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Incapacidad para eliminar la infección persistente neurovirulenta por poliovirus derivada de la vacuna en un hombre
Calman MacLennan1, Glynis Dunn, Aarnoud P Huissoon
1MRC Centre for Immune Regulation, Division of Immunity and Infection, University of Birmingham, Birmingham, UK. cmaclennan@mlw.medcol.mw
Lancet (London, England)
|May 12, 2004
Resumen
La excreción crónica del poliovirus en la hipogammaglobulinemia plantea un desafío significativo para los esfuerzos globales de erradicación. Los tratamientos actuales son ineficaces, lo que destaca la necesidad de nuevas estrategias terapéuticas contra el poliovirus derivado de la vacuna.
Área de la Ciencia:
- Virología Virología.
- Inmunología Inmunología.
- Enfermedades infecciosas Enfermedades infecciosas.
Sus antecedentes:
- La excreción crónica del poliovirus neurovirulento, en particular las cepas derivadas de la vacuna, es una preocupación importante para el programa de erradicación global de la polio.
- La hipogammaglobulinaemia es un factor de riesgo reconocido para la infección persistente por poliovirus.
Objetivo del estudio:
- Investigar estrategias terapéuticas para la eliminación de la infección por poliovirus neurovirulento persistente en un paciente con inmunodeficiencia variable común.
Principales métodos:
- Se llevaron a cabo estudios in vitro e in vivo utilizando inmunoglobulina oral, leche materna, ribavirina y pleconaril.
- Realizó la cuantificación viral, ensayos de neutralización de anticuerpos, pruebas de susceptibilidad a fármacos y secuenciación de genes virales.
Principales resultados:
- Se identificó una excreción asintomática a largo plazo del poliovirus 2 derivado de la vacuna (hasta 22 años) en un varón hipogammaglobulinémico.
- Ningún tratamiento eliminó con éxito el virus, aunque la leche materna redujo temporalmente los niveles de excreción.
- El virus desarrolló una susceptibilidad reducida al pleconaril, y el análisis de la secuencia reveló una mutación clave.
Conclusiones:
- La infección crónica por poliovirus asociada a la vacuna en la hipogammaglobulinemia es difícil de tratar.
- Esta infección persistente presenta un riesgo para la estrategia final de la poliomielitis y el cese de la vacunación contra la poliomielitis.
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