Outline the clinical spectrum from initial infection to paralytic disease.

• A. Asymptomatic infection only
• B. Paralytic poliomyelitis with respiratory failure
• C. Severe encephalitis with seizures
• D. Abortive poliomyelitis (mild febrile illness), nonparalytic aseptic meningitis, and paralytic poliomyelitis with acute flaccid paralysis

Answer: (D)

Poliovirus infection can produce a continuum of illness, from no symptoms to paralytic disease. The best description lists all major forms in the natural sequence: abortive poliomyelitis (a mild febrile illness without CNS involvement), nonparalytic aseptic meningitis (fever with neck stiffness but no paralysis), and paralytic poliomyelitis with acute flaccid paralysis (weakness with decreased tone and reflexes, sometimes involving respiratory muscles). This captures how the infection can progress from initial illness to CNS involvement and, in a minority, to paralysis. Other options fall short because they describe only one end of the spectrum or atypical, nonpolio presentations such as severe encephalitis with seizures, which are not characteristic of polio.