Mucormicosi: fungo nero e Covid
Table of Contents
Definizione
La mucormicosi è un’infezione opportunistica rara provocata da muffe appartenenti all’ordine mucorales, generiRhizopus, 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: isoggetti 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 lamucormicosi rinocerebrale, patologia rapidamente fatale se non trattata,in cui l’infezione, a partenza dai seni paranasali, coinvolge poi ilvolto, 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 diamfotericina B liposomiale, dall’altro la rapida rimozione chirurgica del tessuto necrotico. Fondamentale è, inoltre, il controllo del fattore predisponente: la correzione dellachetoacidosi 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 ilposaconazolo200 mg 4 volte al giorno. La prognosi è sempre grave.
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