Meningite meningococcica: come avviene il contagio?
Definizione
La meningite meningococcica è causata da Neisseria meningitidis, di cui si riconoscono, in base alla struttura antigenica dei polisaccaridi capsulari, 13 diversi sierogruppi. Di questi sierogruppi A,B,C,W135, X,Y possono causare meningite, la meningite meningococcica è epidemica ed endemica nel mondo intero, colpisce soprattutto i bambini e i giovani adulti, è più frequente in inverno e in primavera e colpisce soprattutto le popolazioni che vivono in cattive condizioni igieniche. L’habitat naturale del meningococco è il rinofaringe dell’uomo: è stato stimato che questo microrganismo alberghi nel naso e nella gola del 2-30% della popolazione generale (portatori). I portatori non presentano tuttavia alcun sintomo e non hanno un aumentato rischio di meningite di altre malattie gravi da meningococco, ma possono trasmettere l’infezione. In Italia il 90% dei casi sono dovuti al gruppo B e il 10% al gruppo C.
Come avviene il contagio?
Il contagio avviene per contatto diretto, soprattutto per inalazione di goccioline che provengono dal naso-faringe di portatori di germi “sani” la cui proporzione può estendersi al 30% della popolazione in periodo di epidemia. Il periodo di incubazione è di 3-4 giorni fino a 10 giorni. La meningite è spesso preceduta da una rinofaringite.
Manifestazioni cliniche
Nella maggior parte dei pazienti la meningite da meningococco esordisce con una:
- Faringite acuta febbrile, dopo un breve periodo di incubazione di 24-72 ore. La sindrome meningea compare bruscamente.
- Le alterazioni dello stato di coscienza sono frequenti e possono evolvere rapidamente nel corso di poche ore, mentre le convulsioni e i segni neurologici focali sono meno caratteristici.
- Lesioni cutanee, solitamente petecchie, sono presenti in oltre il 80% dei casi, spesso evidenti anche nelle fasi di esordio e più frequenti sul tronco e sulle superficie estensoria degli arti inferiori.
Il quadro può evolvere rapidamente verso la sepsi e lo shock settico e complicarsi con un quadro di Coagulazione Intravasale Disseminata (CID). Un quadro clinico caratteristico è rappresentato dalla sindrome di Waterhouse-Friderichsen caratterizzata da insufficienza surrenalica secondaria a necrosi emorragica dei surreni, associata a shock e a CID e gravata da elevata letalità. La meningite da meningococco ha un tasso di letalità di circa il 10% dei casi affrontati a diagnosi tardiva e/o a gestione inadeguata; oppure caratterizzati da un’evoluzione particolarmente fulminante. La causa più frequente è lo shock settico complicato da CID. In una certa percentuale di casi, si ha la completa restitutio ad integrum in 7-10 giorni.
Terapia e profilassi
La meningite da meningococco impone il ricovero in ospedale, nella fattispecie il ricovero nel reparto di terapia intensiva. L’antibiotico di prima scelta nelle meningite da meningococco è il ceftriaxone, in associazione a desametasone. Nei casi di meningite meningococcica, anche solo sospetta, occorre applicare tempestivamente le opportune misure di chemioprofilassi dei contatti e inoltrare la notifica di malattia entro 24 ore per avviare le necessarie indagini epidemiologiche. La profilassi antibiotica è raccomandata nei contatti stretti dei malati, che definiscono le persone conviventi che hanno dormito, mangiato spesso nella stessa casa del paziente, che nei 7 giorni precedenti hanno avuto contatti con la sua saliva attraverso (baci, stoviglie, spazzolini da denti) ai sanitari che sono stati direttamente esposti alle secrezioni respiratorie del paziente. I malati di meningite o sepsi da meningococco sono considerati contagiosi per circa 24 ore dall’inizio della terapia antibiotica.
Ti potrebbero interessare:
- Meningiti batteriche acute: cause, sintomi, cure
- Meningite
- Vaccinazione meningococco
- Shock settico
- La meningite in Italia e nel mondo
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