Pneumologie 1999; 53(11): 530-538
DOI: 10.1055/s-1999-9046
ORIGINALARBEIT
Georg Thieme Verlag Stuttgart ·New York

Pathogenese der Pneumocystis carinii-Pneumonie[1]

Pathogenesis of the Pneumocystis carinii pneumonia:G. Höffken1 , G. Bäthge2 , A. F Kiderlen3
  • 1Medizinische Klinik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
  • 2Medizinische Klinik II, Universitätsklinikum Benjamin Franklin der Freien Universität Berlin
  • 3Fachgebiet Zelluläre Infektabwehr, Robert-Koch-Institut Berlin
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Also available at
 

Zusammenfassung:

Pneumocystis carinii ist ein weltweit vorkommender Pilz, welcher bei verschiedenen Säugetierarten einschließlich des Menschen bei Immundefizienz eine - unbehandelt praktisch immer letal verlaufende - Pneumonie (PcP) verursachen kann. In den letzten Jahren wurden große Fortschritte bei der Aufklärung der Pathogenese der P. carinii Infektion gemacht, wobei insbesondere tierexperimentell gewonnene Daten unter Verwendung des SCID-Mausmodells und von Gen-knockout-Mäusen das Verständnis der Erkrankung wesentlich bereichert haben. Die zum Teil divergierenden tierexperimentellen Daten sprechen jedoch dafür, daß nicht von einer einheitlichen Pathogenese der P. carinii-Pneumonie ausgegangen werden kann. Im Zentrum der Immunantwort stehen die CD4+ T-Lymphozyten, welche für eine Infektionsresistenz beziehungsweise für die erfolgreiche Überwindung einer Infektion essentiell sind, trotz nachweisbarer, früher Aktivierung des unspezifischen zellulären Immunsystems mit Rekrutierung von Alveolarmakrophagen und Elaboration zahlreicher Zytokine und anderer Immunmediatoren. Welche Oberflächen- und sekretorischen Antigene von P. carinii für eine protektive Immunantwort und welche möglicherweise für eine Evasion der Infektabwehr von Bedeutung sind, bleibt unklar. Die Charakterisierung dieser Moleküle, die Bestimmung ihrer exakten immunologischen Eigenschaften sowie die Evaluation der Wechselwirkungen zwischen humoralem und zellulärem Immunsystem auf der Basis dieser exakt definierten Antigene dürfte eine weitere Klärung der Pathogenese der P. carinii-Pneumonie erbringen.

Pneumocystis carinii is a ubiquitous fungus and opportunistic resident of the bronchoalveolar lumen of men and a variety of other mammalian species. This microorganism replicates under immunosuppressive conditions, ultimately resulting in lethal pneumonia (PcP) if left untreated. In the past decade, considerable progress has been made concerning the understanding of the underlying pathogenic mechanisms of this infection, mostly with the help of animal models such as SCID (severe combined immunodeficiency) or gene-knock-out mice. Partially conflicting data derived from animal studies lead to the assumption that there is no single relevant model for PcP. The T cell-mediated branch of the immune system is recognised as the major component in the host's ability to resist or overcome an infection with P. carinii. Natural, nonspecific immune mechanisms involving mononuclear phagocytes and elaborating a variety of cytokines and other immunomediators play an important role in initiating the immunoresponse as well as in its effector phase, but it is the CD4+ T lymphocytes which are essential for coordinating the complete eradication of this pathogen. The biological function and immunological effects of antigens expressed on the surface of or secreted by P. carinii organisms is not yet fully known. Hopefully, characterisation of these molecules, clarification of their immunological properties and the evaluation of the interactions between humoral and cellular as well as specific and nonspecific parts of the immune system will lead to new insights into the pathogenesis of P. carinii pneumonia.

1 Herrn Prof. Dr. H. Lode zum 60. Geburtstag gewidmet

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1 Herrn Prof. Dr. H. Lode zum 60. Geburtstag gewidmet

Prof. Dr. med. Gert Höffken

Medizinische Klinik I Universitätsklinikum Carl Gustav Carus

Fetscherstr. 74

01307 Dresden