[
    {
        "page": 1,
        "title": "Meningitis bacteriana aguda (Cap 621)",
        "body": "<p>\n\n\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"ProgId\" content=\"Word.DocumentW\" \/>\n<meta name=\"Generator\" content=\"Microsoft Word 15\" \/>\n<meta name=\"Originator\" content=\"Microsoft Word 15\" \/>\n<link rel=\"File-List\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_filelist.xml\" \/>\n<link rel=\"Edit-Time-Data\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_editdata.mso\" \/>\n\n<style>\nv\\:* {behavior:url(#default#VML);}\no\\:* {behavior:url(#default#VML);}\nw\\:* {behavior:url(#default#VML);}\n.shape {behavior:url(#default#VML);}\n<\/style>\n<xml>\n \n  \n \n<\/xml>\n<link rel=\"themeData\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_themedata.thmx\" \/>\n<link rel=\"colorSchemeMapping\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_colorschememapping.xml\" \/>\n<xml>\n \n  <\/xml><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Definici\u00f3n<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecci\u00f3n grave del sistema nervioso central\n(SNC) causada por bacterias encapsuladas, con alta mortalidad y morbilidad a\npesar del tratamiento.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Epidemiolog\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Factores de riesgo:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\"> falta\n     de inmunidad a serotipos espec\u00edficos, lactantes peque\u00f1os, colonizaci\u00f3n\n     reciente, contacto estrecho, hacinamiento, pobreza, sexo masculino.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Comorbilidades:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     asplenia (trauma, cong\u00e9nita, drepanocitosis), d\u00e9ficit del complemento\n     (C5-C8 \u2192 meningococo; properdina \u2192 meningococo letal), d\u00e9ficit de\n     linfocitos T (riesgo Listeria), derivaciones de LCR (riesgo Pseudomonas,\n     S. aureus, S. coagulasa negativo).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Implante coclear:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     riesgo \u00d730 de meningitis neumoc\u00f3cica.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Transmisi\u00f3n:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     secreciones respiratorias.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Agentes\netiol\u00f3gicos principales<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Streptococcus pneumoniae<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">: m\u00e1s\n     frecuente en pa\u00edses vacunados; riesgo aumentado en VIH y asplenia.\n     (preguntado previamente en CONAREM).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neisseria meningitidis<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">: seis\n     serogrupos (A, B, C, X, Y, W-135). Serogrupo B predomina en lactantes y\n     campus universitarios; brotes invernales\/primaverales; colonizaci\u00f3n 1\u201315%\n     adultos; riesgo secundario en hogares\/guarder\u00edas.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Haemophilus influenzae tipo b (Hib):<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\"> causa principal antes de la vacunaci\u00f3n; m\u00e1xima incidencia 6\u20139\n     meses; hoy rara en pa\u00edses con vacunaci\u00f3n universal.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Otros: Listeria monocytogenes (inmunodeficiencias), gramnegativos\n     ent\u00e9ricos, Staphylococcus spp., Pseudomonas (derivaciones de LCR).<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Anatom\u00eda\npatol\u00f3gica y fisiopatolog\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Exudado purulento men\u00edngeo en convexidad, cisternas basales,\n     m\u00e9dula.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Vasculitis, trombosis cortical, arteritis necrosante \u2192 hemorragia\n     subaracnoidea.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infarto cerebral por inflamaci\u00f3n y vasoespasmo.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Aumento de presi\u00f3n intracraneal (PIC) por edema citot\u00f3xico,\n     vasog\u00e9nico e intersticial; riesgo de herniaci\u00f3n.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hidrocefalia por fibrosis aracnoidea.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Alteraciones del LCR: \u2191 prote\u00ednas, \u2193 glucosa.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Patogenia: colonizaci\u00f3n nasofar\u00edngea \u2192 bacteriemia \u2192 cruce de BHE \u2192\n     proliferaci\u00f3n en LCR (baja opsonizaci\u00f3n). Respuesta inflamatoria mediada\n     por endotoxinas y componentes de pared celular (lipopolisac\u00e1ridos,\n     peptidoglucano).<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Manifestaciones\ncl\u00ednicas<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Inicio t\u00edpico:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     fiebre d\u00edas previos + s\u00edntomas respiratorios\/digestivos \u2192 irritabilidad,\n     letargo.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Inicio fulminante:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     shock, p\u00farpura, CID, coma en 24 h.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Signos sist\u00e9micos:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     fiebre, anorexia, cefalea, exantema petequial\/p\u00farpura (meningococo).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Irritaci\u00f3n men\u00edngea:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     rigidez de nuca, Kernig, Brudzinski (menos frecuentes &lt;18 meses).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neurol\u00f3gicos:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     convulsiones (20\u201330%), alteraci\u00f3n conciencia, d\u00e9ficits focales (10\u201320%),\n     neuropat\u00edas craneales, papiledema en complicaciones.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Sospecha de \u2191 PIC:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     cefalea, v\u00f3mitos, fontanela abombada, anisocoria, apnea, posturas\n     anormales.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">(preguntado previamente en CONAREM: <b>signos\ncl\u00e1sicos de irritaci\u00f3n men\u00edngea<\/b>).<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Diagn\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Punci\u00f3n lumbar (PL):<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     fundamental salvo contraindicaciones (\u2191 PIC, compromiso\n     cardiorrespiratorio, infecci\u00f3n local).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hallazgos LCR t\u00edpicos:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     &gt;1.000 leucocitos\/mm\u00b3 (PMN 75\u201395%), prote\u00ednas \u2191, glucosa \u2193. En sepsis\n     fulminante puede no haber pleocitosis (mal pron\u00f3stico).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Gram:<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\"> positivo &gt;70% sin antibi\u00f3ticos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Limitaciones:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     antibi\u00f3ticos previos \u2192 cultivos negativos en 2\u20134 h, pero persiste\n     pleocitosis, prote\u00ednas altas, glucosa baja.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">PCR y pruebas antig\u00e9nicas:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     \u00fatiles en cultivos negativos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hemocultivos:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     positivos en 80\u201390%.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neuroimagen (TC):<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\"> solo\n     si signos de \u2191 PIC o antecedentes neuroquir\u00fargicos.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Diagn\u00f3stico\ndiferencial<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecciosas:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     tuberculosis, s\u00edfilis, Lyme, nocardiosis, hongos (Criptococcus, Candida,\n     Aspergillus, end\u00e9micos), par\u00e1sitos (Toxoplasma, cisticercosis).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">No infecciosas:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     lupus, sarcoidosis, vasculitis, linfoma, encefalitis autoinmune.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Principal confusi\u00f3n:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     meningoencefalitis v\u00edrica (LCR m\u00e1s benigno, pero superposici\u00f3n en fases\n     iniciales).<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">(preguntado previamente en CONAREM: <b>diferencial\ncon meningitis viral<\/b>).<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Tratamiento<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Inicio inmediato, sin esperar PL si contraindicaci\u00f3n.<\/span><\/b><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Emp\u00edrico fuera del periodo neonatal:<\/span><\/b><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Vancomicina + ceftriaxona<\/span><\/b><span style=\"font-size:12.0pt;\n      font-family:&quot;Times New Roman&quot;,serif\">\n      (cubrir S. pneumoniae resistente, N. meningitidis, Hib).<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">A\u00f1adir ampicilina<\/span><\/b><span style=\"font-size:12.0pt;\n      font-family:&quot;Times New Roman&quot;,serif\"> en\n      &lt;3 meses o inmunodeficiencias (riesgo Listeria).<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Si gramnegativos sospechados:<\/span><\/b><span style=\"font-size:\n      12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n      cefepima o meropenem.<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Alternativas:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     meropenem (al\u00e9rgicos a penicilina\/cefalosporinas), cloranfenicol,\n     fluoroquinolonas.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Duraci\u00f3n:<\/span><\/b><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">S. pneumoniae: 10\u201314 d\u00edas.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">N. meningitidis: 5\u20137 d\u00edas.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">H. influenzae tipo b: 7\u201310 d\u00edas.<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Medidas adicionales:<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     control de PIC, soporte hemodin\u00e1mico, manejo en UCI si shock o falla\n     multiorg\u00e1nica.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Complicaciones<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neurol\u00f3gicas:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     hidrocefalia, infartos cerebrales, crisis epil\u00e9pticas refractarias,\n     d\u00e9ficit motor\/sensorial, sordera neurosensorial.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Sist\u00e9micas:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\"> shock\n     s\u00e9ptico, CID, SIADH, falla multiorg\u00e1nica.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Pron\u00f3stico:<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\"> peor\n     en coma al ingreso, convulsiones persistentes, ausencia de pleocitosis en\n     sepsis fulminante.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">(preguntado previamente en CONAREM: <b>complicaci\u00f3n\nm\u00e1s frecuente: sordera neurosensorial<\/b>).<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Nota sobre\nvacunaci\u00f3n<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Impacto enorme en la disminuci\u00f3n de incidencia de meningitis por\n     Hib, neumococo y meningococo.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Vacunas conjugadas (PCV13, MenACWY, Hib) han modificado\n     radicalmente la epidemiolog\u00eda.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Persisten casos por serotipos no incluidos y en poblaciones no\n     vacunadas.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\u201cLa meningitis bacteriana es\n     una de las infecciones pedi\u00e1tricas m\u00e1s graves, con alta tasa de\n     complicaciones y riesgo elevado de morbilidad y mortalidad\u201d <\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\u201cEl inicio temprano del\n     tratamiento antimicrobiano, incluso con un retraso de pocas horas, se\n     asocia a evoluci\u00f3n cl\u00ednica desfavorable\u201d <\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\u201cHasta un 20% de los ni\u00f1os con meningitis\n     bacteriana muestra signos neurol\u00f3gicos focales\u201d<\/span><\/li>\n<\/ul>\n\n<\/span>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p class=\"MsoNormalM\">&nbsp;<\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<br \/>",
        "footer": "P\u00e1gina 1"
    }
]