Infektionen des zentralen Nervensystems durch Bakterien, Pilze und Parasiten: radiologisch-pathologische Korrelation und historischer Rückblick^[1]

Zusammenfassung

Trotz beachtlicher Fortschritte in Prävention und Behandlung bleiben Infektionskrankheiten mit Beteiligung des zentralen Nervensystems eine wichtige Morbiditäts- und Mortalitätsursache, insbesondere in weniger entwickelten Ländern und bei immunkompromittierten Personen. Bakterielle, Pilz- und parasitäre Pathogene sind lebende Organismen und greifen Gehirn, Rückenmark oder Hirnhäute an. Infektionen durch diese Pathogene sind mit vielfältigen Mustern in der Neurobildgebung assoziiert, die sich in den meisten Fällen am besten in der Magnetresonanztomografie darstellen lassen. Bakterielle Infektionen – am häufigsten auf Streptokokken-, Haemophilus- und Neisseria-Spezies zurückzuführen – verursachen eine signifikante Meningitis, während die weniger häufige Zerebritis und die anschließende Abszessbildung eine gut dokumentierte Progression aufweisen, mit zunehmend hervortretender Veränderung der Signalintensität und entsprechender Kontrastmittelanreicherung. Atypische bakterielle Infektionen sind durch die Entwicklung einer granulomatösen Reaktion charakterisiert, die klassischerweise bei der Tuberkulose beobachtet wird; dabei ist das Tuberkulom die häufigste parenchymale Form der Erkrankung. Durch Spirochäten und Rickettsien verursachte Erkrankungen sind weniger häufig. Pilzinfektionen herrschen bei immunkompromittierten Wirten vor und werden durch Hefepilze, Schimmelpilze und dimorphe Pilze verursacht. Die Kryptokokkenmeningitis ist die häufigste Pilzinfektion, während die Candidiasis die häufigste nosokomiale Infektion ist. Mukormykose und Aspergillose sind angioinvasiv und gehen mit einer hohen Morbidität und Mortalität bei immunkompromittierten Patienten einher. Hinsichtlich einer potenziellen weltweiten Exposition sind parasitäre Infektionen, darunter Neurozystizerkose, Toxoplasmose, Echinokokkose, Malaria und Schistosomiasis, die größte Bedrohung. Seltene Amöbeninfektionen sind wegen ihrer extremen Virulenz und hohen Mortalität erwähnenswert. Das Ziel dieses Artikels ist es, die in der Neurobildgebung charakteristischen Manifestationen von Infektionen durch Bakterien, Pilze und Parasiten hervorzuheben; dabei liegt der Schwerpunkt auf der radiologisch-pathologischen Korrelation und dem historischen Rückblick.

Abstract

Despite remarkable progress in prevention and treatment, infectious diseases affecting the central nervous system remain an important source of morbidity and mortality, particularly in less-developed countries and in immunocompromised persons. Bacterial, fungal, and parasitic pathogens are derived from living organisms and affect the brain, spinal cord, or meninges. Infections due to these pathogens are associated with a variety of neuroimaging patterns that can be appreciated at magnetic resonance imaging in most cases. Bacterial infections, most often due to Streptococcus, Haemophilus, and Neisseria species, cause significant meningitis, whereas the less common cerebritis and subsequent abscess formation have well-documented progression, with increasingly prominent altered signal intensity and corresponding contrast enhancement. Atypical bacterial infections are characterized by the development of a granulomatous response, classically seen in tuberculosis, in which the tuberculoma is the most common parenchymal form of the disease; spirochetal and rickettsial diseases are less common. Fungal infections predominate in immunocompromised hosts and are caused by yeasts, molds, and dimorphic fungi. Cryptococcal meningitis is the most common fungal infection, whereas candidiasis is the most common nosocomial infection. Mucormycosis and aspergillosis are characterized by angioinvasiveness and are associated with high morbidity and mortality among immunocompromised patients. In terms of potential exposure in the worldwide population, parasitic infections, including neurocysticercosis, toxoplasmosis, echinococcosis, malaria, and schistosomiasis, are the greatest threat. Rare amebic infections are noteworthy for their extreme virulence and high mortality. The objective of this article is to highlight the characteristic neuroimaging manifestations of bacterial, fungal, and parasitic diseases, with emphasis on radiologic-pathologic correlation and historical perspectives.

¹ © 2015 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2015; 35: 1141 – 1169. Online published in 10.1148/rg.2015140317. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

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