Sepsis precoz, osteoartritis y meningitis: a propósito de un caso clínico / Early sepsis, osteoarthritis and meningitis: a clinical case / Sepse precoce, osteoartrite e meningite: relato de caso

Se expone el caso de un recién nacido que desarrolló sepsis connatal precoz a Streptococcus agalactiae, con meningitis aguda supurada y osteoartritis de rodilla izquierda. Como factor de riesgo la madre no tenía realizado el exudado rectovaginal, pesquisa que detecta la colonización por estreptococo del grupo B (EGB). Se aisló el germen en hemocultivo y en líquido de punción articular. Recibió tratamiento antibiótico adecuado a la sensibilidad del microorganismo y según pauta de sepsis con meningitis, evolucionando favorablemente. En este trabajo se describe la epidemiología de la sepsis neonatal y los cambios ocurridos luego de la implementación de la profilaxis antibiótica en el preparto.

We hereby present the case of a newborn with early connatal sepsis due to Streptococcus agalactiae, with acute suppurative meningitis and left knee osteoarthritis. As a risk factor, the mother had not performed the rectus vaginal exudate screening that detects colonization by Group B Streptococcus (GBS). The germ was isolated in blood culture and in joint puncture fluid. The patient received germ-sensitive antibiotic treatment for meningitis sepsis and evolved favorably. This paper describes the epidemiology of neonatal sepsis and the changes that have occurred after the administration of the antibiotic prophylaxis during pregnancy.

Apresentamos o caso de um recém-nascido com sepse neonatal precoce por Streptococcus agalactiae, com meningite supurativa aguda e osteoartrite de joelho esquerdo. Como fator de risco, a mãe não realizou teste de exsudato vaginal do reto que detecta a colonização por estreptococos do grupo B (SGB). O germe foi isolado em hemocultura e líquido de punção articular. A paciente recebeu tratamento com antibióticos germinativos para padrão meningite sepse e evoluiu favoravelmente. Este artigo descreve a epidemiologia da sepse neonatal e as mudanças ocorridas após a administração da profilaxia antibiótica durante a gravidez.

Infecciones postneuroquiróºrgicas: Puesta al día y recomendaciones intersociedades / Post-neurosurgical infections. Update and intersociety recommendations

Las infecciones asociadas a procedimientos neuroquiró;ºrgicos son complicaciones graves que contribuyen a la morbimortalidad de los pacientes neurocríticos, así como tambín a la prolongació;n de la estancia en la UTI y/o en el hospital. El diagnó;stico es complejo ya que no se dispone de gold standard y se apoya en la sospecha clínica, las alteraciones físico-químicas del líquido cefalorraquídeo y el aislamiento microbiano. El tratamiento debe ser precoz y guiado por la epidemiología local. La duració;n dependerá del microorganismo causal, su sensibilidad y la disponibilidad de tratamientos antibió;ticos efectivos en el sitio de la infecció;n. La implementació;n de medidas de prevenció;n con evidencia demostrada minimiza el riesgo de infecció;n. Esta puesta al día intersociedades SADI-SATI presenta datos epidemioló;gicos (internacionales y locales), mó;©todos diagnó;sticos, tratamiento, y pautas de prevenció;n, considerando las publicaciones más relevantes de los ó;ºltimos aó;±os sobre el tema.

Infections associated with neurosurgical procedures are serious complications that contribute to the morbidity and mortality of neurocritical patients, as well as to the prolongation of the stay in the ICU and the hospital. The diagnosis is complex since there is no gold standard, so it is based on clinical suspicion, CSF physical-chemical examination, and microbial isolation. Treatment should be initiated early, guided by local epidemiology. The duration will depend on the causative microorganism, its sensitivity and the availability of antibiotic treatments that are effective at the site of infection. The implementation of preventive measures with proven efficacy minimizes the risk of infection. This SADI-SATI intersociety update reviews relevant data recently published on this area at the national at international level regarding epidemiology, diagnostic methodologies, therapeutic approaches, and prevention guidelines.

Asociación entre meningitis y punción dural en ratas bacterémicas. Un análisis crítico / The Association between meningitis and dural puncture in bacteremic rats. A critical análisis

INTRODUCTION: The presence of an active bacteremia has been considered a relative contraindication to perform an intrathecal puncture due to the risk of causing meningitis or epidural abscess. However, a clear and definite causal relationship has not yet been demonstrated. OBJECTIVES: To determine the relationship between intrathecal puncture and the development of meningitis in sub-jects with bacteremia. MATERIALS AND METHODS: Experimental study in rats with chronic bacteremia to which dural puncture was performed. Meningitis was then evaluated by direct drainage of the cisterna magna and histopathological studies of brain tissue. RESULTS AND CONCLUSION: 12 of 40 bacteremic rats that underwent intrathecal puncture developed meningitis. Previous administration of antibiotics seems to reduce this risk.

INTRODUCCIÓN: Se ha considerado la presencia de una bacteremia activa como contraindicación relativa para realizar una punción intratecal por el riesgo de provocar meningitis o absceso peridural. Sin embargo, aún no se ha podido demostrar una relación causal clara y definida. OBJETIVOS: Determinar la relación entre punción intratecal y el desarrollo de meningitis en sujetos con bacteremia. MATERIALES Y MÉTODOS: Estudio experimental en ratas con bacteremia crónica a las que se les realizó punción dural, luego se evaluó la presencia o no de meningitis mediante drenaje directo de la cisterna magna y estudios histopatológicos de tejido cerebral. RESULTADOS Y CONCLUSIÓN: 12 de 40 ratas bacterémicas a las que se le realizó punción intratecal desarrollaron meningitis. La adminis-tración previa de antibiótico parece disminuir este riesgo.

Cochlear implants and bacterial meningitis: A speech recognition study in paired samples

Introduction: Cochlear implants may guarantee sound perception and the ability to detect speech at a close-to-normal hearing intensity; however, differences have been observed among implantees in terms of performance on discrimination tests and speech recognition. Objective: To identify whether patients with post-meningitis deafness perform similarly to patients with hearing loss due to other causes. Method: A retrospective clinical study involving post-lingual patients who had been using Nucleus-22 or Nucleus-24 cochlear implants for at least 1 year. These patients were matched with respect to age (± 2 years), time since the onset of deafness (± 1 year), and the duration of implant use with implant users who had hearing loss due to other causes. Speech perception was assessed using the Portuguese version of the Latin-American Protocol for the Evaluation of Cochlear Implants. Results: The sample consisted of 52 individuals (26 in each of the 2 groups). The post-meningitic group had a median of 18.5 active electrodes. The group with hearing loss due to other causes had a median of 21, but no significant statistical difference was observed (p = 0.07). The results of closed- and open-set speech recognition tests showed great variability in speech recognition between the studied groups. These differences were more pronounced for the most difficult listening tasks, such as the medial consonant task (in the vowel-consonant-vowel format). Conclusion: Cochlear implant recipients with hearing loss due to bacterial meningitis, who had been using the device for 1 year performed more poorly on closed- and open-set speech recognition tests than did implant recipients with hearing loss due to other causes...

Uso de una escala clínica predictiva para el diagnóstico de meningitis bacteriana en pediatría: [revisión] / Utility of a predictive score for the diagnosis of bacterial meningitis in children: [review]

La difícil interpretación de los hallazgos sugestivos de meningitis bacteriana y viral en el líquido cefalorraquídeo con frecuencia imposibilita su diferenciación. Por décadas, los investigadores han intentado crear escalas predictivas que permitan resolver tal disyuntiva. El objetivo del presente trabajo es determinar la validez y seguridad de una escala clínica predictiva para el diagnóstico de meningitis bacteriana en Pediatría. Realizamos un estudio retrospectivo, transversal, de evaluación de una prueba diagnóstica en una muestra de pacientes con edades entre 29 días y 12 años, egresados con diagnóstico de meningitis entre enero de 1992 y diciembre de 2006, del Deparatmento de Pediatría del Hospital "Dr. Jesús Yerena", ubicado en Caracas, Venezuela. aplicamos una escala clínica predictiva y calculamos su sensibilidad, especificidad, valores predictivos y razones de verosimilitud para el diagnóstico de meningitis bacteriana. La muestra estuvo conformada por 41 pacientes. Predomino el sexo masculino (n=29; 70,73 por ciento). El grupo etareo más afectado fue el de los lactantes menores (26=; 63,41 por ciento). Se identificaron 14 meningitis bacterianas y 27 asépticas. Mediante la escala clínica predictiva se clasificaron 31 meningitis como de alto riesgo de meningitis v¡bacteriana y 10 como de bajo riesgo. La sensibilidad y valor predictivo negativo fueron de 100 por ciento. La escala clínica predictiva resultó ser válida y segura para descartar meningitis bacteriana.

The overlapping of finding suggestive of bacterial or viral meningitis in cerebrospinal fluid makes it difficult to differentiate one of another. For decades, investigators have attempted to create clinical prediction scores to resolve such disjunctive. The objetive of this investigation was to determine the validity and safety of a clinical prediction score for the diagnosis of bacterial meningitis in childhood. We perfomed a retrospective, transversal, diagnosis test evaluation study of a sample of patients between 29 days to 12 years of age, dischanged from January 1992 to December 2006, with diagnosis of meningitis, from the Pediatrics Department of Dr. Jesús Yerena Hospital, in Caracas, Venezuela. The clinical prediction score was applied. We evaluated its validity and safety with the calculation of sensibility, specificity, predictive values and likelihood ratios for the diagnosis of bacterial meningitis. A total of 41 patients were included. Male gender was more common (n=29; 70,73%). The infant age group was predominant (n=26; 63,41%). We identified 14 bacterial meningitis and 27 aseptic meningitis. With the clinical predictin score, 31 meningitis were classified as high risk of bacterial meningitis and 10 as low risk. The sensibility and the negative value were 100%. The clinical prediction score applied resulted to be valid and safe for identifying patients without bacterial meningitis.

Validación de una regla de predicción clínica para diferenciar meningitis bacteriana de meningitis aséptica / Validation of a clinical prediction rule to distinguish bacterial from aseptic meningitis

La mayoría de las meningitis en la infancia no son bacterianas, pero la dificultad en descartar tal etiología obliga con frecuencia a utilizar antibióticos inicialmente. El objetivo de este trabajo fue validar, en nuestro medio, una regla de predicción clínica para diferenciar la etiología de las meningitis en niños a su ingreso al hospital. Método. Estudio prospectivo que incluyó pacientes menores 19 años de edad con diagnósitco de meningitis. En todos se obtuvo líquido cefalorraquídeo (LCR) para análisis directo, citoquímico y cultivo, y hemograma. Se calculó el BMS (Bacterial Meningitis Score: puntaje de meningitis basteriana) descripto por Nigrovic (Pediatrics 2002; 110:712): tinción de Gram en LCR positiva = 2 puntos; proteinorraquia mayor o igual 80 mg/dl, neutrófilos en sangre periférica mayor o igual 10000/mn3, neutrofilos en LCR mayor o igual 1000/mm3, convulsiones, un punto cada uno. Se calculó sensibilidad (S), especificidad (E), valores predictivos positivo y negativo (VPP y VPN) y razones de verosimilitud positiva y negativa (RVP y RVN)del BMS para predecir meningitis bacteriana. Resultados. Se incluyeron 70 pacientes con meningitis (14 bacterianas) veinticinco pacientes presentaron BMS=0 puntos, 11 BMS=1 punto, y 34 BMS mayor o igual 2 puntos. Un BMS=0 evidenció S: 100 por ciento E: 44 por ciento, VPP; 31 por ciento, VPN: 100 por ciento, RVP: 1,81 RVN: 0 para predecir meningitis bacteriana. Un BMS mayor o igual 2 mostró S: 100 por ciento, E: 64 por ciento, VPP: 41 por ciento, VPN: 100 por ciento, RVP: 2,8 RVN: 0 para predecir meningitis bacteriana. Conclusión: La utilización del BMS fue simple y permitió identificar pacientes con bajo riesgo de meningitis bacteriana. Su empleo podría constituir una herramienta útil en la toma de decisiones clínicas.

Meningites bacterianas na infância / Bacterial meningitis in childhood

Revisão do sempre atual tema das meningites bacterianas na infância, abordando seu conceito e incidência, agentes etiológicos, epidemiologia, fisiopatogenia, quadro clínico, diagnóstico, em especial o etiológico, diagnóstico diferencial e tratamento.Neste particular trata das medidas de suporte, do emprego de corticosteróides e da antibioticoterapia em cada caso, terminando com a análise das possíveis complicações e seqüelas da moléstia e sua profilaxia, vacinal e medicamentosa.Meningites bacterianas são processos agudos que acometem as leptomeninges (pia-máter e aracnóide) que envolvem o cérebro e a medula espinal, podendo acometer a dura-máter e outras estruturas do sistema nervoso central (SNC), provocando reação purulenta detectável no líquido cefalorraquidiano (LCR). Estão associadas a uma elevada incidência de complicações e risco de seqüelas e são causa de alta morbimortalidade, principalmente em crianças menores de cinco anos de idade, com maior risco entre os lactentes de 6 a 12 meses de idade. O advento de novos e potentes antimicrobianos eficazes para seu tratamento fez com que as meningites bacterianas evoluíssem de doenças potencialmente fatais para infecções de evolução favorável na maioria dos casos. Representam, ainda, importante desafio em saúde pública em todo o mundo, com estimativa de 1 milhão de casos por ano e 171.000 mortes. No Brasil ocorrem aproximadamente 30.000 casos por ano (2,4/100.000 habitantes), com uma letalidade geral que se mantém constante no nível de 20%(9,20).

Intrathecal use of amikacin: a case report

Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.

Prevalence of newborn bacterial meningitis and sepsis during the pregnancy period for public health care system participants in Salvador, Bahia, Brazil

Bacterial meningitis is still a major public health threat inside developing countries. In Brazil, the Department of Public Health estimates that the prevalence of bacterial meningitis is 22 cases per 100,000 persons. During the neonatal period, the bacterial meningitis develops special characteristics that can result in hearing problems and movement loss due to neurological and psychological damages. This study had the aim to analyze the prevalence of bacterial meningitis and sepsis in newborns during the pregnancy period for those using the public health care system in Salvador-Bahia. One of the goal was to describe the risk factors of bacterial meningitis and sepsis in newborns. A second goal was to identify, based on newborn health records, the difficulties to predict issues with the hearing, neurological and psychological problems. This study has a cross-sectional design. The newborns that were included in this study had bacterial meningitis or sepsis within 0-28 days of life. They were admitted in the maternity wards between June-December 2005 at the newborn intensive unit care. We analyzed 72 reports of newborns and only 11 (17 percent) were bacterial meningitis or sepsis newborn cases. These cases were associated to high intake of ototoxic drugs that can cause oto and nephrotoxicity, and cause serious sequels on the child development. Nervous system infection is one of the 2 major problems in clinical practice, especially during the first month after birth. During this first month, the nervous system infection develops special characteristics, which are different from regular symptoms and it requires treatment due to the increased risk to develop complications. It is strongly recommended to monitor ototoxic drugs use to prevent effects on the hearing system.

Partially treated bacterial meningitis among children in Al-Anbar governorate

Partially treated bacterial meningitis is an important clinical entity to be aware of particularly in an environment of empirical prescription of antibiotics, as it may delay the child's presentation to hospital and alter the cerebrospinal fluid findings. To find out the effect of partial antibiotic treatment on the clinical presentation and laboratory findings among children with bacterial meningitis in Al-Anbar governorate. The medical records of fifty children with bacterial meningitis that were admitted to Al-Ramadi Maternity and Children hospital during the period 1[st] February 2000 till 31[st] January 2002, were reviewed retrospectively the patients were divided into untreated group and partially treated group. Partial antibiotic treatment in children with bacterial meningitis had no significant effect on the presenting signs and symptoms, cerebrospinal fluid cell count, protein, and glucose, when compared to the untreated group, while cerebrospinal fluid culture showed significant difference between untreated group 24/24 [100%] and partially treated group 11/26 [42.3%]. P<0.05. Among the different available diagnostic tests, cerebrospinal fluid enzyme linked immunosorbent assay had the best yield in both untreated group [90.9%] and the partially treated group [95.8%]. Partial antibiotic treatment in bacterial meningitis among children does not mask the clinical features nor significantly changes the cerebrospinal fluid cell count, protein, glucose, and bacterial antigen detection by immunoassay, however, it has a significant effect on the positive yield of cerebrospinal fluid culture

Maternal carriage and neonatal colonization of streptococcus agalactiae in Tabriz, Northwest Iran

Group B Streptococcus [GBS] is a major cause of severe systemic and local infections in newborns. This study was performed to evaluate the presence of GBS in pregnant women and their newborns in Tabriz, Iran. Vaginal specimens were collected from 965 women who were candidate for vaginal delivery for bacteriological study of group B streptococci. Several samples from various sites of the newborns' body [ear canal, nose, navel, and groin] were also obtained to study the colonization rate in newborns after vaginal delivery. Identification of GBS strains was accomplished by bacteriological and serological tests. During the study period, 327 microorganisms were isolated from vaginal specimens of pregnant women from which 5.2% were Streptococcus agalactiae. Serotypes of S. agalactiae strains in our study were Ia [17.6%], Ib [13.4%], II [14.2%], III [9.5%], IV [8.2%], V [19.5%] and nontypable [17.6%]. All of the newborns were followed up for eight weeks. Low carriage rate of GBS in vaginal canal of women in this area and probably lack of more virulent serotypes of GBS may explain the rarity of disease due to Streptococcus agalactiae in our region

Perfil etiológico e terapêutico da meningite bacteriana aguda: contribuindo para a vigilância dos serviços de saúde / Bacteria profile and therapeutic of acute bacterial meningitis: contribuition for health services

Com o objetivo de identificar as bactérias e as associações dos antibióticos utilizadas na meningite bacterina aguda, foram investigados 243 prontuários de pacientes internados de 2000 a 2002 no Hospital Giselda Trigueiro, em Natal (RN-Brasil). Os dados foram analisados pela freqüência percentual. Foi constatado que, em 79,4 por cento dos prontuários, a cultura foi indeterminada. Nas idades até 60 meses, houve uma redução do Haemophilus influenzae. De 6 a 14 anos, 15 a 25 anos e maiores de 26 anos, predominou a Neisseria meningitidis. Até os 12 meses, foi constatado o uso da ceftriaxona. De 13 a 60 meses, da ampicilina seguida da ceftriaxona. De 6 a 14 anos, predominou a ampicilina, seguid pelo uso profilático da rifampicina. A partir dos 15 anos, predominou a ampicilina. O estudo chama atenção para o grande número de prontuários sem o resultado da cultura. Dessa forma, este achado traz implicações para os serviços de saúde, suscitando a necessidade de se reavaliarem os métodos de diagnóstico utilizados.

Chryseobacterium meningosepticum--an uncommon pathogen causing adult bacterial meningitis.

Chryseobacterium meningosepticum is an uncommon pathogen causing meningitis. We report a case of adult meningitis caused by chryseobacterium meningosepticum in an 88 year old woman. Immunosuppression due to old age, diabetes mellitus and history of hypertension of 20 years duration were the concomitant factors. chryseobacterium meningosepticum was isolated both from the cerebrospinal fluid and blood cultures. This organism was sensitive to quinolones, rifampicin and resistant to many antibiotics commonly used for empiric therapy for meningitis.

Evolution epidemiologique et bacteriologique des meningites purulentes au CHu de Treichville de 1980 a 2004

INTRODUCTION :Notre etude a ete realisee a partir de S895souches de germes responsables de meningites purulentes au cours des examens cytobacteriologiques du LCR; provenant des malades atteints de meningites bacteriennes et hospitalises dans les differents services du CHUT que sont: le SMIT; la pediatrie et les autres services (PPH; Medecine interne)Les objectifs sont de deux types:OBJECTIF GENERAL: c'est l'etude du visage epidemiologique et bacteriologique des meningites bacteriennes depuis l'introduction de la vaccination anti-meningococcique et anti-Hib.OBJECTIFS SPECIFIQUES qui sont:-d'identifier les bacteries responsables de meningites bacteriennes au cours de ces 25 ans-de decrire la repartition epidemiologique de ces bacteries-de decrire le comportement de ces bacteries vis-a-vis des antibiotiquesMETHODOLOGIE: Il s'agit d'une etude historique a visee descriptive et analytique portant sur des theses et des publications sur les meningites bacteriennes diagnostiquees du 1er Janvier 1980 au 31 Decembre 2004 au C.H.U. de Treichville.RESULTATS : Il ressort de notre etude:- le pneumocoque occupe la premiere place des etiologies des meningites bacteriennes avec une frequence de 41;54pour cent devant les germes tiquetes autres germes; l'Hi; et le meningocoque.-Age; Les adultes sont les plus touches avec 54;84pour cent. Tous les germes etant concernes sauf 1'Hi-Une emergence de meningocoque B et l'apparition de meningocoque W135-Une baisse de la frequence des meningites a Hi-Seul le pneumocoque subit une influence saisonniere (saison seche)-La sensibilite des principaux germes vis-a-vis des antibiotiques utilises dans I traitement des meningites purulentes baisse d'annee en annee pour l'ampicilline et le chloramphenicol; est conservee pour le cefotaxime et les cephalosporines de 3eme generation.CONCLUSION: Le visage epidemiologique et bacteriologique des meningites a change surtout en ce qui concerne les meningites a meningocoque.Nous notons une baisse de la frequence des meningites a Hi. Aussi recommandons nous une vaccination antimeningococcique de masse appropriee et l'introduction du vaccin anti-Hib dans la PEV

Etiology and occurrence of bacterial meningitis in children in Najaf

226 cerebrospinal fluid [CSF] specimens were collected from children aged [1 day-10 years] admitted to of Al-Zahara children's Hospital in Najaf governorate from November 2001 to October 2004. The incidence of bacterial meningitis was [11.6%]. The following bacterial species were identified: Staphylococcus aureus, E.coli, Kiebsiella pneumoniae, Enterobacter spp Acinetobacter calcoaceticus, Haemophilus influenzae Streptococcus pneumoniae. The most common etiologic agents of pediatric meningitis were Staph aureus and Enterobacter spp, together were isolated from 64% of CSF collected samples. The incidence of bacterial meningitis in male [52%] while in female [48%]

Acute bacterial meningitis in adults: a 20 year review.

During the period Jaunuary 1982 to December 2001 (20 years), a retrospective study in patients 15 years or older with acute bacterial meningitis who were admitted to Songklanagarind Hospital was carried out. There were 180 episodes in 161 cases of acute bacterial meningitis with an increasing incidence of disease during the study. Fifty-nine percent of episodes were nosocomial infection. The classic triad of acute bacterial meningitis was found in 54% of cases. The most common pathogen was Streptococcus pneumoniae (11.7%) in which 19% of these strain were penicillin-resistant. Gram-negative bacilli were common organisms in nosocomial meningitis (32.1%). Twenty-five patients died from meningitis with a mortality rate of 15.5%. Risk factors for mortality older age were than 60 years, HIV infection, impaired mental status and shock.