Endemische systemische Mykosen – Besonderheiten bei Reisenden

 

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ZUSAMMENFASSUNG

Die Diagnosestellung einer endemischen Mykose ist häufig schwierig, insbesondere in Nichtendemiegebieten. Eine genaue Reiseanamnese ist entscheidend. Die Histoplasmose ist die häufigste endemische Mykose bei Reisenden. Besichtigungen von Fledermaushöhlen oder Renovierungsarbeiten im Hotel sind mögliche Infektionsquellen. Die Paracoccidioidomykose wurde bei Langzeitreisenden in Südamerika beobachtet, während bei Reisenden nach Südostasien an eine Talaromykose gedacht werden sollte. Abhängig von der Reiseanamnese sind die Coccidioidomykose oder die Blastomykose weitere mögliche endemische Mykosen bei Reisenden. Der kulturelle oder histologische Nachweis ist die Methode der Wahl zur Diagnosesicherung für die meisten endemischen Mykosen. Im Mittelpunkt der antimykotischen Therapie steht Itraconazol bei milden bis mittelschweren und Amphotericin B bei schweren Verlaufsformen.

ABSTRACT

To establish the diagnosis of endemic mycoses is often challenging, especially in low-endemicity settings. A precise travel history is crucial. Histoplasmosis is the most frequently reported endemic mycoses in travelers. Visits of caves colonized by bats or construction activities in hotel are a possible source of infection. Paracoccidioidomycosis has been reported among long-term travelers to South America, while in travelers to South East Asia talaromykosis should be kept in mind. Depending on the travel history coccidioidomycosis and blastomycosis are also possible endemic mycoses in travelers. Culture or histology is the method of choice to establish diagnosis for most endemic mycoses. Antifungal therapy includes itraconazole for mild and moderate and amphotericin B for severe disease.

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