Die Pneumonie auf Reisen

Approximately 1% of the travellers visiting tropical and subtropical regions develop respiratory tract infections or pneumonia during or after their trip.Of the febrile episodes in returning travellers, up to 11% are caused by respiratory tract infections.The spectrum of causative agents includes those seen in temperate regions, with legionellosis being diagnosed increasingly, and a number of other agents which are rare or absent in temperate regions.On a worldwide scale, the most common causative agents of pneumonia are Streptococcus pneumoniae,Haemophilus influenzae,Mycoplasma pneumoniae and Chlamydia pneumoniae.Besides, tuberculosis, legionellosis, and influenza constitute special risks for travellers.Very rare causes of imported pneumonia which are limited to certain regions include tularemia, anthrax, melioidosis, glanders, plague, and infections with dimorphic fungi such as histoplasmosis, coccidioidomycosis, and North or South American blastomycosis. Ubiquitous but rare causes of travel-associated pneumonia are Coxiella burnetii,Chlamydia psittaci,Chlamydia trachomatis,Actinomyces spp., RSV and Hanta viruses, Toxoplasma gondii and Cryptococcus neoformans (European blastomycosis). In addition, lung involvement in generalized diseases after long-distance traveling has to be considered like falciparum malaria, typhus, ehrlichiosis, amebiasis,brucellosis, viral hemorrhagic fevers and others. In case of pneumonia and eosinophilia, an allergic etiology, aspergillosis, or helminthiasis should be considered.Fever and eosinophilia after traveling in tropical regions should also evoke suspicion of Katayama syndrome. In the early stages of some nematode infections (Ascaris lumbricoides, Strongyloides stercoralis, Necator americanus and Ancylostoma Duodenalis), larval migration may provoke lung infiltrates associated with peripheral eosinophilia.Rare causes of eosinophilia-associated lung infiltrates or lung involvement in travellers include infections with lung flukes, echinococcosis, Larva migrans, Dirofilaria immitis, and Toxocara spp.