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Stellenwert der Biopsie in der Diagnostik von Infektionserkrankungen der Haut

Relevance of biopsies for the diagnostics of infectious skin diseases

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Zusammenfassung

Erregerbedingte Hauterkrankungen gehören zu den häufigen Problemen der dermatologischen Praxis. Neben kulturellen und/oder serologischen Nachweismethoden ist die Hautbiopsie eine mögliche diagnostische Maßnahme, insbesondere wenn das klinische Bild noch andere, nichtinfektiöse Erkrankungen differenzialdiagnostisch in Betracht ziehen lässt. Während einige Erreger bereits in der Routinefärbung (mithilfe von Hämatoxylin-Eosin) erkannt werden können (z. B. Hefepilze, Leishmanien), stehen für andere zahlreiche histochemische und immunhistochemische Nachweismethoden zur Verfügung (z. B. „Periodic acid-Schiff reaction“ [PAS] und Grocott-Färbung für Hyphen und Sporen, Ziehl-Neelson- und Fite-Faraco-Färbung für Mykobakterien oder spezifische Antikörpernachweise für Treponema pallidum oder Herpesviren). In anderen Fällen kann eine Infektionserkrankung am Schnittpräparat zwar nicht sicher diagnostiziert werden, es findet sich jedoch ein Infiltratmuster („pattern“), das auf eine erregerbedingte Genese hinweist. Anhand solcher Reaktionsmuster kann der Dermatopathologe den Kliniker auf die notwendige Zusatzdiagnostik (Kultivierung, serologische Untersuchung) aufmerksam machen oder am vorhandenen Biopsiematerial einen molekularbiologischen Erregernachweis veranlassen. Im vorliegenden Beitrag werden Hautinfektionen mit ihren histopathologischen Charakteristika dargestellt, um zu verdeutlichen, inwieweit die Hautbiopsie eine sichere Diagnose ermöglichen oder durch Ausschluss von Differenzialdiagnosen oder molekularbiologische Zusatzdiagnostik hilfreich sein kann.

Abstract

Pathogen-related skin infections are a common problem in the dermatological practice. Apart from culturing and serological detection methods, a skin biopsy is a possible diagnostic procedure, especially when the clinical picture is unspecific and other non-infectious skin diseases are considered as possible differential diagnoses. Some organisms can already be detected by routine staining methods (hematoxylin & eosin, e. g., yeasts, Leishmania), for others numerous histochemical and immunohistochemical stains are available, e. g. periodic acid-Schiff reaction (PAS) and Grocott for hyphae and spores, Ziehl-Neelson and Fite-Faraco for Mycobacteria or specific antibodies for Treponema pallidum or herpesviruses. In other instances, an infectious disease may not be diagnosed with certainty in a histological section but the pattern of inflammatory infiltrates is highly suggestive of an infectious cause. Based on such reaction patterns, the dermatopathologist can advise the clinician to perform cultures or serological investigations or additional molecular biological techniques can be applied to the biopsy specimen in order to identify the pathogens. This article presents skin infections with their histopathological features and highlights diseases that can be diagnosed with certainty in a biopsy and those in which a biopsy is helpful to exclude differential diagnoses or to perform molecular diagnostics on the specimen.

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Böer-Auer, A. Stellenwert der Biopsie in der Diagnostik von Infektionserkrankungen der Haut. Hautarzt 69, 550–562 (2018). https://doi.org/10.1007/s00105-018-4202-x

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