Rabbia:malattia
Table of Contents
Che cos’è la rabbia?
La rabbia viene trasmessa in genere dal morso del cane o da altri animali che fungono da serbatoio (pipistrelli, volpi, procioni) del virus. Il virus è presente nella saliva dell’animale malato e può essere trasmesso a tutti gli altri mammiferi – incluso l’uomo – attraverso un
morso, un graffio, o il semplice contatto della saliva con le mucose o la cute non integra. Se ciò avviene, bisogna intervenire il più rapidamente possibile per evitare il contagio e, quindi, l’insorgenza della malattia. Non esiste, infatti, una cura per la rabbia. Questo di solito si trova nella saliva dell’animale infetto e, una volta iniettato mediante il morso, risale i nervi periferici e attraverso questi raggiunge il SNC. Questo meccanismo di invasione del SNC è stato dimostrato in modo brillante inoculando il virus nel nervo sciatico ed osservando che la sezione del nervo a monte dell’inoculo impedisce lo sviluppo della malattia. Le alterazioni anatomo-patologiche si trovano prevalentemente nellasostanza grigiacon predilezione per ildiencefalo, mesencefalo, lobo limbico,ippocampo o motoneuroniinferiori e sono caratterizzate da infiltrazioni infiammatorie perivascolari, presenza di noduli microgliali e fenomeni di neuronofagia. Anche i nervi periferici ed i gangli spinali sono sede di identiche alterazioni. I noduli microgliali che vanno sotto il nome dinoduli di Babes e, contrariamente a quanto si riteneva, non sono specifici della rabbia, ma si trovano anche in altre encefaliti. Nel citoplasma delle cellule nervose, specialmente nelle cellule delCorno d’Ammoneo nellecellule di Purkinje,e si trovano formazioni rotondeggianti, delle dimensioni di 5-10 micron, note comecorpuscoli del Negrie sono patognomici della rabbia.
Prevenzione
Nonostante le misure di prevenzione (specie la vaccinazione dei cani), è stata ridotta notevolmente la frequenza di questa malattia, ma focolai rabbia si ripresentano talora anche in Europa, soprattutto nei paesi dell’Europa dell’est, e nel nord America. La diagnosi è suggerita principalmente dalla storia di esposizione al contagio, per lo più morsicatura di cane, e dalla sintomatologia che esordisce 2-4 settimane dopo l’infezione. Da ottobre 2008 la rabbia è ricomparsa nella Regione Friuli Venezia Giulia (province di Udine, Pordenone
e Trieste) e da ottobre 2009 anche nella Regione Veneto (provincia
di Belluno) e nella Provincia Autonoma di Trento. Istituzioni e autorità sanitarie sono impegnate su più fronti (sorveglianza,monitoraggio, vaccinazioni obbligatorie per gli animali
domestici e vaccinazione orale per gli animali selvatici) per contenere
il contagio e per prevenire la diffusione della rabbia nel resto del Paese.
Quadro clinico
il quadro clinico è classicamente costituito da due fasi, una di eccitazione e una di paralisi. L’idrofobia è causata da spasmi riflessi dei muscoli della deglutizione conseguenti al tentativo di bere o anche solo alla vista dell’acqua. Le paralisi sono secondarie a gravi e diffuse lesioni del motoneurone periferico ed in genere sono seguita da morte. A quadro clinico conclamato la terapia causale è inefficace e si opera solo una terapia sintomatica. Al contrario, l’uso tempestivo del siero antirabbico (seguito dal vaccino) subito dopo il morso del cane e prima della comparsa della malattia risulta efficace, seppur accompagnato da un significativo rischio di complicanze da vaccinazione. Essenziale è la profilassi mediante vaccinazione nelle persone che sono a contatto, per lavoro, con possibili animali infetti.
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