MENINGITA MENINGOCOCICA VS PENUMOCOCICA VS STAFILOCOCICA VS H.

INFLUENZAE

Patogenie Epidemiologie
Sursa infectiei Transmitere Receptivitate
Meningococ Factori virulentaa a.Bolnavi forme acute de boala AEROGENA Generala
(coc G-, aerob, imobil) a.pilii-aderare
(dispunere diplo,intra,extracel) b.capsula-antifagocitar b.Purtatori sanatosi
c.endotoxine-CID, C faringieni+nazali
!Colonizare
oro/nasofaringe=>purtator
asimptomatic
Pneumococ In sp subarahnoidian prin: a.Bolnavi infectii acute a.Direct AEROGENA
(coc g+, aerob,incapsulat,lance)
(dispunere diplo/lant scurt) a.Hematogen (penumonii) b.Purtatori sanatosi de B.Indirectobiect contaminat
b.Limfatic (faringe) pneumococ
*capsula PZH=invazie+rez. Fag. c.Perinervos (n.olfactiv)
**=>proteaze: inhib fag. d.Contiguitate (sinuzite,
+multiplicare la poarta de osteomielite)
intrare e.Direct: rahianest/trauma
***=>fibrina: protectie AB+fav,
recidive
Stafilococ auriu !Meningita secundara pt focar a.Bolani cu forme acute a.DirectAEROGENA
(coc g+, imobil, nesporulat) supurativ vecin/distantat
(dispunere ciorchine) b.Purtatori sanatosi (faringe, b.Contact direct
!Colonizeaza dupa nastere Penetreaza BHE: nas,tegument)
tegumentele=flora saprofita
a.Hematogen
b.Contiguitate
c.Direct
H.Influenzae Factori patogeni: a.Bolnavi cu forme acute a.DirectAEROGEN
(bacil g-, imobil, aerob) a.Capsula PZH La copii
b.IgA proteaza b.Purtatori b.Contact direct
=>multiplicare poarte, c.Endotoxine sanatosi(faringe+nas)
supravietuire+ strabate BHE d.Proteine ext. mb
 Tablou clinic
Incubatie Debut Stare
Meningococ 3-5 zile 2-3 zile  a.Brusc: FFCSV Sdr. Infectios inflamator+HTIC+encefalitic+-meningean
b.Brutal: FM(C->C) Sdr.Eruptiv:eruptie petesiala(3-10mm)-gambe,coapse
!poate generalizaplacarde necrotice+vezicule
Pneumococ 1.Otogena abces cerebral+tromboflebita endocran
2.Hipertoxica lcr: clar+pneumococi (deces=1-2 zile)
3.Recidivantafocare nesterilizate/fistule postratraumatice
Stafilococ 1-4.Sdr. infectios inflamator+HTIC+meningean+encefalitic

H.Influenzae 3-4 zile Febra, varsaturi, tuse seaca, refuz supt 1.Sdr meningean incomplet
2.Tulb digestive+respiratorii
3.Eruptie eritematoasa
4.Tipat encefalic
5.Convulsii

Meningococ Pneumococ Stafilococ H.influenzae

Forme clinice 1.Septicemica=afectare 1.Din septicemii stafilococice

artic+tegum+endo/pericard 2.La cei cu sunturi ale lcr
2.Sdr Waterhouse-Friedricksen 3.Secundara trombozei
=soc endotoxinic cu CID sinusului cavernos
=eurptie hemoragica in placard
= hTa/MSOF
3.Sugar=debut convulsiv+-
Sdr. Meningean
incomplet/dispeptic/deshidratare
+Acidoza metabolica
4.Decapitata post AB
5.Frusta
 Meningococ Pneumococ Stafilococ H.Influenzae

Complicatii 1.Abces cerebral 1.Septari/cloazonari sp. 1.Abces cerebral 1.Tromboflebite cerebrale

2.Nevrite
3.Colectii subdurale
4.Trombofl. endocraniene
5.Hidrocefalie
6.Pareze/paralizii
7.Hipoacuzie/surditate
8.Epilepsie
9.Endo/miocardite
10.Artrite
Diagnostic diferential 1.Bacteriana=penumo/stafilo/G-
2.Meningita bact. toxica
3.Meningita TBC/virala/fungica
4.Mening. leptospirotica
5.Mening. decapitata
6-7.Meningism+r.meningeana
Subarahnoidian a. Lob frontal: 3xa+paral. 2.Colectii subdurale
Contralat 3.Convulsii
2.Ependimita ventriculara sero. 4.Epilepsie
b.Lob occipital: hemianops 5.Hidrocefalie
3.Abces cerebral bil+haluc. Vizuale 6.Surditate
4.Revarsate subdurale c.Cerebel: tulb vestib.
+adiadokokinezie
1.Bacteriana=stafilo/g-
!!2-7 la fel ca la meningo
 Tratament
Profilaxie
Igieno-Dietetic Antibioterapie Patogenic
1.Rifampicina
copil: 10mg/kg
1.Penicilina G 200Ku/zi-copil//10kkU/zi-adult(10-14)
adult:600mg
2.Ceftriaxona(3):100mg/kg-copil// 2x2(3x2)g.zi-adult
3.Cefotaxim(3): 4x3g/zi
Meningococ +Anticoagulante 2.Ciprofloxacina:
4.Ceftizoxim (3): 4x3g/zi
500mg d.unic
5.Meropenem(carbapenem): 3x2g/zi
6.Augmentin(amoxi+clavu): 100mg/kg-copil//3x1.2/zi-adult
3.Ceftriaxon: 1g d.
unica gravide
1.Penicilina G: dublam dozele fata de mening.(14 z) Depletive(manitol
2.Ceftriaxona: dublam doza copil/pastram la adult3 AINS
Pneumococ
3.Cefotaxim+Ceftizoxim+Meropenempastram dozele Corticoterapie
4.Imipenem: 3x1g/zi Anticonvulsivante
1.Izolare spital 1.Oxacilinacopil:200mg/kg Vitaminoterapie
2.Repaos pat adult:4x2(3)/zi-14-21 zile Reechilibrare
3.Regim hidro- hidroelectrolitică şi AB
lacto-zaharat 2.Nafcilinacopil:100-200mg/kg in 4 prize Oxigenoterapie
adult:6x2g/zi-14-21 zile Corectarea acidozei
Stafilococ metabolice
3.Cefotaxim-la fel
4.Vancomicinacopil:40-60mg/kg in 4 prize
adult: 2x1(2)g
5.Linezolid: 2x600mg/zi
6.Rifampicina: 4x300mg/zi-14-21 zile
1.Augmentincopil: 200mg/kg-rar
adult: 3x2g/zi 14 zile
2.Ceftriaxonsugar:50-100mg/kg
H.Influenzae
adult: 2x2g/zi
3.Cefotaximsugar:100/200 mg/kg
adult: 4x3g/zi