Blastomicosi: che cos’è, come si contrae
Table of Contents
Che cos’è lablastomicosi?
Lablastomicosiè una patologia rara, causata da un fungo dimorfo ubiquitario,Blastomyces dermatitidis,diffuso principalmente nel Nord America, centro America e Sud America, endemico negli Stati Uniti centro-occidentali e Sud-orientali (valli fluviali di Mississipi e Ohio).L’habitat naturale è costituito dal terreno, specialmente se è contaminato da feci di uccelli e animali. Il contagio, più frequentemente tra i maschi, avviene attraverso le vie respiratorie con l’inalazione delle spore. I soggetti più a rischio sono i residenti in aree boscose, i contadini, i cacciatori e i campeggiatori.
Quali sono i sintomi della blastomicosi?
L’infezione polmonare acuta è asintomatica in oltre il 50% dei casi; nelle forme clinicamente manifeste la sintomatologia è aspecifica (tosse con espettorato purulento, dolori toracici, emoftoe, progressivo decadimento generale) e insorge dopo un periodo di incubazione di 3-12 settimane; gli aspetti radiologici sono variabili (da infiltrati polmonari localizzati fino a quadri compatibili con sindrome da distress respiratorio acuto). In entrambi i casi la risoluzione spontanea dell’infezione polmonare è rara, più spesso lamicosi tende a disseminarsi per via linfatica ed ematogenaconlocalizzazioni cutanee(70% dei casi),osteoarticolarisoprattutto a livello vertebrale, dellateca cranica e delle ossa lunghe(30% dei casi),urogenitali(15-35%) e più raramente con un interessamento del SNC o del distretto testa/collo. Lemanifestazioni cutaneesono di tipoverrucoso/ ulceratoe in genere localizzate agli arti, collo e cuoio capelluto, caratterizzate all’ istologia da un’ area centralenecroticopurulentacircondata da un’ampia reazione infiammatoria granulomatosa. Nel paziente immunocompromesso la disseminazione a seguito di un’infezione acuta o della riattivazione endogena di una precedente infezione è spesso rapida, gravata da un tasso di letalità elevato (30- 40%), con interessamento del SNC molto più frequente, soprattutto nei pazienti con infezione daHIV.
Come si fa la diagnosi dellablastomicosi?
La diagnosi clinica può essere problematica per la difficoltà a differenziare la blastomicosi da altre infezioni qualitubercolosie coccidioidomicosi; indicativa appare l’osservazione di lesioni contemporaneamente presenti a livello di cute, ossa e polmone. Deve essere mantenuto un elevato sospetto clinico nei pazienti residenti in aree endemiche o con fattori di rischio occupazionali. Nei casi di blastomicosi polmonare, gli accertamenti diagnostici si basano sull’isolamento colturale del fungo da escreato/broncolavaggio, mentre nelle forme extrapolmonari più spesso sull’ esame istologico; la sierologia non gode né di buona sensibilità né di specificità. E’ possibile anche effettuare la ricerca dell’antigene su sangue e urine, per favorire una diagnosi più precoce. La prognosi è sempre riservata.
Terapia
La terapia di attacco è l’amfotericina B liposomialeper due settimane o fino a stabilizzazione clinica, seguita da una terapia di mantenimento conitraconazolo. Nei pazienti immunocompetenti con quadri di blastomicosi polmonare lieve/moderata è raccomandato l’itraconazolo.
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