Estudio de la circulación del virus de la hepatitis E (HEV) en Córdoba, Argentina: aspectos epidemiológicos, zoonóticos y ambientales
Mots-clés :
Hepatitis E, seroprevalencia, pacientes inmunocomprometidos, monitoreo ambiental, cerdos, epidemiología molecular, ArgentinaRésumé
El HEV es un virus ampliamente distribuido pero su circulación está subestimada. En Argentina, escasos estudios en humanos y cerdos muestran que dicho virus circula pero hasta el presente, no existían reportes de su circulación en matrices hídricas ambientales y los datos clínico-epidemiológicos locales eran escasos, por lo que conocer las implicancias de la infección en individuos inmunocompetentes e inmunosuprimidos, inferir posibles fuentes de infección y profundizar en la epidemiología molecular de HEV fueron los motivos de este proyecto. Al inicio del estudio en Argentina no existían equipos diagnósticos aprobados para la detección de IgM/IgG-anti-HEV, por lo que el acceso al diagnóstico era limitado y los estudios sero-epidemiológicos escasos y desactualizados. La implementación de métodos moleculares era necesaria para concretar estudios que aportaron datos inéditos en la región acerca del HEV. Se realizó el primer estudio en Sudamérica que reportó HEV-3 (a, b, c) en aguas recreacionales que, junto a hallazgos en aguas residuales, corroboraron la utilidad de la vigilancia ambiental para el monitoreo y caracterización de las cepas circulantes de virus poco estudiados, demostrando la circulación constante del mismo subtipo desde hace al menos 7 años. La detección de HEV en cerdos y su estrecha relación filogenética con cepas humanas aumentaron la sospecha de un ciclo de transmisión local zoonótico. La demostración serológica del HEV en 4,4% de la población general sumó evidencias locales de la circulación. La mayor prevalencia en pacientes inmunosuprimidos (7,37% HIV p=0,12; 10,22% dializados p=0,031; 5,8% trasplantados p=0,66) respecto a la población general, significativamente más elevada en individuos con bajos niveles de LT-CD4[+] (16%, p=0,012), resultó poco alentador considerando que son grupos en riesgo de adquirir infección crónica. El hallazgo de IgM-anti-HEV en individuos dializados y en casos de hepatitis agudas NoANoC señalan al HEV como el responsable de casos de hepatitis E aguda subdiagnosticadas, resaltando la necesidad de su inclusión en el algoritmo diagnóstico. La difusión de estos hallazgos y la implementación local de metodologías para la detección en diferentes etapas de la infección, podrán ser transferidas a los efectores de Salud, sanidad animal y ambiental para mejorar el diagnóstico, reforzar la vigilancia y profundizar el control de su diseminación.Téléchargements
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