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Tuberkulose

Pathogenese und Wertigkeit immundiagnostischer Tests

Tuberculosis

Pathogenesis and efficacy of immunodiagnostic methods

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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Tuberkulose – verursacht durch Erreger des Mycobacterium-tuberculosis-Komplexes – ist eine in Deutschland heute selten auftretende Infektionserkrankung. Nach einem kontinuierlichen Rückgang der Fälle über die letzten Jahrzehnte erreichte ihre Inzidenz einen stabil niedrigen Stand. Für den Haus- oder Kinderarzt wurde daher der Umgang mit Erkrankungs- und Kontaktfällen zu einem eher außergewöhnlichen Ereignis. Das ist problematisch, da die Tuberkulose weltweit weiterhin zu den häufigsten und lebensgefährlichsten Infektionserkrankungen zählt und durch das vermehrte Auftreten therapieresistenter Mykobakterien noch an Bedeutung gewinnt.

Diagnostik

Die Diagnose der Tuberkulose bei Kindern ist aufgrund der häufig uneindeutigen Symptomatik schwierig, und der sinnvolle Einsatz von immundiagnostischen, bildgebenden und Erregernachweisverfahren ist für die erfolgreiche Therapie grundlegend.

Ziel des Beitrags

Dieser Beitrag soll einen Überblick über die verfügbaren immunologischen Methoden geben und deren Wertigkeit für die Diagnostik einordnen. Anhand aktueller Erkenntnisse zur Pathogenese der Tuberkulose und der latenten Mycobacterium-tuberculosis-Infektion werden neue Ansätze für die Diagnostik und die Identifizierung von Biomarkern aufgezeigt.

Abstract

Background

Childhood tuberculosis is a chronic infectious disease caused by pathogenic bacteria of the Mycobacterium tuberculosis complex genus. Tuberculosis has become rare in most developed countries during recent decades. In contrast, according to worldwide incidence rates, tuberculosis is still among the most frequent and deadly infectious diseases. In Germany, ‘imported’ tuberculosis cases from countries with high disease incidence are important, but the majority of cases occur in children born in Germany. Low case frequencies as well as lost knowledge about tuberculosis symptoms and diagnosis pose the hazard of nonobservance.

Diagnosis

Diagnosis of tuberculosis in childhood is particularly difficult because of often unclear symptomatology. Therefore, reasonable usage of available tools (i.e., immunodiagnostics, imaging techniques, pathogen detection) is crucial for diagnosis.

Aim of this article

This review focuses on immunodiagnostic methods and discusses limitations of available tests. Finally, it summarizes how recent scientific findings on tuberculosis pathogenesis and latent Mycobacterium tuberculosis infection may lead to novel diagnostic approaches and predictive biomarkers for tuberculosis treatment efficacy.

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Authors and Affiliations

  1. Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    M. Kohns, J. Seyfarth, D. Schramm, E. Mayatepek &  M. Jacobsen

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  1. M. Kohns
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  2. J. Seyfarth
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  3. D. Schramm
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  4. E. Mayatepek
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  5. M. Jacobsen
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Correspondence to M. Jacobsen.

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Kohns, M., Seyfarth, J., Schramm, D. et al. Tuberkulose . Monatsschr Kinderheilkd 161, 697–702 (2013). https://doi.org/10.1007/s00112-013-2882-y

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  • DOI: https://doi.org/10.1007/s00112-013-2882-y

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