Neues zu opportunistischen Infektionen des zentralen Nervensystems bei iatrogener Immunsuppression

Zusammenfassung

Opportunistische Infektionen des zentralen Nervensystems (ZNS) mit infolge einer iatrogenen Immunsuppression auftretenden Virus-, Parasiten-, Pilz- oder Bakterien-induzierten Erkrankungen sind bei der steigenden Zahl an Patienten mit Organtransplantationen oder immunmodulierenden Therapien von großer medizinischer Bedeutung. Hauptsächliche Anwender dieser modernen Behandlungsformen sind neben der Transplantationsmedizin die Dermatologie (Interferone, Rituximab, Fingolimod u. a.), Hämato-/Onkologie (Rituximab u. a.), Neurologie (Beta-Interferon, Glatirameracetat, Natalizumab, Rituximab, Teriflunomid, Fingolimod, Alemtuzumab, Daclizumab u. a.) und Rheumatologie (Rituximab u. a.).

Das Keimspektrum bei iatrogener Immunsuppression in Europa umfasst in der Hauptsache Viren der Herpesgruppe sowie insbesondere bei immunmodulatorisch behandelten Patienten das JC-Virus (JCV); an Pilzerregern sind Aspergillus fumigatus, Candida albicans und Cryptococcus neoformans von Bedeutung. Eine wichtige parasitäre Infektion ist die mit Toxoplasma gondii (T. g.). Typische bakterielle Infektionen des iatrogen immunkompromittierten Patienten werden durch Nocardia asteroides, Listeria monocytogenes und Mycobacterium tuberculosis hervorgerufen.

Es werden typische diagnostische Konstellationen und Therapien vorgestellt.

Abstract

Opportunistic infections of the central nervous system (CNS) with bacteria, parasites, funghi or viruses due to iatrogenic immunosupppression are of immense importance because of the rising numbers of organtransplantations and immunomodulating treatments. Most frequently involved medical subdisciplines are except from transplantation medicine dermatology (interferons, rituximab, fingolimod, a.o.), hemato-oncology (rituximab, a.o.), neurology (beta-interferon, glatiramer acetat, natalizumab, rituximab, teriflunomide, fingolimod, alemtuzumab, daclizumab, a.o.) and rheumatology (rituximab).

In Europe, typical infectious bodies affecting the immunocompromised host are herpes viruses and especially in immunomodulated patients JC-virus (JCV); frequently occurring funghi are Aspergillus fumigatus, Candida albicans and Cryptococcus neoformans. An important parasite is Toxoplasma gondii (T. g.). Typical bacterial infections of the immunocompromised patient are provoked by Nocardia asteroides, Listeria monocytogenes and Mycobacterium tuberculosis.

Modern diagnostic and therapeutic procedures are described.

Schlüsselwörter

opportunistische Infektionen - zentrales Nervensystem (ZNS) - iatrogene Immunsuppression und -modulation - typische Erreger

Keywords

opportunistic infections - central nervous system (CNS) - iatrogenic immunosuppression and -modulation - typical infectious bodies

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