Ossiuriasi: vermi nei bambini
Table of Contents
Definizione
L’ossiuriasi è una parassitosi molto diffusa nel mondo. La malattia è trasmessa dalle uova che sono ingerite con l’acqua, i legumi e la frutta contaminata dalle materie fecali o le mani sporche. Dalle uova embrionali ingerite, lo sviluppo è diretto senza nessuna migrazione; le uova si aprono nello stomaco, da dove le larve si trasferiscono nell’ultima porzione dell’ileo. I vermi diventano adulti qualche mese dopo l’ingestione. L’ossiuriasi è molto frequente nel bambino.
Ossuriasi: eziologia
L’ossiuro o “Enterobius vermicularis” è un piccolo nematode di cui l’adulto maschio è lungo 2-5 mm e la femmina 9-12 mm. I vermi vivono prima nell’ultima porzione dell’ileo da dove migrano nel cieco e nell’appendice. Le femmine fecondate vanno nel retto dove dimorano di giorno; durante la notte, forzano lo sfintere anale e depongono le loro uova sulla pelle intorno all’ano provocando un prurito anale intenso. Le uova sono eliminate con le feci.
Epidemiologia
L’ossiuriasi è diffusa nel mondo intero, soprattutto nei bambini (spesso familiare), dappertutto dove le condizioni d’igiene sono insufficienti. L’infestazione spesso è asintomatica.
Come si trasmette l’ossiuriasi?
L’ infezione si trasmette per ingestione di uova del parassita, a causa di cattive abitudini igieniche, per contagio interumano diretto (attraverso mani contaminate dalle uova) o indiretto (per contaminazione di oggetti o polvere). Una volta ingerito l’uovo, la larva L3 fuoriesce dal guscio e si sviluppa nell’intestino cieco, in meno di un mese, il parassita adulto (maschi e femmine). Il maschio ha vita breve e dopo aver fecondato la femmina muore e viene eliminato con le feci. La femmina gravida migra verso l’ano, supera lo sfintere e a contatto con l’aria muore lasciando le uova adese alla zona perianale (fino a 16.000 uova per femmina). Al mattino le uova sono già mature (contengono L3) e quindi in grado di infettare. Con il passare delle ore la reattività diminuisce e le uova si staccano contaminando oggetti, biancheria intima, lenzuola e polvere che diventano fonte di infezione per gli altri.
Sintomi
Il prurito anale notturno è il sintomo locale dominante; le lesioni dovute al grattamento possono provocare un eczema intertriginoso. Gli ossiuri possono risalire nello stomaco e provocare sintomi gastrici. Si possono osservare episodi diarroici; l’invasione dell’appendice provoca l’appendicite ossiurica acuta o cronica. Nelle bambine può comparire una vulvovaginite con leucorrea.
Diagnosi
L’accertamento diagnostico di elezione consiste nello scotch-test eseguito al risveglio. Si tratta di applicare a livello anale una striscia di nastro adesivo che va poi fissata su un vetrino. L’esame microscopico del preparato consente di osservare le uova di Enterobius. L’esame parassitologico delle feci mette in rilievo, invece, la presenza di vermi adulti.
Terapia
Numerosi sono i preparati attivi nella terapia dell’ossiuriasi. I farmaci più utilizzati sono il mebendazolo e l’albendazolo da somministrare per via orale in un’unica dose per ripetere entro 14 giorni: Il pirantel pamoato da somministrare per via orale in un’unica dose da ripetere ogni 14 giorni per due volte consecutive.
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