Download PDF
Der Klinikarzt 2012; 41(2): 84-88
DOI: 10.1055/s-0032-1307442
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Infektiöse Diarrhöen – Clostridium difficile und Noroviren als Auslöser

Infectious Diarrheas
Johannes Wilhelm Rey
1   I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
,
Ralf Kiesslich
1   I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
,
Torsten Hansen
2   Institut für Pathologie, Universitätsmedizin Mainz
,
Ana Paula Barreiros
1   I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
› Author Affiliations
Further Information

Publication History

Publication Date:
01 March 2012 (online)

Also available at
    Permissions and Reprints

Durchfallerkrankungen sind häufige Erkrankungen des Gastrointestinaltrakts und eine der 5 häufigsten Todesursachen weltweit. Obwohl genaue epidemiologische Angaben fehlen, spielen Diarrhöen auch in entwickelten Ländern eine zunehmende Rolle. Dabei werden akute von chronischen Diarrhöen unterschieden. Die häufigsten Ursachen für eine akute Enteritis infectiosa sind virale und bakterielle Erreger. Im Fall einer bakteriellen Dysenterie sind antibiotikaassoziierte Durchfälle durch Clostridium difficle eine häufige nosokomiale Manifestation der Erkrankung. Bei den viralen Erregern sind Noroviren in etwa 90 % der Fälle Auslöser einer akuten, innerhalb von 48-72 Stunden meist selbstlimitierenden Diarrhö. Bakterielle Dysenterien werden, wenn notwendig, mit Antibiotika behandelt, wobei bei einigen Erregern zunehmende Resistenzentwicklungen zu beachten sind. Eine weiterführende mikrobiologische oder endoskopische Diagnostik ist nicht immer notwendig. Die Therapie orientiert sich an den klinischen Symptomen und berücksichtigt im Allgemeinen die Prävention sekundärer Komplikationen.

Diarrheas are frequent diseases of the gastrointestinal tract and one of the five most common causes of death worldwide. Despite absence of exact epidemiological data we know that diarrheas play an important role even in industrialized countries. Acute diarrheas and chronic diarrheas must be discriminated. Most common causes for an acute enteritis infectiosa are viral and bacterial agents. In case of a bacterial dysentery antibotica associated diarrheas by Clostridium difficile are a frequent nosocomial manifestation of the disease. In the case of viral agents Noroviruses are in 90 % triggers of an acute and within 48-72 hours selflimiting diarrhea. Bacterial dysenterias are treated if necessary with antibiotics, but growing resistances are observed. Continuative microbiological or endoscopic diagnostic measures are not always necessary. Therapeutic measures are oriented at clincical symptoms and consider normally the prevention of secondary complications.

Key words

Acute diarrheas - infectious enteritis - norovirus - Clostridium difficile
 

  • Literatur

  • 1 Fine KD. AGA technical review on the evaluation and management of chronic diarrhea. Gastroenterology 1999; 116: 1464-1486
    CrossrefPubMedGoogle Scholar
  • 2 Guerrant RL. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 2001; 32: 331-351
    CrossrefPubMedGoogle Scholar
  • 3 Bern C. The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Organ 1992; 70: 705-714
    PubMedGoogle Scholar
  • 4 Cohen ML. The epidemiology of diarrheal disease in the United States. Infect Dis Clin North Am 1988; 2: 557-570
    PubMedGoogle Scholar
  • 5 McDonald LC. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis 2006; 12: 409-415
    CrossrefPubMedGoogle Scholar
  • 6 Reichardt C. Dramatic increase of Clostridium difficile-associated diarrhea in Germany: has the new strain PCR-ribotype 027 already reached us?. Dtsch Med Wochenschr 2007; 132: 223-228
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Bartlett JG. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med 1978; 298: 531-534
    CrossrefPubMedGoogle Scholar
  • 8 Johnson S. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 1999; 341: 1645-1651
    CrossrefPubMedGoogle Scholar
  • 9 Pepin J. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005; 41: 1254-1260
    CrossrefPubMedGoogle Scholar
  • 10 Gurwith MJ. Diarrhea associated with clindamycin and ampicillin therapy: preliminary results of a cooperative study. J Infect Dis 1977; 135 (Suppl. 01) 104-110
    CrossrefPubMedGoogle Scholar
  • 11 Glass RI. The epidemiology of rotavirus diarrhea in the United States: surveillance and estimates of disease burden. J Infect Dis 1996; 174 (Suppl. 01) 5-11
    CrossrefPubMedGoogle Scholar
  • 12 Glass RI. Norovirus gastroenteritis. N Engl J Med 2009; 361: 1776-1785
    CrossrefPubMedGoogle Scholar
  • 13 Parashar UD. Global mortality associated with rotavirus disease among children in 2004. J Infect Dis 2009; 200 (Suppl. 01)
    PubMedGoogle Scholar
  • 14 Jiang ZD. Association of interleukin-8 polymorphism and immunoglobulin G anti-toxin A in patients with Clostridium difficile-associated diarrhea. Clin Gastroenterol Hepatol 2007; 5: 964-968
    CrossrefPubMedGoogle Scholar
  • 15 Tedesco FJ. Pseudomembranous colitis: pathogenesis and therapy. Med Clin North Am 1982; 66: 655-664
    PubMedGoogle Scholar
  • 16 Epple HJ. Infectious enteritis. Internist (Berl) 2011; 52: 1046-1046
    PubMedGoogle Scholar
  • 17 Said MA. Healthcare epidemiology: gastrointestinal flu: norovirus in health care and long-term care facilities. Clin Infect Dis 2008; 47: 1202-1208
    CrossrefPubMedGoogle Scholar
  • 18 Rockx B. Natural history of human calicivirus infection: a prospective cohort study. Clin Infect Dis 2002; 35: 246-253
    CrossrefPubMedGoogle Scholar
  • 19 Kelly CP. Clostridium difficile--more difficult than ever. N Engl J Med 2008; 359: 1932-1940
    CrossrefPubMedGoogle Scholar
  • 20 Kyne L. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med 2000; 342: 390-397
    CrossrefPubMedGoogle Scholar
  • 21 Mattner F. Risk groups for clinical complications of norovirus infections: an outbreak investigation. Clin Microbiol Infect 2006; 12: 69-74
    CrossrefPubMedGoogle Scholar
  • 22 Thielman NM. Clinical practice. Acute infectious diarrhea. N Engl J Med 2004; 350: 38-47
    CrossrefPubMedGoogle Scholar
  • 23 Luo RF. Is repeat PCR needed for diagnosis of Clostridium difficile infection?. J Clin Microbiol 2010; 48: 3738-3741
    CrossrefPubMedGoogle Scholar
  • 24 Kaplan JE. Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis. Ann Intern Med 1982; 96: 756-761
    PubMedGoogle Scholar
  • 25 Turcios RM. Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998-2000. Clin Infect Dis 2006; 42: 964-969
    CrossrefPubMedGoogle Scholar
  • 26 Dolin R. Viral gastroenteritis induced by the Hawaii agent. Jejunal histopathology and serologic response. Am J Med 1975; 59: 761-768
    CrossrefPubMedGoogle Scholar
  • 27 Price AB. Pseudomembranous colitis. J Clin Pathol 1977; 30: 1-12
    CrossrefPubMedGoogle Scholar
  • 28 Linsky A. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med 2010; 170: 772-778
    CrossrefPubMedGoogle Scholar
  • 29 Lowe DO. Proton pump inhibitors and hospitalization for Clostridium difficile-associated disease: a population-based study. Clin Infect Dis 2006; 43: 1272-1276
    CrossrefPubMedGoogle Scholar
  • 30 Baines SD. Emergence of reduced susceptibility to metronidazole in Clostridium difficile. J Antimicrob Chemother 2008; 62: 1046-1052
    CrossrefPubMedGoogle Scholar
  • 31 Boone JH. Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency. Eur J Clin Microbiol Infect Dis 2011;
    PubMedGoogle Scholar
  • 32 Solomon K. PCR ribotype prevalence and molecular basis of macrolide-lincosamide-streptogramin B (MLSB) and fluoroquinolone resistance in Irish clinical Clostridium difficile isolates. J Antimicrob Chemother 2011; 66: 1976-1982
    CrossrefPubMedGoogle Scholar
  • 33 DuPont HL. Clinical practice. Bacterial diarrhea. N Engl J Med 2009; 361: 1560-1569
    CrossrefPubMedGoogle Scholar