meningitis bacteriana pao

7/24/2019 Meningitis Bacteriana Pao

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MENINGITIS

BACTERIANAMDICO INTERNO DE PREGRADOPAOLA GRISELL MONTOYA AGUILAR

HOSPITAL GENERAL DE ZACATECASLUZ GONZALEZ COSIO


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Introduccin

Enfr!d"d in#"!"tori" d$"% $&to!nin'%

Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adultsiew of 4! e"isodes. # $ngl J Med %&'!( !%)*%'.
http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults/abstract/3http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults/abstract/3http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults/abstract/3http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults/abstract/3


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E&id!io$o'("

)*+ !i$$on% "nu"$!nt n todo $ !undo,

un" d $"% )- c"u%"% infccio%"% !.% frcunt% d!ort"$id"d

)/0,--- !urt% n todo $ !undo c"d" "1o,

Scu$"% nuro$'ic"% %on frcunt% ntr $o% %u&r2i2in



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C$"%i3c"cin

SEGN EVOLUCIN EN EL TIEMPO:

AGUDA

CRNICA

RECURRENTE

SEGN PERFIL DEL LCR:

SPTICA 45"ctri"n"6

ASPTICA


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CAUSAS DE MENINGITIS

B"ctri"$ Infction%

7ir"$ Infction%

8un'"$ Infction%

(Cryptococcus neoformans

Coccidiodes immitIs)

In#"!!"tor9 di%"%%

(SLE)

C.ncr

Tr"u!" to :"d or %&in,


6/44

Mnin'iti% B"ctri"n", Etio$o'("

Ad;uirid" n $" co!unid"d

Str&tococcu% &nu!oni"4/=6

Li%tri" !onoc9to'n%

A%oci"d" " $" S"$ud

E%t"3$ococo% 40=6 5"ci$o% "ro5io% 'r"!@

n'"ti2o



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Distribucin etaria segn agenteetiolgico

Infancia y adul! "!#$n

Ni%%ri" !nin'itidi%, Str&tococo &nu!oni", St"3$ococo "uru%,

Adul! %$di! S, &nu!oni", S, "uru%,

T$&c$&a $dad: S &nu!oni", S "uru%, L !onoc9to'n%, Gr"!@n'"ti2o%,



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Agente etiolgico segn ruta deadquisicin

Sinu'ii' u !ii': Str&tococo nu!oni"* H"!o&:i$

in#un?"* %tr&tococo "n"ro5io* B"ctroid%* St"3$oco"uru%,

T&au%a c&an$al ($n$&an$ S "uru%,

C!%(licaci!n$' d$ n$u&!ci&u)*a: B"ctri"% Gr"!@n'"ti2" 4$5%i$$" &nu!oni"* Acinto5"ctrc"$co"cticu%* E%c:ric:i" co$i6,



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M$#+#+-+S BAC-$+A#ASecuencia /atog0nica del neurotro"ismo bacteria

$stado#eurotr1"ico Defensa del2u0s"ed $strategia del"at1geno

'. Coloni3aci1n oinvasi1n de lamucosa

+gA secretora

Actividad ciliar$"itelio mucoso

/roteasa "ara +gA

Ciliostasis/ilis ad2esivos

%. Su"ervivencia en el

torrente circulatorio

Com"lemento $vasi1n de la

alternativa "or "olisac5ridos ca"sular

!. -ras"aso de laB6$

$ndotelio cerebral /ilis ad2esivos

4. Su"ervivencia en elLC

/obre actividad e"licaci1n bacteriana

7uagliarello 8 Sc2eld. #$JM %&&(!%9*):4;9%.


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M$#+#+-+S BAC-$+A#ASecuencia /atog0nica

Sc2eld WM,


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MANIFESTACIONES CL+NICAS:

Cf"$" 8i5r Ri'id? d nuc"*

rni' 9Brud?in%i 4!nin'i%!o6

7!ito% 8otofo5i" Dtrioro d$

%n%orio

Con2u$%ion% Si'no% d

foc"$id"d P"r.$i%i% d &"r

cr"n"no%

R"%: cut.no4Mnin'ococo6 S Confu%ion"$

"nci"no%,

Domingo /, Mancebo J, Blanc2 L, et al. ever in adult "atients wit2 acute bacteriitis. J +nfect Dis %&''( ')*4:.


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Cu"dro C$(nico

Tr("d" c$.%ic"

8i5r 4F0=6, > d("% &r2io%, ri'id? d nuc" 4


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En una revisin de 696 casos de meningitis bacteriana

adquirida en la comunidad de 2004, slo el 44% tena latrada clnica, aunque casi todos los pacientes (9%!presentaron al menos dos de las cuatro sntomas" #a tracl$sica era muco m$s probable que ocurra en pacientecon neumococo &rente a la meningitis meningoccica('2)%!" *abe se+alar que los adultos maores pueden

presentar insidiosamente con letargo o embotamiento, s

-ebre signos variables de in.amacin menngea"/

C2oi C. Bacterial meningitis in aging adults. Clin +nfect Dis %&&'( !!*'!)&.
http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults/abstract/8http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults/abstract/8


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Mnin'i%!o

Brud?in%i 8$in %&ont.n" d $" c"dr"

dur"nt $" #in &"%i2" d$cu$$o,

rni'

Rnunci" &"r" &r!itir $"tn%in co!&$t" d $" rodi$$"cu"ndo $" c"dr" % #ion" F-'r"do%


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N, !nin'itidi%

Dr!"to$'ic"%, >= Pt;ui"% F)=

&r&ur" &"$&"5$

Artriti%, =

Artrocnt%i% += &o%iti2"%,

Domingo /, Mancebo J, Blanc2 L, et al. ever in adult "atients wit2 acute bacteriitis. J +nfect Dis %&''( ')*4:.


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P"r"c$(nico%

BH

Lucocito%i% J Luco&ni" Tro!5ocito&ni"

ES Hi&on"tr!i" 4/-=6

H!ocu$ti2o%, + 40-@F-=6,

C2oi C. Bacterial meningitis in aging adults. Clin +nfect Dis %&''( !!*'!)&.


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Puncin $u!5"r

8i%ico@;u(!ico, Cito$'ico, Gr"!* cu$ti2o con "nti5io'r"!

A'$utin"cin n $.t* PCR* ADA,

A lumbar puncture collect

cerebrospinal fluid to chethe presence of disease o

injury.

A spinal needle is inserted

usually between the 3rd a

lumbar vertebrae in the lo

spine.

Diagn1stico, aislamiento, sensibi


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Puncin $u!5"r, IDSA

TAC &r2i", ) o !.% 8"ctor% d ri%'o

%t"do in!unoco!&ro!tido%, Hi%tori" d$ %i%t!" nr2io%o cntr"$ 4SNC6,

Nu2" cri%i% d inicio 4" !no% d un" %!"n" d $"&r%nt"cin6

P"&i$d!",

Ni2$ "nor!"$ d concinci",

dK3cit nuro$'ico foc"$,


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CONTRAINDICACIONES DE PL:

So%&c:" d HTE

Si'no% d foc"$id"d Infccin d$ %itio d &uncin

Co"'u$o&"t("%

M"%" %&in"$

Con2u$%ion%

C2oi C. Bacterial meningitis in aging adults. Clin +nfect Dis %&''( !!*'!)&.


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Intr&rt"cin d$ LCR


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n estudio observacional encontr que la meningitis

bacteriana era altamente probable (1 99%! cuandocualquiera de los siguientes par$metros estuvo presenteuna concentracin de glucosa en #* in&erior a 34mgd#(5"9mmol#!, una concentracin de protenas por encimade 220mgd#, un recuento de glbulos blancos por encimde 2000micro#, o un recuento de neutr-los m$s de55'0micro#"/


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P$ocito%i%

Puncin tr"u!.tic" H!orr"'i" intr"cr5r"$

HSA

Cri%i% 'nr"$i?"d"%

Gr"!, 4S


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TRATAMIENTO


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E2"$u"cin &rtr"t"!into

A$r'i"%

E&o%icin &r2i" AMB &r2io%

Infccin &r2i"

7i"%

Dro'"% intr"2no%"%

Eru&cin &t;ui"$

TCE rcint Otorr" o rinorr"

7IH

In!unoco!&ro!i%o

eiseler /J, #elson ;acuired "urulent meningitis*

of ',!': cases during t2e antibiotic era, '4;'9:. ev +nfect Dis %&'%( %*9%.

i i i $ d
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Princi&io% 'nr"$% d T

Pr2ncin d d!or"%, Rt"rdo &or %tudio% d i!"'n4TAC6 Puncin $u!5"r rtr"%o d :r%

Pr%nt"cin "t(&ic",

Dro'"% 5"ctricid"% n LCR,

Pntr"cin d BHE "$t" %o$u5i$id"d n $(&ido%* d 5"o&%o !o$cu$"r* 5"" unin " &rot(n"%* 9 5"" d

ioni?"cin " &H 3%io$'ico 8"r!"codin"!i", D&ndint d ti!&o o concntr"ci

-unEel A, 6artman BJ,


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Tr"&i" !&iric"

A'nt% !"% &ro5"5$%,

Bt"@$"ct.!ico% Cftri"on" +' c)+:r%cfot"i!" +' c:4cf&i!6

7"nco!icin" )0@+-!'' c


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In!unid"d c$u$"r "$tr"d"

L, Monoc9to'n%* P, "ur'ino%"* S, &nu!oni"

7"nco!icin" )0,+-!'' c


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Mnin'iti% "%oci"d" " "%i%tnci" %"nit"r

S, "uru%* SACN* ntro5"ctri"%* $5%i$" &nu!oni""ur'ino%",

7"nco!icin"

Cft"?idi!" o cf&i! o !ro&n!,

A$r'i" " 5t"@$"ct.!ico%

7"nco!icin"

Moi#o"cino >--!' c+>:r% L, Monoc9to'n% TMPSM c@)+:r%

-unEel A, 6artman BJ,


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Tr"&i" co!&$!nt"ri"

E;ui$i5rio :idro$ctro$itico

PIC c"5cr" " /- 'r"do%

Hi&r2nti$"cion &CO+ +@/-!!H'

G$icro$

No 5n3cio :i&otr!i" inducid"

Puncion $u!5"r r&tid"% no !or(" n >


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D"!t"%on"

Pr2ncin d co!&$ic"cion%

Hi&o"cu%i" c"!5io% in#"!"torio% %2ro% Di%!inu9cintocin"% n LCR

L" d"!t"%on" rduo %i'ni3c"ti2"!nt $" !ort"$id"QRR -*> :"%t" -*F6 9 todo% $o%r%u$t"do% d%f"2or"5$% 4)0 frnt "$ +0 &or cinto* RR

-*0F* IC d$ F0= -*/ " -*F>6,

de ans J, van de BeeE D, $uro"ean DeFamet2asone in Adult2ood Bacterial Me

ud> +nvestigators. DeFamet2asone in adults wit2 bacterial meningitis. # $ngl J M

&%( !49*'4.
http://www.uptodate.com/contents/initial-therapy-and-prognosis-of-bacterial-meningitis-in-adults/abstract/1http://www.uptodate.com/contents/initial-therapy-and-prognosis-of-bacterial-meningitis-in-adults/abstract/1http://www.uptodate.com/contents/initial-therapy-and-prognosis-of-bacterial-meningitis-in-adults/abstract/1http://www.uptodate.com/contents/initial-therapy-and-prognosis-of-bacterial-meningitis-in-adults/abstract/1http://www.uptodate.com/contents/initial-therapy-and-prognosis-of-bacterial-meningitis-in-adults/abstract/1http://www.uptodate.com/contents/initial-therapy-and-prognosis-of-bacterial-meningitis-in-adults/abstract/1


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Antiin#"!"torio rduc &ntr"nci" d 2"nco!icin", 4C@F!c'!$

Sin !odi3c"cion% rif"!&icin" cftri"on",

IDSA d"!t"%on" n !nin'iti% nu!ococic"

-,)0!'' c:r% &or > d("%

Anti5ioticotr"&i" rif"!&icin" %i %n%i5i$id"d intr!di"cfot"i!" o cftri"on",

de ans J, van de BeeE D, $uro"ean DeFamet2asone in Adult2ood Bacterial Me

ud> +nvestigators. DeFamet2asone in adults wit2 bacterial meningitis. # $ngl J M

&%( !49*'4.

Pron%tico
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Pron%tico

Mort"$id"d $in"$!nt con $ "u!nto d d"d,

Mort"$id"d 'nr"$ +0= Mort"$id"d n "%i%tnci" %"nit"ri" /0=

Lt"$id"d )*>=

)< 9 /> "1o% d d"d t"%" d $t"$id"d


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Co!&$ic"cion% 4F* // 9 0=

A$tr"cin d$ %t"do !nt"$

d!" cr5r"$ HIC, Con2u$%ion%

dK3cit% nuro$'ico% foc"$% 4&or !&$o* &"r.$i%i% d$nr2io cr"n"$* :!i&"r%i"6

L" &Krdid" "uditi2" nuro%n%ori"$

Dtrioro int$ctu"$

Pr2ncin


35/44

Pr2ncin

7"cun"%

S, &nu!oni" 9 N, !nin'itidi% H, in#un?" ti&o 5 %&$ncto!(" &r2i",

Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults

iew of 4! e"isodes. # $ngl J Med %&'!( !%)*%'.

Mnin'iti% "%K&tic"
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Mnin'iti% "%K&tic"

E2idnci" c$(nic" 9 d $"5or"torio d in#"!"cin !n(n'con cu$ti2o% 5"ctri"no% d rutin" n'"ti2o%,

c"u%" !.% co!n % $ ntro2iru%

2iru% d$ :r&% %i!&$ 4HS76* 2iru% d $" in!unod3cinci:u!"n" 47IH6* $ 2iru% d$ Ni$o Occidnt"$ 47NO6* $ 2iru% d2"ric$"@?o%tr 47Z76* $" &"rotiditi% 9 $ 2iru% d $"corio!nin'iti% $infoc(tic" 4LCM6,

!ico5"ctri"%* :on'o%* %&iro;ut"%* infccion%

&"r"!n(n'o%* !dic"!nto% 9 !"$i'nid"d,

Mnin'iti% 2ir"$


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Mnin'iti% 2ir"$,

Entro2iru% 4Co%"ci* 2iru% ECHO* otro% ntro2iru% no&o$io2iru%6,

LCR inici"$!nt PMNLinfocito%

PCR d LCR D 0= 4!nin'iti% "%K&tic" con cu$ti2on'"ti2o6,

7IH &r.ctic"% d ri%'o, Encf"$iti%,

7HS, Mnin'iti% 7HS@+ 4)/@/=6* ncf"$iti% 7HS@) Acic$o2ir )-!'' c


38/44

Mnin'iti% 7ir"$

Mnin'iti% !o$$"rt 4MLRB6

7HS@+ 4+-=6 / &i%odio% d 35r 9 !nin'i%!o, +@0 di"% d dur"cin c

r%o$cin %&ont.n",

Corio!nin'iti% $infocitic" 4LCM6

Orin" 9 :c% d rodor%

'ri& cf"$" 9 !nin'i%!o, or;uiti%* &"rotiditi%*

!io&ric"rditi% o "rtriti% P"rotiditi%

co!&$ic"cin tr"%"$i2"$ !.% frcunt d infccin

Sells CJ, Car"enter L, a> C. Seuelae of central;nervous;s>stem enteroviru

ons. # $ngl J Med %&'( %!*'.

Mnin'iti% "%K&tic"
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Mnin'iti% "%K&tic"

E%&iro;ut"%,

T, P"$$idu! 4infccin t!&r"n" o %i3$i% %cund"ri", B, Bur'dorfri 4cf"$"* ri'id?* &"r% cr"n"$%6

Hon'o%

Cr9&tococcu% nofor!"n 4in%idio%o, SIDA6

Coccidioido!ico%i% 4!%% d%&uK%6,

Mnin'iti% tu5rcu$o%"

&$ocito%i% !ononuc$"r

Sells CJ, Car"enter L, a> C. Seuelae of central;nervous;s>stem enteroviru

ons. # $ngl J Med %&'( %!*'.

Mnin'iti% "%K&tic"
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Mnin'iti% "%K&tic"

8unt% &"r"!nin'"%

Endoc"rditi% Mnin'iti% No&$.%ic"

Linfo!" d c$u$"% 'r"nd%* Luc!i"% "'ud"%

C" d !"!"* Pu$!n* !$"no!"* GI,

Mnin'iti% &or !dic"!nto% 4PMN6

Irrit"cin !nin'" dirct" 9 &or :i&r%n%i5i$id"d rt"rd"d

AINE%* TMP* IG I7* rofcoi5* ctui!"5* "ntico!ici"$%,

Connoll>


41/44

Mnin'iti% crnic"

> %!"n"% o !.%

Infccio%" o no infccio%" In%idio%o* cf"$"* 35r* 2!ito,

T5 >-=, )= r%&ondi " t !&irico,

Cr9&tococcu% nofor!"n% 0>=

S"rcoido%i%* 5:ct* "'nr* coccidioido!ico%i%*:i%to&$"%!o%i%* 5$"%to!ico%i%

Mnin'iti% crnic"


42/44

Mnin'iti% crnic"

PPD* R d tr"* 7DRL* 7IH

Puncin $u!5"r, Eo%ino3$i",

Nutro3$ic"

Linfocitic"

Cito!tri" d #uo* PCR,

RMN* TAC,

Bio&%i" 4/F=6

Mnin'iti% no%oco!i"$


43/44

Mnin'iti% no%oco!i"$

'r"!@n'"ti2o%//=

8"ctor% d ri%'o nurociru'(" o TCE n $ $ti!o !%*

di%&o%iti2o d nurociru'("

fu'" d LCR*

Pro3$"i%

E%&ont.n", /,0=

Cirro%i%* DM+* C.ncr* %&$ncto!(",

75

van de BeeE D, DraEe JM, -unEel A. #osocomial bacterial meningitis. # $ngl J

'&( !:%*'4:.
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GRACIASV

meningitis bacteriana pao

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