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Aspergillus-Nachweis im Atemwegsmaterial

Ignorieren oder behandeln?

Aspergillus in airway material

Ignore or treat?

  • Schwerpunkt: Chronische Atemwegsinfektionen
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Schimmelpilze der Gattung Aspergillus sind ubiquitär verbreitet. Obwohl Aspergillus-Sporen von Menschen unter natürlichen Bedingungen täglich eingeatmet werden, treten Aspergillus-assoziierte Erkrankungen nur unter bestimmten Bedingungen auf. Maßgeblich dafür, welche Aspergillus-assoziierte Erkrankung entsteht, ist die Konstitution des Wirts. Neben allergischen Krankheitsbildern, wie der exogen allergischen Aspergillose (EAA), treten allergisch-infektiöse Erkrankungen auf, wie die allergische bronchopulmonale Aspergillose (ABPA) oder die bronchozentrische Granulomatose, und auch infektiöse Erkrankungen, wie die invasive (IA), die semiinvasive (SIA) und die chronische pulmonale Aspergillose (CPA). Der alleinige Nachweis von Aspergillus spp. in Sputum oder Bronchialsekret ist für die Diagnose einer Aspergillus-assoziierten Erkrankung nicht ausschlaggebend. Für die assoziierten Infektionskrankheiten ist der kulturelle oder histopathologische Nachweis von Aspergillus in Lungengewebe ausschlaggebend. Häufiger beruht die Einleitung einer Therapie aber auf einer Verdachtsdiagnose, die durch den Nachweis von Aspergillus-spezifischem IgG-Antikörpern im Blut oder von Galaktomannan-Antigen aus der bronchoalveolären Lavage gestellt wurde. Akute invasive oder semiinvasive Infektionen haben eine hohe Letalität und bedürfen einer raschen medikamentösen Therapie. Die CPA ist allein medikamentös praktisch nicht heilbar, durch eine antimykotische medikamentöse Therapie kann sie in Remission gebracht werden. Eine Eradikation der CPA gelingt i.d.R. nur durch ein kombiniertes antimykotisches/chirurgisches Vorgehen.

Abstract

Fungi of the genus Aspergillus are ubiquitously present. Even though humans inhale Aspergillus spores daily under natural conditions, Aspergillus-associated pulmonary diseases only occur under special circumstances. Whether an Aspergillus-associated disease develops and which type of Aspergillus-associated disease develops depends on the constitution of the host. The spectrum of Aspergillus-associated pulmonary diseases ranges from allergic diseases, such as hypersensitivity pneumonitis to allergic infectious diseases, such as allergic bronchopulmonary aspergillosis (ABPA) and bronchocentric granulomatosis (BG) to infectious diseases, such as invasive (IA) or semi-invasive aspergillosis (SIA) and chronic pulmonary aspergillosis (CPA). Identification of Aspergillus spp. from sputum or bronchopulmonary secretions is not sufficient for a definitive diagnosis of Aspergillus-associated infections. The gold standard is the identification of Aspergillus spp. from lung tissue by culture or by histopathological methods; however, in clinical practice the decision to initiate antifungal therapy is more often based on immunological methods, such as the detection of Aspergillus-specific IgG antibodies from peripheral blood or galactomannan antigens from bronchoalveolar lavages. Acute IA or SIA infections have a high mortality and require immediate antifungal therapy. With rare exceptions CPA cannot be cured by medicinal therapy alone; however, active CPA can be brought into remission with antifungal therapy. Eradication of Aspergillus in CPA can as a rule only be successful using a combined antimycotic and surgical intervention.

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Authors and Affiliations

  1. Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel, Leibniz-Zentrum für Medizin und Biowissenschaften, Parkallee 35, 23845, Borstel, Deutschland

    H. J. F. Salzer MPH & C. Lange

  2. Hamburg – Borstel – Lübeck – Riems DZIF-Standort, Deutsches Zentrum für Infektionsforschung (DZIF), Borstel, Deutschland

    H. J. F. Salzer MPH & C. Lange

  3. International Health and Infectious Diseases, Universität zu Lübeck, Lübeck, Deutschland

    C. Lange

  4. Department of Medicine, Karolinska Institute, Stockholm, Schweden

    C. Lange

  5. Klinische Abteilung für Pulmonologie, Medizinische Universität Graz, Graz, Österreich

    M. Hönigl

  6. Sektion für Infektionserkrankungen und Tropenmedizin, Medizinische Universität Graz, Graz, Österreich

    M. Hönigl

  7. Division of Infectious Diseases, Department of Medicine, University of California – San Diego, San Diego, USA

    M. Hönigl

  8. CBmed – Center for Biomarker Research in Medicine, Graz, Österreich

    M. Hönigl

Authors
  1. H. J. F. Salzer MPH
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  2. C. Lange
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  3. M. Hönigl
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Corresponding author

Correspondence to H. J. F. Salzer MPH.

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Interessenkonflikt

H. Salzer gibt an, dass er eine Forschungsförderung der Firma Gilead erhalten hat sowie Referentenhonorare der Firma Chiesi. C. Lange gibt an, dass er Referentenhonorare der Firmen Chiesi, Gilead, Abbvie, MSD, Becton Dickinson, Janssen, Astra Zeneca, und Lucane erhalten hat. M. Hönigl gibt, dass er eine Forschungsförderung der Firma Gilead erhalten hat sowie der Firmen MSD, Gilead und Basilea.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

B. Salzberger, Regensburg

C.F. Vogelmeier, Marburg

T. Welte, Hannover

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Salzer, H.J.F., Lange, C. & Hönigl, M. Aspergillus-Nachweis im Atemwegsmaterial. Internist 58, 1150–1162 (2017). https://doi.org/10.1007/s00108-017-0334-9

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  • DOI: https://doi.org/10.1007/s00108-017-0334-9

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