Souvenir aus den Tropen: intensivpflichtige ZNS-Infektionen^[*]

Zusammenfassung

Infektiöse ZNS-Erkrankungen, die von tropischen Erregern ausgelöst werden, stellen insbesondere diagnostisch hohe Anforderungen an den Intensivmediziner. Aufgrund der zunehmenden Migration und häufigerer Fernreisen gewinnen sie aber an Bedeutung.

Kernaussagen

• Bei „Tropenanamnese“ ist bei jedem Patienten mit qualitativer und/oder quantitativer Bewusstseinsstörung besonderes Augenmerk auf die Begleitsymptomatik zu legen, vor allem auf Fieber und Hautveränderungen.

• Wenn nach dem Aufenthalt in einem tropischen Land eine akute Bewusstseinsstörung auftritt, die von Fieber und einem epileptischen Anfall begleitet wird, muss man in die Differenzialdiagnose eine zerebrale Malaria, eine virale Enzephalitis und eine akute bakterielle Meningitis einbeziehen.

• Bei akuten infektiösen Erkrankungen des zentralen Nervensystems, die in einem tropischen Land erworben wurden, vor allem bei akuter bakterieller Meningitis und zerebraler Malaria, ist eine Osmotherapie als Dauerinfusionstherapie sowie eine Dexamethason-Therapie nicht indiziert, möglicherweise sogar kontraindiziert.

• Insbesondere nach länger dauerndem Tropenaufenthalt ist bei jedem Epilepsiepatienten, also auch bei einem Status epilepticus, eine akute ZNS-Infektion (virale Enzephalitis, zerebrale Malaria), vor allem aber eine Neurozystizerkose differenzialdiagnostisch auszuschließen.

• Das klinische Bild einer Poliomyelitis kann durch Enteroviren, insbesondere Poliomyelitis-Viren, aber auch durch Arboviren (z. B. Flaviviren wie das Westnil-Virus) verursacht werden.

• Die häufigste Ursache einer akuten eosinophilen Meningitis, Enzephalitis oder Myelitis ist eine Larva migrans visceralis, ausgelöst von Nematoden-Larven. Gnathostoma spinigerum oder Angiostrongylus cantonensis werden vor allem in Südostasien erworben, können aber auch aus dem südlichen Afrika und Mittelamerika stammen.

^* Erstveröffentlichung des Beitrags in: Intensivmedizin up2date 2014; 10: 317 – 332

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