Colera: come si contrae, sintomi e terapia
Table of Contents
Definizione
Il colera è una malattia acuta altamente contagiosa provocata da Vibrio cholerae o vibrione. Il colera è caratterizzato da diarrea profusa e vomito, che evolve verso la disidratazione ed il collasso circolatorio.
Eziologia
L’agente patogeno è il vibrione di Koch oVibrio cholerae;; si tratta di un piccolo bacillo corto a forma di virgola, mobile e gram-negativo. Il vibrione rimane localizzato nel lume intestinale e secerne un’ enterotossina che attiva l’adenilciclasi, che aumenta il tasso dell’ AMP ciclico intracellulare e provoca un’ ipersecrezione intestinale e una perdita massiccia d’acqua e di elettroliti. I sierogruppi diVibrio cholerae che possono causare epidemie sono due: il Vibrio cholerae 01 e il Vibrio cholerae0139. Il sierogruppo 01 provoca la maggior parte delle epidemie.
Trasmissione
La trasmissione avviene pervia oro-fecale.Le principali fonti di contagio sono l’acqua e cibi(pesci, crostacei e molluschi crudi, verdura cruda, latte), contaminati da feci umane con presenza diVibrio cholerae. Il contagio diretto è raro. Il serbatoio dell’infezione è esclusivamente umano e risulta costituito oltre che dal malato, dai portatori (soggetti con infezioni subcliniche, convalescenti, portatori asintomatici). La suscettibilità individuale è variabile e nelle epidemie la malattia si manifesta solo nell’ 1-2 % della popolazione, mentre i portatori di germi sani sono molto numerosi.
Manifestazioni cliniche
Ilperiodo di incubazione è variabile da 1 a 5 giorni.Il sintomo principale è ladiarrea improvvisa, caratterizzata da numerose scariche (fino a 50 100 nelle 24 ore), in assenza di febbre, tenesmo e dolori addominali (attacco colerico). Le feci si presentano liquide, incolori e inodori, con assenza di leucociti, emazie, muco e caratterizzate da fiocchetti costituiti da precipitati chimici e vibrioni conglutinati che conferiscono l’aspetto ad “acqua di riso“. Con l’evacuazione e il vomito,vengono perse notevoli quantità di elettroliti e liquidi.
Come conseguenza compaiono:
- Crampi muscolari
- Intensa astenia
- Secchezza delle fauci
- Ipotermia cutanea
- Tachicardia
- Ipotensione arteriosa
- Riduzione della diuresi.
Nel giro di 24 ore il paziente assume il tipico aspetto algido confacies da mummia(occhi infossati, guance incavate, palpebre semichiuse, naso affilato, labbra secche, cianotiche, adese ai i denti, addome a barca, voce roca e afona. Il sensore rimane invece integro.
Diagnosi
- Anamnesi di soggiorno in una zona di endemia o di epidemia.
- Inizio brusco con diarree profuse liquide.
- Vomito, segni di disidratazione rapida con stato di shock e uremia.
- Diagnosi confermata dalla coltura delle feci e dalla reazione di agglutinazione da siero specifico.
Prognosi
Se nonse non trattato il colera è fatale nel 60% dei casi,sopravviene l’ exitus in 2-3 giorni per shock irreversibile, acidosi, insufficienza renale da necrosi tubulare acuta secondaria alla prolungata ipovolemia.
Terapia
La terapia è rappresentata dallareidratazionedalla reintegrazione dei sali minerali da effettuare in tempi rapidi con utilizzo di soluzioni idroelettrolitiche per via endovenosa fino all’ esaurirsi della diarrea e alla normalizzazione dei parametri clinici di laboratorio. Laterapia antibioticaabbrevia del 50% la durata della diarrea, diminuisce la quantità di liquidi persi con le feci e il periodo di escrezione dei vibrioni. Gli antibiotici, generalmentetetraciclineociprofloxacina,possono abbreviare il decorso della malattia.
Prevenzione
Il colera è una patologia soggetta a notifica obbligatoria.La prevenzione si basa sull’impiego di misure igieniche volte impedire la contaminazione di acqua e cibo da parte di escreti umani infetti (lavaggio accurato delle mani, smaltimento di feci umane, consigli per i viaggiatori in aree endemiche) sul riconoscimento dei portatori asintomatici e sulle misure di vaccinazione. I vaccini iniettabili sono costituiti da microrganismi uccisi. Ilvaccino protegge solo per 6 mesied è efficace nella metà dei casi. La vaccinazione è richiesta per recarsi in alcuni Paesi. Il vibrione è distrutto a 80 ° in 5 minuti e dagli insetticidi usuali.Nelle zone di endemia, utilizzare solo acqua bollita e alimenti cotti.
Due vibrioni sono patogeni per l’uomo
- “Vibrio parahaemolyticus” che provoca in Giappone una gastroenterite dopo ingestione di pesce infetto.
- “”Vibrio alginolyticus che non produce tossine ma che può infettare le piaghe.
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- Colera, per combatterla in Africa arriva la più grande dose di vaccini
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