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Dtsch Med Wochenschr 2012; 137(18): 947-984
DOI: 10.1055/s-0032-1304850
CME-Beitrag | Review article
Infektiologie
© Georg Thieme Verlag KG Stuttgart · New York

Tuberkulose

Aktuelle Übersicht für die Klinik und PraxisTuberculosisCurrent concepts for in- and outpatient management
G. Günther
1   Tuberkulosezentrum Borstel; Medizinische Klinik, Forschungszentrum Borstel
,
J. Heyckendorf
1   Tuberkulosezentrum Borstel; Medizinische Klinik, Forschungszentrum Borstel
,
C. Herzmann
1   Tuberkulosezentrum Borstel; Medizinische Klinik, Forschungszentrum Borstel
,
C. Lange
1   Tuberkulosezentrum Borstel; Medizinische Klinik, Forschungszentrum Borstel
› Author Affiliations
Further Information

Publication History

28 December 2011

08 March 2012

Publication Date:
26 April 2012 (online)

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Zusammenfassung

Die Tuberkulose ist noch immer eine der wichtigsten Infektionserkrankungen weltweit. In Deutschland sinkt die Inzidenz der Tuberkulose seit Jahren auf aktuell ca. 4500 Neuerkrankungen pro Jahr. Eine neue große Herausforderung stellt die Versorgung der zunehmenden Zahl an Patienten mit Medikamenten-resistenten Formen der Tuberkulose dar. Hinsichtlich der Diagnostik der aktiven Tuberkulose gibt es durch neue molekulare Verfahren deutliche Fortschritte, die zu einer wesentlich schnelleren und sicheren Diagnostik besonders Sputum- negativer und Antibiotika-resistenter Tuberkulosen führen können. Eine Tuberkulose durch multiresistente oder extensiv-resistente Stämme von M. tuberculosis ist mit aktuell verfügbaren Medikamenten nur schwer und unter hohen ökonomischen Aufwand erfolgreich behandelbar. Neue Therapiekonzepte und Medikamente sind dringend erforderlich. Inferferon-γ Tests haben die Diagnostik der latenten Tuberkulose spezifischer gemacht, tragen aber als reine Bluttests nicht zur Diagnostik der aktiven Tuberkulose bei.

Der vorliegende Artikel stellt eine kurze Zusammenfassung des aktuellen Wissens hinsichtlich Epidemiologie, Risikofaktoren, Diagnostik und Therapie der Tuberkulose und latenten Infektion mit M. tuberculosis dar. Darüber hinaus werden aktuelle Behandlungskonzepte und ökonomische Aspekte der Therapie behandelt.

Abstract

Tuberculosis is still one of the most important infectious disease worldwide. In Germany the tuberculosis incidence has been declining for decades to currently about 4500 new cases per year. A new challenge poses the rising number tuberculosis cases with drug resistant strains of Mycobacterium tuberculosis. Substantiell progress has been achieved in the diagnosis of tuberculosis with new molecular techniques that can lead to a much faster and more reliable identification of cases with acid-fast bacilli smear-negative tuberculosis and in the identification of drug-resistant strains of M. tuberculosis. Tuberculosis caused by drug resistant strains of M. tuberculosis is difficult to treat with the currently available medications and is related to very high costs of care. New therapeutic approaches and drugs are urgently needed. Interferon-γ tests have made the diagnosis of latent infection with M. tuberculosis more specific, but hardly contribute to the diagnosis of active tuberculosis.

This article presents a brief summary of current knowledge concerning the epidemiology, risk factors, diagnosis and treatment of active tuberculosis and latent infection with M. tuberculosis. Moreover, current treatment approaches and economic aspects of care are discussed.

Schlüsselwörter

Diagnose - MDR-TB - Therapie - Tuberkulose - XDR-TB

Keywords

Diagnosis - MDR-TB - Therapy - Tuberculosis - XDR-TB
 

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