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Intensivmedizin up2date 2014; 10(04): 317-332
DOI: 10.1055/s-0034-1377991
Neuro-Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Souvenir aus den Tropen: intensivpflichtige ZNS-Infektionen

Erich Schmutzhard
,
Bettina Pfausler
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Publication History

Publication Date:
08 October 2014 (online)

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Kernaussagen

  • Bei „Tropenanamnese“ ist bei jedem Patienten mit qualitativer und/oder quantitativer Bewusstseinsstörung besonderes Augenmerk auf die Begleitsymptomatik zu legen, vor allem auf Fieber und Hautveränderungen.

  • Wenn nach dem Aufenthalt in einem tropischen Land eine akute Bewusstseinsstörung auftritt, die von Fieber und einem epileptischen Anfall begleitet wird, muss man in die Differenzialdiagnose eine zerebrale Malaria, eine virale Enzephalitis und eine akute bakterielle Meningitis einbeziehen.

  • Bei akuten infektiösen Erkrankungen des zentralen Nervensystems, die in einem tropischen Land erworben wurden, vor allem bei akuter bakterieller Meningitis und zerebraler Malaria, ist eine Osmotherapie als Dauerinfusionstherapie sowie eine Dexamethason-Therapie nicht indiziert, möglicherweise sogar kontraindiziert.

  • Insbesondere nach länger dauerndem Tropenaufenthalt ist bei jedem Epilepsiepatienten, also auch bei einem Status epilepticus, eine akute ZNS-Infektion (virale Enzephalitis, zerebrale Malaria), vor allem aber eine Neurozystizerkose differenzialdiagnostisch auszuschließen.

  • Das klinische Bild einer Poliomyelitis kann durch Enteroviren, insbesondere Poliomyelitis-Viren, aber auch durch Arboviren (z. B. Flaviviren wie das Westnil-Virus) verursacht werden.

  • Die häufigste Ursache einer akuten eosinophilen Meningitis, Enzephalitis oder Myelitis ist eine Larva migrans visceralis, ausgelöst von Nematoden-Larven. Gnathostoma spinigerum oder Angiostrongylus cantonensis werden vor allem in Südostasien erworben, können aber auch aus dem südlichen Afrika und Mittelamerika stammen.

 

  • Literatur

  • 1 Bochud PY, Hawn TR, Siddiqui MR et al. Toll-Like Receptor 2 (TLRW) Polymorphisms Are Associated with Reversal Reaction in Leprosy. J Infect Dis 2008; 197: 253-261
    CrossrefPubMedGoogle Scholar
  • 2 Carod Artal F, Mouräo Mesquita H et al. Neurological symptoms and disability in HTLV-1 associated myelopathy. Neurologia 2008; 23: 78-84
    PubMedGoogle Scholar
  • 3 Dent W, Spiss H, Helbok R et al. Prevalence of migraine in a rural area in South Tanzania: a door-to-door survey. Cephalalgia 2004; 24: 960-966
    CrossrefPubMedGoogle Scholar
  • 4 Helbok R, Pongpakdee Sy, Yenjun S et al. Chronic meningitis in Thailand. Clinical characteristics, laboratory data and outcome in patients with specific reference to tuberculosis and cryptococcosis. Neuroepidemiology 2006; 26: 37-44
    CrossrefPubMedGoogle Scholar
  • 5 Kothari VM, Karnad DR, Bichile LS. Tropical infections in the ICU. J Assoc Physicians India 2006; 54: 291-298
    PubMedGoogle Scholar
  • 6 Roman GC. The neuroepidemiology of tropical spastic paraperesis. Ann Neurol 1998; 23: 113-120
    PubMedGoogle Scholar
  • 7 Roman GC, Spencer PS, Schoenberg BS. Tropical myeloneuropathies: the hidden endemias. Neurology 1985; 35: 1158-1170
    CrossrefPubMedGoogle Scholar
  • 8 Senanayake N, Roman GC. Toxic neuropathies in the tropics. J trop Georg Neurol 1993; 1: 3-15
    PubMedGoogle Scholar
  • 9 Sigler E, Shvidel L, Shtalrid M et al. Lathyrism, leg cramps, and thrombocytopenia: cascade of events starting in a concentration cAMP. Am J Med 2007; 120: e3
    PubMedGoogle Scholar
  • 10 Schmutzhard E. Neurologie in den Tropen. In: Löscher T, et al., Hrsg. Tropenmedizin in Klinik und Praxis. Stuttgart: Thieme; 2010: 228-235
    Article in Thieme ConnectGoogle Scholar
  • 11 Schmutzhard E, Helbok R. Parasitäre Erkrankungen des ZNS. In: Schwab S, et al., Hrsg. Neuro Intensiv. Berlin: Springer; 2012: 524-530
    Google Scholar
  • 12 Schmutzhard E, Pfausler F. Pilzinfektionen des ZNS. In: Schwab S, et al., Hrsg. Neuro Intensiv. Berlin: Springer; 2012: 530-534
    Google Scholar
  • 13 Tylleskar T, Banea M, Bikangi N et al. Cassava cyanogens and konzo, an upper motorneuron disease found in Africa. Lancet 1992; 339: 208-211
    CrossrefPubMedGoogle Scholar
  • 14 Benca J, Ondrusova A, Adamcova J et al. Ten years experience with 497 cases of neuroinfections in tropic: in limited laboratory infrastructure initially treat both, cerebral malaria and meningitis. Neuro Endocriol Lett 2007; 2: 49-50
    PubMedGoogle Scholar
  • 15 D’Acremont V, Kilowoko M, Kyungu E et al. Beyond malaria – causes of fever in outpatient Tanzanian children. N Engl J Med 2014; 370: 809-817
    CrossrefPubMedGoogle Scholar
  • 16 Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010; 23: 467-492
    CrossrefPubMedGoogle Scholar
  • 17 Daza P, Banda R, Misoya K et al. The impact of routine infant immunization with Haemophilus influenza type b conjugate vaccine in Malawi, a country with high human immunodeficiency virus prevalence. Vaccine 2006; 24: 6232-6239
    CrossrefPubMedGoogle Scholar
  • 18 Kasanmoentalib ES, Brouwer MC, van de Beek D. Update on bacterial meningitis: epidemiology, trials and genetic association studies. Curr Opin Neurol 2013; 26: 282-288
    CrossrefPubMedGoogle Scholar
  • 19 Branco RG, Tasker RC. Meningococcal meningitis. Curr Treat Options Neurol 2010; 12: 464-474
    CrossrefPubMedGoogle Scholar
  • 20 Matuja W, Janabi M, Kazema R et al. Stroke subtypes in Black Tanzanians: a retrospective study of computerized tomography scan diagnoses at Muhimbili National Hospital, Dar es Salaam. Trop Doct 2004; 34: 144-146
    PubMedGoogle Scholar
  • 21 Glimaker M, Johansson B, Bell M et al. Early lumbar puncture in adult bacterial meningitis – rationale for revised guidelines. Scand J Infect Dis 2013; 45: 657-663
    CrossrefPubMedGoogle Scholar
  • 22 Török ME, Nghia HD, Chau TT et al. Validation of a diagnostic algorithm for adult tuberculous meningitis. Am J Trop Med Hyg 2007; 77: 555-559
    PubMedGoogle Scholar
  • 23 Fernandes D, Goncalves-Pereira J, Janeiro S et al. Acute bacterial meningitis in the intensive care unit and risk factors for adverse clinical outcomes: Retrospective study. J Crit Care 2014; 29: 347-350
    CrossrefPubMedGoogle Scholar
  • 24 Mourvillier B, Tubach F, van de Beek D et al. Induced hypothermia in severe bacterial meningitis: a randomized clinical trial. JAMA 2013; 310: 2174-2183
    CrossrefPubMedGoogle Scholar
  • 25 US-Department of Health and Human Services, Centers for Disease control and Prevention. Antibiotic resistance threats in the United States. CDC; 2013
    Google Scholar
  • 26 ECDC. Surveillance Report: Annual epidemiological report. Reporting on 2010 surveillance data and 2011 epidemic intelligence data. ECDC; 2012
    Google Scholar
  • 27 Koster-Rasmussen R, Korshin A, Meyer CN. Antibiotic treatment delay and outcome in acute bacterial meningitis. J Infect 2008; 57: 449-454
    CrossrefPubMedGoogle Scholar
  • 28 Brouwer MC, McIntyre P, Prasad K et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2013; 6: CD004405
    PubMedGoogle Scholar
  • 29 Török ME. Neurological infections: clinical advances and emerging threats. Lancet Neurology 2007; 6: 16-18
    CrossrefPubMedGoogle Scholar
  • 30 Krishna S. Adjunctive management of malaria. Curr Opin Infect Dis 2012; 25: 484-488
    CrossrefPubMedGoogle Scholar
  • 31 Schut ES, Westendorp WF, de Gans J et al. Hyperglycemia in bacterial meningitis: a prospective cohort study. BMC Infect Dis 2009; 9: 57-63
    CrossrefPubMedGoogle Scholar
  • 32 Glimaker M, Johansson B, Halldorsdottir H et al. Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis. Plos ONE 2014; 9: e91976
    CrossrefPubMedGoogle Scholar
  • 33 Kutleša M, Baršić B, Lepur D. Therapeutic hypothermia for adult viral meningoencephalitis. Neurocrit Care 2011; 15: 151-155
    CrossrefPubMedGoogle Scholar
  • 34 Lepur D, Kutleša M, Baršić B. Induced hypothermia in adult community-acquired bacterial meningitis – more than just a possibility?. J Infect 2011; 62: 172-177
    CrossrefPubMedGoogle Scholar
  • 35 Pelkonen T, Roine I, Cruzeiro ML et al. Slow initial β-lactam infusion and oral paracetamol to treat childhood bacterial meningitis: a randomised, controlled trial. Lancet Infect Dis 2011; 11: 613-621
    CrossrefPubMedGoogle Scholar
  • 36 Török ME. Immediate or deferred antiretroviral therapy for central nervous system opportunistic infections. AIDS 2005; 19: 535-536
    CrossrefPubMedGoogle Scholar
  • 37 Meyding Lamadé U, Menon S. Akute Virusinfektionen des ZNS. In: Schwab S, et al., Hrsg. Neuro Intensiv. Berlin: Springer; 2012: 505-515
    Google Scholar
  • 38 Pelkonen T, Roine I, Anjos E et al. Herpesviruses in cerebrospinal fluid of children with meningitis in Luanda, Angola. Acta Paediatr 2013; 102: e281-e283
    CrossrefPubMedGoogle Scholar
  • 39 Mallewa M, Fooks AR, Banda D et al. Rabies encephalitis in malaria-endemic area, Malawi, Africa. Emerg Infect Dis 2007; 13: 136-139
    CrossrefPubMedGoogle Scholar
  • 40 Schmutzhard E, Gerstenbrand F. Cerebral malaria in Tanzania. Its epidemiology, clinical symptoms and neurological long term sequelae in the light of 66 cases. Trans R Soc Trop Med Hyg 1984; 78: 351-353
    CrossrefPubMedGoogle Scholar
  • 41 Schmutzhard E, Helbok R. Rickettsiae, protozoa, and opisthokonta/metazoa. Handb Clin Neurol 2014; 121: 1403-1443
    PubMedGoogle Scholar
  • 42 Jelinek T. Imported falciparum malaria in Europe: 2007 data from TropNetEurop. Euro Surveill 2008; 13 (4–6)
    PubMedGoogle Scholar
  • 43 WHO. Global Malaria Programme. World Malaria Report. 2013
    PubMedGoogle Scholar
  • 44 Biryukov S, Stoute JA. Complement activation in malaria: friend or foe?. Trends Mol Med 2014; 5: 1471-4914
    PubMedGoogle Scholar
  • 45 Craig AG, Khairul MF, Patil PR. Cytoadherence and severe malaria. Malays J Med Sci 2012; 19: 5-18
    PubMedGoogle Scholar
  • 46 Dietmann A, Helbok R, Lackner P et al. Endoglin African children with Plasmodium falciparum malaria: a novel player in severe malaria pathogenesis?. J Infect Dis 2009; 200: 1842-1848
    CrossrefPubMedGoogle Scholar
  • 47 Gay F, Zougbédé S, N’dilimabaka N et al. Cerebral malaria: what is known and what is on research. Rev Neurol (Paris) 2012; 168: 239-256
    CrossrefPubMedGoogle Scholar
  • 48 Ioannidis LJ, Nie CQ, Hansen DS. The role of chemokines in severe malaria: more than meets the eye. Parasitology 2013; 13: 1-2
    PubMedGoogle Scholar
  • 49 Isah MB, Ibrahim MA. The role of antioxidants treatment on the pathogenesis of malarial infections: a review. Parasitol Res 2014; 113: 801-809
    CrossrefPubMedGoogle Scholar
  • 50 Lackner P, Beer R, Broessner G et al. Nogo-A expression in the brain of mice with cerebral 2malaria. PLos One 2011; 6: e25728
    CrossrefPubMedGoogle Scholar
  • 51 Lackner P, Beer R, Helbok R et al. Scanning electron microscopy of the neuropathology of murine cerebral malaria. Malar J 2006; 5: 116
    CrossrefPubMedGoogle Scholar
  • 52 Lackner P, Beer R, Heussler V et al. Behavioural and histopathological alterations in mice with cerebral malaria. Neuropathol Appl Neurobiol 2006; 32: 177-188
    CrossrefPubMedGoogle Scholar
  • 53 Lackner P, Burger C, Pfaller K et al. Apoptosis in experimental cerebral malaria: spatial profile of cleaved caspase-3 and ultrastructural alterations in different disease stages. Neuropathol Appl Neurobiol 2007; 33: 560-571
    PubMedGoogle Scholar
  • 54 Lackner P, Hametner C, Beer R et al. Complement factors C1q, C3 and C5 in brain and serum of mice with cerebral malaria. Malar J 2008; 7: 207-215
    CrossrefPubMedGoogle Scholar
  • 55 Shikani HJ, Freeman BD, Lisanti MP et al. Cerebral malaria: we have come a long way. Am J Pathol 2012; 181: 1484-1492
    CrossrefPubMedGoogle Scholar
  • 56 Kampfl A, Pfausler B, Haring HP et al. Impaired microcirculation and tissue oxygenation in human cerebral malaria: a single photon emission computed tomography and near infrared spectroscopy study. Am J Trop Med Hyg 1997; 56: 585-587
    PubMedGoogle Scholar
  • 57 Santos LC, Abreu CF, Xerina SM et al. Severe imported malaria in an intensive care unit: a review of 59 cases. Malar J 2012; 11: 96-104
    CrossrefPubMedGoogle Scholar
  • 58 Kyobutungi C, Grau A, Stiegelbauer G et al. Absolute temperature changes and stroke risk: a case-crossover study. Eur J Epidemiol 2005; 20: 693-698
    CrossrefPubMedGoogle Scholar
  • 59 Ajdukiewicz KM, Cartwright KE, Scarborough M et al. Glycerol adjuvant therapy in adults with bacterial meningitis in a high HIV seroprevalence setting in Malawi: a double-blind, randomised controlled trial. Lancet Infect Dis 2011; 11: 293-300
    CrossrefPubMedGoogle Scholar
  • 60 Krishna S, Kremsner PG. Antidogmatic approaches to artemisinin resistance: reappraisal as treatment failure with artemisinin combination therapy. Trends Parasitol 2013; 29: 313-317
    CrossrefPubMedGoogle Scholar
  • 61 Brewster DR, Kwaitkowski D et al. Neurological sequelae of cerebral malaria in children. Lancet 1990; 336: 1039-1043
    CrossrefPubMedGoogle Scholar
  • 62 Schmutzhard E, Boongird P, Vejjajiva A. Eosinophilic meningitis and radiculomyelitis in Thailand caused by CNS invasion of Gnathostoma spinigerum and Angiostrongylus cantonensis. J Neurol Neurosurg Psychiatry 1988; 51: 80-87
    CrossrefPubMedGoogle Scholar
  • 63 Schmutzhard J, Kositz CH, Glueckert R et al. Apopotosis of the fibrocytes type 1 in the spiral ligament and blood labyrinth barrier disturbance cause hearing impairment in murine cerebral malaria. Malar J 2012; 11: 30-39
    CrossrefPubMedGoogle Scholar
  • 64 Winkler AS, Salmhofer G, Helbok R et al. In-Hospital Risk Estimation in Children with Malaria-Early Predictors of Morbidity and Mortality. J Trop Pediatr 2008; 54: 184-191
    PubMedGoogle Scholar
  • 65 Dent W, Helbok R, Matuja WB et al. Prevalence of active epilepsy in a rural area in South Tanzania: a door-to-door survey. Epilepsia 2005; 46: 1963-1969
    CrossrefPubMedGoogle Scholar
  • 66 Mac TL, Tran DS, Quet F et al. Epidemiology, aetiology, and clinical management of epilepsy in Asia: a systematic review. Lancet Neurol 2007; 6: 533-543
    CrossrefPubMedGoogle Scholar
  • 67 Marin B, Boussinesq M, Druet-Cabanac M et al. Onchocerciasis-related epilepsy? Prospects at a time of uncertainty. Trends Parasitol 2006; 22: 17-20
    CrossrefPubMedGoogle Scholar
  • 68 Mosser P, Schmutzhard E, Winkler AS. The pattern of epileptic seizures in rural Tanzania. J Neurol Sci 2007; 258: 33-38
    CrossrefPubMedGoogle Scholar
  • 69 Nicoletti A, Bartoloni A, Sofia V et al. Epilepsy and toxocariasis: a case-control study in Burundi. Epilepsia 2007; 48: 894-899
    CrossrefPubMedGoogle Scholar
  • 70 Tran DS, Odermatt P, Le TO et al. Prevalence of epilepsy in a rural district of central Lao PDR. Neuroepidemiology 2006; 26: 199-206
    CrossrefPubMedGoogle Scholar
  • 71 Tran DS, Zen J, Strobel M et al. The challenge of epilepsy control in deprived settings: Low compliance and high fatality rates during a community-based phenobarbital program in rural Laos. Epilepsia 2007; 48: 1-2
    PubMedGoogle Scholar
  • 72 Prado-Jean A, Kanobana K, Druet-Cabanac M et al. Combined use of an antigen and antibody detection enzyme-linked immunosorbent assay for cysticercosis as tools in an epidemiological study of epilepsy in Burundi. Trop Med Int Health 2007; 12: 895-901
    CrossrefPubMedGoogle Scholar
  • 73 Jauréguiberry S, Ansart S, Perez L et al. Acute neuroschistosomiasis: two cases associated with cerebral vasculitis. Am J Trop Med Hyg 2007; 76: 964-966
    PubMedGoogle Scholar
  • 74 Sommer C, Ringelstein EB, Biniek R. Adult Toxocara canis encephalitis. J Neurol Neurosurg Psychiatry 1994; 57: 229-231
    CrossrefPubMedGoogle Scholar