Meningitis posquirúrgica por Acinetobacter baumannii multirresistente. Actividad sinérgica in vivo de la asociación sulbactam/avibactam / Post-surgical meningitis due to multiresistant Acinetobacter baumannii. In vivo synergistic activity of the sulbactam/avibactam association

Acinetobacter baumannii (AB) es un bacilo gram negativo, no fermentador,con frecuencia oportunista, ubicuo en el medio ambiente, con capacidad para sobrevivir en condiciones medioambientales adversas promoviendo su persistencia y diseminación en diferentes áreas de un hospital. Ha sido relacionado con múltiples brotes de infecciones asociadas al cuidado de la salud como neumonía, bacteriemias, contaminación de heridas quirúrgicas o infecciones del tracto urinario, especialmente entre pacientes con comorbilidades graves, como aquellos que motivan el ingreso a unidades de cuidados intensivos (UCI). Las cepas más problemáticas son aquellas resistentes a los carbapenémicos, resistencia causada por enzimas de la clase de las oxacilinasas (bla OXA) cromosómicas o plasmídicas y más recientemente bla NDM-1. La aparición de estas cepas deja escasos antimicrobianos activos (colistin, minociclina, tigeciclina; amikacina) que son limitados en su eficacia y su uso se asocia con toxicidad. A esto se agrega, como en la paciente que se describe, que desarrolló una meningitis posquirúrgica, la limitada capacidad de difusión en el sistema nervioso central (SNC) de estas últimas opciones. Una de las alternativas terapéuticas, es buscar asociaciones como sulbactam/avibactam que mostraron una adecuada actividad sinérgica y bactericida en asilamientos resistentes a ampicilina/sulbactam en base a una significativa reducción de la CIM que permite administrar dosis habituales, con mejor tolerancia y lograr concentraciones terapéuticas en SNC. Se presenta una paciente que desarrolló una meningitis posquirúrgica debida a una cepa de AB multirresistente.

Acinetobacter baumannii (AB) is a non-fermenting gram-negative bacillus, largely opportunistic, ubiquitous in the environment, with the ability to survive in adverse environmental conditions, promoting its persistence and dissemination in different areas of the hospital. It has been implicated in many outbreaks of healthcare-associated infections such as pneumonia, bacteremia, surgical wounds contamination, or urinary tract infections, especially among patients with previous severe illnesses such as those requiring admission to intensive care units (ICU). The most problematic strains are those resistant to carbapenems, resistance caused by chromosomal or plasmid oxacillinase class (bla OXA), and more recently bla NDM-1. The appearance of these strains leaves few active antimicrobials (Colistin, Minocycline, Tigecycline; Amikacin) that are limited in their efficacy and toxic. To this we must add, as is the case of our patient who presented post-surgical meningitis, the limited diffusion capacity in the central nervous system (CNS) of these last options. One of the therapeutic alternatives is to search for synergistic associations such as sulbactam/avibactam that showed rapid synergistic and bactericidal activity in isolates resistant to ampicillin/sulbactam due to a significant reduction in its MIC, which allows us to administer usual, better tolerated doses that reach therapeutic concentrations in CNS. Here, we present a patient who developed a post-surgical meningitis due to multiresistant AB

Meningite bacteriana: uma atualização / Bacterial meningitis: an update

A meningite é um processo inflamatório das meninges que envolve as duas membranas cerebrais (pia-máter e aracnoide) e o líquido cefalorraquidiano (LCR), podendo ser causado por diversos fatores, infeccioso ou não. Para o desenvolvimento do trabalho realizou-se uma pesquisa por artigos que estivessem disponíveis na base de dados SciELO, PubMed e Sinan, entre os anos de 2013 a 2018, utilizando os seguintes descritores: meningite, meningite bacteriana, diagnóstico, epidemiologia e fisiopatologia. O presente estudo tem como objetivo explanar informações atualizadas sobre a meningite bacteriana quanto à sua ocorrência no Brasil, abordando dados epidemiológicos, bem como suas manifestações clínicas, forma de diagnóstico, transmissão e tratamento.

Associação de meningite e pericardite na doença pneumocócica invasiva: um caso raro / Association of meningitis and pericarditis in invasive pneumococcal disease: a rare case

RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.

ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.

Importance of cerebrospinal fluid investigation during dengue infection in Brazilian Amazonia Region

BACKGROUND Amazon, the largest tropical forest of the world, has suffered from dengue outbreaks since 1998. Cerebrospinal fluid (CSF) of patients, from Amazonas state, suspected of central nervous system (CNS) viral infection was studied using molecular and immunological methods. OBJECTIVE To evaluate the importance of CSF investigation in patients with acute dengue virus (DENV) infection of CNS. METHODS CSF samples of 700 patients were analysed by reverse transcription polymerase chain reaction (RT-PCR) to detect the presence of dengue virus (DENV) RNA and by enzyme-linked immunosorbent assay (ELISA) to detect presence of DENV specific IgM. FINDINGS DENV infection was detected in 4.3% of the CSF samples; 85.7% (24/28) by DENV IgM and 14.3% (4/28) by viral RNA. DENV detected by viral RNA were to be found serotypes DENV-2 (three patients) and DENV-1 (one patient). The neurological diagnosis in patients CNS infection of DENV included encephalitis (10), meningoencephalitis (10), meningitis (6), acute myelitis (1), and encephalomyelitis (1). The majority (89.3%) had intrathecal inflammation: pleocytosis, hyperproteinorrachia and DENV IgM antibodies. Hypoglycorrhachia and/or high levels of lactate in CSF were found in 36% of the patients. Co-infection (CMV, HIV, EBV, and/or Mycobacterium tuberculosis) was observed in eight (28.6%) cases. CONCLUSIONS We found intense inflammatory CSF that is unusual in CNS disorders caused by dengue infection. It may be due co-infections or the immunogenetic background of the local Amerindian Brazilian population. CSF examination is an important diagnostic support tool for neurological dengue diagnosis.

Meningitis in Yemen

The Ministry of Health in Yemen, in collaboration with WHO, are closely monitoring the epidemiological pattern of the ongoing reported cases of menin-gitis in Yemen. Since the beginning of the year up to 8 July 2017 [Epidemiological week 27], a total of 2,146 suspected cases have been reported through the electronic early warning surveillance system [eDEWS] in the country

Tratamiento Antimicrobiano / Antibiotic treatment

Las Meningitis Bacterianas Agudas (MBA) siguen constituyendo un capítulo de extraordinario interés dentro de los procesos infecciosos. El conocimiento de la epidemiología local es fundamental. La terapia específica con antibióticos debe ser aplicada en forma precoz, con drogas bactericidas de buena concentración en líquido cefalorraquídeo. El conocimiento de la resistencia de los gérmenes causales de las MBA es capital para el logro de un tratamiento eficaz, buscando la menor morbi-mortalidad posible. Cada paciente debe individualizarse en función de la edad, factores asociados y evolución del caso

Acute bacterial meningitis (ABM) remains a chapter of extraordinary interest in infectious processes. Knowledge of local epidemiology is essential. Specific therapy with the use of antibiotics must be used early, using antibacterial drugs with good concentration in cerebrospinal fluid. Knowledge of the resistance of the causative organisms of the MBA is valuable in achieving an effective treatment, seeking the lowest possible morbidity and mortality. Each patient should be individualized for each patient age, associated factors and its evolution. Treatment should be individualized for each patient age, associated factors and clinical course

Aproximación al diagnóstico y tratamiento de meningitis por microorganismos poco frecuentes / Diagnosis and treatment of meningitis caused by uncommon microorganisms

La adecuada evaluación de pacientes pediátricos con meningitis debe considerar la posibilidad de infección por microorganismos poco frecuentes, principalmente virus Herpes simplex, que causa enfermedad aguda, y otros patógenos con evolución clínica prolongada, tales como Mycobacterium tuberculosis, Candida spp y Cryptococcus spp. Aunque la mayoría de estas infecciones son más comunes en pacientes con inmunosupresión, también se producen en personas previamente sanas. La dificultad para el diagnóstico diferencial inicial está relacionada con la similitud en los hallazgos clínicos y los parámetros básicos de líquido cefalorraquídeo. En consecuencia, la aproximación al diagnóstico etiológico requiere de un alto índice de sospecha y un análisis minucioso de síntomas y signos, datos epidemiológicos y antecedentes médicos. La terapia antimicrobiana precoz disminuye el riesgo de secuelas neurológicas y muerte, por lo tanto, debe comenzarse tan pronto aparezcan evidencias sugestivas de la infección, aun sin tener los resultados de las pruebas específicas para confirmación del diagnóstico

Appropriate assessment of pediatric patients with meningitis should consider the possibility of infection with uncommon microorganisms, mainly herpes simplex virus, which causes acute disease and other pathogens with prolonged clinical course, such as Mycobacterium tuberculosis, Candida spp and Cryptococcus spp. Although most of these infections are more common in immunosuppressed patients, they also may occur in previously healthy individuals. The difficulty for the initial differential diagnosis is related to the similarity in clinical findings and basic parameters of cerebrospinal fluid. Consequently, the approach to etiologic diagnosis requires a high index of suspicion and a careful analysis of signs and symptoms, epidemiological data and medical history. Early antimicrobial therapy reduces the risk of neurological sequelae and death, therefore, it should be initiated as soon as evidence suggestive of infection appears, even without the results of specific tests to confirm the diagnosis

Meningitis recurrente en el adulto: un reto diagnóstico y terapeútico / Recurrent meningitis in the adult: a diagnostic and therapeutic challenge

La meningitis recurrente no es una entidad común pero tiene el potencial de generar secuelasimportantes a mediano y largo plazo. Su cuadro clínico depende del agente causal aunque en lamayoría de los pacientes se conserva al menos uno de los síntomas clásicos de la meningitisaguda (cefalea intensa, fiebre y rigidez de nuca). Debido a su variabilidad clínica se requieren unalto nivel de sospecha y usar bien las pruebas de laboratorio para llegar oportunamente aldiagnóstico. El presente artículo contiene una revisión de la literatura sobre la epidemiología, laetiología, el cuadro clínico, el diagnóstico y el tratamiento de esta enfermedad.

Recurrent meningitis in the adult: a diagnostic and therapeutic challengeRecurrent meningitis is an uncommon condition with the capability of causing important midandlong-term sequelae. Its clinical presentation depends on the etiologic agent, although mostpatients exhibit at least one of the classical symptoms of acute meningitis (intense headache,fever and neck stiffness). Due to the clinical variability of the disease, a high level of suspicionand an adequate use of laboratory tests are required in order to establish a timely diagnosis. Thisarticle contains a literature review regarding epidemiology, etiology, clinical presentation,diagnosis and management of recurrent meningitis.

Meningitis / Meningitis

En el presente artículo, la autora describe los diferentes tipos de meningitis, su patología, evolución y tratamiento. presenta un caso y un plan de cuidados de un paciente con meningitis viral.

impact of splenectomy on the patient's susceptability to infection

Splenectomy, is a procedure that has significantly decreased in frequency as the understanding of its complications increase. Susceptibility to infection is the best-defined and most widely understood complication of splenectomy. The aim was to study the impact of splenectomy on the patients susceptibility to infections, and its effect on morbidity and mortality statistics of patients admitted to fever hospitals. The study included 506 patients admitted to fever hospital and they divided according to history of splenectomy into group 1 of 432 patients with no history of splenectomy and group II of 74 patients with history of splenectomy. The cause and duration of splenectomy, hospital stay, the type and duration of antibiotic prescribed in hospital the diagnosis and the outcome at discharge were the main history items. Chronic liver disease [CLD] was the main cause of splenectomy followed by trauma and Thalassemia 67%, 20% and 12% respectively. No significant difference in blood culture between the 2 group but capsulated organism were more in group II. Respiratory tract infection was the main cause of admission in both groups with a high incidence of respiratory, urinary tract infection, meningitis and pyrexia of unknown origin in group II. Quinolones, Penicillin and Cephalosporins were the commonly used groups of antibiotics with statistical difference in group 2 than group 1. Prolonged hospital stay in group II with high statistical difference than group I [14.07 +/- 8.68 versus 4.57 +/- 3.29] [P<0.001]. The improved outcome were significantly higher in group 1 than group 2 and the not improved outcome [frequent admission, escape from hospital and university hospital referral] were higher in group 2 than group 1 and it correlate with duration of splenectomy

La ceftriaxone comme alternative au chloramphenicol dans le traitement des meningites en periode d'epidemie

La meningite sevit regulierement sous la forme d'une flambee epidemique au Burkina Faso. C'est une maladie caracterisee par l'inflammation des meningites; membranes qui enveloppent l'encephale et la moelle epiniere. il ya un protocole national de prise en charge a base de Chloramphenicol; disponible en principe dans toutes les formations sanitaires ; une etude comparant l'efficacite du chloramphenicol a celle de la Ceftriaxone a ete realisee au Niger. Vu les ressemblances geographique; epidemiologique et du mode de vie des populations Burkinabe et Nigerienne; nous pensons que les conclusions peuvent etre extrapolees a notre pays

Meningitis de etiología poco habitual en niños / An unusual cause of meningitis in children

La meningitis por Listeria monocytogenes es una enfermedad infrecuente en la población pediátrica y más aún en pacientes inmunocompetentes. Presentamos un niño de cuatro años, previamente sano, que se internó con diagnóstico de síndrome meníngeo con líquido cefalorraquídeo patológico. Inicialmente se trató con cefotaxima y dexametasona, pero al persistir la fiebre, a las 48 horas se agregó vancomicina y aciclovir al tratamiento anterior. A las 72 horas se recibió el informe del líquido cefalorraquídeo(LCR) que mostró bacilos grampositivos, el cultivo informó Listeria monocytogenes, por lo cual se inició tratamiento con ampicilina y se suspendieron los antibióticos indicados previamente. Como complicaciones presentó estado epiléptico por hiponatremia con osmolaridad plasmática normal, a los 20 días evolucionó a una hidrocefalia aguda que requirió colocación de un sistema dederivación ventriculo peritoneal. Ponemos énfasis en la importancia de la tinción de Gram del LCR para orientar el tratamiento empírico inicial y en la observación del equilibrio hidroelectrolítico para disminuir la morbimortalidad en esta enfermedad grave

Actualidades en el tratamiento de la meningitis bacteriana aguda / Current treatment of acute bacterial meningitis

Hace poco más de 50-60 años cuando las sulfonamidas y la penicilina iniciaron su auge, la meningitis bacteriana era una enfermedad mortal. Desde entonces ésta ha podido ser curable; sin embargo, los porcentajes de mortalidad y morbilidad continúan siendo aún altos, con variables en su incidencia de acuerdo a los diferentes patógenos como por ejemplo: Streptococcus pneumoniae, Haemophilus influenzae tipo b, Neisseria meningitidis, Streptococcus del grupo B, Escherichia coli, Pseudomonas sp, Staphylococcus aureus y epidermidis, etc., así como a los diferentes tipos de pacientes (neonatos, lactantes, inmunosuprimidos, neuroquirúrgicos, con traumatismo de cráneo, adultos, ancianos, etc.). Con base en ello nuevos agentes antimicrobianos de amplio espectro y estrategias adyuvantes antiinflamatorias están siendo empleadas y evaluadas para mejorar los resultados en el paciente con meningitis bacteriana. Con la disminución en porcentajes de infecciones causadas por H. influenzae tipo b, posterior a la introducción de vacunas conjugadas, investigaciones para encontrar medidas preventivas para infecciones causadas por S. pneumoniae y N. meningitidis es el camino a seguir, y principalmente los estudios están dirigidos a tratar enfermedades causadas por cepas de neumococo multirresistente. Meningitis bacteriana; tratamiento; actualidades.

Primer aislamiento clínico de Prototheca wickerhamii en Costa Rica / First clinic insulating of Prototheca wickerhamii in Costa Rica

Se presenta una revisión sobre Prototheca wickerhamii con motivo del primer caso de infección en humanos que se reporta en Costa Rica. Se trata de un caso de meningitis en recién nacidos cuyo origen parece ser la madre en quien también se aisló el microorganismo

Meningite por Streptococcus pneumoniae de evoluçäo clínica desfavorável a terapeutica com cefalosporinas / Streptococcus pneumoniae meningitis with bad clinical evoluation treated with cephalosporins

Relatamos o caso de um lactente com um mês de idade portador de miningite por Streptococcus pneumoniae de evoluçäo clínica desfavorável, sendo o agente sensível in vitro ao ceftriaxone, porém resistente in vivo. Comentamos a antibioticoterapia baseada nos testes de sensibilidade e sugerimos a associaçäo de antibióticos de largo espectro desde o início do tratamento, objetivando evitar sequelas neurológicas graves

Complicaçöes intracranianas das otites médias crônicas supurativas: uma realidade / Intracranial complications of chronic suppurative otitis media: a reality

Os autores fazem uma revisao acerca das complicaçoes intracranianas das otites médias crônicas supurativas, chamando a atençao para a ainda alta incidência das mesmas e de sua potencialmente elevada morbi-mortalidade, ilustrando com apresentaçao de casos.