Coinfección de chlamydia trachomatis y papiloma virus humano en muestras cervicouterinas de pacientes de SOLCA. Guayaquil, 2012.
Fecha
2012
Autores
Título de la revista
ISSN de la revista
Título del volumen
Editor
Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Chlamydia trachomatis es una bacteria intracelular obligada, Gram-negativa causante de infecciones genitourinarias asintomáticas en pacientes femeninas, pudiendo bajo las circunstancias apropiadas desencadenar enfermedad inflamatoria pélvica, embarazo ectópico e infertilidad. (1)
Recientemente se ha observado la relación entre la exposición a C. trachomatis y el desarrollo subsecuente de lesiones cervicales pre cancerosas o cancerosas. (2,3)
Dicha evidencia epidemiológica sobre la contribución de C. trachomatis en el desarrollo de carcinoma cérvico uterino se sospecha resultaría de favorecer la infección por PVH de diversas formas, entre ellas el cambio de una respuesta inmune de tipo celular, adecuada para la contención viral, a otra de tipo humoral y por completo ineficaz en esas circunstancias. (3,4)
Otras investigaciones sugieren que la coinfección C. trachomatis/PVH provoca alteraciones en el equilibrio entre cinasas y ciclinas responsables del control del ciclo celular, en especial la ciclina dependiente de cinasa p16INK4a encargada de reducir la expresión del factor de transcripción E2F. (5)
Nuevos reportes y publicaciones manifiestan que la coinfección de PVH y C. trachomatis es común en ASCUS, del inglés ´´atypical cells of unknown significance´´, traducido al
español como células escamosas atípicas de significado incierto y que la citada interacción podría contribuir a la aparición de lesiones intraepiteliales. (6)
Respecto a la probable asociación de C. trachomatis con genotipos específicos de PVH se dispone de resultados variados, ya que las diferentes combinaciones incluyen genotipos de PVH de alto y bajo riesgo oncogénico. (4, 6)
Desde otro punto de vista y como resultado de innumerables estudios moleculares y epidemiológicos, la infección causada por genotipos oncogénicos de PVH se considera inequívocamente como el principal factor causal necesario para la transformación progresiva hacia la neoplasia intraepitelial cervical y el cáncer de cérvix avanzado. (4)
A pesar de la citada importancia del PVH en el desarrollo de cáncer de cérvix, se ha logrado demostrar que la mayoría de las veces causa solo una infección transitoria y que solo un pequeño porcentaje persiste y progresa hacia lesiones displásicas. (7)
Las razones para una historia natural tan variable se comprenden poco todavía, y se acepta por lo general la contribución de factores de riesgo adicionales, entre ellos el genotipo y la carga viral de PVH.
Se consideran también factores ambientales encabezando la lista, el consumo de tabaco, el número de compañeros sexuales, la anticoncepción de larga data, tanto como las coinfecciones, sobre todo las causadas por Herpes Virus de tipo 2 y Chlamydia trachomatis. (4, 3)
Chlamydia trachomatis is a mandatory, Gram-negative intracellular bacterium that causes asymptomatic genitourinary infections in female patients, being able to trigger pelvic inflammatory disease, ectopic pregnancy and infertility under the appropriate circumstances. (one) Recently, the relationship between exposure to C. trachomatis and the subsequent development of pre-cancerous or cancerous cervical lesions has been observed. (2,3) Such epidemiological evidence on the contribution of C. trachomatis in the development of uterine cervical carcinoma is suspected as a result of favoring HPV infection in various ways, including the change of a cellular-type immune response, suitable for viral containment, to another of humoral type and completely ineffective in these circumstances. (3.4) Other research suggests that C. trachomatis / PVH coinfection causes alterations in the balance between kinases and cyclines responsible for the control of the cell cycle, especially the kinase dependent cyclin p16INK4a responsible for reducing the expression of the E2F transcription factor. (5) New reports and publications state that the co-infection of HPV and C. trachomatis is common in ASCUS, from the English ´´atypical cells of unknown significance´´, translated into Spanish as atypical squamous cells of uncertain significance and that the aforementioned interaction could contribute to the appearance of intraepithelial lesions. (6) Regarding the probable association of C. trachomatis with specific genotypes of HPV, varied results are available, since the different combinations include genotypes of high and low oncogenic risk. (4, 6) From another point of view and as a result of innumerable molecular and epidemiological studies, infection caused by oncogenic genotypes of HPV is unequivocally considered as the main causal factor necessary for the progressive transformation towards cervical intraepithelial neoplasia and advanced cervical cancer. (4) Despite the aforementioned importance of HPV in the development of cervical cancer, it has been demonstrated that most of the time it causes only a transient infection and that only a small percentage persists and progresses towards injuries
Chlamydia trachomatis is a mandatory, Gram-negative intracellular bacterium that causes asymptomatic genitourinary infections in female patients, being able to trigger pelvic inflammatory disease, ectopic pregnancy and infertility under the appropriate circumstances. (one) Recently, the relationship between exposure to C. trachomatis and the subsequent development of pre-cancerous or cancerous cervical lesions has been observed. (2,3) Such epidemiological evidence on the contribution of C. trachomatis in the development of uterine cervical carcinoma is suspected as a result of favoring HPV infection in various ways, including the change of a cellular-type immune response, suitable for viral containment, to another of humoral type and completely ineffective in these circumstances. (3.4) Other research suggests that C. trachomatis / PVH coinfection causes alterations in the balance between kinases and cyclines responsible for the control of the cell cycle, especially the kinase dependent cyclin p16INK4a responsible for reducing the expression of the E2F transcription factor. (5) New reports and publications state that the co-infection of HPV and C. trachomatis is common in ASCUS, from the English ´´atypical cells of unknown significance´´, translated into Spanish as atypical squamous cells of uncertain significance and that the aforementioned interaction could contribute to the appearance of intraepithelial lesions. (6) Regarding the probable association of C. trachomatis with specific genotypes of HPV, varied results are available, since the different combinations include genotypes of high and low oncogenic risk. (4, 6) From another point of view and as a result of innumerable molecular and epidemiological studies, infection caused by oncogenic genotypes of HPV is unequivocally considered as the main causal factor necessary for the progressive transformation towards cervical intraepithelial neoplasia and advanced cervical cancer. (4) Despite the aforementioned importance of HPV in the development of cervical cancer, it has been demonstrated that most of the time it causes only a transient infection and that only a small percentage persists and progresses towards injuries
Descripción
PDF
Palabras clave
Chlamydia trachomatis, Virus del papiloma humano, Manejo de especímenes, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador, Coinfección, Cuello uterino, Técnicas de laboratorio clínico, Enfermedades del cuello del útero