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Echinococcosi: come si trasmette, sintomi, terapia

Table of Contents




Definizione

L’echinococcosi è una parassitosi causata dalla forma larvaleidatidediEchinococcus granulosus (agente eziologico della sindrome nota comeidatidosi cistica)e diEchinococcus multilocularis(agente eziologico dell’idatidosi alveolare).

 

Eziologia

Echinococcus  granulosus: il cane, il lupo e talvolta lo sciacallo sono gli ospiti definitivi del parassita (i vermi adulti vivono nell’intestino).L’uomo e numerosi erbivori sono ospiti intermedi; l’infestazione si verifica per ingestione di uova morfologicamente identiche a quelle della (taenia saginata) provenienti da feci di cani che contaminano i legumi crudi o l’acqua non filtrata o tramite le mani leccate dal cane e poi portate alla bocca. Gli embrioni liberati dalle uova attraversano la mucosa intestinale, penetrano nelle vene e arrivano nel fegato o in altri organi dove formano cisti idatidee uniloculari. La trasmissione ad un nuovo ospite definitivo si realizza per ingestione da parte di quest’ultimo di carne di erbivori che contiene cisti idatidea con scolici all’interno; di conseguenza, nelle zone con allevamenti di pecore, la profilassi dell’ echinococco  comporta la somministrazione diantielminticiai cani e l’incenerimento delle carcasse delle pecore infette.

Echinococcus multilocularis: il cane, il gatto, la  volpe o altri roditori sono gli ospiti definitivi; l’infestazione accidentale dell’uomo, per ingestione di frutta selvatica insudiciata dalle feci delle volpi, o mentre si taglia a pezzi una volpe, provoca cisti multiloculari del fegato.

 




Epidemiologia dell’echinococcosi

L’idatidosi cisticaè diffusa in tutto il mondo ed è endemica nei paesi nei paesi del bacino del Mediterraneo Italia compresa, dove si riscontra soprattutto in Basilicata e Sardegna. Il cane si infetta mangiando  viscere degli animali parassitati dalle cisti idatidea e, per poi diffondere l’infezione quando i cestodi adulti che si sono sviluppati nel suo intestino cominciano ad eliminare attraverso le feci le proglottidi contenenti uova, fonte di infezione per gli erbivori e per l’uomo che ingeriscono cibo o acqua da esse contaminate. Meno frequente la trasmissione diretta mediante contatto con il cane nel quale le uova possono contaminare la zona perianale e  il pelo.

 

L’idatidosi alveolareha una distribuzione geografica limitata ad alcune aree dell’emisfero settentrionale (Europa centrale, Canada, Stati Uniti Giappone, Russia) l’uomo contrae la parassitosi mangiando frutti di bosco contaminati dalle  deiezioni delle volpi.




Quali soni i sintomi dell’echinococcosi?

Forme daEchinococcus  granulosus:

  • Il periodo di incubazione dura diversi mesi. La cisti idatidea si sviluppa lentamente; si stima ad esempio che in 6 mesi  non arriva a più di 1 cm di diametro.

Si distingue:

  • Cisti idatidea del fegato: spesso latente, scoperta allapalpazione del fegatoche è ingrandito e non doloroso; talvolta si manifesta con la rottura nel peritoneo o nelle vie biliari. La diagnosi è confermata dalla scintigrafia, ecografia e Tac.
  • Cisti idatidea del polmone: spesso latente, scoperta  in caso di un esame radiologico. Complicazioni:rottura convomito(liquido chiaro),emottisi,infezionee formazione diascesso.
  • Altre localizzazioni:cervello(sindrome pseudotumorale),miocardio,milza,rachide(compressione midollare).

Reazioni anafilattiche: in caso di rottura della ciste, la fuoriuscita di liquido provoca reazioni che possono essere lievi (orticaria, febbre) o molto gravi (sincope,edema polmonare, stato dishock, crisi convulsive.

Echinococcosi secondaria: la rottura della cisti può provocare inoltre la disseminazione degli scolici in essa   contenuti e la formazione di cisti secondarie sia nei pressi della ciste sia a distanza.




Diagnosi

La diagnosi si basa su una corretta anamnesi, su indagini strumentali (ecografia TAC, RMN) e sulla ricerca degli anticorpi mediante emoagglutinazione o test immunoenzimatici. La più specifica èimmunoprecipitazione in gel ,riservata ai laboratori specialistici.

 

Terapia

La terapia può essere chirurgica o medica. L’intervento chirurgico è utile nei casi di grave conpressione tissutale; occorre però evitare ogni diffusione del liquido idatideo (complicanza intraoperatoria). Il  farmaco di scelta l’albendazolo somministrato per via orale per 28 giorni.

 

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