Vibrio vulnificus, eine zunehmende Sepsisgefahr in Deutschland?

Der Anaesthesist - Tập 69 - Trang 672-678 - 2020
C. Metelmann1, B. Metelmann1, M. Gründling1, K. Hahnenkamp1, G. Hauk2, C. Scheer1
1Klinik für Anästhesiologie, Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
2Abteilung 3, Dezernat Umwelthygiene, Umweltmedizin, Landesamt für Gesundheit und Soziales Mecklenburg-Vorpommern, Rostock, Deutschland

Tóm tắt

Die Prävalenz von Vibrio vulnificus hängt entscheidend von der Temperatur und dem Salzgehalt des Meerwassers ab. Am ehesten bedingt durch den Klimawandel sind auch an den deutschen (Ostsee)-Küsten zunehmend Fälle von V.-vulnificus-bedingter Sepsis mit letalem Verlauf zu verzeichnen. Aufmerksamkeit generieren für eine lebensbedrohliche Infektion mit steigender Inzidenz in Deutschland. Dieser Artikel stellt eine Übersicht der aktuellen Literatur dar, gefolgt von exemplarischen Schilderungen von Fällen mit V.-vulnificus-Sepsis nach Kontakt mit Ostseewasser, die im Sommer 2018 an der Universitätsmedizin Greifswald behandelt wurden. Beim Vorhandensein von Risikofaktoren wie Leber- und Nierenerkrankungen, Immunsuppression oder männlichem Geschlecht besteht bei Kontakt geschädigter Haut mit kontaminiertem Meereswasser die Gefahr für eine schwere Sepsis. Häufig zeigt sich schon bei Aufnahme eine ausgeprägte Organdysfunktion. In diesen Fällen muss der Verdacht rasch gestellt werden und frühzeitig mit einer chirurgischen Sanierung und antiinfektiven Therapie (beispielsweise eine Kombination von Tetrazyklinen und Cephalosporinen der 3. Generation) begonnen werden. Die V.-vulnificus-bedingte Sepsis wird vermutlich in den kommenden Jahren zunehmen. Da in einigen Fällen eine zeitliche Latenz zwischen Infektion und Beginn der Sepsis besteht, müssen Ärzte auch außerhalb der Küstenregion über dieses Krankheitsbild informiert sein.

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