Perfil etiológico das meningites bacterianas em crianças

Abstract

Artigo submetido em 25.06.02, aceito em 11.09.02. ResumoObjetivo: analisar o perfil etiológico e alguns aspectos epidemiológicos das crianças com meningite bacteriana, internadas em um hospital público universitário.Métodos: foram seguidas, prospectivamente, as crianças internadas com meningite bacteriana, diagnosticada segundo os critérios clínicos e laboratoriais habituais. Foram excluídos os casos de meningite pós-trauma, de meningite na vigência de derivação liquó-rica, ou de defeitos congênitos do tubo neural, e de meningite tuberculosa.Resultados Results: from a total of 415 children with bacterial meningitis, the etiologic agent was detected in 315 (75.9%): Haemophilus influenzae b in 54.2%, meningococci in 20.6%, pneumococci in 18.1% and other agents, in 6.9%. Previous antibiotic treatment, observed in 47.2% of the cases, led to a significant decrease in positive blood cultures (from 50.8% to 38.7%) and in cerebrospinal fluid cultures (from 71.7% to 57.6%). Among children younger than 48 months Haemophilus influenzae b was predominant, particularly when compared to meningococci. The overall mortality was 10.1%, with a significant difference between the rates of pneumococcal (17.5%) and meningococcal meningitis (4.6%).Conclusions: children affected by Haemophilus influenzae b and by pneumococci were younger than those with meningitis caused by meningococci. The blood and/or cerebrospinal fluid culture remains an important laboratory tool for etiologic diagnosis, despite the negative impact caused by antibiotic previous treatment. The agents most commonly detected were Haemophilus influenzae b, meningococci and pneumococci. Bacterial meningitis continues to present an important mortality among children, particularly when caused by pneumococci.

Epidemiological profile of meningococcal disease in the State of Minas Gerais and in the Central, North, and Triângulo Mineiro regions, Brazil, during 2000-2009

“…Considering the absolute frequency of the cases, the highest ratio was observed in males of the 1-4-years age group in MG, which agrees with the findings of other studies [24][25][26] . Possible explanations for the high proportion of male cases are the facts that men have a tendency of taking less care of their health, expose themselves to a higher amount of risky situations, and seek the help of health care services less often than women.…”

“…21 These data suggest that the underreporting of meningitis cases due to the lack of a standardized system and the consolidation of information resulting from the decentralization of the system with the transfer of data entry to the Regional Health Management and, later, to almost all municipalities in the state, added to the constant turnover of epidemiological surveillance technicians [22][23][24] .…”

Epidemiological profile of acute bacterial meningitis in the state of Rio Grande do Norte, Brazil

“…The high rate of failure to determine the etiological agent at GTH is consistent with other Brazilian reports, which range from 46.8 to 55.5% 3,6 . Although only 6.5% of the patients in the current study reported previous use of antibiotics, which is most likely an underestimation, the low bacterial culture rate is probably greatly affected by the previous use of antibiotics 5 . In a Brazilian national study conducted by Mantese et al 5 , 47.2% of the patients reported previous antibiotic use 5 .…”

“…The initial antibiotic regimen is usually empirical, and therefore, knowledge of the epidemiological profile of ABM in the community could lead to the best therapeutic choice 5 .…”

Bacterial meningitis and living conditions

“…The last 2 are the predominant etiological agents in countries where the Hib conjugate vaccine is used routinely [6][7][8][9][10] . Despite the positive effect obtained with the widespread use of this vaccine and also the growing trend toward the use of meningococcal and pneumococcal conjugate vaccines of specific serogroups or serotypes, these forms of meningitis remain a significant public health problem in poorer countries and regions, particularly among children 6,7,9,[11][12][13][14][15][16] .…”