Zusammenfassung
Parasitäre Erkrankungen des Nervensystems sind weltweit verbreitet; sie kommen in kontinentalen oder regionalen Schwerpunkten vor. In Zeiten der Globalisierung der Medizin, Migration und Tourismus sind sie ein wesentlicher Faktor auch in der mitteleuropäischen Neurologie. Eine erhebliche Zahl von Protozoen und Helminthen invadieren direkt das zentrale Nervensystem, sie können aber auch über indirekte Mechanismen (z. B. Mikrozirkulationsstörung, Inflammation, intrakranielle Blutung, raumfordernder Effekt von Granulomen oder Zysten) neurologische Symptome verursachen. Die Kenntnis der klinischen Symptomatik bei entsprechender Expositionsanamnese, insbesondere auch das Wissen um die Zusammenhänge zwischen immunsuppressiven Therapiestrategien und dem Auftreten von parasitären ZNS-Erkrankungen (z. B. Toxoplasma gondii, Strongyloides stercoralis) ermöglicht die in diesen Fällen oft lebensnotwendige frühestmögliche Diagnose und Einleitung einer spezifischen Therapie. In den letzten Jahren haben sich sowohl im spezifischen antihelminthischen bzw. antiprotozoalen Management wesentliche Neuerungen ergeben, aber auch adjuvante therapeutische Strategien konnten im letzten Jahrzehnt zur Verbesserung von Mortalität und Morbidität von ZNS-Parasitosen beitragen.
In dieser Zusammenfassung werden, überwiegend tabellarisch, alle wesentlichen parasitären Erkrankungen (Protozoen und Helminthen) des ZNS dargestellt, ihre Epidemiologie, Diagnostik, klinische Symptomatik und Therapie aufgelistet und adjuvante therapeutische Strategien diskutiert.
Summary
Central nervous system infections and infestations by protozoa and helminths constitute a problem of increasing importance throughout all of central European and northern/western countries. This is partially due to the globalisation of our society, tourists and business people being more frequently exposed to parasitic infection/infestation in tropical countries than in moderate climate countries. On top of that, migrants may import chronic infestations and infections with parasitic pathogens, eventually also – sometimes exclusively – involving the nervous system. Knowledge of epidemiology, initial clinical signs and symptoms, diagnostic procedures as well as specific chemotherapeutic therapies and adjunctive therapeutic strategies is of utmost important in all of these infections and infestations of the nervous systems, be it by protozoa or helminths. This review lists, mainly in the form of tables, all possible infections and infestations of the nervous systems by protozoa and by helminths. Besides differentiating parasitic diseases of the nervous system seen in migrants, tourists etc., it is very important to have in mind that disease-related (e.g. HIV) or iatrogenic immunosuppression has led to the increased occurrence of a wide variety of parasitic infections and infestations of the nervous system (e. g. babesiosis, Chagas disease, Strongyloides stercoralis infestation, toxoplasmosis, etc.).
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Schmutzhard, E. Parasitäre Erkrankungen des Nervensystems. Nervenarzt 81, 162–171 (2010). https://doi.org/10.1007/s00115-009-2853-7
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DOI: https://doi.org/10.1007/s00115-009-2853-7