Çocuklarda Akut Bakteriyel Menenjitlere Güncel Yaklaşım

Year 2021, Volume: 15 Issue: 5, 437 - 446, 23.09.2021

Sevim Gonca Kocagözoğlu , Aslınur Özkaya Parlakay

https://doi.org/10.12956/tchd.848175

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

References

• Prober CG, Srinivas NS, Mathew R. Central Nervous System Infections. In: Kliegman R, Stanton B, St. Geme J, Schor N (eds), Nelson Textbook Of Pediatrics 20th Edition. Philadelpia: Elsevier Inc 2016:2936-48.
• Sarıtaş Nakip Ö, Merkezi Sinir Sistemi Enfeksiyonları. In: Yurdakök M (ed) Yurdakök Pediatri, Ankara, Güneş Tıp 2016: 2533-50.
• Castelblanco RL, Lee MJ, Hasburn R. Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based obsevational study. Lancet Infect Dis 2014;14: 813-9.
• Ceyhan M, Gürler N, Ozsurekci Y, Keser M, Aycan AE, Gurbuz V, et al. Meningitis caused by Nesisseria meningitidis, Hemophilus influenzae type b and Streptococcus pneumoniae during 2005-2012 in Turkey. Hum Vaccin Immunother 2014;10: 2706-12.
• Ceyhan M, Ozsurekci Y, Tanır Basaranoglu S, Guler N, Sali E, Keser Emiroğlu M, et al. Multicenter Hospital-Based Prospective Surveillance Study of Bacterial Agents Causing Meningitis and Seroprevalence of Different Serogroups of Neisseria meningitidis, Haemophilus influenzae Type b, and Streptococcus pneumoniae during 2015 to 2018 in Turkey. mSphere 2020;5: e00060-20.
• Gaschigard J, Levy C, Romain O, Cohen R, Bigen E, Aujard Y. Neonatal bacterial meningitis: 444 cases in 7 years. Pediatr Infect Dis J 2011;3013: 212-7.
• Basmaci R, Bonacorsi S, Bidet P, Biran V, Aujard Y, Birgen E, et al. Escherichia coli meningitis features in 325 children from 2001 to 2013 in France. Clin Infect Dis 2015 1;61: 779-86.
• Mook-Kanamori BB, Celdhoff M, Van der Poll T, Van de Beek D. Pathogenesis and pathophysiology of pneumococcal meningitis. Clin Microbiol Rev 2011;24: 557-91.
• Clinical Overview Bacterial Meningitis in Children. Clinical Key. Erişim tarihi 12. Mart.2018. Available from: https://www.clinicalkey.com/#!/content/clinical_overview/67-s2.0-fc8fff12-52f7-4261-8054-c4c944a7386f
• Heckenberg SGB, Brouwer MC, Van de Beek D. Bacterial meningitis. In: Biller J, Ferro JM. (eds) Handbook of Clinical Neurology, vol 121 (3rd series) Neurologic aspect of systemic disease part III. Elsevier Inc 2014:1361-75.
• Tacon CL, Flover O, Diagnosis and management of bacterial meningitis in the pediatric population: a review. Emerg Med Int 2012; 2012:320309.
• Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010;23: 467-92.
• Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004 1:39:1267-84.
• Henry BM, Roy J, Ramakrishnan PK, Vikse J, Tomoszewski KA, Walocha JA. Procalcitonin as a serum biomarker for differantiation of bacterial meningitis from viral meningitis in children: evidence from a meta-analysis. Clin Pediatr (Phila) 2016; 55:749-64.
• Feigin RD, Cutrer WB. Bacterial meningitis beyond the neonatal period. In: Cherry J, Demmler-Harrison GJ, Kaplan SL, Steinbach WJ, Hotez (eds). Feigin & Cherry’s Textbook of Pediatric Infectious Diseases (6th Edition). Philadelphia: Saunders Elsevier 2009: 439-72.
• Roos KL. Encephalitis. In: Biller J, Ferro JM (eds). Handbook of Clinical Neurology. Neurologic Aspects of Systemic Disease. Elsevier 2014:121.
• Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015;2015:CD004405.
• Edmond K, Clark A, Korzack VS, Sanderson C, Graffiths UK, Rudan I, Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis 2010;10:317-328.
• Ciofi delgi Atti M, Esposito S, Paola L, Rava L, Gargantini G, Langi R. In-hospital management of children with bacterial meningitis in Italy. Italy J Pediatr 2014, 40:87
• Tibussek D, Sinclair A, Teatero S, Fitipaldi N, Richardson SE, Mayatepek E, et al. Late onset group B Streptococcal meningitis has cerebrovascular complications. J Pediatr 2015;166:1187-92.
• Snedeker JD, Kaplan SL, Dodge PR, Holmes SJ, Feigin RD. Subdural effusion and its relationship with neorologic sequelae of bacterial meningitis in infancy: a prospective study. Pediatrics 1990;86:163-70.
• Moore MR1, Link-Gelles R2, Schaffner W3, Lynfield R4, Lexau C4, Bennett NM, et al. Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance. Lancet Infect Dis 2015;15:301-9.
• CDC: Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2017. CDC website. Published 2017. http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
• Schuchat A1, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, Lefkowitz L. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med1997 337:970-6.
• Kara M, Somer A, Meningokok Aşıları, Çocuk Dergisi 2019;19:51-9.
• Acevedo R, Bai X, Borrow R, Caugant DA, Carlos J, Ceyhan M, et al The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations, Expert Rev Vaccines 2018;18:15-30.
• Meningokok Aşıları Uygulama Önerileri, Mehmet Ceyhan 2019, https://www.klimik.org.tr/wp-content/uploads/2019/11/meningokok-klimik_compressed.pdf
• Logan SA, McMahon E, Viral meningitis BMJ 2008;336:36-40.
• Irani D, Aseptic meningitis and viral myelitis. Neurol Clin 2008;26: 635-55.