor-dependent and -independent pathway."
- reference: PMID:24367151
  title: "Molecular aspects of poliovirus pathogenesis."
- reference: PMID:25360208
  title: "Poliomyelitis: historical facts, epidemiology, and current challenges in eradication."
- reference: PMID:32644370
  title: "Poliomyelitis."
- reference: PMID:32941411
  title: "Progress Toward Poliovirus Containment Implementation - Worldwide, 2019-2020."
- reference: PMID:33490061
  title: "Modeling Poliovirus Infection Using Human Engineered Neural Tissue Enriched With Motor Neuron Derived From Embryonic Stem Cells"
- reference: PMID:35980868
  title: "Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022."
- reference: PMID:38535567
  title: "Inactivated Poliovirus Vaccine: Recent Developments and the Tortuous Path to Global Acceptance."
📚

References & Deep Research

References

9
PMID:10915595
Expression of the human poliovirus receptor/CD155 gene during development of the central nervous system: implications for the pathogenesis of poliomyelitis.
No top-level findings curated for this source.
PMID:22529845
Poliovirus trafficking toward central nervous system via human poliovirus receptor-dependent and -independent pathway.
No top-level findings curated for this source.
PMID:24367151
Molecular aspects of poliovirus pathogenesis.
No top-level findings curated for this source.
PMID:25360208
Poliomyelitis: historical facts, epidemiology, and current challenges in eradication.
No top-level findings curated for this source.
PMID:32644370
Poliomyelitis.
No top-level findings curated for this source.
PMID:32941411
Progress Toward Poliovirus Containment Implementation - Worldwide, 2019-2020.
No top-level findings curated for this source.
PMID:33490061
Modeling Poliovirus Infection Using Human Engineered Neural Tissue Enriched With Motor Neuron Derived From Embryonic Stem Cells
No top-level findings curated for this source.
PMID:35980868
Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater - New York, June-August 2022.
No top-level findings curated for this source.
PMID:38535567
Inactivated Poliovirus Vaccine: Recent Developments and the Tortuous Path to Global Acceptance.
No top-level findings curated for this source.