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Gravedad de la meningitis bacteriana infantil y duración de la enfermedad antes del diagnóstico
T Kilpi1, M Anttila, M J Kallio
1Children's Hospital, University of Helsinki, Finland.
Lancet (London, England)
|August 17, 1991
Resumen
El diagnóstico rápido de la meningitis bacteriana infantil (BM) es crucial. Sin embargo, una mayor duración de la enfermedad antes del ingreso al hospital se correlacionó con mejores resultados clínicos en los niños, lo que sugiere que los patrones de enfermedad insidiosa pueden causar retrasos diagnósticos inevitables.
Área de la Ciencia:
- La pediatría es la medicina de los niños.
- Enfermedades infecciosas Enfermedades infecciosas.
- La medicina clínica es la medicina clínica.
Sus antecedentes:
- El diagnóstico rápido de la meningitis bacteriana infantil (BM) se considera esencial para obtener resultados favorables.
- La relación entre la duración de la enfermedad antes del ingreso hospitalario y la gravedad de la enfermedad en el BM pediátrico requiere una investigación adicional.
Objetivo del estudio:
- Investigar la asociación entre la duración de la enfermedad antes del ingreso hospitalario y la gravedad clínica de la meningitis bacteriana infantil.
Principales métodos:
- Un estudio prospectivo recogió datos de 286 niños con BM positivo en cultivos en 18 hospitales pediátricos finlandeses (1984-1989).
- Los casos se clasificaron en grupos de historia corta (≤24h), historia intermedia (>24h a ≤48h) y historia larga (>48h).
- La gravedad clínica se evaluó utilizando variables que incluían el nivel de conciencia, las convulsiones, la proteína del LCR, la tinción de Gram, el cultivo de sangre, la PCR y el sodio en la orina.
Principales resultados:
- Los niños con duradas de enfermedad más cortas (≤48h) exhibieron condiciones clínicas significativamente peores en comparación con aquellos con historias más largas (>48h).
- Se observaron peores resultados en términos de conciencia, convulsiones, proteína del LCR, tinción positiva de Gram en el LCR, cultivo de sangre positivo (H. influenzae), CRP sérico y sodio en la orina.
- Estas diferencias fueron independientes del organismo causante, el sexo, la edad o el uso previo de antimicrobianos.
Conclusiones:
- Una mayor duración de la enfermedad antes del ingreso hospitalario en la meningitis bacteriana pediátrica se asocia paradójicamente con una mejor condición clínica.
- La aparición insidiosa de BM puede conducir a retrasos inevitables en el diagnóstico, lo que podría tener implicaciones médico-legales.
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