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RESUMEN
ABSTRACT
La tularemia es una enfermedad infecciosa clsicamente trasmitida por vector, de reas geogrficas circunscritas, provocada
por Francisella tularensis, bacteria muy virulenta que provoca en el
ser humano diversos sndromes clnicos definidos. La enfermedad tiene especial relevancia debido a su potencial como arma
terrorista. El pronstico est determinado por la variedad clnica
y es curable con antibiticos.
P ALABRAS CLAVE : tularemia, Francisella tularensis
Introduccin
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Sinnimos
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Historia
DCMQ
110
n rarenas98@hotmail.com, drfelac@yahoo.com
Departamento de Dermatologa del Hospital General Dr. Manuel Gea Gonzlez, SSA
Calzada de Tlalpan 4800, Mxico, D.F., 14080
TULAREMIA
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Microbiologa
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BERVJSJS MB FOGFSNFEBE -B TVCFTQFDJF NgT WJSVMFOUB FT
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MBIPMBSDUJDB
Distribucin geogrfica
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DVOTDSJUBT -B CBDUFSJB QVFEF EF IFDIP FTUBS FO FM BN
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Epidemiologa
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Dermatologa cosmtica, mdica y quirrgica
DCMQ
111
ARTCULOS DE REVISIN
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FONVDIPTQBrTFT&YJTUFOEPTQJDPTEFFEBEEFMPTDJODP
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DJBTPOWFSBOP NBZPBBHPTUP
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GFCSFSP
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DPOFCSF
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EnNJDBT
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UP[PBSJPT4FIBOEFTDSJUPEPTDJDMPTVOPUFSSFTUSFZPUSP
BDVgUJDP&OFMDJDMPUFSSFTUSFUJFOFOVOQBQFMJNQPSUBOUF
MPTDPOFKPTZMBTMJFCSFT
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BOJNBMFT
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MBMPDBMJ[BDJwOHFPHSgDBQPSMPHFOFSBMTFEFTDSJCFBMB
HBSSBQBUB4JOFNCBSHP
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FTUPTBOJNBMFT
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HBSSBQBUBTQFSUFOFDFOBMBTVCDMBTFgDBSPT
FDUPQBSgTJUPT
BSUSwQPEPTPCMJHBEPT
IFNBUwGBHPTOPFYDMVTJWPTRVFTF
BMJNFOUBO EF NBNrGFSPT
BWFT
SFQUJMFT Z BOCJPT &YJT
UFO FO UPEP FM QMBOFUB
QFSP FM NBZPS O|NFSP EF FTQF
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CPSOF EFTDSJCJFSPO FM QBQFM QBUPHnOJDP EF MB HBSSBQBUB
DCMQ
112
ZFOMBSFMBDJPOBSPODPOMBCBCFTJPTJT FOGFSNFEBE
QPS#BCFTJBCJHFNJOB
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QSFOEFOUFRVFMBHBSSBQBUBMMFHVFBWJWJSIBTUBBvPTTF
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Mecanismo de contagio
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QBSBMBNBOVGBDUVSBEFBSNBTRVFMJCFSFOVOBUBRVFFO
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BNCPTUJQPTEFGB
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FMDVBESPDMgTJDPPDPOGVOEJFSPODPOUVMBSFNJBFMDVBESP
UrQJDPEFPUSBFOGFSNFEBE&OFTUBTQSVFCBTTFDPODMVZw
RVFTJNQMFNFOUFMBDPNVOJEBENnEJDBOPFTUgFOHFOF
SBMTFOTJCJMJ[BEBDPOFMDPOPDJNJFOUPEFMBUVMBSFNJB
Z
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GFSNP
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TULAREMIA
Patognesis
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PSHBOJTNPWrBNVDPTBTrOUFHSBT
IFSJEBT NPSEFEVSBEF
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DPOBDUJWB
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Cuadro clnico
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ErBT
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NBOBT
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OFVNwOJDB MBNgTMFUBM
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DBTPTIBZQSwESPNPTDPODFGBMFB
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HFOFSBM
Ulcero-ganglionar
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MBNgTGSFDVFOUFZBEFNgTDPOGPSNB
VOEJBHOwTUJDPFNJOFOUFNFOUFEFSNBUPMwHJDP4FDBSBD
UFSJ[BQPSMJOGBEFOPQBUrBVDUVBOUFZTVQVSBUJWBMBTMJO
GBEFOPNFHBMJBTPTDJMBOFOUSFDNBDNEFEJgNFUSP
BVORVFDBTJTJFNQSFMPTHBOHMJPTNJEFODN"TJNJTNP
TFNBOJFTUBQPSVOBQMBDBVMDFSBEBFSJUFNBUPTBJOEVSBEB
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Fotografa 2. Lesin primaria de forma ulcero-ganglionar.
Manifestaciones reactivas
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Pulmonar
DCMQ
113
ARTCULOS DE REVISIN
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CSJOPJEFQVMNPOBSDPOJOMUSBEPJOBNBUPSJPNJYUP
BTr
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Diagnstico diferencial
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Diagnstico
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BVORVFFSBOFDPOwNJDBTZGgDJMFTEFJOUFS
[BEP
FOGFSNFEBEEF)PEHLJO
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QSFUBS GPUPHSBGrB
-BJOUSBEFSNPSSFBDDJwODPOUVMBSHFOP
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QFSPDBTJOPFTUgEJTQPOJ
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DPOTUJUVZF
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FYVEBEP
Histopatologa
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NFEJPEFUJPHMJ
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BHBS EF DBSCwO
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EFNVFTUSBTTJIBZTPTQFDIBEFUVMBSFNJB
QVFTEFMPDPO
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EFCFNBOFKBSFOMBCPSBUPSJPTDPOOJWFMEFCJPTFHVSJEBE
0USBUnDOJDBQBSBJEFOUJDBSFMHnOFSPEFMBCBD
UFSJBFTBOBMJ[BSMBDPNQPTJDJwODFMVMBSEFgDJEPTHSBTPT
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NJDSPBHMVUJOBDJwO 1.
DPO&-*4"PDPOFTUVEJPTJO
NVOPFO[JNgUJDPT
RVFNVFTUSBONBZPSTFOTJCJMJEBERVF
Fotografa 4. La imagen histopatolgica muestra un granuloma supurativo con cMPTFTUVEJPTEFBHMVUJOBDJwO
lulas gigantes (HE 40x).
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BVO
RVF
DPNP ZB DPNFOUBNPT
UBSEB IBTUB EPT TFNBOBT FO
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PCTFSWBDJPOFTBDFSDBEFMEJBHOwTUJDPTFSPMwHJDPTPO
MPT
BOUJDVFSQPTQVFEFOQFSNBOFDFSFMFWBEPTQPSBvPTMVFHP
EFMBDPOWBMFDFODJB
MBTFSPMPHrBFTQPTJUJWBDVBOEPIBZ
VO JODSFNFOUP DVgESVQMF FO MPT UrUVMPT EF BOUJDVFSQPT
BHMVUJOBDJwOFOUVCPPNJDSPBHMVUJOBDJwO
Z
MPTUrUV
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QPTJUJWPTFOBEFMPTDBTPTBMBTEPTTFNBOBT
Z
UJFOFOVOQJDPNgYJNPBMBTPDIPTFNBOBT-BTUnDOJDBT
EF JONVOPIJTUPRVrNJDB DPO BOUJDVFSQPT NPOPDMPOBMFT
Fotografa 5. Reaccin ultrarrpida de Tovar.
EJSJHJEPT DPOUSB MJQPQPMJTBDgSJEPT TPO |UJMFT QBSB WJTVB
DCMQ
114
TULAREMIA
MJ[BS'UVMBSFOTJTFOUFKJEPTKBEPTDPOGPSNBMJOB
QFSPOP
FTUgOEJTQPOJCMFTFOMBNBZPSrBEFMPTMBCPSBUPSJPTDMrOJ
DPT
0USPTFTUVEJPT
DPNP1$3
JONVOPCMPUUJOHZQSVFCBT
DPOFMFDUSPGPSFTJTFTUgOEJTQPOJCMFTFOBMHVOPTTJUJPT MB
JONVOPDSPNBUPHSBGrBUJFOFVOBFDBDJBDPNQBSBCMFDPO
1$3
ZTFIBOFTUBCMFDJEPDPNPQSPDFEJNJFOUPEFSVUJOB
&M1$3
TPCSFUPEPFOMFTJPOFTQSJNBSJBTFOQBDJFOUFT
DPOTPTQFDIBEFUVMBSFNJBVMDFSPHBOHMJPOBS
QSPQPSDJPOB
VOBDPOSNBDJwOSgQJEBEFMEJBHOwTUJDP NgTSgQJEPB|O
RVF MBT QSVFCBT TFSPMwHJDBT
Z DPO BMUBT FTQFDJDJEBE Z
TFOTJCJMJEBE&MFOTBZP5BR.BOEFOVDMFBTB UJFNQP
SFBM1$3
TFVTBQBSBEFUFDUBSMBJOGFDDJwOFOBOJNBMFT
VUJMJEBE WFUFSJOBSJB
4J FT QPTJCMF
TJFNQSF FT
QSFGFSJCMF TPMJDJUBS 1$3 QBSB VO QBDJFOUF EFUFSNJOBEP
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BIBLIOGRAFA
DCMQ
115
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