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Doença invasiva meningocócica : a propósito de um caso clínico
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Apesar dos avanços científicos conseguidos, a doença invasiva meningocócica (DIM) constitui ainda hoje um importante problema de saúde pública em idade pediátrica. A distribuição global, a elevada mortalidade e a persistência de sequelas incapacitantes e graves, contribuem para a diminuição da qualidade de vida das crianças e justificam o alarme em torno desta entidade.
O agente etiológico responsável, Neisseria meningitidis, presente muitas vezes na nasofaringe de indivíduos saudáveis, permite a continuidade da transmissão. As manifestações clínicas iniciais de DIM são frequentemente associadas à existência de processo infecioso incaracterístico, o que, em alguns casos, pode atrasar o diagnóstico e a implementação de medidas terapêuticas.
Desde a introdução em programas nacionais de vacinação (PNV) da vacina contra o serogrupo C do meningococo (MenC), o serogrupo B (MenB) tornou-se na causa mais frequente de DIM. A primeira vacina aprovada e dirigida contra MenB, Bexsero®, mostra-se promissora e poderá constituir o ponto de viragem da DIM tal como a conhecemos.
Por todas estas razões pretende-se, a partir da análise de um caso clínico de sépsis meningocócica fulminante, a realização de uma revisão teórica acerca de DIM e da sua prevenção, enfatizando o impacto que a utilização das vacinas poderá acarretar.
Despite the ongoing scientific progress, invasive meningococcal disease (IMD) is still an important public health problem in the pediatric population. The concerns around this entity are justified by its global distribution, high mortality rate and frequently persistent severe sequelae, which significantly reduce the quality of life of the children affected. Neisseria meningitidis, the etiologic agent, is often present in the naso and oropharynx of healthy individuals, allowing for continuous transmission. In addition, the clinical presentations of IMD are frequently attributed to nonspecific infectious processes, and this fact can delay the correct diagnosis and implementation of adequate therapeutic measures, in some cases. Since the widespread introduction of meningococcal serogroup C vaccine into national immunization program, serogroup B has become the most frequent cause of IMD. The first vaccine to be approved for MenB, Bexsero®, is promising and may constitute the turning point for IMD as we know it. For all these reasons, the objectives of this work are to analyse a case of fulminant meningococcal sepsis and to do a theoretical review about IMD and its prevention, emphasizing the possible impact of the use of vaccines.
Despite the ongoing scientific progress, invasive meningococcal disease (IMD) is still an important public health problem in the pediatric population. The concerns around this entity are justified by its global distribution, high mortality rate and frequently persistent severe sequelae, which significantly reduce the quality of life of the children affected. Neisseria meningitidis, the etiologic agent, is often present in the naso and oropharynx of healthy individuals, allowing for continuous transmission. In addition, the clinical presentations of IMD are frequently attributed to nonspecific infectious processes, and this fact can delay the correct diagnosis and implementation of adequate therapeutic measures, in some cases. Since the widespread introduction of meningococcal serogroup C vaccine into national immunization program, serogroup B has become the most frequent cause of IMD. The first vaccine to be approved for MenB, Bexsero®, is promising and may constitute the turning point for IMD as we know it. For all these reasons, the objectives of this work are to analyse a case of fulminant meningococcal sepsis and to do a theoretical review about IMD and its prevention, emphasizing the possible impact of the use of vaccines.
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Neisseria meningitidis Meningite meningocócica Pediatria