Leptospirosi
Generalità
La leptospirosi è una zoonosi si che si manifesta con diversi quadri clinici. E’ causata da una spirocheta, la Leptospira interrogans. La leptospirosi (zoonosi: malattia trasmessa all’uomo da un animale) è diffusa in tutto il mondo e il suo serbatoio naturale è rappresentato da molti animali selvatici (soprattutto topi, roditori, volpi, procioni, puzzole), che possono contagiare con il morso o tramite le urine gli animali domestici (cani, maiali, equini, bovini, ma anche uccelli, anfibi, pesce eccetera.) I gatti si ammalano raramente. Gli animali possono ammalarsi o essere portatori sani: in entrambi i casi i microrganismi si localizzano a livello dei tubuli renali e pertanto si diffondono nell’ambiente tramite le urine, attraverso le quali raggiungono terreni e acque. L’uomo può infettarsi per contatto diretto con animali infetti (morso), ma solitamente la leptospirosi si contrae venendo a contatto con acqua, suoli o vegetazioni contaminate. La leptospirosi riconosce molti sinonimi nelle sue varie forme: malattia di Weil (che la forma più grave e può portare a morte), malattia dei giovani porcai, febbre delle risaie, febbre del fango, febbre canicola, febbre della canna da zucchero.
Epidemiologia
La leptospirosi è presente in tutto il mondo con eccezione delle regioni polari. La leptospirosi rappresenta un problema di salute pubblica soprattutto in America Latina e nel Sud-est asiatico.
Incubazione e decorso
Il periodo di incubazione della leptospirosi è variabile: in genere si considera sia attorno ai 10 giorni (2-26 giorni). Dal punto di vista clinico invece si distinguono due fasi:
- una prima fase nella quale le leptospire si trovano nel sangue e nel liquido cefalorachidiano;
- una seconda fase caratterizzata dalla comparsa degli anticorpi specifici per tali microrganismi i quali però possono rifugiarsi in altri organi (fegato, sistema nervoso centrale, rene).
La leptospirosi può esordire con:
- febbre improvvisa
- brividi scuotenti
- intense mialgie e cefalee
Da un punto di vista obiettivo da non sottovalutare è la soffusione congiuntivale, presente in circa il 20-30% dei casi. La sua presenza non è comune alle malattie infettive e il suo riscontro in una malattia febbrile aspecifica deve indurre il sospetto di leptospirosi. Anche mialgie e diatesi emorragica ( epistassi, ecchimosi, ecc..) sono reperti caratteristici della leptospirosi.
Alcuni soggetti riferiscono sofferenza renale (nefrite) o sintomi polmonari (tosse, dolore toracico).
Diagnosi
La diagnosi di leptospirosi viene fatta valutando il quadro clinico ed effettuando degli esami specifici. Oltre agli esami di laboratorio che evidenziano:
- leucocitosi neutrofila
- aumento della VES
- minimo incremento delle transaminasi (elemento importante per la diagnosi differenziale con l’epatite)
si effettuano degli esami colturali attraverso i quali si ricercano le leptospire nel sangue e nel liquido cefalorachidiano (nella prima e nella seconda settimana di malattia) e nelle urine (nelle settimane successive). E’ importante prendere in considerazione tale malattia quando nell’ anamnesi delle persone colpite esistono dei fattori di rischio (contatto con animali, lavori a rischio, bagno in acque stagnanti).
Terapia
La grande maggioranza di infezioni da leptospira si autolimita. Tuttavia, se si ritiene che la malattia sia abbastanza seria da richiedere una visita medica e venga posto il sospetto diagnostico di leptospirosi, si deve somministrare la terapia antibiotica. Essa, infatti, riduce la durata della malattia e previene e riduce l’eliminazione urinaria della leptospira, anche se non comporta benefici sulla mortalità. Gli antibiotici devono essere somministrati nei primi 2-3 giorni di malattia a dosaggi elevati, perché altrimenti non si ottengono i risultati sperati. Nelle forme complicate (morbo di Weil) va trattata anche la sindrome epatorenale con cortisonici, soluzioni elettrolitiche, glucosio.
Complicanze
In alcuni casi la guarigione è solo apparente, infatti dopo 1-3 giorni ricompaiono sia la febbre che gli altri sintomi della prima fase accompagnati questa volta dai sintomi specifici dell’organo nel quale si è “rifugiato” il microrganismo. Se sono colpiti fegato e rene la malattia che si sviluppa è detta morbo di Weil, un quadro piuttosto grave caratterizzato da:
- ittero
- epatomegalia (ingrossamento del fegato con dolore in sede epatica)
- ematuria
- proteinuria
- oliguria
- ed eventualmente anuria da interessamento renale.
Si possono riscontrare anche emorragie, soprattutto cutanee. Nelle forme a esito favorevole c’è una guarigione completa, nelle altre purtroppo si può arrivare alla morte per coma epatico, insufficienza renale, soprattutto nei soggetti anziani.
Altra possibile localizzazione delle leptospire è nel sistema nervoso centrale. In questo caso si ha la comparsa di un quadro di meningite asettica dominato da:
- cefalea
- vomito
- rigidità nucale
Questa forma, tranne casi rari, ha un’ evoluzione benigna.
Ti potrebbero interessare:
- Tetano: sintomi, incubazione e trattamento
- Lebbra: una malattia non ancora sconfitta
- Rabbia:malattia
- Leptospirosi epidemiologia
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