Schwere Gelbfieber-impfassoziierte Erkrankung: ein Fallbericht und aktuelle Übersicht

Zusammenfassung

Anamnese und klinischer Befund 5 Tage nach einer Gelbfieber (GF)-Impfung traten bei einem 56-jährigen Mann hohes Fieber auf mit starken Kopfschmerzen, Abgeschlagenheit, Konzentrationsstörungen und Exanthem.

Laboruntersuchungen Die Leberwerte und GF-Antikörperreaktion waren deutlich erhöht. Im Urin war mittels PCR GF-Impfvirus nachweisbar.

Diagnose und Therapie Es wurde zunächst eine schwere GF-Impfvirus-assoziierte viszerotrope Erkrankung vermutet und symptomatisch behandelt.

Verlauf Das Fieber sistierte nach insgesamt 10 Tagen, Organversagen traten keine auf. Es bestanden jedoch noch über 3 Monate postenzephalitische Beschwerden mit Abgeschlagenheit, Konzentrations-, Gedächtnis- und Leseschwächen und nur teilweiser Arbeitsfähigkeit, sodass der Verdacht auf eine neurotrope GF-impfassoziierte Erkrankung besteht.

Folgerung Schwere Impfnebenwirkungen müssen bei der Indikationsstellung zur GF-Impfung bedacht werden.

Abstract

History and physical examination A 56-year-old man developed high fever with severe headaches, fatigue, impaired concentration skills, and an exanthema 5 days after a yellow fever (YF) vaccination.

Laboratory tests Liver enzymes and YF antibody titers were remarkably elevated. YF vaccine virus was detected in urine by PCR.

Diagnosis and therapy Initially, severe YF vaccine-associated visceral disease was suspected and treated symptomatically.

Clinical Course His fever ceased after 10 days in total, no organ failure developed. However, postencephalitic symptoms persisted with fatigue and impaired concentration, memory, and reading skills and partly incapability to work for over 3 months. A diagnosis was made of suspected YF vaccine-associated neurotropic disease.

Conclusion Severe vaccine-derived adverse effects need to be considered in the indication process for YF vaccination.

Schlüsselwörter

Gelbfieberimpfung - schwere Nebenwirkung - Impfreaktion - neurotrope Erkrankung

Key words

yellow-fever vaccine - serious adverse event - vaccine-associated - neurotropic disease

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