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Haut- und Weichgewebe-Infektionen durch nicht-tuberkulöse Mykobakterien: Ätiologie, Epidemiologie, Pathogenese, Klinik, Diagnostik, differenzialdiagnostische Aspekte und Empfehlungen für die Therapie

Skin and soft tissue infections due to non-tuberculous mycobacteria: etiology, epidemiology, pathogenesis, differential diagnostic aspects and therapeutic recommendations

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Summary

Non-tuberculous mycobacteria are rarely responsible for skin and soft tissue infections. These infections are caused by different mycobacterial species originating from the environment (water, soil, plants, and animals). Various factors influence the clinical manifestation of the cutaneous infection: the immunological situation of the patient, the degree of cutaneous impairment, and the extent of the contact with the contaminated environment. The clinical manifestation is non-specific and often the cause of extensive diagnostic activities. The diagnosis is based on the cultural detection of the causative pathogen. The management of these skin and subcutaneous infections is a challenge for each physician. The treatment comprises administration of several antibiotics and antituberculosis drugs for many months. Surgical procedures are necessary in some patients.

Zusammenfassung

Haut-Weichgewebe-Infektionen durch nicht-tuberkulöse Mykobakterien sind selten. Sie können durch verschiedene mykobakterielle Spezies hervorgerufen werden. Diese entstammen der Umgebung des Menschen (Wasser, Erde, Pflanzen, Tiere). Für die Morphologie und Ausprägung der Läsionen sowie für den Verlauf der Infektion sind der Grad der Hautschädigung im Bereich der Eintrittspforte (Mikro- und Makrotraumen), die Dauer des Kontaktes mit der mykobakteriell kontaminierten Umgebung und die Immunität des Patienten wichtig. Das klinische Bild der kutan-subkutanen Infektion ist untypisch und führt oft zu differenzialdiagnostischen Problemen. Daraus ergibt sich die Notwendigkeit, verschiedene serologische, mikrobiologische, immunhistochemische und ggf. apparative diagnostische Tests anzuwenden, um die Diagnose zu stellen bzw. wichtige Differenzialdiagnosen (z. B. Sarkoidose, Leishmaniose, Lepra) auszuschließen. Letztendlich basiert die Diagnose auf dem Erregernachweis. Zur Behandlung werden verschiedene Antibiotika, in der Regel als Kombinationstherapie, über viele Monate eingesetzt. Bei manchen Patienten sind chirurgische Maßnahmen nötig.

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Authors and Affiliations

  1. Labor für medizinische Mikrobiologie, Mölbis, Germany

    Pietro Nenoff

  2. Department of Dermatology and Venerology, Trakian University, Stara Zagora, Bulgaria

    Georgi Tchernev

  3. Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Europäisches Ausbildungszentrum für Andrologie, Leipzig, Germany

    Uwe Paasch

  4. Institut für Medizinische Diagnostik Oderland, Frankfurt (Oder), Germany

    Werner Handrick

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  1. Pietro Nenoff
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  2. Georgi Tchernev
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  3. Uwe Paasch
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  4. Werner Handrick
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Correspondence to Pietro Nenoff.

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Nenoff, P., Tchernev, G., Paasch, U. et al. Haut- und Weichgewebe-Infektionen durch nicht-tuberkulöse Mykobakterien: Ätiologie, Epidemiologie, Pathogenese, Klinik, Diagnostik, differenzialdiagnostische Aspekte und Empfehlungen für die Therapie. Wien Med Wochenschr 161, 426–432 (2011). https://doi.org/10.1007/s10354-011-0027-2

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