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Mucormicosi: fungo nero e Covid




Mucormicosi: il fungo nero e il Covid-19
Mucormicosi: allarme in India

Definizione

La mucormicosi è un’infezione opportunistica rara provocata da muffe appartenenti all’ordine mucorales, generi Rhizopus, Lichtheimia, Mucor, Rhizomucor, Cunninghamella, Apophysomyces e Saksenaea,  ubiquitariamente presenti nel terreno e nei cibi avariati( frutta, pane). Si tratta di miceti dotati di scarsissima invasività e attività patogena, ma che in soggetti gravemente immunocompromessi determinano un’infezione invasiva molto aggressiva.

Come si contrae?

L’infezione avviene soprattutto per inalazione delle spore per via aerea; i principali fattori predisponenti sono la neutropenia, l’immunosoppressione, il diabete e i traumi penetranti.


Leggi anche>Diabete

Leggi anche> AIDS: sintomi e terapia


 

Epidemiologia

L’epidemiologia non è ben definita: uno studio francese riporta un’incidenza nella popolazione generale di 1,2 casi per milione/anno, altri due studi (uno spagnolo l’altro californiano) mostra un’incidenza compresa tra lo 0,4 e 1,7 casi per milione/anno. La mucormicosi si riscontra principalmente in tre gruppi di pazienti: i soggetti affetti da neoplasie ematologiche, gli individui con diabete scompensato e le persone vittime di politraumi con ferite penetranti.




Quali sono i sintomi della mucormicosi ?

Le manifestazioni cliniche possono interessare gli apparati: respiratorio, gastroenterico, cutaneo; la forma clinica più frequente è la mucormicosi rinocerebrale, patologia rapidamente fatale se non trattata, in cui l’infezione, a partenza dai seni paranasali, coinvolge poi il volto, il palato, l’orbita e l’encefalo.

Diagnosi

La diagnosi si basa sulla dimostrazione microscopica dei miceti nel materiale ottenuto dalle lesioni necrotiche, la cui sensibilità può raggiungere l’80%. L’isolamento culturale non gode invece di sensibilità ottimale, sebbene offra l’identificazione di specie e la possibilità di ottenere il test di suscettibilità agli antifungini: la crescita tende ad essere rapida con positività della cultura dopo pochi giorni. L’esame istopatologico mostra angioinvasione, infarti prominenti, necrosi coagulativa invasione perineurale.




Terapia

Le possibilità terapeutiche si fondano sul trattamento combinato medico chirurgico: da un lato, il precoce impiego di amfotericina  B liposomiale, dall’altro la rapida rimozione chirurgica del tessuto necrotico. Fondamentale è, inoltre, il controllo del fattore predisponente: la correzione della chetoacidosi diabetica, la riduzione dell’immunosoppressione laddove possibile e la somministrazione di fattori di crescita granulocitaria nei pazienti neurotropenici con neoplasie ematologiche. Come terapia medica di salvataggio è raccomandato il posaconazolo 200 mg 4 volte al giorno. La prognosi è sempre grave.

 

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