Meningitis and encephalitis in infants and children

بيصت يتلا ةريطلخا ضارملأا نم غامدلاو اياحسلا باهتلا لازام رفوت نم مغرلاب كلذو 25% ىلإ لصي تايفو لدعبمو لافطلأا تافعاضم نم ينباصلما نم ريثك ىناعي .ةثيدلحا تاجلاعلا ةينهذلا تابوعصلاو ،عرصلا اهنمو لجلأا ةليوطو ةددعتم عيرسلا جلاعلاو صيخشتلاب ةيبهذلا ةدعاقلا لظتو .ةيكولسلاو مدقن .ةزكرلما ةيانعلاب جلاعلا وأ ةثيدلحا تاجلاعلا ريفوت نم مهأ ىدل غامدلاو اياحسلا تاباهتللا ةثيدح ةعجارم لاقلما اذه يف يف تاميعطتلا ةيمهأ ىلإ ريشن نأ مهلما نمو .لافطلأاو عضرلا تلازام اهنكلو ،ةريطلخا تاباهتللاا هذهب ةباصلإا ةبسن ليلقت بسن اهيف ضفخنت يتلا ةيمانلا لودلا هجاوت يتلا لكاشلما نم ،ةيوعلما تاسوريفلا نم لًاك ةيسوريفلا تاباهتللاا لمشت .ميعطتلا عمو ،تايلصفلماب ةلوقنلما تاسوريفلاو ،طيسبلا سبرهلا سوريفو كلذو ةيسوريفلا تاباهتللاا نع فشكلا بعصي دق هنإف كلذ ديدتح لهسي هنإف لباقلمابو .تلاالحا نم 70% ىدعتي لدعبم ةيويلحا تاداضلما اًقباس ضيرلما لوانت اذإ لاإ ةيريتكبلا تاباهتللاا بسح فلتخت تاباهتللاا هذه نأ ملعلا عم ،مفلا قيرط نع ىضرلما ةرشتنم ريغلا ةيرطفلا تاباهتللاا بيصتو .باصلما رمع .ةعانلما صقنب ينباصلما Despite the availability of modern therapies, meningitis and encephalitis remain potentially lifethreatening infections in children with mortality rates reaching up to 25%. Treated patients are at a high risk of long term sequelae including epilepsy, learning, and behavioral disorders. The golden rule of early diagnosis and treatment to achieve a good outcome has not yet been challenged by the new, often expensive antibiotics or contemporary critical care. In this article, an updated overview of meningitis and encephalitis in infants and children is presented. It is important to note that routine childhood immunization has significantly decreased the number of serious infections. However, meningitis and encephalitis remain problematic particularly in developing countries where immunization rates are suboptimal. The most common viral etiologies include enteroviruses, herpes simplex virus, and arboviruses. However, the causative virus may not be identified in up to 70% of cases. This is not the case for bacterial infections unless the patient had received prior oral antibiotics. The causative bacterial organisms vary Meningitis and encephalitis in infants and children Mohammed M. Jan, MBChB, FRCPC. 11 I of the meninges (meningitis) and the brain (encephalitis) need to be identified and managed promptly in order to prevent associated morbidity and mortality.1 Despite the availability of modern antibiotics, bacterial meningitis is still a potentially life threatening infection. The mortality rate is 10-25% in infants, 37% in young children, and 10-25% in adults.2-4 Even if the meningitis is not fatal, sequelae such as epilepsy, cranial nerve palsies, hydrocephalus, learning, and behavioral disorders can occur. The golden rule of early diagnosis and treatment to achieve a good outcome has not yet been challenged by the new, often expensive antibiotics or contemporary critical care. Symptoms and signs suggestive of raised intracranial pressure (Table 1) are frequently the initial features of meningitis caused by viral or bacterial infections.5 Encephalitis is more frequently caused by viral infections with features that include seizures, personality change, decreased consciousness, and focal neurological manifestations. As the infection progress, mixed features are frequently encountered (meningo-encephalitis). In this article, an updated overview of meningitis and encephalitis in infants and children is presented. Etiology. Routine childhood immunization has significantly decreased the number of serious infections. However, viral infections remain more common than bacterial infections. Both are more problematic in developing countries where immunization rates are suboptimal.6 The most common viruses that cause meningitis and encephalitis are listed in Table 2 and included enteroviruses, herpes simplex virus, and Review Article with age, and the less common fungal infections occur mainly in immune compromised patients. Saudi Med J 2012; Vol. 33 (1): 11-16 From the Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. Address correspondence and reprint request to: Prof. Mohammed M. S. Jan, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. Tel. +966 (2) 6401000 Ext. 20208. Fax. +966 (2) 6403975. E-mail: [email protected]