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Mononucleosi infettiva: sintomi , diagnosi e complicanze


La mononucleosi infettiva è una malattia è causata del virus Epstein - Barr
Mononucleosi infettiva

La mononucleosi infettiva è una malattia acuta importante, molto diffusa tra i giovani di età compresa tra i 17 e i 25 anni ed è dovuta al virus Epstein-Barr che è costantemente associato a a due neoplasie: il linfoma di Burkitt e il carcinoma naso-faringeo. Il virus si trasmette con le goccioline di saliva e per tale motivo la mononucleosi infettiva è chiamata “malattia del bacio”.

La mononucleosi pone importanti problemi di diagnostica differenziale con la leucemia acuta linfoblastica e i linfomi.

 

Eziopatogenesi della mononucleosi 

La mononucleosi infettiva è dovuta ad un herpes virus, chiamato Epstein-Barr dal nome dei ricercatori che per primi lo hanno identificato, nel 1964, nelle cellule del linfoma africano di Burkitt, coltivate in vitro. Dopo 3 anni, nel 1967, il virus è stato scoperto anche nelle colture dei linfociti prelevati a una biologa, poco prima che si ammalasse di mononucleosi infettiva. La mononucleosi infettiva  è quindi un’infezione virale specifica dei linfociti B. 

Sintomatologia

 

La mononucleosi si presenta clinicamente con i caratteri propri di un’infezione virale acuta:

  • Malessere generale di varia intensità;
  • Febbre continua anche elevata che dura quasi sempre pochi giorni, ma che spesso si potrae in una febbricola;
  • Tumefazioni linfoghiandolari che possono osservarsi ovunque, ma che sono di gran lunga più frequenti in sede laterocervicale;
  • La milza è moderatamente aumentata di volume nella metà dei casi;
  • Frequentemente, si osserva  un’ angina eritemato essudativa

L’intensità dei sintomi e dei segni clinici sono fortemente variabili: si va da quadri assai modesti, quasi banali, che rientrano rapidamente e sfuggono all’accertamento diagnostico a quadri che, o per la gravità dell’ impegno generale o linfoghiandolare, o per la lenta risoluzione, evocano immediatamente la diagnosi differenziale nei confronti della leucemia acuta o dei linfomi maligni. Come in molte altre infezioni virali, infine possono osservarsi manifestazioni eritemato papulose, sia a livello della cute che della mucosa orofaringea e sindromi neurologiche sul tipo della meningite linfocitaria.

Analisi di laboratorio

 

Il quadro ematologico periferico della mononucleosi è caratteristico, ma talora è così  profondamente abnorme da richiedere un occhio esperto, per distinguerlo dalla leucemia linfiblastica acuta. Il numero dei leucociti è aumentato da 10000 a 40000/mm³, con 60-80% di cellule mononucleate di medie e grandi dimensioni, al citoplasma basofilo, aventi caratteri morfologici della cellula linfoide attivata.

La diagnosi si completa con gli esami microbiologici:

  1. Ricerca degli anticorpi eterofili;
  2.  Ricerca degli anticorpi specifici antivirus di EB;
  3. Ricerca del DNA virale nel sangue mediante PCR specifica.

I test di laboratorio vanno completati con la determinazione del titolo delle agglutinine fredde, con il test di Coombs e con la determinazione delle transaminasi sieriche.

La biopsia linfonodale non è indispensabile per la diagnosi di mononucleosi infettiva, ma va fatta ogni volta che si deve sciogliere un dubbio diagnostico con il linfoma.

Decorso e prognosi

La mononucleosi guarisce spontaneamente nella maggior parte dei casi, in qualche settimana. Più raramente dura qualche mese.

 

Complicanze:

Le principali complicanze della mononucleosi, anche se rare, insorgono in circa il 5% dei casi di mononucleosi.

  • La complicanza più grave è la rottura della milza, tale evento può esitare in emorragie interne che possono provocare lo stato di shock ipovolemico o la morte del paziente.
  • Epatite.
  • Anemia emolitica e trombocitopenia.
  • Miocardite.
  • Sindrome di Guillain-Barre
  • Meningite
  • Encefalite.


Terapia

Non esiste terapia specifica; nei casi più gravi, ove l’interessamento epatico e meningeo sia evidente, o quando la malattia si complichi con un’anemia emolitica con una porpora trombocitopenica autoimmune, è indicata la terapia corticosteroidea.

 

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