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2010, Número 1

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Rev Mex Patol Clin Med Lab 2010; 57 (1)


Avances recientes en el diagnóstico, epidemiología y prevención de la influenza. Revisión crítica

Carrada BT

Idioma: Español
Referencias bibliográficas: 130
Paginas: 4-53
Archivo PDF: 1521.44 Kb.


RESUMEN

Cada año, 20% de los niños y 5% de los adultos desarrollan influenza A o B sintomática. El curso clínico es modificable por la edad del enfermo, el nivel de inmunidad preexistente, las propiedades del virus, las comorbilidades, la inmunosupresión, el tabaquismo y el embarazo. La infección se contagia principalmente por las gotitas expulsadas al toser o estornudar, pero los fómites son otro modo de transmitir la infección. La hemaglutinina viral facilita el enlace del virus con el receptor de ácido siálico y la replicación viral comienza sobre el epitelio ciliado, los macrófagos y los neumocitos tipo 2, la carga viral sube hasta 103–107 TCID50/mL en el exudado nasofaríngeo, permanece así por 24-72 horas y cae al quinto día. La virulencia microbiana reside en el tipo de hemaglutinina, aunque otros factores como la proteína no estructural-1, PB-2 y neuraminidasa también participan en la patogenia. La neumonitis hemorrágica se ha relacionado con la producción excesiva de citocinas causantes de daño tisular y la muerte. La mortalidad atribuible a la influenza se ha rastreado contando las defunciones codificadas como neumonía o influenza; sin embargo, ese indicador es menos sensible que las muertes por todas las causas. La morbilidad específica puede cuantificarse usando el diagnóstico clínico más la confirmación por el laboratorio. Las aves acuáticas silvestres son el reservorio principal del virus A, habiéndose demostrado la transmisión a los humanos, cerdos, aves de corral y otros animales, por medio del análisis filogenético de las nucleoproteínas virales. Las vacunas inactivadas son el medio principal de prevenir la influenza, pero las vacunas virales adaptadas en frío ofrecen una protección más amplia para los niños. El oseltamivir por vía oral y zanamivir inhalado han demostrado su eficacia clínica para prevenir y tratar la influenza.


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