Çocuklarda Akut Bakteriyel Menenjitlere Güncel Yaklaşım

Abstract

Erken çocukluk döneminde komplikasyonlarının ağır seyretmesi ve uzun dönem morbiditesinin yüksek olması nedeniyle akut bakteriyel menenjit bu yaş grubunda en önemli enfeksiyonlar arasında yer alır. Menenjit etkenleri yaşa, konak faktörlerine, yaşanılan bölgelere göre farklılık gösterir. Menenjitin semptom ve bulguları sistemik enfeksiyonla ilişkili ateş, iştahsızlık, zayıf beslenme, baş ağrısı, üst solunum yolu enfeksiyon semptomları gibi nonspesifik bulgulardan, meningeal iritasyon bulguları, kafa içi basınç artışı sendromu ve nöbetlere kadar değişiklik gösterir. Akut bakteriyel menenjitin erken tanısı ve tedavisine hızla başlanması hastalığın prognozu açısından çok önemlidir. Tanıda altın standart yöntem, etkenin beyin omurilik sıvısında gösterilmesidir. Tedavi protokolü enfeksiyonun eradikasyonu için en kısa zamanda uygun antibiyotik tedavisinin başlanması, enfeksiyona bağlı sekellerin en aza indirilmesi ve eğer kardiyopulmoner bozukluk varsa destek sağlanmasıdır. Aşılama ve kemoprofilaksi bakteriyel menenjit gelişimini azaltan iki önemli antitedir. Türkiye’de pnömokok ve Hib aşılarının ulusal aşı programına dahil edilmesiyle meningokok menenjitinin görülme sıklığı artmıştır. Meningokok aşısı risk grubundakilere kuvvetle önerilirken, yaygınlığı dünyada bölgesel olarak değişiklik gösterdiğinden aşı tercihi, lokal epidemiyolojik ve ekonomik değerlendirmelere göre ülke bazında yapılmalıdır.

Keywords

• çocuk
• menenjit
• meningokok aşısı
• tedavi

Current Approach to Acute Bacterial Meningitis in Children

Abstract

In early chilhood, due to severe course of complications and long term morbidity, acute bacterial meningitis is one of the most important infection diseases. Causative agents are different according to age, host factors and living areas. Meningeal symptoms and findings vary from non-spesific findings such as fever, poor feeding, head ache, upper airway infection sypmtoms to meningial irritation findings,increased intracranial pressure syndrome and seizures. Early diagnosis and rapid treatment of acute bacterial meningitis is very important for the prognosis of the disease. The gold standart of the diagnosis is showing the agent in cerebrospinal fluid. The treatment protocol includes starting appropriate antibiotics rapidly, minimizing sequelaes due to infection and providing supportive treatment if there is a cardiopulmonary disorder. Vaccination and chemoprophylaxis are two important entities that reduce the development of bacterial meningitis. In Turkey since the addition of Hib and pneumococcal vaccines to national vaccine programme, the incidence of meningococcus meningitis has increased. While the meningococcal vaccine is strongly recommended for risk groups, since its prevalence varies regionally in the world, the choice of vaccine should be made on country basis according to local epidemiological and economic evaluations.

Keywords

• child
• meningitis
• meningococcal vaccine
• treatment

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