Etiología de la meningitis aguda en adultos inmunocompetentes: Una revisión sistemática de estudios observacionales
DOI:
https://doi.org/10.66476/mf.v2n2.6273Keywords:
meningitis, etiología, adulto, inmunocompetente, revisión sistemática, Streptococcus pneumoniae, herpesvirusAbstract
Objetivo: Identificar y sintetizar la evidencia observacional reciente sobre los agentes etiológicos causantes de meningitis aguda comunitaria en adultos inmunocompetentes.
Métodos: Se realizó una revisión sistemática siguiendo las directrices PRISMA. Se ejecutaron búsquedas en PubMed y Scopus (hasta octubre de 2025) para identificar estudios observacionales (cohortes, transversales) que reportaran la prevalencia de patógenos en adultos (≥18 años) inmunocompetentes con meningitis aguda. Se excluyeron revisiones, reportes de caso, estudios en poblaciones pediátricas o inmunocomprometidas, y estudios de validación diagnóstica con alto riesgo de sesgo de selección. La síntesis de datos fue narrativa debido a la heterogeneidad clínica de los estudios.
Resultados: De 29 registros únicos identificados, 7 fueron evaluados a texto completo, resultando en la inclusión de 3 estudios observacionales (dos prospectivos, uno retrospectivo) que abarcaron 1316 pacientes de Países Bajos, Corea del Sur y Francia. En la meningitis bacteriana comunitaria (n = 696), Streptococcus pneumoniae (51 %) y Neisseria meningitidis (37 %) fueron los agentes predominantes, con una mortalidad asociada al neumococo del 30 %. En la meningitis aséptica/encefalitis (n = 471), los herpesvirus tratables fueron causas significativas, incluyendo el Virus Varicela-Zóster (VZV) (8,0 %) y el Virus Herpes Simple tipo 2 (HSV-2) (5,1 %). Se observó una brecha diagnóstica sustancial, con un 71,5 % de los casos de meningitis aséptica sin un herpesvirus identificado.
Conclusión: La etiología de la meningitis en adultos inmunocompetentes sigue siendo un desafío heterogéneo. S. pneumoniae continúa siendo el principal patógeno bacteriano con alta mortalidad. Los herpesvirus (VZV, HSV-2) son causas virales tratables clave. La persistencia de una amplia brecha diagnóstica subraya la necesidad de adoptar tecnologías moleculares más amplias (p. ej., PCR multiplex, mNGS) y considerar etiologías no infecciosas.
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