Opportunistische Infektionen: Was gibt es Neues?

Was ist neu?

Zerebrale Toxoplasmose Als intravenöse Therapie ist die Gabe von Trimethoprim und Sulfamethoxazol möglich. Auch als orale Prophylaxe können sie nun schon ab einer CD4-T-Helferzellzahl von < 200/µl eingesetzt werden.

Pneumocystis jiroveci Zur Prophylaxe und Therapie der Pneumocystis-jiroveci-Pneumonie ist die Kombination aus Trimethoprim und Sulfamethoxazol weiterhin Mittel der Wahl.

Kryptokokkose Eine neue Therapieoption besteht aus liposomalem Amphotericin B plus Fluconazol.

Tuberkulose Um ein Immunrekonstitutions-Inflammations-Syndrom (IRIS) zu vermeiden, kann eine präventive Steroidbehandlung in Betracht gezogen werden.

Humanes Herpes-Virus Typ 8 (HHV8) Das „Kaposi-Sarkom-Herpesvirus-Inflammations-Zytokin-Syndrom“ (KICS) wurde als neue HHV8-assoziierte Erkrankung beschrieben.

Varizella zoster In der Therapie sollte man Lokalisation und Ausbreitung berücksichtigen.

Abstract

Guidelines from 3 clinical societies and peer-reviewed publications have been reviewed for recent changes in the management of opportunistic infections. Trimethoprim and sulfamethoxazol administered intravenously is an option to treat cerebral toxoplasmosis if oral therapy is not feasible. CD4 T cell cut-off for starting prophylaxis with trimethoprim and sulfamethoxazole is now 200/µl. For prophylaxis and treatment of Pneumocystis pneumonia trimethoprim and sulfamethoxazole still are recommended. Liposomal amphotericin B + fluconazole is a new treatment option for cryptococcosis. Addition of steroids can be considered in the treatment of tuberculosis to avoid immune reconstitution inflammatory syndrome. A new syndrome associated with HHV8 has been described: Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS). Localization and dissemination of herpes zoster have to be considered for treatment determination.

Schlüsselwörter

Opportunistische Infektionen - HIV - EACS - DAIG - IDSA

Key words

opportunistic infections - HIV - EACS - DAIG - IDSA

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