Scarlattina: incubazione, sintomi, complicanze
Definizione
La scarlattina è una malattia esantematica acuta caratterizzata da febbre, esantema maculo-papuloso puntiforme, angina rossa, enantema e con un esantema tipico. Il contagio è diretto attraverso l’inalazione delle goccioline di saliva emesse dai malati o dai portatori sani. La malattia dà immunità permanente.
Eziologia
L’agente patogeno è un batterio,Streptococcus pyogenes, gruppo A, β-emolitico, che produce una tossina eritrogenica.
Epidemiologia
La scarlattina è endemica con esacerbazioni nella stagione fredda e sono colpiti soprattutto i bambini in età scolare (3- 10 anni); l’esantema non è contagioso, mentre lo sono le forme streptococciche cutanee. La contagiosità termina un paio di giorni dopo l’inizio di un’idonea terapia antibiotica.
Manifestazioni cliniche
Incubazione: da 1 a 3 giorni (fino a 8 giorni).
- L’inizio è brusco conmalessere,brivido intenso o brividi ripetuti, ascesa dellafebbrefino a 40° C,tachicardia; ilvomitoè frequente e leconvulsionisono possibili nei bambini.
- L’esantemapuò essere preceduto dalla comparsa del tipico enantema; insieme all’iperemia tonsillare si può avere un eritema puntiforme diffuso a tutta la mucosa del cavo orale, più evidente a livello del palato.
- Lalinguarisulta tutta ricoperta da una patina biancastra dalla quale emergono le papille arrossate (“lingua a fragola”); dopo pochi giorni la lingua va incontro a disepitelizzazione o assume un colorito rossastro (“lingua a fragola rossa o a lampone”). L’esantema compare dopo 2-3 giorni, dapprima alla partesuperiore del tronco e al collo, quindi agliartie alvolto, con risparmio della zona circumorale, del mento e del naso. Sono anche risparmiati le piante dei piedi e i palmi delle mani.
- L’esantema è di tipo maculo-papuloso;le lesioni sono minute, puntiformi, ravvicinate tanto da dare l’apparenza di un eritema uniforme, e tipicamente scompaiono alla vitropressione.
- La cute assume un aspetto ruvido a carta vetrata.
Prognosi
La prognosi della scarlattina è favorevole. Nei casi tipici l’esantema regredisce in 4-5 giorni provocando una fine desquamazione cutanea diffusa, mentre la febbre si attenua per lisi.
Complicanze della scarlattina
Le complicanze possibili della malattia, se non adeguatamente curata, possono essere:meningite, polmonite, setticemia, encefalite, endocardite, malattia reumatica, glomerulonefrite e mastoidite.
Come si fa la diagnosi della scarlattina?
La diagnosi di scarlattina è agevole nella maggior parte dei casi, data la peculiarità dell’esantema in presenza di un focolaio di infezione streptococcica in atto; quest’ultima è facilmente diagnosticabile dall’indagine microscopica e soprattutto colturale del tampone faringeo o dei campioni biologici ottenuti da altri tipi di sospetta infezione.
Terapia
L’Amoxicillina o una singola dose di benzilpenicillina per via intramuscolare restano i farmaci di prima scelta; i macrolidi sono utili in caso di allergia alle penicilline, ma occorre considerare che la resistenza degli streptococchi a questa classe di farmaci è in aumento ovunque; un’altra alternativa sono le cefalosporine orali. In tutti casi, l’antibiogramma sul ceppo isolato consente di effettuare trattamenti mirati con antibiotici efficaci.
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