Parâmetros laboratoriais do líquido cefalorraquidiano em indivíduos com meningite por enterovírus / Laboratory parameters of cerebrospinal fluid in individuals with enterovirus meningitis

A meningite é a principal síndrome infecciosa que afeta o sistema nervoso central, e grande parte dos casos são ocasionados por infecções virais, principalmente por Enterovirus. O diagnóstico clínico para a verificação da etiologia da meningite ainda apresenta grandes desafios. O teste de Reação em Cadeia da Polimerase, leucócitos, hemácias, glicose, proteína e lactato no líquido cefalorraquidiano fornecem os primeiros indícios para o diagnóstico. No entanto, os valores de referência de alguns parâmetros podem sofrer alteraçõesOBJETIVO: Verificar parâmetros laboratoriais do líquido cefalorraquidiano em indivíduos com meningite por Enterovirus e, posteriormente, analisar suas relações por faixa etáriaMÉTODO: Foi realizado um estudo descritivo, com base nos dados do serviço de referência de coleta de líquido cefalorraquiano, localizado em São Paulo, Brasil. Totalizou-se em 202 indivíduos que apresentaram meningite por Enterovirus. Os dados foram analisados pelo teste de Shapiro-Wilk e Kruskal-Wallis (IC = 95%, p < 0,05) e representados pela mediana e percentil 25 e 75...

Meningitis is the leading infectious syndrome that affects the central nervous system, and most cases are caused by viral infections, mainly enterovirus. The clinical diagnosis for meningitis etiology still presents major challenges. The analysis of polymerase chain reaction (PCR), white blood cells, red blood cells, glucose, protein, and lactate in the cerebrospinal fluid (CSF) provides the first clues to the diagnosis. However, the reference values of some parameters can suffer changesOBJECTIVE: Analyze the laboratory parameters of CSF in patients with enterovirus meningitis, and then, theirrelationship by age groupMETHODS: A descriptive study was conducted based on data from a CSF reference service, located in São Paulo, Brazil, on 202 individuals who had enterovirus meningitis. Data was analysed by the Shapiro-Wilk and Kruskal-Wallis tests (CI = 95%, p < 0.05) and represented by the median and percentile 25 and 75, respectively...

Estudio de 312 niños con meningitis atendidos en un Hospital Universitario en el Sur de Brasil / Study of 312 children with meningitis treated at a University Hospital in the South of Brazil

El objetivo de este trabajo fue evaluar los aspectos clínicos, análisis de laboratorio, el perfil etiológico y las características evolutivas de los distintos tipos de meningitis aguda atendidos en un Servicio de Pediatría de un Hospital Público Universitario. Fueron evaluados a partir de un estudio descriptivo y retrospectivo de niños atendidos en el Servicio de Pediatría del Hospital de Clínicas de la Universidad Federal del Paraná, durante el periodo entre enero 2003 a enero 2007, con el diagnóstico probable de meningitis basado en manifestaciones clínicas y en alteraciones citológicas y bioquímicas del LCR. Se diagnosticó meningitis viral (MV) en 140 niños (45%), meningitis bacteriana (MB) en 58 (19%) y en 114 la etiología fue indeterminada (36%). Entre las MB el agente etiológico más frecuente fue Neisseria meningitidis (25 casos). Lo datos clínicos predominantes fueron fiebre, vómitos y cefalea. En el LCR de la MB hubo predominio de polimorfonucleares, proteína elevada y glucosa baja. En la MV predominaron los mononucleares. Las complicaciones neurológicas fueron más frecuentes en la MB, siendo la convulsión el hallazgo más común (6/58 pacientes). El óbito ocurrió en un caso en la MV y tres en la MB. Se llegó a la conclusión de que la clásica tríada fue la manifestación clínica más común, las anormalidades citológicas y bioquímicas fueron típicas auxiliando en la diferenciación entre las MB y MV, aunque un gran número de casos haya quedado sin definición etiológica; las complicaciones neurológicas inmediatas y los óbitos han sido pocos frecuentes en esta muestra.

The aim of this study is to evaluate the clinical and laboratorial aspects, as well as the etiological profile and the evolution characteristics, of the diverse types of severe meningitis treated at a Pediatric Clinic of a public university hospital. From a descriptive and retrospective study, 312 children at the Pediatric Clinic of the Hospital de Clínicas of the Federal University of Paraná were evaluated between January 2003 and January 2007. All of them had a probable diagnosis of meningitis based on clinical signs, and on the cytological and biochemical alterations in the cerebrospinal fluid routine examination. Viral meningitis (VM) was present in 140 children (45%), 58 had bacterial meningitis (BM - 19%) and etiology was undetermined in 114 (36%). In MB, Neisseria meningitidis was the most frequent etiological agent (25 cases). Predominant clinical symptoms were fever, sickness and headache. The cerebrospinal fluid test showed a high number of polymorphonuclear leukocytes, high protein and low glucose level in MB; mononuclear cells were predominant in VM. Neurological complications were more frequent in BM, and convulsion the most common symptom (6/58 patients). Death happened to one case in VM and 3 in BM. Our conclusions were that the classical triad (headache, vomiting and fever) was the most common clinical manifestation, the cytological and biochemical abnormalities were typical, helping in the differentiation of MB from VM, although a good number of cases ended up with no etiological definition and, finally, immediate neurological complications and death were rare.