Der Internist

, Volume 47, Issue 8, pp 825–834

Kala Azar

Seltener Import und wichtige Differenzialdiagnose
Schwerpunkt: Parasitosen

Zusammenfassung

Bei einer positiven Reiseanamnese für Endemiegebiete der Leishmaniase sollte – auch noch nach Jahren – bei allen unklaren fieberhaften Allgemeinsymptomen, besonders bei Vorliegen einer Splenomegalie mit Anämie und Thrombopenie, aber auch bei Symptomen und Laborwertveränderungen im Sinne einer Autoimmunerkrankung eine Diagnostik hinsichtlich einer Leishmaniase erfolgen. Gerade auch bei Immunsupprimierten, bei denen der serologische Antikörpernachweis negativ ausfallen und die klinische Symptomatik atypisch und nicht „lehrbuchhaft“ sein kann, und bei vermeintlich nur auf die Milz bezogenen Lymphomen ist vor Splenektomie eine gezielte weitere Diagnostik zum sicheren Ausschluss eines Kala Azar, zum Beispiel auch unter Einsatz moderner PCR-Methoden zu fordern. Die Betreuung von Patienten mit dieser bei uns seltenen Erkrankung sollte in spezialisierten Zentren erfolgen, um Expertise und Erfahrungen zu konzentrieren. Hierfür bieten sich die Tropeninstitute an, die auch mit der Diagnostik die meisten Erfahrungen haben. Die Therapie der viszeralen Leishmaniase sollte den gerade überarbeiteten deutschen AWMF-Leitlinien folgen.

Schlüsselwörter

Viszerale Leishmaniase Kala Azar Splenomegalie Milzlymphom Unklares Fieber 

Kala azar: rare import and significant differential diagnosis

Abstract

After traveling into regions endemic for leishmaniasis all patients presenting with generalized febrile symptoms, pancytopenia, hepatosplenomegaly and symptoms as well as laboratory parameters also seen in autoimmune diseases should be screened for leishmaniasis even after a longer time period. Doctors should bear in mind that especially immunosuppressed patients can present with atypical and abortive symptoms and that in this group of patients immune diagnosis is unreliable. A diagnosis of a lymphoma related only to the spleen should not be made and splenectomy must not be carried out before reliable exclusion of kala azar, using modern diagnostic tools like PCR. Patients should be referred to specialized centers e.g. institutes for tropical medicine and therapy must follow actual guidelines, such as the German guidelines published by the AWMF.

Keywords

Visceral leishmaniasis Kala azar Splenomegaly Splenic lymphoma Fever 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Sektion Tropenmedizin/Bernhard-Nocht-AmbulanzZentrum für Innere Medizin am Universitätsklinikum Hamburg-EppendorfHamburg

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