Febbre tifoide: cause, sintomi, trattamento
Table of Contents
Definizione
La febbre tifoide è un’ infezione sistemica causata daSalmonella typhi(bacillo di Eberth) che interessa soprattutto il sistema monocito-macrofagico, caratterizzata da febbre, cefalea, disturbi del sensorio, leucopenia e splenomegalia.
Epidemiologia
La febbre tifoide è una malattia diffusa in tutto il mondo. La malattia è presente soprattutto nei paesi in via di sviluppo. Latrasmissione della febbre tifoide avviene per via fecale-orale; fonte di infezione sonol’acquao glialimenti contaminati con salmonellatyphi. Ifrutti di mareingeriti crudi o cotti solo in superficie rappresentano, in Italia, uno dei veicoli più importanti di salmonelle. Un altro veicolo di infezione sono lemoscheche, posandosi su materiali fecali contaminati e poi sugli alimenti, possono inquinare questi ultimi. L’unico serbatoio è l’uomo, malato portatore asintomatico.Salmonella typhipuò persistere nell’intestino o nella colecisti per anni e anche per tutta la vita (portatore cronico).
Eziologia
Salmonellatyphi èun bacillo Gram–, asporigeno, della famiglia delle Enterobacteriaceae; diversamente dalle altre salmonelle, è in grado di metabolizzare il glucosio con la produzione di acido e non di gas. Una volta penetrata nell’organismo attraverso la via orale,Salmonella typhisupera la barriera gastrica e giunge nell’intestino tenue, dove invade le cellule epiteliali arrivando fino alla lamina propria.
Manifestazioni cliniche
Il periodo di incubazione può variare da 3 a 60 giorni, ma è in genere 8-14 giorni. Il decorso clinico della malattia viene classicamente suddiviso in “quattro settenari”, ciascuno dei quali corrisponde all’analogo stadio evolutivo delle lesioni intestinali. In realtà questa suddivisione era valida soprattutto in epoca pre-antibiotica in quanto la somministrazione precoce di antibiotici ha modificato la storia naturale di questa patologia.
Esordio
L’esordio della malattia è generalmente brusco e caratterizzato da:
- Febbre elevata(39-40 C) ad andamento continuo
- Cefalea
- Tosse stizzosa
- Modesti dolori addominalidiffusi o localizzati alla fossa iliaca destra
- L’alvo è per lo più stiticoe solo eccezionalmente diarroico.
- Le labbra appaiono aride, lingua asciutta
- A carico del cavo orale si possono evidenziaretumefazioni tonsillari
- Possono essere presentibradicardia
- Addome meteorico
- Splenomegalia
Seconda settimana
Nella seconda settimana il quadro clinico è caratterizzato da:
- Febbre elevatacontinuaper almeno 15-20 giorni
- Diarrea semiliquidacon feci a “purea di piselli”
- Esantema roseiformefugace all’addome e alla base del torace nel 30% dei casi
- Alterazioni del sensoriocaratterizzati daapatia, astenia, adinamia, rare allucinazioni(cosiddetto “stato tifoso stuporoso” che ha dato il nome alla malattia).
Terza settimana
- Nella terza settimana i segni e sintomi sopra descritti rimangono invariati ad eccezione della bradicardia che regredisce e della febbre che modifica il suo andamento presentando ampie oscillazioni.
Quarta settimana
- Nella quarta settimana di malattia il quadro va gradualmente risolvendosi; oltre allalenta caduta della febbreper lisi, il sensorio migliora e i reperti addominali si risolvono. Segue una lunga fase di convalescenza durante la qualenell‘8-10% dei casi si possono verificarsi ricadute e recidive. Il paziente risulta contagioso per tutto il tempo in cui i bacilli sono presenti negli escreti. Circa il 10% dei pazienti affetti da febbre tifoide non trattata elimina i batteri per 3 mesi dall’insorgenza dei sintomi il2,5% diventa portatore cronico.
Esami di laboratorio
Nella fase febbrile della malattia è possibile osservare unaleucopeniaconneutropeniae una velocità di eritrosedimentazione lievemente aumentata. Nelle fasi più avanzate si possono riscontrare un’anemia normocromicanormocitica, unaproteinuriamodesta e aumento degli indici dinecrosi epatica.
Diagnosi
Il sospetto diagnostico, avanzato sulla base dell’andamento clinico e degli esami di laboratorio deve essere confermato nelle prime fasi dell’infezione dall’isolamento diSalmonella typhie più tardi dalla dimostrazione nel siero del paziente degli anticorpi specifici.
Decorso e prognosi
L’evoluzione della febbre tifoide, fatale in assenza di terapia nel 10% dei casi, è stata nettamente modificata dall’introduzione dell’antibioticoterapia; dopo 7-8 giorni di terapia il paziente può essere già considerato in fase di convalescenza.
Complicanze
Le complicanze della febbre tifoide possono essere digestive ed extradigestive. Fra le prime, le più importanti sono le l’enterorragia e la perforazione intestinale. Fra le complicanze extradigestive le più importanti sono la miocardite, le endocarditi e le tromboflebiti.
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