dc.contributor | Camargo, Sandra Milena | |
dc.contributor | Patarroyo Gutierrez, Manuel Alfonso | |
dc.contributor | Biología Molecular e InmunologíaFundación Instituto de Inmunología de Colombia | |
dc.creator | Hernandez Buelvas, Lauren Dayam | |
dc.date.accessioned | 2022-09-06T14:37:57Z | |
dc.date.available | 2022-09-06T14:37:57Z | |
dc.date.created | 2022-09-06T14:37:57Z | |
dc.date.issued | 2021 | |
dc.identifier | https://repositorio.unal.edu.co/handle/unal/82256 | |
dc.identifier | Universidad Nacional de Colombia | |
dc.identifier | Repositorio Institucional Universidad Nacional de Colombia | |
dc.identifier | https://repositorio.unal.edu.co/ | |
dc.description.abstract | Las Infecciones de Transmisión Sexual (ITS) son una causa importante de morbilidad, generando gran impacto por las secuelas a las que conllevan. Trichomonas vaginalis (T. vaginalis), es la ITS parasitaria de mayor distribución, siendo sugerida su asociación con el desarrollo de Cáncer de Cérvix (CC). En la actualidad es considerada como una infección desatendida, por lo que
estudios dirigidos a determinar su distribución e impacto en la población resultan relevantes. El objetivo de este estudio fue determinar la dinámica de infección, depuración y persistencia de T. vaginalis en una cohorte retrospectiva de mujeres
provenientes de tres ciudades de Colombia y la evolución de asociaciones longitudinales de diversos factores de riesgo en relación con el curso clínico de las infecciones parasitarias. Este estudio hace parte de una cohorte bidireccional (componente prospectivo y
retrospectivo); en el análisis prospectivo, se realizó la toma de muestras cervicales entre abril de 2007 y marzo de 2010 en tres centros hospitalarios de Colombia: Hospital San Juan Bautista – Chaparral, el Nuevo Hospital San Rafael – Girardot, y
el Hospital de Engativá Nivel II; en el componente prospectivo, se determinó la
historia natural de la infección por VPH y C. trachomatis.
En el componente retrospectivo (correspondiente a este estudio), se realizó la
identificación de T. vaginalis por PCR convencional con el uso de dos juegos de
cebadores: TVK1/7 y BTUB2/9 y Mycoplasma hominis (M. hominis) usando el juego
de cebadores RNAH1/2. Se empelaron modelos de riesgo proporcional de Cox para
evaluar la relación entre el desenlace de las infecciones por T. vaginalis y los
factores de riesgo (como ITS activas, factores sociodemográficos y
comportamentales).
Un total de 264 mujeres fueron incluidas en el estudio retrospectivo; la media de
edad fue 41,8 años (DE= 10,9); un 26,1% (n= 64) presentaron T. vaginalis al inicio
6
del estudio, un 40,9% (n= 108) tuvieron al menos un episodio de infección incidente
y el 13,0% (n= 23) presentó más de un episodio de T. vaginalis; las tasas de
infección y depuración fueron 3,4 y 15,0 por cada 100 personas en un mes,
respectivamente.
En cuanto a los factores de riesgo asociados con el desenlace de T. vaginalis,
mujeres con VPH tuvieron mayor riesgo (aHR= 1,59; IC 95%= 1,08-2,35) de
infección parasitaria, siendo la carga viral (CV) alta (>102) para VPH-16 relacionada
con un mayor riesgo de infección parasitaria y para VPH-18 y -33 una menor
probabilidad de depuración de T. vaginalis, la etnia (afrodescendiente/indígena) y
más de dos compañeros sexuales fueron factores relacionados con un mayor riesgo
(aHR= 5,11 and aHR=1,94, respectivamente) de infección parasitaria; en contraste,
aquellas con antecedentes de abortos presentaron menor probabilidad (aHR= 0,50;
IC 95%= 0,27-0,94) de presentar T. vaginalis.
En cuanto a los factores relacionados con la persistencia parasitaria, los resultados
mostraron que mujeres entre los 35 a 49 años (aHR= 2,08; IC 95%= 1,12-3,88), el
incremento en el número de años desde el inicio de la vida sexual (aHR= 1,10; IC
95%= 1,02-1,19), múltiples parejas sexuales (aHR= 8,86; IC 95%= 1, ,13-12,33) y
mujeres multíparas (aHR= 3,85; IC 95%= 1,16-12,81), fueron características que
aumentaron la probabilidad de tener infecciones persistentes. Finalmente, mujeres
con empeoramiento del hallazgo cervical (diagnosticado por colposcopia) a través
del tiempo, presentaron 9,99 veces más probabilidad de persistencia de T. vaginalis.
Se sabe que la mayor parte de las infecciones por T. vaginalis cursan asintomáticas,
por lo que la epidemiología y la verdadera carga de éstas en términos de la salud
pública, aún son desconocidos. Nuestros resultados mostraron que la distribución
del parásito es elevada en la población analizada; la coexistencia con VPH y otros
factores riesgo, influyen en la dinámica de las infecciones de T. vaginalis y la
progresión de lesiones a nivel cervical; estos datos sugieren la relevancia de la
detección rutinaria de esta parasitosis, principalmente en población en riesgo.
7
Este estudio aporta información sobre la epidemiología, depuración y persistencia
de las infecciones causadas por esta parasitosis en población colombiana; la
comprensión de los factores relacionados con la dinámica de T. vaginalis y la
influencia de factores de riesgo es relevante y plantea nuevos retos en el abordaje
e implementación de estrategias acertadas que mejoren la calidad de vida en la
población femenina. (Texto tomado de la fuente) | |
dc.description.abstract | Trichomonas vaginalis (TV), the most common non-viral sexually-transmitted
infection is considered a neglected infection and its epidemiology is not well known.
This study determined TV-infection dynamics in a retrospective cohort of Colombian
women and evaluated associations between risk factors and TV-outcome. TV was
identifed by PCR. Cox proportional risk models were used for evaluating the
relationship between TV-outcome (infection, clearance and persistence) and risk
factors (sexually-transmitted infections and sociodemographic characteristics).
Two hundred and sixty-four women were included in the study; 26.1% had TV at the
start of the study, 40.9% sufered at least one episode of infection and 13.0% sufered
more than one episode of TV during the study. Women sufering HPV had a greater
risk of TV-infection (aHR 1.59), high viral-load (> 102 ) for HPV16 being related to a
greater risk of persistent parasite infection; a high viral load (> 102 ) for HPV-18 and
-33 was related to a lower probability of TV-clearance. Ethnicity
(afrodescendent/indigenous people: aHR 5.11) and having had more than two
sexual partners (aHR 1.94) were related to greater risk of infection, contrasting with
women having a background of abortions and lower probability of having TV (aHR
0.50). Women aged 35- to 49-years-old (aHR 2.08), increased years of sexual
activity (aHR 1.10), multiple sexual partners (aHR 8.86) and multiparous women
(aHR 3.85) led to a greater probability of persistence.
Women whose cervical fndings worsened had a 9.99 greater probability of TVpersistence. TV distribution was high in the study population; its coexistence with
HPV and other risk factors infuenced parasite infection dynamics. The results suggested that routine TV detection should be considered regarding populations at
risk of infection. | |
dc.publisher | Universidad Nacional de Colombia | |
dc.publisher | Bogotá - Ciencias - Maestría en Ciencias - Microbiología | |
dc.publisher | Instituto de Biotecnología (IBUN) | |
dc.publisher | Facultad de Ciencias | |
dc.publisher | Bogotá, Colombia | |
dc.publisher | Universidad Nacional de Colombia - Sede Bogotá | |
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dc.rights | Atribución-NoComercial-SinDerivadas 4.0 Internacional | |
dc.rights | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
dc.rights | info:eu-repo/semantics/openAccess | |
dc.title | Persistencia y depuración de Trichomonas vaginalis en una cohorte de mujeres colombianas | |
dc.type | Trabajo de grado - Maestría | |