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Der Internist

, Volume 58, Issue 11, pp 1150–1162 | Cite as

Aspergillus-Nachweis im Atemwegsmaterial

Ignorieren oder behandeln?
  • H. J. F. SalzerEmail author
  • C. Lange
  • M. Hönigl
Schwerpunkt: Chronische Atemwegsinfektionen

Zusammenfassung

Schimmelpilze der Gattung Aspergillus sind ubiquitär verbreitet. Obwohl Aspergillus-Sporen von Menschen unter natürlichen Bedingungen täglich eingeatmet werden, treten Aspergillus-assoziierte Erkrankungen nur unter bestimmten Bedingungen auf. Maßgeblich dafür, welche Aspergillus-assoziierte Erkrankung entsteht, ist die Konstitution des Wirts. Neben allergischen Krankheitsbildern, wie der exogen allergischen Aspergillose (EAA), treten allergisch-infektiöse Erkrankungen auf, wie die allergische bronchopulmonale Aspergillose (ABPA) oder die bronchozentrische Granulomatose, und auch infektiöse Erkrankungen, wie die invasive (IA), die semiinvasive (SIA) und die chronische pulmonale Aspergillose (CPA). Der alleinige Nachweis von Aspergillus spp. in Sputum oder Bronchialsekret ist für die Diagnose einer Aspergillus-assoziierten Erkrankung nicht ausschlaggebend. Für die assoziierten Infektionskrankheiten ist der kulturelle oder histopathologische Nachweis von Aspergillus in Lungengewebe ausschlaggebend. Häufiger beruht die Einleitung einer Therapie aber auf einer Verdachtsdiagnose, die durch den Nachweis von Aspergillus-spezifischem IgG-Antikörpern im Blut oder von Galaktomannan-Antigen aus der bronchoalveolären Lavage gestellt wurde. Akute invasive oder semiinvasive Infektionen haben eine hohe Letalität und bedürfen einer raschen medikamentösen Therapie. Die CPA ist allein medikamentös praktisch nicht heilbar, durch eine antimykotische medikamentöse Therapie kann sie in Remission gebracht werden. Eine Eradikation der CPA gelingt i.d.R. nur durch ein kombiniertes antimykotisches/chirurgisches Vorgehen.

Schlüsselwörter

Chronische pulmonale Aspergillose  Invasive pulmonale Aspergillose Sputum Galaktomannan Bronchoalveoläre Lavage 

Aspergillus in airway material

Ignore or treat?

Abstract

Fungi of the genus Aspergillus are ubiquitously present. Even though humans inhale Aspergillus spores daily under natural conditions, Aspergillus-associated pulmonary diseases only occur under special circumstances. Whether an Aspergillus-associated disease develops and which type of Aspergillus-associated disease develops depends on the constitution of the host. The spectrum of Aspergillus-associated pulmonary diseases ranges from allergic diseases, such as hypersensitivity pneumonitis to allergic infectious diseases, such as allergic bronchopulmonary aspergillosis (ABPA) and bronchocentric granulomatosis (BG) to infectious diseases, such as invasive (IA) or semi-invasive aspergillosis (SIA) and chronic pulmonary aspergillosis (CPA). Identification of Aspergillus spp. from sputum or bronchopulmonary secretions is not sufficient for a definitive diagnosis of Aspergillus-associated infections. The gold standard is the identification of Aspergillus spp. from lung tissue by culture or by histopathological methods; however, in clinical practice the decision to initiate antifungal therapy is more often based on immunological methods, such as the detection of Aspergillus-specific IgG antibodies from peripheral blood or galactomannan antigens from bronchoalveolar lavages. Acute IA or SIA infections have a high mortality and require immediate antifungal therapy. With rare exceptions CPA cannot be cured by medicinal therapy alone; however, active CPA can be brought into remission with antifungal therapy. Eradication of Aspergillus in CPA can as a rule only be successful using a combined antimycotic and surgical intervention.

Keywords

Chronic pulmonary aspergillosis  Invasive pulmonary aspergillosis Sputum Galactomannan Bronchoalveolar lavage 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

H. Salzer gibt an, dass er eine Forschungsförderung der Firma Gilead erhalten hat sowie Referentenhonorare der Firma Chiesi. C. Lange gibt an, dass er Referentenhonorare der Firmen Chiesi, Gilead, Abbvie, MSD, Becton Dickinson, Janssen, Astra Zeneca, und Lucane erhalten hat. M. Hönigl gibt, dass er eine Forschungsförderung der Firma Gilead erhalten hat sowie der Firmen MSD, Gilead und Basilea.

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

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© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • H. J. F. Salzer
    • 1
    • 2
    Email author
  • C. Lange
    • 1
    • 2
    • 3
    • 4
  • M. Hönigl
    • 5
    • 6
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  1. 1.Klinische Infektiologie, Medizinische Klinik, Forschungszentrum BorstelLeibniz-Zentrum für Medizin und BiowissenschaftenBorstelDeutschland
  2. 2.Hamburg – Borstel – Lübeck – Riems DZIF-StandortDeutsches Zentrum für Infektionsforschung (DZIF)BorstelDeutschland
  3. 3.International Health and Infectious DiseasesUniversität zu LübeckLübeckDeutschland
  4. 4.Department of MedicineKarolinska InstituteStockholmSchweden
  5. 5.Klinische Abteilung für PulmonologieMedizinische Universität GrazGrazÖsterreich
  6. 6.Sektion für Infektionserkrankungen und TropenmedizinMedizinische Universität GrazGrazÖsterreich
  7. 7.Division of Infectious Diseases, Department of MedicineUniversity of California – San DiegoSan DiegoUSA
  8. 8.CBmed – Center for Biomarker Research in MedicineGrazÖsterreich

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