Subscribe to RSS
DOI: 10.1055/s-2005-872502
© Georg Thieme Verlag Stuttgart · New York
Parasitosen bei pädiatrisch-onkologischen Patienten
Parasitic Diseases in Pediatric Cancer PatientsPublication History
Publication Date:
15 November 2005 (online)
![](https://www.thieme-connect.de/media/klinpaed/2005S1/lookinside/thumbnails/10.1055-s-2005-872502-1.jpg)
Zusammenfassung
Parasitäre Infektionen werden bei Kindern mit onkologischen Erkrankungen nur selten gesehen. Infektionswege und Krankheitsverläufe der Parasitosen unterscheiden sich nicht wesentlich von denen bei sonst gesunden Kindern. Bei Immunsuppression können aber latente Infektionen mit Cryptosporidium spp., Leishmania spp., Strongyloides stercoralis und Toxoplasma gondii exazerbieren. Mit Ausnahme der Toxoplasmose ist ein Screening zum Nachweis einer asymptomatischen, latenten Infektion bei den genannten Erregern nur wenig aussagekräftig. Die Nachweisverfahren weisen eine nur geringe Sensitivität auf, auch wenn die Patienten aus Endemiegebieten stammen. Wichtiger ist die Kenntnis der potenziell letalen Parasitosen, um bei Auftreten von Symptomen eine gezielte Diagnostik und Therapie durchzuführen. Die vorliegende Arbeit enthält Empfehlungen der Arbeitsgruppe „Infektionen bei immunsupprimierten Kindern” der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) und der Deutschen Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) zu Diagnose und Behandlung von parasitären Infektionen bei Kindern mit onkologischen Erkrankungen.
Absract
Parasitic infections are rare events in pediatric oncology. Transmission routes and diseases of most parasites do not differ significantly from those seen in otherwise healthy children. However, latent asymptomatic infections with Cryptosporidium spp., Leishmania spp., Strongyloides stercoralis and Toxoplasma gondii might exacerbate during immunosuppression. Screening in asymptomatic patients is often unsuccessful due to the low sensitivity of available assays except in toxoplasmosis. This article provides the recommendations of the Infectious Diseases Working Party of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Hematology/Oncology (GPOH) for the appropriate diagnostic procedures and antiparasitic treatment immunocompromised patients.
Schlüsselwörter
Kryptosporidiose - Leishmaniasis - Leukämie - Strongyloidiasis - Toxoplasmose
Key words
cryptosporidiosis - leishmaniasis - leukemia - strongyloidiasis - toxoplasmosis
Literatur
- 1 Bialek R, Binder N, Dietz K, Joachim A, Knobloch J, Zelck U E. Comparison of fluorescence, antigen and PCR assays to detect Cryptosporidium parvum in fecal specimens. Diagn Microbiol Infect Dis. 2002 a; 43 283-288
- 2 Bialek R, Binder N, Dietz K, Knobloch J, Zelck U E. Comparison of autofluorescence and iodine staining for detection of Isospora belli in feces. Am J Trop Med Hyg. 2002 b; 67 304-305
- 3 Bleggi-Torres L F, de Medeiros B C, Werner B, Zanis Neto J, Loddo G, Pasquini R, de Medeiros C R. Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases. Bone Marrow Transplant. 2000; 25 301-307
- 4 Bretagne S, Costa J M, Foulet F, Jabot-Lestang L, Baud-Camus F, Cordonnier C. Prospective study of toxoplasma reactivation by polymerase chain reaction in allogeneic stem-cell transplant recipients. Transpl Infect Dis. 2000; 2 127-132
- 5 Chiodini P L, Reid A JC, Wiselka M J, Firmin R, Foweraker J. Parenteral ivermectin in Strongyloides hyperinfection. Lancet. 2000; 355 43-44
- 6 Daubenton J D, Buys H, Hartley P S. Disseminated strongyloidiasis in a child with lymphoblastic lymphoma. J Ped Hematol Oncol. 1998; 20 260-263
- 7 Derouin F, Dévergie A, Auber P, Gluckman E, Beauvais B, Garin Y JF, Lariviere M. Toxoplasmosis in bone marrow-transplant recipients: report of seven cases and review. Clin Infect Dis. 1992; 15 267-270
- 8 Di Cataldo A, Nigor L L, Marino S, Schilirò G. Visceral leishmanisis in three children with leukemia. Pediatr Infect Dis J. 1996; 15 916-918
- 9 DTG (Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit) .Diagnose und Therapie der viszeralen Leishmaniasis (Kala-Azar). http://leitlinien-online.de; Stand 10. Januar 2005
- 10 Dubey J P. Toxoplasmosis - a waterborne zoonosis. Vet Parasitol. 2004; 126 57-72
- 11 Einsele H, Bertz H, Beyer J, Kiehl M G, Runde V, Kolb H -J, Holler E, Beck R, Schwerdfeger R, Schumacher U, Hebart H, Martin H, Kienast J, Ullmann A J, Machmeyer G, Krüger W, Niederwieser D, Link H, Schmidt C A, Oettle H, Klingebiel T. Infectious complications after allogeneic stem cell transplantation: epidemiology and interventional therapy strategies - guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol. 2003; 82 (Suppl 2) S175-S185
- 12 Edvinsson B, Jalal S, Nord C E, Pedersen B S, Evengard B, ECSMID Study group on T oxoplasmosis. DNA extraction and PCR assays for detection of Toxoplasma gondii. APMIS. 2004; 112 342-348
- 13 Grech V, Mizzi J, Mangion M, Vella C. Visceral leishmaniasis in Malta - an 18 year paediatric, population based study. Arch Dis Child. 2002a; 82 381-385
- 14 Grech V, Vella C, Lenicker H. Absence of bone marrow amastigotes in a child with kala-azar and acute lymphoblastic leukaemia. Ann Trop Paediatr. 2002b; 20 237-238
- 15 Grove D I. Human strongyloidiasis. Adv Parasitol. 1996; 38 251-310
- 16 Herwaldt B L. Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin Infect Dis. 2000; 31 1040-1057
- 17 Hunter P R, Hughes S, Woodhouse S, Raj N, Syed Q, Chalmers R M, Verlander N Q, Goodacre J. Health sequelae of human cryptosporidiosis in immunocompetent patients. Clin Infect Dis. 2004; 39 504-510
- 18 Igual-Adell R, Oltra-Alcaraz C, Soler-Company E, Sanchez-Sanchez P, Matogo-Oyana J, Rodriguez-Calabuig D. Efficacy and safety of ivermectin and thiabendazole in the treatment of strongyloidiasis. Expert Opin Pharmacother. 2004; 5 2615-2619
- 19 Jurges E, Young Y, Eltumi M, Holliman R E, Vellodi A, Rogers T R, Hobbs J R. Transmission of toxoplasmosis by bone marrow transplant associated with Campath-1G. Bone Marrow Transplant. 1992; 9 65-66
- 20 Keiser P B, Nutman T B. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev. 2004; 17 208-217
- 21 Lewis I J, Hart C A, Baxby D. Diarrhoea due to Cryptosporidium in acute lymphoblastic leukaemia. Arch Dis Childh. 1985; 60 59-62
- 22 Mahmoud A AF. Strongyloidiasis. Clin Infect Dis. 1996; 23 949-953
- 23 Mansfield L S, Niamatali S, Bhopale V, Volk S, Smith G, Lok J B, Genta R M, Schad G A. Strongyloides stercoralis: maintenance of exceedingly chronic infections. Am J Trop Med Hyg. 1996; 55 617-624
- 24 Marti H, Haji H J, Savioli L, Chwaya H M, Mgeni A F, Ameir J S, Hatz C. 1996. A comparative trial of single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop Med Hyg. 1996; 55 477-481
- 25 Mehrotra R, Choudry V P, Saxena R, Kapila K, Saraya A K. Asymptomatic visceral leihmanisis in a child with acute lymphoblastic leukaemia. J Infect. 1995; 30 157-159
- 26 Michel G, Thuret I, Chambost H, Scheiner C, Mary C, Perrimond H. Lung toxoplasmosis after HLA mismatched bone marrow transplantation. Bone Marrow Transplant. 1994; 14 455-457
- 27 Naquira C, Jimenez G, Guerra J G, Bernal R, Nalin D R, Neu D, Aziz M. Ivermectin for human strongyloidiasis and other intestinal helminths. Am J Trop Med Hyg. 1989; 40 304-309
- 28 Nucci M, Portugal R, Pulcheri W, Spector N, Ferreira S B, Braga de Castro M, Noe R, Pacheco de Oliveira H. Strongyloidiasis in patients with hematologic malignancies. Clin Infect Dis. 1995; 21 675-677
- 29 Resiere D, Vantelon J M, Bourée P, Chachaty E, Nitenberg G, Blot F. Isospora belli infection in a patient with non-Hodgkin's lymphoma. Clin Microbiol Infect. 2003; 9 1065-1067
- 30 Rivera-Luna R, Càrdenas-Cardos R, Martìnez-Guerra G, Ayòn A, Leal C, Rivera-Ortegòn F. Childhood acute leukemia and intestinal parasitosis. Leukemia. 1989; 3 825-826
- 31 Russell T S, Lynch J, Ottolini M G. Eradication of Cryptosporidium in a child undergoing maintenance chemotherapy for leukemia using high dose azithromycin therapy. J Ped Hematol Oncol. 1998; 20 83-85
- 32 Safdar A, Malathum K, Rodriguez S J, Husni R, Rolston K VI. Strongyloidiasis in patients at a comprehensive cancer center in the Unites States. Cancer. 2004; 100 1531-1536
- 33 Sandlund J T, Kauffman W, Flynn P. Strongyloides stercoralis infection mimicking relapse in a child with small noncleaved cell lymphoma. Am J Clin Oncol. 1997; 20 215-216
- 34 Sato Y, Kobayashi J, Toma H, Shiroma Y. Efficacy of stool examination for detection of Strongyloides infection. Am J Trop Med Hyg. 1995; 53 248-250
- 35 Schaffel R, Nucci M, Carvalho E, Braga M, Almeida L, Protugal R, Pulcheri W. The value of an immunoenzymatic test (enzyme-linked immunosorbent assay) for the diagnosis of strongyloidiasis in patients immunosuppressed by hematologic malignancies. Am J Trop Med Hyg. 2001; 65 346-350
- 36 Schaffel R, Nucci M, Portugal R, Castro M B, Ferreira S B, Almeida L, Spector N, Pulcheri W. Thiabendazole for the treatment of Strongyloidiasis in patients with hematologic malignancies. Clin Infect Dis. 2000; 31 821-822
- 37 Siddiqui A A, Berk S L. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis. 2001; 33 1040-1047
- 38 Sindermann H, Engel K R, Fischer C, Bommer W. for the Miltefosine Compassionate Use Program . Oral miltefosine for leishmaniasis in immunocompromised patients: compassionate use in 39 patients with HIV infection. Clin Infect Dis. 2004; 39 1520-1523
- 39 Smedts Walters H, Bader-Meunier B, Dommergues J P. Syndrome hémophagocytaire associé à une anguillulose chez une enfant traitée pour leucémie aiguë lymphoblastique. Arch Pédiatr. 1998; 5 346-347
- 40 Stine K C, Harris J S, Lindsey N J, Cho C T. Spontaneous remission of cryptosporidiosis in a child with acute lymphocytic leukemia. Clin Pediatr. 1985; 24 722-724
- 41 Trad O, Jumaa P, Uduman S, Nawaz A. Eradication of Cryptosporidium in four children with acute lymphoblastic leukemia. J Trop Pediatr. 2003; 49 128-130
- 42 Tzipori S, Ward H. Cryptosporidiosis: biology, pathogenesis and disease. Microb Infect. 2002; 4 1047-1058
- 43 Viney M E, Brown M, Omoding N E, Bailey J W, Gardner M P, Roberts E, Morgan D, Elliott A M, Whitworth J AG. Why does HIV infection not lead to disseminated strongyloidiasis?. J Infect Dis. 2004; 190 2175-2180
- 44 Walker M, Zunt J R. Parasitic central nervous system infections in immunocompromised hosts. Clin Infect Dis. 2005; 40 1005-1015
PD Dr. med. Ralf Bialek
Institut für Tropenmedizin · Universitätsklinikum Tübingen
Keplerstraße 15
72074 Tübingen
Email: ralf.bialek@med.uni-tuebingen.de