Die bronchopulmonale Salmonellose – eine Fallserie und Literaturübersicht

Widmung

Die Autoren widmen diesen Artikel Herrn Prof. Dr. med. habil. Heinrich Friedel (2. 5. 1920 – 21. 6. 2012), dem langjährigen ärztlichen Direktor und Chefarzt der Lungenklinik Lostau.

Zusammenfassung

Bronchopulmonale Salmonellosen sind eine seltene Manifestation extraintestinaler fokaler Salmonellenerkrankungen im Erwachsenenalter. Sie treten auch ohne vorausgegangene gastroenteritische Symptomatik insbesondere bei Patienten über 60 Jahren, abwehrgeschwächten und chronisch lungenkranken Patienten auf. Die Übertragung erfolgt sowohl hämatogen als auch durch Aspiration kontaminierten Mageninhalts. Komplikationen sind das acute respiratory distress syndrome, Lungenabszesse und Pleuraempyeme. Da gehäuft komplikationsreiche und tödliche Verläufe vorkommen, sollte in jedem Fall eine ausreichend lange resistogrammgerechte antibiotische Therapie mit Cephalosporinen der 3. Generation, Trimethoprim/Sulfamethoxazol, Ampicillin oder Fluorchinolonen erfolgen. In dieser Übersichtsarbeit werden 4 unterschiedliche klinische Verläufe bronchopulmonaler Salmonellosen durch Salmonella enterica subsp. enterica Serovar Brandenburg sowie Salmonellen der Gruppen B (O4), C (O6) und O11 bis O67 dargestellt und im Kontext der aktuellen Literatur diskutiert.

Abstract

Broncho-pulmonary salmonelloses are rare manifestations of extraintestinal focal infections in adults caused by different subspecies of Salmonella. They may appear without previous gastroenteritic symptoms especially in patients older than 60 years, as well as in patients who are immunocompromised or suffer from chronic pulmonary diseases. The transmission route is hematogenous or via aspiration of contaminated gastric fluid. Complications are acute respiratory distress syndrome, lung abscesses and pleural empyemas. Complicated und lethal courses have been described frequently. Therefore, antibiotic therapy should be initiated in every case with sufficient duration of treatment and in accordance to antibiotic resistance. Recommended antibiotics are third generation cephalosporins, trimethoprim-sulfamethoxazole, ampicillin or fluoro-quinolones. In this review 4 different clinical courses of broncho-pulmonary salmonellosis caused by Salmonella enterica subsp. enterica serovar Brandenburg, Salmonella groups B (O4), C (O6) and O11 to O67 are presented and discussed in the context of the current literature.

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