Skip to main content
SpringerLink
Log in

Infektionen des ZNS beim immuninkompetenten Patienten

Infections of the central nervous system in the immuno-compromised

  • CME Weiterbildung • Zertifizierte Fortbildung
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Infektionen des zentralen Nervensystems (ZNS) werden von unterschiedlichen Erregern verursacht, je nachdem, ob eine unzureichende T-Zell- oder Monozytenfunktion [wie bei mit HIV (humanes Immundefizienzvirus) infizierten Patienten] oder eine supprimierte Zahl oder Funktion v. a. der Granulozyten vorliegen, wie sie typischerweise unter zytostatischer Therapie, nach einer Transplantation, bei Autoimmunerkrankungen usw. gesehen werden. Im 1. Teil werden die mit abnormer T-Zell- oder Monozytenfunktion assoziierten ZNS-Infektionen bei HIV, v. a. die zerebrale Toxoplasmose, ZNS-Kryptokokkose, Zytomegalievirusinfektion, progressive multifokale Leukenzephalopathie, detailliert in klinischer Symptomatik, Diagnostik sowie therapeutischem und prophylaktischem Management dargestellt. Im 2. Teil werden die mit einer Granulozytenfehlfunktion einhergehenden bzw. die bei absoluter Neutropenie gesehenen opportunistischen Infektionskrankheiten aus dem viralen, bakteriellen und pilzlichen Spektrum in Epidemiologie, klinischer Symptomatik, diagnostischem, therapeutischem und prophylaktischem Management detailliert vorgestellt.

Summary

Infections of the central nervous system (CNS) can be caused by a variety of pathogens, depending on whether the number and function of T-cells or monocytes are impaired (as in HIV patients) or whether the number and function of polymorphonuclear granulocytes are reduced or impaired, as typically seen in patients on immunosuppressive therapy, post transplantation, etc.. The first part of the chapter deals with CNS infections associated with reduced or abnormal T-cell (or monocytic) function and number, mainly seen in HIV patients, such as cerebral toxoplasmosis, CNS cryptococcosis, cytomegalovirus encephalitis, and progressive multifocal leukoencephalopathy. The clinical presentation, diagnostic procedures, as well as therapeutic and prophylactic management of these diseases are described in detail. The second part of the chapter deals with diseases usually seen in patients with impaired or reduced number and function of polymorphonuclear granulocytes. Such CNS infections are frequently caused by viral, bacterial, or fungal pathogens and are described in their clinical presentation, their diagnostic procedures and the best possible therapeutic and prophylactic management.

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

Abbreviations

Aids:

„acquired immuno deficiency syndrom“

CMV:

Zytomegalievirus

DNA:

Desoxyribonukleinsäure

EBV:

Epstein-Barr-Virus

FACS:

„fluorescence activated cell sorter“

HAART:

Hochaktive antiretrovirale Therapie

HHV:

Humanes Herpesvirus

HIV:

Humanes Immundefizienzvirus

Ig:

Immunglobulin

IRIS:

Immunrekonstitutionssyndrom

JC-Virus:

John-Cunningham-Virus

KBR:

Komplementbindungsreaktion

KG:

Körpergewicht

MDR:

„multidrug resistant“

PCR:

Polymerasekettenreaktion

PDLD:

Posttransplantationslymphoproliferative Erkrankung

PET:

Positronenemissionstomographie

PML:

Progressive multifokale Leukenzephalopathie

RT-PCR:

Reverse-Transkriptase-PCR

SMZ:

Sulfamethoxazol

TMP:

Trimethoprim

VCA:

Virales Kapsidantigen

VZV:

Varicella-Zoster-Virus

XDR:

„extended drug resistant“

ZNS:

Zentrales Nervensystem

Literatur

  1. Arendt G (2005) Neurologische Manifestationen der HIV-Infektion in der Ära der hochaktiven antiretroviralen Therapie (HAART). Fortschr Neurol Psychiatr 73: 1–10

    Article  Google Scholar 

  2. Arribas JR, Clifford DB, Fichtenbaum CJ et al. (1995) Detection of Epstein-Barr virus DNA in cerebrospinal fluid for diagnosis of AIDS-related central nervous system lymphoma. J Clin Microbiol 33: 1580–1583

    PubMed  CAS  Google Scholar 

  3. Arribas JR, Storch GA, Clifford DB et al. (1996) Cytomegalo-virus encephalitis. Ann Intern Med 125: 577–514

    PubMed  CAS  Google Scholar 

  4. Bartt R (2000) Listeria and atypical presentations of Listeria in the central nervous system. Semin Neurol 20: 361–374

    Article  PubMed  CAS  Google Scholar 

  5. Berger JR (2007) Progressive multifocal leukoencephalopathy. Curr Neurol Neurosci Rep 7: 461–469

    Article  PubMed  CAS  Google Scholar 

  6. Bhatt V, Saleem A (2004) Drug-induced neutropenia – pathophysiology, clinical features, and management. Ann Clin Lab Sci 34: 131–137

    PubMed  Google Scholar 

  7. Bjorklund A, Aschan J, Labopin M et al. (2007) Risk factors for fatal infectious complications developing late after allogeneic stem cell transplantation. Bone Marrow Transplant 40: 1055–1062

    Article  PubMed  CAS  Google Scholar 

  8. Black KE, Baden LR (2007) Fungal infections of the CNS: treatment strategies for the immunocompromised patients. CNS Drugs 21: 293–318

    Article  PubMed  CAS  Google Scholar 

  9. Brouwer AE, Rajanuwong A, Chierakul W et al. (2004) Combination antifungal therapies for HIV associated cryptococcal meningitis: a randomised trial. Lancet 363: 1764–1767

    Article  PubMed  CAS  Google Scholar 

  10. Chedid MB, Chedid MF, Porto NS et al. (2007) Nocardial infections: report of 22 cases. Rev Inst Med Trop Sao Paulo 49: 239–246

    PubMed  Google Scholar 

  11. Chuck SL, Sande MA (1989) Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. N Engl J Med 321: 794–799

    PubMed  CAS  Google Scholar 

  12. Clifford DB (2006) Neurological complications of HIV infection. In: Noseworthy JH (ed) Neurological therapeutics – principles and practice, 2nd edn. Informa Health Care, Abingdon, Oxon, pp 1060–1073

  13. Cole PD, Stiles J, Boulad F et al. (1998) Successful treatment of human herpesvirus 6 encephalitis in a bone marrow transplant recipient. Clin Infect 27: 653–654

    Article  CAS  Google Scholar 

  14. Dannemann B, McCutchan JA, Israelski D et al. (1992) Treatment of toxoplasmic encephalitis in patients with AIDS – a randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfadiazine. Ann Intern Med 116: 33–34

    PubMed  CAS  Google Scholar 

  15. Denning DW (1998) Invasive aspergillosis. Clin Infect Dis 26: 781–805

    Article  PubMed  CAS  Google Scholar 

  16. Drake AK, Loy CT, Brew BJ et al. (2007) Human immunodeficiency virus-associated progressive multifocal leucoencephalopathy: epidemiology and predictive factors for prolonged survival. Eur J Neurol 14: 418–423

    Article  PubMed  CAS  Google Scholar 

  17. Foerster BR, Thurnher MM, Malani PN et al. (2007) Intracranial infections: clinical and imaging characteristics. Acta Radiol 48: 875–893

    Article  PubMed  CAS  Google Scholar 

  18. Furrer H, Fux C (2002) Opportunistic infections: an update. J HIV Ther 7: 2–7

    PubMed  Google Scholar 

  19. Hoffman JM, Waskin HA, Schifter T et al. (1993) FDG-PET in differentiating lymphoma from nonmalignant central nervous system lesion in patients with AIDS. J Nucl Med 35: 268–269

    Google Scholar 

  20. Hovens MM, Vaessen N, Sijpkens YW et al. (2007) Unusual presentation of central nervous system manifestations of varicella zoster virus vasculopathy in renal transplant recipients. Transpl Infect Dis 9: 237–240

    Article  PubMed  CAS  Google Scholar 

  21. Jarvis JN, Harrison TS (2007) HIV-associated cryptococcal meningitis. AIDS 21: 2119–2129

    PubMed  Google Scholar 

  22. Kloska SP, Husstedt IW, Schlegel PM et al. (2008) Magnetresonanztomografische Befunde des Gehirns bei adulten Patienten mit HIV und AIDS. Fortschr Röntgenstr 180: 21–29

    Article  CAS  Google Scholar 

  23. Komaroff AL, Jacobson S, Ablashi DV et al. (2006) Highlights from 5th International Conference on HHV-6 and -7. Herpes 13: 81–82

    PubMed  Google Scholar 

  24. Luft BJ, Remington JS (1992) Toxoplasmic encephalitis in AIDS. Clin Infect Dis 15: 211–222

    PubMed  CAS  Google Scholar 

  25. Manischewitz JF, Quinnan GV, Lane HC et al. (1990) Synergistic effect of ganciclovir and foscarnet on cytomegalovirus replication in vitro. Antimicrob Agents Chemother 34: 373–375

    PubMed  CAS  Google Scholar 

  26. Mizuno S, Zendejas IR, Reed AI et al. (2007) Listeria monocytogenes following orthotopic liver transplantation: central nervous system involvement and review of the literature. World J Gastroenterol 13: 4391–4393

    PubMed  Google Scholar 

  27. Murdoch DM, Venter WD, Feldman C et al. (2008) Incidence and risk factors for the immune reconstitution inflammatory syndrome in HIV patients in South Africa: a prospective study. AIDS 22: 601–610

    Article  PubMed  CAS  Google Scholar 

  28. Noguchi T, Mihara F, Yoshiura T et al. (2006) MR imaging of human herpesvirus-6 encephalopathy after hematopoietic stem cell transplantation in adults. AJNR Am J Neuroradiol 27: 2191–2195

    PubMed  CAS  Google Scholar 

  29. Patchell RA (2005) Neurological complications of organ transplantation. Ann Neurol 36: 688–703

    Article  Google Scholar 

  30. Roos KL (2006) Infection in solid organ and bone marrow transplant recipients. In: Noseworthy JH (ed) Neurological therapeutics – principles and practice, 2nd edn. Informa Health Care, Abingdon, Oxon, pp 1185–1195

  31. Ruhnke M, Kofla G, Otto K et al. (2007) CNS aspergillosis: recognition, diagnosis and management. CNS Drugs 21: 659–67

    Article  PubMed  CAS  Google Scholar 

  32. Sabatelli F, Patel R, Mann PA et al. (2006) In vitro activities of posaconazole, fluconazole, itraconazole, voriconazole, and amphotericin B against a large collection of clinically important molds and yeasts. Antimicrob Agents Chemother 50: 2009–2015

    Article  PubMed  CAS  Google Scholar 

  33. Sacktor N, Lyles RH, Skolasky R et al. (2001) HIV associated neurologic disease incidence changes: Multicenter AIDS Cohort Study 1990–1998. Neurology 56: 257–260

    PubMed  CAS  Google Scholar 

  34. Sarmiento E, Rodríguez-Hernàndez C, Rodríguez-Molina J et al. (2006) Impaired anti-pneumococcal polysaccharide antibody production and invasive pneumococcal infection following heart transplantation. Int Immunopharmacol 6: 2027–2030

    Article  PubMed  CAS  Google Scholar 

  35. Shelburne SA 3rd, Montes M, Hamill RJ (2006) Immune reconstitution inflammatory syndrome: more answers more questions. J Antimicrob Chemother 57: 167–170

    Article  PubMed  CAS  Google Scholar 

  36. Singh N, Bonham A, Fukui M (2000) Immunosuppressive associated leukoencephalopathy in organ transplant recipients. Transplantation 69: 467–472

    Article  PubMed  CAS  Google Scholar 

  37. Singh N, Alexander BD, Lortholary O et al. (2008) Pulmonary cryptococcosis in solid organ transplant recipients: clinical relevance of serum cryptococcal antigen. Clin Infect Dis 15: 12–18

    Article  Google Scholar 

  38. Srinivasan A, Burton EC, Kuehnert MJ et al. (2005) Transmission of rabies virus from an organ donor to four transplant recipients. N Engl J Med 352: 1103–1111

    Article  PubMed  CAS  Google Scholar 

  39. Van de Beek D, Patell R, Daly RC et al. (2007) Central nervous system infections in heart transplant recipients. Arch Neurol 64: 1715–1720

    Article  Google Scholar 

  40. Van de Beek D, Kremers WK, Del Pozo JL et al. (2008) Effect of infectious diseases on outcome after heart transplant. Mayo Clin Proc 83: 304–308

    Article  Google Scholar 

  41. Waruiru C, Slatter MA, Taylor C et al. (2007) Outcome of hematopoietic stem cell transplantation in severe combined immune deficiency with central nervous system viral infection. Pediatr Infect Dis 26: 129–133

    Article  Google Scholar 

  42. Zerr DM (2006) Human herpesvirus 6 and central nervous system disease in hematopoietic cell transplantation. J Clin Virol 37: 52–56

    Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Neurologische Intensivstation, Universitätsklinik für Neurologie, Anichstraße 35, 6020, Innsbruck, Österreich

    E. Schmutzhard & B. Pfausler

Authors
  1. E. Schmutzhard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Pfausler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Schmutzhard.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmutzhard, E., Pfausler, B. Infektionen des ZNS beim immuninkompetenten Patienten. Nervenarzt 79 (Suppl 2), 93–111 (2008). https://doi.org/10.1007/s00115-008-2462-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-008-2462-x

Schlüsselwörter

Keywords

Search

Navigation