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Malattia di Lyme: malattia trasmessa dalle zecche



 

 

 

Definizione

 Il morso di una zecca può rappresentare l’inizio di un incubo. Un batterio che infesta questi parassiti, la Borrelia burgdorferi, può infatti essere trasmesso all’uomo provocando la malattia di Lyme, con il suo lungo strascico fatto di mal di testa, dolori articolari, debolezza, disturbi cardiovascolari e neurologici. Lamalattia di Lyme (o boreliosi di Lyme) è la più frequente infezione trasmessa dazecchein Nord America ed Europa: è causata da uno spirochete del genere Borrelia spp. Lamalattia di Lymeprende il nome dalla località in cui fu osservata per la prima volta nel Connecticut, su pazienti che manifestavano artrite reumatoide giovanile, chiamata in principioartrite di Lyme,che ne caratterizzava la sintomatologia clinica, ora chiamatamalattia di Lyme. Lo spirochete venne successivamente identificato da parte di Burgdorfer e  Barbour nel 1982. La malattia di Lyme viene di solito diagnosticata dal rilievo del quadro clinico caratteristico in associazione alla conferma sierologica.

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Eziologia ed epidemiologia

Il complessoBorrelia burgdorferi sl comprende almeno 18 genospecie che presentano diversa distribuzione geografica e si associano a quadri clinici talora differenti.

La malattia di Lyme è causata da 4 diverse specie di Borrelia:

  • B. burgdorferi sensu lato;
  • B. burgdorferi sensu stricto;
  • B.afzelii
  • B garinii


Le diverse genospecie in causa possono essere all’origine delle differenti presentazioni cliniche osservate in Europa rispetto al Nord America. Si tratta dispirochete di 8-30 micronin lunghezza per 0,2-0,5 mobili. Sono difficili da coltivare e necessitano di terreni specifici. La distribuzione geografica della malattia di Lyme è la seguente:

  • negli Usa la sola causa della malattia eB. burgdorferi senso stricto
  • in Europa sono in causa B.afzelii,  B. gariniie forseB. valaisiana e minor misuraB. burgdorfersensu stricto
  • in Asia B.afzelii,  B garinii

Lamalattia Lymecostituisce la principale infezioni trasmesse da vettori negli Stati Uniti (con più di 20.000 nuovi casi/anno e in Europa con circa 65.500 casi/anno).  In natura il microrganismo presenta un ciclo enzootico che interessa 14 diverse specie di zecche che appartengono al complessoIxodes ricinus. 

 

 

Trasmissione



La trasmissione avviene attraverso il morso di una zecca infetta del genereIxodes in Europa; negliUSApossono trasmettere la malattia altre specie di Ixodidae  tra cui:

  • I. scapularis 
  • I. pacificus

in Asia il vettore è:

  • I. persulcatus.

Le zecche sono contraddistinte da un ciclo che presenta tre stadi di sviluppo e si protrae per 1-2 anni: larva. ninfa e stadio adulto, ognuno dei quali richiede un pasto ematico che dura alcuni giorni per lo sviluppo. Gli studi epidemiologici  di sorveglianza è più recenti indicano che hanno roba da prevalenza media di infezione delle zecche da parte di Borelli aspp e del 13,7%. e, la maggiore prevalenza si osserva in Europa centrale Austria Germania Repubblica Ceca Slovenia Svizzera e Slovacchia

La prevalenza della malattia di Lyme è osservata negli USA dove ha incidenza di 6-8 /100.000 abitanti; in Italiasono stati descritti in quasi tutte le regioni in particolare Trentino-alto Adige, Veneto, Friuli-Venezia Giulia, Liguria, Emilia.

Serbatoio della malattia sono roditori ed altri mammiferi (cervidi). Il ciclo vitale si svolge nell’ambito degli animali portatori deglispirocheti. Le larve di zecca (99% indennità daBorrelia) alla nascita si nutrono su topi e ratti (che sono infetti per tutta la vita, peraltro senza malattia), in occasione del primo pasto di sangue si infettano; dopo il pasto la larva si stacca e cade nel terreno da dove riemerge in primavera come ninfa infettante; a questo punto è in grado di trasmettere l’infezione ad altri roditori e mammiferi suscettibili, tra cui l’uomo.

Il 90% delle infezioni sono trasmesse dalle ninfe, attive soprattutto in tarda primavera e inizio estate, mentre il 10% dei casi consegue al morso della zecca adulta, attiva soprattutto a fine estate e nei giorni caldi dell’autunno. La trasmissione avviene tardivamente nel corso del pasto ematico, di solito dopo 48-72 ore di permanenza​.

Manifestazioni cliniche

Nellamalattia di Lymesi distinguono 3 stadi:

  • precoce localizzato
  • precoce disseminato
  • tardivo disseminato

Ilprimo stadio (precoce localizzato) si verifica nell’ 80% dei casi; si manifesta da 4 a 60 giorni dopo l’inoculazione, è caratterizzato da:

  • febbre
  • mialgia
  • astenia
  • eritema cronico migrante(EM classico di questa malattia

L’eritema appare come un’area arrossata il cui centro tende a schiarirsi (lesione a bersaglio)e che tende gradualmente a espandersi (migrante)fino a un diametro di 20 cm, sovente singola ma talvolta multipla, corrisponde alla sede di inoculazione. E’ diagnostico, può essere il solo sintomo della malattia. Sede più frequente:

  • regione inguinale
  • ascelle
  • fossa poplitea
  • vita

 

non doloroso può talora prudere o causare sensazione di bruciore.

Il secondo stadio (precoce disseminato) inizia da alcune settimane a mesi dopo l’infezione. Si osservano multiple lesioni eritematose intorno alla sede di inoculazione, associate a manifestazioni extracutanee.

 

Neurologiche:

  • cefalea
  • meningite linfocitaria
  • paralisi faciale unilaterale o bilaterale
  • radiculopatia
  • neuropatia periferica
  • radiculopatia
  • neuropatia periferica
  • monoeuropatia multipla
  • atassia cerebellare (rara)

La classica triade consiste in:

  • meningite
  • neuropatia cranica
  • radiculoneuropatia sensitivo/motoria

 

Cardiache

(8/10% dei casi non trattati in USA 0,3-0,4% in Europa): possono essere il solo aspetto evidente della malattia; i pazienti possono essere asintomatici o presentare:

  • sincope
  • palpitazione
  • dolore toracico
  • dispnea
  • ECG, anormalità di conduzione

Oculari

  • congiuntivite(10%)

Altre molto più rare:

  • cheratite
  • iridociclite
  • vasculite retinica
  • coroidite
  • neuropatia ottica
  • uveite

In Europa è descritto il linfocitoma, che consiste in una lesione singola rosso-bluastra, edematosa, del diametro di alcuni centimetri e che si estingue spontaneamente.

 

Il terzo stadio (tardivo disseminato) si manifesta da tre mesi a anni dopo l’infezione. Si presenta consintomi articolari o neurologici.

  1. Artrite delle grandi articolazioni.L’artrite è intermittente o persistente, a carico delle grandi articolazioni (soprattutto del ginocchio).
  2. Manifestazioni neurologiche(rare). Encefalopatia moderata, neuropatia periferica encefalomielite.
  3. Manifestazioni cutanee.Acrodermatitis chronica atrophicanssulla faccia estensoria delle mani o dei piedi; da una fase di edema di colorito rosso-bluastro, le lesioni evolvono allargandosi e atrofizzandosi.


Diagnosi

La diagnosi per la malattia di Lyme presuppone il sospetto clinico (attenzione perché molte volte i pazienti non ricordano la puntura della zecca) e la corretta valutazione delle manifestazioni; gli esami sierologici (Elisa,Western blot) permettono di confermare il sospetto diagnostico. L’anamnesi deve essere accurata: devono essere ottenuti i dettagli del viaggio, delle attività svolte, eventuali osservazioni della zecca e devono essere poste precise domande su precedenti manifestazioni cutanee consistenti con la malattia.

Diagnosi clinica e sierologica

La diagnosi di malattia di Lyme  è clinica nella prima fase, sierologica successivamente. Due terzi dei pazienti con malattia di Lyme sono sieronegativi quindi, in presenza di quadro clinico  e anamnesi epidemiologicamaente consistente o positiva per contatto con zecca, il trattamento si impone. Nei pazienti con malattia di Lyme disseminata precoce o  tardiva la diagnosi risiede su un quadro clinico compatibile associato ad anamnesi positiva di soggiorno in aree endemiche e presenza di anticorpi. L’assenza di una storia di EM non esclude l’infezione.

La malattia di Lyme  non deve essere diagnosticata soltanto sulla base di un dato sierologico in assenza di una evidenza epidemiologica di esposizione e di un quadro clinico compatibile. Non deve essere fatta diagnosi di malattia di Lyme in quadri clinici complessi soprattutto se mancano  segni obiettivi di danno d’organo di infiammazione.

Sierologia

Nelle fasi precoci, le sierologie possono essere negative; pertanto, in caso di sospetto clinico, la ricerca degli anticorpi deve essere ripetuta. Gli anticorpi possono essere presenti anche anni dopo che l’infezione è stata curata, la sierologia deve essere sempre valutata con attenzione sulla base della storia clinica del paziente.


Prevenzione

Nelle aree endemiche , durante i mesi estivi è buona norma impiegare indumenti protettivi (pantaloni lunghi e camicia a maniche lunga) quando si effettuano escursioni in zone boschive o con erba alta; è inoltre opportuno al rientro dall’escursione effettuare un’attenta ispezione di tutto il corpo alla ricerca di eventuali zecche attaccate.

Per riassumere:

Sono importanti le seguenti precauzioni per non essere morsi dalle zecche:

  • repellenti
  • vestiti coprenti
  • ricerca di eventuali zecche sulla pelledopo soggiorno in aree dove queste sono presenti  (boschi, prati);

Le zecche che rimangono attaccate per meno di 24 ore raramente trasmettono la malattia di Lyme.

 

Valutazione del morso di zecca

 

In caso di puntura di zecca sono da considerare alcuni aspetti: 

  • il genere di zecca in causa: solo lezecche del genere Ixodestrasmettono la malattia;
  • stadio di sviluppo della zecca: adulti e ninfe trasmettono la malattia;
  • effettivo morso di zecca e durata: se il morso è durato meno di 36-48 ore è molto improbabile che la zecca abbia potuto trasmettere la malattia di Lyme.

Rimozione della zecca

Per la rimozione della zecca valgono le indicazioni fornite dal Ministero della Salute:

  • La zeccadeve essere afferrata con una pinzetta a punte sottili, il più possibile vicino alla superficie della pelle e rimossa tirando dolcemente, cercando di imprimere un leggero movimento di rotazione.
  • Durante la rimozionebisogna prestare la massima attenzione a non schiacciare il corpo della zecca, per evitare il rigurgito che aumenterebbe la possibilità di trasmissione di agenti patogeni. Disinfettare la cute prima e dopo la rimozione della zecca con un disinfettante non colorato.
  • Evitare di toccarea mani nude la zecca nel tentativo di rimuoverla, le mani devono essere protette (con guanti) e poi lavate.
  • Spesso il rostrorimane all’interno della cute: in questo caso deve essere estratto con un ago sterile.
  • Distruggere la zecca, possibilmente bruciandola.

Terapia

La terapia delle manifestazioni precoci della malattia di Lyme si avvale dell’impiego di antibiotici somministrati per per 3-4 settimane. Quando la malattia di Lyme viene diagnosticata in modo rapido, soprattutto nei bambini,  è quasi sempre curabile. Anche l’eruzione cutanea scompare dopo qualche giorno l’inizio del trattamento ma altri segni possono restare per diverse settimane.

 

La malattia di Lyme ha colpito diversi personaggi famosi tra cui: Justin Bieber, Victoria Cabello, Avril Lavigne.

 


Ti potrebbero interessare:

 

Lebbra: una malattia non ancora sconfitta

Leptospirosi

Rickettsiosi-Wikipedia 



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Bibliografia

  •  V. Gai,G.Agnelli e C.Busti,Medicina d’urgenza, Pratica e Progresso II edizione, Settembre 2013
  • Ministero della Salute
  • Omar, Osservatorio malattie rare)
  • M.Moroni, S. Antinori, V. Vullo, Manuale di Malattie Infettive, Agosto 2015

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    References:
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    References:
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  • 3 stars
    Crown Resort’s six star hotel makes up the lower levels of the tower from levels 6 to 32, including the protruding lower south east wing of the building. In October 2012, Premier O’Farrell announced that the NSW Cabinet had reviewed the proposal and decided that the government would enter into detailed negotiations with Crown Resorts for the establishment of a casino and hotel complex at Barangaroo. The new Brisbane casino isn’t exactly a jewel in the crown for the Cheng family, whose international business empire ranges from coal mining to hotels, healthcare and financial services. Trump was 40 years old, already world famous, and the owner of two casinos in Atlantic City, the US gambling hub.
    Initial concepts for a hotel development in Barangaroo as part of its urban redevelopment plan first circulated in 2010. The tower sits on the site of former industrial wharves, which were progressively paved over through land reclamation in the 1960s and 70s after falling into disuse, forming the unoccupied concrete site on which the tower was constructed. The Chengs have the Australian casino stake Trump wanted but could not get.

    References:
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  • 2 stars
    It’s a convenient spot for short stays, road trips and regional exploring, with easy access to shops, cafés and the Northern Rivers’ scenic drives. Always check with the official event website and/or facebook page for the most recent information. Listings are based on information found on the official event website, facebook page and/or from event directors.
    The Showground upgrade has now been completed and Council looks forward to the many benefits it will bring to the community and the local economy. A total of $8.2 million was provided under the Bushfire Local Economic Recovery Fund to help transform the site into a regional centre for equestrian activities and major community events. The NICC also conducts scheduled and adhoc inquiries and, where necessary, can amend a casino’s licence conditions, instruct casinos to comply, and utilise a range of financial penalties. The NICC is also working with casinos and stakeholders to improve electronic surveillance methods and adopt new ways to address the risks and challenges of modern casino environments. Because of the risks of money laundering, junkets are now banned in NSW casinos.
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    References:
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  • 4 stars
    The maximum amount that can be cashed out here is five times the bonus’s worth. The wagering requirement is the number of times the bonus amount must be bet before it can be withdrawn. Simply use the “CASINORITY” promo code during account creation, and you’re ready to enjoy your bonus rounds on The Dog House Megaways slot machine.
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    As a result, licensed and regulated casinos are authorized to operate and provide services to Australian players. Evaluating the fairness and transparency of these offers is vital to ensure a positive and rewarding experience for players. A well-optimized mobile experience not only enhances player satisfaction but also significantly increases engagement, allowing players to enjoy seamless gaming anytime, anywhere. A thoughtfully designed platform not only simplifies gameplay but also contributes to a seamless and engaging gaming experience. Explore new games, features, and bag yourself some banging bonuses as we deliver the freshest content tailored for your next big win! Companies based in Australia can’t offer online gambling services to Australians, but it’s not illegal for Australians to gamble online.

    References:
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  • 1 star
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    References:
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    So, the availability of responsible gambling tools varies. As in all other niches, in the gambling one there is still place for scammers. We have compiled the most important gambling numbers and facts in this infographic. If you thought you knew everything about gambling in Australia, you might be wrong. This is thanks to HTML5 technology, which allows casino content to fit various screens. They come from none other than the industry’s top producers of online slots.
    In fact, more than 2 million Australian gamblers play online casino slots. In online Australian casinos, pokies are not a new term. Australian law prohibits local operators from offering online casino services locally.

    References:
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  • 2 stars
    PlayCroco welcomes players from any jurisdiction where online gambling is legal, but it’s designed for players from Australia. The casino offers support through live chat or email. Daily perks range from deposit bonuses to free spins. The games include pokies and slots, table games, video poker, specialty games, and progressives. You play online in the convenient instant play casino. The choice is yours, and you don’t have to download an online casino app for your Android or iOS device.
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    References:
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