DGI:ZNS-Infektionen/Hirnabszess/Erreger: Difference between revisions

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==<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Erreger</span>==
 
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Der Hirnabszess ist häufig eine Infektion mit aeroben und anaeroben Erregern in einer Mischinfektion. Mit Einsetzen der PCR als Diagnosemittel wurde in bis zu 40% der Fälle eine Mischinfektion diagnostiziert, wobei mindestens 1 Erreger als Anaerobier nachzuweisen war <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">[19</span></span><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">, 26</span></span><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">]</span></span><ref name=":0"><span style="color: #333333">19. <span style="box-sizing: inherit">       </span> Darlow CA, et al., Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius. </span>J Infect, 2020; '''80'''(6): 623-629</ref><ref><span style="color: #333333">26. <span style="box-sizing: inherit">       </span> Sonneville R, et al., An update on bacterial brain abscess in immunocompetent patients''.'' Clin Microbiol Infect, 2017; '''23'''(9): 614-620</span></ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">.</span>
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Der Hirnabszess ist häufig eine Infektion mit aeroben und anaeroben Erregern in einer Mischinfektion. Mit Einsetzen der PCR als Diagnosemittel wurde in bis zu 40% der Fälle eine Mischinfektion diagnostiziert, wobei mindestens 1 Erreger als Anaerobier nachzuweisen war <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><ref name=":0">Darlow CA et al. Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius. J Infect 2020; 80(6): p. 623-629.</ref><ref>Sonneville R et al. An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect 2017; 23(9): p. 614-620.</ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">.</span>
{| class="wikitable sortable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: &quot;Open Sans&quot;, Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; border: none;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: \&quot;Open Sans\&quot;, Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; border: none;&quot;}"
 
{| class="wikitable "
|+
|+
! style="width:226.4pt;" class="col-grey-light-bg" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">'''Bakterielle Erre<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">ger</span>'''</span>
|+<span id="Tabelle 4: Erregerspektrum Hirnabszess">Tabelle 4: Erregerspektrum Hirnabszess</span>
! style="width:226.4pt;" class="col-grey-light-bg" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Häufigkeit'''</span>
!Bakterielle Erreger
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
!Häufigkeit
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Streptokokken</span>
|-  
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">30-50%</span>
|Steptokokken
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
|30-50%
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Staphylococcus aureus</span>
|-
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">10-15%</span>
|Staphylococcus aureus
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
|10-15%
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">KNS</span>
|-
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">5-10%</span>
|KNS
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
|5-10%
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Anaerobier</span>
|-
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">15-40%</span>
|Anaerobier
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
|15-40%
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Gram-negative Aerobier</span>
|-
| style="width:226.4pt;" width="302" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:226.4pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">15-30%</span>
|Gram-negative Aerobier
|15-30%
|-
|}
|}
<span class="ve-pasteProtect" style="color: rgb(32, 33, 36)" data-ve-attributes="{&quot;style&quot;:&quot;color: rgb(32, 33, 36)&quot;}">KNS = Koagulase negative Staphylokokken</span>
<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Tabelle 4: Erregerspektrum Hirnabszess</span>




<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Bei Patienten mit einer Immunsuppression sollte man zusätzlich an Nokardien, Actinomyceten und Pilze (Aspergillus spp, Candida spp, Cryptococcus neoformans, Mucorales) denken.</span>
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Bei Patient:innen mit einer Immunsuppression sollte man zusätzlich an Nokardien, Actinomyceten und Pilze (''Aspergillus'' spp, ''Candida'' spp, ''Cryptococcus neoformans'', ''Mucorales'') denken.</span>


<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Scedosporium apiospermum ist nach Beinahe-Ertrinken sowie bei Immunsupprimierten ein möglicher kausaler Erreger. Bei entsprechender Reise- oder Expositionsanamnese sind auch Protozoen (Entamoeba histolytica, Baylisascaris procyonis, Toxoplasma gondii) und Würmer (Schistosoma spp., Echinococcus spp., Taenia solium, Paragonimus spp.) in Betracht zu ziehen <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">[19</span></span><ref name=":0" /><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">, 22</span></span><ref><span style="color: #333333">22. <span style="box-sizing: inherit">       </span> Brouwer MC, et al., Brain abscess. N Engl J Med, 2014; '''371'''(5): 447-56</span></ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">, 27</span></span><ref><span style="color: #333333">27. <span style="box-sizing: inherit">       </span> Sharma R, Mohandas K, and Cooke RP, ''I''ntracranial abscesses: changes in epidemiology and management over five decades in Merseyside''.'' Infection, 2009; '''37'''(1): 39-43</span></ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">]</span>.</span>
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">''Scedosporium apiospermum'' ist nach Beinahe-Ertrinken sowie bei Immunsupprimierten ein möglicher kausaler Erreger. Bei entsprechender Reise- oder Expositionsanamnese sind auch Protozoen ''(Entamoeba histolytica'', ''Baylisascaris procyonis'', ''Toxoplasma gondii'') und Würmer (''Schistosoma'' spp., ''Echinococcus'' spp., ''Taenia solium'', ''Paragonimus'' spp.) in Betracht zu ziehen </span><ref name=":0" /><ref>Brouwer MC et al. Brain abscess. N Engl J Med 2014; 371(5): p. 447-56.</ref><ref>Sharma R et al. Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection 2009; 37(1): p. 39-43.</ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">.</span>
<br />
<br /><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span>
<references />

Latest revision as of 20:04, 9 August 2021

Der Hirnabszess ist häufig eine Infektion mit aeroben und anaeroben Erregern in einer Mischinfektion. Mit Einsetzen der PCR als Diagnosemittel wurde in bis zu 40% der Fälle eine Mischinfektion diagnostiziert, wobei mindestens 1 Erreger als Anaerobier nachzuweisen war [1][2].

Tabelle 4: Erregerspektrum Hirnabszess
Bakterielle Erreger Häufigkeit
Steptokokken 30-50%
Staphylococcus aureus 10-15%
KNS 5-10%
Anaerobier 15-40%
Gram-negative Aerobier 15-30%


Bei Patient:innen mit einer Immunsuppression sollte man zusätzlich an Nokardien, Actinomyceten und Pilze (Aspergillus spp, Candida spp, Cryptococcus neoformans, Mucorales) denken.

Scedosporium apiospermum ist nach Beinahe-Ertrinken sowie bei Immunsupprimierten ein möglicher kausaler Erreger. Bei entsprechender Reise- oder Expositionsanamnese sind auch Protozoen (Entamoeba histolytica, Baylisascaris procyonis, Toxoplasma gondii) und Würmer (Schistosoma spp., Echinococcus spp., Taenia solium, Paragonimus spp.) in Betracht zu ziehen [1][3][4].

  1. ↑ 1.0 1.1 Darlow CA et al. Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius. J Infect 2020; 80(6): p. 623-629.
  2. ↑ Sonneville R et al. An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect 2017; 23(9): p. 614-620.
  3. ↑ Brouwer MC et al. Brain abscess. N Engl J Med 2014; 371(5): p. 447-56.
  4. ↑ Sharma R et al. Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection 2009; 37(1): p. 39-43.
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