CASO

Anamnesi |  Un ragazzo di 22 anni d’improvviso mentre è a casa inizia ad accusare una strana sintomatologia. Avverte mialgia e atralgia, ha rinorrea ed è inappetente. A questi sintomi si associa un’irregolarità dell’alvo cui seguono 3 scariche diarroiche. Ad esse fa seguito un picco febbrile che si stabilisce su 38.5°C. Il ragazzo chiama immediatamente il suo medico curante che imposta subito una terapia antibiotica empirica. Risolve così la sintomatologia intestinale ma resta piretico e rinorroico. Cosa può soffrire il ragazzo?


SOLUZIONE

Diagnosi | Influenza

L’influenza è la più semplice ma anche la più comune virosi stagionale del mondo Occidentale. E’ causata da un ortomixovirus di cui sono state identificate tre specie e cioè l’influenzavirus A, B e C. L’influenza A è un’antropozoonosi che si contrae da numerosi animali domestici come polli oppure suini (influenza aviaria, suina etc.). L’influenza A è l’influenza più comune ed è particolarmente importante nei sistemi segnalazione-notifica dell’OMS e delle sanità mondiali poiché, a partire dal caso indice, si procede all’isolamento del virus e l’elaborazione del vaccino stagionale ceppo specifico per i soggetti a rischio (immunodepressi, malati oncologici, bambini, anziani, coloro che vivono in comunità ristrette, nosocomi etc.). Il virus dell’influenza è infatti caratterizzato da due surface proteins, la Neuroaminidasi e l’emoagglutinina. Queste due proteine sono responsabili dei fenomeni di antigenic-drift e shift frutto della ricombinazione delle proteine suddette del capside virale ad ogni infezione. Non si conosce bene il meccanismo con cui questi fenomeni avvengono ma è certo che avvengono perlopiù negli ospiti animali. Questa è la ragione per la quale l’influenza A è più aggressiva e importante (non solo epidemiologicamente ma anche clinicamente) della B e della C. Queste ultime infatti sono solo a contagio interumano e non presentano i fenomeni di antigenic drift e shift della A. I farmaci a disposizione contro l’influenza sono di due tipi: inibitori della proteina M2 endosomale responsabile della spoliazione virale nonché dell’Emoagglutinina impedendo l’adesione e la penetrazione dell’ospite ovvero Amantadina e Rimantadina e gli analoghi dall’acido sialico cioè inibitori della Neuroaminidasi che impediscono il rilascio virionico ovvero Zanamivir ed Oseltamivir. Raramente accade che i soggetti abbiano bisogno di questi farmaci, specie se giovani, ma la loro somministrazione va presa in considerazione nei soggetti a rischio che contraggono l’infezione. Di norma però l’influenza è una malattia facilmente risolta dal sistema immunitario nel giro di 3-4 giorni che conferisce protezione per il resto della stagione fino all’arrivo di un altro ceppo


Redazione | Nato a Torre del greco il 27/03/1992 5°anno facoltà di medicina e chirurgia Federico II Napoli Appassionato di molte discipline diverse la medicina rappresenta sicuramente la più importante. Non disdegno alcun settore ma le branche che più mi interessano sono quelle della diagnostica clinica, della dermatologia, della ricerca oncologica, della farmacologia, della pediatria e della medicina interna. La mia idea di medico è quella di un lavoro di gruppo che possa essere parte di un team multidisciplinare ben strutturato che garantisca ai pazienti un iter di cura completo ed efficace. Spero un giorno di poter fare esperienze anche in zone di guerra specialmente in medio oriente magari con MSF o Emergency

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