<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2393-6797</journal-id>
<journal-title><![CDATA[Revista Uruguaya de Medicina Interna ]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Urug. Med. Int.]]></abbrev-journal-title>
<issn>2393-6797</issn>
<publisher>
<publisher-name><![CDATA[Sociedad de Medicina Interna del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2393-67972018000300027</article-id>
<article-id pub-id-type="doi">10.26445/03.01.4</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Meningitis tras anestesia espinal: reporte de un caso.]]></article-title>
<article-title xml:lang="en"><![CDATA[Meningitis after spinal anesthesia: report of a case.]]></article-title>
<article-title xml:lang="pt"><![CDATA[Meningite após raquianestesia: relato de caso.]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rocha]]></surname>
<given-names><![CDATA[Valeria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gómez]]></surname>
<given-names><![CDATA[José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rivero]]></surname>
<given-names><![CDATA[Rodrigo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Hospital de Clínicas -&#8220;Dr. Manuel Quintela&#8221; Instituto de Neurología]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2018</year>
</pub-date>
<volume>3</volume>
<numero>3</numero>
<fpage>27</fpage>
<lpage>32</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S2393-67972018000300027&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S2393-67972018000300027&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S2393-67972018000300027&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción: La meningitis asociada a los cuidados de salud es aquella que aparece en pacientes que han sido sometidos a procedimientos invasivos que involucran punción de las meninges o pacientes portadores de dispositivos intratecales. La ocurrencia de la misma luego de procedimientos de anestesia raquídea es poco frecuente con una prevalencia que oscila entre 0-2 cada 10.000 casos, aunque es una entidad subreportada y subdiagnosticada.  Materiales y métodos:  Se realiza un análisis retrospectivo del caso de un paciente atendido en el Instituto de Neurología en el Hospital de Clínicas de Montevideo, Uruguay. Se llevó a cabo una búsqueda bibliográfica a través de pubmed utilizando los siguientes términos mesh: &#8220;meningitis&#8221;, &#8220;health care associated&#8221;, &#8220;spinal anesthesia&#8221; &#8220;meningitis post dural puncture&#8221;. Además, se analizaron guías actualizadas en cuanto a meningitis asociada a cuidados de salud.  Caso Clínico:  Se presenta el caso de un paciente de 24 años que a las 24hs de un procedimiento de anestesia raquídea por cirugía de hernia inguinal comienza con cefalea, vómitos y fiebre agregando en las siguientes 72hs rigidez de nuca, afectación del nervio motor ocular común bilateral, con compromiso pupilar y abducens derecho, realizándose diagnóstico de meningitis asociada a cuidados de salud el cual se confirma mediante el estudio del LCR. Se realiza tratamiento con antibioticoterapia con buena evolución a pesar del no aislamiento de gérmenes.  Conclusiones:  La meningitis asociada a atención en salud es una emergencia infectológica cuyo reconocimiento y tratamiento precoz guardan relación directa con el pronóstico. Su diagnóstico etiológico no siempre se logra con las técnicas convencionales como se evidencia en este caso. Para su prevención, se destaca la necesidad de mantener estrictas condiciones de asepsia y uso correcto de máscaras de protección facial en los procedimientos invasivos para disminuir el riesgo de complicaciones infecciosas.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Healthcare associated meningitis occurs in patients exposed to invasive procedures with dural puncture or who carry intrathecal devices. Meningitis associated to spinal anesthesia has a low frequency, 0-2/10,000 cases, though is thought to be an underreported and underdiagnosed entity.  Materials and methods:  This is a case report of a patient admitted to the Neurological Institute of the Hospital de Clinicas in Montevideo, Uruguay. The team conducted a literature research trough pubmed using the terms: &#8220;meningitis&#8221;, &#8220;health care associated&#8221;, &#8220;spinal anesthesia&#8221;, and &#8220;meningitis post dural puncture&#8221;. We also reviewed updated clinical practice guidelines on health-care associated meningitis.  Case presentation: We report the case of a 24 years old patient who underwent inguinal hernia surgery with spinal anesthesia, presenting with headache, vomits and fever 24hs later. 72hs hours later the patient demonstrated bilateral compromise of oculomotor nerve and right abducens nerve. Analysis of cerebrospinal fluid (CSF) confirmed the diagnosis of healthcare associated meningitis. Antibiotic therapy was initiated with excellent response. No germ was isolated on blood and CSF cultures.  Conclusion:  Health-care associated meningitis is an emergency that requires prompt diagnosis and treatment for good outcomes. Conventional techniques not always allow to reach microbiological diagnosis, as in the case reported above. We emphasize on the need to hold strict asepsia and to use facial protection masks when executing spinal puncture to prevent this potentially mortal complication.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  A meningite associada aos cuidados de saúde é aquela que aparece em pacientes que foram submetidos a procedimentos invasivos envolvendo punção das meninges ou pacientes portadores de dispositivos intratecais. A ocorrência do mesmo depois de procedimentos de anestesia espinal é rara com uma prevalência variando entre 0-2 10000 casos, embora um underreported e pouco diagnosticada.  Materiais e métodos:  Uma análise retrospectiva do caso de uma paciente atendida no Instituto de Neurologia do Hospital de Clínicas de Montevidéu, Uruguai. Foi realizada uma pesquisa bibliográfica através do PubMed, utilizando os seguintes termos de malha "meningite", "cuidados de saúde associados", "anestesia espinhal" "post meningite punção". Além disso, foram analisados guias atualizados sobre meningite associada à assistência à saúde.  Caso clínico:  o caso de um doente de 24 anos que 24 horas de um método de anestesia espinal para cirurgia hérnia inguinal começa com dor de cabeça, vómitos e febre adicionando nas 72 horas seguintes torcicolo, nervo oculomotor envolvimento é apresentado bilateral, com comprometimento pupilar e abducente direito, realizando diagnóstico de meningite associada à assistência à saúde, o que é confirmado pelo estudo do LCR. O tratamento com antibioticoterapia é realizado com boa evolução, apesar do não isolamento dos germes.  Conclusões:  A meningite associada aos cuidados de saúde é uma emergência infecciosa cujo reconhecimento e tratamento precoce estão diretamente relacionados ao prognóstico. Seu diagnóstico etiológico nem sempre é obtido com técnicas convencionais, como evidenciado neste caso. Para sua prevenção, destaca-se a necessidade de manter condições estritas de assepsia e uso correto de máscaras faciais em procedimentos invasivos para reduzir o risco de complicações infecciosas.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[meningitis]]></kwd>
<kwd lng="es"><![CDATA[meningitis asociada a cuidados de salud]]></kwd>
<kwd lng="es"><![CDATA[anestesia espinal]]></kwd>
<kwd lng="en"><![CDATA[meningitis]]></kwd>
<kwd lng="en"><![CDATA[health care associated]]></kwd>
<kwd lng="en"><![CDATA[spinal anesthesia]]></kwd>
<kwd lng="en"><![CDATA[meningitis post dural puncture.]]></kwd>
<kwd lng="pt"><![CDATA[meningite]]></kwd>
<kwd lng="pt"><![CDATA[meningite associada à assistência à saúde]]></kwd>
<kwd lng="pt"><![CDATA[raquianestesia]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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