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Febbre gialla: come si contrae, sintomi e vaccino



Che cos'è la febbre gialla? La febbre gialla è una malattia infettiva caus ata dalla pntura di zanzare infette. La febbere gialla è trsmessa da un arbovirus. La febbre gialla è un'infezione sistemica che provoca danni soprattutto a carico del fegato. La febbre gialla può essere prevenuta con la vaccinazione. La febbre gialla è endemica in Sud America, in Africa
Febbre gialla


Che cos’è la febbre gialla?

La febbre gialla è una malattia infettiva, presente in alcune aree tropicali, causata da un arbovirus (famiglia Flaviviridae) trasmessa all’uomo da zanzare. Si presenta come un virione sferico di circa 49 nm di diametro;il genoma è costituito da una singola molecola di RNA.  I quadri clinici sono variabili; nelle forme più gravi è tipica la presenza di ittero, emorragie, proteinuria.



Quali sono i Paesi a rischio di febbre gialla?

L’infezione è endemica nelle aree umide (foreste tropicali) dell’Africa subsahariana e dell’America centro-meridionale. La trasmissione è mediata da zanzare del genere Haemagogus e Sabethes  in America meridionale e Aedes  in Africa. Il serbatoio può essere rappresentato sia dall’uomo sia dai primati. Da un punto di vista epidemiologico si distingue un ciclo urbano e ciclo silvestre. Nel primo, la anzara si infetta pungendo l’uomo durante la fase viremica (i primi 3 giorni di infezione). Nel secondo caso si tratta di un’infezione enzootica che coinvolge primati infetti. In Africa la trasmissione avviene soprattutto durante la stagione delle piogge e l’inizio della stagione secca nella savana. Una volta infetta, la zanzara rimane tale per il resto della vita trasmettendo l’infezione alle uova.

 

Quali sono i sintomi della febbre gialla ?

Dopo un periodo di incubazione di 3-6 giorni, la febbre gialla esordisce in modo brusco con:

  • Temperatura elevata (39-40°C)
  • Brividi
  • Cefalea
  • Rachialgia
  • Nausea
  • Vomito

In poche ore subentra la fase rossa, caratterizzata da:

  • Aspetto rosso acceso del volto
  • Iniezione congiuntivale
  • Epistassi
  • Bradicardia relativa (segno di Faget)
  • Oliguria
  • Febbre persistente di tipo continuo

La fase rossa coincide con la viremia e si esaurisce  in 3 giorni. Segue una fugace remissione dei sintomi che perdura per non più di 24 ore e che prelude alla fase gialla, che compare pertanto al quarto- quinto giorno di malattia ed è dominata dalla comparsa di:

  • Ittero
  • Manifestazioni emorragiche (epistassi, gengivorragie, ematemesi, melena e oliguria. La temperatura si eleva e permane di tipo continuo intorno ai 40° C .
  • Può comparire danno miocardico con ipocinesia grave.
  • Nei casi favorevoli il paziente si avvia a gurigione senza reliquati dopo 12-14 giorni.
  • L’exitus può subentrare per insufficienza epatica, renale o miocardica grave.

 

Terapia

Non esiste una terapia specifica. Un trattamento sintomatico può alleviare i sintomi della malattia, quali deidratazione e febbre. Dieta liquida ricca in idrati di carbonio e in proteine.



 

Prevenzione e vaccinazione

 

Oltre alla bonifica ambientale (lotta alle zanzare) e all’isolamento del paziente, la prevenzione della febbre gialla si fonda sulla vaccinazione. Si utilizza un (YF-17D) che, dopo un’unica somministrazione sottocute, conferisce immunità protettiva per almeno 10 anni. Non contiene alluminio. Il vaccino è abitualmente ben tollerato e sono rare le complicanze neurologiche.

Molto raramente è possibile sviluppare reazioni gravi, se non addirittura mortali.

Queste includono:

  • Una reazione allergica, con difficoltà a respirare o a deglutire (anafilassi).
  • Un edema del cervello, del midollo spinale o dei tessuti circostanti (encefalite o meningite).
  • La sindrome di Guillain-Barré, una malattia rara del sistema nervoso nella quale il sistema immunitario danneggia le cellule nervose causando debolezza muscolare e, talvolta paralisi.
  • Una disfunzione o insufficienza di un organo interno.

 

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