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Definitie

Meningita este o inflamaie a

membranelor de protecie care nvelesc


creierului i mduva spinrii, cunoscute
sub denumirea colectiv de meninge.
Inflamaia poate fi provocat de infecia
cu virusuri, bacterii sau alte
microorganisme, sau, n cazuri mai rare,
de anumite medicamente.

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

streptococii de grup B, Listeria


monocytogenes ,Klebsiella
pneumoniae,Escherichia Coli

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

3. Modificri specifice ale


lichidului cefalo-rahidian:
S. licvorean meningitic:
creterea att a numrului
de celule, ct i a
coninutului de proteine

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-

24 ore sau cefotaxim 2 g la 6-8 ore ) reprezint


tratamentul de elecie n Europa i America de
Nord pentru meningitele pneumococice
In cazul suspiciunii M.meningococica-

benzilpenicilina (250.000 U/kg/zi)

Tratament
etiologic(Antibacterian)
Pneumococ

Pneumococii cu susceptibilitate redus la


penicilin sau cefalosporine

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

terapie de susinere; majoritatea virusurilor care


provoac meningit nu rspund la tratamentul
specific
AINS
Dexametazona 0,5mg/kg/zi,prednison 1mg/kg/zi
10 z
Vitaminoterapie(Vit B1,B6,Vit C)
Virusul herpes simplex i virusul varicella zoster
pot rspunde la tratamentul cu medicamente
antivirale cum este aciclovir 15-30 mg/kg/zi in 3
prize,10 zile

Age or Predisposing
Feature
Age 0-4 wk

Antibiotics
Ampicillin plus either cefotaxime or
an aminoglycoside

Age 1 mo-50 y

Vancomycin plus cefotaxime or


ceftriaxone*

Age >50 y

Vancomycin plus ampicillin plus


ceftriaxone or cefotaxime plus
vancomycin*
Vancomycin plus ampicillin plus
either cefepime or meropenem

Impaired cellular immunity


Recurrent meningitis

Vancomycin plus cefotaxime or


ceftriaxone

Basilar skull fracture

Vancomycin plus cefotaxime or


ceftriaxone

Head trauma, neurosurgery,


or CSF shunt

Vancomycin plus ceftazidime,


cefepime, or meropenem

Multumesc pentru
atentie!

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