RESUMEN
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.
Asunto(s)
Meningitis Bacterianas/terapia , Meningitis Viral/terapia , Adolescente , Brasil , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Meningitis/etiología , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/psicología , Meningitis Viral/diagnóstico , Meningitis Viral/psicología , Estudios RetrospectivosRESUMEN
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.
Asunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/terapia , Meningitis Viral/terapia , Brasil , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/psicología , Meningitis Viral/diagnóstico , Meningitis Viral/psicología , Meningitis/etiología , Estudios RetrospectivosRESUMEN
The neurologic, psychologic, language, and academic skills were evaluated and compared in children who had had enteroviral meningitis in infancy and their siblings. The study population consisted of 45 children in whom enteroviral meningitis developed between the ages of 4 days and 12 months. Three died of heart failure caused by viral myocarditis. Thirty-three survivors and 31 siblings were comprehensively evaluated with physical and neurologic examinations; hearing, vision, and achievement tests; and tests of cognitive, perceptual-motor, language, memory, and emotional-behavioral functions. The remaining nine survivors of meningitis and eight of their siblings were assessed by telephone interviews and analysis of school and medical records. None of the survivors had major adverse neurologic sequelae. In addition, they performed as well as their siblings on all tests administered. Our study did not demonstrate either overt or covert impairments of neurologic function or development in survivors of infantile enteroviral meningitis.