Liquordiagnostik bei erregerbedingten neurologischen Erkrankungen

 

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Zusammenfassung

Die Analytik des Liquor cerebrospinalis ist von zentraler Bedeutung in der frühen Diagnosestellung erregerbedingter neurologischer Erkrankungen. Neben der Bestimmung grundlegender liquoranalytischer Parameter wie Zellzahl, Proteine und Laktat, ist die gezielte Suche nach Erregern bakterieller, viraler oder pilzbedingter Infektionen des ZNS entscheidend. Dies kann direkt mittels mikrobiologischer Spezialfärbungen, Kulturmethoden, Nukleinsäure- oder Antigennachweis erfolgen oder indirekt serologisch im Blut oder mittels Nachweis einer erregerspezifischen Antikörpersynthese im Liquor. Neben der Vermittlung von Grundlagen der klinischen Liquordiagnostik soll dieser Fortbildungsartikel den Blick für die speziellen Aspekte der Erregerdiagnostik schärfen. Auf diese Weise soll ermöglicht werden, durch konkrete Fragestellungen an das Labor eine zielgerichtete Analytik zu veranlassen und deren Ergebnisse kritisch zu interpretieren, um dem Patienten die bestmögliche Behandlung zukommen lassen zu können.

Abstract

Cerebrospinal fluid analysis is of prime importance to establish an early diagnosis of central nervous system infections. Beside the basic diagnostics containing CSF white cell count, lactate concentration and protein analysis, the targeted search for agents of bacterial, viral or fungal CNS infectious diseases is essential. Decisive methods are bacterial and fungal staining techniques, microbiological culture methods, nucleic acid amplification and antigen detection methods or indirect identification of pathogens by serologic testings including the determination of pathogen-specific intrathecal immunoglobulin synthesis. Besides imparting basic principles of cerebrospinal fluid analysis, this article focuses on special aspects of detection of infectious agents. Well-directed questions and a close communication between clinician and laboratory allow optimal diagnostic analysis for successful confirmation of the diagnosis and for optimal treatment of the patient.

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