Fatores microbiológicos da criptococose e sua importância na carga da doença em pacientes atendidos em um hospital de referência do Estado de São Paulo / Not available

Introdução: A meningite criptocócica causa elevada mortalidade, sobretudo em pacientes acometidos de alguma condição imunossupressora. O objetivo deste estudo foi identificar fenômenos de baixa suscetibilidade a antifúngicos e outros preditores clínicos que possam explicar falha terapêutica e recidiva da neurocriptococose Metodologia: Foram avaliados 96 casos com coleta de dados clínicos epidemiológicos e laboratoriais. Os isolados foram identificados quanto a genótipo molecular, suscetibilidade de anfotericina B (AMB) e fluconazol (FCZ) pela determinação da concentração inibitória mínima (Minimal Inhibitory Concentration, MIC), nível de heteroresistência ao FCZ (NHF) e determinação do tempo de morte frente AMB (Time-Kill, TK). Foram selecionados isolados heterorresistentes para análise quantitativa de DNA por PCR em tempo Real, expressão de bombas de efluxo por citometria de fluxo e isolados tolerantes a AMB para estudo de resistência ao estresse oxidativo. Foi realizada análise univariável e múltipla usando regressão logística para identificar preditores de óbito hospitalar e de um desfecho composto definido pelo óbito, encaminhamento para unidade de terapia intensiva ou recidiva 6 meses após alta hospitalar. Resultados: A maioria dos pacientes eram imunodeprimidos, com CD4 de 2 a 722 cel./mm3 e 96,7% eram portadores do HIV. Foram identificados 93 isolados de C. neoformans, sendo 76 do genótipo VNI e 17 VNII e 3 C. gattii, todos VGII. MIC de AMB variou de 0,012 a 0,94 mg/L e MIC de FCZ estiverem entre 0,12 e 64 mg/L. Resistência a FCZ (MIC>16mg/L) foi maior em VNI do que em VNII (p=0,03). Dentre os isolados VNI, 64,5% sofreu atividade fungicida até as 24h (TK24) de exposição à AMB e 6 cepas VNI não sofreram ação fungicida (TK>72). A maioria dos isolados VNII (64,7%) apresentou TK24. Os 3 isolados VGII sofreram atividade fungicida a partir de TK24. A maioria dos isolados VNI, VNII e todos os isolados VGII apresentaram alto NHF (>32mg/L). Diferença no NHF de acordo com os genótipos foi observada (p=0,005). No modelo múltiplo, as variáveis associadas significativamente ao óbito foram: idade em anos (OR=1,08;IC95%=1,02-1,15), contagem de leveduras no líquido cefalorraquidiano em logaritmo (LCR) (OR=1,66;IC95%=1,21-2,28) e uma variável composta por hipertensão arterial sistêmica ou diagnóstico de edema cerebral ou dilatação ventricular por tomografia (OR=35,68;IC95%=4,97-256,31). Para o desfecho composto, as variáveis associadas foram: contagem de leveduras do 1D em logaritmo (OR=1,50; IC95%=;1,20-1,86; p=<0,001), cultura de sangue positiva para Cryptococcus spp. (OR=3,30; IC95%=0,86-12,59; p=0,08) e descrição de neurotoxoplasmose (OR=18,62; IC95%=1,85-187,5; p=0,01). As associações foram consistentes em modelos de sobrevida. Conclusão: Foi possível descrever genótipos mais frequentes e identificar fatores genéticos, como aumento da expressão de genes e bombas de efluxo, relacionados à resistência aos fármacos. Nenhum dos testes de suscetibilidade esteve associado com os desfechos. Variáveis obtidas nos primeiros dias de internação mostraram utilidade para predizer o prognóstico em pacientes com meningite criptocóccica. Estes preditores podem ajudar a identificar os casos com maior potencial de óbito e que necessitam da otimização dos recursos terapêuticos.

Background: Cryptococcal meningitis causes high mortality in immunocompromised patients. The objective of this study was to identify the phenomena of low susceptibility to antifungal and other clinical predictors that may explain therapeutic failure and relapse of neurocryptococcosis Methodology: It was analyzed 96 cases with clinical and epidemiological data. The respective isolates were identified for genotype, susceptibility profile by Minimal Inhibitory Concentration (MIC), FCZ heteroresistance level (NHF), and time to death determination against 1 mg / L BMA (Time-Kill, TK). We isolated heteroresistant DNA expression analysis by real-time PCR, expression of efflux pumps by flow cytometry and, some isolates tolerant to AMB were selected to study resistance to oxidative stress. Univariable and multiple analyses using logistic regression were performed to identify predictors of in-hospital mortality and a composed outcome defined by death, referral to the intensive care unit and relapse 6 months after hospital discharge. Results: Most of the patients were immunocompromised, with CD4 range from 2 to 722 cells/mm3 and 96.7% patients HIV-positive. It was analyzed 93 strains of Cryptococcus neoformans of which 76 were genotype VNI and 17 were VNII and 3 were C. gattii, all were VGII. AMB MIC ranged from 0.012 to 0.94 mg/L and FCZ MIC were between 0.12 and 64 mg/L. Resistance to FCZ (MIC>16mg/L) was higher to VNI than VNII (p=0.03). Among the VNI strains, 64.5% had fungicidal activity up to 24h (TK24) of exposure to AMB and 6 VNI did not present this activity until 72h (TK> 72). Most VNII strains (64.7%) had TK24. The 3 VGII strains presented fungicidal activity from TK24. According to the MIC, all strains were susceptible to AMB. The majority of VNI strains (93.4%) and VNII (76.5%) and 3 VGII strains showed high NHF (>32mg/L) and it was observed statistical difference according to the genotypes VNI and VNII (p=0.005). At the multiple analysis, the variables significantly associated with the death were the age in years (OR=1.08,95%CI=1.02-1.15), the cerebrospinal fluid (CSF) yeasts count-log (OR=1.66,95%CI=1.21-2.28), and a variable composed of systemic arterial hypertension or diagnosis of cerebral edema or ventricular dilatation by tomography (OR=35.68,95%CI=4.97-256.31). At the composed outcome, the variables associated were: CSF yeasts count-log (OR=1,50; IC95%=;1,20-1,86; p=<0,001), positive blood culture for Cryptococcus spp. (OR=3,30; IC95%=0,86-12,59; p=0,08) and neurotoxoplasmosis (OR=18,62; IC95%=1,85-187,5; p=0,01). The associations were consistent at survival models. Conclusion: It was possible to describe more frequent genotypes and to identify genetic factors, such as increased gene expression and efflux pumps, related to drug resistance. The antifungal susceptibilities were not associated with the outcomes. were not associated with outcomes. Variables available in the first days of hospitalization showed utility to predict the prognosis in patients with cryptococcal meningitis. These predictors can help to identify the cases with higher potential of death and that require the optimization of the therapeutic resources.

Mucormicosis Rinocerebral asociado a Cetoacidosis diabética / Rhinocerebral Mucormycosis associated to diabetic ketoacidosis

Mucormycosis is an infrequent fungal infection This infection is difficult to diagnose and treat and have a high morbility and mortality and affects immunocompromised patients, especially those patients with decompensated diabetes mellitus. We report the case of a 60 years old diabetic patient with poor metabolic control who was admitted for diabetic ketoacidosis and days later present right periorbital swelling and pain, is diagnosed of mucomycosis and is successfully treated with amphoterin B and surgery.

Histoplasmosis del sistema nervioso central en un paciente inmunocompetente / Histoplasmosis of the central nervous system in an immunocompetent patient

La histoplasmosis es una afección polifacética producida por el hongo dimorfo Histoplasma capsulatum , cuyas esporas son inhaladas y llegan al pulmón, órgano primario de infección. La forma meníngea, considerada como una de las manifestaciones más graves de esta micosis, suele presentarse en individuos con alteraciones en la inmunidad celular: pacientes con síndrome de inmunodeficiencia humana adquirida, con lupus eritematoso sistémico o con trasplante de órgano sólido, así como en lactantes, debido a su inmadurez inmunológica. La forma de presentación más usual es de resolución espontánea y se observa en individuos inmunocompetentes que se han expuesto a altas concentraciones de conidias y fragmentos miceliares del hongo. En estas personas, la afección se manifiesta por trastornos pulmonares y por la posterior diseminación a otros órganos y sistemas. Se presenta un caso de histoplasmosis del sistema nervioso central en un niño inmunocompetente.

Histoplasmosis is a multifaceted condition caused by the dimorphic fungi Histoplasma capsulatum whose infective spores are inhaled and reach the lungs, the primary organ of infection. The meningeal form, considered one of the most serious manifestations of this mycosis, is usually seen in individuals with impaired cellular immunity such as patients with acquired immunodeficiency syndrome, systemic lupus erythematous or solid organ transplantation, and infants given their immunological immaturity. The most common presentation is self-limited and occurs in immunocompetent individuals who have been exposed to high concentrations of conidia and mycelia fragments of the fungi. In those people, the condition is manifested by pulmonary disorders and late dissemination to other organs and systems. We report a case of central nervous system histoplasmosis in an immunocompetent child.

Iatrogenic meningitis / Meningites iatrogenicas

Iatrogenic meningitis can be caused by a number of mechanisms. The recent case reports of fungal meningitis after application of epidural methylprednisolone caused warning in the medical community. Cases were caused by contaminated lots of methylprednisolone from a single compounding pharmacy. Several medications can cause meninigitis by probable hypersensitivity mechanism. Neurologists should be alert to the recent description of the use of lamotrigine and development of aseptic meningitis.

As meningites iatrogênicas podem ser provocadas por uma série de mecanismos. Os recentes relatos de casos de meningite por fungos após a aplicação de injeção epidural de metilprednisolona causou alerta na comunidade médica. Os casos foram causados por lotes contaminados de metilprednisolona produzidos por uma única farmácia de produção. Diversos medicamentos podem causar meningite por provável mecanismo de hipersensibilidade. Neurologistas devem ficar alerta para a recente descrição do uso de lamotrigina e o desenvolvimento de meningite asséptica.

Epidemia de meningitis fúngica ligada a inyecciones contaminadas con un esteroide (metilprednisolona) impactaen Estados Unidos, obligando a este país a impulsar una importante acción investigativa y de control / Fungal meningitis outbreak associated to contaminated steroid shots (methylprednisolone) obliges the USA to conduct important research and implement control actions

Se refieren los aspectos fundamentales de informes periodísticos estadounidenses de octubre 3, 20 y 26 del 2012, incluyendo opiniones, entre otros, de distinguidos especialistas enla materia del CDC de Atlanta, Georgia, sobre un presente brote de 313 casos de meningitis fúngica en un total de14.000 personas pertenecientes a 23 estados. Dichas personas habían recibido inyecciones epidurales en la columna vertebral o periarticulares de acetato de metilprednisolona proveniente de tres lotes contaminados con varias especies de hongos de origen exógeno, distribuidos por una empresafarmacéutica de Framingham, Massachusetts. De aquellos 313 casos, 25 personas fallecieron. Hacia fines de octubre, la FDA (Food and Drug Administration) comunicó oficialmentela constatación de una intensa contaminación fúngica y bacteriana en los laboratorios de la empresa implicada, declarándola fuera de control.El principal objetivo del trabajo es contribuir a la difusión del conocimiento del importante problema en nuestra región para estar alertas ante la posibilidad de situaciones similares ocomparables y su correcta prevención.Se comentan algunas características estructurales y la experiencia clínica nacional respecto a Exserohilum rostratum, la principal especie fúngica responsable del brote comentado.

Esteroides epidurales: consideraciones sobre los nuevos casos de meningitis infecciosa en Estados Unidos y revisión de sus indicaciones terapéuticas / Epidural steroids: considerations regarding the new cases of infectious meningitis in the United States and a review of their therapeutic indications

La administración de esteroides epidurales es ampliamente utilizada para el manejo del dolor lumbar. Recientemente hemos presenciado la aparición de infecciones del neuroeje en Estados Unidos debido a la contaminación de los envases fabricados por una farmacia de formulación “magistral” en Nueva Inglaterra. Este hecho nos ha obligado a preguntarnos sobre la utilidad y riesgos de esta terapia. El propósito de este artículo es presentar una revisión de la evidencia disponible que sustenta el uso de inyecciones epidurales de esteroides y los riesgos asociados...

Epidural steroid injections are widely used in the treatment of low back pain. In the United States, we have recentlywitnessed an outbreak of neuraxial infections, likely due to contaminated steroids made by a compounding pharmacy in New England. This has forced us to question the utility and risks of this therapy. The following article presents a review of the available evidence supporting the use of steroid injections for low back pain, as well as the associated risks...

Assessment of a real-time PCR method to detect human non-cryptococcal fungal meningitis

The signs and symptoms associated with fungal meningitis are similar to those seen with more common bacterial infections. In this study, we investigate whether Aspergillus or Candida DMA can be detected in cerebrospinal fluid [CSF] samples from patients suspected of fungal meningitis using real-time PCR assay. From April 2007 to November 2009, we evaluated CSF samples and sera from patients with risk factors for cerebral fungal meningitis in Nemazi Hospital, Shiraz University of Medical Sciences, Iran, by real-time PCR assay and routine mycological studies [direct microscopy examination and culture]. Two CSF and two serum samples from each patient were examined. CSF and serum samples from 38 patients [total: 152] suspected of fungal meningitis were examined. India ink staining and KOH smear were negative for all patients. C. albicans was isolated from two CSF samples. There were ten patients with positive real-time PCR results in their CSF samples: three patients had C. albicans, one with C. glabrata, four with Aspergillus species and two with both C. albicans and Aspergillus species DMA. Four patients had positive serum results for Aspergillus or Candida infections. Considering the findings, it seems that molecular examination can help in the diagnosis of fungal meningitis in patients with clinical and radiological presentations. Further studies should be conducted in other regions and settings to confirm these findings

Avaliação in vitro da atividade antifúngica de óleos essenciais sobre Cryptococcus neoformans / Action of essential oils against Cryptococcus neoformans

Cryptococcus neoformans é uma levedura patogênica e o agente etiológico da criptococose, uma doença infecciosa cosmopolita que acomete o homem, animais domésticos e silvestres. A infecção ocorre por inalação das leveduras e a doença se manifesta com mais freqüência em pessoas e animais com baixa imunidade celular. C. neoformans, tem tropismo para o sistema nervoso central. O tratamento efetivo para a criptococose é a anfotericina B associada ou não a 5 –flucitosina apesar da alta toxicidade e nefrotoxicidade. O objetivo deste trabalho foi avaliar a atividade in vitro dos óleos essenciais de Eucalyptus citriodora Hooker, Eucalyptus globulus Labill, Eugenia caryophyllus Sprengel, Melaleuca alternifolia Chell e Thymus vulgaris Linneaus e uma mistura de E. caryophyllus, M. alternifolia e T. vulgaris denominada Blend sobre C. neoformans. Em doses subinibitórias avaliar a produção de cápsula e de exoenzimas proteinase e fosfolipase. Foram utilizadas 21 isolados de origem humana, 29 isolados ambientais e uma cepa padrão de C. neoformans ICB 163 D (NIH 163D). Para a avaliação da atividade antifúngica e obtenção da concentração inibitória mínima (CIM) utilizou-se a técnica de microdiluição em caldo, em meio RPMI 1640, com Tween-20 a 0,02% como emulsificador. E a confirmação da inibição em Agar Sabouraud dextrose, a 37°C por 48 hs com obtenção da concentração fungicida mínima (CFM). Para a avaliação da sensibilidade ao fluconazol utilizou-se microdiluição em caldo com meio RPMI 1640 e para a avaliação da sensibilidade a anfotericina B foi utilizado o teste comercial Etest®. Para cada óleo essencial foram encontrados os seguintes resultados de CFM50 e CFM90: E. citriodora CFM50 de 21,97 a 2812,5μg/mL e CFM90 de 703,12 a 2812,5μg/mL; E. globulus CFM50 de 175,78 a 703,12μg/mL e CFM90 de 703,12 a 2812,5μg/mL; E. caryophyllus CFM50 de 87,89 a 175,78μg/mL e CFM90 de 703,12μg/mL; M. alternifolia CFM50 de 11.250 a 45.000μg/mL e CFM90 de 45.000μg/mL; T...

Candida tropicalis as an emerging pathogen in Candida meningitis: case report and review

Candida species are an uncommon cause of meninigitis. Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy for Candida meningitis are poorly defined. The authors report on a paraplegic patient due to spinal cord injury who developed C. tropicalis meningitis. In addition, we review and discuss other reported cases of C. tropicalis meningitis in the medical literature.

Candida albicans meningitis in an infant with noonan syndrome

Noonan syndrome is a rare disorder, characterized by several malformations such as dysplasia and stenosis of the pulmonary valve, atrial septal defect and a typical pattern of hypertrophic cardiomyopathy. We describe here a 1-month old girl, who was referred to our center with seizure and apnea. She had wide anterior fontanel, head circumference and sunset eye. Intaventricular hemorrhage by sonography and atrial septal defect and hypertrophy cardiomyopathy by echocardiography were detected. Clinical and laboratory findings of the patient were compatible with a diagnosis of Noonan syndrome, which was also confirmed by molecular analysis. Candida albicans was grown in the blood and cerebrospinal fluid cultures. Treatment with Amphotrycine B was started for the patient and she responded well to this therapy. Early diagnosis and appropriate diagnosis of a rare condition in the patient with such rare disease are the main keys to avoid further complications and even death of patient.

Chronic meningitis by histoplasmosis: report of a child with acute myeloid leukemia

Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20 percent-40 percent and the relapse rate is as high as 50 percent; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML), that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole.

Meningitis due to Rhodotorula glutinis in an HIV infected patient.

Rhodotorula spp, though considered a common saprophyte, recently has been reported as causative agent of opportunistic mycoses. We present a case of meningitis in an immunocompromised human immunodeficiency virus infected patient who presented with longstanding fever. He was diagnosed as a case of chronic meningitis. Diagnosis was confirmed by cell cytology, India ink preparation, Gram staining and culture of cerebrospinal fluid (CSF) sample. CSF culture grew Rhodotorula glutinis. Therapy with amphotericin B was successful in eliminating the yeast from CSF and the patient was discharged after recovery.

Criptococosis meningea en pacientes VIH negativo: presentacion de un caso y revision de la literatura / Meningeal cryptococcosis in HIV negative patients: a case report and literature review

Baja en individuos inmunocompetentes; se presenta frecuentemente en pacientes con compromiso de la inmunidad de tipo celular como el SIDA, las neoplasias malignas, enfermedades reumatológicas o uso de medicamentos inmunosupresores. La meningoncefalitis es la principal forma extrapulmonar y su presentación es atípica con síntomas neurológicos subagudos. El diagnóstico se puede realizar mediante observación de las blastoconidias encapsuladas en líquido cefaloraquideo con el método de tinta china, cultivo, detección de antígeno capsular o reacción en cadena de la polimerasa; es necesario un alto índice de sospecha del médico para hacerlo correcta y oportunamente. El esquema de tratamiento depende del tipo de paciente a tratar pero incluye en todos los casos anfotericina B, flucitocina y fluconazol. Se presenta el caso de una paciente de 50 años VIH negativa con meningoencefalitis por criptococo y su evolución.

Cryptococcus infection is a worlwide disease caused by a fungus, although it has low incidence in immunecompetent patients compared with patient with a compromised cellular immunity such as AIDS, malignant cell cancer, rheumatologic diseases or persons in immnunosupressant therapy (such as chemotherapy or steroids) in which is more frequently diagnosed. Meningitis is the most frequent extrapulmonar infection characterized by an atypical presentation with subacute neurological signs and symptoms. Diagnosis can be carried out either by direct observation of the spores in the cerebrospinal fluid stained with Chinese ink, culturing, capsular antigen detection by latex agglutination technique or polymerase chain reaction; although a high index of the physician’s suspicion is necessary to diagnose it appropriately . Treatment depends on the type of patient you are dealing with, but in every case amphotericin B, flucytosine and fluconazol with dose and frequency adjustments must be used. We present the case of a 50 year old HIV negative woman with cryptoccocal meningitis and her evolution.

Meningitis caused by Rhodotorula rubra in an human immunodeficiency virus infected patient.

Rhodotorula spp. are common saprophytes but may be responsible for systemic infections in immunocompromised patients. Meningitis caused by Rhodotorula spp. in human immunodeficiency virus (HIV) infected patients has been reported only rarely. We present a case of meningitis caused by Rhodotorula rubra in HIV infected patient. The presumptive diagnosis of cryptococcal meningitis was made on the basis of India ink preparation, Gram staining and latex agglutination test (LAT) for cryptococcal antigen. The final diagnosis was confirmed by isolation of Rhodotorula rubra from cerebrospinal fluid on culture. LAT was considered false positive. Amphotericin B and 5-fluorocytosine were administered but the patient succumbed to his illness.

Cerebral aspergilloma presenting as atypical meningioma in an immunologically competent patient: a case report.

A 36-year-old man presented with history suggestive of intracranial space occupying lesion. Computed tomography of brain revealed a large lobulated, extra axial, hyperdense lesion in the right fronto-temporal region extending up to to the right frontal and ethmoidal sinuses, eroding the bone, enhancing homogeneously with contrast, which was suggestive of atypical meningioma. He had no predisposing factors that could lead to the suspicion of opportunistic infection. Craniotomy and total excision of the lesion was done. Histopathological study revealed aspergilloma.

An outbreak of Aspergillus meningitis following spinal anaesthesia for caesarean section in Sri Lanka: a post-tsunami effect?

An outbreak of Aspergillus fumigatus meningitis occurred in 5 women following spinal anaesthesia, performed between 21 June and 17 July 2005 for caesarean section, in Colombo, Sri Lanka. The patients' median age was 27 years. Different teams in 2 maternity hospitals gave spinal anaesthesia. Mean incubation period was 11.2 days. Fever, headache and nuchal rigidity were common presentations. Remittent fever continued despite broad-spectrum intravenous antibiotics. Papilloedema, lateral rectus palsy, cerebral infarction and haemorrhage developed later. Three patients died. Cerebrospinal fluid pleocytosis with low glucose yielded negative PCR for fungi. Fungal cultures subsequently grew Aspergillus fumigatus. A post-mortem of the first patient confirmed Aspergillus meningitis, followed by treatment with amphotericin B and voriconazole, that saved the lives of others. Visual and hearing impairment in one and complete recovery in the other were observed a year after treatment. Examination of unused plastic syringes, needles, cannulae, and ampoules of anaesthetic agents confirmed that 43 syringes from three different manufactures were contaminated with Aspergillus fumigatus. The stores for drugs and devices of the Ministry of Health were examined and found to be full of tsunami donations, while regular procurements of the Ministry were kept in a poorly maintained humid warehouse. Inadequate space for tsunami donations was identified as the most plausible explanation for sub-optimal storage. Withdrawal and incineration of all unused syringes controlled the outbreak. The survival of those aggressively treated for Aspergillus meningitis suggests in hindsight that the availability of diagnostic tests and specific treatment, and early recognition of the outbreak could have saved the lives of victims who died. Early life-threatening side-effects and permanent long term sequelae of antifungal medication stress the need to be cautious with empirical treatment in immuno-competent low-risk individuals.

Meningitis Agudas en Córdoba, Colombia 2002 - 2004 / Acute meningitis in Córdoba, Colombia (2002-2004)

Objetivo: Establecer las características epidemiológicas y microbiológicas de las meningitis agudas del departamento de Córdoba. Métodos: Se realizó un estudio descriptivo de vigilancia epidemiológica en el Hospital San Jerónimo de Montería. Se tomaron todos los casos de meningitis, presentados (junio 2002 - junio 2004), las pruebas de laboratorio incluyeron: citoquímico, prueba de látex, tinción de Gram y cultivo. Resultados: Se analizaron 503 muestras de liquido cefalorraquídeo, confirmados por cultivo 57 (11,3 por ciento) casos y 85 (16,8 por ciento) casos probables. Se presentaron 63 aislamientos distribuidos así: 17 bacilos Gram negativos no fermentadores (26,9 por ciento), 16 Streptococcus pneumoniae (25,4 por ciento), 7 Enterobacterias (1 por ciento), 5 Criptococcus neoformans (8 por ciento), 4 Neisseria meningitidis serotipo B (6,3 por ciento), 3 S. viridans (4,8 por ciento), 2 Streptococcus grupo B (3,2 por ciento), 2 Haemophilus influenzae tipo B (3,2 por ciento), 2 S. aureus (3,2 por ciento), 2 Staphylococcus coagulasa negativos (3,2 por ciento), 2 Enterococcus (3,2 por ciento) y 1 Candida albicans (1,6 por ciento). Los serotipos de S. Pneumoniae fueron: 5 (n=4), 23F (n=3), 14 (n=2), 18C (n=2), 18A (n=1), 17F (n=1), 1 (n=1). Conclusión: El estudio permitió determinar los aspectos epidemiológicos y microbiológicos hasta ahora desconocidos de las meningitis agudas en el departamento de Córdoba. Streptococcus pneumoniae (25,4 por ciento) fue el principal agente causal de meningitis, los aspectos epidemiológicos establecidos confirman la necesidad de fortalecer e implantar medidas para el control y vigilancia de las meningitis en Córdoba.