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Resumen
Aunque la tuberculosis es una enfermedad antigua, se acepta que la revolución industrial es la causa de una exacerbación epidémica, debido a las condiciones socioeconómicas por ella creadas (hacinamiento, falta de higiene, que influyen tanto de forma directa, facilitando los contagios en cadena, como indirecta al disminuir la resistencia del organismo frente al germen. Sin embargo, se ha supervalorado la influencia de los factores sociales, y la moderna quimioterapia ha demostrado la falsedad del predominio de aquéllos sobre los estrictamente médicos.
Clásicamente se pensaba que la infección primaria confería una inmunidad suficiente para prevenir nuevas infecciones, pero modernos estudios han demostrado que los individuos con reacción positiva a la tuberculina presentan un riesgo de tres a cinco veces mayor de desarrollar tuberculosis activa.
Sannarelli por un lado y Lange y Lydtin por otro expusieron sendas teorías, según las cuales la tuberculosis era inextirpable de la sociedad. Los modernos métodos de lucha antituberculosa han puesto de manifiesto lo errado de aquellas teorías. Actualmente se considera posible no sólo erradicar la enfermedad, sino extirpar la infección. Todo esto se concretaría en cuatro fases: superación, control, eliminación y erradicación verdadera.
Igualmente erróneo es el concepto de que la primoinfección en el adulto es de mayor gravedad que en la infancia. Actualmente, en los países desarrollados, aun en aquellos con baja endemia, la infección se produce en una mayor proporción en adultos que en niños, pero sin diferencias en cuanto a la gravedad.
Finalmente se comenta el tema de la reinfección como factor de tisiogénesis y su importancia práctica a la hora de programar la lucha antituberculosa.
Summary
Although tuberculosis is an ancient disease, it is accepted that the industrial revolution was the cause of an epidemic exacerbation due to the socio-economic condictions said revolution created (crowding, lack of hygiene). These conditions influenced both directly, facilitating chain contagion, and indirectly by decreasing the resistance of the organism to the germ. However, the influence of social factors have been overevaluated, and modern chemotherapy has demonstrated the falsity of the predominance of social factors over strictly medical factors.
Classically, it was thought that the primary infection conferred sufficient immunity to prevent new infections, but modern studies have shown that individuals with a positive reaction to tuberculin present a risk, three to five times greater, of developing active tuberculosis.
Sannarelli, on the one hand, and Lange and Lydtin on the other, presented noteworthy theories, according to which tuberculosis couid not be eradicated from society. Modern methods for fighting against tuberculosis, however, hace shown the errors of these theories. Currently it is thought that it is possible not oniy to eradicate the disease, but aiso to eliminate the infection. This wouid be carried out in four phases: surmount, control, elimination and true eradication.
The concept that the first infection in adulthood is of greater severity than in infancy is aiso wrong. Currently, in developed countries, even those with low endemia, the infection is produced, in greater proportion, in adults than in children, but with no differences with respect to severity.
Finally the authors comment on the topic of reinfection as a factor of pthisiogenesis and its practical importance for programming the fight against tuberculosis.
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