Diagnostik von Pilzinfektionen der Lunge

Zusammenfassung

Die Erkennung und Therapie von Pilzinfektionen der Lunge stellt auch erfahrene Kliniker immer wieder vor Probleme. Die Abgrenzung invasiver Mykosen der Lunge von nicht therapiebedürftiger Pilzbesiedlung ist klinisch schwierig und kann häufig auch durch weitergehende mikrobiologische Diagnostik nicht hinreichend geklärt werden. Zu unterscheiden sind primäre, häufig lokal begrenzte, endemisch vorkommende pulmonale Mykosen von pulmonalen Mykosen auf dem Boden eines lokal oder systemisch geschwächten Immunsystems. Zu den Risikopatienten zählen dabei insbesondere Personen mit fortgeschrittener HIV-Infektion, Langzeit-Antibiotika-therapierte Patienten sowie onkologische und multimorbide Patienten. Die pulmonale Manifestation einer Mykose kann Ausgangspunkt sein für eine systemische Disseminierung, aber auch im Rahmen einer hämatogenen Streuung auftreten. Letzteres z. B. als invasive pulmonale Aspergillose bei Immunsupprimierten. Die frühzeitige klinische, radiologische und mikrobiologische Diagnosesicherung ist somit essenziell zur Vermeidung von Komplikationen bei pulmonalen Mykosen.

Abstract

Recognition of and therapy for fungal infections of the lungs still presents problems even for the experienced clinician. The distinction between invasive mycoses of the lungs and fungal colonisations that do not require therapy is cinically difficult and can often not be made satisfactorily even with advanced microbiological diagnostics. One must differentiate between a primary, often locally limited, endemic pulmonary mycosis and a pulmonary mycosis against the background of a locally or systemically compromised immune system. Patients at risk include those with advanced HIV infections, patients under long-term antibiotic therapy as well as oncological and multimorbid patients. The pulmonary manifestation of a mycosis may not only be the starting point for a systemic dissemination but can also arise in the course of hematogenous spread of the infection. The latter can appear, for example, as an invasive pulmonary aspergillosis in immunesuppressed patients. Thus, early clinical, radiological and biological confirmation of the diagnosis is essential in order to avoid the possible complications of pulmonary mycosis.

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