Akut Viral Menenjit

Özet

Akut menenjit, bebek ve çocuklarda etkin tedavi, aşılamaya rağmen mortalite ve morbiditeyle sonuçlanabilen yaşamı tehdit eden önemli bir enfeksiyon hastalığıdır. Etken genellikle virüslerdir. Viral menenjitin belirtileri genellikle bakteriyel menenjite benzerdir ancak daha az şiddetlidir. Bebekler spesifik olmayan bulguların (huzursuzluk, yetersiz beslenme, uyku hali, kusma, ishal, döküntü ve solunum semptomları) eşlik ettiği ani başlayan ateş ile başvurabilirler. Büyük çocuklarda tipik menenjit bulguları (ateş, baş ağrısı, kusma) görülebilir. Fizik muayenede bebeklerde fontonel kabarıklığı, büyük çocuklarda ense sertliği, kernig ve brudzinski bulguları tespit edilebilir. Tanıda BOS’ta mononükleer karakterde pleositoz varlığı, bakteriyolojik açıdan steril BOS ve nükleik asit amplifikasyon ile bakılan PCR testinin çalışılması ile konulabilir. Viral menenjitin en sık nedeni enterovirüslerdir, yaz sonu/sonbahar başında salgınlara neden olabilir. Klinik ve muayene bulguları ile bakteriyel-viral ayrımını yapmak oldukça güçtür ve menenjitten şüphelenilen çocuklarda bakteriyel menenjit dışlanana kadar bakteriyel menenjit gibi yönetilmelidir. Bakteriyel menenjit ile ayrımının yapılması gereksiz antibiyotik kullanımını engelleyebilir. Destek tedavisi önerilir, prognoz genellikle iyidir.

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