– 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.
* 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