At first, it resembles a simple infection – it can even be mistaken for a cold , but in a few hours the disease progresses aggressively.
The meningitis bacteria is serious and needs of early drug intervention.
The delay in diagnosis results in high rates of irreversible damage, such as changes in hearing, vision and, in up to 30% of cases, can lead to death.
There are several antibiotics capable of treating the condition, but it is through vaccination and immunization that the risks are considerably reduced.
Bacterial meningitis are inflammatory conditions that develop in the meninges – membranes that surround the brain and the brain marrow – resulting from the infection of bacteria. They are usually severe and rapidly evolving conditions, which can lead to death.
Although there are other causes for meningitis (such as viruses or fungi), bacterial is among the most dangerous. This is due both to the impact on the organism, with risks of death, and to the ability to spread and outbreaks of the disease.
Among the bacteria most related to meningitis are Neisseria meningitidis (Meningococcus), Streptococcus pneumoniae, Mycobacterium tuberculosis and Haemophilus influenzae .
Among them, two main causative agents stand out, meningococcus and pneumococcus.
So, bacterial meningitis is the inflammation of the meninges caused by bacteria, which can be from various serogroups, such as B, C, Y and W.
When the infection is caused by a specific type of agent, neisseria meningitidis (or meningococcus), the condition is called meningococcal disease.
Like other infectious conditions, bacterial meningitis can be transmitted by droplets of saliva when the infected person speaks or coughs , or by contact with infected nasal secretions.
Although everyone can contract the disease, it is children, the elderly and patients with weakened immunity who are most vulnerable.
When the infection starts to manifest, it can generate fever , stiff neck, headaches, nausea, vomiting and mental confusion. In some cases, with severe evolution, the disease can trigger seizures , paralysis and tremors.
Treatment consists of medication to fight bacteria (antibiotics) and auxiliary therapy, such as rest and hydration replacement.
In ICD-10, meningitis is listed under the codes:
- G00.0 – Haemophilus meningitis;
- G00.1 – Pneumococcal meningitis;
- G00.2 – Streptococcal meningitis;
- G00.3 – Staphylococcal meningitis;
- G00.8 – Other bacterial meningitis;
- G00.9 – Bacterial meningitis, unspecified.
Meningitis is an inflammation of the meninges, which are the membranes that surround the brain.
The condition hinders the oxygenation of body cells and can cause symptoms such as severe headaches, stiff neck, fevers and vomiting.
The symptoms are not very different between each type, but the causative agents do. That’s because there are infectious (septic) and non-infectious (aseptic) types of meningitis.
While the infectious can be caused by bacteria, viruses or fungi, the second group can result from trauma or drug intoxication.
Read more: Know about viral meningitis
Meninges are layers that cover the brain and spinal cord. It’s basically like thinking that beneath the skull bone is a layer that separates it from the brain.
One does not, in fact there are 3: dura mater, arachnoid and pia mater.
The dura mater is the outermost layer. It is also the most resistant (also called pachimeninge), having its own system of vessels and nerves.
Then there is the arachnoid, an intermediate layer, which has no nerves and is very delicate.
The name also stems from its appearance, which refers to a spider web. The pia mater is the innermost layer, quite thin and transparent.
Between the arachnoid layer and the pia mater there is the so-called subarachnoid space, which concentrates the cerebrospinal fluid, responsible for the protection of the central nervous system.
The last two, due to the finer characteristic, are called leptomeninge.
The meninges cover the central nervous system, which is formed by the brain and the spinal (or epinal) cord.
The brain does not only comprise the brain, as many people think.
In addition to it, there is also the cerebellum (mainly controls balance), hypothalamus (related to temperature and blood pressure control, for example), thalamus (conducts sense stimuli, such as smell) and bridge (coordinates movements).
The spinal cord, on the other hand, is an elongated segment located in the vertebral canal and is about 45 cm. That is, the spine acts as a protection for the spinal cord.
The function of the spinal cord makes communication between the organism and the brain. Therefore, signals from the brain reach the body’s receptors through the spinal cord.
All of these structures are protected by the meninges.
In general, bacteria invade the body and colonize the nasopharyngeal mucosa.
That is, when an infected person sneezes or coughs, for example, droplets of saliva containing the bacteria come into contact with the healthy organism and the agents invade the tissues.
The concentration of bacteria in the nasopharynx is considered a transient, usually asymptomatic, phase of infection. Gradually, the bacteria penetrate the mucous membranes and, overcoming the immune agents, reach the bloodstream.
If they manage to survive on the path, they reach the blood-brain barrier (membrane that surrounds and protects the central nervous system) and finally reach the subarachnoid space.
As there are no concentrations of antibodies there, the infectious agent finds an environment of easy replication. The release of inflammatory substances begins, which are responsible for the appearance of characteristic symptoms.
Bacterial infections, in general, have the capacity to affect the meninges and trigger inflammation of the layer.
Typically, types are defined according to the bacterial agents involved. The most common are:
Neisseria meningitidis ou meningococo
It is a bacterium that has a shape similar to the coconut, rounded. This group has several subgroups, called serotypes.
Each of them is defined according to the structure of the bacteria. That is, it is more or less as if each serotype had some small difference in the body (capsule).
The most frequent ones are serogroups A, B, C, W135 and Y. In fact, these types have vaccines in Brazil.
When the inflammation is due to meningococcus, the bacteria (which are initially located in the nasopharynx) can spread through the body, being called meningococcemia. Both are called meningococcal diseases.
It is a spherical bacterium, also similar to a coconut and there are more than 90 serotypes of the agent. Despite this great variety, in Brazil there are some more common types: 14, 1, 6B, 5, 6A, 23F, 19F, 9V, 3,4, 10A, 8 and 7F.
The agent is also related to other infections, such as lung infections, ear infections and sinusitis.
Its structure is similar to a rod. The incidence is high in young children and, in general, its evolution is slower compared to other types of meningitis.
There are 6 serotypes of the bacteria (A, B, CD, E and F). The agent mainly affects children and lactating women, with about 90% of cases being in children under 5 years of age.
Meningitis is a common condition in children, as the immune system is, in general, weaker compared to adults.
This causes several diseases to manifest more easily in childhood and, when they affect small children, they are quite similar to adults, causing high fever, vomiting, tiredness and headaches.
However, it is worth noting that there are some types of meningitis that have a high incidence in children under 5 years.
As it is difficult for the child to report what he is feeling, other signs should be observed to raise suspicions of the infection. As with adults, symptoms suddenly appear.
This is especially true for those who are still babies. Therefore, it is important to observe signs such as drowsiness, irritation for no reason, constant crying, tiredness and changes in behavior (such as stop playing or loss of appetite).
In older children, the report of headaches together with the perception of a feverish state is a warning sign.
The procedure is the same for treating adults, based mainly on the administration of antibiotics and monitoring of the clinical status.
On average, 35% of newborns who are infected can suffer from seizures. This number is lower in older children, with a 20% risk of having a seizure.
The prognosis tends to vary according to the bacteria and the child’s age. Between 5% and 25% of newborns die, and among those who survive, up to half of them can suffer irreversible damage to the brain (such as reduced hearing or cognitive loss).
Meningococcal disease is a term used to refer to infections and manifestations caused by the bacterium Neisseria meningitidis , also called meningococcus.
This specific type of agent can infect the body and remain localized, triggering meningitis (inflammation of the meninges) or spreading through the body ( sepsis ), a condition called meningococcemia.
Meningococcemia: what is the difference for meningitis?
Meningococcemia is an aggravated condition of bacterial infection by Neisseria meningitidis . It is also called meningococcal disease and is characterized by the spread of the agent throughout the body.
When symptoms occur, they are usually sudden and severe malaise, high fever, chills and skin lesions, such as bruises (bruises) and red spots (petechiae).
The conditions can be associated, that is, they occur together (meningitis + meningococcemia) or isolated (including, sepsis can occur without meningitis). The following may occur:
- Meningococcal meningitis: presence of bacteria in the meninges;
- Meningococcemia: presence of bacteria in the bloodstream;
- Meningococcal meningitis and meningococcemia: presence of bacteria in the meninges and in the bloodstream.
The cause of bacterial meningitis is infection by bacteria. Although several can trigger meningitis, Neisseria meningitidis, Streptococcus pneumoniae, Mycobacterium tuberculosis or Haemophilus influenzae are the most frequent.
Dissemination can occur when the person carrying the agent coughs, sneezes, shares objects or kisses another healthy person.
On average, the transmission time, after the person is infected, is about 24 hours, because only while the agent is in the region of the oropharynx (part of the throat where air and food pass) can it be disseminated in the secretions and Spittle.
Remembering that it is usually the asymptomatic person who is most likely to transmit the agent.
That is, the patient who has symptoms is a less likely route of transmission compared to someone who has the bacteria but does not know or has not manifested symptoms.
According to the Fiocruz Agency, there are few episodes in which the transmission is due to contact with the sick person – that is, the person who is evidently ill – except in cases where there is a kiss or exchange of body fluids. The spread of the agent is more likely to occur through someone without symptoms.
Transmission happens because the bacteria is lodged in the part of the throat. Therefore, forms of contagion can occur in the following ways:
- Droplets of saliva;
- Coughing and sneezing;
- Sharing intimate objects.
The time that the bacteria can be transmitted varies both by the agent (ie, what type of bacteria) and the stage of the infection.
Other less common ways of being infected include:
- Bacteria that invade open wounds on the head or close to the meninges;
- Bacteria that infect cuts after brain or spinal cord surgery;
- When the patient uses drains to reduce brain pressure and infection of the accessory occurs.
Some conditions can favor the incidence of bacterial meningitis. Some of them are:
Although it can affect anyone, bacterial meningitis is more common in children under the age of 5 and the elderly. This is because the immune capacity (that is, the body’s defenses) may be lower in these age groups.
People with diseases that can affect immunity (such as diabetes , cancer or AIDS ) are more susceptible to infection. This is due to low immunity, which is less effective in combating external and harmful agents to the organism.
People who work or live in crowded places, with great circulation and concentration of people, are also at greater risk.
Even without other associated factors, the greater exposure to possible infected secretions favors contagion.
Poorly ventilated places, companies with air conditioning (and without natural ventilation), airports, public transport, restaurants and schools are places of greatest incidence.
Whether for the active or passive smoker, being in contact with the cigarette increases the chances of infection.
In this case, there are two mechanisms involved: greater exposure to saliva droplets (when inhaling other people’s smoke, for example) and also the involvement of the oronasal mucosa.
The cigarette can irritate and affect the functionality of the throat defenses, facilitating the infection.
In general, bacterial meningitis begins with general malaise, fever and vomiting. Neck and throat pain can occur – a condition that can be mistaken for other illnesses, such as the flu . But in a few hours the condition evolves, weakens the organism and worsens the manifestations, which can also affect the skin.
The main symptoms include:
The fever manifests itself quickly and tends to be high. It is a characteristic symptom in both children and adults, as a response to inflammation and infection.
Nausea, changes in appetite, and jet vomiting can occur, and conditions are generally common in adults and children.
Headaches are frequent signs between the manifestations of meningitis. In addition, there may be obstructions in the vessels that drain brain fluids, which causes the accumulation of fluids in the region.
Sensitivity to light
Also called photophobia, sensitivity to light is a common sign of the manifestation of meningitis. In the presence of headache , exposure to light can increase sensitivity and intensify pain and discomfort.
Meningitis can cause stiff neck, a classic sign of meningeal irritation. The condition is characterized by resistance to movement of the head.
That is, when the patient tries to move his head, his neck feels stiff.
When the condition is associated with headache and sensitivity to light, this triad is considered to be the classic symptoms of meningism.
Although common, the stiff neck may not affect younger children.
Skin rashes and bleeding
In meningococcal meningitis, as there is a change in the permeability of blood vessels, blood begins to leak to the surface of the skin.
As a result, red or purple spots may appear that intensify, forming extensive plaques. Bleeding and skin rashes can also occur.
When the spots and rashes appear, they result from the large amount of bacteria circulating in the bloodstream (a condition called septicemia).
Reduction of mental and physical capacities
In a short time, bacterial meningitis can affect mental as well as physical abilities. Thus, drowsiness, prostration (dejection), slowness, reduced reasoning, speech difficulties, tremors, imbalance, difficulties in moving around, may occur.
School-age children (older than 5 years) tend to have Brudzinski’s sign, which is the involuntary movement or flexion of the legs when the neck is moved.
As with Brudzinski’s sign, movement limitation may also occur in patients with this disease.
When the patient is lying on his back and has his legs flexed at a 90º angle, for example, limitation may occur when trying to extend or stretch his legs.
The diagnosis is made based on the patient’s clinical status, taking into account the presence of symptoms and signs. When there are suspicions, the doctor uses exams to confirm the diagnosis and identify the causative agent, assisting in the choice of pharmacological therapy.
The professional responsible for the evaluation is the general practitioner , pediatrician or infectious disease specialist .
The doctor assesses the patient’s skin, looking for spots and rashes characteristic of bacterial meningitis. In addition, the neck is moved, looking for signs of stiffness.
A small sample of blood is collected by means of a common test. With this, it is possible to identify the presence of bacteria.
A small, extremely fine needle is inserted into the spinal region to collect a substance called cerebrospinal fluid.
Then, the analyzes of the substance help to determine the type of meningitis, according to the presence of proteins , glucose and white blood cells in the sample.
The liquid has a clear appearance, but when there is the presence of infection by meningitis, it appears cloudy, with a leukocyte, protein and glucose count altered.
Microscopic examination of cerebrospinal fluid
The analyzes also investigate the presence of bacteria in the blood sample through the application of coloring substances (Gram stain).
If necessary, the doctor can order other laboratory tests to determine the specific type of bacteria, such as Bacterioscopy, which allows the identification of meningococcemia.
In addition, imaging procedures, such as computed tomography and magnetic resonance imaging, may also be requested to analyze if there is damage to the brain region.
-Yeah . Bacterial meningitis can be cured, but it depends on the speed of diagnosis and the start of treatment.
The longer the intervention, the greater the risks to the patient’s life.
In general, bacterial meningitis requires hospitalization and isolation of the patient. The therapy aims to combat and eliminate the infectious agent through antibiotics, in addition to reducing symptoms through rehydration and analgesic therapy based on corticosteroids.
The conduct adopted in the treatment of bacterial meningitis consists of the medication administration of:
The application of antibiotic drugs is the main form of intervention, which is done intravenously for at least 7 to 14 days. In some cases, it can be maintained for a longer time, according to the patient’s condition.
Often, the detection of the bacteria takes time, which can delay the start of therapy.
In such cases, it is possible that substances of low toxicity capable of attacking the most common bacteria are applied.
For this, the doctor takes into account the symptoms and the prevalence of each group of bacteria to choose the best therapeutic option.
- Children under 2 months: Ampicillin + Aminoglycoside ( Gentamicin or Amikacin );
- Between 2 months and 5 years: Ampicillin + Chloramphenicol ;
- Over 5 years: Penicillin G. Crystalline + Ampicillin.
According to the infectious agent, the medications can be:
- Neisseria meningitidis (meningococcal): Penicillin G. Crystalline or Ampicillin;
- Haemophilus influenzae: Cloranfenicol ou Ceftriaxona;
- Streptococcus pneumoniae: Penicilina G. Cristalina;
- Staphylococcus : Oxacillin or Vancomycin ;
- Enterobacteria : Ceftriaxone or Sulfametaxazole + Trimetropim;
- Pseudomonas : Ceftaridima + Amicacin or Carbenicillin + Amicacin.
Among the possibilities, the most frequent is Dexamethasone , administered about 15 minutes before the antibiotic. This is because, in general, the brain region is already swollen. The condition can worsen with the action of the antibiotic.
With the action of corticosteroids, risks to the patient are avoided.
Replacement and control
Serums can be administered to replace fluids and minerals lost due to vomiting.
Other conditions, resulting from the worsening of bacterial meningitis, can be controlled with medications and support for breathing (ventilation).
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
If treatment is started quickly, the course of the infection tends to be good. Patients in non-aggravated conditions, in general, respond well to medications and the bacteria is eliminated, resulting in symptom relief.
In general, the course of treatment also depends on factors such as the patient’s age and immune status.
However, the delay in the perception of symptoms may cause the disease to be noticed only late, which favors a more aggressive evolution.
In such cases, it is possible for bacterial meningitis to be cured, but leave irreversible complications, such as loss of vision, or lead to death.
-Yeah . Bacterial meningitis can quickly worsen if left untreated, putting the patient at risk. Possible complications include:
Inflammation can affect blood vessels in the brain region, causing blood clots to form. As a result, there may be risks of stroke.
Edema or swelling in the brain
Inflammation can cause swelling in brain tissue, causing damage to the structure. As a result, swelling may occur, which is called edema , with or without bleeding.
Increased pressure in the brain
Inflammation can block drainage channels for brain fluids. Sometimes, this liquid can accumulate and pressure the brain internally.
In addition, the swellings, if they are very serious, can cause herniation of the brain, which results from the alteration of the structure. Simply put, as if the brain was displaced due to the change in size.
Inflammation of the nerves
Inflammation can affect nerves in the brain. These nerves are responsible for the reception and emission of signals related to the senses and body control, such as sight and smell.
In severe cases, inflammation can permanently affect these systems, causing deafness, blindness or reduced muscle control, for example.
If the bacteria spread throughout the body, the condition is characterized as meningococcemia, a sepsis resulting from meningococcus.
For example, there may be a sudden and severe drop in pressure (septic shock), in addition to the formation of clots throughout the body, causing bleeding and bleeding.
When treatment is late or inefficient, bacterial meningitis can lead to death. If left untreated, meningococcal meningitis affects the patient quickly, therefore, early diagnosis is essential.
In general, bacterial meningitis is more prevalent in winter, according to the Ministry of Health. Among the causative agents, the main one related to the epidemic possibilities is N. meningitidis.
In Brazil, the history of the disease is marked by several occurrences, in different regions. In the 1970s and 1980s, types A, B and C were very present. However, from the 1990s, the incidence of type B declined, while type C presented more diagnoses.
From the 2000s, the vaccine against H. influenzae was placed in the SUS vaccination booklet, causing cases of the disease to fall dramatically.
Data from the Ministry of Health indicate that, between 2001 and 2006, pneumococcal meningitis had one of the highest lethality rates, affecting up to 30% of patients.
Currently, meningococcal and pneumococcal meningitis are the types of most concern.
The World Health Organization (WHO), in a survey conducted in 2018, pointed out that meningococcal disease, even when diagnosed early and treated, results in between 8% and 15% of deaths within 48 hours after the onset of symptoms.
In the absence of treatment or late onset, the disease leads to death in up to half of the patients and leaves brain damage or limitations in up to 20% of those who survive.
In 2018, the Ministry of Health recorded 1072 cases of the disease, with 2018 deaths.
For the ministry, the disease is considered endemic, which means that cases are expected throughout the year, with peaks of occurrence.
Tips for the prevention of meningitis include basic care with hygiene and air circulation in the environments, as well as having the vaccination card up to date.
Clean hands and objects
Some hygiene precautions are important to avoid risks of infections caused by bacteria and viruses.
Hand hygiene, especially before bringing it to the eyes and mouth, not sharing objects for intimate use (such as makeup and cutlery), and avoiding sharing objects is very important.
Closed environments, with little air circulation or crowded people can be quite favorable to the spread of the disease.
It is worth remembering that the transmission occurs with greater predominance while the patient does not present to be ill, therefore, it is not always easy to identify who has the bacterium.
The immune status is also determinant in the manifestation of the disease. This is because when the body is weakened, fighting bacteria and invaders becomes much more difficult.
One of the best ways to ensure the good resistance of the body is through proper nutrition. A balanced diet, rich in nutrients and diversified is a simple way to protect health.
The best form of prevention is through vaccination. Remembering that there are several agents capable of causing meningitis and, therefore, there are different vaccines for some of them.
Against the most common types, with a higher incidence, vaccination is offered by the public health network for children and adolescents, in addition to adults who have a medical indication (such as those with chronic diseases).
Others, less common, can be found in private networks, and for most of the population, the indication occurs only in outbreak situations or when there are factors that make the individual vulnerable to infection.
There are vaccines for specific types of the most common bacteria, which are meningococcal, pneumococcal and influenzae (Hib) meningitis. For this, doses are available:
3 doses are administered to children up to 1 year old, with 60 days between each application (ideally, they are done at 2, 4 and 6 months).
The vaccine protects against tuberculosis , which can affect meninges. Vaccination is done as soon as the child is born, still in the maternity ward and does not need another dose or booster.
Haemophilus influenzae B (Hib)
The isolated dose of the vaccine, that is, only Hib, is found in private vaccination centers. In the public health network, she is part of the pentavalent dose.
The immunizer provides protection against the bacterium Haemophilus influenzae and should be offered, in 3 doses, to children between 2 and 6 months of age, with 2 months between each application.
Pneumococcal (VPC) 10-valent conjugate
Offers protection against S. pneumonia bacteria, being able to immunize against 10 types of pneumococcal bacteria (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, 23F).
2 doses are applied, at 2 and 4 months, with a booster at 12 months of age.
Pneumococcal (VPC) 13-valent
The 13-valent Pneumococcal (VPC) dose is also available only in private immunization centers. Its action protects against 13 types of pneumococcus bacteria, which are 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F.
The dose can be taken by children from 2 years old, with 1 booster after 5 years. For adults over 50, two doses are offered with an interval of 6 months between each one.
The dose is able to protect the organism against 23 bacteria, a sense made available in private vaccination centers.
The recommendation is that it be given to children from 2 years of age who have some risk factor for infection, and to elderly people over 60 years of age who live in shared homes (such as nursing homes) or who are hospitalized.
Meningococcal C (conjugated)
Protects against infections of N. meningitis C. and offers immunization against meningococcal meningitis C.
2 doses should be applied, at 3 months and 5 months, with 1 booster at 12 months.
In unvaccinated adolescents, a single dose is made between 11 and 14 years of age.
Meningococcal ACWY (conjugated)
This vaccine is not part of the public vaccination schedule, but can be obtained from private clinics and vaccination centers.
The dose protects against types A, C, W and Y, that is, it confers immunity to the 4 serotypes of the infection.
It is recommended for children from 2 or 3 months of age, and the amount of doses depends on the manufacturer of the vaccine.
Meningococcal B (recombinant)
The vaccine against meningitis B can only be found in private health networks. It is indicated for people aged between 2 months and 50 years, and the amount of doses varies between 2 or 3, according to the patient’s age group.
The options for meningitis B and the quadrivalent or conjugated options are available in the private health network. They protect against meningitis B, A, C, W and Y.
Can I have bacterial meningitis more than once?
Yes , but if it occurs again, the infection is caused by another agent. That is, when someone is infected by a bacterium, the body develops immunity only to that specific type of infection.
Then it will not be possible to acquire the same type of meningitis again. However, there are several other bacteria that can cause meningitis, making it possible to have another manifestation of the disease.
How long does it take for meningitis to manifest?
The incubation time of the bacteria is approximately 2 to 10 days, with an average time of 4 to 5 days.
After that period, the symptoms begin.
How long is meningitis transmissible?
In general, the possibility of transmission occurs while the bacteria are lodged in the nasopharynx (region that permeates the respiratory tract).
The incubation time is, on average, from 2 to 10 days. After this period, the symptoms appear and the chances of transmission are less, as the bacteria have already migrated to other tissues of the body.
After antibiotic medication is started, it takes about 24 hours before the agent can no longer be transmitted.
What is the cup test for meningitis?
The cup test or Tumbler test is a simple process that can indicate whether the spots and lesions on the skin may be due to meningitis.
Basically, you need to press or compress a clear glass cup on the lesions.
If they disappear or become more whitish, they are possibly caused by allergies, insect bites or other conditions.
It is worth noting that even if the rashes and spots remain red, it does not mean that the patient has meningitis. Anyway, it is not a test that does not require a diagnosis made by the doctor.
Both cause inflammation in the meninges, but the viral one is caused by viruses and the bacterial one is caused by some bacteria. In general, viruses are usually milder and less dangerous than bacterial ones.
As the symptoms can be quite similar, only the exams can indicate the infectious agent.
In addition to these two causes, there are also meningitis caused by fungi (fungal meningitis) and non-infectious ones, which can be caused by trauma (such as injuries or accidents involving the head) or use of medications.
Meningitis is a very common condition, especially in childhood – due to the low immunity of children.
There are several causes for inflammation, but those that occur due to bacterial infections are among the most common and also among the most aggressive.
The best way to reduce the risk of infection is through vaccination. Doses can be found in public and private health units, always as recommended by the immunization schedule and the doctor.
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