Schistosomiasi: cos’è, come si contrae
Table of Contents
Che cos’è laschistosomiasi?
Laschistosomiasi, nota anche come bilharziosi, è una delle più importantimalattie parassitariecausate datrematodidel genere schistosoma responsabili di circa 300 milioni di casi di infestazione a livello mondiale. E’ contratta dal camminare a piedi nei terreni umidi e dal fare il bagno nei fiumi. La malattia si manifesta prima con lesioni cutanee nel luogo dove la cercaria ha attraversato la pelle (dermatite papulosa). Poi sopravvengono i sintomi generali:febbre, cefalea, disturbi intestinali, talvolta orticaria gigante.Il parassita diventa adulto in 3 mesi e si installa nelle vene della vescica. Il periodo di stato è caratterizzato da:disuria, pollachiuria ed ematuria terminale.Vi possono essere fistole urinarie, ulcere, calcoli e papillomi e talvolta carcinoma della vescica. La diagnosi è stabilita con esame microscopico delle urine nelle quali si trovano le uova del parassita.
Eziologia
Laschistosomiasisi contrae attraverso la penetrazione transcutanea delle cercarie: gli individui che lavorano con i piedi nell’acqua, soprattutto nelle risaie, sono particolarmente esposti.Il maschio del parassita è una fasciola piattai cui bordi rialzati formano una specie di grondaia nella quale alloggia la femmina.Le bilarzie vivono nelle vene del malato. Dopo la fecondazione, la femmina emigra verso ipiccoli vasi e penetra nella vescica o nel lume intestinalee le uova sono eliminate nelle urine o nelle feci; hanno una valvola e possiedono uno sperone. Le uova e escrete possono vivere fino a 15 anni; si schiudono nell’acqua e nasce un embrione cigliato o “miracidium” che evolve nei molluschi del genere “Biomphalaria“, “Bulinus“, “Oncomelania“,si localizza nel fegato e nel pancreas. Ilmiracidium si trasforma in cercaria e ha una lunga coda forcuta; lascia il mollusco, va nell’acqua (dove può vivere 24 ore) e infetta l’uomo attraversando la pelle; la cercaria perde allora la sua coda e va ad alloggiare nelle vene del soggetto. I vermi provocano manifestazioni allergiche nella fase di invasione, poi le uova causano lesioniulcero- granulomatose viscerali.
Come si manifesta la schistosomiasi?
Si riconoscono unaforma acuta e una cronica della malattia.
Forma acuta
La forma acuta, generalmente asintomatica nelle popolazioni che vivono in aree endemiche, è osservata più spesso negli individui non immuni che vivono in aree urbane e nei viaggiatori esposti per la prima volta al infestazione. A distanza di 20-50 giorni dall’ avvenuta esposizione compaiono:febbre elevata, tosse, epatosplenomegalia, malessere generale e importante eosinofilia periferica(febbre Katayama).
Forme croniche
Le forme croniche vengono osservati a distanza di mesi o anni dall’avvenuta infestazione e spesso sono misconosciute a lungo. La forma urogenitale (provocata daS. haematobium)è contraddistinta da sintomi che simulano un’ infezione delle vie urinarie, pollachiuria, disuria, senso di peso in regione perineale accompagnata da micro-macroematuria Nei quadri di lunga durata si osservanopoliposi vescicale e stenosi ureterale con idronefrosi. Il carcinoma a cellule squamose della vescica è una complicanza a lungo termine di questa infestazione. La forma intestinale si presenta con:diarrea, muco ematico, dolori addominali crampiformi, tenesmo rettale.Anche in questo caso la mucosa intestinale può andare incontro ad alterazioni di tipo iperplastico (polipi e papillomi talora ulcerati) e fibrotico. Nelle forme causate daS. mansoneS. japonicusi assiste al coinvolgimento epatosplenico indotto dalla reazione granulomatosa nei confronti delle uova. La progressiva fibrosi parenchimale è responsabile di quadri clinici simile a quello osservati in corso dicirrosi(ematemesi e melena da rottura di varici esofagee, ascite e splenomegalia). La coinfezione con il virus dell’epatite C, frequente in Egitto, accelera la progressione della malattia. In circa il 10% dei pazienti con fibrosi epatica è possibile dimostrare anche ipertensione polmonare.
Esami di laboratorio
- Ricerca ed identificazione delle uova nelle feci o nelle urine a seconda della forma di schistosomiasi; la gravità dell’infezione si misura con il numero di uova per grammo di feci.
- Si può anche ricorrere alla fissazione del complemento o di altre reazioni sierologiche (immunofluorescenza indiretta, immunoelettroforesi).
- Le forme con splenomegalia presentano una iperleucocitosi marcata, con numerosi leucociti giovani; più tardi si osserva un’ anemia con leucopenia e mononucleosi da ipersplenismo.
Diagnosi
La diagnosi definitiva, in presenza di dati epidemiologici, si basa sulla dimostrazione delleuova degli schistosomi ricercata nelle urine o su campioni di feci. Le uova possono essere dimostrate anche su biopsie rettali e occasionalmente subiopsie epatiche. La sierologia è utile soprattutto per la diagnosi di infestazione acuta. Sono disponibile anche test antigeni che utilizzano siero o urina.
Terapia
I farmaci quale praziquantel in singola somministrazione è efficace contro tutte le specie ed è impiegato nelle campagne di trattamento di massa.Ti potrebbero interessare:
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