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¿Explican los mutantes de escape los rápidos aumentos en las tasas de mortalidad por dengue en las epidemias?
M G Guzmán1, G Kourí, S B Halstead
1Institute of Tropical Medicine Pedro Kouri, Havana, Cuba. lupe@ipk.sld.cu
Lancet (London, England)
|June 24, 2000
Resumen
Durante las epidemias de dengue, se observó un aumento de la fiebre hemorrágica severa del dengue (FDH) y el síndrome de shock del dengue (SSD). Esto sugiere que la inmunidad previa al virus del dengue 1 puede mejorar las infecciones graves por el virus del dengue 2.
Área de la Ciencia:
- Virología Virología.
- Epidemiología La epidemiología.
- Inmunología Inmunología.
Sus antecedentes:
- Los brotes de virus del dengue en Cuba en 1981 y 1997 mostraron un aumento en las proporciones de casos de fiebre hemorrágica severa del dengue (FHD) y de síndrome de shock del dengue (SSD).
- Las tasas de mortalidad tanto para la fiebre del dengue como para la DHF/DSS también aumentaron durante estas epidemias.
Objetivo del estudio:
- Para explicar los aumentos observados en los casos graves de dengue y la mortalidad durante las epidemias cubanas.
- Investigar el papel de los anticuerpos de reacción cruzada de las infecciones primarias por el virus del dengue 1 en la exacerbación de las infecciones secundarias por el virus del dengue 2.
Principales métodos:
- El estudio propone una hipótesis basada en los datos epidemiológicos observados de las epidemias de dengue en Cuba.
- Se trata de analizar las interacciones inmunológicas entre los serotipos del virus del dengue y las respuestas de anticuerpos del huésped.
Principales resultados:
- Los anticuerpos de las infecciones primarias por el virus del dengue 1 pueden reaccionar de forma cruzada con los virus del dengue 2.
- Estos anticuerpos heterotípicos pueden mejorar, en lugar de neutralizar, las infecciones secundarias por el virus del dengue 2 en individuos previamente infectados.
- Las cepas del virus del dengue 2 que se replican en huéspedes inmunes al dengue-1 pueden escapar de la neutralización, lo que lleva a una enfermedad grave tras la infección posterior.
Conclusiones:
- La inmunidad al virus del dengue 1 puede, paradójicamente, aumentar el riesgo de enfermedad grave tras la posterior infección con el virus del dengue 2.
- Este fenómeno, conocido como pecado antigénico original o mejora dependiente de anticuerpos, contribuye a la gravedad de las epidemias de dengue.
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