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Antes Revista del Instituto Nacional de Enfermedades Respiratorias

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2015, Número 3

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Neumol Cir Torax 2015; 74 (3)


Determinación del interferón-gamma en tuberculosis: Principios básicos y utilidad

Machado-Villarroel L, Acosta-Loya JA, Orozco-Andrade I, Bravo-Rodríguez G, Dimakis-Ramírez DA

Idioma: Español
Referencias bibliográficas: 42
Paginas: 197-206
Archivo PDF: 300.94 Kb.


RESUMEN

La tuberculosis es una enfermedad transmisible distribuida globalmente con tasas de morbimortalidad elevadas. Resulta fundamental establecer un diagnóstico y tratamiento oportunos de la infección por tuberculosis. La reducción de tuberculosis latente reduce el riesgo de progresión a tuberculosis activa. La prueba cutánea de tuberculina es el método estándar de detección de infección por tuberculosis latente, empero presenta limitaciones en su desempeño, sensibilidad y especificidad; principalmente en individuos inmunocomprometidos y/o previamente vacunados con bacilo Calmette-Guérin. La prueba IGRA (del inglés interferon-gamma release assay, ensayo de liberación de interferón-gamma) fue diseñada para complementar el diagnóstico de infección latente por tuberculosis e incrementar la sensibilidad y especificidad, al cuantificar el interferón-gamma producido por linfocitos-T sensibilizados en respuesta al contacto con antígenos específicos de Mycobacterium tuberculosis. El IGRA aún es incapaz de discriminar una infección previa o actual por Mycobacterium tuberculosis, tampoco puede diferenciar entre infección latente por tuberculosis y tuberculosis activa. Existen dos pruebas IGRA disponibles comercialmente: QuantiFERON®-TB Gold In-Tube y T-SPOT®TB. El desempeño es superior en individuos inmunocompetentes › 5 años de edad. Sin embargo, la eficacia clínica resulta afectada en individuos inmunodeprimidos, debido a una síntesis reducida y fluctuante de interferón-gamma en dicho grupo de pacientes. Factores como la inmunosupresión contribuyen a obtener resultados indeterminados, lo cual debe considerarse al momento de interpretar la prueba


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