Documente Academic
Documente Profesional
Documente Cultură
Actualitatea temei
Meningita bacterian
apare, anual, la
aproximativ 3
persoane din 100.000
n rile vestice.
Studiile populaionale
pe scal larg au
artat c meningita
bacterian este mai
frecvent, cu 10,9
cazuri din 100.000, i
Evenimente
precoce
Fiziopatologie
Faza 1
Eliberarea
citokinelor
pro-inflamatorii
din
invazia
bacterian i
inflamaia
consecutiv
la
nivelulspaiului
subarahnoidian
Clinic
Febr, cefalee
Etiopatogenie
Elemente
Elemente
intermediar tardive
e
Faza2
Encefalopatie
subpial indus
de
cytokine i ali
mediatori
chimici
Faza 3
Alterarea
barierei
hematoencefalic
e,
migrarea
transendotelial
a
leucocitelor i
dezvoltarea
edemului
cerebral
Meningism,
confuzie,
nivel
redus al
glicorahie
Stare de
contien
alterat,
presiune
LCR ridicat
Alterarea
Leziuni
fluxului
neuronale
sanguin
focale
cerebral,
creterea
presiunii
intracraniene
i
vasculita
Obnubilare,
crize,
simptome i
semne
neurologice
focale
Paralizie,
deteriorare
cognitiv, com
Clasificare
A. Caracterul
inflamaiei:
meningit
purulent
meningit
seroas (aseptic)
D. Criteriu evolutiv:
meningit fulminant
meningit acut
meningit subacut
meningit cronic
B. Criteriu
patogenic:
meningit
primar
meningit
secundar
C. Criteriu
etiologic:
bacterian, viral,
micotic,
protozoic,
micoplasmic,
amebian
E. Gravitatea bolii:
forma uoar
forma de gravitate medie
forma grav
forma extrem de grav
Etiologie :Meningita
bacteriana
Virsta
< 1 luna
1-23 luni
S.agalactiae,E.Coli,Hemophilus
influenze,Streptococcus
pneumoniae,Neisseria
meningitidis
2-50 ani
Streptococcus
pneumoniae,Neisseria
meningitidis
> 50 ani,imunocompromisi
Streptococcus
pneumoniae,Neisseria
meningitidis,L.Monocytogenes
Postraumatic
Staphylococus
Etiologie: Meningita
seroasa
Manifestari clinice
Triada meningitic
1. Semne i
smptome generale
de infecie:
febr, cefalee, foto-,
fonofobie, greuri,
vom
2. Prezena
sindr.meningian:
redoarea cefei
S. Kernig
S.Brudzinski superior,
mediu, inferior
Semnele meningiene
Manifestri clinice
Meningita
aseptic
Meningita
purulent
febr
cefalee
nausee, vom
alterarea contienei
(letargie, confuzie)
accese convulsive
afectare de n.cranieni
(nn. VI, III, VII, VIII, II)
Hemipareza, afazie
sindrom HIC
erupii cutanate
++
++
+
rar
ocazional
Tbc, borelioza, sifilis,
carcinomatoz
Tbc
+
HSV -1,2, VZV,
enterovirus
+++
+++
+
+++ (75%)
++ (40%)
++
+
+++
meningococ,
stafilococ, streptococ
LCR
Meningita
viral
Meningita
bacterian
Caracteristi
ca
LCR
Norma
Culoarea
Transparen
a
Presiunea(
mm H2O)
Proteine
(g/l)
Celule (1
ml)
-limfocite
-neutrofile
galbenincolor
incolor
transparent transparent verzuie
tulbure
80-200
250-300
400
0,15 0,33 0,66 - 1,0
1,0 - 5,0
5-7
300 900
100025
5
80%
000
2
20%
15%
85%
50%
norma
-glicemie
<50%
glicemie
7,0
7,0-7,5
Glucoza
(mmol/l)
Cloruri (g/l
7,0
Meningita
Tbc
incolor
xantocrom
250-300
1,0 - 4,0
200-700
60-70%
30-40%
<50%
glicemie
2,0 3,0
Tratament preventiv
Initierea tratamentului
Pina la obtinerea rezultatelor testelor de
confirmare a diagnosticului de
meningita,tratamentul trebuie initiat cu AB de
spectru larg
Cefalosporinele de gen III(Ceftriaxona 2 g la 12-
Tratament
etiologic(Antibacterian)
Pneumococ
Meningococ
Haemophilus influenzae
tip B
Rifampici
na=+Cipr
ofloxacina
Vancomici
na+rifam
picina
Listeria Monocytogens
Tratament adjuvant
Corticoterapie 5-10 zile(dexametazona 0,5
mg/kg/zi)
AINS(diclofenac,indometacin)
Asigurarea aportului energetic,reechilibrare
echilibrului hidroelectic si acidobazica cu glucoza 510%,ser fiziologic
Sustinerea functiilor vitale
Vitamine grupei B
Combaterea sindromului de coagulare
intravasculara diseminata cu heparina
Ig standart in forme severe
Depletive:manitol 20% 1-2 mg/kg/zi
Prevenirea si combaterea convulsiilor cu diazepam
sau fenobarbital
Durata
tratamentului
Meningite bacteriene
nespecifice
10-14 zile
Meningite pneumococice 1014 zile
Meningite meningococice 5-7
zile
Meningita viral
Meningita viral necesit n mod obinuit numai
Age or Predisposing
Feature
Age 0-4 wk
Antibiotics
Ampicillin plus either cefotaxime or
an aminoglycoside
Age 1 mo-50 y
Age >50 y
Multumesc pentru
atentie!
Bibliografie
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