Zusammenfassung
Durch nichttuberkulöse Mykobakterien ausgelöste, pulmonale Erkrankungen (pNTM) haben in den letzten Jahren und Jahrzehnten weltweit zugenommen. Da die Erkrankung bei Patienten mit Immunschwäche oder einer chronischen Lungenerkrankung (Bronchiektasen, fortgeschrittene chronisch obstruktive Lungenerkrankung [COPD], zystische Fibrose [CF]) häufiger ist, sollte bei diesen Patientengruppen an eine Infektion mit Mykobakterien gedacht werden. Der alleinige Nachweis im Sputum ist keine Therapieindikation, sondern die korrekte Diagnose sollte auf den entsprechenden klinischen Symptomen sowie radiologischen und mikrobiologischen Kriterien basieren. Häufig wird die Diagnose zu spät gestellt, da die Symptome unspezifisch sind. Die Therapie der pNTM-Erkrankung ist schwierig und langwierig. Aus diesem Grund wird sie häufig früher beendet. Auch die Adhärenz der behandelnden Ärzte zu den Guidelines ist auffallend niedrig. Vor einer Therapie sollte mit dem Patienten sorgfältig über Ziele und Nebenwirkungen gesprochen werden. Da es unter der Therapie zu unterschiedlichen Toxizitäten kommen kann, sollte diese engmaschig überwacht werden. Bei Infektionen durch seltene Erreger oder einem schweren Verlauf sollte Kontakt zu spezialisierten Zentren aufgenommen werden.
Abstract
Pulmonary diseases caused by nontuberculous mycobacteria (NTM) have increased over the last years and decades in Germany and also worldwide. Because the disease is more frequent in patients with immunodeficiencies and chronic respiratory diseases, e.g. bronchiectasis, advanced chronic obstructive lung disease (COPD) and cystic fibrosis (CF), an infection with mycobacteria should always be considered in this patient group. The detection in sputum alone is not an indication for treatment but the correct diagnosis should be based on the appropriate clinical symptoms as well as radiological and microbiological criteria. The diagnosis is often delayed because the symptoms are unspecific. The treatment of pulmonary NTM disease is difficult and tedious and for these reasons is often prematurely terminated. Adherence of treating physicians to the guidelines is also conspicuously low. Before starting treatment, it is important to carefully define the goals and clarify the risks and benefits of the treatment with the patient. As adverse toxic events can occur during treatment, it should be closely monitored. In the case of an infrequent pathogen or a severe course of the disease, referral to an NTM specialist center should be undertaken.
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J. Rademacher hat Honorare für Vorträge und Advisory-Board-Tätigkeit von Grifols, Insmed, OmniaMed und Bayer erhalten.
Dieser Beitrag beinhaltet keine von der Autorin durchgeführten Studien an Menschen oder Tieren.
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B. Salzberger, Regensburg
C.F. Vogelmeier, Marburg
T. Welte, Hannover
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Rademacher, J. Nichttuberkulöse Mykobakterien im Sputum. Internist 58, 1163–1170 (2017). https://doi.org/10.1007/s00108-017-0330-0
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DOI: https://doi.org/10.1007/s00108-017-0330-0
Schlüsselwörter
- Antibiotika
- Bronchiektasen
- Zystische Fibrose
- Chronisch obstruktive Lungenerkrankung
- Medikamententoxizität