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Pneumologie 2014; 68(10): 685-695
DOI: 10.1055/s-0034-1378081
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Pneumonien mit Reiseanamnese[*]

Travel-Associated Pneumonias
H. F. Geerdes-Fenge
Abteilung für Infektionskrankheiten und Tropenmedizin, Zentrum für Innere Medizin, Universitätsmedizin Rostock
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Publication History

eingereicht 21 July 2014

akzeptiert nach Revision 01 September 2014

Publication Date:
07 October 2014 (online)

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Zusammenfassung

Fieberhafte Erkrankungen nach Tropenaufenthalt werden in bis zu 11 % der Fälle durch Atemwegsinfektionen verursacht. Pneumonien bei Reiserückkehrern oder bei Migranten aus tropischen oder subtropischen Regionen werden in der Regel durch die auch in Europa üblichen Erreger verursacht: Pneumokokken, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Influenza, Legionella pneumophila. Es gibt jedoch auch Lungenerkrankungen, die nach einem Aufenthalt in den Tropen oder Subtropen auf dort endemische bakterielle, parasitäre, virale oder mykotische Erreger zurückgeführt werden können. Häufige importierte Infektionen sind Malaria, Denguefieber und Tuberkulose. Bei Reiserückkehrern und Migranten mit Lungenerkrankungen und Eosinophilie sollte an folgende Krankheiten gedacht werden: Katayama-Fieber (Bilharziose), Löffler-Syndrom (Lungenpassage von Rundwürmern: Ascaris lumbricoides, Strongyloides stercoralis, Ancylostoma duodenale und Necator americanus), tropische pulmonale Eosinophilie (Mikrofilarien), Amöbiasis, Infektion mit Lungenegeln, Echinokokkose und Toxocariasis. Durch Grasmilben wird das in Asien endemische Tsutsugamushi-Fieber übertragen, durch Zecken verschiedene Fleckfiebererkrankungen (Rickettsiosen). Zoonosen werden durch Kontakt zu infizierten Tieren bzw. deren Ausscheidungen erworben und sind in der Regel nicht von Mensch zu Mensch übertragbar: MERS-CoA (Kamele), pulmonale Hantavirusinfektion (Mäuse), Tularämie (Hasen), Leptospirose (Ratten), Q-Fieber (Schafe und Ziegen), sehr selten auch Anthrax (Tierfelle von Wiederkäuern) und Pest (infizierte Ratten und Wildtiere). Durch Inhalation von kontaminiertem Staub kann es zu Infektionen mit dimorphen Pilzen kommen: Histoplasmose (Fledermauskot) und Coccidioidomykose in Amerika und Teilen Afrikas, Blastomykose in Amerika. Einige Infektionen und deren Folgeerscheinungen können noch Jahre bis Jahrzehnte nach einem Tropenaufenthalt auftreten (Melioidose, Tuberkulose, Histoplasmose, Schistosomiasis-assoziierte pulmonale Hypertonie). Nichtinfektiöse Lungenerkrankungen können durch starke Luftverschmutzung oder Inhalation von toxischem Staub ausgelöst werden.

Abstract

Respiratory infections are responsible for up to 11 % of febrile infections in travellers or immigrants from tropical and subtropical regions. The main pathogens are the same as in temperate climate zones: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, influenza viruses, Legionella pneumophila. However, some pulmonary diseases can be attributed to bacterial, parasitic, viral or fungal pathogens that are endemic in tropical and subtropical regions. The most commonly imported infections are malaria, dengue, and tuberculosis. Pulmonary symptoms and eosinophilia in returning travellers and migrants may be caused by several parasitic infections such as Katayama syndrome, Loeffler syndrome, tropical pulmonary eosinophilia, amebiasis, paragonimiasis, echinococcosis, and toxocariasis. In Asia, Tsutsugamushi fever is transmitted by chiggers, spotted fever rickettsiae are transmitted by ticks. Transmission of zoonotic diseases occurs mainly via contact with infected animals or their excretions, human-to-human transmission is generally rare: MERS-CoA (dromedary camels), pulmonary hantavirus infection (rodents), tularemia (rabbits and hares), leptospirosis (rats), Q-fever (sheep and goats), very rarely anthrax (hides of ruminants) and pest (infected rats and wildlife). Inhalation of contaminated dust can cause infections with dimorphic fungi: histoplasmosis (bat guano) and coccidioidomycosis in America and parts of Africa, blastomycosis in America. Some infections can cause symptoms years after a stay in tropical or subtropical regions (melioidosis, tuberculosis, histoplasmosis, schistosomiasis-associated pulmonary hypertension). Noninfectious respiratory diseases caused by inhalation of high amounts of air pollution or toxic dusts may also be considered.

* Professor Hartmut Lode zum 75. Geburtstag gewidmet.


 

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