Mononucleosi infettiva: sintomi , diagnosi e complicanze
Table of Contents
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: illinfoma di Burkitte 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 laleucemia acuta linfoblastica e i linfomi.
Eziopatogenesi della mononucleosi
La mononucleosi infettiva è dovuta ad unherpes virus, chiamatoEpstein-Barrdal 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 generaledi varia intensità;
- Febbrecontinua anche elevata che dura quasi sempre pochi giorni, ma che spesso si potrae in una febbricola;
- Tumefazioni linfoghiandolariche possono osservarsi ovunque, ma che sono di gran lunga più frequenti in sede laterocervicale;
- La milza è moderatamente aumentata di volumenella metà dei casi;
- Frequentemente, si osserva un’angina eritemato essudativa.
L’intensità dei sintomi e dei segni clinici sono fortemente variabili: si va daquadri assai modesti, quasi banali, che rientrano rapidamente e sfuggono all’accertamento diagnosticoa 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:
- Ricerca degli anticorpi eterofili;
- Ricerca degli anticorpi specifici antivirus di EB;
- Ricerca del DNA virale nel sangue mediante PCR specifica.
I test di laboratorio vanno completati con la determinazione del titolo delle agglutinine fredde, con iltest di Coombse con la determinazione delle transaminasi sieriche.
La biopsia linfonodalenon 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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