Babesiosi: che cos’è e come si trasmette
Che cos’è la babesiosi ?
La babesiosi è una patologia trasmessa da zecche causata da protozoi intraeritrocitari del genere Babesia originariamente descritti da Babes nel 1888 in bovini e ovini. I sintomi di solito esordiscono 1-4 settimane dopo il morso di una zecca infetta, o 1-6 mesi dopo trasfusione con sangue contaminato.
Eziologia
Diverse specie di protozoi intracellulari del genere babesia provocano delle zoonosi e sono occasionalmente trasmesse all’uomo da zecche dei roditori. La trasmissione per trasfusione sanguigna è possibile. L’infezione si osserva nell’uomo soprattutto in caso di immunodepressione (infezione opportunistica) o di splenectomia.
Babesiosi: manifestazioni cliniche
Circa un quarto delle infezioni da babesiosi microti negli adulti e la metà di quelle osservate nei bambini decorrono in maniera asintomatica. Nei casi sintomatici si osserva la comparsa graduale di febbre (intermittente o continua), malessere generale, astenia, mialgia e cefalea. L’esame obiettivo può mostrare epatosplenomegalia. La forma europea provocata da babesiosi divergens presenta un esordio brusco con febbre elevata (40-41 C), brividi scuotenti, cefalea, mialgie ed emoglobinuria. Il decorso può essere caratterizzato dall’insorgenza di insufficienza multiorgano, responsabile della morte nei pazienti immunocompromessi.
Esami di laboratorio
La diagnosi è confermata dalla ricerca delle forme intraeritrocitarie del parassita (esame dello striscio, inoculazione in una cavia) e da test sierologici.
Terapia
Per le forme causate da babesiosi microti di gravità lieve-moderata si impiega una combinazione di atovaquone e azitromicina che si è dimostrata di pari efficacia alla terapia con clindamicina e chinina. Quest’ultima combinazione per via parentale viene invece utilizzata nelle forme gravi. Nei pazienti immunocompromessi possono essere necessari cicli terapeutici ripetuti per negativizzare la parassitemia. In presenza di parassitemia elevata (>10%) associata a insufficienza d’organo o emolisi importante può essere necessario ricorrere all’exsanguinotrasfusione.
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