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      Durch Luft übertragbare Erkrankungen

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          Zusammenfassung

          Die Bedeutung der Luft als Infektionsüberträger wird nicht selten überschätzt: Nur wenige Infektionen wie Tuberkulose oder Aspergillose werden tatsächlich aerogen, d. h. durch die Luft in Form von Aerosolen übertragen. Aerosole sind z. B. wässrige, feste, ölige Schwebstoffe, d. h. winzige Partikel, die wegen ihres geringen Gewichts lange Zeit in der Luft schweben, bevor sie sedimentieren. Hiervon abzugrenzen sind Kontaktinfektionen durch erregerhaltige »große Tröpfchen« (z. B. Influenza, RSV), die durch Husten, Sprechen oder Niesen ausgestoßen werden. Als aerogen übertragbare Infektionen gelten neben Tuberkulose und Aspergillose unter bestimmten Bedingungen auch Masern, Windpocken und Zoster sowie Mukormykosen. Für die von Mensch zu Mensch übertragbaren Infektionen gilt als wichtigste Isolationsmaßnahme die Unterbringung der Patienten in einem Einzelzimmer, möglichst mit negativer Druckführung. Wegen der besonderen klinischen und krankenhaushygienischen Relevanz wird die invasive Aspergillose im Folgenden ausführlich dargestellt, die übrigen Infektionen werden kurz abgehandelt. Die invasive Aspergillose ist eine seltene, überwiegend bei immungeschwächten Patienten nach lang andauernder Neutropenie auftretende Pilzinfektion, die häufig letal verläuft.

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          Most cited references 22

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          Aspergillus fumigatus and aspergillosis.

          Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Humans and animals constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms, and aspergilloma and allergic bronchopulmonary aspergillosis, uncommon clinical syndromes, are the only infections observed in such hosts. Thus, A. fumigatus was considered for years to be a weak pathogen. With increases in the number of immunosuppressed patients, however, there has been a dramatic increase in severe and usually fatal invasive aspergillosis, now the most common mold infection worldwide. In this review, the focus is on the biology of A. fumigatus and the diseases it causes. Included are discussions of (i) genomic and molecular characterization of the organism, (ii) clinical and laboratory methods available for the diagnosis of aspergillosis in immunocompetent and immunocompromised hosts, (iii) identification of host and fungal factors that play a role in the establishment of the fungus in vivo, and (iv) problems associated with antifungal therapy.
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            Invasive aspergillosis.

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              Therapeutic outcome in invasive aspergillosis.

               D Denning (1996)
              A review of series of > or = 4 cases of invasive aspergillosis (total, 1,223 cases) was undertaken to establish the crude mortality and rate of response to therapy with amphotericin B in the major at-risk host groups. In association with pulmonary, sinus, and cerebral aspergillosis in immunocompromised patients, the crude mortality rates were 86%, 66%, and 99%, respectively. No untreated patient survived. Among 84 patients treated for 1-13 days, only one survived. Among those with invasive pulmonary aspergillosis treated for > or = 14 days, the response rates to amphotericin B deoxycholate were 83% (in cases of heart and renal transplantation), 54% (leukemia), 33% (bone marrow transplantation) and 20% (liver transplantation). Patients with AIDS mostly received both amphotericin B and itraconazole, and 37% of those treated for > or = 14 days responded to therapy. Substantial variation in outcome from series to series was related to underlying disease status, site of disease, and management. Invasive aspergillosis remains a devastating opportunistic infection despite current treatment.
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                Author and article information

                Journal
                978-3-540-34525-1
                10.1007/3-540-34525-6
                Praktische Krankenhaushygiene und Umweltschutz
                Praktische Krankenhaushygiene und Umweltschutz
                978-3-540-23746-4
                978-3-540-34525-1
                2006
                : 99-106
                Affiliations
                GRID grid.7708.8, ISNI 0000000094287911, Institut für Umweltmedizin und Krankenhaushygiene, , Klinikum der Albert-Ludwigs-Universität, ; Hugstetter Straße 55, 79106 Freiburg,
                GRID grid.412301.5, ISNI 0000000086531507, Zentralbereich für Krankenhaushygiene, , Universitätsklinikum Aachen, ; 52057 Aachen,
                Article
                9
                10.1007/3-540-34525-6_9
                7143833
                © Springer Medizin Verlag Heidelberg 2006

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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                © Springer Medizin Verlag Heidelberg 2006

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