Gastroenteriti virali
Table of Contents
I
Definizione
Le gastroenteriti virali sono infezioni intestinali identificabili, sotto il profilo epidemiologico, in due quadri clinici distinti: una forma da norovirus (in precedenza denominati virus Norwalk), che interessa i bambini e gli adulti, responsabili di epidemie più o meno estese nell’ambito di comunità o di gruppi di soggetti che hanno consumato lo stesso alimento, e una forma da rotavirus, che interessa neonati e lattanti e ha un andamento stagionale.
Eziologia
Gli agenti eziologici delle gastroenteriti virali possono essere identificati nei rotavirus, negli adenovirus umani (specie F, sierotipi 40 e 41), nei norovirus, nei sapovirus e negli astrovirus. I norovirus e i sapovirus appartengono alla famiglia Caliciviridae: sono piccoli virus con genoma a RNA a singolo filamento e sono privi di involucro. Il genere norovirus viene classificato in cinque genogruppi di cui solo tre (GI, GII e GIV infettano l’uomo). Ogni genogruppo viene poi suddiviso in genotipi. Il virus Norwalk è il prototipo del genogruppo I genotipo 1. I rotavirus appartengono alla famiglia Reoviridae e sono virus icosaedrici, di grandi dimensioni e genoma costituito da RNA segmentato a doppia elica. Per la diversità genetica vengono classificati in gruppi denominati con le lettere dell’alfabeto da A a G. Il riassortimento genetico, gli errori di trascrizione dell’ RNA polimerasi e la pressione selettiva immunitaria sono alla base dell’ ampia eterogeneità genetica osservata per questi virus.
Epidemiologia
La trasmissione è per via fecale-orale, tuttavia è stata ipotizzata (per i norovirus) anche una trasmissione per via aerea (tramite droplet durante gli accessi di vomito) o per contatto. Si possono verificare epidemie in comunità chiuse o semichiuse, ospedali, strutture di lungodegenza, carceri, scuole e nell’ambito di ristretti i nuclei familiari.
Patogenesi
La patogenesiè tuttora poco conosciuta. Sembra che il principale evento responsabile della diarrea sia un diminuito assorbimento dell’ acqua e dei sali per compromissione selettiva delle cellule intestinali deputate all’assorbimento, con conseguente disidratazione isotonica e acidosi metabolica compensata.
Manifestazioni cliniche
Il periodo di incubazione è breve 24 -72 ore, solo eccezionalmente fino a 96 ore. L’esordio clinico è improvviso
con nausea, vomito, dolori addominali, diarrea e in alcuni
casi febbre moderata. Le feci, di colore giallastro, sono prive
di muco e sangue. Il decorso si risolve nel volgere di qualche giorno 23 ore nelle forme da norovirus, fino a 8 giorni in quelle
da rotavirus. La malattia predilige l’infanzia. Nella forma da adenovirus, che interessa preferibilmente i bambini più piccoli, ai disturbi gastrointestinali possono associarsi sintomi respiratori.
Nei lattanti, negli immunocompromessi e negli anzianisi può verificare una grave disidratazione.
Alterazioni di laboratorio
Le alterazioni degli indici di laboratorio sono aspecifiche. Si può osservare una lieve riduzione dei leucociti con formula conservata, mentre sono rare le alterazioni degli elettroliti sierici.
Diagnosi
L’accertamento richiede l’identificazione del virus nelle feci. Sono disponibili i test immunoenzimatici per la ricerca del rotavirus, norovirus, adenovirus e sapovirus e test di agglutinazione al lattice per la ricerca dei soli rotavirus.
Prognosi
La prognosi è generalmente buona, ma la letalità è più elevata nei paesi in via di sviluppo, dove la disidratazione e gli squilibri elettrolitici sono più frequenti e meno facilmente correggibili.
Terapia
La terapia è costituita dalla reidratazione.
Prevenzione
La prevenzione si basa sul l’impiego di misure igieniche atte a impedire la contaminazione di acqua e cibo da parte dei virus (pulizia ambientale e dei fomiti, igiene personale, isolamento dei casi). La vaccinazione nei confronti dei rotavirus con i due vaccini disponibili (un vaccino monovalente attenuato di virus umano e un vaccino pentavalente modificato contenente virus umano e bovino ha un’efficacia intorno al 50% nei Paesi a risorse limitate, ma riduce la frequenze delle forme gravi e l’OMS ne raccomanda di impiego routinario.



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