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Molekularpathologische Infektionsdiagnostik in der orthopädischen Pathologie

Molecular pathological diagnostics of infections in orthopedic pathology

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Zusammenfassung

Die Infektionsdiagnostik bei Patienten mit Arthritis und/oder Gelenkprothesen erfordert eine interdisziplinäre Zusammenarbeit unter Einsatz modernster Methoden. Die histologische Untersuchung der Synovialmembran ermöglicht die Einteilung in akute, chronische und granulomatöse Synovialitiden. Die Anwendung der Polymerasekettenreaktion (PCR), welche auf die Detektion konservierter Regionen des mikrobiellen Genoms zielt, speziell 16S rRNA für Bakterien und 18S rRNA für Pilze, ist ein breiter Ansatz, um nichtkultivierbare Pathogene bei Infektionen schnell nachzuweisen. Infektiöse Arthritiden und periprothetische Infektionen teilen das Erregerspektrum mit der Sepsis. Deshalb können auch multiplex-PCR-basierte Sepsistests eingesetzt werden.

Die molekulare Diagnostik minimaler Infektionen in periprothetischen Geweben ist auch nach Antibiotikatherapie möglich. Reaktive Arthritiden können unter Kenntnis der Anamnese (enterale oder urogenitale Infektion), Klinik (Oligoarthritis) und weiterer Parameter (HLA-B27 etc.) von anderen Arthritiden abgegrenzt werden. Molekulare Methoden erlauben in zahlreichen Fällen den Nachweis der Erreger-DNA oder RNA in der Synovia/Synovialis. Die geringe Sensitivität histochemischer Verfahren bei der Differenzialdiagnose granulomatöser Synovialitiden kann durch die Anwendung der PCR kompensiert werden, speziell bei mykobakteriellen Infektionen. Molekulare Methoden in der Infektionsdiagnostik von Arthritiden können sowohl bei septischen als auch reaktiven Arthritiden eingesetzt werden. MicroRNA-Techniken kombiniert mit molekularer Keimdetektion können zur Unterscheidung der rheumatoiden Arthritis mit einer hohen entzündlichen Aktivität infektiöser Arthritiden beitragen. Proteomische Methoden könnten das Spektrum der molekularen Infektionsdiagnostik zukünftig ergänzen.

Abstract

The diagnosis of infections in patients with arthritis and/or in joint prostheses requires interdisciplinary cooperation and the application of up-to-date methods. The histological investigation of the synovial membrane allows the differentiation of acute, chronic and granulomatous synovialitis. Detection of conserved regions of the microbial genome by PCR, especially 16S rRNA for bacteria and 18S rRNA for fungi, is a broad approach for the classification of pathogens which cannot be cultured. Acute infectious arthritis and periprosthetic infections share the spectrum of pathogens with sepsis, therefore multiplex PCR-based methods for the detection of sepsis can be employed. Molecular diagnostics can detect minimal infections in periprosthetic tissues even after antibiotic therapy. The anamnesis (enteral or urogenital infection), clinical picture (oligoarthritis) and further parameters (e.g. HLA B27 status) are important for the diagnosis of reactive arthritis. In many cases of reactive arthritis, molecular methods allow the detection of bacterial DNA or RNA in synovial fluid or tissue samples. The low sensitivity of histopathological methods may be compensated by application of PCR techniques, especially in the differential diagnosis of granulomatous synovitis including mycobacterial infections. Molecular methods can be used to support the differential diagnosis of septic and reactive arthritis. MicroRNA techniques combined with PCR for detection of pathogens support the differential diagnosis of rheumatoid arthritis with severe inflammatory activity compared to infectious arthritis. Proteomic methods could expand the methodological spectrum for the diagnosis of infections.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Kriegsmann und R. Casadonte weisen auf folgende Beziehung hin: Technische Unterstützung von Bruker Daltonik GmbH. N. Arens, C. Altmann, M. Kriegsmann, M. Otto geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Medizinisches Versorgungszentrum für Histologie, Zytologie und molekulare Diagnostik, Max-Planck-Str. 5, 54296, Trier, Deutschland

    J. Kriegsmann & M. Otto

  2. Molekularpathologie, Trier, Deutschland

    J. Kriegsmann, N. Arens, C. Altmann & M. Otto

  3. Proteopath GmbH, Trier, Deutschland

    J. Kriegsmann & R. Casadonte

  4. Institut für Pathologie, Universität Heidelberg, Heidelberg, Deutschland

    M. Kriegsmann

Authors
  1. J. Kriegsmann
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  2. N. Arens
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  3. C. Altmann
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  4. M. Kriegsmann
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  5. R. Casadonte
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  6. M. Otto
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Correspondence to J. Kriegsmann.

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Kriegsmann, J., Arens, N., Altmann, C. et al. Molekularpathologische Infektionsdiagnostik in der orthopädischen Pathologie. Pathologe 35 (Suppl 2), 225–231 (2014). https://doi.org/10.1007/s00292-014-1983-2

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  • DOI: https://doi.org/10.1007/s00292-014-1983-2

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