Current Approach to Meningitis in Pediatric Patients

Yıl 2014, Cilt: 14 Sayı: 3, 95 - 99, 01.07.2014

Manolya Acar Murat Sütçü Ayper Somer

https://doi.org/10.5222/j.child.2014.095

Öz

introduction of pneumococcal, and most recently meningo- coccal conjugated vaccines into clinical practice. Menengitis is defined as the infection of the meninges around the brain. The specificity of the symptoms and signs of menengitis is decreased in infants. In infants subtle symptoms like fever, agitation, poor breast feeding and disorientation can be observed. New diagnostic methods based on available symptoms and signs like “Bacterial Menengitis Scoring” system was developed to predict the probability of bacterial menengitis. in stable patients. With suspect menengitis lum- bar punction and appropriate blood tests should be perfor- med. Complete blood count, peripheral blood glucose, leucocyte,erythrocyte, glucose, protein in CSF, should be determined and gram stain should be evaluated at a first step. Treatment of bacterial meningitis should be initiated without delat with broad spectrum antibiotherapy based on antibiotic susceptibility in the community. Studies focus on decreased mortality with the early antimicrobial therapy.At present meningitis is still a major cause of mortality and morbidity in pediatric age group, and infants, and adoles- cents constitute the most risky groups

Anahtar Kelimeler

Child, meningitis, treatment

Çocuklarda Menenjite Güncel Yaklaşım

Öz

Çocuklarda pnömokok ve son olarak da meningokok konjü- ge aşıların kullanılmaya başlanmasıyla bakteriyel menenjit daha az görülmektedir. Menenjit, beyni çevreleyen menink- slerin enfeksiyonu olarak tanımlanıp hastaların yaşı küçül- dükçe, menenjit semptom ve bulguları özgüllüğünü kaybet- mektedir. Sütçocuklarında ateş, emmede azalma, huzursuz- luk, çevreyle ilgisizlik gibi silik bulgular gözlenebilmekte- dir. Mevcut semptom ve bulgulara dayanarak bakteriyel menenjit olasılığını öngörmek için Bakteriyel Menenjit Skorlaması gibi modeller geliştirilmiştir. Menenjit şüphesi olan stabil hastalarda, uygun kan testleri yanında kesinlik- le lomber ponksiyon yapılmalıdır. İlk aşamada tam kan sayımı, periferik glukoz, BOS’da lökosit, eritrosit, glukoz, protein tayini ve gram boyama değerlendirilmelidir. Bakteriyel menenjit tedavisine esas olarak zaman kaybet- meden ve toplumdaki antibiyotik duyarlılığına dayanılarak geniş spektrumlu ampirik antibiyotik başlanmalıdır. Antibiyotik tedavisi ne kadar erken başlanırsa sağ kalım üzerine olumlu etkisinin o derece fazla olduğu gösterilmiş- tir. Hâlen menenjit, çocukluk çağının önemli bir morbidite ve mortalite nedeni olup, en riskli gruplar süt çocukları ile adolesanlardır

Anahtar Kelimeler

Çocuk, menenjit, tedavi

Kaynakça

• 1. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011;364:2016-25. http://dx.doi.org/10.1056/NEJMoa1005384
• 2. American Academy of Pediatrics. Pneumococcal infections. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics, 2012: 571-82.
• 3. Garcia CG, McCracken GH. Acute bacterial meningitis beyond the neonatal period. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases, 4th ed. Edinburgh: Elsevier Saunders, 2012: 272- 79.
• 4. Romero JR. Aseptic and viral meningitis. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases, 4th ed. Edinburgh: Elsevier Saunders, 2012: 292-97.
• 5. Ceyhan M, Yildirim I, Balmer P, Borrow R, Dikici B, Turgut M, et al. A prospective study of etiology of childhood acute bacterial meningitis, Turkey. Emerg Infect Dis 2008;14: 1089-96. http://dx.doi.org/10.3201/eid1407.070938
• 6. Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis 2010;10:32-42. http://dx.doi.org/10.1016/S1473-3099(09)70306-8
• 7. Tunkel AR, Hartmen BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis, IDSA guidelines. Clin Infect Dis 2004;39:1267-84. http://dx.doi.org/10.1086/425368
• 8. Prober CG, Dyner L. Central nervous system infections. In: Kliegman RM, Stanton BF, Schor NF, St Geme III JW, Behrman RE, eds. Nelson Textbook of Pediatrics, 19th ed. Philadelphia: Saunders, 2011: 2086-99. http://dx.doi.org/10.1016/B978-1-4377-0755-7.00595-9
• 9. Curtis S, Stobart K, Vandermeer B, Simel DL, Klassen T. Clinical features suggestive of meningitis in children: a systematic review of prospective data. Pediatrics 2010;126:952- 60. http://dx.doi.org/10.1542/peds.2010-0277
• 10. Bilavsky E, Leibovitz E, Elkon-Tamir E, Fruchtman Y, Ifergan G, Greenberg D. The diagnostic accuracy of the ‘classic meningeal signs’ in children with suspected bacterial meningitis. Eur J Emerg Med 2013;20:361-3. http://dx.doi.org/10.1097/MEJ.0b013e3283585f20
• 11. Hatipoğlu N, Yalçın I. Menenjit. In: Salman N, Somer A, Yalçın I, eds. Çocuk Enfeksiyon Hastalıkları, 2.Baskı, İstanbul: Akademi, 2015:150-74.
• 12. Nigrovic LE, Malley R, Kuppermann N. Meta-analysis of bacterial meningitis score validation studies. Arch Dis Child 2012;97:799-805. http://dx.doi.org/10.1136/archdischild-2012-301798
• 13. Centers of Disease Control and Prevention (CDC). Lyme Lyme disease--United States, 2001-2002. MMWR Morb Mortal Wkly Rep 2004;53:365-9.
• 14. Nigrovic LE, Kimia AA, Shah SS, Neuman MI. Relationship between cerebrospinal fluid glucose and serum glucose. N Engl J Med 2012;366:576-8. http://dx.doi.org/10.1056/NEJMc1111080
• 15. King RL, Lorch SA, Cohen DM, Hodinka RL, Cohn KA, Shah SS. Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger. Pediatrics 2007;120:489-96. http://dx.doi.org/10.1542/peds.2007-0252
• 16. Nigrovic LE, Malley R, Agrawal D, Kuppermann N; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Low risk of bacterial meningitis in children with a positive enteroviral polymerase chain reaction test result. Clin Infect Dis 2010;51:1221-2. http://dx.doi.org/10.1086/656919
• 17. Shin SH, Kim KS. Treatment of bacterial meningitis: an update. Expert Opin Pharmacother 2012;13:2189-206. http://dx.doi.org/10.1517/14656566.2012.724399
• 18. Bronstein DE, Glaser CA. Aseptic meningitis and viral meningitis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez P, eds. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed. Philadelphia: Elsevier Saunders, 2014: 484-92.
• 19. Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2010;9:CD004405. http://dx.doi.org/10.1002/14651858.cd004405.pub3