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Invasive pulmonale Aspergillose

Auftreten bei einer nichtneutropenischen Patientin mit abdomineller Sepsis

Invasive pulmonary aspergillosis

Occurrence in a non-neutropenic female patient with abdominal sepsis

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Zusammenfassung

Die invasive pulmonale Aspergillose (IPA) ist eine lebensgefährliche Erkrankung, die vorwiegend bei Patienten mit gestörter Immunabwehr, z. B. im Rahmen einer akuten Leukämie, auftritt. Das vorliegende Fallbeispiel belegt, dass mit dieser Infektion auch bei nichtneutropenischen Patienten einer operativen Intensivstation gerechnet werden muss. Berichtet wird über eine 63-jährige Patientin, die im Rahmen einer diffusen eitrigen Peritonitis eine invasive Aspergillose des Respirationstrakts entwickelte. Die primäre Therapie mit Voriconazol führte zu keiner Besserung der Symptomatik. Erst durch die Umstellung auf Caspofungin, intensive Lagerungsmaßnahmen (einschließlich Bauchlage) und die Sanierung der Atemwege mithilfe der starren Bronchoskopie konnte dieses schwere Krankheitsbild zur Ausheilung gebracht werden.

Abstract

Invasive pulmonary aspergillosis (IPA) is a life-threatening infection predominantly affecting immunocompromised patients, e.g. with acute leukemia. This case report demonstrates that IPA can also occur in non-neutropenic critically ill surgical patients. The case of a 63-year-old woman is reported, who developed IPA of the respiratory tract in the course of diffuse purulent peritonitis. First-line therapy with voriconazol failed to be effective. However, application of caspofungin, intensive kinetic therapy (including prone position) and airway management by interventional bronchoscopy enabled successful treatment of this severe complication.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Operative Intensivmedizin,, Krankenhaus Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Anästhesiologie II der Privaten Universität Witten/Herdecke, Ostmerheimerstr. 200, 51109, Köln, Deutschland

    D. Knüttgen, S.G. Sakka & F. Wappler

  2. Neurochirurgische Klinik, Universitätsklinikum, Universität Düsseldorf, Düsseldorf, Deutschland

    M. Kamp

  3. Klinik für Viszeral-, Gefäß- und Transplantationschirurgie, Krankenhaus Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Chirurgie I der Privaten Universität Witten/Herdecke, Köln, Deutschland

    M. Ströhlein

  4. Institut für Mikrobiologie, Krankenhaus Merheim, Kliniken der Stadt Köln gGmbH, Köln, Deutschland

    J. Matten

  5. Lungenklinik, Krankenhaus Merheim, Kliniken der Stadt Köln gGmbH, Köln, Deutschland

    A. Chemaissani

  6. Institut für Pathologie, Krankenhaus Merheim, Kliniken der Stadt Köln gGmbH, , Köln, Deutschland

    K. Ernestus

Authors
  1. D. Knüttgen
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  2. M. Kamp
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  3. M. Ströhlein
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  4. J. Matten
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  5. A. Chemaissani
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  6. K. Ernestus
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  7. S.G. Sakka
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  8. F. Wappler
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Corresponding author

Correspondence to D. Knüttgen.

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Knüttgen, D., Kamp, M., Ströhlein, M. et al. Invasive pulmonale Aspergillose. Anaesthesist 58, 262–267 (2009). https://doi.org/10.1007/s00101-008-1496-6

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  • DOI: https://doi.org/10.1007/s00101-008-1496-6

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