Prevalencia de meningitis bacteriana en el hospital de niños Francisco de Icaza Bustamante
Fecha
2003
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Universidad de Guayaquil. Facultad de Ciencias Químicas
Resumen
La meningitis bacteriana es un padecimiento que a la fecha continúa generando alta mortalidad y secuelas neurológicas de grado variable a los sobrevivientes
Se realizó un estudio prospectivo con todos los pacientes admitidos con el diagnostico de Meningitis Bacteriana y que se encontraba hospitalizados en la Unidad de Infectología del Hospital de Niños Francisco de Icaza Bustamante tratados en el período de Septiembre del 2001 a Febrero del 2002. Se encontró un total de 40 pacientes, de ellos fallecieron 7, con una letalidad de 17.5%.
La edad de mayor incidencia fue de 2 meses a 5 años con el 57% presentándose con mayor frecuencia en el sexo masculino.
Las manifestaciones clínicas predominantes fueron fiebre, diarrea, decaimiento, convulsiones, signos de Kerning.
Para confirmar el diagnóstico se realizó punción lumbar y las muestras de líquido céfalo raquídeo (LCR) fueron procesadas para tinción de Gram, examen citoquímico, pruebas bioquímicas, cultivos, pruebas en látex. Destacándose pruebas en látex para la detección del agente causal con un porcentaje del 20% seguido de cultivos con el 12.5% tomando en consideración que la mayoría de pacientes han recibido tratamiento antimicrobiano previo a las pruebas esto conlleva a negativizar los cultivos y demuestra la utilidad del test de aglutinación con látex. Con respecto a los otros parámetros de laboratorio el rango de celularidad en el estudio citoquímico fue de 10-1200 mm3 con predominio polimorfo nuclear e hiperproteinorraquia con hipoglucorraquia, que corresponde al perfil clásico de la meningitis bacteriana.
Los agentes etiológicos más frecuentes encontrados fueron Haemophillus Influenzae 44.4 % siendo el agente etiológico más frecuente seguido de Neisseria Meningitidis 22.2 % y Streptococo Pneumoniae 22.2%
Ninguno de los pacientes había sido vacunado con anti - H. Influenzae anti-N. Meningitidis anti-S.pneumoniae
Las infecciones estaban más asociadas a la del tracto respiratorio.
En el tratamiento antibiótico instaurado según la edad del paciente y antes de tener la certificación bacteriológica del LCR se aplico el siguiente esquema.
De 1 a 2 meses de edad: ampicilina + ceftriaxone o cefotaxime
De 2 meses a 5 años: ampicilina + cloranfenicol o ceftriaxona
Edad mayor a 5 años: penicilina o ceftriaxona.
Adjunto al esquema antimicrobiano se utiliza un antiinflamatorio un corticoide la dexametasona que es eficaz para prevenir la sordera y otros daños neurológicos en el tratamiento de las meningitis producida por H. Influenzae o por S. Pneumoniae.
Meningitis bacterium is non a desease which is producing a high quantity of death and neurologycal consequences in differents ways to survivors of this. An analysis was done with Meningitis Bacterium patients who were in Children Hospital “Francisco de Icaza Bustamante” (Infected Section) Patients were taken care of their disease from in September 2001 to February 2002 but 40 patients died of wich 7 died with a mortal percent about 17.5%. The most of people died 2 month or 5 years old so it means 57% percent which was more common in male sex. The most common syntons were fiver, diahorrea, weakness, convulsions, sign of Kerning. To test the diagnostics, it was necessary to do a lumbar puncture and líquido céfalo raquídeo samples which were made to show dyeing of gram, citochemical examination, biochemical tasting, bacteriological examination and latex tasting. The most remarkable tasting was done in latex to detect the cause with 20 percent and bacteriological examination with 12.5%. In this case it is putting into consideration the majority of patients have received antimicrobiano treatment before the tasting were made this action reduces the effect of bacteriologycal examination and this displays the utility of agglutination tasting with látex. Refering to other laboratory chances, the celular space was about 10-1200 mm3 according to citochemical study with a high percent of polimorfo nuclear and hiperproteinorraquia with hipoglucorraquia belong to the main characteristics of Meningitis Bacterium. The most comman etiologycal agents found, were Haemophilus Influenzae 44.4% this one etiologycal agent was the more comman and after that Neiseria Meningitidis 22.2% and Streptococo Pneumoniae 22.2%. None of patient was vaccinated with anti H. Influenzae anti N. Meningitidis anti S. Pneumoniae. The infection were link to tracto respiratorio. According to patient age, it was tasted antibiotico treatment and before to have the bacteriologycal certification LCR, was necessary to apply the next schema: From 1 to 2 months: ampicilina + ceftriaxone o cefotaxime From 2 month to 5 years old ampicilina + chloramphenicol o ceftriaxone 5 years old or older: penicillin o ceftriaxone Apart from antimicrobiano schema, it is important to use an anti-inflammatory which is corticoid dexametasona. It is efficient to prevent deafness and other neurologycal problems when meningitis treatment is going on wich es produced by H. Influenzae or S. Pneumoniae.
Meningitis bacterium is non a desease which is producing a high quantity of death and neurologycal consequences in differents ways to survivors of this. An analysis was done with Meningitis Bacterium patients who were in Children Hospital “Francisco de Icaza Bustamante” (Infected Section) Patients were taken care of their disease from in September 2001 to February 2002 but 40 patients died of wich 7 died with a mortal percent about 17.5%. The most of people died 2 month or 5 years old so it means 57% percent which was more common in male sex. The most common syntons were fiver, diahorrea, weakness, convulsions, sign of Kerning. To test the diagnostics, it was necessary to do a lumbar puncture and líquido céfalo raquídeo samples which were made to show dyeing of gram, citochemical examination, biochemical tasting, bacteriological examination and latex tasting. The most remarkable tasting was done in latex to detect the cause with 20 percent and bacteriological examination with 12.5%. In this case it is putting into consideration the majority of patients have received antimicrobiano treatment before the tasting were made this action reduces the effect of bacteriologycal examination and this displays the utility of agglutination tasting with látex. Refering to other laboratory chances, the celular space was about 10-1200 mm3 according to citochemical study with a high percent of polimorfo nuclear and hiperproteinorraquia with hipoglucorraquia belong to the main characteristics of Meningitis Bacterium. The most comman etiologycal agents found, were Haemophilus Influenzae 44.4% this one etiologycal agent was the more comman and after that Neiseria Meningitidis 22.2% and Streptococo Pneumoniae 22.2%. None of patient was vaccinated with anti H. Influenzae anti N. Meningitidis anti S. Pneumoniae. The infection were link to tracto respiratorio. According to patient age, it was tasted antibiotico treatment and before to have the bacteriologycal certification LCR, was necessary to apply the next schema: From 1 to 2 months: ampicilina + ceftriaxone o cefotaxime From 2 month to 5 years old ampicilina + chloramphenicol o ceftriaxone 5 years old or older: penicillin o ceftriaxone Apart from antimicrobiano schema, it is important to use an anti-inflammatory which is corticoid dexametasona. It is efficient to prevent deafness and other neurologycal problems when meningitis treatment is going on wich es produced by H. Influenzae or S. Pneumoniae.
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MENINGITIS BACTERIANA, PEDIATRÍA, MENINGOCOCO, NEUROLOGÍA