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Molekularpathologische Diagnostik von Gelenkinfektionen

Applications of molecular pathology in the diagnosis of joint infections

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Zusammenfassung

Die Diagnostik von Infektionen bei Patienten mit Arthritis und/oder Gelenkprothesen erfordert eine interdisziplinäre Zusammenarbeit unter Einsatz modernster Methoden. Massive bakterielle Gelenkinfektionen können mittels Kultur diagnostiziert werden. Die molekularpathologische Diagnostik ermöglicht die Detektion von Low-grade-Infektionen nach spezifischer Anreicherung bakterieller und fungaler DNA, Amplifizierung und Identifizierung der Erreger-DNA durch Gelelektrophorese, Sequenzierung oder Chiptechnologien.

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 eine Detektion der Erreger-DNA oder -RNA in der Synovialflüssigkeit oder im Gewebe. Von besonderem Interesse ist die molekularpathologische Differenzialdiagnose granulomatöser Synovialitiden innerhalb kürzester Zeit ohne vorausgehende Bakterienkultur. Die Weiterentwicklung molekularbiologischer Techniken zur Detektion bakterieller und fungaler DNA- und RNA-Spezies im Gewebe wird die Sensitivität und Geschwindigkeit der Infektionsdiagnostik weiter erhöhen.

Abstract

The diagnosis of infections in patients with arthritis and/or joint prostheses requires interdisciplinary cooperation and the use of up-to-date methods. Massive bacterial infection can be identified by bacterial culture, and minimal infection can be detected by molecular pathological methods. These processes include specific enrichment of bacterial and fungal DNA, amplification, and identification of the DNA by gel electrophoresis, sequencing techniques, and chip technologies.

Anamnesis (enteral or urogenital infection), the 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 detection of bacterial DNA or RNA in synovial fluid or tissue. Molecular pathological methods allow the fast and reliable differential diagnosis of granulomatous synovialitis without prior cultivation of bacteria or fungi. The development of new molecular pathological methods for detecting bacterial and fungal nucleic acids will increase diagnostic accuracy.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Die Molekularpathologie Trier (Prof. Dr. Dr. Kriegsmann, PD Dr. Otto, Dr. Arens) ist Referenzlabor der SIRS-Lab, Jena. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Straße 18+20, 54296 , Trier, Deutschland

    J. Kriegsmann, V. Krenn, M. Kriegsmann & M. Otto

  2. Molekularpathologie, Trier, Deutschland

    J. Kriegsmann, N. Arens & M. Otto

  3. Abteilung Orthopädie, Krankenhaus der Barmherzigen Brüder, Trier, Deutschland

    T. Hopf & D. Jacobs

  4. Arcus Sportklinik, Pforzheim, Deutschland

    R. Schmitt-Wiedhoff & C. Heisel

  5. Abteilung Orthopädie, Diakonie-Krankenhaus, Bad Kreuznach, Deutschland

    C. Biehl & H. Thabe

  6. SIRS-Lab, Jena, Deutschland

    R.P.H. Schmitz & M. Lehmann

Authors
  1. J. Kriegsmann
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  2. T. Hopf
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  3. D. Jacobs
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  4. N. Arens
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  5. V. Krenn
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  6. R. Schmitt-Wiedhoff
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  7. M. Kriegsmann
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  8. C. Heisel
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  9. C. Biehl
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  10. H. Thabe
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  11. R.P.H. Schmitz
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  12. M. Lehmann
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  13. M. Otto
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Corresponding author

Correspondence to J. Kriegsmann.

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Kriegsmann, J., Hopf, T., Jacobs, D. et al. Molekularpathologische Diagnostik von Gelenkinfektionen. Orthopäde 38, 531–538 (2009). https://doi.org/10.1007/s00132-008-1394-2

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  • DOI: https://doi.org/10.1007/s00132-008-1394-2

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