Nichttuberkulöse Mykobakteriosen unterscheiden sich in Klinik und Therapie erheblich von Infektionen durch Erreger aus dem Mycobacterium-tuberculosis-Komplex. Bei HIV-Infizierten spielen fast ausschließlich Infektionen durch Keime aus der Spezies Mycobacterium avium eine Rolle, die sich als pulmonale Erkrankungen mit besonderen Charakteristika und disseminierten Verläufen manifestieren. Bei Nicht-HIV-Infizierten prädisponieren sowohl eine Reihe lokaler, resistenzmindernder Faktoren als auch systemische Umstände zu Infektionen mit oder ohne Krankheitswert, die wegen ihres Facettenreichtums sowohl des klinischen Erscheinungsbildes als auch der speziesspezifischen Behandlung praktisch für jeden einzelnen Patienten eine individuelle Beurteilung erfordern. Die medikamentöse Behandlung kann sich - im Gegensatz zur Tuberkulose - nur eingeschränkt auf Resistenztests in vitro stützen und richtet sich daher zumindest zu Beginn nach den bisherigen klinischen Erfahrungen und nur wenigen kontrollierten Studien. Angesichts der - im Vergleich zur Tuberkulose - hohen Rezidivrate nach der medikamentösen Therapie sollte die operative Sanierung lokaler Risikofaktoren (Bronchiektasen, Bullae, postspezifische Veränderungen) und damit der Infektion regelhaft in Erwägung gezogen werden.
Non-tuberculous mycobacterioses differ substantially from infections with M. tuberculosis complex in regard to both clinical presentation and treatment. In persons infected with HIV the pathogenic organism is almost always M. avium complex, which leads to various pulmonary diseases with specific characteristics and disseminated courses. In patients not infected with HIV, a number of factors that reduce local resistance and certain systemic conditions increase the risk of the infection's reaching a degree of severity requiring treatment. Since these factors are associated with a wide variety of clinical presentations and treatment is species-specific, assessment needs to be individualised for almost all patients. In contrast to the treatment of tuberculosis, in non-tuberculous mycobacterioses the extent to which the treatment can be based on in vitro resistance tests is limited. Clinicians therefore have to draw on their previous clinical experience and the few existing controlled studies, at least initially. In view of the high rate of recurrence compared to tuberculosis, surgical removal of local risk factors (bronchiectasis, bullae, post-specific changes) and thus the mycobacterial infection itself should be considered in all cases.
Key words
nontuberculous mycobacterial disease - antimycobacterial chemotherapy - chronic lung disease - HIV
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1 Global initiative for chronic Obstructive Lung Disease
Korrespondenz
Dr. Nicolas Schönfeld
Lungenklinik Heckeshorn HELIOS Klinikum Emil von Behring
Walterhöferstraße 11
14165 Berlin
eMail: schoenfeld.berlin@t-online.de
