Skip to main content
SpringerLink
Log in

Haut- und Schleimhautinfektionen bei Immunsuppression

Mucocutaneous infections in immunosuppression

  • Schwerpunkt: Dermatologie für Internisten
  • Published:
Der Internist Aims and scope Submit manuscript

An Erratum to this article was published on 05 September 2009

Zusammenfassung

Die Haut besitzt physikalische, chemische und immunologische Faktoren, um die inneren Organe zu schützen. Zusätzlich verhindert eine physiologische mikrobiologische Hautflora die Ausbreitung pathogener Keime. Eine konstitutionelle oder erworbene Immunsuppression zeigt Rückwirkungen auf diese Parameter. Erworbene Immunmangelsyndrome werden vorwiegend medikamentös verursacht, z. B. um eine Organabstoßung nach Transplantation zu vermeiden. Das HI-Virus führt unbehandelt ebenfalls meist zu einer ausgeprägten Abwehrschwäche. Patienten mit schwerer Immunsuppression zeigen nicht selten sehr atypische Manifestationen mukokutaner Infektionen, sodass die Indikation zur Biopsie mit gleichzeitiger Asservierung eines Gewebeteils für mikrobiologische Kulturen großzügig gestellt werden sollte. Neben akuten Infektionen sind auch Langzeitauswirkungen durch onkogene Viren zu berücksichtigen, wie z. B. Epitheliome durch HPV, Kaposi-Sarkome durch HHV8 und Lymphome durch EBV. Indikatordermatosen können auf das Vorliegen einer Immunschwäche hinweisen. So wird die orale Haarleukoplakie besonders bei AIDS-Patienten beobachtet, kann aber auch bei anderweitig verursachter Immundefizienz auftreten. Diese Übersicht beschreibt die Pathophysiologie der Hautschutzmechanismen und zeigt typische Infektionen der Haut und Schleimhaut, welche gehäuft bei Immunsuppression auftreten.

Abstract

The skin has several physical, chemical and immunological properties which help to protect the internal organs. In addition, there is a physiological colonisation of commensal microbes which help to suppress the expansion of pathogenic germs on the skin. Genetic or acquired immunodeficiency will have an impact to these factors. Drug induced immunodeficiency is common in organ transplanted patients with the aim to prevent organ rejection. HIV infection most commonly leads without therapy to marked immune suppression. Such patients with prolonged immunodeficiency often develop atypical manifestation of mucocutaneous infections. Therefore such patients should be biopsied liberally and besides the conventional histology a part of the biopsied tissue should be used for microbiological cultures. In addition to acute infections of the skin, long-term effects of oncogenic viruses have to be taken in account which can lead to epithelial cancers (HPV), Kaposi sarcomas (HHV8) and lymphomas (EBV). There are mucocutaneous markers for immunosuppression such as oral hairy leukoplakia, which are commonly seen in AIDS patients but may also be observed in otherwise chronically immune suppressed patients. This work gives an overview to the pathophysiology of skin protection and describes typical mucocutaneous infections in immune suppressed patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10

Literatur

  1. Aberg KM, Radek KA, Choi EH et al. (2007) Psychological stress downregulates epidermal antimicrobial peptide expression and increases severity of cutaneous infections in mice. J Clin Invest 117: 3339–3349

    Article  PubMed  CAS  Google Scholar 

  2. Baran R, Faergemann J, Hay RJ (2007) Superficial white onychomycosis – a syndrome with different fungal causes and paths of infection. J Am Acad Dermatol 57: 879–882

    Article  PubMed  Google Scholar 

  3. Beltraminelli H, Itin PH (2006) Human immunodeficiency virus and dermatology – a focus on special diseases and a review of the literature. G Ital Dermatol Venereol 141: 267–277

    Google Scholar 

  4. Castelnuovo B, Byakwaga H, Menten J et al. (2008) Can response of a pruritic papular eruption to antiretroviral therapy be used as a clinical parameter to monitor virological outcome? AIDS 22: 269–273

    PubMed  Google Scholar 

  5. Cathomas G, Tamm M, McGandy CE et al. (1997) Transplantation-associated malignancies. Restriction of human herpes virus 8 to kaposi’s sarcoma. Transplantation 64: 175–178

    Article  PubMed  CAS  Google Scholar 

  6. Chiller K, Selkin BA, Murakawa GJ (2001) Skin microflora and bacterial infections of the skin. J Invest Dermatol Symp Proc 6: 170–174

    Article  CAS  Google Scholar 

  7. Choi EH, Man MQ, Xu P et al. (2007) Stratum corneum acidification is impaired in moderately aged human and murine skin. J Invest Dermatol 127: 2847–2856

    Article  PubMed  CAS  Google Scholar 

  8. Heidary N, Naik H, Burgin S (2008) Chemotherapeutic agents and the skin: An update. J Am Acad Dermatol 58: 545–570

    Article  PubMed  Google Scholar 

  9. Hirsch HH, Kaufmann G, Sendi P, Battegay M (2004) Immune reconstitution in HIV-infected patients. Clin Infect Dis 38: 1159–1166

    Article  PubMed  Google Scholar 

  10. Hogg R, Lima V, Sterne JA Antiretroviral Therapy Cohort Collaboration (2008) Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 372: 293–299

    Article  Google Scholar 

  11. Itin PH (2000) Checkup der Haut – wer und wann? Therap Umschau 57: 22–25

    Article  CAS  Google Scholar 

  12. Itin PH, Frei R, Lautenschlager S et al. (1998) Cutaneous manifestations of paecilomyces lilainus infection induced by a contaminated skin lotion in patients who are severely immunosuppressed. J Am Acad Dermatol 39: 401–409

    Article  PubMed  CAS  Google Scholar 

  13. Kassiotis GOA, Kassiotis G, O’Garra A (2008) Immunology. Immunity benefits from a little suppression. Science 320: 1168–1169

    Article  PubMed  CAS  Google Scholar 

  14. Lee D, Benson CA, Lewis CE et al. (2007) Prevalence and factors associated with dry skin in HIV infection: the FRAM study. AIDS 21: 2051–2057

    Article  PubMed  Google Scholar 

  15. Schaub N, Gilli L, Rufli Th et al. (1996) Epidemiologie von Hauterkrankungen bei HIV-infizierten Patienten: eine prospektive Kohortenstudie. Schweiz Rundsch Med (PRAXIS) 85: 1162–1166

    Google Scholar 

  16. Segre JA (2006) Epidermal barrier formation and recovery in skin disorders. J Clin Invest 116: 1150–1158

    Article  PubMed  CAS  Google Scholar 

  17. Tominaga M, Ozawa S, Tengara S et al. (2007) Intraepidermal nerve fibers increase in dry skin of acetone-treated mice. J Dermatol Sci 48: 103–111

    Article  PubMed  CAS  Google Scholar 

  18. Ulrich C, Hackethal M, Meyer T et al. (2008) Skin infections in organ transplant recipients. J Dtsch Dermatol Ges 6: 98–105

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Dermatologie, Universitätsspital, Petersgraben 4, 4031, Basel, Deutschland

    P.H. Itin

  2. Klinik Infektiologie und Spitalhygiene, Universitätsspital, Basel, Schweiz

    M. Battegay

Authors
  1. P.H. Itin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Battegay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P.H. Itin.

Additional information

Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00108-009-2449-0 zu finden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Itin, P., Battegay, M. Haut- und Schleimhautinfektionen bei Immunsuppression. Internist 50, 150–159 (2009). https://doi.org/10.1007/s00108-008-2207-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-008-2207-8

Schlüsselworte

Keywords

Search

Navigation