RESUMO
@#<p style="text-align: justify;">Serratia marcescens is a recognized nosocomial opportunistic pathogen but rarely caused central nervous system infection especially in the neonates. Outbreaks have been documented in the neonatal intensive care units (NICU) and a higher incidence among those with surgical procedures. This review aims to describe a neonate with nonleaking lumbosacral myelomeningocele presenting with multiple pyogenic brain abscesses caused by S. marcescens admitted in a NICU. This review also presents a concise literature review discussing the potential risk factor involved, diagnostic measures and therapeutic possibilities. We present a neonate with Chiari II malformation admitted in the NICU developing S. marcescens ventriculitis after a lumbosacral myelomeningocele repair. With an empiric treatment of meropenem for one week, repeat ventricular cerebrospinal fluid analysis worsened and developed cerebral abscess as detected using cranial ultrasound. Ciprofloxacin was added and completed for six weeks with improved neurologic status. On a 6-month follow-up, sensorineural hearing loss, focal epilepsy and developmental delay were documented. A systematic review showed that prematurity and NICU outbreaks were among the most common risk factors for the central nervous system involvement of S. marcescens. Meropenem remains to be the antibiotic of choice adjunct with timely neurosurgical intervention. Brain abscess showed the worst prognosis among the neurologic sequelae.</p>
Assuntos
Serratia marcescensRESUMO
Objetivo: analisar a epidemiologia dos pacientes com malfrmações de Chiari tipo II atendidos na FundaçãoSanta Casa de Misericórdia do Pará. Método: coletaram-se dados através de um protocolo próprio para pesquisa, entrevistando-se com os responsáveis dos pacientes e análises dos prontuários. Resultados: a maior porcentagem era de pacientes do sexo feminino, procedentes do interior com presença de fistula liquórica devido ruptura de membranas da mielomeningocele. A maioria das parturientes realizou pré-natal, entretanto, poucas compareceram ao mínimo de consultas necessárias para considerar um pré-natal "completo" (mínimo 6 consultas). Grande parte dos pacientes com mielomeningocele estava associada com hidrocefalia, que necessitou, igualmente, de intervenção cirúrgica para ventriculostomia. Conclusão: estudou-se um perfil das malformações de Chiari tipo II atendidas nessa instituição, enfatizando a necessidade de melhorar os métodos de assistência e diagnóstico pré-natal permitindo intervenções precoces.
Objective: To analyse the epidemdogy and profile of pediatric patients harboring Chiari II malformation treated at Santa Casa de Misericórdia do Pará Hospital. Method: Data were collected from note registers through aproper protocol research, along interviews with responsible persons for the young patients. Results: Most patients belonged to feminine sex, coming, from small cities far away from our reference hospital, with an active CSF fistula due rupture of myelomeningocele. Most mothers accomplished prenatal, however, a minority attended to a minimum desired medical consultations, in order to consider a "complete" prenatal follow-up (at least 6 medical visitations). Most patients with myelomeningocele evolved with hydrocephalus, requiring a ventriculostomy. Conclusion: The study trace a profile of Chiari II malformations at our institution, emphasizing the importance of prenatal to fetus and mother's health, enabling an improvement in our health care, concerning prevention measures, precise diagnosis and precoeious treatment of such malformations.