Schmutzhard Erich, Pfausler Bettina
Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
Nervenarzt. 2020 Feb;91(2):161-169. doi: 10.1007/s00115-019-00865-0.
The numbers of migrants, refugees and asylum seekers reached an unprecedented high in Europe in 2015 and 2016 but in 2019 they are back to the average numbers of the last 30 years. In contrast, frequencies of international and intercontinental travelers have continuously increased over the past decades and will continue to do so in the coming years. In 2018 more than 1.35 billion incoming travelers were reported worldwide by international organizations. Detailed knowledge of the epidemiology, transmission types, risk behavior and clinical presentation of acute and chronic central nervous system (CNS) infections enables timely diagnosis and initiation of potentially life-saving emergency treatment. Acute infections of the CNS, e.g. cerebral Plasmodium falciparum malaria or arboviral encephalitis, are seen most frequently and almost exclusively in travelers returning from tropical countries, whereas chronic CNS infections, e.g. tuberculous meningitis or neurocysticercosis, are typically seen in migrants and refugees. Beside CNS infections genetic diseases, environment-associated, nutrition-related, metabolic or cerebrovascular diseases also need to be considered when discussing differential diagnostic possibilities.
2015年和2016年,欧洲的移民、难民和寻求庇护者数量达到了前所未有的高度,但在2019年,这些数字又回到了过去30年的平均水平。相比之下,在过去几十年里,国际和洲际旅行者的数量持续增加,并且在未来几年还将继续增长。2018年,国际组织报告称全球入境旅行者超过13.5亿人次。详细了解急慢性中枢神经系统(CNS)感染的流行病学、传播类型、风险行为和临床表现,有助于及时诊断并启动可能挽救生命的紧急治疗。中枢神经系统的急性感染,如脑型恶性疟原虫疟疾或虫媒病毒性脑炎,最常见且几乎仅见于从热带国家返回的旅行者,而慢性中枢神经系统感染,如结核性脑膜炎或神经囊尾蚴病,则通常见于移民和难民。在讨论鉴别诊断可能性时,除了中枢神经系统感染,还需要考虑遗传疾病、环境相关疾病、营养相关疾病、代谢疾病或脑血管疾病。