La parotite è un’infezione virale acuta, contagiosa ed epidemica, caratterizzata da una tumefazione dolente delle ghiandole salivari, soprattutto della parotide e a volte con lesioni di altri organi (testicoli, ovaie, pancreas, sistema nervoso centrale). L’agente responsabile della parotite, un paramyxovirus, viene diffuso tramite piccole gocce di saliva, il virus è presente dal giorno che precede la tumefazione parotitica fino al sesto giorno di malattia.
Quanto è diffusa la parotite?
La parotite è endemica nelle zone urbane dove talora si hanno epidemie. Nelle città colpisce soprattutto i bambini, mentre in zone rurali si osserva anche spesso negli adulti. Le forme asintomatiche sono frequenti e hanno ruolo importante nella trasmissione del virus. L’infezione dà un’immunità permanente nel 95% dei casi. Si verifica soprattutto nelle popolazioni non vaccinate.
Anatomia patologica
Nelle ghiandole colpite vi sono edemi, degenerazioni delle cellule acinose, piccole emorragie ed infiltrazione dei tessuti adiposi interstiziali da parte di mononucleati; rigenerazione totale della struttura ghiandolare alla guarigione.
Quali sono i sintomi della parotite?
Incubazione: 2-3 settimane.
Inizio: malessere, brividi, febbre moderata.
Periodo di stasi: il giorno seguente compaiono dolori davanti all’orecchio e disturbi della masticazione e della deglutizione, seguiti da una tumefazione parotitica prima unilaterale poi spesso bilaterale. Si osserva a volte un punto rosso all’uscita del canale di Stenone, poi un discreto enantema e a volte un’angina eritematosa o poltacea. Le ghiandole salivari sottomascellari e sublinguali possono essere lese e comparire adenopatie regionali. La febbre raggiunge i 40°.
Evoluzione: la febbre recede verso il terzo-quarto giorno se non ci sono complicazioni. La tumefazione regredisce in 6-10 giorni.
Quali possono essere le complicazioni della parotite?
Orchite: si riscontra a volte nei giovani nell’età della pubertà e si manifesta 5-10 giorni dopo l’inizio della malattia con una ripresa della febbre, una tumefazione testicolare e dolorosa spesso unilaterale. La tumefazione regredisce in una decina di giorni e può essere seguita, dopo 1-2 mesi, da un’atrofia testicolare. Se la lesione è bilaterale (un terzo dei casi) può risultarne una sterilità.
Meningite:segni di meningite si osservano nel 10% dei casi tra il quarto e il settimo giorno. L’evoluzione è benigna salvo in casi molto rari di meningoencefalite che può lasciare postumi neurologici.
Pancreatite: si manifesta alla fine della prima settimana con nausea, vomito, dolori addominali talora glicosuria. Evoluzione favorevoli senza postumi.
Complicazioni rare: mastite, polmonite da sovrainfezione batterica, prostatite, nefrite, artrite, nevrite periferica. La tiroidite subacuta, la miocardite, l’epatite e la sordità sono eccezionali.
Prognosi
La prognosi è favorevole, l’orchite porta alla sterilità molto raramente.
Terapia
Riposo a letto per tutta la durata della tumefazione parotitica.
Analgesci-anipiretici.
Può essere utile evitare l’assunzione di alimenti dal forte sapore che stimolano la salivazione e conseguentemente il dolore.
Profilassi
Si deve isolare il malato subito sin dall’inizio della malattia e per tutta la durata della tumefazione. Il Vaccino trivalente Morbillo-Parotite-Rosolia (MPR) viene ora offerto in forma attiva e gratuita per tutti i bambini al 13° mese di vita con richiamo al 5°-6° anno
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