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Febbre bottonosa del Mediterraneo

Table of Contents




 

Definizione

La febbre bottonosa del mediterraneo è una malattia infettiva a decorso acuto e a evoluzione generalmente benigna, specialmente in età pediatrica, causata da Rickettsia conorii, trasmessa all’uomo dalla zecca del cane, Rhipicephalus sanguineus. La febbre bottonosa del mediterraneo  è caratterizzata dalla triade sintomatologica febbre, esantema papuloso e tache noire (piccola area di necrosi indurita).

 

Eziologia

L’agente patogeno è la “Rickettsia conorii”. Nelle zone attorno al Mediterraneo, la malattia è trasmessa dalla zecca del cane (Rhipicephalus sanguineus), altrove dalle zecche dei roditori selvatici. Il cane e i roditori selvatici costituiscono gli ospiti intermedi ed i serbatoi del virus. La malattia si presenta soprattutto nel periodo tra giugno e settembre con un picco ad agosto, periodo in cui il ruolo della zecca non è solo quello di vettore ma anche di principale serbatoio dell’infezione.




Manifestazioni cliniche

Nella sede della puntura della zecca, si osserva una piccola macchia nera, o escara superficiale, che può ulcerarsi e che si accompagna ad adenopatia regionale. Dopo un’incubazione di 5-7 giorni, compaiono i segni generali:

  • Febbre a plateau
  • Atralgie
  • Disturbi gastrointestinali.

Tre o quattro giorni dopo l’inizio della febbre, un’ eruzione maculo papulosa compare sul tronco e si estende rapidamente alle estremità, fino alle palme delle mani e le piante dei piedi. Il viso è colpito raramente.  Le lesioni cutanee possono eccezionalmente essere  l’origine di emorragie; si può osservare una reazione meningea normalmente benigna, si ha regolarmente guarigione in 1-2  settimane.




Complicazioni

Le complicanze sono molto più frequenti se il paziente presenta comorbidità (insufficienza renale o cardiaca, emoglobinopatie o coagulopatie) o ha una compromissione del microcircolo come avviene nel soggetto diabetico. Encefalite, gastrite emorragica, trombosi renale, embolia polmonare, scompenso metabolico, miocardite, anemia, piastrinopenia e coagulazione intravascolare disseminata sono le complicanze che vengono più frequentemente osservate.

Alterazioni di laboratorio

Gli esami di laboratorio mostrano in genere una modica leucopenia, trombocitopenia e lieve incremento delle transaminasi e degli indici di flogosi.

Diagnosi

La diagnosi clinica è facile nelle aree endemiche  in presenza di tache noire; la conferma di laboratorio si basa sulla ricerca degli anticorpi specifici di classe  IgM e IgG con metodiche di immunofluorescenza indiretta; spesso in fase acuta l’esame può dare un esito negativo e in tal caso per diagnosi sarà esclusivamente clinica.




Terapia

Nel paziente adulto vengono impiegate tetracicline o cloramfenicolo In età pediatrica nei casi non complicati, possono essere utilizzati macrolidi (claritromicina e azitromicina). I farmaci vengono in genere  somministrati fino a 2 giorni dopo la defervescenza.




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