Shigellosi:infezione batterica che causa dissenteria
Che cos’è la shigellosi ?
La shigellosi (o dissenteria bacillare) è un’infezione intestinale acuta e contagiosa, causata da batteri del genere shigella appartenente alla famiglia delle Enterobacteriaceae Gram-negativo, anaerobio facoltativo. Si tratta di germi molto sensibili ai comuni detergenti e disinfettanti, ma che nell’ambiente esterno possono presentare gradi variabili di resistenza, soprattutto quando siano contenuti in materiale organico. Clinicamente si manifesta con una sintomatologia di intensità variabile, da una forma lieve e non particolarmente impegnativa a quella più grave caratterizzata da febbre, intensi dolori addominali, tenesmo e diarrea muco-sanguinolenta.
Epidemiologia
La shigellosi è una malattia ubiquitaria, con un totale stimato di 600.000 morti l’anno. Due terzi dei casi e la maggior parte dei morti sono bambini di età inferiore a 10 anni. E’ endemica sia nei paesi tropicali sia in quelli temperati.
Esistono quattro specie:
Shigella dysenteriae
Shigella flexneri
Shigella boydii
Shigella sonnei
tutte responsabili della dissenteria bacillare e quasi esclusivamente limitate agli ospiti umani. La trasmissione è per via fecale-orale, ma anche per inquinamento di alimenti o di acque; ulteriore veicolo sono le mosche. Nei paesi occidentali è riconosciuta la trasmissione per via sessuale. L’unico serbatoio è l’uomo malato o portatore asintomatico; per provocare la malattia è sufficiente una bassa carica microbica.
Quali sono i sintomi della shigellosi ?
Il periodo di incubazione è breve, da sei ore a 4-5 giorni.
Le forme lievi sono caratterizzate da:
Dolori addominalidiffusi crampiformi, seguiti dopo 12-24 ore da diarrea, con scariche ravvicinate, associata a tenesmo.
Le feci, inizialmente poltacee e ricche di muco, nel volgere di 1-2 giorni appaiono liquide ed ematiche.
La febbreè generalmente assente.
L’addome appare diffusamente dolente, ma senza segni di difesa.
Nei bambini si può associare vomito, segni di disidratazione acuta e talora interessamento meningeo.
Nelle forme gravii dolori addominali sono più marcati, la febbrepiù elevata e le scariche diarroiche più numerose. La diarrea può essere inizialmente acquosa, simil-colerica, ma in breve le feci assumono un aspetto caratteristico a “lavatura di carne” o “gelatina di ribes” per la presenza di muco, pus e sangue abbondante.
Come si fa la diagnosi di shigellosi?
La malattia viene sospettata in base all’anamnesi e ai caratteristici segni e sintomi. L’esame microscopico diretto delle feci evidenzia la presenza di eritrociti e numerosissimi i granulociti neutrofili (reperto a specifico). La diagnosi di certezza si fonda sulla coprocultura, costantemente positiva in fase precoce di malattia e spesso negativa a partire dal terzo giorno di malattia.
Prognosi
La malattia è in genere a evoluzione benigna nei soggetti adulti immunocompetenti, ma assume particolare gravità nell’età estreme della vita, nei soggetti immunocompromessi o malnutriti e in generale nei casi che si osservano nei Paesi in via di sviluppo. In queste evenienze la malattia porta facilmente a grave disidratazione e comparsa di squilibri elettrolitici che, se non vengono prontamente corretti sono causa di un’elevata letalità.
Terapia
Il trattamento si basa sulla somministrazione di antibiotici, chinolonie cotrimoxazoloe sulla reidratazione, che sono in grado di alleviare i sintomi, sostituzione delle perdite di liquidi e di elettroliti che avviene con la diarrea. Bisogna rivolgere una particolare attenzione alla prevenzione, mantenendo sempre un’igiene adeguata. È essenziale che i soggetti affetti siano posti in stretta quarantena per limitare l’epidemia. Si tratta di una malattia a dichiarazione internazionale obbligatoria.
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