Méningites/Méningo-Encéphalites

Question 1

diagnostic meningite et encephalite

purpura fulminans

Answer 1

CLINIQUE urgence diag et therap avant 3h sinon séquelles.
- sd meningé + plier jambes diminue tension (Kernig/Brudzinski (nuque))
- sd encephalique =troubles cs focalisation convusion.
/!\ purpura fulminans (extensif) = EC nu. biopsie bacterio. = N meningitidis. bacterio + a 80%, jusqu’a 24h post ATB

Question 2

6 SdG meningite

Answer 2

• purpura extensif,
• tb hemodynamiques.
  neuro+++
• HTIC,
• TdCs,
• convulsion
• focalisation/engagement : enroulement/mydriase unilat

Question 3

diag+ meningite = PL : indications, CI, complication

Answer 3

PL = urgence 4/5 tubes + gly concommittante
Purpura et HTIC ne sont pas CI.
CI = engagement, tb hemostase/hemodynamique AVERES.
Sd post PL cephalees/vomissement dans les 24h a l’orthostatisme.
prevention = biseau+ friction postPL.
ttt = antalgiq +/- cafeine/blood patch ssi med = echec>48h et CI si fievre/PL CI.

Question 4

PEC meningite

Answer 4

1) Bilan (+gly veineuse)
2) Hemoc +/-ATB si SdG
3) PL +/-ATB
4) Scanner +/- PL.

Question 5

ECBLCR
utilité
couleur
proteinorachie/glycorachie/lactates

Answer 5

ED = identification, culture = affirme, etabli sens (ATBgramme)
nl = eau de roche
eau de riz = trouble/purulent = N Meningitidis++
xantochromiq = jaune citrin
hemorragiq = rose/rouge
proteinorachie nl sup a 0,4g/L, si inf = bact/BK/viral
glycorachie nl sup a 60% glycemie si inf a 40% = bact/BK (mange sucre)
lacatate si inf a 3,2 = bact tres peu probable

Question 6

meningite : pari microbio devant terrain et mode d’apparition

Answer 6

enceinte = listeria
OH = pneumocoq listeria
migrant = BK
ID = tout, cryptocoq++
ATCD TC +purulent = pneumocoq
vaccin ? Hib
apparition brutale = pneumo/meningo/BGN
apparition progressive = BK

Question 7

meningite : pari microbio selon age :

Answer 7

moins de 3 mois = strepto B+++, EColi, Hib, S Pneumoniae
1 an jusqu’a 5 = N Meningitidis, S Pneumoniae
18-25 = N Meningitidis
plus de 50 ans = Listeria+++, S Pneumoniae

Question 8

Meningites :

viral/bact epidemio

Answer 8

viral = osef si enterovirus guérison spontanée++
si HSV = rea.
- souvent rat.
bacterien = grave.
- meningo+++ 85% des meningites nact. +sieurs serogroupes
- pneumo = extremes de la vie++

Question 9

etiologie meningite selon ED PL :
liquide clair + lympho + de 50%
liquide panaché lympho = PNN
liquidie trouble = PNN + de 50%

Answer 9

1) = viral si normoglycorachie BK si hypoCl
2) listeria/BK/crypto
# = visinle si GB + de 200/mm3 bacterien+++
/!\ proteinorachie = +0,1g/1kGR/mm3

Question 10

PEC immediate devant meningite en ville = HAD

Answer 10

Hospit
ATB post PL avant 3h car risq séquelles
DXM si meningite bact, avant ou pendant ATB

Question 11

mesures associee a PEC meningites = RALHeR

si meningo = VIDA

Answer 11

Rea si purpura/glasgow -8/ signe focaux
Anticonvulsivants = si convulse.
Lutte HTIC = surelever tete 
Hydroelectrolytique = correction
Regul T et gly

Vaccin
Isolement
DO
ATBprophylaxie entourage.

Question 12

ATB selon ED LCR
inconnu
CG+ S Pneumo = rond violet
CG- N Meningo = rond rose
BG+ Listeria = baton violet
BG- Hib/EColi = baton rose

Answer 12

inconnu = C3G TFD 14j
CG+ = C3G TFD14j. si strepto B amox 21j
CG- = C3G FD 7j
BG+ = amox FD 21j + genta 7j
BG- = C3G FD 7j +genta 2j

Question 13

NPO Meningite =

Answer 13

scan SSI PL CI.
HAD si ville
purpura --> couche. meningo.
meningo +++ si bact
VIDA si meningitidis
chercher ffavorisants
recherche breche osteomeningee si récidive