Análisis de la especificidad de la definición de caso en el diagnóstico clínico de la gripe

espanolIntroduccion: Para el estudio epidemiologico de la gripe se ha establecido la definicion de caso sospechoso que deberia ser confirmado a traves del analisis virologico. El objetivo es estudiar la etiologia viral de las muestras de la red centinela y su relacion con la definicion de caso. Pacientes y metodo: Se ha realizado un estudio prospectivo en la temporada gripal 2013-2014 sobre la etiologia viral de las muestras respiratorias procedentes de la red centinela. La deteccion del virus se realizo mediante una tecnica de amplificacion genomica RT-PCR en tiempo real. Resultados: Se han estudiado 153 muestras; correspondiendo 121 (79%) a adultos y 32 (21%) a ninos. De ellas, 60 (39.2%) fueron positivas a los virus gripales (49 gripe A(H1N1)pdm09 y 11 gripe A (H3N2)), 55 (35.9%) negativos y en 38 (24.8%) pudo detectarse un virus no gripal. En 98 (64%) muestras se pudo detectar la presencia de algun virus. En las 38 muestras positivas a otros virus, se detectaron 20 (52.6%) rinovirus, 6 (15.7%) coronavirus, 3 (7.8%) adenovirus, 3 (7.8%) parainfluenza tipo 1, 3 (7.8%) virus respiratorio sincitial, 1 (2.6%) bocavirus, 1 (2.6%) metapneumovirus y 1 (2.6%) enterovirus. El numero medio global de sintomas que presentaron las 153 muestras fue de 6.25. En las muestras positivas a gripe fue de 6.45, en las negativas de 6.16 y en las positivas a otros virus de 6.07. Conclusiones: La actual definicion de caso utilizada por los medicos centinela para la sospecha de gripe presenta una baja especificidad. Solo la exigencia de presentar 7 sintomas permitiria incrementar esa especificidad. espanolIntroduction: For the epidemiological study of flu has established the suspected case definition but should be confirmed through virological analysis. The objective is to study the viral etiology of the samples from the sentinel network and relation with the case definition. Patients and methods: We performed a prospective study in the 2013-2014 influenza season on the viral etiology of respiratory samples from the sentinel network. Viral detection was performed using a technique of RT-PCR genmic amplification in real time. Results: We have studied 153 samples; corresponding 121 (79%) adults and 32 (21%) children. Of these, 60 (39.2%) were positive for influenza viruses (49 influenza A (H1N1)pdm09 and 11 influenza A (H3N2)), 55 (35.9%) were negative and in 38 (24.8%) could be detected for the presence of other virus. In 98 (64%) samples could detect the presence of viruses. In other virus 38 positive samples, were detected 20 (52.6%), rhinovirus, 6 (15.7%), coronavirus, 3 (7.8%) adenovirus 3 (7.8%), parainfluenza type 1, 3 (7.8%) Respiratory syncytial virus 1 (2.6%) bocavirus, 1 (2.6%) metapneumovirus and 1 (2.6%) enterovirus. The overall average number of symptoms that presented the 153 samples was 6.25. In influenza-positive samples was 6.45, 6.16 in the negative and 6.07 in positive to other viruses. Conclusions: The current case definition used by sentinel physicians for suspected flu has low specificity. As the requirement of presenting symptoms 7 would increase the specificity.