Infektionsdiagnostik in der Pneumologie

Zusammenfassung

Pneumonien gehören zu den bedeutendsten Krankheitsbildern der Inneren Medizin. Der Nachweis von verursachenden Mikroorganismen der Pneumonien ist ebenso schwierig wie die Differenzialdiagnose gegenüber nicht pneumonischen Infiltraten. Zu den neuen diagnostischen Entwicklungen gehören die Analyse des Serum-Procalcitonin zur verbesserten Identifizierung und zur Beurteilung des Therapieverlaufs von bakteriell bedingten pulmonalen Infektionen und ein einfaches Bewertungssystem, z. B. der CRB-65/CURB-Score, zur raschen Risikostratifizierung. In Abhängigkeit vom Schweregrad der Erkrankung, der Prädisposition und Exposition der Patienten ist eine rationale Diagnostik zur Identifikation von Mikroorganismen, die als Verursacher von Atemwegsinfektionen infrage kommen, notwendig, um frühzeitig eine gezielte Therapie einzuleiten. Ergänzend zur klassischen Kultur spielen Schnelltests zur raschen Erregeridentifikation dabei eine immer größer werdende Rolle. In dem ersten Teil der Arbeit werden Methoden zur Infektionsdiagnostik bei Atemwegserkrankungen detailliert vorgestellt. Im zweiten Teil der Übersicht werden spezielle Krankheitsbilder erörtert.

Abstract

Lower respiratory tract infections rank among the most important illnesses in medicine. However, the identification of a causative microbiological agent is often difficult. Pulmonary infections must be differentiated from non-infectious causes of pulmonary diseases with similar symptoms and infiltrates on chest imaging. Among the important novel developments ranks the analysis of serum procalcitonin for a better identification and treatment monitoring of bacterial pneumonias compared to conventional tests and a simple scoring system, like the CRB-65/CURB score, for a rapid risk stratification. A rational diagnostic approach is necessary to identify causative microorganisms of pulmonary infectious diseases depending on the severity of the illness, the exposition and predisposition of the patient. In addition to the classical microbiological methods, rapid test systems for the identification of microorganisms are becoming increasingly important. The first part of this review gives a detailed survey of the methods for the diagnosis of pulmonary infectious diseases. In the second part of the manuscript, we will focus on special pulmonary infectious diseases.

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