Der Nervenarzt

, Volume 79, Supplement 2, pp 93–111 | Cite as

Infektionen des ZNS beim immuninkompetenten Patienten

CME Weiterbildung • Zertifizierte Fortbildung

Zusammenfassung

Infektionen des zentralen Nervensystems (ZNS) werden von unterschiedlichen Erregern verursacht, je nachdem, ob eine unzureichende T-Zell- oder Monozytenfunktion [wie bei mit HIV (humanes Immundefizienzvirus) infizierten Patienten] oder eine supprimierte Zahl oder Funktion v. a. der Granulozyten vorliegen, wie sie typischerweise unter zytostatischer Therapie, nach einer Transplantation, bei Autoimmunerkrankungen usw. gesehen werden. Im 1. Teil werden die mit abnormer T-Zell- oder Monozytenfunktion assoziierten ZNS-Infektionen bei HIV, v. a. die zerebrale Toxoplasmose, ZNS-Kryptokokkose, Zytomegalievirusinfektion, progressive multifokale Leukenzephalopathie, detailliert in klinischer Symptomatik, Diagnostik sowie therapeutischem und prophylaktischem Management dargestellt. Im 2. Teil werden die mit einer Granulozytenfehlfunktion einhergehenden bzw. die bei absoluter Neutropenie gesehenen opportunistischen Infektionskrankheiten aus dem viralen, bakteriellen und pilzlichen Spektrum in Epidemiologie, klinischer Symptomatik, diagnostischem, therapeutischem und prophylaktischem Management detailliert vorgestellt.

Schlüsselwörter

ZNS-Infektion Abnormale T-Zell-/Monozytenfunktion Neutropenie HIV Transplantation 

Abkürzungen

Aids

„acquired immuno deficiency syndrom“

CMV

Zytomegalievirus

DNA

Desoxyribonukleinsäure

EBV

Epstein-Barr-Virus

FACS

„fluorescence activated cell sorter“

HAART

Hochaktive antiretrovirale Therapie

HHV

Humanes Herpesvirus

HIV

Humanes Immundefizienzvirus

Ig

Immunglobulin

IRIS

Immunrekonstitutionssyndrom

JC-Virus

John-Cunningham-Virus

KBR

Komplementbindungsreaktion

KG

Körpergewicht

MDR

„multidrug resistant“

PCR

Polymerasekettenreaktion

PDLD

Posttransplantationslymphoproliferative Erkrankung

PET

Positronenemissionstomographie

PML

Progressive multifokale Leukenzephalopathie

RT-PCR

Reverse-Transkriptase-PCR

SMZ

Sulfamethoxazol

TMP

Trimethoprim

VCA

Virales Kapsidantigen

VZV

Varicella-Zoster-Virus

XDR

„extended drug resistant“

ZNS

Zentrales Nervensystem

Infections of the central nervous system in the immuno-compromised

Summary

Infections of the central nervous system (CNS) can be caused by a variety of pathogens, depending on whether the number and function of T-cells or monocytes are impaired (as in HIV patients) or whether the number and function of polymorphonuclear granulocytes are reduced or impaired, as typically seen in patients on immunosuppressive therapy, post transplantation, etc.. The first part of the chapter deals with CNS infections associated with reduced or abnormal T-cell (or monocytic) function and number, mainly seen in HIV patients, such as cerebral toxoplasmosis, CNS cryptococcosis, cytomegalovirus encephalitis, and progressive multifocal leukoencephalopathy. The clinical presentation, diagnostic procedures, as well as therapeutic and prophylactic management of these diseases are described in detail. The second part of the chapter deals with diseases usually seen in patients with impaired or reduced number and function of polymorphonuclear granulocytes. Such CNS infections are frequently caused by viral, bacterial, or fungal pathogens and are described in their clinical presentation, their diagnostic procedures and the best possible therapeutic and prophylactic management.

Keywords

CNS infections Abnormal T-cell/monocyte function Neutropenia HIV Transplantation 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Neurologische IntensivstationUniversitätsklinik für NeurologieInnsbruckÖsterreich

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