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Meningitis Bacteriana

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Revisión de Meningitis Bacteriana - Cesmed

Revisión de Meningitis Bacteriana - Cesmed

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  • 1. MENINGOENCEFALITIS BACTERIANA Alexander Cruz Sotomayor CESMED
  • 2.  
  • 3. MEC AGUDA CRONICA Virus Bacterias Treponema Pallidum Tuberculosis Micobacterium avium complex Leptospirosis Actinomyces Cryptococcus neoformans
  • 4. EPIDEMIOLOGIA Y ETIOLOGIA
  • 5. CECIL, TEXTBOOK OF MEDICINE 22ED 2005
  • 6. Otros agentes
    • Listeria monocitogenes:
      • Neonatos
      • Embarazadas
      • Mayores de 60 años
      • Inmunosuprimidos
    • Staphylococcus aureus
      • Neurocirugía
    HARRISON, PRINCIPIOS EN MEDICINA INTERNA, 16ED 2004
  • 7. FISIOPATOLOGIA
    • St. pneumoniae y Neisseria meningitidis:
      • Coloniza epitelio nasal
      • Vía hematógena
      • Plexos coroideos
      • LCR
    • TNF e IL-1, como mediadores inflamatorios.
    • Aumento de proteínas en LCR
    • Infiltración linfocitaria.
  • 8. PATOLOGIA
    • Infección purulenta del espacio subaracnoideo, compromiso de meninges.
    • Cerebro congestionado y edematoso.
      • Tromboflebitis cortical
      • Infarto cerebral
      • Edema cerebral
      • Ventriculitis
  • 9. CLINICA
    • Cuadro agudo fulminante.
    • Cuadro agudo.
    • Cuadro subagudo.
    • Cuadro crónico.
  • 10.  
  • 11. 5% de sensibilidad 92% de especificidad 26% de valor predictivo positivo signo de Brudzinski JAMA, 2005
  • 12. 5% de sensibilidad 90% de especificidad 26% de valor predictivo positivo JAMA, 2005
  • 13. DIAGNOSTICO
    • Hemograma
    • Hemoglobina
    • Glucosa
    • Rx tórax
    • TTP e INR
    • Punción lumbar
      • Descartar Hipertensión Endocraneana
    • TEM
      • Vasculitis like
      • Edema
      • Herniación
  • 14. IDSA, PRACTICE GUIDELINE FOR THE MANAGEMENT OF BACTERIAL MENINGITIS, 2004
  • 15. IDSA, PRACTICE GUIDELINE FOR THE MANAGEMENT OF BACTERIAL MENINGITIS, 2004
  • 16. ADA > 6mg/dl ====MEC TBC Sensibilidad: 50% Especificidad 92% Valor Predictivo Positivo 76% 150-200 mg/dl <45 mg% 50-1000 LMN >18cm H2O MEC TBC Leve Aumento <45 mg% 20-500 LMN >18cm H2O MEC Fúngica >50 mg/dl Normal 25-500 LMN >18cm H2O MEC Viral 100-500 mg/dl <45 mg% 200- 2000 PMN >18cm H2O MEC Bacteriana 20-45mg/dl 50% Gluc Seric <6 leucocitos <18cm H2O Normal Proteínas Glucosa Celularidad Presión de apertura
  • 17. IDSA, PRACTICE GUIDELINE FOR THE MANAGEMENT OF BACTERIAL MENINGITIS, 2004
  • 18. IDSA, PRACTICE GUIDELINE FOR THE MANAGEMENT OF BACTERIAL MENINGITIS, 2004
  • 19. IDSA, PRACTICE GUIDELINE FOR THE MANAGEMENT OF BACTERIAL MENINGITIS, 2004