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Meningococo: más allá de la enfermedad aguda Miguel Ángel Luengas Monroy, MD1 Jerly Maybelline Díaz Herrera, MD2 Juan Esteban Luengas Melgarejo, MD3

Precop SCP

INTRODUCCIÓN

Volumen 24 Número 2

27

1. Infectólogo Pediatra, Hospital Militar Central, Fundación HOMI. Correo electrónico: miguelluengas@gmail.com, miguelluengas2@hotmail.com 2. Residente de Pediatría, Universidad Militar Nueva Granada. Correo electrónico: dra.jerlydiaz@gmail.com 3. Médico interno, Pontificia Universidad Javeriana. Correo: juanestebanluengas@gmail.com, luengas.juanes@ javeriana.edu.co

Meningococo: más allá de la enfermedad agudacríticos Enfermedad meningocócica: desafíos y estrategias en cuidados

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Precop SCP

PATOGENIA

Volumen 24 Número 2

28

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Luengas Monroy, Jerly Maybelline Díaz Díaz Herrera, Juan esteban Luengas Melgarejo MiguelMiguel ÁngelÁngel Luengas Monroy, Jerly Maybelline Herrera, Juan Esteban Luengas Melgarejo

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29 Volumen 24 Número 2

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

Precop SCP

* #* -0 " .-0 *-1 32-0#1

Meningococo: másdesafíos allá dey estrategias la enfermedad aguda críticos Enfermedad meningocócica: en cuidados

Precop SCP

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Volumen 24 Número 2

30

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Luengas Monroy, Jerly Maybelline Díaz Juan esteban Luengas Melgarejo MiguelMiguel ÁngelÁngel Luengas Monroy, Jerly Maybelline DíazHerrera, Herrera, Juan Esteban Luengas Melgarejo

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Precop SCP

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31 Volumen 24 Número 2

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Precop SCP

Meningococo: más allá de la enfermedad agudacríticos Enfermedad meningocócica: desafíos y estrategias en cuidados

Volumen 24 Número 2

32

#&)) (,3 & & # *!&% * ,+1% * &% ,% #+ + * '&*!+!-! % $, *+) * & + %! * %+ * # !%! !& # + ) '! %+! !5+! ,%(, # #,+!% !5% '&) #1+ . %& * ,+!#!0 ),+!% )! $ %+ ' )$!+ + + ) %+3 %&* % *, )& / &)!% * +2 %! * $&# ,# ) * &$& # ) !5% % % # '&#!$ ) * *&% 6+!# * % ' ! %+ * &% $ %!% & & $! & $ %!% !+!* ' ) ! #$ %+ +) + * / (, %& * - % + * '&) #&* %+! !5+! &* / +! % % ,% #+ * %*! !#! #& (, ' )$!+ !% #,*& ! ) % ! ) * )& ),'&* ' )& %& ) $'# 0 % #&* ,#+!-&* % +! $'& ) # * $&*+) & &$& # '), $1* * %*! # % &$' ) !5% &% &+) * +2 %! * &% ,% #+ *' ! ! ! / ,) !5% '&*!+!-! *+ &) * ) + )! % % # % )$ $ %!% & 5 ! *+1 *& ! &% ,% $ /&) )! * & $&) + #! / * , # * / # + $ !2% !#!+ # ) + )!0 !5% $&# ,# ) !% #,! # ! %+! ! !5% ),'&* '*,# ) * # * , % ! !5% +!'&* / # * ')&+ 3% * $ $ ) % .+ )% !% #$ %+ # * , % ! !5% %&$ &$'# +& * # )) $! %+ $1* &$'# + / (, ' )$!+ & + % ) +& # !% &)$ !5% # * $ +& &#& 3 * ') -! * / !#!+ # *+, !& +&) * -!),# % ! % * ) *!*+ % ! / '&*! # * %, -&* # % &* - ,% # * # ' % # $ %!% !+!* % #!+!* '&) !& !) !#$ )) / * ,% . $ % ! %5*+! & / $,#+!'# . & (, ) #!0 # + !5% )1'! / *!$,#+1% ' +5 %&* !) + $ %+ # &) *, ' )+ &$& * $ % !&% & ,% - 0 ) *, #+ # !% !5% , * ,% )! * # +!'& !% !5% / #&* +&) * )! * & !% !-! , # * ', % ') * %+ )* * , # * # - * & $,/ ) - * '& ! & & * )- ) (, ) , %+ $ %+ #&* ) +) *&* % # * ))&##& % ,)&#5 ! & ', % * ) *,+!# * / * '&*! # (, %& * ! %&*+!(, % , $ %+ % #&* .1$ % * #3%! &* ),+!% (, * $ %! ! *+ % &% # !%! !& # + ' * &# ) & (, %,% * ! %&*+!(, % #& (, % ) ,% !$' +& % # * ))&##& +!-! * * &# ) * & # &) # * % # ,+,)&

% , %+& # *&) ) % ,)&* %*&)! # ,% # * * , # * % ,)&#5 ! * (, * ', % ') * %+ ) % *+&* ' ! %+ * * ) '&)+ & (, # ! %5*+! & + ) 3& / # )!- !5% # %+ ,% , !5#& & ', % ) - ) # '2) ! , !+!- #&* %!4&* / '&*! # $ %+ ) +) * ) *, # ! !#! ' ) !$'# %+ * & # ) * '&) #& (, * &%*! ) (, * % ) #!0 ) '), * , !&#5 ! * % +& &* #&* %!4&* !%$ ! + $ %+ *',2* # !% # # * , # % )$ / (, # * '), * % ) ' +!)* *! # ')!$ ) ) *,#+ & * !% &)) +& * % * )! ,% )!- !5% )1'! ,% , !5#& & / (, # '2) ! , !+!- ,* '&) # $ %!% !+!* + )! % ', ')&-& ) # &*! ! !5% # 5 # #& (, ', ! ! ,#+ ) & !$'&*! !#!+ ) # !$'# %+ !5% * '), * , !&#5 ! * ', % !% #,!) , !& $ +)3 &% , +, # &+& $!*!&% * 6*+! * / '&+ % ! # * -& &* , !+!-&* !% #,! * # * ) *', *+ * , !+!- * # +)&% & % 1#! & / # * ) *', *+ * , !+!- * % *+ & *+ # % %!4&* $ /&) * &* 4&* / $ !& # , !&$ +)3 &% , +, # ', ,+!#!0 )* ' ) - #, ) # , ! !5% % &3 & '&) * ' ) & ' )& * ,% '), *, " +!- % %!4&* $1* ' (, 4&* ', ) #!0 )* ,% , !&$ +)3 &% , +, # &% &% ! !&% $! %+& & & ' ! %+ ' !1+)! & &% %+ %+ !% !5% $ %!% & 5 ! !%- *!- )3 * ) - #&) & '&) ,% ')& *!&% # % * #, $ %+ # %& *&#& ,) %+ *, *+ % ! &*'!+ # )! *!%& + $ !2% *',2* *+ ' ) ) ,% ! %5*+! & ') &0 # '&*! # &$')&$!*& % ,)&'*!(,!1+)! & $& & (, * ', % ') - %!) / $ % " ) # * * , # * '*! &#5 ! * *+& * *' ! #$ %+ ) # - %+ % #&* ' ! %+ * (, ) (,!)! )&% $ % "& % % $, * & *!&% * *+ - #&) !5% * .+ % ) #&* ' ) * / $!#! ) * # ' ! %+

TRATAMIENTO Y SEGUIMIENTO ')!&)! % # $ % "& # !% !5% $ %!% & 5 ! * # +) + $! %+& # &(,

Luengas Monroy, Jerly Maybelline Díaz Juan esteban Luengas Melgarejo MiguelMiguel ÁngelÁngel Luengas Monroy, Jerly Maybelline DíazHerrera, Herrera, Juan Esteban Luengas Melgarejo

#! " # " " $ ! ! ! ! #)! # " ! " ! ! " ! * ! " ' " ' # ! # , " ! # " # ! ! + ! ! #)! !" ! # " " " , " # # " # " $ ! $ , " * # ! " # " $ , "# # ! ! ! ! ! #! " , " " " ' , # , &

! ! # " ! " ! # # #" , ! # ! ! ! #) # " , " & # " ! ! # # " " ' # , # & " , # $ , *! !" ' ! ! " # , ! # #! " !# $ & # #"# ," ! ! ! # " ) " ! ! " ! *! ! # $ , " "# ! & ! " $ ! $ !" ! ! # ! ! # " ! & # !" ! " $ ! " ! ! " ) !#! ! !"# ! ' ! ! " ! !" ! # ! # ! ! " $ ! #" ! ! (! ! & ! ! # ! ! (! ! # ! " " ' # + " # " " # " # ! # " # " ! ! !" # ! ! " " " $ , " ! ! % " ! ! # " # ! ! " $ ! " )#" ! ! " $ ! ! " " # # ! $ , ! " ! ! ! ) ! !" !

Precop SCP

! #)! ! # " , # , # " *" " ' # , # & $ # # " ! # #& # , ! ! " #" ! " #" ! # ! # , ! & # ! , ! ! + " ! " , $ # ' ! !" ! ! ! ! # ! ! * ! # , " " ! " ! # ! " $ ! " $)! " # ! , & " $ , " !" ! # ! # " # , ' ! ! " ' $ # , ! ! #!" ! !" " ! " , & & " # ! " ! & !#! ! ! " ,

# " $ ! $ " # " ! ' !" " , # # " ! # " $ ! ! * ! #! # * ! " ! ! ! - $ ) & !" " ! # , # " " , ! ! # ! " + ! & $ $ # " " $ , " & " # " , # " $ ! # " ' " #! ! & $ "

33 Volumen 24 Número 2

& " ! # # * ! " !" ' , " " ! , " " " " ! ! ! ) " ! & $ , ! ! # ! " " " " ," ! " " ! ! ! !# " ! # " $ ! $ ' !# " " ! ' # ! # " # ' # " " " "# " # " # # " " " + ! " ! " ! $ $ ( # (! ! ! " !

Meningococo: másdesafíos allá dey la enfermedad aguda críticos Enfermedad meningocócica: estrategias en cuidados

=.062;A2@ =.?. /?6;1.? 64B.91.1 12 <=<?AB;6 1.12@ 12 .A2;06K; ?25./696A.06K; 21B0.06K; 2@=206.96G.1. F 2:=92<

CONCLUSIONES . ! 0<;@A6ABF2 B;. =.A<9<4J. 4?.C2 0<; B; 6:=.0A< ;24.A6C< 0<;@612?./92 2; 9. 0.961.1 12 C61. ?29.06<;.1. 0<; 9. @.9B1 .320A.;1< 12 :.;2?. :B9A616:2;@6<;.9 9. 3B;06<;.961.1 3J@60.

0<4;6A6C. 2:<06<;.9 F @<06.9 12 9<@ 6;16C61B<@ >B2 9. =.1202; ; 2@A2 0<;A2EA< 9. 612;A636 0.06K; A2:=?.;. 12 9.@ @20B29.@ >B2 =B212; @B?46? 9B24< 12 9. 3.@2 .4B1. 12 9. 6;32006K; @2 2?642 0<:< B; 3.0A<? 3B;1.:2;A.9 =.?. 9.

6:=92:2;A.06K; <=<?AB;. 12 2@A?.A246.@ 12 6;A2?C2;06K; 2@=20J360.@ F =2?@<;.96G.1.@

Precop SCP

9 16.4;K@A60< A2:=?.;< F 29 A?.A.:62;A< 6;:2 16.A< 12 9. ! 2; @B 3.@2 .4B1. 0<;@A6ABF2; =69.?2@ 3B;1.:2;A.92@ =.?. :6A64.? 9. .=.?606K;

@A.@ 16360B9A.12@ 2; 29 12@.??<99< 12 .0A6C61.12@ 16.?6.@ 42;2?.; B; 6:=.0A< ;24.A6C< 2@0<9.?

20<;K:60< F @<06.9 A.;A< 2; 9<@ =.062;A2@ 0<:< 2; @B@ 3.:696.?2@ F @2 =B212 </@2?C.?

6;09B@< 2; .94B;<@ 0.@<@ 9. ?2;B;06. . =B2@A<@ 12 A?./.7< =<? =.?A2 12 9<@ =.1?2@ =.?. .@J =<12? 12160.? B; :.F<? A62:=< .9 0B61.1< 12 9<@ 567<@ 9< >B2 0<;992C. 9. 16@:6;B06K; 12 6;4?2@<@ 20<;K:60<@ .9 5<4.?

LECTURAS RECOMENDADAS

34 Volumen 24 Número 2

F 9. 4?.C21.1 12 9.@ =<@6/92@ 0<;@20B2;06.@ .

9.?4< =9.G< . =.?A606=.06K; 0<<?16;.1. 12 B; 2>B6=< :B9A616@06=96;.?6< 12 2@=206.96@A.@ >B2 6;09BF. =?<32@6<;.92@ 2; ;2B?<9<4J. .B16<9<4J. ?25./696A.06K; 3J@60. F <0B=.06<;.9 ;2B?<=@60< 9<4J. F @.9B1 :2;A.9 2@ 2@2;06.9 =.?. <3?202?

B; ./<?1.72 6;A24?.9 F <=A6:6G.? 9<@ ?2@B9A.1<@ 3B;06<;.92@ F 9. 0.961.1 12 C61. 12 9<@ @</?2C6 C62;A2@ . 6;C2?@6K; 2; 6;C2@A64.06K; 0<;A6;B. 2@ 0?B06.9 =.?. 0<:=?2;12? :27<? 9<@ :20. ;6@:<@ @B/F.02;A2@ . 9.@ @20B29.@ F 12@.??<99.?

6;A2?C2;06<;2@ :H@ 2320A6C.@

52??F .??6@<; .=9.; & &A26;/.05 *

./?69 12

<A2G $ 2646; .;1 052??FO@ A2EA/<<8 <3 =216.A?60

/B@0.1<? 2C2;A<@ ;3<?:2@122C2;A< ! " " ' &

6;320A6<B@ 16@2.@2@ . 21606K; 69.12936. @A.1<@

' % "

(;61<@ 9@2C62?

=13

2:=6;2; &..A % "62:29I & .B9.7.6;2; <;46@A< .?;6@.9< "62:6;2; ' 2A .9 "2B?<9<460.9

9. 1<92@02;06. , ;A2?;2A- &<0621.1 .A6;<.:2?60.;.

@2>B29.2 .3A2? 056915<<1 /.0A2?6.9 :2;6;46A6@ B?

12 ;320A<9<4J. $216HA?60.

$216.A?

,0<;@B9A.1< 29 12

- 6@=<;6/92 2; 5AA=@ @96=2 <?4 D2/ D=

0<;A2;A B=9<.1@

@

1<6

D

$B/960.06<; :2;6;4<0<0< =13

!2;@.5 .:=/299 9.?8 & %6/26?< & B06

2??2?. %2@A?2=< # 3?<G " ./?2?. & %2.;2F !

1.?:2 .6 + 2A .9 #BA0<:2@ <3 :2;6;4<0<00.9

&<D299 B:.? % 2A .9 632 3A2? ;C.@6C2 !2;6;

@2?<4?<B= 16@2.@2 6; 05691?2; .3A2? 6:=92:2;A.A6<;

4<0<00.9 6@2.@2 ;@645A@ 3?<: &B?C6C<?@ .;1 '526?

<3 ?<BA6;2 6;3.;A !2; C.006;.A6<; 6; ;49.;1 .;

.?246C2?@ ;320A 6@ '52?

.0A6C2 =?<@=20A6C2 ;.A6<;.9 @B?C2699.;02 @AB1F .;02A

1<6

@

5691 1<92@0 2.9A5 &

)

2//.4 % 2;A692 ;32?:21.1 !2;6;4<0K060. 2;

./?69 12

$

- 6@=<;6/92 2; 5AA=@ DDD 6;@ 4<C 0<

1<6

;@A6ABA< ".06<;.9 12 &.9B1 !2;6;46A6@ /.0A2?6.;.

F 2;32?:21.1 :2;6;4<0K060. , ;A2?;2A- <92AJ; =612:6<9K460< &2:.;.9

,0<;@B9A.1< 29 12

#9/?605 !L992? &05B:.052? & 208 !2@G.?<@ <2?/2? &F@A2:.A60 %2C62D <3 ;C.@6C2 !2;6;4<0<00.9

Luengas Monroy, JerlyMaybelline Maybelline Díaz Juan esteban Luengas Melgarejo MiguelMiguel ÁngelÁngel Luengas Monroy, Jerly DíazHerrera, Herrera, Juan Esteban Luengas Melgarejo

3=/+=/ &/;?/6+/ +8. $?+63>B 90 30/ 7:+-> 98 #+>3/8>=

!+<<+>3@/ %/@3/A 3-<99<1+83=7=

+8. '2/3< +</13@/<= 80/-> 3= '2/<

.93

.93 =

73-<99<1+83=7=

&2/8 /1?7 ! %?3C +<-3+ * +<>3898 '9<</=

#9?635+59= # +:83=3= )3<913+883 3+59? '=963+

/55+> /<5+83 % /=C+<9= %+81/ 90 38@+=3@/

3-29= /> +6 8@+=3@/ /83819-9--+6 3=/+=/ 38

7/83819-9--+6 .3=/+=/ =/;?/6+/ +8. 2/+6>2 /-98973-

236.</8 "?>-97/= +8. %3=5 +->9<= 09< &/;?/6+/ +8.

+::63-+>398 + =B=>/7+>3- +8. -6383-+6 </@3/A #?,63-

+>+6 +=/= 38 <//-/ 3-<99<1+83=7=

/+6>2 .93 =

.93

73-<99<1+83=7= &96/< &98/3<+ 7366+>/1?3 9= &+8>9= % 98CD6/C

%?=389A=5+ 'B,?6-C?5 </@3/A 90 2/+<381

(3+./<9

37:+3<7/8> .?/ >9 ,+->/<3+6 7/83813>3= 38 -236.</8

+89 #9<>/<9 % 80/<7/.+. 7/83819-E-3-+ 38@+=3@+

37:9<>+8-/ 90 /+<6B .3+189=3= +8. ></+>7/8> 9?<

'/7:9<+.+

&

8+6 "0 /+<381 &-3/8-/

2>>:= .93

<+8/<9 /6-E8 +,/C+= (366+

=

.93

9<1 42= (9== && !3/6=/8 (+6/8>38/< <+8>2 # %3=5 90 =/;?/6+/

.93 =

Precop SCP

!/?<96913-+6 &/;?/6+/ 9669A381 +->/<3+6 /83813>3=

+0>/< 38@+=3@/ 7/83819-9--+6 .3=/+=/ 80/-> 3=

35 Volumen 24 Número 2

&-23/== ! <9-/ ! ?+ ' '2/ 7:+-> +8. ?<./8 90