Mier MPA, Ayala DDT, Méndez SER, Reséndiz MMA, Chávez ML, Olvera RJE

Language: Spanish
References: 20
Page: 165-171
PDF size: 340.97 Kb.

ABSTRACT

Background: The pyogenic leptomeningitis or bacterial meningitis is an infectious disease of the arachnoid and piamatter caused by bacteria, it has a worldwide distribution. It occurs in the extremes of life, in all socioeconomic levels and is often secondary to infectious processes of the respiratory system.
Objectives: To analyze the autopsy material in pyogenic leptomeningitis, a disease that through history has had major changes and determine their epidemiology in Mexico, its clinical manifestations, diagnostic assistants used, the time course, histopathological characteristics and therapeutic management during the hospital stay.
Materials and methods: We reviewed the autopsy performed in the Pathology Unit of the General Hospital of Mexico, were selected protocols with bacterial meningitis were excluded protocols diagnosed with viral diseases, tuberculosis and fungal and described pathological findings collected.
Results: In the pathology unit of the Mexico City General Hospital 3,346 protocols were reviewed. The autopsies were performed in a 16 year period and 174 cases of bacterial meningitis were found (5.2%). Most cases occurred during the fifth decade of life (17.2%) and in newborns (14.9%). In 117 cases an infectious primary focus was described in the respiratory system (51.2%), urinary system (16.2%) and ear (8.5%). In 14 protocols a history of a surgical procedure was found (9-1%). The predisposing factors were diabetes mellitus (14.4%) and carcinomas (10.8%), the uterine cervix and colon at the head of the list. The clinical manifestations in descending order of frequency were generalized seizures (47 cases), fever and headache (30 cases), nuchal rigidity (29) and disturbances of the waking state (18 cases). In only 38 cases (21.3%) a cerebrospinal fluid study was documented. In 24 cases (13.7%) Gram-positive microorganisms were identified, Gram-positive cocci in 9 cases (37.5%), Pseudomonas sp. in 4 (16.6%), Gram-negative bacteria in 3 (12.5%), Enterobacter sp. in 2 (8.3%), Streptococcus pneumoniae in 2 (8.3%), Klebsiella sp. in 2 (8.3%), Staphylococcus aureus plus Escherichia coli in 1 (4.2%) an Serratia marcescens in 1 (4.2%). In 148 the time of evolution could be established. Acute evolution in 118 (79.7%) and subacute evolution in 30 (20.2%).
Conclusions: The right clinical diagnosis was made in most cases, however, in just a few the study of cerebrospinal fluid was performed, even though this study is considered the gold standard for the exact diagnosis. Thanks to the antibiotic treatment, the pyogenic meningitis with sequelae is a rarity.

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