Die Rolle von Viren bei tiefen Atemwegsinfektionen des Erwachsenen[1]

Zusammenfassung

Infektionen des Respirationstrakts sind in industrialisierten Ländern eine der häufigsten Ursachen für ärztliche Konsultationen, wobei rund ein Drittel dieser Erkrankungen die tiefen Atemwege betreffen. Hierzu zählen neben der akuten Bronchitis auch die akute Exazerbation einer chronisch obstruktiven Lungenerkrankung (COPD), die ambulant oder nosokomial erworbene Pneumonie und als besondere Entität die Influenza, die sämtliche Abschnitte des Respirationstrakts betreffen kann. Über lange Zeit wurde durch Mangel an geeigneten Untersuchungsmethoden die Bedeutung von respiratorischen Viren bei der Genese dieser Infektionen wahrscheinlich unterschätzt. Da bislang oft eine bakterielle Genese vermutet wurde, erfolgte in vielen Fällen im klinischen Alltag, insbesondere bei der akuten Bronchitis oder der exazerbierten COPD, eine antibiotische Behandlung, die wahrscheinlich nicht erforderlich ist und zudem das Risiko einer Resistenzentwicklung beinhaltet. Erst mit der Einführung von sensitiveren Nachweisverfahren für Viren, wie zum Beispiel der Polymerasekettenreaktion (PCR), gelingt ein sicherer und zuverlässiger Nachweis von respiratorischen Viren, der Aussagen über deren Bedeutung bei Infektionen des tiefen Respirationstrakts erlaubt. Im Rahmen dieser dreiteiligen Serie soll deshalb anhand der aktuellen Literatur ein Überblick über den derzeitigen Kenntnisstand zur Bedeutung von respiratorischen Viren bei tiefen Atemwegsinfektionen des Erwachsenen gegeben werden. Der erste Teil der Serie befasst sich mit den ursächlichen Erregern, der Pathogenese und Diagnostik bei tiefen Atemwegsinfektionen des Erwachsenen. In den folgenden Abschnitten werden Krankheitsbilder (Teil II: akute Bronchitis, exazerbierte COPD, Pneumonie und Influenza) sowie Therapie und Prävention (Teil III) vorgestellt.

Abstract

In industrialised countries respiratory tract infections are one of the most common reasons for medical consultations. It is assumed that almost one third of these infections include the lower respiratory tract (LRTI), e. g. acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease (COPD), community- or hospital-acquired pneumonia and influenza. Due to a lack of sufficient and valid investigations on the epidemiology of respiratory viruses, their impact on the pathogenesis of LRTI has probably been underestimated for a long time. Therefore, there might have been many cases of needless antibiotic treatment, particularly in cases of acute bronchitis or acute exacerbations of COPD, because of an assumed bacteriological aetiology. Following the introduction of diagnostic procedures with increased sensitivity, such as polymerase chain reaction, it is possible to reliably detect respiratory viruses and to illuminate their role in the pathogenesis of LRTI of the adult. We have reviewed the current literature to elucidate the role of viruses in the pathogenesis of LRTI. The first part of this series deals with the relevant pathogens, pathogenesis, and diagnostic procedures. In the subsequent 2 parts of this series a review will be given on the most common variants of viral LRTI (part II), and therapeutic and preventive options (part III).

1 ¹ Gefördert durch die Paul Ehrlich Gesellschaft (PEG).

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1 ¹ Gefördert durch die Paul Ehrlich Gesellschaft (PEG).

2 Alle Autoren haben gleichermaßen zur Erstellung des Manuskriptes beigetragen.

Bisher erschienene Beiträge dieser Serie

• 84 Strassburg A. et al . Infektionsdiagnostik in der Pneumologie.  Pneumologie. 2008;  62 730-743
• 85 Rohde G. et al . Nachweis von Atemwegsviren – wie, warum, wann und wo?.  Pneumologie. 2009;  63 14-22
• 86 Gillissen A. et al . Biomarker bei infektiösen und nicht infektiösen Lungenerkrankungen außer Malignome.  Pneumologie. 2009;  63 439-450