Purulent Meningitis

 

– Newborn: Escherichia coli (40%); Strep B; Listeria

– Children <6 years: Haemophilus influenzae; meningitis; pneumococcus

– Adult and E> 6 years: meningococcal; pneumococcus

– Subject> 50: meningococcal; pneumococcal; Listeria; BGN.

* Antibiotics that cross the brain barrier are cephalosporins; aminopenicillins; penicillin G; the phenicols and sulfonamides.

* If asplenia (splenectomy, sickle cell anemia), two bacteria predominate: pneumococcus and Haemophilus influenzae b.

* In 50% of cases of listeriosis occurs in a patient without risk factors; for the rest it is mostly cellular immunosuppression and pregnancy.

* HIV infection is not linked to an increased risk of bacterial meningitis (except tuberculosis) meningeal involvement is especially parasitic (cryptococcal) and viral.

* The notion of prior pharyngitis is in favor of meningitis; an infection of the middle ear before three years is for Haemophilus.

Vaccination against meningitis

Vaccination against meningitis

* Meningococcal is suggested by the presence of arthralgia or arthritis, herpes outbreak, a maculopapular rash and especially a petechial purpura (sometimes vesicular-pustular or bullous -> allows isolate the germ).

* Pneumococcus: grounds (alcoholism, diabetes …)tendon breach; ENT or lung home.

The table is often severe; one can find a coma, seizures, neurological deficits, autonomic disorders, sometimes purpura fulminans (asplénisme).

Neuroméningé partitioning risk.

Sequelae.

We must determine the MIC of the organism to ß-lactam antibiotics. Mortality = 30% (5% for meningococcal meningitis).

* Haemophilus influenzae: reaching children between 6 months and 6 years (between 2 months and 5 years).

The onset is often insidious and discreet meningeal syndrome.

* Listeria: causes rhombencephalitis, meningitis being secondary.

The onset is gradual but definite.

Brain stem, cranial nerves, altered consciousness.

* Some pyogenic bacterial meningitis, seen at the beginning, may have lymphocytic or mixed form.

* Complications are more common in cases of pneumococcal meningitis, neuromeningitis listeriosis, tuberculosis, herpes meningoencephalitis.

* Phénicolé + vancomycin in case of allergy to beta-lactam antibiotics.

Cotrimoxazole is used in case of listeria meningitis when penicillin allergy.

* In case of mixed liquid meningoencephalitis (Listeria, herpes) -> aciclovir association IV + ampicillin + gentamicin (in doubt TB treatment).

* Post-surgical or post-traumatic meningitis (staphylococcus, BGN) -> C3G + fosfomycin +/- Flagyl

* Prevention: spiramycin is used for subjects contacts for meningitis.

It also relates to children under 4 years for Haemophilus influenzae meningitis in the entourage.

* The school crowding, closure or disinfection of premises are useless.

* The hypochlorurachie (eg hypoglycemia) is a typical element of bacterial meningitis.

ANTIBIOTICS:

– Listeria: Amoxicillin + gentamicin (21j) / Cotrimoxazole

– H. influenzae: Cefotaxime (200 mg / kg / d) / Chloramphenicol

– Pneumococcus: Amoxicillin (200-300 mg / kg / d) / cefotaxime

– Meningococcal: Amoxicillin / cefotaxime

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