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Pneumocystis-jirovecii-Pneumonie bei Patienten mit Autoimmunerkrankungen

Pneumocystis jirovecii pneumonia in patients with autoimmune diseases

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Zusammenfassung

Die Pneumocystis-jirovecii-Pneumonie spielt bei Patienten mit Autoimmunerkrankungen aufgrund der intensiveren immunsuppressiven Therapie eine zunehmende Rolle. Der Mensch ist wahrscheinlich das wichtigste Erregerreservoir. Erkrankungen entstehen wohl aerogen durch Neuinfektionen. Leitsymptome sind Husten, subfebrile Temperaturen und Belastungsdyspnoe. Neben der Bildgebung, insbesondere der hochauflösenden Computertomographie, spielt der Erregernachweis mittels Färbungen oder Molekulargenetik die entscheidende Rolle. Trimethoprim-Sulfamethoxazol (TMP-SMX) ist das wichtigste Medikament zur Therapie. Eine adjuvante Kortikosteroidtherapie wird z. T. empfohlen, der Nutzen ist bei rheumatologischen Patienten aber nicht gut belegt. Bei hochdosierter systemischer Kortikosteroidtherapie oder intensiver kombinierter Immunsuppression empfehlen viele Experten eine primäre Prophylaxe, Mittel der ersten Wahl bleibt auch hier TMP-SMX.

Abstract

Pneumocystis jirovecii pneumonia plays an increasing role in patients with autoimmune disorders, due to more intensive immunosuppressive therapy. Humans seem to be the most important pathogen reservoir. Diseases are probably caused by airborne new infections. Cough, subfebrile temperature and dyspnea on exertion are the leading symptoms. In addition to imaging, in particular high-resolution computed tomography, pathogen detection by staining methods or molecular genetic methods plays the decisive role. Trimethoprim and sulfamethoxazole (TMP-SMX) is the most important medication for treatment. Adjuvant corticosteroid treatment is sometimes recommended, but evidence for benefits in patients with rheumatological disorders is not well documented. For patients on high-dose systemic corticosteroid treatment or intensive combined immunosuppression, primary prophylaxis is recommended by many experts. TMP-SMX remains the first-choice preventive treatment in these patients.

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  1. Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstraße 68, 93093, Donaustauf, Deutschland

    S. Blaas

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B. Ehrenstein, Bad Abbach

U. Müller-Ladner, Bad Nauheim

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Blaas, S. Pneumocystis-jirovecii-Pneumonie bei Patienten mit Autoimmunerkrankungen. Z Rheumatol 76, 761–766 (2017). https://doi.org/10.1007/s00393-017-0390-5

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