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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