Introduction: Acute bacterial meningitis (ABM) is denifed as the inflammation of leptomeninges due to the presence of pyogenic bacteriae. Epidemiology is variable and multifactorial. In spite of advance in medicine, ABM’s mortality has remained stable, hence the need to study the causative microorganisms in order to guide prevention and treatment strategies. Objectives: To determine the prevalence of the etiological agents of ABM confirmed in adults in a medium complexity hospital located in Quillota, Chile, between 2012 and 2018, to establish the rate of resistance of these to antibiotics. Determine the profile of the patients and establish the relationship between profile, etiological agent identified and outcome. Methods: A sample of 38 cases with ABM was evaluated during, the prevalence of the pathogens involved was established and a statistical analysis was carried out considering the risk factors of patients, their days of in-hospital stay and their condition at hospital discharge. Results: We analyzed 38 cases, 15 without isolated pathogens, 13 of Streptococcus pneumoniae, 4 of Haemophilus spp., 3 of Neisseria meningitidis, 2 of Staphylococcus spp. and we obtained one case of Mycobacterium tuberculosis. In the group without isolated pathogens, a better prognosis was observed, lower blood CRP values and higher glucose on spinal fluid values. 6 deaths per ABM were recorded. Conclusion: The prevalence of etiological agents was similar to that described in the literature, with pneumococcus as the most frequent microorganism, no cases of Listeria monocytogenes were reported. Probably in the group in which no agent was isolated, cases of viral meningitis were included.

Resumen Introducción: La Meningitis Bacteriana Aguda (MBA) corresponde a la inflamación de las leptomeninges por presencia de bacterias piógenas. La epidemiología es variable y depende multifactorial. A pesar de los avances en medicina la mortalidad de la MBA se ha mantenido estable, evidenciando la necesidad de estudiar esta patología para orientar estrategias de prevención y tratamiento. Objetivos: Determinar la prevalencia de los agentes etiológicos de MBA confirmadas en adultos en el Hospital San Martín de Quillota (HSMQ) entre los años 2012 y 2018. Establecer la tasa de resistencia a antibióticos. Determinar el perfil de los pacientes, y establecer la relación entre perfil, agente etiológico identificado y desenlace. Métodos: c muestra de 38 casos, se estableció la prevalencia de los patógenos involucrados y se realizó un análisis estadístico considerando los factores de riesgo, sus días de estadía y su condición al egreso hospitalario. Resultados: 15 casos en que no se aisló patógeno en LCR (líquido cefalorraquídeo), 13 MBA por neumococo, 4 por Haemophilus spp, 3 por meningococo, 2 por Staphylococcus spp y 1 por Mycobacterium tuberculosis. En el grupo sin agente aislado se observó un mejor pronóstico, valores de PCR (proteína C reactiva) en sangre menores y valores de glucorraquia mayores. Se registraron 6 fallecimientos por MBA. Conclusión: La prevalencia de los agentes etiológicos fue similar a la descrita en la literatura, con neumococo como el microorganismo más frecuente, no se reportaron casos de Listeria monocytogenes. Probablemente en el grupo sin agente aislado se incluyeron casos de meningitis virales.

Resumo Objetivo: Estudar o desempenho do lactato no líquido cefalorraquidiano como biomarcador para diferenciar a meningite bacteriana da meningite viral em crianças, e definir uma concentração de lactato ótima no líquido cefalorraquidiano que possa ser significativa para a diferenciação. Métodos: Foram estudadas crianças com achados clínicos compatíveis com meningite. O nível de lactato no líquido cefalorraquidiano e outros parâmetros convencionais do líquido cefalorraquidiano foram registrados. Resultados: Em um valor de corte de 3 mmol/L, o lactato no líquido cefalorraquidiano apresentou uma sensibilidade de 0,90, especificidade de 1,0, valor preditivo positivo de 1,0, valor preditivo negativo de 0,963, com uma precisão de 0,972. Os índices de probabilidade positivo e negativo foram 23,6 e 0,1, respectivamente. Para comparação entre a meningite bacteriana e viral, a área abaixo da curva do lactato no líquido cefalorraquidiano foi 0,979. Conclusões: Concluímos que o lactato no líquido cefalorraquidiano possui alta sensibilidade e especificidade na diferenciação da meningite bacteriana da meningite viral. Embora em um valor de corte de 3 mmol/L o lactato no líquido cefalorraquidiano possua alta precisão de diagnóstico da meningite bacteriana, os níveis médios na meningite viral permanecem basicamente abaixo de 2 mmol/L.

Abstract Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut-off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2 mmol/L.

RESUMO Objetivo Avaliar o papel da pesquisa de enterovírus no líquido cefalorraquidiano em comparação com o Escore de Meningite Bacteriana em crianças com meningite. Métodos Coorte retrospectiva, realizada pela análise de prontuários, incluindo pacientes pediátricos, com diagnóstico de meningite e atendidos em um hospital privado e terciário, localizado em São Paulo, entre 2011 e 2014. Foram excluídos os pacientes com doença crítica, púrpura, derivação ventricular ou neurocirurgia recente, imunossupressão, outra infecção bacteriana concomitante que necessitasse de antibioticoterapia parenteral e aqueles que receberam antibiótico 72 horas antes da punção lombar. Resultados Foram incluídos no estudo 503 pacientes. Destes, 64 foram excluídos e 94 não realizaram todos os exames para análise. Dos 345 pacientes restantes, 7 ficaram no Grupo de Meningite Bacteriana e 338 no Grupo de Meningite Asséptica. Não houve diferença estatística entre os grupos. Na análise do Escore de Meningite Bacteriana, dos 338 pacientes com possível meningite asséptica (culturas negativas), 121 deles tiveram um ou mais pontos para o Escore de Meningite Bacteriana, com valor de sensibilidade de 100%, especificidade de 64,2% e valor preditivo negativo de 100%. Dos 121 pacientes com Escore de Meningite Bacteriana positivo, 71% (86 pacientes) tiveram a pesquisa de enterovírus positiva no líquido cefalorraquidiano. Conclusão A pesquisa de enterovírus no líquido cefalorraquidiano mostrou-se eficaz em diferenciar a meningite bacteriana da viral. Analisada junto com o Escore de Meningite Bacteriana, a especificidade foi maior em comparação ao Escore de Meningite Bacteriana isolado.

ABSTRACT Objective To measure the role of enterovirus detection in cerebrospinal fluid compared with the Bacterial Meningitis Score in children with meningitis. Methods A retrospective cohort based on analysis of medical records of pediatric patients diagnosed as meningitis, seen at a private and tertiary hospital in São Paulo, Brazil, between 2011 and 2014. Excluded were patients with critical illness, purpura, ventricular shunt or recent neurosurgery, immunosuppression, concomitant bacterial infection requiring parenteral antibiotic therapy, and those who received antibiotics 72 hours before lumbar puncture. Results The study included 503 patients. Sixty-four patients were excluded and 94 were not submitted to all tests for analysis. Of the remaining 345 patients, 7 were in the Bacterial Meningitis Group and 338 in the Aseptic Meningitis Group. There was no statistical difference between the groups. In the Bacterial Meningitis Score analysis, of the 338 patients with possible aseptic meningitis (negative cultures), 121 of them had one or more points in the Bacterial Meningitis Score, with sensitivity of 100%, specificity of 64.2%, and negative predictive value of 100%. Of the 121 patients with positive Bacterial Meningitis Score, 71% (86 patients) had a positive enterovirus detection in cerebrospinal fluid. Conclusion Enterovirus detection in cerebrospinal fluid was effective to differentiate bacterial from viral meningitis. When the test was analyzed together with the Bacterial Meningitis Score, specificity was higher when compared to Bacterial Meningitis Score alone.

ABSTRACT Introduction: Meningitis is an important public health problem, which affects children under 5 years of age. The most frequent etiology is viral. Since the introduction of the conjugate vaccine against H. b, S. pneumoniae and N. meningitidis, they became the most frequent agents. In the hole country, in 2014 and 2015, the viral etiology was the most frequent with values of 69% and 77%, respectively, being attributed to the bacterial ones as the second cause. Objectives: To know the epidemiological characteristics of meningitis in all ages hospitalized patients from January 2014 to October 2015 at the National Hospital of Itaugua, Paraguay. Methodology: Epidemiological, descriptive, cross-sectional study. Patients of all ages admitted with suspected meningitis and / or encephalitis were included in the study. Results: During the study, 173 probable cases of 201 suspected cases of meningitis corresponding to 0.5% (173/35140) of all hospital admissions were registered. The more affected age group was the group of children under 5 and among patients with more than 5 years, were between 5 to 14 years; In 53%, they came from the central department.98 cases (57%) were viral encephalitis; Acute bacterial meningitis 65 cases (37%); 7 cases (4%) Fungal Meningitis (Cryptococcus). Of 41 confirmed viral cases (42%), 29 cases (71%) were by Enterovirus. 18 cases of MBA were confirmed; S.pneumoniae (8) or Spn, S were identified. Aureus (4), N.meningitidis (2) or NmStreptococcus group B (1), E. coli (1), S. Epidermidis MR (1) and S. agalactiae (1); From 5 Spn the sero types / serogroups were identified: 6C / 6D (1), serotype14 (1), serotype3 (1), NmW 135 (1), Nmsero group B (1) in a young adult case. There were 3 cases of encephalitis and 9 cases of MBA. Twenty-five cases were vaccinated for Hib and 16% were vaccinated against P.pneumoniae; No vaccination has been registered for Nm. Conclusions: The total incidence of meningitis in this period of study was 173 cases. More than half of the cases were of viral etiology; The most frequently identified bacterium was S. pneumoniae. In general, the most affected age group was children under 5 years of age. The majority coming from the Central department and Cordillera. The lethality was 3% in cases of viral encephalitis; 14% in MBA and 43% in Cryptococcus meningitis. It is unknown the vaccination status of almost half of the cases especially of the anti pneumococcal.

RESUMEN Introducción: las meningitis constituyen un importante problema de Salud Pública, que afectan de manera especial a los niños menores de 5 años. La etiología más frecuente es viral. Desde la introducción de la vacuna conjugada contra H. influenzae tipo b, S. pneumoniae y N. meningitidis los virus pasaron a ser los agentes más frecuentes. A nivel país, en 2014 y 2015, la etiología viral fue la más frecuente con valores de 69% y 77%, respectivamente, atribuyéndose a las bacterianas como segunda causa. Objetivos: describir las características epidemiológicas de las meningitis, en pacientes de todas las edades internados en el lapso de enero del 2014 a octubre del 2015 en el Hospital Nacional de Itauguá, Paraguay. Metodología: estudio epidemiológico, descriptivo, transversal. Se incluye a pacientes de todas las edades que ingresaron con sospecha de meningitis y/o encefalitis en el periodo de estudio. Resultados: en el periodo de estudio ingresaron 173 casos probables de 201 casos sospechosos de meningitis correspondiendo al 0,5% (173/35140) de todos los ingresos hospitalarios. El grupo etario más afectado fue el de menores de 5 años y entre los mayores de 5 años el de 5 a 14 años. En el 53% procedieron del Departamento Central. Los cuadros clínicos fueron: 98 casos (57%) encefalitis viral, meningitis bacteriana aguda 65 casos (37%), 7 casos (4%) meningitis micótica (Criptococcus). Fallecieron 3 casos de encefalitis y 9 casos de meningitis bacteriana aguda. De 25 casos en edad de vacunarse, 52 % se vacunaron para H. influenzae b y 16% contra P. pneumoniae. No se ha registrado vacunación para N. meningitis en ningún caso. Conclusiones: la incidencia total de meningitis en este periodo de estudio fue de 173 casos. Más de la mitad de los casos fueron de etiología viral. La bacteria más frecuentemente identificada fue S. pneumoniae. En general el grupo de edad más afectado fue el de menores de 5 años. La letalidad fue de 3% en los casos de encefalitis viral, 14% en meningitis bacteriana aguda y 43% en meningitis a Criptococcus. Se desconoce el estado de vacunación de casi la mitad de los casos sobre todo de la antineumocóccica.

Resumen: La meningitis es una enfermedad cuya importancia es de Salud Pública, no solo por su incidencia, sino también por su mortalidad y secuelas en quienes la padecen. El Sistema Nervioso Central está protegido de manera especial, sin embargo los microorganismos se las ingenian para evadir las defensas; al ser infectadas las meninges, se inicia la respuesta del sistema inmune, piedra angular en la fisiopatología. La manifestación clínica puede ser muy florida, sin embargo es importante reconocer los signos claves para la sospecha oportuna y la realización de exámenes complementarios esenciales en el diagnóstico, tal como la punción lumbar; no se debe olvidar reconocer aquel paciente que previo a este procedimiento, debe de realizarse un estudio de imágenes; a pesar de esto, el inicio de los antibióticos y el uso de glucocorticoide no puede ser retrasado, y se debe administrar en el menor tiempo posible, fundamental para un mejor pronóstico del paciente.

Abstract: Meningitis is a disease which is of Public Health importance, not only for its incidence, but also its mortality and sequelae in patients. The Central Nervous System is protected in a special way; however microorganisms manage to evade the defenses. When the Meninges are infected, the Immune System’s response begins, of great significance in the pathophysiology. The clinical manifestations may be many, but it is important to recognize the key signs for suspicion and timely implementation of essential complementary tests in the diagnosis, such as lumbar puncture. It is vital to recognize the patient prior to the procedure, needs an imaging study. Despite this, the beginning of antibiotics and the use of glucocorticoid must not be delayed and should be administered as soon as possible, essential to a better prognosis.

Resumen Introducción: la meningitis es un síndrome clínico que conlleva riesgos en la morbimortalidad sobre todo en edad pediátrica, la variabilidad de las manifestaciones clínicas dependientes de la edad, ha permitido el empleo de scores que permitan objetivar la toma de decisiones sobre posibilidades etiológicas y criterios terapéuticos, tal es el caso del "Score de Boyer". Objetivo: determinar la validez del Score de Boyer y la utilidad en el diagnóstico diferencial de meningitis bacteriana y no bacteriana. Material y métodos: el presente estudio es de tipo analítico, longitudinal, prospectivo, realizado en el periodo de marzo del 2014 a enero del 2015 en el Hospital del Niño Manuel Ascencio Villarroel. La muestra fue conformada por de 32 pacientes entre las edades de 1 mes a 15 años, los cuales fueron diagnosticados de meningitis por clínica, laboratorio, y por citoquímico de líquido cefalorraquídeo. Resultados: se encontró que el 25% de la población presento el diagnóstico de meningitis bacteriana confirmado con cultivo de LCR positivo. El score de Boyer en este estudio demostró una especificidad del 92% y una sensibilidad del 100 % para el diagnóstico diferencial de meningitis bacteriana. Conclusión: el Score de Boyer es una herramienta útil, rápida, fácil para el diagnóstico diferencial de la etiología de la meningitis, en cuya asociación con otros marcadores biológicos aumenta su sensibilidad y especificidad.

Abstract Introduction: meningitis is a clinical syndrome that carries risks in morbidity and mortality especially in pediatric patients, the variability of the dependent clinical manifestations of age, has allowed the use of scores that allow objectify decisions on etiological possibilities and therapeutic criteria, as in the case of "Boyer Score". Objective: to determine the validity of Score Boyer and utility in the differential diagnosis of bacterial and non-bacterial meningitis. Methods: this study is analytical, longitudinal, prospective, conducted in the period from March 2014 to January 2015 in the Children's Hospital Manuel Ascencio Villarroel. The study group was made up of 32 patients between the ages of 1 month to 15 years who were diagnosed with meningitis by clinical, laboratory, and cytochemical CSF. Results: we found that 25% of the population presented the diagnosis of bacterial meningitis confirmed positive CSF culture. Boyer's score in this study showed a specificity of 92% and a sensitivity of 100 %for the differential diagnosis of bacterial meningitis. Conclusión: the Score Boyer is a useful, fast, easy for the differential diagnosis of the etiology of meningitis, whose association with other biological markers increases the sensitivity and specificity tool.

A apoplexia é uma síndrome clínica rara, mas potencialmente fatal, caracterizada por infarto isquêmico ou hemorragia em um tumor pituitário. O diagnóstico de apoplexia de tumor pituitário é frequentemente complicado pela natureza inespecífica dos seus sinais e sintomas, que podem simular diferentes processos neurológicos, incluindo a meningite. Vários fatores estão associados com a apoplexia, como o uso de agonistas dopaminérgicos, radioterapia ou trauma da cabeça, mas a meningite foi raramente relatada. Descrevemos o caso de uma mulher de 51 anos de idade com acromegalia por um macroadenoma pituitário. Antes do tratamento cirúrgico, ela foi trazida ao pronto-socorro com febre, náusea, vômitos e meningismo. Os sintomas e análises laboratoriais sugeriram meningite bacteriana e o tratamento com antibióticos foi iniciado, com melhora rápida dos sintomas. Uma tomografia computadorizada (CT) na admissão ao hospital não revelou nenhuma alteração no adenoma pituitário, mas algumas semanas depois uma ressonância magnética (MRI) mostrou informações de apoplexia pituitária, com desaparecimento completo do adenoma. Atualmente, a acromegalia está curada, mas ela desenvolveu hipopituitarismo e diabetes insipidus depois da apoplexia. Questionamo-nos se a paciente realmente apresentou meningite que levou à apoplexia ou se a apoplexia foi mal interpretada como sendo meningite. A relação entre a meningite e a apoplexia pode ser bidirecional. A apoplexia pode simular a meningite viral ou bacteriana, mas a meningite também pode causar apoplexia. Esse fato enfatiza a importância do diagnóstico diferencial ao se avaliar pacientes com adenomas pituitários e sintomas neurológicos.

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterized by ischemic infarction or hemorrhage into a pituitary tumor. The diagnosis of pituitary tumor apoplexy is frequently complicated because of the nonspecific nature of its signs and symptoms, which can mimic different neurological processes, including meningitis. Several factors have been associated with apoplexy, such as dopamine agonists, radiotherapy, or head trauma, but meningitis is a rarely reported cause. We describe the case of a 51-year-old woman with acromegaly due to a pituitary macroadenoma. Before surgical treatment, she arrived at Emergency with fever, nausea, vomiting and meningismus. Symptoms and laboratory tests suggested bacterial meningitis, and antibiotic therapy was initiated, with quick improvement. A computerized tomography (CT) scan at admission did not reveal any change in pituitary adenoma, but a few weeks later, magnetic resonance imaging (MRI) showed data of pituitary apoplexy with complete disappearance of the adenoma. Currently, her acromegaly is cured, but she developed hypopituitarism and diabetes insipidus following apoplexy. We question whether she really experienced meningitis leading to apoplexy or whether apoplexy was misinterpreted as meningitis. In conclusion, the relationship between meningitis and pituitary apoplexy may be bidirectional. Apoplexy can mimic viral or bacterial meningitis, but meningitis might cause apoplexy, as well. This fact highlights the importance of differential diagnosis when evaluating patients with pituitary adenomas and acute neurological symptoms.

The objective of this review is an update on etiology, diagnosis, prevention and treatment of meningitis after spinal anesthesia and analgesia. Although it is a major complication of this technique and its incidence is low, there are more and more frequent cases in the medical literature. According to its etiology are classified in septic meningitis, viral and aseptic. The septic meningitis are the most common, and its etiology increasingly plays a more prominent role as Streptococcus salivarius agent involved. Aseptic meningitis are classified as those in which cerebrospinal fluid culture is negative, with a latency period of symptoms less than six hours, which may present with eosinophilia in the cerebrospinal fluid and levels close to normal in the CSF glucose. They usually have good response and evolution with antibiotic treatment with vancomycin and third-generation cephalosporins. Prophylaxis influence the aseptic precautions, especially the use of a face mask to perform the technique, as practical to reduce the incidence of bacteria whose origin is in the oral cavity and oropharynx. They could also reduce the incidence of aseptic meningitis measures such as hand washing, use of gloves and skin antisepsis. The differentiation between aseptic meningitis and septic will more securely when standardize techniques for detecting bacterial genome in the cerebrospinal fluid, now labeled as aseptic meningitis those in which cerebrospinal fluid culture is negative and whose negative Gram stain. Although the prognosis and evolution in general features of meningitis after spinal anesthesia and analgesia is good, compared with community-acquired meningitis, the low virulence of the bacteria involved (Streptococcus salivarius), cases have been described with poor outcome suppurative meningoencephalitis have led to death within hours.

El objetivo de esta revisión es una puesta al día en la etiología, diagnóstico, profilaxis y tratamiento de la meningitis tras anestesia y analgesia espinales. Aunque es una complicación mayor de esta técnica y su incidencia es baja, cada vez son más frecuentes los casos publicados en la literatura médica. Según su etiología se les clasifica en meningitis sépticas, víricas y asépticas. Las meningitis sépticas son las más frecuentes, y en su etiología cada vez juega un papel más destacado como agente implicado el estreptococo salivarius. Como meningitis asépticas se clasifican aquellas en las que el cultivo de líquido cefalorraquídeo es negativo, con un periodo de latencia de síntomas inferior a seis horas, que pueden cursar con eosinofilia en el líquido cefalorraquídeo y unos niveles cercanos a la normalidad en la glucorraquia. Suelen tener buena respuesta y evolución con tratamiento antibiótico con vancomicina y cefalosporinas de tercera generación. Como profilaxis incidir en las medidas de asepsia, sobre todo en el uso de mascarilla facial para realizar la técnica, como práctica para disminuir la incidencia de gérmenes cuyo origen está en la cavidad oral y orofaringe. Asimismo podrían reducir la incidencia de meningitis las medidas de asepsia tales como el lavado de manos, uso de guantes y asepsia de la piel. La diferenciación entre meningitis séptica y aséptica se hará con mayor seguridad cuando se estandaricen las técnicas para detectar genoma bacteriano en el líquido cefalorraquídeo; actualmente se etiquetan como meningitis asépticas aquellas en las que el cultivo de líquido cefalorraquídeo es negativo y cuya tinción de Gram es negativa. Pese a que el pronóstico y evolución en rasgos generales de las meningitis tras anestesia y analgesia espinal es bueno, en comparación con las meningitis adquiridas en la comunidad, por la escasa virulencia de las bacterias implicadas (Estreptococo salivarius), hay descritos casos con mala evolución de meningoencefalitis supurativa que han llevado a la muerte en pocas horas.

INTRODUCTION. The aim of present research was to present the antibiotic-therapy experience in febrile newborn (NB) presenting with cerebrospinal fluid pleocytosis (CSFP) and supposed viral meningitis. METHODS. A retrospective study was conducted in 310 NB diagnosed with aseptic meningitis admitted in the Neonatology Service of the "Juan Manuel Márquez" Children University Hospital between 1992 and 2009. Using the descriptive statistic method the indication or not of antibiotic treatment, moment and indication reasons were determined. RESULTS. There were 204 NB (65,8%) presenting with aseptic meningitis favorably discharged without antibiotic treatment. In 106 NB (34,2%) antibiotics were prescribed (in 76 immediately to be diagnosed with meningitis and in 30 cases, due to different reasons. The reasons for immediate treatment were mainly the results of cytochemical examination of CSF very similar to that of bacterial meningitis and backgrounds of a high or persistent fever. In mediate indication the main reason was the concurrence urinary tract infection. In patients that never were received antibiotic treatment, the hospital stay mean was of 4 days (inter-quartile interval 3-5 days), and for those that received treatment it was of 5 days (inter-quartile 3-7 days) (p < 0,0001). CONCLUSIONS. It is advisable to review the approach to use the antibiotic treatment in the case of a NB from the community when there is CSF pleocytosis and the supposed existence of viral meningitis provided that there are conditions of qualified and continuous professional surveillance and a laboratory with enough resources to support a treatment strategy with a rational use of the antibiotic therapy.

INTRODUCCIÓN. El objetivo de esta investigación fue presentar la experiencia en antibioticoterapia en recién nacidos (RN) febriles con pleocitosis del líquido cefalorraquídeo (LCR) y presunción médica de meningitis viral. MÉTODOS. Se realizó un estudio retrospectivo con 310 RN con diagnóstico de meningitis aséptica, ingresados en el Servicio de Neonatología del Hospital Pediátrico Universitario «Juan Manuel Márquez» entre 1992 y 2009. Se determinó, utilizando estadística descriptiva, la indicación o no de tratamiento antibiótico, momento y motivos de la indicación. RESULTADOS. Hubo 204 RN (65,8 %) con meningitis aséptica que egresaron favorablemente sin haber recibido tratamiento antibiótico. En 106 RN (34,2 %) se indicaron antibióticos (en 76 inmediatamente al diagnóstico de meningitis y en 30 casos, mediatamente por diversos motivos). Los motivos para tratamiento inmediato fueron principalmente los resultados del examen citoquímico del LCR muy semejantes a los de una meningitis de causa bacteriana y los antecedentes de fiebre elevada o persistente. En la indicación mediata el principal motivo fue la concurrencia de infección del tracto urinario. En los pacientes que nunca recibieron tratamiento antibiótico, la mediana de estadía hospitalaria fue de 4 días (intervalo intercuartil 3-5 días) y para los que sí lo recibieron fue de 5 días (intervalo intercuartil 4-7 días) (p < 0,0001). CONCLUSIONES. Es aconsejable revisar el enfoque de utilizar tratamiento antibiótico ante todo RN proveniente de la comunidad cuando se encuentra pleocitosis del LCR y se presume la existencia de una meningitis viral, siempre y cuando existan condiciones de vigilancia profesional calificada y continua, y un laboratorio de microbiología con recursos suficientes para respaldar una estrategia de tratamiento con uso racional de la antibioticoterapia.

La neuroinfección es un cuadro muy importante dentro de la salud, no tanto por su frecuencia, mas por su gravedad y pronóstico ya que un alto porcentaje se recuperan con secuelas neurológicas. Objetivo: Conocer las características de la neuroinfección en los niños menores de 14 anos que se internaron en el Hospital del Niño Dr. Ovidio Aliaga Uría. Metodología: Es un estudio descriptivo retrospectivo, donde se revisó historias clínicas de todos los niños menores de 14 años que fueron internados con el diagnostico de meningitis en los últimos 10 años. Resultados: Ingresaron 280 historias, el 44,6% correspondió a meningitis bacteriana, 32.1% tuberculosa, 16,4% viral y en 6,8% no se obtuvo germen. Clínicamente la fiebre, convulsiones e hipoactividad son los síntomas y signos más frecuentes. H. influenzae el agente más encontrado. Un 60% de los que cursan con meningitis bacteriana recibió la vacuna pentavalente. Conclusiones: Las infecciones del SNC representan actualmente el 0,3% de las internaciones, hace 10 años representaba el 1,2% del total de las hospitalizaciones en nuestro nosocomio. El origen bacteriano es el más frecuente.

Neuroinfections in children is a serious disease with high morbidity and mortality. Objectives: To describe the characteristics of meningitis en children less than 14 years of age admitted to the Hospital del Niño "Ovidio Aliaga Uría". Methods: Retrospective and descriptive study of children under 14 years of age with the diagnosis of meningitis Results: Of 280 cases, 44.6% were bacterial meningitis, 32.1% tuberculous meningitis and 6.8% with negative cultures. The prevalent signs were: fever, seizures and hypoactivity. The most common bacteria were H. Influenzae. 60% of children received the pentavalent vaccine. Conclusions: 0.3% of the present admissions to our hospital is due to meningitis; ten years ago they represented 1.2% of the admissions. Bacterial meningitis is the most common cause.

Objectives: To analyze risk factors for serious bacterial illness (SBI) in children less than 2 years of age admitted with fever without source. Population: Children under 2 years admitted at the Pediatric Service of Sanatorio Mater Dei from May 2004 to December 2005. Design: Observational, prospective and longitudinal study. Materials and Methods: Independent variables: age, gender, siblings, household viral infections, day care attendance, vaccination, season, laboratory data, Rochester criteria, YIOS scale, antibacterial treatment, length of hospitalization, and final diagnosis. A multiple logistic regression stepwise model was used. Results: 70 out of 201 patients developed SBI, 56 were under 3 months of age. Predominant diagnosis were: urinary tract infection (n: 47), meningitis (n: 11) and bacteremia (n: 9). Predictive factors: white-cells count > 15.000/mm³ (coef 1.05, OR = 2.17, 95% CI 1.13-4.15) and household viral contact (coef -0.79, OR 0.42, CI 0.23-0.77). Conclusions: Risk factor for SBI was leucocytes count >15.000/mm³. Household viral contact proved being a protective factor.

Objetivo: Analizar los factores de riesgo asociados a infección bacteriana grave (IBG) en niños < 2 años internados por fiebre sin foco aparente. Población: Niños bajo 2 años de edad internados en el Servicio de Pediatría del Sanatorio Mater Dei entre mayo 2004 y diciembre 2005. Diseño: Observacional, prospectivo, longitudinal. Material y Métodos: Variables independientes: edad, sexo, hermanos, infección viral en el hogar, concurrencia a jardín maternal, vacunación, época del año, laboratorio, criterios de Rochester y escala de YIOS, tratamiento antimicrobiano, días de internación y diagnóstico final. Se utilizó un modelo de regresión logística múltiple por pasos. Resultados: Setenta IBG de 201 pacientes, 56 < 3 meses de edad. Diagnósticos principales: infección urinaria (n: 47), meningitis (n: 11), bacteriemias (n: 9). Factores predictores: recuento de leucocitos > de 15.000/ mm³ (coef. 1,05 OR: 2,17 IC 1,13-4,15) e infección viral en el hogar (coef. -0,79 OR 0,42, IC 0,23- 0,77). Conclusiones: El factor asociado a IBG fue recuento de leucocitos > 15.000/mm³. La presencia de infección viral en el hogar demostró ser un factor de protección.

Introducción: La difícil interpretación de los hallazgos sugestivos de meningitis bacteriana y viral en el líquido cefalorraquídeo con frecuencia imposibilita su diferenciación. Por décadas, los investigadores han intentado crear escalas predictivas que permitan resolver tal disyuntiva. El objetivo del presente trabajo es determinar la validez y seguridad de una escala clínica predictiva para el diagnóstico de meningitis bacteriana en Pediatría. Métodos: Realizamos un estudio retrospectivo, transversal, de evaluación de una prueba diagnóstica en una muestra de pacientes con edades entre 29 días y 12 años, egresados con diagnóstico de meningitis entre enero de 1992 y diciembre de 2006, del Departamento de Pediatría del Hospital “Dr. Jesús Yerena”, ubicado en Caracas, Venezuela. Aplicamos una escala clínica predictiva y calculamos su sensibilidad, especificidad, valores predictivos y razones de verosimilitud para el diagnóstico de meningitis bacteriana. Resultados: La muestra estuvo conformada por 41 pacientes. Predominó el sexo masculino (n=29; 70,73 %). El grupo etareo más afectado fue el de los lactantes menores (n=26; 63,41 %). Se identificaron 14 meningitis bacterianas y 27 asépticas. Mediante la escala clínica predictiva se clasificaron 31 meningitis como de alto riesgo de meningitis bacteriana y 10 como de bajo riesgo. La sensibilidad y valor predictivo negativo fueron de 100 %. Conclusiones: La escala clínica predictiva aplicada resultó ser válida y segura para descartar meningitis bacteriana.

Introduction: The overlapping of findings suggestive of bacterial or viral meningitis in cerebrospinal fluid makes it difficult to differentiate one of another. For decades, investigators have attempted to create clinical prediction scores to resolve such disjunctive. The objective of this investigation was to determine the validity and safety of a clinical prediction score for the diagnosis of bacterial meningitis in childhood. Methods: We performed a retrospective, transversal, diagnostic test evaluation study of a sample of patients between 29 days to 12 years of age, discharged from January 1992 to December 2006, with diagnosis of meningitis, from the Pediatrics Department of Dr. Jesús Yerena Hospital, in Caracas, Venezuela. The clinical prediction score was applied. We evaluated its validity and safety with the calculation of sensibility, specificity, predictive values and likelihood ratios for the diagnosis of bacterial meningitis. Results: A total of 41 patients were included. Male gender was more common (n= 29; 70,73 %). The infant age group was predominant (n=26 ; 63,41 %). We identified 14 bacterial meningitis and 27 aseptic meningitis. With the clinical prediction score, 31 meningitis were classified as high risk of bacterial meningitis and 10 as low risk. The sensibility and the negative predictive value were 100 %. Conclusions: The clinical prediction score applied resulted to be valid and safe for identifying patients without bacterial meningitis.

Cerebrospinal fluid (CSF) provides mechanical support and contributes to the control of the cerebral chemical environment. Meningitis is the most common of the infections that affect the nervous central system and can progress rapidly producing important brain damage. Bacterial meningitis gives rise to a reduction in the irrigation of the brain, followed by hypoxia, anaerobic catabolism with the formation of lactic acid (LA) and increase in its level in cerebrospinal fluid. In order to carry out an earlier diagnosis, lactic acid levels were studied, trying to demonstrate the importance of the determination of this parameter, correlate the levels with those of other components, and obtain limit values to differentiate the different groups in the paediatric population. A prospective study was performed in which samples of patients suspected of having meningitis, who were admitted into hospital and/or attending the emergency service of the Children's Hospital of Cordoba, Argentina were analysed. The increase in the levels of lactate was one of the most reliable pieces of information in the diagnosis of BM, comparing it with the rest of the parameters studied and differentiating it from the control group or with viral encephalitis. The levels of LA and lactate dehydrogenase (LD) enabled the observation of subpopulations according to the virulence of the causal agent and the intensity of the pathological manifestations in the BM group.

El líquido cefalorraquídeo (LCR) proporciona un sostén mecánico y contribuye al control del medio químico cerebral. La meningitis es la más común de las infecciones que afectan el sistema nervioso central (SNC) y puede progresar rápidamente produciendo un daño cerebral importante. En la meningitis bacteriana (MB) se produce una disminución de la irrigación cerebral, seguida de hipoxia, catabolismo anaeróbico con formación de ácido láctico (AL) y aumento de su nivel en LCR. Con el fin de realizar un diagnóstico precoz se estudiaron los niveles de AL intentando demostrar la importancia de la determinación de este parámetro, correlacionar sus niveles con los de otros componentes y obtener valores límite para diferenciar los distintos grupos en la población pediátrica. Se realizó un estudio prospectivo en el cual se procesaron muestras de pacientes internados y/o atendidos en el servicio de emergencia del Hospital de Niños de Córdoba, Argentina, con sospecha de meningitis. El aumento de los niveles de lactato fue uno de los datos más confiables en el diagnóstico de meningitis bacteriana al ser comparado con el resto de los parámetros estudiados, diferenciándose del grupo control o con encefalitis viral. Los niveles de AL y lactato dehidrogenasa (LD) permitieron observar subpoblaciones según la virulencia del agente causal e intensidad del cuadro patológico en el grupo con MB.

INTRODUÇÃO: a infecção do sistema nervoso central permanece como um problema de saúde pública em diversos países, havendo uma relação direta entre pobreza e subdesenvolvimento e taxas mais elevadas de morbidade e mortalidade. As crises convulsivas correspondem a uma das complicações das infecções centrais, representando uma emergência clínica e necessitando investigação neurológica. OBJETIVO: neste artigo nosso objetivo foi descrever a incidência e os fatores de risco para crises convulsivas em crianças com infecções do sistema nervoso central. MÉTODOS: estudo retrospectivo realizado entre 01/10/2007 e 01/10/2008 sendo avaliados todos os pacientes internados com diagnóstico de infecção do sistema nervoso central. Foram excluídos os recém nascidos. Os pacientes foram divididos em GRUPO 1 (sem crise convulsiva) e GRUPO 2 (com crise convulsiva) para análise. RESULTADOS: foram incluídos 731 paciente, 47,75% do sexo masculino, com idade média de 15,7 anos. GRUPO 1 - predomínio de febre (652/92,35%), cefaléia (580/82,15%), vômitos (550/77,90%) e do diagnóstico de meningite viral (657/93,06%). No GRUPO 2 - predomínio de febre (25/100%), vômitos (12/48%), cefaléia (6/24%) e do diagnóstico de encefalite viral (14/56%). Dez (40%) pacientes do GRUPO 2 apresentaram alteração no EEG. A incidência de crise convulsiva foi de 3,42% e houve diferença estatisticamente significativa quanto a idade média (p<0,000069), presença de cefaléia (p<0,0000), vômitos (p<0,0005), rigidez de nuca (p<0,0105) e sonolência (p<0,0265). CONCLUSÕES: crise convulsiva durante o internamento é significativamente mais freqüente nos casos de encefalite viral e meningite bacteriana quando comparado à meningite viral. Quanto menor a idade da criança maior o risco de crise convulsiva durante o internamento. Cefaléia, vômitos, rigidez de nuca e sonolência são mais freqüentes nas crianças com infecção do sistema nervoso central que apresentam crise convulsiva no internamento.

INTRODUCTION: The infections of the central nervous system remain as a public health problem in several countries and there is a direct relation between poverty and underdevelopment with high mortality and morbidity rates. Seizures represents a complication related to infections of the central nervous system, are considered a clinical emergency and requiring neurological investigation. OBJECTIVE: In this article, we propose to describe the incidence and risk factors for seizures in central nervous system infections in childhood. METHODS: a retrospective study was performed between October 2007 and October 2008 and all patients who were hospitalized with the diagnosis of infections of the central nervous system were analyzed. Newborns were excluded. The patients were divided into GROUP 1 (without seizures) and GROUP 2 (with seizures). RESULTS: 731 patients were included, 47.75% males, with average age of 15.7 years. GROUP 1 - with fever (652/92.35%), headache (580/82.15%), vomits (550/77.9%), and viral meningitis predominance (652/93.06%). GROUP 2 - with fever (25/100%), vomits (12/48), headache (6/24%), and viral encephalitis predominance (14/56%). Ten (40%) patients from the GROUP 2 presented EEG alterations. The incidence of seizures was 3.42% and a significant statistical difference was noticed related to mean age (p<0.000069), presence of headache (p<0.0000), vomits (p<0.0005), stiff neck (p<0.0105) and drowsiness (p<0.0265). CONCLUSIONS: the occurrence of seizures during the hospitalization is significantly more frequent in cases of viral encephalitis and bacterial meningitis compared to viral meningitis. The risk of seizures increases in early ages. Headache, vomits, stiff neck and drowsiness are more frequent symptoms in children with infection of the central nervous system who presented seizures during the hospitalization.

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.

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.