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2002, Número 3

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Rev Inst Nal Enf Resp Mex 2002; 15 (3)


Patofisiología y patogenia de la bronquiolitis viral Avances recientes y perspectivas

Carrada-Bravo T

Idioma: Español
Referencias bibliográficas: 122
Paginas: 172-191
Archivo PDF: 806.56 Kb.


RESUMEN

Después de un período de incubación de dos a ocho días, el virus sincicial respiratorio, los virus parainfluenza y los rinovirus, se replican en el epitelio nasofaríngeo y al cabo de tres días se propagan al tracto respiratorio inferior, la respuesta inflamatoria de la bronquiolitis viral se caracteriza por necrosis y desprendimiento del epitelio que reviste los bronquiolos pequeños, edema, secreción de moco aumentada y obstrucción de las vías aéreas terminales. Las manifestaciones clínicas principales de la bronquiolitis son: sibilancias, hiperinflación alveolar y atelectasia. Alrededor del 50% de los niños hospitalizados con virus sincitial respiratorio presentan episodios subsecuentes de sibilancias, con reclutamiento de linfocitos TH-2, eosinófilos y la liberación de mediadores solubles tales como histamina, kininas, leucotrienos y, las sibilancias intensas se han correlacionado con niveles altos de anticuerpos de la clase IgE y la liberación de células y mediadores de la inflamación que, suelen afectar también las vías neurales con hiperreactividad bronquial, tan característica de la bronquiolitis viral y del asma alérgica. Los estudios de investigación han despertado la inquietud de averiguar si la epidemia actual de asma bronquial podría ser abatida, al controlarse las infecciones causadas por el virus sincitial respiratorio y los parainfluenza.


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