CASO

Un uomo sulla trentina è visitato a domicilio per una febbre alta da alcuni giorni. Riferisce di avere mialgia, atralgia, malessere generale e cefalea. Riferisce di non aver fatto viaggi particolari se non un picnic al parco la settimana prima. Sul corpo presenta un diffuso rush maculo papulare e vasculite periferica nonché una papula ulceronecrotica eritematosa crostosa e desquamante in periferia in regione del quadrante addominale inferiore sinistro.

Il medico è indeciso sul da farsi. Quale potrebbe essere la patologia ?

DIAGNOSI –  Febbre bottonosa del Mediterraneo

La febbre bottonosa è una malattia infettiva causata da un battere intracellulare obbligato detto Rickettsia conorii il quale è veicolato dall’uomo da alcuni specie di zecche fungenti da vettore. La malattia è una antropozoonosi tipica delle zone del mediterraneo che si trasmette tramite le secrezioni salivari infette del batterio da parte dell’artropode parassita durante il pasto ematico . E’ caratterizzata da febbre alta di grado spesso severo,  accompagnata da un rash maculo papulare esantematico ad andamento centripeto (cioè verso il centro), linfoadenosplenomegalia, cefalea, vasculite, mialgia e malessere generale. Le rickettsiosi di norma non sono particolarmente gravi ma vanno trattate. La difficoltà è principalmente diagnostica. Difatti sono malattie mimo che spesso difficilmente si caratterizzano per segni specifici da altre differenziali.

Le Rickettsiosi si dividono in due gruppi:
Il gruppo delle Rickettsiosi tifoidi e quello delle  febbri esantematiche

Al primo gruppo appartiene:

  • Il tifo epidemico classico, il tifo per eccellenza, veicolato da alcuni tipi di pidocchi da uomo a uomo
  • il tifo murino veicolato da pulci o ratti, malattia che flagellò i campi di concentramento tedeschi durante la seconda guerra mondiale
  • Lo Tsutsugamushi o febbre fluviale Giapponese veicolato da acari minor come i trombiculidi o ratti
  • Tifo da zecche del Qeensland

Al secondo gruppo appartengono:

  • La febbre bottonosa del mediterraneo
  • La febbre maculosa delle Montagne rocciose
  • La febbre maculosa elvetica
  • La febbre bottonosa delle Isole Flinders

Queste ultime sono TUTTE trasmesse da zecche !
Il segno tipico della febbre bottonosa è il bottone cioè un’ulcera necrotico emorragica ove la zecca ha effettuato il suo pasto e sito d’inoculo primario delle Rickettsie. E’ caratterizzata da un’area centrale nera (tache noir) con un alone attorno eritemato desquamante
Il nostro paziente è stato morso da una zecca probabilmente durante il suo pic nic
La terapia elettiva per le Rickettsiosi è il Cloramfenicolo o le tetracicline.

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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