Lepra: Un trastorno bipolar
Palabras clave:
lepra, inmunología de la lepra, reacciones lepróticasResumen
El Mycobacterium leprae, agente causal de la lepra o enfermedad de Hansen, es un bacilo ácidoalcohol resistente de muy lenta replicación, con características muy especiales en su estructura, las cuales son responsables de varias de las respuestas inmunológicas presentadas por el huésped. Se cree que la vía de entrada del bacilo es a través de secreciones nasales y orales, para luego diseminarse e invadir el tejido nervioso por el cual presenta un tropismo especial. Una vez se desarrolla la enfermedad, diferentes factores, entre los cuales se encuentran los genéticos, hacen que las manifestaciones clínicas, inmunológicas y patológicas varíen de paciente a paciente, en un espectro que va desde el polo tuberculoide hasta el polo lepromatoso. En el polo tuberculoide, la respuesta de inmunidad celular del tipo Th 1 logra erradicar de manera eficiente la infección pero ocasiona daño tisular importante. En el polo lepromatoso, la respuesta celular Th 1 es inefectiva, predominando la inmunidad humoral y la inadecuada destrucción del agente causal. El espectro de la enfermedad es dinámico, lo cual permite el desarrollo de los estados reaccionales de tipo I, tipo II y tipo III, los cuales empeoran los síntomas cutáneos y neurales y entorpecen la recuperación clínica del paciente. Los tratamientos para las reacciones buscan frenar esta exagerada respuesta inmunológica, y los esteroides y la talidomida son los medicamentos utilizados por excelencia. Se necesitan más investigaciones para una mejor comprensión del comportamiento inmunológico y patológico de la infección por el bacilo de Hansen.
Biografía del autor/a
Adriana Cruz A
RII Dermatología, Universidad del Valle, Cali.
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