Meningite meningococcica: come avviene il contagio?
Table of Contents
Definizione
Lameningite meningococcicaè causata daNeisseria meningitidis, di cui si riconoscono, in base alla struttura antigenica dei polisaccaridi capsulari, 13 diversi sierogruppi. Di questi sierogruppi A,B,C,W135, X,Y possono causare meningite, lameningite meningococcicaè epidemica ed endemica nel mondo intero, colpisce soprattutto i bambini e i giovani adulti, è più frequente in inverno e in primavera e colpisce soprattutto le popolazioni che vivono in cattive condizioni igieniche. L’habitat naturale del meningococco è ilrinofaringe dell’uomo: è stato stimato che questo microrganismo alberghinel naso e nella gola del 2-30% della popolazione generale(portatori). I portatori non presentano tuttavia alcun sintomo e non hanno un aumentato rischio di meningite di altre malattie gravi da meningococco, ma possono trasmettere l’infezione. In Italia il 90% dei casi sono dovuti al gruppo B e il 10% al gruppo C.
Come avviene il contagio?
Il contagio avviene per contatto diretto, soprattutto perinalazione di gocciolineche provengono dal naso-faringe di portatori di germi “sani” la cui proporzione può estendersi al 30% della popolazione in periodo di epidemia. Il periodo di incubazione è di 3-4 giorni fino a 10 giorni. La meningite è spesso preceduta da una rinofaringite.
Manifestazioni cliniche
Nella maggior parte dei pazienti la meningite da meningococco esordisce con una:
- Faringite acuta febbrile, dopo un breve periodo di incubazione di 24-72 ore. La sindrome meningea compare bruscamente.
- Le alterazioni dello stato di coscienzasono frequenti e possono evolvere rapidamente nel corso di poche ore, mentre le convulsioni e i segni neurologici focali sono meno caratteristici.
- Lesioni cutanee,solitamente petecchie, sono presenti in oltre il 80% dei casi, spesso evidenti anche nelle fasi di esordio e più frequenti sul tronco e sulle superficie estensoria degli arti inferiori.
Il quadro può evolvere rapidamente verso la sepsi e loshock setticoe complicarsi con un quadro di Coagulazione Intravasale Disseminata (CID). Un quadro clinico caratteristico è rappresentato dalla sindrome di Waterhouse-Friderichsen caratterizzata da insufficienza surrenalica secondaria a necrosi emorragica dei surreni, associata a shock e a CID e gravata da elevata letalità. La meningite da meningococco ha un tasso di letalità di circa il 10% dei casi affrontati a diagnosi tardiva e/o a gestione inadeguata; oppure caratterizzati da un’evoluzione particolarmente fulminante. La causa più frequente è lo shock settico complicato da CID. In una certa percentuale di casi, si ha la completarestitutio ad integrum in7-10 giorni.
Terapia e profilassi
La meningite da meningococco impone ilricovero in ospedale, nella fattispecie il ricovero nel reparto di terapia intensiva. L’antibiotico di prima scelta nelle meningite da meningococco è ilceftriaxone, in associazione adesametasone. Nei casi di meningite meningococcica, anche solo sospetta, occorre applicare tempestivamente le opportune misure di chemioprofilassi dei contatti e inoltrare la notifica di malattia entro 24 ore per avviare le necessarie indagini epidemiologiche. Laprofilassi antibioticaè raccomandata nei contatti stretti dei malati, che definiscono le persone conviventi che hanno dormito, mangiato spesso nella stessa casa del paziente, che nei 7 giorni precedenti hanno avuto contatti con la sua saliva attraverso (baci, stoviglie, spazzolini da denti) ai sanitari che sono stati direttamente esposti alle secrezioni respiratorie del paziente. I malati di meningite o sepsi da meningococco sono considerati contagiosi per circa 24 ore dall’inizio della terapia antibiotica.
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