RESUMEN
JUSTIFICATIVA E OBJETIVOS: As meningites assépticas (MA) representam a grande maioria das meningites presentes em nosso meio. Os principais causadores dessa doença são os enterovírus. O quadro clínico caracteriza-se por cefaleia, fotofobia, sinais de irritação meníngea, náuseas, vômitos e febre. A grande dificuldade diagnóstica é que estes mesmos sintomas são encontrados nos quadros de meningites bacterianas, mais graves, demandando condutas mais agressivas. O objetivo deste estudo foi rever o assunto, destacando o manuseio dos casos suspeitos bem como suas etiologias e fisiopatologias. CONTEÚDO: Conceitos de MA, suas etiologias virais e não virais, incluindo àquelas causadas pela utilização de medicamentos. CONCLUSÃO: Devido às sobreposições sintomatológicas, introduziu-se empiricamente a antibioticoterapia intra-hospitalar no momento da suspeita de infecção meníngea, observando a evolução clínico-laboratorial do paciente.
BACKGROUND AND OBJECTIVES: The aseptic meningitis (AM) representing the vast majority of meningitis in our society. The main cause of this disease is the enteroviruses. The clinical picture is characterized by headache, photophobia, and signs of meningeal irritation, nausea, vomiting and fever. The diagnostic difficulty is that these same symptoms are found in the tables of bacterial meningitis, the most serious, demanding more aggressive treatment. This article aims to review the issue, emphasizing the management of suspected cases as well as its etiology and pathophysiology. CONTENTS: Address the concept of AM, its viral and nonviral etiologies, including those caused by medication use. CONCLUSION: Due to the overlap of the symptoms, we introduced an empirical intrahospital antibiotic treatment at the moment we suspect meningeal infection, observing the evolution of clinical and laboratory signs.
Asunto(s)
Humanos , Líquido Cefalorraquídeo , Meningismo/diagnóstico , Meningismo/fisiopatología , Meningitis Aséptica/diagnóstico , Meningitis Aséptica/fisiopatologíaRESUMEN
Durante el año 1993 se presentó un aumento de 3 veces el número promedio de casos de meningitis asépticas en el Hospital Roberto del Río. Se presentan las características clínicas de 50 niños mayores con meningitis aséptica, y se detallan las de 16 casos de ellos con diagnóstico comprobado de meningitis por enterovirus. El cuadro clínico fue benigno, no hubo complicaciones, muerte o secuelas al alta. Dentro de los hallazgos de laboratorio, se destaca el promedio de neutrófilos en el 30 por ciento de los casos en la punción lumbar de control,luego de 24 horas o más de evolución de la enfermedad.El echovirus 30 fue el enterovirus predominante. Se comparan los hallazgos con la literatura, y se comenta la utilidad de una segunda punción lumbar en casos como éstos
Asunto(s)
Humanos , Masculino , Femenino , Infecciones por Enterovirus/fisiopatología , Enterovirus/patogenicidad , Meningitis Aséptica/fisiopatología , Meningitis Viral/fisiopatología , Líquido Cefalorraquídeo/virologíaRESUMEN
In this study the level of interleukin-6 [IL[6]] was evaluated in cerebrospinal fluid [CSF] and serum of septic [n=14] and aseptic meningitis [n=16] patients, in addition to its evaluation in 10 controls. CSF IL6 was elevated in 85.7% of patients with septic meningitis [SM] [mean 1471. 4 pg/ml] and in 43.7% of aseptic meningitis [AM] patients [mean 192.8 pg/ml], the difference in between was significant [P< 0. 0001]. Elevation of serum IL[6] was found in 28. 6% of the SM group [means 192.8 pg/ml] and none of the AM group [mean 122.5]. CRP was elevated in CSF and serum of SM and Am groups. Positive correlation was found between IL[6] and CRP in CSF and serum but not with other inflammatory parameters. It is concluded that marked elevation of IL[6] in patients with meningitis suggest a septic aetiology. It is also claimed that IL[6] plays a role in aseptic meningitis which is believed to be dependant on the causative agent