Toxocara, il parassita che convive con noi…

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Chi non ha mai toccato della terra oppure ha manipolato del fango? Penso un po’ tutti. Ricordo che quando ero bambino mi ritrovavo spesso imbrattato di fango quando si giocava a calcio con i coetanei subito dopo un breve temporale primaverile oppure quando si cadeva dalla bicicletta mentre in autunno si percorrevano a tutta velocità i sentieri di campagna o quando si faceva la “guerra” tra amici che spesso terminava con estenuanti e divertenti lotte nel fango!

Anche da adulto mi sono ritrovato in più circostanze a toccare della terra soprattutto durante varie operazioni di giardinaggio (travasi di piante, interramento di bulbi, concimazioni, ecc.) e nelle attività agronomiche derivanti dalla gestione di alcune vigne e frutteti di famiglia.

Insomma spesso, e un po’ a tutte le età, mi sono ritrovato a manipolare la terra oppure a toccare il fango eppure non mi è mai successo niente. Molto probabilmente da giovinetto sono stato fortunato e da adulto abbastanza accorto perché i rischi igienico-sanitari derivanti dalla manipolazione senza protezioni della terra non sono pochi. Uno di questi rischi deriva dall’eventuale presenza nel terreno delle uova del parassita Toxocara.

Il genere Toxocara comprende diverse specie di parassiti in grado di causare antropozoonosi (malattie trasmesse all’uomo da animali vertebrati) a seguito dell’ingestione delle uova presenti nell’acqua e/o negli alimenti contaminati dalle feci di animali parassitati. Molto spesso si contrae la toxocariasi in quanto le uova si trovano nel terreno che viene toccato con le mani e poi mettendo queste in bocca oppure maneggiando del cibo che successivamente viene consumato.

I precursori di questa particolare zoonosi sono soprattutto i cani e i gatti (principalmente quelli randagi) infatti, si possono distinguere due specie: la Toxocara canis e la Toxocara cati.

Ciclo negli animali

Il ciclo vitale di questi parassiti è molto complesso e può avvenire secondo differenti percorsi. Semplificando il ciclo si può affermare che il parassita adulto, nematode (verme di forma cilindrica) che vive nell’intestino del cane o del gatto, depone le uova che finiscono nelle feci e quindi nel terreno. Se queste uova (caratterizzate da da un guscio protettivo spesso e molto resistente) vengono ingerite, sempre da questi animali, finiscono nel loro stomaco dove schiudono dando origine alle larve. Queste perforano la parete intestinale e finiscono nel circolo sanguigno raggiungendo diversi organi (soprattutto i polmoni). Le larve che giungono nei polmoni risalgono le vie aeree (bronchi, trachea, laringe e faringe) sino a essere deglutite e quindi ritornare nell’intestino dove la larva si trasforma nel parassita adulto in grado di produrre uova che sono in grado di resistere parecchio tempo (anche anni) grazie al resistente guscio che le protegge.

Questo ciclo vitale è tipico dei cuccioli di cane (cioè con pochi mesi di vita) pare che circa il 90% dei cuccioli è parassitato dalla Toxocara. Nei cani più grandi la migrazione delle larve dall’apparato respiratorio a quello digerente avviene di rado (soprattutto dopo i sei mesi) infatti, queste larve tendono a migrare in diversi organi (cuore, ecc.) dove restano quiescenti. Qualora l’animale parassitato dovesse essere di sesso femminile, durante la gravidanza queste larve si riattivano giungendo nel feto e nelle ghiandole mammarie.

La Toxocara canis, diversamente della Toxocara cati, riesce a superare la placenta (trasmissione trasplacentale) ed entrambe possono essere trasmesse grazie al colostro (primo alimento dei neonati costituito da un liquido sieroso prodotto dalla ghiandola mammaria).  Nei gatti le larve di T. cati possono essere trasmesse con il latte.

Generalmente i principali soggetti produttori di uova sono i cuccioli che non superano i sei mesi di età.

La diagnosi viene fatta attraverso la ricerca delle uova nelle feci (esame coprologico) e qualora venissero riscontrate si interviene con specifico trattamento antiparassitario.

Le uova riescono a rimanere vitali nel terreno per lunghi periodi (anche 3-4 anni).

Ciclo nell’uomo

Se le uova di Toxocara dovessero essere ingerite dall’uomo a livello gastro-intestinale queste schiudono dando origine a delle larve le quali migrano (LMV – Larva Migrans Viscerale) verso vari organi secondo una sorta di tropismo, ma soprattutto nel cervello (determinando la sindrome da LME – Larva Migrans Encefalica), negli occhi (sindrome da LMO – Larva Migrans Oculare), nel fegato, nei polmoni e nel cuore producendo differenti sintomi e patologie a seconda dell’organo compromesso. Generalmente la sindrome da LMO è monolaterale.

Nell’uomo (ospite paratenico cioè accidentale) la Toxocara non riesce a compiere il ciclo completo perché le larve non sono in grado di passare allo stadio adulto. Le larve, una volta giunte nei vari organi, provocano una reazione granulomatosa.

I sintomi possono essere differenti, i più frequenti sono la tosse, la febbre, eruzioni cutanee, polmoniti ricorrenti, epatomegalia (ingrossamento del fegato), dolori addominali, splenomegalia, disturbi neurologici (disturbi del comportamento, convulsioni, nei bambini può essere causa di problemi di apprendimento e cognitivi, ecc.), disturbi oculari (granuloma parassitario retinico e endoftalmite), ecc. Esistono anche casi asintomatici.

Generalmente la patologia è autolimitante entro 6-18 mesi. Con la morte delle larve si può avere la calcificazione delle cisti che le contenevano con eventuali danni ai tessuti/organi che le contenevano. La gravità della toxocariasi dipende dal numero di uova ingerite e dalla localizzazione delle larve.

Attraverso determinati test sierologici si può diagnosticare la patologia ed eseguire la specifica terapia.

La Toxocariasi è cosmopolita, anche se diffusa soprattutto nei Paesi in via di sviluppo, dove il rispetto delle norme igieniche non è diffuso.

Prevenzione

La toxocariasi colpisce soprattutto i bambini che giocano nei parchi, giardini, spiagge e cortili frequentati da cani e gatti soprattutto se randagi quindi non sottoposti a regolari controlli coprologici e a trattamenti vermifughi.

Secondo un recente studio (settembre 2017) condotto dal CDC (Centers for Disease Control and Prevention: Centri per la Prevenzione e il Controllo delle Malattie) degli Stati Uniti, pubblicato nella rivista Clinical Infectious Diseases, il 5% della popolazione degli USA (circa 16 milioni di persone) ha gli anticorpi per il Toxocara quindi, nell’arco della propria vita, ha ingerito le uova di questo parassita.

Sempre secondo una ricerca del 2017 effettuata in 21 parchi della città di New York si sono trovate uova di Toxocara in ben 9 parchi.

Secondo il Preside del National School of Tropical Medicine del Baylor College di Houston il Toxocara è connesso all’epilessia e a un basso quoziente intellettivo.

Questa zoonosi è particolarmente a rischio nei bambini affetti da picacismo (o allotriofagia), disturbo del comportamento alimentare definito dall’ingestione incontrollata di sostanze non alimentari, quindi non edibili, come oggetti, terra (geofagia), carta, sapone, ecc.

Per ridurre il rischio della Toxocariasi, zoonosi emergente in ambiente urbano, è sufficiente:

  1. che le aree destinate ai giochi dei bambini siano recintate e distinte da quelle dove possono accedervi gli eventuali cani randagi e i cani con padrone. Quindi bisogna cercare di ridurre la contaminazione del verde urbano pubblico (aree ricreazionali, ecc.) e condominiale;
  2. che i padroni dei cani rispettino le norme igieniche raccogliendo e smaltendo, in maniera idonea, le feci dei propri animali;
  3. effettuare i periodici esami coprologici e le regolari sverminazioni dei propri animali domestici;
  4. controllare i bambini quando giocano nelle aree aperte evitando che questi si mettano le mani in bocca dopo aver toccato il terreno o gli oggetti (es. giocattoli) che sono stati a contatto con questo;
  5. effettuare periodici lavaggi delle mani soprattutto dopo aver manipolato la terra;
  6. usare idonei guanti protettivi durante le operazioni di giardinaggio e specifici lavori agronomici;
  7. che i bambini piccoli giochino con cani e gatti (specialmente se cuccioli) con la dovuta cautela igienico-sanitaria e sotto il controllo degli adulti;
  8. lavare molto bene le verdure se consumate crude specialmente se coltivate in orti familiari dove è probabile l’accesso di cani e gatti. Ovviamente bisognerebbe sempre evitare l’accesso dei cani e gatti domestici e randagi nelle aree coltivate a ortaggi e verdure;

che le aree destinate al Mud Running (1) siano recintate e monitorate al fine di evitare eventuali accessi di cani randagi, di cani con padrone e di animali selvatici. Chi pratica questo sport emergente deve prendere particolari attenzioni.

(1) Il Mud Running (letteralmente “corsa nel fango”) è una nuova disciplina sportiva in pieno boom negli USA, ma che si sta diffondendo anche in Italia.

In pratica si deve correre, spesso dopo una pioggia, in un percorso ricco di ostacoli (staccionate, buche, dislivelli, muretti, tronchi, ecc.) attraversando boschi, prati, ruscelli, sentieri di montagna e anche aree paludose. Durante questa corsa capita di arrampicarsi, di gattonare e di strisciare nel fango.

In genere i percorsi da fare vanno dai 5 agli oltre 10 km.

Sicuramente questa particolare disciplina fa bene alla coordinazione delle differenti masse muscolari, rafforza i glutei e gli addominali, migliora l’attività cardio-respiratoria e sicuramente apporta anche benefici psicologici in quanto l’attività fisica viene svolta all’aperto in totale immersione nella Natura dando un forte senso di libertà. Oltre a ciò questa particolare corsa sprona i praticanti ad andare oltre i propri limiti quindi, oltre alla prestanza fisica, implica una forte motivazione tipica delle sfide.

Insomma questa particolare corsa racchiude tanti aspetti benefici, ma poiché parte del percorso, viene effettuato in ambiente fangoso bisogna che le aree destinate a tale sport siano esenti da problemi di parassiti, che i praticanti seguano dei corsi basilari sui potenziali rischi e soprattutto come evitarli e che gli organizzatori di eventi di mud running (allenamenti, gare, ecc.) diano determinate garanzie igienico-sanitarie.

© Produzione riservata

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Dr. Luciano O. Atzori

Biologo – Esperto in Sicurezza degli Alimenti e in Tutela della Salute
Divulgatore Scientifico – Consulente agroalimentare

Co-founder dello ISQAlimenti.it

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