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El cultivo constituye el método de referencia para el diagnóstico de la infección por Bordetella pertussis. Sin embargo, el retraso en la obtención de muestras y el tratamiento antibiótico previo pueden limitar su sensibilidad. La inmunofluorescencia directa proporciona, teóricamente, un diagnóstico inmediato. No obstante, es un procedimiento subjetivo que resulta poco sensible y específico. Las técnicas de reacción en cadena de la polimerasa (PCR) incrementan la sensibilidad del cultivo, manteniendo una elevada especificidad, pero también en este caso su rendimiento disminuye a lo largo de la evolución de la enfermedad. Los métodos serológicos representan la principal alternativa en los casos en los que el diagnóstico se demore. Se recomiendan técnicas de enzimoinmunoanálisis (ELISA) que incluyan antígenos purificados como la hemaglutinina filamentosa y, especialmente, la toxina pertussis. Aunque la confirmación tradicional del diagnóstico serológico se realiza mediante demostración de seroconversión, en la actualidad se plantea el diagnóstico basado en la titulación de una única muestra de suero.
Culture is the reference method for the diagnosis of infection by Bordetella pertussis. Nevertheless, delayed sample collection and previous antibiotic treatment can limit culture sensitivity. In principle, direct immunofluorescence provides immediate diagnosis. It is, however, a subjective procedure that shows low sensitivity and specificity. PCR techniques increase culture sensitivity while maintaining high specificity, but their performance decreases along the evolution of the disease. Serologic methods are the main alternative for cases in which diagnosis is delayed. Current recommendations center on ELISA techniques that include purified antigens, such as filamentous hemaglutinin, and particularly, pertussis toxin. Traditionally, serological diagnosis requires confirmation by demonstrated seroconversion, but now the possibility of diagnosis based on titration of a single serum sample is being evaluated.
Palabras clave:
Tos ferina
Diagnóstico
Serología
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