L’amebiasi è l’infezione da Entamoeba histolytica. La malattia si contrae per ingestione di cisti che provengono da feci di soggetti infetti. La trasmissione può essere diretta tramite mani sporche di feci o indirettamente tramite legumi crudi, mosche o acqua contaminata che può provocare epidemie. I portatori di cisti “sani” sono frequenti in zone endemiche; si tratta di soggetti infetti che non hanno mai avuto sintomi clinici o che sono convalescenti da una amebiasi acuta. Tra i sintomi: dolori colici, tenesmo rettale e scariche frequenti (fino a 10-15 volte al giorno).
Eziologia
L’agente patogeno è un protozoo, “Entamoeba histolytica”, che possiede un ciclo evolutivo nel corso del quale si presenta sotto due forme: i trofozoiti, che sono fragili e non sono infettivi, e le cisti, più piccole, che si circondano di una membrana resistente. Le cisti sono infettive e possono sopravvivere in ambienti esterni per diverse settimane in climi tropicali e per diversi giorni in climi temperati; sono distrutti dalla cottura.
Prodromi: dopo un periodo di incubazione da 3 a 6 settimane, compaiono vaghi disturbi digestivi (dolori addominali, anoressia), con compromissione dello stato generale (astenia, sudorazioni, malesseri) che precedono normalmente la sindrome dissenterica.
Sindrome dissenterica: dolori colici, tenesmo rettale (scariche frequenti fino a 10-15 al giorno), muco purulente, sanguinolente, contenente pochi o nessun elemento solido. Sintomi generali variabili: febbre incostante, disidratazione, dimagrimento.
Evoluzione: la durata della fase acuta varia da qualche giorno ad alcune settimane, secondo la precocità della terapia. Le ricadute o le recidive sono frequenti e bisogna tener conto della possibile evoluzione verso la forma cronica.
Amebiasi intestinale cronica
L’amebiasi intestinale cronica può verificarsi in pazienti con infezione paucisintomatica non trattata durante la fase acuta. La sintomatologia è caratterizzata da diarrea ricorrente a decorso subdolo associata a febbriciattola, astenia, dimagrimentoe anemia. Le feci si presentano pastose e luccicanti. Su questo fondo di enterocolite sopravvengono a qualche settimana o mese di intervallo degli episodi dissenterici acuti.
All’esame clinico, dolore alla palpazione del colonche è contratto, con gorgoglii, mentre il sigma è spesso spastico, a corda.
Amebiasi extraintestinale
L’amebiasi extraintestinale si localizza più comunemente a carico del fegatoe del polmone. L’ascesso epatico amebico si presenta con dolore gravativo all’ipocondrio destro (accentuato dai movimenti respiratori), epatomegaliae febbre elevata. L’ascesso non adeguatamente trattato può calcificare, ma spesso si verifica la diffusione del parassita per continuità con emorragie da erosione di vasi e necrosi parenchimale estesa.
L’amebiasi polmonare, può presentarsi con varie espressioni cliniche: polmonite, ascesso polmonarepleurite sierofibrinosa, bronchite e scissurite. Il coinvolgimento dell’apparato respiratorio si manifesta con dolore toracico, insufficienza respiratoria acuta. E’ possibile l’emissione dalla bocca di materiale color cioccolata (vomica) per perforazione dell’ascesso in un bronco. Le complicanze in corso di malattia sono rappresentate da emorragie digestive, colite fulminante con perforazione, peritonite e megacolon tossico.
Esami di laboratorio
Dimostrazione dell’ameba con l’esame diretto al microscopio: la diagnosi è stabilita con l’identificazione dei trofozoitio delle cistinelle feci fresche o conservate a 37 °, nei campioni prelevati per rettoscopia, per aspirazione di un ascesso o per biopsia.
In corso di amebiasi intestinale sono presenti anemiae aumento degli indici di flogosi. In corso di ascesso amebico si osservano aumento della velocità di eritrosedimentazione, leucocitosi neutrofila, aumento della fosfatasi alcalina sierica e talvolta un discreto incremento delle transaminasi.
Prognosi
La prognosi della colite amebica è in genere buona; la letalità è elevata solo nei rari casi di colite necrotizzante. L’ascesso amebico può andare incontro a rottura intraperitoneale nel 2-7 % dei casi con conseguente peritonite, frequentemente letale.
Terapia
Nella dissenteria amebica i farmaci di scelta sono costituiti da derivati imidazolici (metronidazoloper 7-10 giorni o tinidazoloper 3 giorni per via orale). Entrambi i farmaci devono essere seguiti dal trattamento con paromomicina per 7 giorni.
Profilassi
Risanamento dell’ambiente, protezione delle condotte d’acqua potabile (il cloro a concentrazioni usuali non distrugge le cisti); educazione sanitaria della popolazione, in particolare sulle misure di igiene necessarie nella preparazione degli alimenti e sul pericolo di contaminazione da legumi crudi e dalle mosche. Ricerca e terapia sistemica dei portatori di cisti sani.
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