Malaria: che cos’è, sintomi, come curarla
Table of Contents
Che cos’è la malaria?
Lamalariaè una malattia causata da protozoi intracellulari del generePlasmodiumtrasmessa all’uomo dalla puntura di zanzareAnophelesinfette. La malaria è caratterizzata da accessi difebbre intermittente con brividi e sudorazioni, che evolve verso un’ anemia con splenomegalia e un ittero emolitico.La malaria è endemica in gran parte dei paesi delle aree tropicali e subtropicali di Africa, America centrale e meridionale, Sud-Est asiatico e Oceania; circa il 40% della popolazione mondiale in 97 paesi vive in aree malariche ma la popolazione a maggior rischio si concentra in Africa subsahariana.
La malaria osservata nel nostro paese e nella maggior parte dei paesi occidentali è una malattia di importazione tipica delviaggiatore o degli immigrati. A parte l’infezione naturale (autoctona o introdotta), trasmessa dalla zanzaraAnophelesinfetta, è possibile la trasmissione della malaria contrasfusioni di sangue infetto,plasmaferesi, contrapianto d’organo(malaria indotta) o in seguito a incidenti di laboratorio, a con scambio disiringhecontenenti sangue infetto tra tossicodipendent. E’ inoltre possibile latrasmissione transplacentare(malaria congenita).
Eziologia
Nell’uomo la malaria è causata da 4 specie diverse di plasmodi:
- Plasmodium falciparum, responsabile della malaria maligna o terzana
- Plasmodium vivax responsabile della terzana benigna
- Plasmodium ovale che provoca una forma simile di malaria terzana benigna
- Plasmodium malariaeresponsabile di una forma di malaria definita “quartana” a causa della caratteristica periodicità con cui si presenta la febbre.
Il ciclo biologico dei plasmodi è caratterizzato da unciclo sessuatoosporogonicoche avviene nella zanzara e unciclo asessuato oschizogonicoche avviene nell’uomo o in altri ospiti intermedi. L’infezione umana inizia quando una zanzaraAnophelesfemmina, che sia portatrice dei plasmodi, effettuando il proprio pasto ematico inietta glisporozoiticontenuti nelle cellule salivari; questi una volta penetrati nel torrente circolatorio, raggiungono nell’arco di qualche ora il fegato dove ha luogo la prima replicazione asessuata (fase schizogonica pre-eritrocitaria).
Un singolo sporozoite può dare origine a un numero dimerozoiticompreso tra 10.000 e 30.000. I merozoiti vengono rilasciati in circolo al termine della prima replicazione da parte degli epatociti che vanno incontro a lisi; una volta in circolo i merozoiti invadono i globuli rossi dove, seconda della specie in causa (in un periodo di 48-72 ore) si moltiplicano(fase schizogonica eritrocitaria) e portano alla lisi del globulo rosso con rilascio in circolo di nuovi merozoiti. All’interno del globulo rosso una volta prenetrato il merozoite, inizia la divisione asessuata e il parassita va incontro a diversi stadi di sviluppo: trofozoite giovane, trofozoite maturo, infine schizonte.
Sintomi della malaria
I sintomi della malaria inizialmente si manifestano con:
- Febbree sintomi aspecifici (cefalea, astenia, dolori muscolari). Sono frequenti anche nausea, vomito e ipotensione ortostatica.
- I parossismi febbrile a intervalli regolari possono verificarsi nelle forme daPlasmodium vivaxo daPlasmodium ovale.
- Può svilupparsi splenomegalia associata all’anemia, epatomegalia e ittero.
La grave malariafalciparumcausa disfunzioni di più organi:
- Malaria cerebrale: si caratterizza per un’ encefalopatia diffusa simmetrica e la comparsa di coma; è contraddistinta da una letalità del 20% negli adulti del 15% tra i bambini; l’esordio può essere improvviso dopo una crisi comiziale. Le convulsioni vengono osservate nel 50% dei bambini con malattia celebrale; in questi ultimi possono residuare disturbi cognitivi di apprendimento, deficit del linguaggio ed epilessia.Coma, ottundimento, delirium.
- Segni di prognosi infausta:ipoglicemia, soprattutto nei bambini e nelle donne gravide,acidosi,edema polmonarenon cardiogeno,insufficienza renale, graveanemiaeanomalie della coagulazione, graveitteroe disfunzione epatica.
Malaria in età pediatrica:la maggior parte dei decessi per malaria riguarda i bambini, nei quali sono molto frequenti le crisi convulsive, il coma, l’acidosi e la grave anemia.
Malaria da emotrasfusione: presenta un periodo incubazione più breve rispetto alla forma naturalmente acquisita.
Splenomegalia tropicale:risposta anomala a infezioni ripetute. I pazienti presentano splenomegalia massiva e, in misura minore, epatomegalia. I pazienti riferiscono una sensazione di tensione addominale.
Diagnosi
Il dato anamnestico del viaggiatore o la provenienza da zone malariche è fondamentale per il sospetto diagnostico di malaria nel paziente febbrile. La diagnosi definitiva richiede l’esecuzione dell’esame microscopico, strisci sottili di sangue colorati con la colorazione diWright-Giemsaconsentono la valutazione della morfologia del parassita all’interno dei globuli rossi, spesso la speciazione, e la determinazione della percentuale di parassitemia (densità del parassita). Accanto all’indagine emonoscopica tradizionale si è andata affermando negli ultimi anni l’impiego deitest diagnostici rapidiche si basano sulla dimostrazione di antigeni derivati dei parassiti malarici, come lattato-deidrogenasio la HRP-2 presenti nel sangue lisato o impiegando metodi di immunocromatografici.
Come si cura la malaria?
Il miglior trattamento disponibile, in particolare per la malaria da plasmodium falciparum è la terapia combinata a base diartemisinina. È efficiente contro tutte le specie di plasmodio, però risulta specialmente utile in presenza di infezioni da parassiti resistenti alla clorochina o multiresistenti ai farmaci.
Prevenzione
La prevenzione si basa essenzialmente sull’impiego di misure per ridurre l’esposizione alle punture delle zanzare, nell’assunzione di farmaci per la chemioprofilassi. Importante non espo rsi nelle ore di maggiore attività delle zanzare dall’alba al tramonto; dormire in stanze con aria condizionata o impiegare zanzariere intorno al letto. Usare indumenti preferibilmente chiari che coprono la maggior parte del corpo; repellenti (antizanzare spray) sulla pelle e sugli abiti.
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