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Pneumonien bei Immunsuppression

Pneumonias and immunosuppression

  • Schwerpunkt: Lunge und Infektion
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Zusammenfassung

Pneumonien bei immundefizienten Patienten sind häufige, lebensbedrohliche Komplikationen. Eine rasche, zielgerichtete Diagnostik und Therapie sind für den Krankheitsverlauf entscheidend. Das ätiologische Spektrum ist deutlich breiter als bei immunkompetenten Patienten. Wichtige Hinweise liefern Art und Intensität der Immunsuppression, Lücken im Prophylaxekonzept sowie besondere Expositionen. Zur Planung des diagnostischen Vorgehens ist häufig ein hoch auflösendes Computertomogramm des Thorax erforderlich. Standardmethode zur Erregergewinnung ist die flexible Bronchoskopie mit bronchoalveolärer Lavage. Die Indikation für invasivere bioptische Maßnahmen ist individuell zu stellen und hängt vom erwarteten Erregerspektrum sowie von Risikofaktoren und Kontraindikationen des Patienten ab. Nichtinvasive Antigen- und PCR-Tests ergänzen das diagnostische Spektrum, insbesondere für schwer anzüchtbare Erreger wie Schimmelpilze und Herpesviren. Die Wahl der initialen, kalkulierten antimikrobiellen Therapie erfolgt leitliniengestützt und sollte nach Erhalt mikrobiologischer Daten möglichst fokussiert weitergeführt werden.

Abstract

Pneumonias are common, life threatening complications in immunodeficient patients. A rapid, targeted diagnosis and therapy are decisive for the course of the disease. The etiological spectrum is substantially broader than for immunocompetent patients. Important indications are provided by the type and intensity of the immunosuppression, gaps in the prophylactic concept and particular exposures. For diagnostic planning, high resolution computed tomogram of the thorax is necessary. The standard method for isolating the pathogen is flexible bronchoscopy with bronchoalveolar lavage. Indications for invasive bioptic measures depend on the individual situation, the expected spectrum of pathogens as well as risk factors and adverse effects. Non-invasive antigen and PCR tests complement the diagnostic spectrum, especially for difficult to cultivate pathogens such as fungi and Herpes viruses. The selection of the initial, targeted antimicrobial therapy is based on guidelines. The treatment should be followed after obtaining the relevant microbiological data.

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Authors and Affiliations

  1. Medizinische Klinik III, Pulmologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    K. Dalhoff

  2. Medizinische Klinik I, Hämatologie/Onkologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    J. Marxsen

  3. Medizinische Klinik I, Nephrologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    J. Steinhoff

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Correspondence to K. Dalhoff.

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Dalhoff, K., Marxsen, J. & Steinhoff, J. Pneumonien bei Immunsuppression. Internist 48, 507–518 (2007). https://doi.org/10.1007/s00108-007-1838-5

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