Análise dos casos de meningites e meningoencefalites nos pacientes pediátricos internados em um hospital terciário

Abstract

Meningitis remains a disease with high morbidity rates in Brazil. The Santa Maria University Hospital is a reference for the entire central-western region of the state, covering 32 municipalities and has specialized services in pediatric neurology and infectious diseases, so that it concentrates most of the care and hospitalizations for meningitis in the region. This work aims to outline the clinical and vaccine profile of patients hospitalized for meningitis, to know the most prevalent infectious agents, as well as to relate symptoms and liquoric findings with the chances of complications and sequelae. The records of the epidemiological surveillance center were consulted and all 61 cases of meningitis admitted to the pediatric service over a period of 24 months were subsequently reviewed. The age of the patients ranged from zero to fifteen years. Most patients were between zero and two years old, half of whom were premature. The rate of patients with an unknown vaccination status was 41% and the rate of non-isolation of the germ was greater than 70% of cases of bacterial meningitis, 64% of patients with bacterial meningitis had been on antibiotics for more than 24 hours at the time of CSF collection, and only about 20% of patients had been asked for a latex agglutination test. However, the use of antimicrobials prior to collection does not seem to have influenced the possibility of germ identification. The clinical findings varied significantly according to age groups, the classic triad of vomiting, fever and headache predominated in the group of adolescents and schoolchildren, while seizures were present mainly in the group of infants. In the neonate group, extreme irritability predominated as the main clinical manifestation. There was a significant association between the presence of seizures at the time of diagnosis and sequelae of epilepsy after the end of treatment. Likewise, seizures and changes in mental status at admission were associated with complications during treatment, as well as elevated proteinorakia in the examination of CSF. The present study revealed an underreporting of the patients' vaccination status, as well as a low percentage of germ isolation in bacterial meningitis, calling attention to the need for greater agility in collections, better use of available diagnostic resources and indiscriminate use of antibiotics.