Infectologista alerta para os riscos da meningite

A meningite é um processo inflamatório das meninges, membranas que envolvem o cérebro e a medula espinhal, e pode ser desencadeada por vários tipos de agentes, sendo os principais, vírus e bactérias. No Brasil, a meningite é considerada uma doença endêmica, ou seja, casos do problema são esperados ao longo de todo o ano, sendo mais comum a ocorrência das meningites bacterianas no inverno e das virais, no verão. A vacinação é a principal ferramenta na prevenção da doença bacteriana. Para falar sobre os principais tipos de meningite, suas causas, sintomas e tratamento, o infectologista pediátrico do Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/Fiocruz) Leonardo Menezes responde às principais dúvidas sobre a doença.

Quais são os sintomas?

Os sintomas variam de acordo com a faixa etária. As crianças maiores de dois anos de idade apresentam, na maioria das vezes, cefaleia (dor de cabeça), vômitos, febre, dor, rigidez de nuca com ou sem manchas na pele. Nas crianças menores, os sintomas se apresentam de uma forma mais inespecífica, como: sonolência ou irritabilidade intensa, choro inconsolável, recusa em mamar, febre alta, abaulamento de fontanela (moleira alta).

Como se transmite?

Em geral, a transmissão é de pessoa para pessoa, através das vias respiratórias, por gotículas e secreções do nariz e da garganta. A transmissão fecal-oral (ingestão de água e alimentos contaminados e contato com fezes) é de grande importância para a meningite viral, em infecções por enterovírus.

Como é feito o diagnóstico da doença? E o tratamento?

O diagnóstico da doença é feito a partir da suspeita clínica e confirmado através da análise do líquido cefalorraquidiano obtido, na maioria das vezes, por meio de uma punção lombar. O tratamento das formas virais se dá apenas com medidas de suporte e sintomáticos, enquanto, que a doença bacteriana necessita do uso de antibióticos, além das medidas adotadas nas formas virais. Destaca-se que o uso dos antibióticos deve acontecer, idealmente, o mais precoce possível.

Existe alguma forma de prevenção?

A vacinação é a forma mais eficaz de prevenção. O calendário vacinal oficial brasileiro oferece vacinas contra meningococo do tipo C, Haemophilus Influenzae do tipo B, Pneumococo e Tuberculose. O serviço público oferece também a vacina para meningococo do tipo A, porém, essa opção só é utilizada em casos de surtos e epidemias por esse sorotipo. Existem as vacinas para meningococo dos tipos A, B, Y e W 135, contudo, só estão disponíveis na rede privada.

Existe também a possibilidade de prevenção com uso de antibióticos para os contactantes de casos de meningite por meningococo e por Haemophilus Influenzae. No entanto, esse tipo de abordagem deve ser dirigida e realizada pelas autoridades de saúde ou pelos serviços de saúde responsáveis pelos casos de meningite. Para as meningites virais, ainda não existem formas eficazes de prevenção.

Existe algum grupo que esteja mais vulnerável à doença, ou qualquer pessoa, em qualquer idade está sujeita a contrair a doença?

Qualquer pessoa está sujeita a ter a doença, porém, as pessoas que não foram vacinas, crianças menores de um ano de vida, os adolescentes e os idosos apresentam maiores chances de contraírem a doença.

A meningite pode ter relação com algum quadro de infecção, como gastroenterite ou otite?

A meningite infecciosa está relacionada a qualquer infecção que possa acarretar uma invasão da corrente sanguínea por agentes infecciosos. Normalmente, o agente infeccioso ganha a corrente sanguínea e atinge o sistema nervoso central, causando a inflamação das membranas meníngeas.

Crianças de creches, berçários e escolas estão mais suscetíveis à doença?

Crianças de creches ou em fase de escolaridade são mais acometidas do ponto de vista epidemiológico. Isso pode se dar por vários motivos, desde um sistema imunológico ainda em formação e exposto aos novos agentes infecciosos de maneira mais prevalente do que o resto da população, até a convivência com outras crianças com as mesmas características em locais fechados e aglomerados.

Em estações como outono e inverno, em que os ambientes tendem a ficar fechados, a incidência de contaminação é ainda maior. Medidas simples, como lavar as mãos, não compartilhar talheres e alimentos, manter o ambiente limpo e os brinquedos higienizados, podem evitar o contágio, não só da meningite, mas também de outras doenças. Outra orientação importante é manter o cartão de vacinação das crianças atualizado.

O diagnóstico precoce reduz o agravamento da doença? Explique.

Sim, sobretudo nas formas bacterianas, onde a administração do antibiótico de forma precoce pode diminuir as complicações e a mortalidade. Além dos antibióticos, a adoção de medidas de suporte (controle de dor, febre, náuseas/vômitos e suporte das condições vitais), de maneira precoce e intensa também atuam em conjunto com os antibióticos para o mesmo objetivo. A doença causada por vírus, habitualmente, possui um melhor prognóstico e menos complicações.

Por: Suely Amarante (IFF/Fiocruz)

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