Klinisches Bild, Diagnostik und Therapie der Chlamydien-Pneumonie

Einleitung

In den letzten Jahren wurde mehrfach über einen kontinuierlichen Wandel im Erregerspektrum der ambulant erworbenen Pneumonie berichtet. Hierbei zeigte sich der allgemeine Trend einer relativen Zunahme so genannter atypischer Pneumonieerreger bei gleichzeitigem Rückgang grampositiver Mikroorganismen [1] [2] [3] [4] [5] [6] [7] [8]. Zu diesen atypischen bzw. intrazellulär agierenden Bakterien gehören auch die Chlamydien. In epidemiologischen Studien wurde in bis zu 15 % aller erfassten Pneumoniefälle Chlamydia pneumoniae identifiziert [1] [2] [3] [4] [5] [9] [10]. Gleichzeitig gelang jedoch häufig der Nachweis eines zweiten oder dritten Erregers im Sinne einer Mischinfektion, so dass die Frage nach der pathogenetischen Bedeutung von Chlamydia pneumoniae für die Pneumonie zum Teil sehr kontrovers diskutiert wurde [11] [12] [13]. Das derzeitige Hauptproblem und der Schwerpunkt in der Chlamydienforschung betrifft die Diagnostik dieser obligat intrazellulären, gramnegativen Bakterien [14]. Trotz einer Vielzahl von Nachweismethoden ist zur Zeit keine Technik in der Lage, einen schnellen und zugleich verlässlichen Erregernachweis zu erbringen. Zudem fehlt noch jegliche Standardisierung. Zur Therapie von Chlamydieninfektionen insbesondere der Pneumonie stehen sehr potente Antibiotika wie die Makrolide und das Azalid Azithromycin, das Ketolid Telithromycin, das Tetracyclin Doxycyclin und die Fluorochinolone der neuen Generation zur Verfügung.

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