Skip to main content
SpringerLink
Log in

Bakterielle Infektionen des Zentralnervensystems

Bacterial infections of the central nervous system

  • Leitthema
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Bakterielle Infektionen des Nervensystems stellen den behandelnden Arzt häufig vor eine große Herausforderung, da mangelnde Sensitivität und vor allem Spezifität klinischer Zeichen die Diagnostik bei Patienten mit Infektionen des Zentralnervensystems (ZNS) erschweren. Bei der Neuroborreliose und bakteriellen Meningitis ist eine Liquoruntersuchung zur Sicherung oder zum Ausschluss der Diagnose notwendig; bei Hirnabszessen wird die Diagnose in der Regel mittels Bildgebung und neurochirurgischer Eiteraspiration gestellt. Der Beitrag fasst entscheidende diagnostische und therapeutische Aspekte der drei wichtigsten behandelbaren bakteriellen Infektionen des Nervensystems (Neuroborreliose, bakterielle Meningitis und Hirnabszess) zusammen.

Summary

Bacterial infections of the nervous system are often challenging for the treating physician because sensitivity and specificity of clinical signs do not reach 100%. In patients with neuroborreliosis and bacterial meningitis, investigations of the cerebrospinal fluid are necessary to confirm or rule out the diagnosis. In intracranial and spinal abscesses, the alterations of the cerebrospinal fluid are most often non-specific and imaging and neurosurgical aspiration of purulent material are additionally needed to make the diagnosis. Here, the relevant diagnostic and therapeutic aspects of three common bacterial infections of the central nervous system (neuroborreliosis, bacterial meningitis, and brain abscess) are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Huppertz HI et al (1999) Incidence of Lyme borreliosis in the Wurzburg region of Germany. Eur J Clin Microbiol Infect Dis 18:697–703

    Article  CAS  PubMed  Google Scholar 

  2. Rauer S et al (2008) Neuroborreliose. Leitlinien für Diagnostik und Therapie in der Neurologie der DGN

  3. Nau R et al (2009) Lyme disease–current state of knowledge. Dtsch Arztebl Int 106:72–81

    PubMed  Google Scholar 

  4. Wilske B et al (2007) Microbiological and serological diagnosis of Lyme borreliosis. FEMS Immunol Med Microbiol 49:13–21

    Article  CAS  PubMed  Google Scholar 

  5. Kaiser R, Fingerle V (2009) Neuroborreliosis. Nervenarzt 80:1239–1251

    Article  CAS  PubMed  Google Scholar 

  6. Halperin JJ et al (2007) Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 69:91–102

    Article  CAS  PubMed  Google Scholar 

  7. Ljostad U et al (2008) Oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial. Lancet Neurol 7:690–695

    Article  PubMed  Google Scholar 

  8. Wormser GP, Halperin JJ (2008) Oral doxycycline for neuroborreliosis. Lancet Neurol 7:665–666

    Article  PubMed  Google Scholar 

  9. Rupprecht TA et al (2005) The chemokine CXCL13 (BLC): a putative diagnostic marker for neuroborreliosis. Neurology 65:448–450

    Article  CAS  PubMed  Google Scholar 

  10. Pfister HW et al (2007) Diagnostik und Therapie der Neuroborreliose. Neurol Psychiatr 1:31–38

    Google Scholar 

  11. Rupprecht TA et al (2006) Cytokine CXCL13–a possible early CSF marker for neuroborreliosis. Nervenarzt 77:470–473

    Article  CAS  PubMed  Google Scholar 

  12. Kastenbauer S, Pfister HW (2003) Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain 126:1015–1025

    Article  PubMed  Google Scholar 

  13. Beek D van de et al (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351:1849–1859

    Article  PubMed  Google Scholar 

  14. Heckenberg SG et al (2008) Clinical features, outcome and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore) 87:185–192

    Google Scholar 

  15. Ostergaard C et al (2005) Clinical presentation and prognostic factors of Streptococcus pneumoniae meningitis according to the focus of infection. BMC Infect Dis 5:93

    Article  PubMed  Google Scholar 

  16. Thomas KE et al (2002) The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis 35:46–52

    Article  PubMed  Google Scholar 

  17. Nigrovic LE et al (2008) Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics 122:726–730

    Article  PubMed  Google Scholar 

  18. Schwarz S et al (2000) Serum procalcitonin levels in bacterial and abacterial meningitis. Crit Care Med 28:1828–1832

    Article  CAS  PubMed  Google Scholar 

  19. Dubos F et al (2008) Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study. Arch Pediatr Adolesc Med 162:1157–1163

    Article  PubMed  Google Scholar 

  20. Krysan D (2009) Serum procalcitonin levels aid in distinguishing bacterial from aseptic meningitis in children. J Pediatr 154:773

    Article  CAS  PubMed  Google Scholar 

  21. Koedel U et al (2009) Akute bakterielle Meningitis: Neues aus Forschung und Klinik. Akt Neurol 36:381–396

    Article  Google Scholar 

  22. Welinder-Olsson C et al (2007) Comparison of broad-range bacterial PCR and culture of cerebrospinal fluid for diagnosis of community-acquired bacterial meningitis. Clin Microbiol Infect 13:879–886

    Article  CAS  PubMed  Google Scholar 

  23. Pfister HW (2002) Meningitis: Klinik – Differentialdiagnose – Pathophysiologie – Therapie. W Kohlhammer GmbH

  24. Tunkel AR et al (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39:1267–1284

    Article  PubMed  Google Scholar 

  25. Diggle MA, Clarke SC (2006) Molecular methods for the detection and characterization of Neisseria meningitidis. Expert Rev Mol Diagn 6:79–87

    Article  CAS  PubMed  Google Scholar 

  26. Fuglsang-Damgaard D et al (2008) Positive blood cultures and diagnosis of bacterial meningitis in cases with negative culture of cerebrospinal fluid. Scand J Infect Dis 40:229–233

    Article  PubMed  Google Scholar 

  27. Proulx N et al (2005) Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM 98:291–298

    Article  CAS  PubMed  Google Scholar 

  28. Auburtin M et al (2006) Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study. Crit Care Med 34:2758–2765

    Article  CAS  PubMed  Google Scholar 

  29. Koster-Rasmussen R et al (2008) Antibiotic treatment delay and outcome in acute bacterial meningitis. J Infect 57:449–454

    Article  PubMed  Google Scholar 

  30. Sudarsanam T et al (2008) Pre-admission antibiotics for suspected cases of meningococcal disease. Cochrane Database Syst Rev CD005437

  31. Chaudhuri A et al (2008) EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol 15:649–659

    Article  CAS  PubMed  Google Scholar 

  32. Pfister HW et al (2008) Bakterielle (eitrige) Meningoenzephalitis. Leitlinien für Diagnostik und Therapie in der Neurologie der DGN. 4. überarb. Aufl. Georg Thieme, Stuttgart

  33. Beek D van de et al (2007) Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev CD004405

  34. Klein M et al (2009) Therapy of community-acquired acute bacterial meningitis: the clock is running. Expert Opin Pharmacother 10:2609–2623

    Article  CAS  PubMed  Google Scholar 

  35. Nau R et al (2008) Hirnabszess. Leitlinien der Deutschen Gesellschaft für Neurologie. Thieme, Stuttgart, S 408–413

  36. Nath K et al (2009) Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesions. Magn Reson Imaging 27:198–206

    Article  PubMed  Google Scholar 

  37. Fertikh D et al (2007) Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging. J Neurosurg 106:76–81

    Article  PubMed  Google Scholar 

  38. Pfister HW et al (2009) Bakterielle Infektionen des ZNS: Diagnostik und Therapie. Intensivmedizin Kompendium und Repetitorium zur interdisziplinären Weiter- und Fortbildung 35. Ergänzungslieferung 1–40

  39. Bok AP, Peter JC (1993) Subdural empyema: burr holes or craniotomy? A retrospective computerized tomography-era analysis of treatment in 90 cases. J Neurosurg 78:574–578

    Article  CAS  PubMed  Google Scholar 

  40. Sendi P et al (2008) Spinal epidural abscess in clinical practice. QJM 101:1–12

    Article  CAS  PubMed  Google Scholar 

  41. Reihsaus E et al (2000) Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 23:175–204

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Neurologische Klinik und Poliklinik, Klinikum Großhadern, Universität München, Marchioninistraße 15, 81377, München, Deutschland

    M. Klein &  H.-W. Pfister

Authors
  1. M. Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.-W. Pfister
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.-W. Pfister.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klein, M., Pfister, HW. Bakterielle Infektionen des Zentralnervensystems. Nervenarzt 81, 150–161 (2010). https://doi.org/10.1007/s00115-009-2854-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-009-2854-6

Schlüsselwörter

Keywords

Search

Navigation