Botulismo: che cos’è, cause, sintomi, terapia
Table of Contents
Che cos’è il botulismo?
Il botulismo è una gravissima intossicazioneprovocata daClostridium botulinum. La tossina prodotta dal microorganismo, una volta ingerita, viene assorbita nell’intestino tenue da dove raggiunge il sistema nervoso periferico attraverso il circolo sanguigno. I primi sintomi (nausea, vomito, diarrea) si manifestano 12-48 ore dopo l’ingestione del cibo contaminato. Dopo breve tempo, si associano disturbi a carico del sistema nervoso periferico (diplopia, alterazione della deambulazione, paralisi dei muscoli fino al coinvolgimento di quelli respiratori).
Eziologia
L’agente patogeno è il “Clostridium botulinum”, un bastoncino ciliato, poco mobile, gram positivo, anaerobio con spore subterminali. Lo si trova nel terreno, nella frutta e nei legumi, nel tubo digerente degli animali e dell’uomo. Il bacillo non è direttamente patogeno; però in condizioni anaerobie ad esempio in alcuneconserve alimentari,produce unaesotossinachiamatabotulina.
Si descrive anche ilbotulismo da ferita e ilbotulismo del lattanteda colonizzazione del tubo digerente da parte del bacillo botulinico. Lespore del bacillo resistono all’ebollizione per 22 ore, ma sono distrutti a 120 ° da autoclave.La tossina è invece termolabileed è inattivata dall’ebollizione in 10 minuti. Il botulismo è provocato dall’ingestione della tossinache è stata liberata precedentemente nelleconserve, nei salumi e in ogni alimento conservato sotto olio senza sterilizzazione. I caratteri organolettici dei cibi inquinati non si modificano significativamente, mentre è caratteristico il rigonfiamento delle scatole metalliche provocato dalla formazione di gas, espressione della moltiplicazione del bacillo.
Quali sono i sintomi del botulismo?
I primi sintomi dell’intossicazione compaiono in genere dopo 12- 48 ore dall’ingestione del cibo inquinato, ma il periodo di incubazione può variare da poche ore a più di una settimana. In genere il decorso della malattia è tanto più grave quanto più precoce è l’esordio clinico. Un periodo prodromico, caratterizzato daastenia, nausea diarrea, può precedere la comparsa delle manifestazioni tipiche.
Il quadro è tipicamente caratterizzato da:
- Paralisi oculari, con strabismo divergente
- Ptosi palpebrale e diplopia, talora accompagnate da fotofobia.
La contemporanea compromissione dell’innervazione oculare intrinseca si manifesta con:
- Paralisi dell’accomodazione
- Midriasi
- Anisocoria.
La progressione dei disturbi neurologici è generalmente discendente; vengono via via interessati i nervi glossofaringeo e vago, condisfagia e disartria, il nervo ipoglosso e il facciale.
Il coinvolgimento della muscolatura respiratoria, sebbene non raro, è per lo più asintomatico e solo nei casi a evoluzione più grave si possono avere dispnea e insufficienza respiratoria. Altre manifestazioni comprendono unaparalisi flaccida asimmetrica degli artiealterazioni della muscolatura liscia dei tratti digerente urinariocon conseguente stipsi e ritenzione urinaria. All’esame obiettivo il paziente appare generalmente lucido, ben orientato e sempre apiretico anche nelle fasi acute della malattia.
Decorso del botulismo
Il decorso del botulismo è variabile in relazione al tipo e alla quantità di tossina ingerita e alla precocità delle cure di supporto. Nel 5-20 % dei casi la malattia conduce rapidamente a morte per insufficienza respiratoria o arresto cardiaco da paralisi bulbare. Nei casi a evoluzione favorevole, i disturbi neurologici si risolvono nell’arco di settimane o mesi residuando talora alterazione dell’accomodazione e della meccanica respiratoria.
Diagnosi
- Anamnesi diingestione di conserve,in particolare se prodotta in casa, servite a freddo e di disturbi collettivi.
- Diplopia, secchezza della bocca, disfonia, disfagia, debolezza muscolareche evolve verso la paralisi respiratoria.
- Stipsidi tipo occlusivo,oliguria o anuria.
- Diagnosi confermata dalla ricerca della tossina negli alimenti.
Trattamento
I pazienti con sintomi da intossicazione botulinica devono essere immediatamente ricoverati in Unità di Terapia Intensiva per poter procedere, se necessario alla respirazione assistita ed eventualmente alla tracheotomia, e se il consumo di degli alimenti inquinati è recente, alla lavanda gastrica. La somministrazione il più presto possibile dellatossina botulinicaneutralizza la tossina libera,ma non agisce su quella che si è già fissata sulle placche motrici.Di conseguenza la somministrazione nelle prime 48 ore è essenziale. Va somministrata, in questi casi, l’antitossina specifica trivalente verso le tossine A, B ed E, che è in grado di legare e inattivare la tossina ancora in circolo. L’utilizzo di antibiotici (penicillina, metronidazolo) è raccomandato nel botulismo da ferita, ma controindicato nel botulismo infantile, perché può incrementare la liberazione di tossine.
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