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Der Nervenarzt

, Volume 89, Issue 12, pp 1320–1331 | Cite as

Neurologische Komplikationen bei Infektionen mit (neuen) Enteroviren

  • N. Möhn
  • T. Skripuletz
  • M. Stangel
Leitthema

Zusammenfassung

Enterovirus(EV)-Infektionen sind häufig und betreffen insbesondere Kinder. Das Auftreten neurologischer Manifestationen ist insgesamt selten. Die Folgen einer solchen neurologischen Mitbeteiligung können z. T. aber sehr schwerwiegend sein. Seit 2014 kam es weltweit zu vermehrten EV-D68- und EV-71-Ausbrüchen mit Zunahme neurologischer Komplikationen mit Rhombenzephalitis (EV-71) und akuter schlaffer Myelitis (EV-D68). Zunehmend ist auch eine Verbreitung in Europa mit einzelnen Fällen in Deutschland zu beobachten. Insbesondere bei Kindern gehen den neurologischen Symptomen typischerweise Prodromi mit Atemwegsinfekt oder gastrointestinalen Beschwerden voraus. In diesen Fällen sollte an eine EV-Infektion gedacht und die entsprechende Diagnostik eingeleitet werden. Neben häufig entzündlich verändertem Liquor sind insbesondere die MRT-Veränderungen wegweisend. Problematisch ist, dass häufig der Virusnachweis im Liquor nicht gelingt, sodass weitere Proben aus z. B. Stuhl oder Nasen‑/Rachenabstrichen benötigt werden. Bisher gibt es für keine der beiden EV-Infektionen eine kausale Therapie, weshalb eine umfassende supportive Therapie von entscheidender Bedeutung ist. In Taiwan wurden Erfolge im Rahmen von Therapien mit intravenösen Immunglobulinen verzeichnet. Eine verlässliche Studie hierzu fehlt bislang jedoch.

Schlüsselwörter

Rhombenzephalitis (EV-71) Akute schlaffe Myelitis (EV-D68) Liquordiagnostik Magnetresonanztomographie Intravenöse Immunglobulinen 

Neurological complications of infections with (novel) enteroviruses

Abstract

Enterovirus (EV) infections are frequent and predominantly affect children. Neurological manifestations are rare but can induce severe consequences. Since 2014 a global rise in EV-D68 and EV-71 infections manifesting with neurological complications, namely rhombencephalitis (EV-71) and acute flaccid myelitis (EV-D68), has been observed with an increased distribution in Europe and isolated occurrences in Germany. Typically prodromes with respiratory infections and gastrointestinal conditions precede neurological symptoms. In these cases, an EV infection should be considered as the underlying cause and appropriate diagnostic tests should be performed. Other than the typical inflammatory signs in cerebrospinal fluid (CSF), the changes on magnetic resonance imaging (MRI) in particular are seminal; however, confirmation of the virus is often not possible in the CSF so that other specimens from, e.g. feces or the respiratory tract are required. To date there are no causal therapies for either of these EV infections; therefore, a comprehensive supportive therapy is of major significance. In Taiwan some beneficial effects could be observed by administration of intravenous immunoglobulins; however, a reliable study has not yet been published.

Keywords

Rhombencephalitis (EV-71) Acute flaccid myelitis (EV-D68) Cerebrospinal fluid diagnostics Magnetic resonance imaging Intravenous immunoglobulins 

Notes

Danksagung

Martin Stangel wird unterstützt vom Niedersachsen-Research Network on Neuroinfectiology (N‑RENNT) des Ministriums für Wissenschaft und Kultur des Landes Niedersachsen.

Einhaltung ethischer Richtlinien

Interessenkonflikt

N. Möhn, T. Skripuletz und M. Stangel geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinische Neuroimmunologie und Neurochemie, Klinik für NeurologieMedizinische Hochschule HannoverHannoverDeutschland

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