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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