Cazul 1

Dr. Maria Obreja

 L.M.D, 19 ani- 13.06.2016
• MI: febra
• -24 ore

• APP:
- politraumatism (toracic, vertebral, nazal) –accident
rutier (pasager dreapta)
- craniectomie decompresiva (in urma cu 3 saptamani)
- fractura baza craniu fronto-parietal stang operat
- hematom subdural parietal stang operat
- fractura piramida nazala
 Examen clinic general :
• Cicatrice postchirugicala frontoociipitala
nazala, escoriatii nazale, torace anterior,
cicatrice tub dren, gambe bilateral
• Herpes labial
• Craniectomie stanga cu pierdere de substanta
osoasa,fronto parietal
• Semne de contractura meningeana prezente
• SUSPICIUNEA ???
 Examene de laborator:
• GA= 19.180/mmc
• PMN=71.9%

• PCR=48mg/dl
• VSH=50mm/h
Examene de laborator:
• PL(1): -13.06

• LCR opalescent
• 3840 elem
• 98% PMN, 2% Ly
• Alb=18,9g/dl
• G=20mg/dl
• Cl=11,7g/l
 Diagnostic

• MENINGITA BACTERIANA
 Tratament
Varsta Agent etiologic Tratament Alternative
Nou nascut N.meningitidis, Ceftriaxona Meropenem
BGN Gentamicina
Listeria Ampicilina
Copil H.influenzae, Ceftriaxona Meropenem
N.meningitidis
Tanar S.pneumoniae, Ceftriaxona Meropenem
N.meningitidis
Varstnic S.pneumoniae, Ceftriaxona Meropenem
N.meningitidis
Listeria Ampicilina
*politrauma, S. aureus Vancomicina
postoperator
Gravida S.pneumoniae, Ceftriaxona Meropenem
Listeria Ampicilina
 Tratament

• etiologic

• MEROPENEM + VANCOMICINA
 Tratament

• patogenic

• MANITOL
• SG 10%

• DEXAMETAZONA
Tratament

• simptomatic

• PARACETAMOL
• VITAMINE B1,B6
 Examene de laborator:
• PL(1): -13.06 • PL(1):

• LCR opalescent • LCR – cultura – 48 ore

• 3840 elem • Bulkholderia cepacia
• 98% PMN, 2% Ly
• Alb=18,9g/dl
• G=20mg/dl
• Cl=11,7g/l
 Examene de laborator:
• PL(2): -17.06 • PL(2):

• LCR tulbure • LCR – cultura – 48 ore

• 4270 elem • Pseudomonas
• 95% PMN, 5% Ly aeruginosa
• Alb=11,9g/dl
• G=33mg/dl
• Cl=7,23g/l
 Examene de laborator:
• PL(3): -23.06 • PL(3):

• LCR tulbure • LCR – cultura – 48 ore

• 1015 elem • Pseudomonas
• 90% PMN, 10% Ly aeruginosa
• Alb=7,9g/dl
• G=28mg/dl
• Cl=7,32g/l
 Examene de laborator:
• PL(4): -30.06 • PL(4):

• LCR intens hematic • LCR – cultura – 48 ore

• 215 elem negativa
• 62% PMN, 38% Ly
• Alb=1,12g/dl
• G=40mg/dl
• Cl=7,56g/l
 MEROPENEM + VANCOMICINA
4270
3840

1015

215
1 2 3 4
Durata???
 Cazul 2

Dr. Maria Obreja

 C.E, 42 ani- 22.08.2017
• MI: cefalee, frisoane, varsaturi, febra
• -7 zile

• APP:
- nesemnificative
 Examen clinic general :
• Stare generala usor influentata
• Ficat la rebord

• In rest normal
cefalee, frisoane, varsaturi, febra
stare generala usor influentata, ficat la rebord

• SUSPICIUNEA ???
cefalee, frisoane, varsaturi, febra
stare generala usor influentata, ficat la rebord

• INVESTIGATII ???
 Examene de laborator:
• GA= 7790/mmc
• PMN=71.4%
• Ly=16%

• PCR=15.81mg/dl
• VSH=12mm/h
Examene de laborator:
• PL(1): -25.08

• LCR clar
• 124 elem
• 15% PMN, 85% Ly
• Alb=0,63g/dl
• G=30mg/dl
• Cl=6,8g/l
 Diagnostic

• MENINGITA - ???
 Diagnostic diferential
MENINGITA ENCEFALITA MENIGOENCEFALITA
Diagnostic diferential
MENINGITA BACTERIANA MENINGITA VIRALA MENINGITA TBC
 Examene de laborator:
• PL(1): -25.08

• LCR clar
PI E • 124 elem
DIP LO
• 15% PMN, 85% Ly

• Alb=0,63g/dl
• G=30mg/dl
• Cl=6,8g/l
 Diagnostic

• MENINGITA TBC
 Tratament

76 elem, 64% Ly
124 elem 910 elem 370 elem
PCR M.tuberculosis
85% Ly 65% PMN 77% PMN
-pozitiv
ETB,PZN,HIN ETB,PZN,HIN • ETB,PZN,HIN,RIFA
CLARITRO CIPRO
CIPRO CIPRO, RIFA • MEROPENEM
CEFTRIAX ETB,PZN,HIN
RIFA LINEZOLID • VANCOMICINA
 Tratament

47 elem
90% Ly
• ETB,PZN,HIN,RIFA + MEROPENEM + VANCOMICINA
 Tratament
• CLARITROMICINA
• CEFTRIAXONA
• CIPROFLOXACINA
• ETB,PZN,HIN
• ETB,PZN,HIN
• CIPROFLOXACINA 370 elem 47 elem
• RIFAMPICINA 77% PMN 90% PMN

• ETB,PZN,HIN
• CIPROFLOXACINA
124 elem
• RIFAMPICINA
85% Ly • LINEZOLID • ETB,PZN,HIN
76 elem, 64% Ly • RIFAMPICINA
PCR M.tuberculosis -pozitiv 910 elem • MEROPENEM
65% PMN
• VANCOMICINA
Durata???
Va multumesc!