Çocuk Sağlığı ve Hastalıkları Dergisi 2003 , Vol 46 , Num 1
Meningitis-I: etiopathogenesis
Güler Kanra1, Mehmet Ceyhan1, Ateş Kara2
Hacettepe Üniversitesi Tıp Fakültesi 1Pediatri Profesörü, 2Pediatri Uzmanı Meningitis is inflammation of the meninges, the lining surrounding the brain and the spinal cord. It can be caused by many different organisms including bacteria, viruses and fungi. Bacterial meningitis in the pediatric population is comprised of three microorganisms in more than 95% of cases: S. pneumoniae, N. meningitidis and H. influenzae type B. Routine administration of HIB vaccine in developed countries has resulted in a remarkable decline of meningitis with this bacterium. As an exception, Group B streptococcus, Gram-negative enteric bacilli and Listeria monocytogenes are responsible for the vast majority of the cases in the newborn period. There are four steps in meningitis pathogenesis which are not very well-documented yet. These are (1) colonization and mucosal invasion, (2) survival against body defense mechanisms in the circulation, (3) crossing the blood-brain barrier, (4) survival in CSF and multiplication. Acute bacterial meningitis is fairly uncommon, but it is the most dangerous infection in normal host. It can be extremely serious, as it is fatal in one in 10 cases; one in seven survivors is left with severe handicap, such as deafness or brain injury. Although fever, headache, vomiting, stiff neck, and meningeal irritation findings are highly suggestive of meningitis, the definite diagnosis must be based on CSF examination. A low CSF glucose with an increase in CSF protein, and presence of PMNL dominating cells predict a bacterial origin. In extreme ages as in the newborn period or in the elderly, atypical presentation must be considered. The etiologic agent must be named by isolation or latex agglutination for an effective antibiotic coverage. Therapy aims at not only the sterilization of the CSF but also the prevention of inflammation as soon as possible. The physician should use antibiotics with bactericidal activity which sustain at least 10 times minimal bactericidal concentration in the CSF. Many controlled trials have been performed to determine whether adjuvant corticosteroid therapy is effective in children. The results, however, do not point unequivocally to a beneficial effect in meningococcal and pnemococcal meningitis, whereas the advantages are well documented in H. influenzae type B meningitis. As a result, early diagnosis and prompt treatment are essential in avoiding the complications of this serious infection in the childhood Anahtar Kelimeler : menenjit, çocuk, invazif enfeksiyonlar, meningitis, childhood, invasive infection
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