jueves, 6 de septiembre de 2007

Historia de la Meningitis

La meningitis bacteriana ha sido reconocida desde hace varios siglos como un gran síndrome en la literatura médica universal, encontrándose descripciones de la misma desde el siglo XVI.

Pero fue Viesseux, que en el año 1805 asoció esta patología a un cuadro con características epidémicas asociado a la presentación de un exantema purpúrico, mencionado como "fiebre purpúrica maligna" (meningococcemia con compromiso del sistema nervioso central).

La Historia de la meningitis representa el mejor ejemplo de el efecto en la salud pública de la introducción de las agentes antimicrobiales. En 1920, 77 de 78 niños en el Boston Children´s Hospital los que tuvieron meningitis por Haemophilus influenzae fallecieron. El pronóstico de la meningitis por neumococo sin tratamiento era igual de fatal: de 300 pacientes, todos fallecieron. En 1913, Simon Flexner fue el primero en reportar alguna elevación en la tasa de mejoría de la meningitis bacteriana con la aplicación intratecal de suero equino antimeningococo, de 1300 pacientes en una epidemia de meningitis, la mortalidad se redujo al 31%. Fothergill reportó en 1937 que el tratamiento de H. influenzae combinado con antisuero intravenoso e intratecal, la mortalidad de 201 niños se redujo al 85%. En 1930, con la introducción de las sulfonamidas, la mortalidad asociada con meningitis meningococcica se redujo al 15%. En 1950, el tratamiento con Cloranfenicol (con sulfonamidas) redujo la rata de fatalidad por H. influenzae hasta un 5 a 10% e hizo el uso del antisuero innecesario.

El uso terapéutico de la penicilina para meningitis por neumococo a mediados de lo 40´s, combinando intravenoso con la administración intratecal, dio resultados de tasas de mortalidad cercanas al 49%. Los modernos tratamientos con dosis “meníngeas” sin administración intratecal empezaron en 1949, reportado por Dowling et al. en un estudio con 21 pacientes con meningitis neumococcica, siendo tratada con 1 millón de unidades de penicilina intramuscular cada 2 horas, con resultados de reducción de la mortalidad a un 38%.

En los últimos 15 años, la terapia para meningitis bacteriana adquirida en la comunidad ha considerado el uso de penicilina intravenosa (o ampicilina), cefalosporinas de 3ra generación, o ambas; reduciendo la mortalidad por meningitis meningococcica alrededor del 10%, para meningitis por H. influenzae se ha reducido a menos del 5%.


LINKS:

Sitios Argentinos - Meningitis
http://www.sitiosargentina.com.ar/notas/2007/mayo/meningitis.htm

Salamandra (Centro Internacional de Entre-
namiento en Urgencias y Emergencias)
http://www.salamandra.com.co/page/index.php?p=temas_academicos.vsitemview&itemact=view_art&id_art=3B99DF65-6218-A4F5-41B8-2CBA12C98D0D

Medline Plus (Información de Salud para ud.)
http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000680.htm

Meningitis (Sección para padres)
http://www.cpnlac.org/temas_cpnl/Tema_meningitis.htm

Meningitis Bacteriana: Avances en el diagnós-
tico y Tratamiento
http://neurologia.rediris.es/congreso-1/conferencias/infecciosas-5.html

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