meningite acute bacteriene

8/19/2019 Meningite Acute Bacteriene

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Meningite acute

Forme etio-clinice


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Meningite la nou-nascut

• Etiologie

– Streptococi B, E.Coli, Listeria monocytogenes (75%)

• Talou clinic

– Bomarea !ontanelei ant.

– "nstailitate termica

– "nsu#cienta respiratorie

– $i#cultati e alimentatie

– &arsaturi

– Semnele tipice e meningite sunt mai rare

• $iagnostic

–

'unctie lomara si e. LC (se repeta la *+-+ ore)• Tratament etiologic

– mpicilina ce!otaim sau ampicilina aminoglico/i

– $o/e ule e etalactamine o/e normale e aminoglico/i

– $urata *-+* /ile


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Tratamentul in !unctie e 0arsta si etiologievarsta Etiologie probabila Antibiotice de prima

linie1- saptamani Streptococi grup B,

E.Coli, L.monocytogenesmpicilinace!otaimmpicilinaaminoglico/i

23 luni Streptococi grup B,E.Coli, L.monocytogenes,

4. inuen/ae, S.pneumoniae

mpicilinace!otaim66ce!triaona,sau

mpicilina0ancomicinacloram!enicol

3 luni-*7 ani S. pneumoniae,. meningitiis,4. inuen/ae

Ce!otaim6ce!triaona6- 0ancomicina sau mpicilinacloram!enicol sau Meropenem

*8-51 ani S. pneumoniae,. meningitiis

Ce!otaim6ce!triaona6- 0ancomicina saumeropenem saupenicilinacloram!enicol

951 ani S. pneumoniae,. meningitiis, B:

mpicilinace!otaim66ce!triaona6-0ancomicina


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Meningite acteriene comunitare

• Etiopatogenie – 9;5% (intre + luni si *8 ani)

S.pneumonie, .meningitiis si

4.inuen/ae tip

• Talou clinic – $eut< rusc, ce!alee intensa (i!u/a sau

locali/ata) , !risoane, 0arsaturi, = sm.emeningism

– 'erioaa e stare< ce!alee, mialgii,lomalgii, reoare e cea!a, sm. >erning

, Bru/in?i , sarutului , = sm.


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Meningite acteriene nosocomiale

• Meningite cu acili :- – E.coli, Serratia marcescens,

's.aeruginosa, Salmonele

– par la nou nascuti, 0arstnici, ga/eimuneprimate

– E0olutie se0era

– Tratament

• "nitial< 0ancomicina ce!alosporina

• "n M. cu 's.aeruginosa @ ce!ta/iim i0. aminoglico/i


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• Meningita cu S.aureus – $upa inter0entii cAirurgicale


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• Mani!estari clinice

– Bacteriemie !ara sepsis

– Meningococemie !ara meningita

– Meningita cu sau !ara menincocemie

– Meningo-ence!alita• Eantemul caracteristic < petesii care nu ispar la 0itro sau

igitopresiune, pot conua D aspect ecAimotic

• LC

– 4ipertensi0, tulure, elemente celulare 9 *1116mm ('M)

– luminoraAia 999, glicoraAia 2• Complicatii

– Miocarita, pericarita, artrita, is!unctii ner0i cranieni

– Mortalitate 2*1%


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• Tratament

– 'enicilina : sau

– Ce!alosporine :en3 (ce!triaona +g6/i @ault sau*11mg6?g6/i la copil) sau

– Cloram!enicol (*11mg6?g6/i, i0.)

• 'ro#laie

– Contacti• i!ampicina *1-+1 mg6?g6/i @ 8 ore

• Ce!triaona *+5mg2*+ ani, +51 mg la ault (o/a unica)

– "munopro#laie• &accin antimeningococic


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Meningita pneumococica

• S.pneumonie – La ault si la copilul9 luni

– Coc :,in iplo, capsulati

•

Surse e in!ectie – Bolna0i si purtatori sanatosi, portaF maim in lunile

reci

• Transmiterea –

erogena – ecepti0itate generala ar cu preispo/itie la

olna0ii cu< asplenie, e!ecte structurale cuscurgeri e LC, otite, sinu/ite, e#cite anticorpi


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• Mani!estari clinice

– Similare cu alte M.acteriene

– Gorme Aipertoice , e0olutie rapia spre eces

(+-8 ore) – Gorme recii0ante, /eci e episoae

• LC

– purulent

– Sarac in elemente celulare, ogat inpneumococi

• Mortalitate mare (9 1%)


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• Tratament – "n !unctie e sensiilitatea la penicilina, 0ariaila /onal

(omania- +5%)

– 'enicilina•

ult *+-+ MH6/i, i0.• Copii +11.111-311.111 u 6?g6/i

– Ce!riaona +- g6/i

– Can este re/istent la 'enicilina• &ancomicina ce!alosporina :en3, ri!ampicina, cloram!enicol

• 'ro#laie – u sunt necesare masuri e pre0enire a ca/urilor sec.

– &acinare la copii 9 + ani

– "g"& (11mg6?g la +8 /ile) la copii cu imunoe#ciente


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Meningita cu 4.inuen/aetip B

• 4.inuen/ae

– Cocoacili :-, aeroi

• Copil mic (*8-+ luni)

•

Sursa e in!ectie – Bolna0i cu i0erse in!ectii sau purtatori sanatosi

• Transmiterea

– erogena

– ecepti0itate crescuta la copilul mic• :reutate mica la nastere

• splenie

• cAimioterapie


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• Mani!estari clinice – Hrmea/a, e oicei, unei in!ectii respiratorii

– Eista !orme !ulminante, coma si stop respirator

• Mortalitate 5%

•

Complicatii < secAele neurologice• Tratament

– Ce!otaima• Copil +11mg6?g6/i in oua o/e asociat cu eameta/ona 1,mg6?g6/i in

o/e, /ile (pre0ine secAelele neurologice)

• ult +g

• 'ro#laie

– i!ampicina ( *1-+1 mg6?g6/i) la contacti

– &accinare

– "g:i0


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Meningita cu Listeria

monocytogenes

• Listeria monocytogenes – Bacil :, !acultati0 anaero

• Sursa e in!ectie – alimente contaminate (0egetale crue,

lapte ne#ert,ran/a moale, carne e puisau 0ita)

– La nou nascut in!ectie suclinica atractului genital matern


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• Mani!estari clinice – "ncuatia meie 31 /ile

– $eut acut sau suacut miman M. tuerculoasa

–

eoarea e cea!a asenta la +1% in aulti – taie, tremor, mioclonii

• 4emoculturi (75%)

• LC – :licoraAia normala – 'reominenta mononuclarelor la *63 in ca/uri

– Grotiurile :ram


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• Tratament

– 'enicilina :• Copil 311.11u6?g6/i

–

mpicilina = gentamicina (in !ormele se0ere) – Cotrimoa/ol (TM' +1mg6?g6/i)

– $urata +-3 saptamani

• 'ro#laie

– Tratamentul in!ectiei la gra0ia

– "giena alimentara


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Meningite 0irale

• Etiopatogenie – &irusul urlian (in omania)

– Entero0irusuri (EcAo si Coac?ie) in /onele une se practica0accinarea antiuriliana

– M.cu 0irus poliomielitic @rara (atorita 0accinarii)

– M.Aerpetica, M. cu aeno0irusuri, M.cu 0irusuri gripale siparagripale @ rare

– M. cu aro0irusuri

– M. 4"&

– M. Iest ile

• Transmiterea – Mai !rec0enta 0ara-toamna

– La orice 0arsta , mai !rec0ent la copii

– Gocar in !amilie sau colecti0itate


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• Mani!estari clinice – $eutul

• Brusc, uneori proroame e tip gripal,

in!.respiratorii superioare sau igesti0e• Eruptii cutanate, tume!actie parotiiana

– 'erioaa e stare• Gera, ce!alee, greturi, 0arsaturi, semne e

iritatie meningeala

– E0olutia• *1 /ile

• "n maForitatea ca/urilor- 0inecare completa


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• $iagnosticul e M.0irala – $ate epiemiologice

• Contet epiemiologic

• Contact cu persoana in!ectanta

– $ate clinice•

$eut preceat e o in!ectie 0irala• Ce!alee intensa

• &arsaturi repetate

– $iagnostic etiologic• "/olarea 0irusului in LC, materii !ecale, euat !aringian

• $eterminarea serocon0ersiei titrului anticorpilor anti0irali

– $iagnostic i!erential• M.acteriene la eut sau JecapitateK

• M. micoplasmatice sau ri?ettsiene

• M.carcinomatoasa


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• Complicatii

– are

– :ra0e < meningoence!alite, Airoce!alie ostructi0a,suritate

•

E0olutie – Ga0oraila

• Tratament

– 'atogenic si simptomatic

• 'ro#laie

– "muni/are acti0a @ M.urliana

– 're0enirea intepaturilor, comaterea 0ectorilor (M.Iest ile)

– Masuri e igiena


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Meningite cronice

• Meningita tuerculoasa – LC cu lim!ocite mici (aulte), cu proteinoraAie mare, cu

Aipo Cl si glucoraAie

– Teren imunepresie (iaet, 4"&)

– Meningita a/ala (a!ectare n. cranieni) – Tratament < asociere antitu. 6- corti/on-; luni

• M. cu Cryptococcus neo!ormans – La pacienti 4"&6S"$

–

'acienti cu imunepresie celulara – $eFecte e la porumei (neoformans) sau plantatii

eucalipt (gatii)

– Tratament < am!otericina B ucito/ina apoi ucona/ol


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Ence!alite

• 'rocese inamatorii ale parencAimuluicereral e natura in!ectioasa, in primul ran0irala

•

Meningo-ence!alita< interesea/a si meningele• Ence!alomielita < proces etins si la mau0a

• Ence!alo-mielo-poli-raiculone0rita< ner0iiperi!erici

• Ence!alopatie < !ara inamatia creierului(eye, 4"&)


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Clasi#care

• Ence!alite primare 0irale

– E. aro0irale, raia

• Ence!alite proail 0irale

– E. letargica

• Ence!alite secunare 0irale

– Secunare postin!ectioase ( entero0irusuri, ruFeola, 0aricela, urlian, 4"&)

– 'ost 0accinale (polio, ruFeola, raie)

• Ence!alite lente

– 4"&

– 'ML

–

'ESS• Ence!alopatii spongio!orme

– >uru

– Creu/!elt-aco

– Sinr. :erstmann-Straussler


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Mani!estari clinice

• Sinrom in!ectios general nei!erentiat

– Gera, !rison, mialgii, anoreie

• Sinrom ence!alitic – !ectare stare constienta, con0ulsii, tipat

ence!alitic, tulurari motorii si sen/iti0e,Bains?i ilatera

• Sinr. e Aipertensiune intracraniana

– Ce!alee, 0arsaturi, raicarie, tulurari resp.

• Sinr. meningean


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ces cereral


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ces cu eem cereral

meningite acute bacteriene

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