RÉSUMÉ
Objetivo: determinar a prevalência dos agentes etiológicos das meningites bacterianas em serviço dereferência, no atendimento de doenças infecciosas para o estado de Minas Gerais, e verificar a resposta ao tratamento utilizado. Métodos: estudo descritivo em que foram incluídas todas as crianças com diagnóstico provável de meningite,admitidas na instituiçào no período de junho a novembro/99. Resultados: obteve-se 210 casos de meningite, sendo 111 casos de etiologia bacteriana (52,9 por cento). Destes, 52 casos foram diagnósticos prováveis ( por alteração do liquor rotina) e 59 com diagnósticos de certeza ( por cultura e/ou isolamento de antígeno). Os principais agentes isoldos foram, em ordem decrescente, H. influenzae, N. meningitidis e S. pneumoniae. O tratamento inicial para a faixa etária de três meses a cinco anos foi ampicilina e cloranfenicol, sendo posteriormente restrito para penicilina em casos de meningococo e pneumococo, e para cloranfenicol nos casos de H.influenzae. A mudança para antimicrobiano de maior espectro foi realizada com base em dados clínicos ou laboratoriais, não havendo isolamento de microorganismo resistente. Conclusões: o acompanhamento do perfil epidemiológico das meningites deve ser contínuo, e cada serviço deve se basear em dados locais para direcionar a terapia antimicrobiana. A monitorização contínua dos agentes prevalentes em cada instituição e de sua resistência é fundamental para a escolha antimicrobiana, atuando com menor interferência na colonização individual, sem contribuir para a crescente resistência dos agentes responsáveis pelas infecções meníngeas
Sujet(s)
Humains , Mâle , Femelle , Nouveau-né , Nourrisson , Liquide cérébrospinal , Méningite bactérienne , PrévalenceRÉSUMÉ
OBJECTIVE: To establish the prevalence of the etiological agents of bacterial meningitis in a reference center for the treatment of infectious diseases in the state of Minas Gerais. METHODS: Descriptive study including all children with probable diagnosis of meningitis between June/1999 and November/1999. RESULTS: There were 210 cases of meningitis, and 111 (52.9%) were caused by bacteria. Actually, 52 were probable bacterial meningitis (with liquor alterations) and 59 were confirmed (with culture and/or antigen tests). The main agents were: Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae. The initial treatment for children aged between three months and five years consisted of ampicillin and chloramphenicol. Later, the antibiotic was changed to penicillin in cases of Neisseria meningitidis and Streptococcus pneumoniae. and to chloramphenicol in cases of Haemophilus influenzae. Extended spectrum antimicrobial agents were used on clinical or laboratory basis, but resistant microorganisms were not found in cultures. CONCLUSIONS: The epidemiology of meningitis should be continuous and should consider local data in order to guide antimicrobial therapy. The continuous monitoring of the prevalent agents in each institution and their resistance is fundamental to the selection of antimicrobial drugs, preserving the antimicrobial agents, and causing less interference with individual colonization, without contributing to the increasing resistance of the agents responsible for meningeal infections.
RÉSUMÉ
Studies of risk factors for colonic adenomatous polyps have been reported in greater numbers in 1993 than in all previous years combined. This explosion in interest in polyps has not arisen because polyps themselves cause serious illness. They are in the vast majority of cases asymptomatic. However, adenomas have become the surrogate for colon cancer in a number of phase III dietary intervention trials. These trials were undertaken at a time when very little was known of adenoma risk factors. Data accumulated in the past 18 months in general demonstrate a similarity in risk factors for cancer and polyp. Since it has also been recently established that polypectomy diminishes colon cancer risk, the adenomatous polyp has been established as an ethical and convenient surrogate for cancer of the colon. Prevention of colorectal cancer is the goal of all the above studies, and it is hoped that the dietary intervention trials currently under way will generate the data that will make prevention possible.