Kryptokokkose: Kasuistiken, Epidemiologie und Therapiestrategien

Zusammenfassung

Die Kryptokokkose ist eine Pilzinfektion, die meist durch Cryptococcus neoformans verursacht wird. Neben den seltener werdenden Erkrankungen bei HIV-Infizierten werden zunehmend Fälle bei anderen Patientenkollektiven wie Organtransplantierten, Patienten mit chronischen Organerkrankungen oder auch bei Patienten ohne Immundefekt diagnostiziert. Das Krankheitsbild reicht von lokalisierten Infektionen der Atemwege oder der Haut bis hin zur typischen Meningoenzephalitis nach hämatogener Dissemination. Da aber auch alle anderen Organe beteiligt sein können, resultiert eine vielgestaltige Präsentation der Erkrankung. Daher muss die Kryptokokkose oft in die differenzialdiagnostischen Überlegungen einbezogen werden. Aufgrund sensitiver Labortests kann die Erkrankung bei disseminierter Infektion rasch gesichert werden. Für therapeutische Entscheidungen sind Patientenfaktoren und die jeweilige Organbeteiligung ausschlaggebend. Während in der ersten Therapiephase bei disseminierten oder schweren lokalen Erkrankungen in der Regel Amphotericin B-Derivate und 5-Flucytosin in Kombination eingesetzt werden, ist nach dieser Induktionstherapie oder bei leichten lokalisierten Infektionen eine Therapie mit Fluconazol indiziert. Echinocandine sind bei der Kryptokokkose nicht wirksam.

Abstract

Cryptococcosis is a fungal infection that is usually caused by Cryptococcus neoformans. Given the decreasing number of cases in HIV-infected patients in developed countries, infections in other patient populations, such as solid organ transplant recipients, patients with chronic organ diseases or even patients without immunodeficiency gain more attention. Due to a possible involvement of many organs, the clinical presentation varies from localized infections of the respiratory tract and the skin, to the characteristic meningoencephalitis or other organs after hematogenous dissemination. Sensitive laboratory tests allow a rapid diagnosis in patients with disseminated infection. Crucial therapeutic decisions depend on the underlying patient condition and the particular organ involvement. The induction therapy of disseminated infections or severe localised infections is based on amphotericin B in combination with 5-flucytosine. In non-severe localised infections and after induction therapy, antifungal treatment with fluconazole is indicated. Echinocandins are not effective in cryptococcosis.

Schlüsselwörter

Cryptococcus - Kryptokokkose - Meningoenzephalitis - Therapie

Keywords

Cryptococcus - cryptococcosis - meningoencephalitis - treatment

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