 |
|
|
 |
 |
|
|
 |
|
 |
 |
 |
 |
 |
 |
Frequent questions | |
|
He asks the doctor | |
 |
Beginning | |
 |
 |
 |
|
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
 |
MENINGITIS | |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
 DEFINITION INCIDENCE SYMPTOMS INFECTED EVOLUTION EPIDEMIC PREVENTION VACCINATION REVACCINATION EMBARRASSED PROPHYLAXIS SOURCES TO CONSULT |
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
It is an infectious affectation of the meninges (that are the membranes of recovering of the brain and of the spinal cord). Type can owe to the infection for Haemophilus influenzae b (Hib) to itself and for the Neisseria meningitidis (groups A, B, C, Y, W 135), there can be other causative but less representative bacteria for his frequency in epidemics. It affects principally the children from 3 until 8 months, but his incidence can become of 1 for every 100.000 inhabitants, more than half of the affected ones is 15-year-old minors. The frequency of the causes of epidemic they are:
There exists an increase of risk of infection in persons with deficit of factors of the complement (C3, C5-C9), in persons without spleen, or in affected by AIDS (in these cases especially the infection has turned out to be developing for the serotipo A). In the military service the serotipo epidemics have turned out to be developing C, for it in USA the Meningitis vaccine puts itself like prevention with groups A, C, Y, W 135. The most frequent symptoms are:
And the most dangerous symptoms are also:
It is transmitted by the nasal secretions, salivates and for the air contaminated with sneezes or coughs of the affected patients. That is to say that the contact must be nearby so that it is possible to transmit. Except in cases of problems of absence of defenses for previous illnesses (linfomas, immunodeficiencies, diabetes, etc...) the susceptibility is scarce, since the causative bacterium is usually in the gullet of 10 % of the individuals and the illness does not develop. The illness develops before an intense contact with the bacteria of the secretions of an affected individual of meningitis. The infection develops the 2 to 10 days of the contact with the patient, appearing the symptoms previously stated and must talk each other before 24-36 hours, in this one period the illness can be fatal. The mortality in these cases comes to 1 of every affected 7, and with the treatment adapted before 12 p.m. it can turn reduced 10 %. In spite of recovering there usually stay cerebral injuries, motorboats, you reflect, etc... Group is considered to be a meningitis epidemic by Neisseria meningitidis C when in a community 3 cases appear in less than three months and the entire predominance is of more than 10 cases for 100.000 inhabitants, and it is ONLY in this case when there is recommended the widespread vaccination (The American Academy of Pediatrics. Edition nº 16 of the CCDM pag 305-306, of 21/June / 1996). To improve the hygiene (Southwestern Medical Center at Dallas 1997) diminishes the extension of the epidemic. Also it is necessary to use paper tissues to cover the cough or sneezes of possible affected. In the cases of next contact with affected a prophylaxis is indicated with Rifampicina, Sulfamidas (if the bacterium is capable) and as alternative one can associate Ceftriaxona and Ciprofloxacin (to see further on). In the cases of alterations previous to the route of the complement and the absence of spleen, there is always indicated the vaccine of Meningitis (groups A, C, Y, W 135). If there is epidemic (10 cases by 100.000 inhabitants) the vaccination of the children is indicated. The new vaccine of the meningitis C. There is called he a vaccine MenC, it is a combined vaccine proceeding from the covering of polysaccharides of the meningococo C brought together to a protein. On having been injected into the human being, it produces immunity for the meningitis C from 2 months of age. It is administered in three doses, 2, 3 and 4 months after age. In major children two doses are needed and from 18 months only they need only one dose. Side effects:
More ancient vaccine. The vaccine for the meningitis produced by the Neisseria meningitidis group A, C, Y, W 135, administers injectable route in only one dose 0,5 ml subcutaneous route, containing 50 g of capsular polysaccharides of every serotipo of Neisseria meningitidis. As side effects it is possible to appreciate the local inflammation and something of fever. The protective effects begin to 7-10 days. His efficacy is good (not whole) in the children older than 2 years. In the children from 3 months until 2 years it is of doubtful efficacy (it does not cover), and it is not indicated in the minors of 3 months. (The serotipo A can produce antibodies in children of 3 months of age but not comparable at the level that is reached from 5 years of age. The serotipo C is slightly effective before 2 years).
The antibodies measurement against the serotipos A and C it diminishes in the first three years of the only dose, this antibodies descent is more rapid in children than in adults. His protective effect lasts from 1 to 3 years according to the age and not more. The indication of the vaccination happens in meningitis epidemics C, in children older than 2 years, and of meningitis A in children from 3 months until 18 months in two separated doses three months. It is recommended in the cases with factors of risk (immunodeficients, convalescent, inmunodeprimidos, esplenectomizados, etc...) in addition to laboratory personnel with exhibition to the Neisseria meningitidis. It is possible to administer simultaneously that other vaccinations without problems. The vaccine contains Thiomersal, therefore it is necessary to be careful in the allergic ones to antiseptic to mercurial or phenol. The group B of the Neisseria meningitidis, has no vaccine and by it it is not covered of this infection with the current vaccine. Other meningitises caused by Haemophilus and other bacteria it has other vaccines. With the piece of news of the menigitis C it is not necessary. With the ancient one it is recommended in persons living in areas with endemia, in children younger than 4 years (between 2-3 years of the first dose). In persons of more age, major of 4 years and adults 5 years of the first dose are recommended to the 3-. It is possible to administer without problems for the mother or the child, producing high antibodies levels to him in the newborn baby that disappear rapidly in the first months. For it the vaccination rules should not falter for having done it during the pregnancy. It is necessary to realize in case of:
The quimioprofilaxis is effective in the first days of the contagion, and not more than 15 days later. The cultivation of pharyngeal exudado is not useful for the delay of the result with regard to the effective period of the same one. The quimioprofilaxis is carried out with Rifampicina, this one colors the orange urine, and also other secretions therefore it can color the lenses of contact or the clothes for the perspiration. It is not necessary to use Rifampicina in the pregnancy, and with the contraceptive ones it intergesticulates therefore they can fail. The ciprofloxacino is a valid and more comfortable alternative for adults, since it is not necessary to give this medicine in children in growth phase. The Ceftriaxona is a valid alternative, not this way different cefalosporinas.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
DEFINITION
