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;}">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;}"></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"><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"><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>+
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{| 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: 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>




Revision as of 10:05, 17 June 2021

Erreger

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%

KNS = Koagulase negative Staphylokokken


Bei Patienten 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 19.         Darlow CA, et al., Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius. J Infect, 2020; 80(6): 623-629
  2. ↑ 26.         Sonneville R, et al., An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect, 2017; 23(9): 614-620
  3. ↑ 22.         Brouwer MC, et al., Brain abscess. N Engl J Med, 2014; 371(5): 447-56
  4. ↑ 27.         Sharma R, Mohandas K, and Cooke RP, Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection, 2009; 37(1): 39-43
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