Opportunistische Infektionen: Was gibt es Neues?

Was ist neu?

Zerebrale Toxoplasmose Als intravenöse Therapie ist die Gabe von Trimethoprim und Sulfamethoxazol möglich. Auch als orale Prophylaxe können sie nun schon ab einer CD4-T-Helferzellzahl von < 200/µl eingesetzt werden.

Pneumocystis jiroveci Zur Prophylaxe und Therapie der Pneumocystis-jiroveci-Pneumonie ist die Kombination aus Trimethoprim und Sulfamethoxazol weiterhin Mittel der Wahl.

Kryptokokkose Eine neue Therapieoption besteht aus liposomalem Amphotericin B plus Fluconazol.

Tuberkulose Um ein Immunrekonstitutions-Inflammations-Syndrom (IRIS) zu vermeiden, kann eine präventive Steroidbehandlung in Betracht gezogen werden.

Humanes Herpes-Virus Typ 8 (HHV8) Das „Kaposi-Sarkom-Herpesvirus-Inflammations-Zytokin-Syndrom“ (KICS) wurde als neue HHV8-assoziierte Erkrankung beschrieben.

Varizella zoster In der Therapie sollte man Lokalisation und Ausbreitung berücksichtigen.

Abstract

Guidelines from 3 clinical societies and peer-reviewed publications have been reviewed for recent changes in the management of opportunistic infections. Trimethoprim and sulfamethoxazol administered intravenously is an option to treat cerebral toxoplasmosis if oral therapy is not feasible. CD4 T cell cut-off for starting prophylaxis with trimethoprim and sulfamethoxazole is now 200/µl. For prophylaxis and treatment of Pneumocystis pneumonia trimethoprim and sulfamethoxazole still are recommended. Liposomal amphotericin B + fluconazole is a new treatment option for cryptococcosis. Addition of steroids can be considered in the treatment of tuberculosis to avoid immune reconstitution inflammatory syndrome. A new syndrome associated with HHV8 has been described: Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS). Localization and dissemination of herpes zoster have to be considered for treatment determination.

Schlüsselwörter

Opportunistische Infektionen - HIV - EACS - DAIG - IDSA

Key words

opportunistic infections - HIV - EACS - DAIG - IDSA

• Literatur

• 1 Robert-Koch-Institut. Epidemiologisches Bulletin Nr. 47 (23. November 2017). Im Internet: www.rki.de Stand 13.08.2018
• 2 Robert-Koch-Institut. HIV-Erstdiagnosen und AIDS-Erkrankungen in Deutschland: Diagramme und Karten (März 2015). Im Internet: www.rki.de Stand 13.08.2018
• 3 European AIDS-Clinical-Society. Leitlinien. Version 9.0 (Oktober 2017). Im Internet: http://www.eacsociety.org/guidelines/eacs-guidelines/eacs-guidelines.html Stand 10.08.2018
• 4 Infectious Diseases Society of America. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents (Mai 2018). Im Internet: https://aidsinfo.nih.gov/guidelines Stand 9.08.2018
• 5 Deutsche AIDS Gesellschaft. Deutsch-Österreichische Leitlinien zur Therapie und Prophylaxe opportunistischer Infektionen bei HIV-infizierten erwachsenen Patienten (September 2014). Im Internet: https://daignet.de/site-content/hiv-therapie/leitlinien-1 Stand 08.08.2018
• 6 Hernandez AV, Thota P, Pellegrino D. et al. A systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option?. HIV Med 2017; 18: 115-124
• 7 van Bilsen WPH, van den Berg CHSB, Rijnders BJA. et al. Immune reconstitution inflammatory syndrome associated with toxoplasmic encephalitis in HIV-infected patients. AIDS 2017; 31: 1415-1424
• 8 Costa D, Razakandrainibe R, Sautour M. et al. Human cryptosporidiosis in immunodeficient patients in France (2015–2017). Exp Parasitol 2018; 192: 108-112
• 9 Chavez MA, White Jr AC. Novel treatment strategies and drugs in development for cryptosporidiosis. Expert Rev Anti Infect Ther 2018; 16: 655-661
• 10 Liu Y, Su L, Jiang SJ. et al. Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis. Oncotarget 2017; 8: 59729-59739
• 11 Baulier G, Issa N, Gabriel F. et al. Guidelines for prophylaxis of Pneumocystis pneumonia cannot rely solely on CD4-cell count in autoimmune and inflammatory diseases. Clin Exp Rheumatol 2018; 36: 490-493
• 12 Lu YM, Lee YT, Chang HC. et al. Combination of echinocandins and trimethoprim/sulfamethoxazole for the treatment of Pneumocystis jiroveci pneumonia after heart transplantation. Transplant Proc 2017; 49: 1893-1898
• 13 Pasquier E, Kunda J, De Beaudrap P. et al. Long-term mortality and disability in cryptococcal meningitis: a systematic literature review. Clin Infect Dis 2018; 66: 1122-1132
• 14 Boulware DR, Meya DB, Muzoora C. et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med 2014; 370: 2487-2498
• 15 Ford N, Shubber Z, Jarvis JN. et al. CD4 cell count threshold for cryptococcal antigen screening of HIV-infected individuals: a systematic review and meta-analysis. Clin Infect Dis 2018; 66: S152-S159
• 16 Kim T, Park SY, Lee HJ. et al. Assessment of cytomegalovirus and cell-mediated immunity for predicting outcomes in non-HIV-infected patients with Pneumocystis jirovecii pneumonia. Medicine (Baltimore) 2017; 96: e7243
• 17 Cherrier L, Nasar A, Goodlet KJ. et al. Emergence of letermovir resistance in a lung transplant recipient with ganciclovir-resistant cytomegalovirus infection. Am J Transplant 2018;
• 18 Chou S, Satterwhite LE, Ercolani RJ. New locus of drug resistance in the human Cytomegalovirus UL56 gene revealed by in vitro exposure to letermovir and ganciclovir. Antimicrob Agents Chemother 2018; 62: e00922-18
• 19 Mularoni A, Gallo A, Riva G. et al. Successful treatment of Kaposi sarcoma-associated Herpesvirus inflammatory cytokine syndrome after kidney-liver transplant: correlations with the human Herpesvirus 8 miRNome and specific T cell response. Am J Transplant 2017; 17: 2963-2969
• 20 Karass M, Grossniklaus E, Seoud T. et al. Kaposi sarcoma inflammatory cytokine syndrome (KICS): a rare but potentially treatable condition. Oncologist 2017; 22: 623-625