22. St. Galler Infekttag - Honolulu Infektiologie - narrenfrei · Gnathostomiasis Respiratory (n = 288) Influenza Pulmonary TB Legionella Atypical mycobacteria Pertussis Streptococcal

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22. St. Galler Infekttag - Infektiologie - narrenfreiCarol Strahm

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Antipode Solothurn

Honolulu

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Fieber bei ReiserückkehrernNarren aus aller Welt Carol Strahm

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2016 1.235 Milliarden Touristen (+3.9%)

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1. Februar 2017 21:10

www.unwto.org

http://www.unwto.org

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12 %

11 %

20 %

23 %

34 %

Gastrointestinale SymptomeFieberDermatologische Symptomerespiratorische Infektionenandere

Kategorien von reiseassoziierten Erkrankungen

• Gastrointestinal: Akute Diarrhö (Spezifische Erreger: Campylobacter, Salmonella, Shigella, Giardia); ETEC?; Chronische Diarrhö; postinfektiöses „colon irritabile“

• Fieber als Leitsymptom in fast 1/4 der Patienten

• Dermatologisch: Verletzungen von Tieren (Bisse, Kratzer), Insektenstiche, Haut-Weichteilinfektionen und Juckende Hautausschläge

• Respiratorisch: Infektionen obere Atemwege, Influenza oder grippale Infekte; Bronchitis, Pneumonie

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Leder (2013). Ann Int Med, 158(6), 456–468

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Lebensbedrohlichen Infekte: >90% Fieber

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Beck - 2016 // Jensenius (2013). Am J Trop Med Hyg, 88(2), 397–404. // Mueller (2014) J Travel Med 21(3), 169–182 // Leder (2013). Ann Int Med, 158(6), 456–468

THE BIG 5 (n=32136)

Lebensbedrohlich (n=3655/82825 (4%))

Todesfälle (n=13/3655 (0.4%))

in der Praxis

Malaria Malaria Malaria (10) 50% globale Infektionen (Harnwegsinfekte, obere/ untere Atemwegsinfekte,

Gallenwegs-Infekte, Wundinfekte, …

Dengue Typhus abdominalis Melioidose (2)

Typhus abdominalis Leptospirose Dengue (1)

Rickettsiosen Rickettsiosen auch: Rickettsiosen, andere bakterielle Infekte

(Pneumonie, Urosepsis) Influenza, Enephalitiden

Malaria selten (wsh 0.2%)

Chikungunya Dengue Dengue? HIV?

31 versc

hieden

e Diag

nosen

!

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Fieber bei Reiserückkehrern in der Praxis

• 1.5 Mio Schweizer mit aussereuropäischen Übernachtungen (2014)

• ca 3-19% Fieber in der ersten Woche nach Rückkehr (45 000 bis 280 000)

• ca 50% melden sich in Praxis/ Ambulatorium —> 1 Konsultation pro Monat!

• Herausforderung

• Wer hat exotische Krankheit mit individuellem Risiko?

• Wer hat exotische Krankheit mit Risiko für Übertragungen?

• keine Infektionen …? Venenthrombosen und Lungenembolien; Medikamentenallergien

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Thwaites (2017) NEJM, 376(6), 548–560 // Beck - der informierte Arzt - 2016

1 2 3

Prioritätes Denken!

www.fevertravel.ch

http://www.fevertravel.ch

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Vorgehen in der Praxis - Anamnese• Reiseland? Genau Reiseroute?

• Städtereise? Ländliche Gebiete?

• Reisestil: Rucksack? Luxustourismus? Hygiene? Visiting Family?

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WO?

WANN?

WIE?• Essen und Trinken: Qualität?

• Wasserkontakt? Süsswasser? (e.g. Schwimmen? Rafting?)

• Tierkontakte? Tierbisse? Insektenstiche?

• Sexualkontakte?

• Trockenzeit? Regenzeit?

• Dauer des Aufenthaltes?

• Zeitpunkt der Rückkehr? (Inkubationszeit!!)

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Subsahara-Afrika

Lateinamerika und Karibik

Südzentral-Asien

Südostasien

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Leder (2013). Ann Int Med, 158(6), 456–468

Neu: Chikungunya und ZIKA

Figure 2. Top identified specific causes for gastrointestinal, febrile, dermatologic, and respiratory illnesses by region among illreturned travelers.

Proportion

Gastrointestinal (n = 3323)Giardia

StrongyloidesCampylobacter

SalmonellaShigella

Febrile (n = 4222)P. falciparumRickettsia, SF

DengueP. vivax

Enteric feverDermatologic (n = 1731)

CLMRabies PEP

MyiasisTungiasis

ScabiesRespiratory (n = 982)

Pulmonary TBInfluenza

Atypical mycobacteriaPertussis

Legionella

Sub-Saharan Africa (n = 11 251)

Proportion



D. fragilisE. histolytica

Febrile (n = 1436)DengueP. vivax

Enteric feverP. falciparum

Hepatitis ADermatologic (n = 2435)

CLMCutaneous leishmaniasis

Rabies PEPMyiasisScabies

Respiratory (n = 689)Influenza

Pulmonary TBLegionella

PertussisAtypical mycobacteria

Latin America and aribbean (n = 8099)

Proportion

Gastrointestinal (n = 2038)Campylobacter

GiardiaSalmonella

StrongyloidesD. fragilis

Febrile (n = 1818)Dengue

P. falciparumP. vivax

ChikungunyaEnteric feverLaptospirosis

Dermatologic (n = 226)Rabies PEP

CLMScabies

Marine envenomationGnathostomiasis


Pulmonary TBStreptococcal pharyngitis

Atypical mycobacteriaLegionella

Pertussis

Southeast Asia (n = 6890)

Proportion

00.0

50.1

00.1

50.2

00.2

5


CampylobacterShigella

E. histolyticaD. fragilis

Febrile (n = 1355)Enteric fever

DengueP. vivax

ChikungunyaExtrapulmonary TB


Cutaneous leishmaniasisScabies

CLMLeprosy

Respiratory (n = 512)Pulmonary TB

InfluenzaStreptococcal pharyngitis

PertussisHigh-altitude pulmonary edema

South-Central Asia (n = 5752)

Proportion


CampylobacterSalmonella

ShigellaStrongyloides

Febrile (n = 254)Hepatitis A

P. falciparumAcute brucellosis

Enteric feverDengueQ fever


Cutaneous leishmaniasisCLM

Marine envenomationScabies




Middle East and North Africa (n = 2553)

Proportion


GiardiaD. fragilis

SalmonellaC. difficile

Febrile (n = 213)Acute HIVHepatitis A

Nonpulmonary TBMeaslesQ fever


Cutaneous leishmaniasisErythema chronicum migrans

ScabiesCLM

Marine envenomationRespiratory (n = 498)

InfluenzaPulmonary TB

LegionellaAtypical mycobacteria

Streptococcal pharyngitis

Europe (n = 1993)

Proportion0 0.1 0.2 0.3 0.4

0 0.1 0.2 0.3 0.4

0 0.1 0.2 0.3 0.4


GiardiaAscaris

D. fragilisTapeworm


Nonpulmonary TBHepatitis EHepatitis A

Enteric feverRickettsia, SF


ScabiesCLM

MyiasisGnathostomiasis





Northeast Asia (n = 1135)

Proportion

00.0

50.1

00.1

50.2

0

00.0

50.1

00.1

50

0.05

0.10

0.150.2

0


CampylobacterCryptosporidium


Febrile (n = 43)Coccidioidomycosis

Rickettsia, SFHantavirusHepatitis E


Rabies PEPMarine envenomation

ScabiesCLMLice


Pulmonary TBAtypical mycobacteria

Pertussis

North America (n = 623)

Proportion

0 0.1 0.2 0.3

0 0.1 0.2 0.3

Gastrointestinal (n = 123)Strongyloides

CampylobacterGiardia


Febrile (n = 120)P. vivaxDengue

P. falciparumRoss River virus



ScabiesLice

CLMRespiratory (n = 130)


PertussisPulmonary TB

Australia, New Zealand, and Oceania (n = 576)

C

More than 5 diagnoses are shown if !1 cause had equal numbers of cases. These graphs represent proportions, and there is variability in the number ofill travelers represented from panel to panel (shown from largest to smallest traveler numbers). CLM " cutaneous larva migrans; D. fragilis "Dientamoeba fragilis; E. histolytica " Entamoeba histolytica; P. falciparum " Plasmodium falciparum; P. vivax " Plasmodium vivax; PEP " postexposureprophylaxis; SF " spotted fever; TB " tuberculosis.

Original ResearchIllness in Returned Travelers

www.annals.org 19 March 2013 Annals of Internal Medicine Volume 158 • Number 6 461

Downloaded From: http://annals.org/pdfaccess.ashx?url=/data/journals/aim/926560/ by a Universitat Zurich User on 02/04/2017


Proportion



SalmonellaShigella


DengueP. vivax


CLMRabies PEP

MyiasisTungiasis




Legionella


Proportion













Proportion


GiardiaSalmonella






CLMScabies





Pertussis


Proportion

00.0

50.1

00.1

50.2

00.2

5





DengueP. vivax




CLMLeprosy





Proportion














Proportion


GiardiaD. fragilis






ScabiesCLM





Europe (n = 1993)

Proportion0 0.1 0.2 0.3 0.4

0 0.1 0.2 0.3 0.4

0 0.1 0.2 0.3 0.4


GiardiaAscaris

D. fragilisTapeworm





ScabiesCLM







Proportion

00.0

50.1

00.1

50.2

0

00.0

50.1

00.1

50

0.05

0.10

0.150.2

0








ScabiesCLMLice



Pertussis


Proportion

0 0.1 0.2 0.3

0 0.1 0.2 0.3








ScabiesLice





C






Proportion



SalmonellaShigella


DengueP. vivax


CLMRabies PEP

MyiasisTungiasis




Legionella


Proportion













Proportion


GiardiaSalmonella






CLMScabies





Pertussis


Proportion

00.0

50.1

00.1

50.2

00.2

5





DengueP. vivax




CLMLeprosy





Proportion














Proportion


GiardiaD. fragilis






ScabiesCLM





Europe (n = 1993)

Proportion0 0.1 0.2 0.3 0.4

0 0.1 0.2 0.3 0.4

0 0.1 0.2 0.3 0.4


GiardiaAscaris

D. fragilisTapeworm





ScabiesCLM







Proportion

00.0

50.1

00.1

50.2

0

00.0

50.1

00.1

50

0.05

0.10

0.150.2

0








ScabiesCLMLice



Pertussis


Proportion

0 0.1 0.2 0.3

0 0.1 0.2 0.3








ScabiesLice





C






Proportion



SalmonellaShigella


DengueP. vivax


CLMRabies PEP

MyiasisTungiasis




Legionella


Proportion













Proportion


GiardiaSalmonella






CLMScabies





Pertussis


Proportion

00.0

50.1

00.1

50.2

00.2

5





DengueP. vivax




CLMLeprosy





Proportion














Proportion


GiardiaD. fragilis






ScabiesCLM





Europe (n = 1993)

Proportion0 0.1 0.2 0.3 0.4

0 0.1 0.2 0.3 0.4

0 0.1 0.2 0.3 0.4


GiardiaAscaris

D. fragilisTapeworm





ScabiesCLM







Proportion

00.0

50.1

00.1

50.2

0

00.0

50.1

00.1

50

0.05

0.10

0.150.2

0








ScabiesCLMLice



Pertussis


Proportion

0 0.1 0.2 0.3

0 0.1 0.2 0.3








ScabiesLice





C





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Reisende in Mittelmeerländer

• Phlebotomusfieber (Pappataci-Fieber)

• Leishmaniose, Rickettsiosen, West-Nile-Virus

• Autochthone Fälle von Dengue und Chikungunya

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epidemic is still ongoing, although the implemented mea-sures and the decrease in temperatures led to an importantreduction of the daily reported cases. If in the week 46 (Nov12e18) there was a peak of 315 weekly reported cases,after 3 weeks, in the week 49 (Dec 03e09), the number ofweekly reported cases dropped at 57 (Fig. 3). As theclimate is very favorable (the winter temperature does notdrop below 10 !C) the breeding activity of Ae. aegypti isexpected to continue till at least the beginning of 2013[28,31,33]. Furthermore, the risk of another wave of in-fections in springtime, when the Aedes mosquitoes aremore active, remains a threat and Madeira has a landscaperich in vegetation that provides many possible breedingsites.

Discussion

Although the presence of Ae. albopictus in Italy and Francewas reported in the ’90s, local transmission of CHIKV andDENV occurred at the earliest in 2007 and 2010 respec-tively. This can be explained by the presence of importedvirus and a wide distribution of a competent vector Ae.albopictus.

In order to assess the risk of reappearing of epidemics inthe coming years many aspects should be considered:vector distribution, vector competence, virus introductionand host characteristics.

Vector distribution

Ae. aegypti and Ae. albopictus have recently shown a largegeographical expansion in to new territories. In particularthe latter, also known as Tiger Mosquito, is ranked as themost invasive species of mosquito in the world [35].

Ae. albopictus was originally to found in Southeast Asiaand the islands of the western Pacific and Indian Ocean, butin the last three to four decades it has spread to newcontinents. At present, it is found in many regions fromNorth to South America, Africa, Australia and Europe,where its presence has been reported in 20 Europeancountries (Fig. 4). In Europe, it was first reported in Albania(1979) and then in Italy (1990), France (1999), Belgium(2000), Spain (2003), Switzerland (2003), Croatia (2004),the Netherlands (2005) and subsequently in the othercountries [25,35e37]. This rapid territorial expansion canbe attributed to the ability to survive long voyages and coldtemperatures. It was probably introduced in Albania and inItaly through cargo ships (from China and USA respectively)transporting the eggs in used tyres [35,37]. Ae. albopictus

Figure 4 Distribution of Aedes albopictus in Europe (Sept 2012), modified from VBORNET.

39 40 41 42 43 44 45 46 47 48 49 50 51 52 10

500

1000

1500

2000

2500

9145 173 219

395

164 252 315219

102 57 53 24 9 8

Dengue cases, Madeira weeks 39/12-1/13Probable and confirmed cases

Cases by weekAll cases

Week

N°o

f cas

es

Figure 3 Distribution of cases by week and total of all cases,week 39/12e1/13.

Chikungunya and dengue autochthonous cases in Europe 279

Ehehalt (2014) Travel Med Infect Dis 12(2), 167–172 // Tomasello (2013) Travel Med Infect Dis 11(5), 274–284 // Schlagenhauf (2015). Lancet Inf Dis 15(1), 55–64

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of Aedes albopictus in the region. The index case wasidentified at the beginning of September and was found tobe a man who had just returned from India. Two daysbefore becoming febrile, on 23rd of June, he visited rel-atives in Castiglione di Cervia and the first detected casewas a relative of this man. The outbreak lasted from 4thJuly till 28th September, resulting in 337 suspected casesfulfilling clinical and/or epidemiological criteria, 217 ofwhich were laboratory confirmed and 30 were categorizedas probable cases (i.e. no laboratory analysis was done,butboth clinical and epidemiological criteria were fulfilled)[11,12]. The infection spread to the two neighbouringvillages, Castiglione di Cervia and Castiglione di Ravenna,where 142 cases were later confirmed. Small clusters werefound in other towns of the Emilia-Romagna region, up to100 km away: Cervia (19 cases), Cesena (15), Ravenna (9),Rimini (6) and Bologna (5) [13] (Fig. 1 and Fig. 2). A studyfrom Moro et al. [14] on chikungunya seroprevalence,conducted in a sample of residents of Castiglione di Cerviasome months after the end of the outbreak, showed 12more individuals with a positive titer, not being identifiedby the active surveillance system at the time of theoutbreak. This number may be overestimated, becausetwo of the cases were immigrants from Senegal (endemicfor chikungunya) and had had a recent stay (<2 yearsearlier) in their country of origin. As a consequence, thefinal number of laboratory confirmed cases was 229. Ingeneral, almost all patients showed high fever andarthralgia in many joints, and half of them presented alsowith skin rash. One person died e an elderly man debili-tated by some co-morbidities. Thus, compared to theoutbreak of La Reunion (2005e07), the mortality was quitesimilar (0.5% compared to 0.1% in La Reunion) and theattack rate calculated in Castiglione di Cervia much lower(5.4% compared to 34% in La Reunion). Molecular analysisshowed that the virus had the acquired E1-A226V muta-tion, favorable for the transmission from Ae. albopictus[11,14e16].

A retrospective analysis was done to identify which ofthe 247 cases identified during the epidemic was hospital-ized due to the viral infection.

Matching vital statistics with univocal regional code, itwas possible to identify 216 individuals who made contactwith the regional sanitary system. 32 of them had hospital

discharge whereof 25 with a diagnosis compatible withchikungunya fever (11.6% of 216 cases).

Long-lasting rheumatic disorders were described in acohort study from Moro et al. [17]: Twelve months after theacute stage of disease, 66.5% of the patients suffered fromarthralgia, myalgia or asthenia. Similar results were re-ported from other studies conducted after the outbreak inLa Reunion Island. The evaluation of joint functionalityespecially showed disability in the use of lower extremitiesand in the daily activities. Risk factors for disability wereolder age and a history of rheumatic diseases. These vari-ables and also female gender were linked with an increasedinflammatory response during the acute stage of thedisease.

In 2010, other cases of chikungunya fever were re-ported in France. The index case was a young girl living inFrejus, who presented with fever, headache and abdom-inal pain on the day following her return from India. Afterthree weeks, two other young girls presented with febrilesymptomatology; one of them was a neighbour who invitedanother girl, a classmate, to spend a night at her home, on15th of September, where both girls reported being bittenseveral times by mosquitoes. These two girls had no travelhistory. All the three patients had no acute complications,but after 3 months they still presented with asthenia andarthralgia. The molecular analysis revealed a genotypetypical of the Asian strain (E1-211E), but, unlike from theoutbreak in Italy, it did not present with the mutation E1-A226V [18].

Autochthonous cases of dengue fever in Europe

Dengue fever disappeared in Europe at the beginning of thelast century. The last outbreak occurred in Greece in theyears 1927e1928. During this epidemic, DENV caused onemillion cases with more than 1000 deaths and was trans-mitted by Aedes aegypti [19]. Currently, as a result of thespread of competent vectors and the increase in the num-ber of viremic travellers importing the infection, local caseshave reappeared in Europe. Cases of nosocomial acquiredinfections (after needle stick injures) which have been re-ported in France and Germany in the last years (4 cases)will not be considered in this review [20e22].

The first autochthonous dengue case was reported inNice (France), in the late summer of 2010. A 64 years oldman, presented with fever, myalgia and asthenia on the23rd of August. After 4 days he was admitted to hospital.The serological tests revealed the presence of

Figure 1 Distribution of cases during the Chikungunyaoutbreak in Emilia-Romagna 2007 (map design: LucaDall’Acqua).

Figure 2 Local cases of chikungunya fever and dengue feverin Europe, 2007e2012 (map design: Luca Dall’Acqua).

276 D. Tomasello, P. Schlagenhauf

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www.guideliens.ch // Sanford (2016). Medical Clinics of North America

Inkubationszeiten

Kurz <2 Wochen 2-3 Wochen > 3 Wochen

Malaria Malaria Malaria

Influenza Akuter HIV Hepatitis A, B, E

Dengue/ Chikungunya/ ZIKA Bruzellose Bilharziose (Katayama-Fieber)

Rickettsiosen (Fleckfieber, African tick bite fever) Q-Fieber Leishmaniose

Leptospirose Amöben-Leberabszess

hämorrhagisches Fieber Filariosen

Typhus abdominalis Tuberkulose

WANN?

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Tropische Krankheiten nach Expositionen

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Rohe, exotische Speisen Gastroenteritis, Hepatitis A/E, Trichinellose

Wasser, unpast Milchprodukte Typhus, Gastroenteritis, Hepatitis A, Brucellen

Schwimmen Süsswasser Bilharziose, Leptospirose

Sexuelle Kontakte (akuter) HIV und andere STDs, Hepatitis B

Insektenstiche Malaria, Dengue, Chikungunya, ZIKA, Rickettsien, Trypanosomen (afrikan. und südamerikanische), Tularämie, Leishmania

Tiere und Tierbisse Tollwut, Pest, Q Fieber, Tularämie, virale hämorrhagische Fieber

Kranke Personen, gedrängte Verhältnisse

Lassa, Marburg, Ebola, Hepatitis A, Meningokokkenmenigitis, Influenza, Tuberkulose

WIE?

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Reisevorbereitung

• Reiseberatungen?

• Impfungen?

• Gelbfieberimpfung? Hepatitis A?

• Malaria

• Prophylaxe eingenommen? Medikament? Dosierung? Compliance?

• Moskitonetz? Klimaanlagen? Repellentien?

• ABER: Keine Prävention ist 100% effektiv —> Malaria muss trotzdem gesucht werden!

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Klinische Untersuchung• Pathognomonische Symptome sind selten!

• Schwere Erkrankung? —> Meningismus, Bewusstseins-einschränkungen, Dyspnö, Hypotonie und Schock, spontane Blutungen

• quickSOFA-Score

• Integument: Hautausschläge (Viren, Rickettsien, HIV), Eschar (Afrika -> African Tick Bite Fever; Asien -> Scrub Typhus), Blutungen -> VHF, Meningokokken, Leptospirose

• Relative Bradykardie: Typhus abdominalis

• Hepatosplenomegalie: häufig bei febrilen tropische Erkrankungen (typisch: Amöben, virale Hepatitis, Leishmaniose)

• Konjunktivitis: Leptospiren, Rickettsien, ZIKA

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Fieber und intrahepatische Raumforderung

Die wichtigsten Differenzialdiagnosen sind der Amöbenleberabszess (s. oben), bakterielle Leberabszess sowie – selten – eine akute Leberegelinfektion durch Fa-sciola hepatica.

Krankheiten

LeptospiroseDie Leptospirose ist eine weltweit verbrei-tete Zoonose. Am häufigsten erfolgt die Übertragung auf den Menschen indirekt durch Wasser oder Erde, die durch infi-zierten Tierurin, meist von Hunden, Rat-ten, Rindern oder Schweinen, verunrei-nigt ist. In vielen Fällen verläuft die Infek-tion inapparent oder mit milden, unspe-zifischen Allgemeinsymptomen. Jedoch

treten regelmäßig auch lebensbedroh-liche Verläufe mit Blutungsneigung so-wie Leber- und Nierenversagen auf (Mor-bus Weil). Insbesondere bei Vorliegen der Kombination aus Myalgien, Konjunktivi-tis, Ikterus und Petechien sollte an eine Leptospirose gedacht werden.

Fieber und Lymphknotenschwel-lungen bzw. Splenomegalie

Generalisierte Lymphknotenschwellun-gen mit Fieber treten bei einer Vielzahl von viralen, bakteriellen und parasitären Infektionen auf. Lymphotrope Virusin-fekte, z. B. Mononukleose oder Zytome-galie, werden häufig importiert. Diffe-renzialdiagnosen sind die akute HIV-In-fektion und die Toxoplasmose. Ansons-ten sollte an Denguefieber und Brucello-se gedacht werden. Nuchale Lymphkno-

tenschwellungen bei Fieber nach Afrika-aufenthalt sind pathognomonisch für die sehr selten importierte Schlafkrankheit (Winterbottom-Zeichen), die Diagnose beruht auf dem Nachweis der Trypanoso-men im Blut.

D Eine Splenomegalie findet sich häufig bei infektiösen Systemerkrankungen.

Bei jedem Patienten mit Fieber, (Hepato-)Splenomegalie und Panzytopenie sollte an die viszerale Leishmaniasis (Kala-Azar) gedacht werden. Die Brucellose ist eine wichtige Differenzialdiagnose, bei lang anhaltendem Fieber auch die Tuberkulo-se. Bei der akuten Malaria des Nichtim-munen ist die Splenomegalie kein Früh-symptom, erst nach 1–3 Wochen kommt es zur Milzvergrößerung (. Infobox 5).

Abb. 2 8 Patient mit Fieber nach Safari in Südafrika: Afrikanisches Zecken-bissfieber mit typischem Eschar

Abb. 3 8 Patient mit rezidivierendem Fieber nach Westafrikareise: Rückfallfieber mit Borrelia duttoni im Blutausstrich

Abb. 4 9 Patient mit einer pulmonalen His-toplasmose nach Be-such einer Fleder-maushöhle (zunächst unter Verdachtsdiag-nose einer Sarkoido-se mit Kortison behan-delt, darunter rasche Progredienz der Infil-trate)

Abb. 1 9 Patient mit Fieber und Oberbauchschmerzen: Amöbenleberabs-zess im Computertomogramm

277Der Internist 3 · 2014 |

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Wichtigste initiale Laboruntersuchungen

• Blutbild mit Diff. (inkl Leukozyten, Thrombozyten, Eosinophile), CRP, Kreatinin, Leberwerte

• Malaria suchen: Malariaschnelltest, Ausstrich und dicker Tropfen (Wiederholen?!)

• bei Verdacht auf Dengue: Serologien oder Schnelltest (Nullserologie?)

• Urinstatus

• weitere Tests…

• nach Symptom: HIV?, Röntgen-Thorax, US Abdomen, LP, …

• Aktuelle Epidemiologie: zB 2014 Ebola; 2016/17 ZIKA; 2017 Gelbfieber

• Blutkulturen

14

www.safetravel.ch www.who.int/csr/don/en/

3

http://www.safetravel.ch

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Aktive ZIKA-TransmissionSchwangere: Abraten von Reisen; nach Rückkehr „safer sex“ ( 6 Mt; 8 Wo CDC/ 6 Mt WHO

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CDC Website

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Take Home Messages

• Erste Einschätzung des Patienten —> vitale Gefährdung (qSOFA)? Ansteckende Krankheit?

• Malaria-Risiko? Dengue (häufig Asien und Süd-/ Mittelamerika)?

• Praxis: oft banale/ globale Infekte: virale und bakterielle Infekte

• Inkubationszeiten > 3 Wochen —> kein Dengue/ Chikungunya/ ZIKA, keine Rickettsien, Leptospiren

• virale hämorrhagische Fieber und seltene bakterielle Ursachen bedenken (Leptospiren, Meningokokken, Rickettsien, …)

• ZIKA: Länder mit aktiver Transmission —> abraten für Schwangere (Mikrozephalie), Safer Sex nach Rückkehr (Sexuelle Transmission möglich)

16

Beck - der informierte Arzt - 2016

2 31

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Zapfenstreich - «I ma nümm»Narren aus aller Welt

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Quellen: www.guidelines.ch // www.cdc.gov // slides of 23rd swiss international short course on travellers’ health // PMID 28177860 24557143 26027485 27884405

http://www.guidelines.ch

http://www.cdc.gov

22. St. Galler Infekttag - Honolulu Infektiologie - narrenfrei · Gnathostomiasis Respiratory (n = 288) Influenza Pulmonary TB Legionella Atypical mycobacteria Pertussis Streptococcal

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