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Progreso clínico y carga viral en un brote comunitario de neumonía SARS asociada al coronavirus: un estudio

J S M Peiris¹, C M Chu, V C C Cheng

¹Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China.

Lancet (London, England)

|June 5, 2003

Resumen

Los pacientes con síndrome respiratorio agudo severo (SARS) a menudo empeoran en la semana 2, no debido a la replicación viral, sino a un probable daño inmunopatológico. Esta progresión afecta los resultados clínicos y radiológicos.

Área de la Ciencia:

Enfermedades infecciosas Enfermedades infecciosas.
Virología Virología.
Pulmonología Pulmonología.

Sus antecedentes:

Investigó la progresión temporal de los cambios clínicos, radiológicos y virológicos durante un brote comunitario de síndrome respiratorio agudo severo (SARS).
Se examinó a 75 pacientes durante 3 semanas utilizando un protocolo de tratamiento estándar.

Objetivo del estudio:

Para evaluar el patrón de la enfermedad clínica, la carga viral y los factores de riesgo para los malos resultados en pacientes con SARS.
Evaluar la utilidad de los métodos de diagnóstico virológico en el manejo del SARS.

Principales métodos:

Se realizó un seguimiento de 75 pacientes con SARS durante 3 semanas con tratamiento con ribavirina y corticosteroides.
Enfermedad clínica evaluada, carga viral a través de RT-PCR, cambios radiológicos y factores de riesgo para el ARDS.
Analizó la presencia de coronavirus asociado al SARS en las heces y el tiempo de seroconversión.

Principales resultados:

El 85% de los pacientes experimentaron fiebre recurrente, el 73% tuvo diarrea acuosa y el 80% mostró empeoramiento radiológico después de la mejora inicial.
El 34% desarrolló nuevas lesiones radiológicas, el 12% neumomediastinum espontáneo y el 20% síndrome de dificultad respiratoria aguda (ARDS).
El pico de la carga viral se produjo alrededor del día 10, con el derramamiento viral en las heces detectadas en el 97% de los pacientes en el día 14.

Conclusiones:

El empeoramiento clínico y radiológico en la semana 2 sugiere un daño inmunopatológico en lugar de una replicación viral incontrolada.
La edad y la infección crónica por el virus de la hepatitis B fueron factores de riesgo significativos para la progresión de la ERA.
El perfil de carga viral V invertida apoya la hipótesis de que la inmunopatología impulsa la progresión de la enfermedad.

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