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 o Vibrio 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 di Vibrio cholerae che possono causare epidemie sono due: il Vibrio cholerae 01 e il Vibrio cholerae 0139. Il sierogruppo 01 provoca la maggior parte delle epidemie.
Trasmissione
La trasmissione avviene per via 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 di Vibrio 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
Il periodo di incubazione è variabile da 1 a 5 giorni. Il sintomo principale è la diarrea 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 con facies 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 non se 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 dalla reidratazione dalla 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. La terapia antibiotica abbrevia del 50% la durata della diarrea, diminuisce la quantità di liquidi persi con le feci e il periodo di escrezione dei vibrioni. Gli antibiotici, generalmente tetracicline o ciprofloxacina,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. Il vaccino protegge solo per 6 mesi ed 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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