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'C Ce'
'' !ena ' nnune ('l) y la a!C'Cgia CCn C' |e' aC' COa
Ca. tl ' !ena ' nnuOe e e' enCa|gaCC Ce |C!ege| al
' OC' v' CuC Ce ' a ag|e' Cne Ce CI|C e|e v'vC |CCe
Cen!e Ce' neC' C anO'en!e ex!e|'C| (n'C|CC|gan'nC,
eln' n!C, e!C) C Ce' |CiC neC' C 'nIe|nC (CC' u' a
OeCp' 'Ca).
t' '' , en vez Ce e| una e!|uC!u|a 'n!eg|aCa C| C|gaOC
y aa|a!C, e n O' en, uOa |eC Ce CC' ul a Cl !|l Ou' Ca
pC| ICCC e' C|gan' nC, 'n!e|CCnun' CaCa y e|IeC!a
neO!e CCC|ClOaCa.
tIa CC' u' a !'eneO una g|an nCv' ' ' CaC y ueCen 'CCa' '
za|e en |a ang|e C '!ua|e en C|ganC, CCnC e' gang' ' C,
en !ejlCC, CCnC 'a u' a O'aOCa Ce' OazC, C O' en enCCn
!|a|e C' e|a en e' enC Ce !ejl CC e|!eOeC'en!e a
C!|C C|ganC C aa|a!C, CCnC 'C ' ' nICC'!C 'CCa''zaCC
eO e' !ej' CC CCnj un!'vC.
'unC' Cna' neO!e, e' '!ena ' nnune e! 'n!eg|aCC C|
CC g|anCe '!ena C neCan'nC CeIen'vC I|en!e a
'C agen!e ex!|anC vl|!ual neO!e a!CgenC: ' a l OnuO'
CaC na!u|a' y 'a aCa!aI'va.
|HUH|O8O H8|u|8| O |HSQO||O8
'u CCnCneO!e e!n ' en|e |een!e y C' ue!C
a|a aC!ua| ' nneC'a!anenIe 'n |eque|'| !' enC Ce 'a
!enC'a a|a e' CeeOCaCeOan' eO!C Ce ' a aCC'Cne CeIeO-
'vaS 'a ' OnuO'CaC Oa!u|a' Ca|eCe Ce eeC'hCl CaC y Ce
nenC|' a. |n C!|a a|aO|a, u |eueIa Cn eIe|eCI'
aCa, CCO ' nCeenCenC' a Ce 'a naIu|a' eza Ce' an!lgenC,
y nC |eg'!|an un aunen!C Ce ehCaC'a eO uCelva ex C
8CU8DA |es1infeci-
'C 'Cne a' n' nC. la ' nnuO' CaC
tes nesencem
nentesde|ainmunidad
natura|(MI8 J F,
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Oa!u|a' eI CCnI'!u'Ca C|:
'a Oa||e|a e'!e' 'ale
l Onun'CaC Oa!u|al Celu|a|: Ia-
gCC'!C (nCOCC'!CnaC|CIagC
y 'eUCCC'IC |MN) y CCl u' a ag|eC|a Oa!u|ale (CC' u' a
Na!U|a' ' ' ' e| C 'l). (M| K 01 0|, 05)
l nnun' CaC na!u|a| unC|a' . llCz'na, CCn' enen!C e
' nIC|IC|CnCS
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!e|'za C|: aCa!aO' ' ' CaC a' an!lgenC, eeC'hC' CaC y ne
nC|l a.
1|a ' a eO!|aCa Ce uO ge|nen, C| |' ne|a vez, eO e' C|
gan' nC e Cea||Cl'a una |eue!a ' nnune |l na|l a.
L' Cha |eue!a e ueCe e!|uCIu|a| en !|e e!aa
HeCCnCCi n' en!C Ce' aO!'geOC.
|e|'CCC Ce 'a!enC'a, Cu|a va|'C C'a, en lC que 'C llO
ICCl!C eeClhCC an' 'hCan u nune|C (exaO'Cn C'C
Oal), a ' a ve? que e ClIe|enC'an eO CC' ul a eIeC!C|a.
Heue!a eIeC!C|a, CCO'!e eO
'eC|eC'CO Ce an!'Cue|C eeC'hCC.
cea||C' ' C Ce aC!'v'CaC C' IC' '!'Ca eeC'lCa
''Oe|aCiCn Ce IaC!C|e que aCI'vaO 'a CC' u' a
agCC!'Ca.
ACqu'iC'CO Ce nenC|' a ' nnun'Ia|'a.
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'C l l O|CC'!C CO 'a |lOC'a' e CC' u' a |eCOaO' e Ce
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C|gan' nC en C|ganC O'eO Ce' ' n'!aCC, C en !C|na Ce
aCunu'aC'Cne C'Iua, al CCOjun!C Ce e!a e!|uC!u|a
e 'e CenCnl Oa l!ena ' ' nI!|CC y e!D en ' n!e|CCnun'
CaCi Cn CCO!l nua g|aC' a a' !|O'!C, CeCe uOa a C!|a,
Ce ' C l ' OICCi!C a I|avC Ce 'a C' |Cu' aC' COe aOgu'nea
y ' l nI!'Ca.
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n !a|Ce (a a|!l | Cel 5?ne) a l a nCCul a Cea, C|ganC
ena!CCyCI'CC IuOCaneOIal a|a el |eIC Ce ' a v' Ca
'C ' ' nICC'!C que naCu|aO (e CiIe|enC' aO) en l a nC
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na||Cv) y e!n eeC' al ' zaCC eO l a |CCuCC' Cn Ce
an!' Cue|C.
t' n' C|CanO' enIe Ce 'a nCCu' a Cea que Ce!e|n' na la
naCu|aC' Cn Ce lC l l nICC' !C J nC e CCnCCe CCO |e
C' l CO. CCO' !e eO |a l ' Oe|aC' CO Ce IaC!C|e C' uO' e
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' nC|!aOIe 'a 'O!e|aCC'CO Ce l a CCl ul a ' OnaCu|a CCO
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I' | Ce ' a J y 4 OCla Ia|'Ogea, y e e' |' ne| C|gaOC
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' a|gC Ce ' a vl Ca Ie!a' y CIOaIal a!a a' |eCeCC| Ce ' a
uOe|!aC, nCneO!C a a|I' | Ce' Cual enleza a 'OvClu
C' COa|. cn e' aCu'IC, ' a |CCuCC'CO y naCu|aC'CO Ce ' C
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'Cn ' C C|gaOC CCOCe lC l l nICC'IC ya naCu|C, e
' OnunC' Cg' Canen!e CCneIeOIe, !Cnan CCOIaCIC
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aCCi aCC a nuCCa (MAl) . t' IunC' Cnan'eOIC Ce ' C
!|e e l n' l a|, Cl !' Ogu' COCCe Oi Canen!e C| ' a |C
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I) 'i nIa (neC' O exI|aCe' u' a| Ce ' C !ejl CC), en el CaC
Ce 'CS gaOg' lCS l ' OI3IlCCS.
2) 'ang|e, eO el CaC Ce' OazC
J) luz l n!eI' Oal , eO e' CaC Ce la laCa Ce leye| (Iej l
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Ln |os u|t|mos os, este tem h perd|do | M
|mpo|tnC| que tuVo en otrs poCs. No
obstnte, es |mpresC|nd|b|e tener C|ros |os
ConCeptos que se desCr|ben en este tem
porque no sO|o son undment|es y pue
den se| objeto de pregunts (de heCho, h
Vue|to ser preguntdo en 207)s|no pr
que Vn ser neCesr|os pr poder bordr
pregunts |e|C|onds Con | |nmuno|og|
que pueden preCer en otrs s|gntu|s
Como |neCC|oss, ped|tr|, etC.
AtpctIt Etc6t||ct [||
Lx|sten C|nCo C|ses de |nmunog|obu||ns
que, ordends de myor menor bun-
dnC| en e| suero, son: |gG, |gA, |gM, |gD y
|gL (p|br nemotCn|C GAMDL).
L |nmunog|obu||n protot|po est orm.
d po| dos Cdens pesds (H) y dos Cde
ns ||gers (L). Lx|sten b t|pos de Cdens
pesds (]O yD y }.
L C|se de |nmunog|obu||n V|ene deter M
m|nd por | Cden pesd que t|ene.
L 2on de un|On | nt|geno se orm en
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1ras ormarse |a s|naps|s |nmun|tar|a y re- M
conocerse e| antgeno, |os ||nkc|tos 1 se
act|van y presentan un enot|po d|st|nto,
destacando en eI m|smo |a expres|n de.
T ) LD25 (receptor de a|ta ahn|dad para |l2).
2). HLA de c|ase I|,y
J). LD9.
Los || noc|tos 1 co|aboradores se subO|v|-
den, segn su unc|n y|as c|toqu|nas que
secretan, en tres t|pos: 1H\ , encargados
de coord|nar |as respuestas de |nmun|dad
ce|u|ar. 1H2, coord|nan |as respuestas de
|nmun|dad humora|. 1jJ, desmontan |a
respuesta una veZ conc|u|da |a |necc|n.
Los ||noc|tos b se caracter|Zan por expre M
sar en su membrana |nmunog|obu||na de
superhc|e (su mo|cu|a para reconocer an-
t|genos). L |g de superhc|e se asoc|a a |a
mo|cu|a LD\9, por |o que se puede ahr-
mar que |os | |noc|tos b son LDT9+.
Los | |noc|tos NK son c|u|as c|totx|cas
que |dent|hcan ye||m|nan c|u|as |neOa-
das por v|rus o con mutac|ones. Se caraOe
r|Zan por expresar LD\, LD5 yLU94.
Las L|u|as Presentadoras de Ant|genos
(L|A) son as que pueden presentar ant|-
genos a todos |os | |noc|tos 1 (tanto LU4
como LD8) porque expresan tanto HLA de
c|ase | (como todas |as c|u|as) como de
c|ase ||.
Los superant|genos son mo|cu|as capaces M
de aO|var hasta un 2U de | |noc|tos 1 de
sangre per|r|ca de or

a |nespec|hca.
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M|R 1-2, 245
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|. NC Cx|C>| L|H UC c| >C .|CUI|C>, >| |c|IlCI|C
lCCl>IC y | gu|C> C>c>C> I|UCc|!C>.
l> UC| Ccu| > L|H UC c|>C | UCjC| cC|Cc|U> >C|
Hl, HLb y HLL. L| gC| UC l CC!zU|c|Cg
| CCul l | C> C| u||cC uC cCU|c |IC UC| L|H y |C
>C C|cuC|!| C| Cl cCU| CC L|H UCl c|CUC>CU
(C>I C| C| c|CUC>CU ! b). L HL C> u| I|C UC
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gUC y ICj|UC> lCI| C>. SC |C| c|C| cC| | IC| C||c|,
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I|C> c| >C> UC UC| Ccu| > L|H UC c| >C ' U> cC|Cc|
U> >C| HL|H, HL|| yHL| (MlK U-U7, 242,
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La maIer|a IraIada en esIe Iema es com,|e-
menIar|a de |a que v|mos en e| Iema J. Para
reso|ver una p|egunIa MlK |e|ac|onada con
|a acI|vac|n ||noc|Iar|a o |a Io|eranc|a, es
esenc|a| manear |os concepIos expuesIos
en |os Ires Iemas. 1amO|n IraIaremos de
|os mecan|smos Os|cos de |os mecan|smos
de rechaZo de rganos, por |o que esIamos
anIe un Iema de mx|ma |mporIanc|a que
no puedes dear de esIud|ar ...
ktpccIt Etc1c|lct [|}
L| comp|eo pr|nc|pa| de h|sIocompaI|O|-
||dad (LPH) esI compuesIo por un gru-
po de mo|cu|as que, por su esIrucIura y
unc|n, se c|as|hcan en dos I|pos: LPH de
c|ase | y LPH de c|ase l|.A esIas mo|cu|as
IamO|n se |es denom|na con |a nomen
c|aIura anI|gua HLA (Human LeukocyIe
AnI|gen).
Las mo|cu|as HLA de c|ase | presenIan
anI|genos s|nIeI|Zados en |a prop|a c|u|a
que |os expresa. !os de c|ase l| presenIan
anI|genos exgenos, que han s|do capIu
rados yagoc|Iados por |as c|u|as que |os
expresan.
odas |as c|u|as de| cuerpo, menos |os he- M
maI|es, expresan en su memOrana mo|cu
|as LPH de c|ase l. Los pr|nc|pa|es son |os
HLA-A, HLA-b yHLA-L.
Los LPH de c|ase || (HLA-UK, UP yU) s|o
|os expresan conunIos concreIos de c|u-
|as: monoc|Ios, macragos, c|u|as den
drI|cas y de| s|sIema reI|cu|o endoIe||a|,
|| nfoc|Ios b y ||noc|Ios acI|vados (|os en
reposo no |o expresan).
Se denom|na c|u|as presenIadoras de M
anI|genos proes|ona|es a aque||as que ex
presan LPH de c|ase .
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unC Ue |C8 m8 pC||m|hCC8 que 8e CCnC-
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quC C' ICu nuunC Cn! Cn CCn!CIC CCn C' nI'gC
nC Cn CuCICn. bC CCIC2 pC|quC, CCpuC CC l Cx
pCCCn ' n!'gCnC, hy.
lC CC l!CnC CC b/ Cl. |n C! IC ICCvl nC
pCCCn n!iCuC|pC.
C CC l nCCuCnIC. l CCnCCn!|ClCn CC lC nIl
CuCpC CCC uuCn! Cn pCg|CCn gCCuCIC
hI 'Cn2 ' .
C CC uCC!. l CC|CCCn C unIlCnC Cu|nIC unC
Cl (Jb) y luCgC CCClCnCC lCn!,
KbLUbKA L |gM
prmIte deteaf
pCC p|CgCvuCn!C, Cn ' C i
enMrmedade$ auae$ gulCnIC ! 0 ! b Cl.
0 muy fecIente$
(MlK b, 242).
|n l |CpuC! p|iul, lC n!
CuC|pC Cn lCup|C CC l ClC
'gM y CCn Oj niCC prCl n-
!'gCnC (M|K UbU, Z4Z M|K VbM, 1 4).
c |espuest seCund|| IlCnC l ug| CunCC Cl ICu
uunC CnCuCn! un nI'gCnC pC CgunC vCz C Cn
uOguCn!C CClCnC. bC C I nguC CC l p u pC.
) MyC piCCz Cn n!u||C, C CCC, p|CCn! un
IC CC lICnC| u CCI.
O) lC nICuC|pC Cu|n u ICupC Cn Cl uC|C
(IC CC uCC! u p|ClCngC).
L) |l I'Iu'C CC n!lCuC|pC lCn2 un vlC| uuCC
u l!C (uyC| pCICnC).
C) CuO C CC C'C. cC nI CuCpC, Cn vCz CC 'gM
Cn ' gC, ' gA C ' gz (Cv| CuOlC CC C' C C lCIpC
KbLUbKA L fe$-
CCl ' nICC!C b).
pue$ta prImarIa e$t
C) c nl CC CC lC nIlCuC|pC
medIada p| cUa$ pC| Cl n!lgCnC C uyC (M| K
yrgene$ y a $MUndafIa
UU-U1 F, ZUZ).
| cua$ memofIa.
c CCICl!lC CC uyC| pC
ICnC y |pCCz CC ' |CpuC! CCunC|l C CCOCn .
Un uyC nuuC|C CC ' l nlCC!C by ]C'CCC|CnCC p Cl
Ag, quC Cn l CpuC! plu| (CC'u' CC uCuCl). L
C!ICg CC vCunC|Cn C On Cn gCnC|| ' l nlCCIC
CC uCuCl pC| CxpCiClCn n!lgCnC ICupCCC, CC
uCCC quC, Cn CC CC nlCCCCn pC Cl pICgCnC, C puCC
C!O'CCC pCuCn!C un CpuC! CCunC
l CC'ul b CC uCuC gCnCC n CxpCuCnICC
h pC|uuIClCnC Cu!lC pun!u' C Cn l 2Cn CC unl Cn
l n!'gCnC quC 'C CCnCCn uyC nCC pC| CIC
HI|g0HOS IO0Q0HO|0HI0S
c uyC' CC ' C ' nICC!C b CpCC|hCC nCCC!n '
yuC CC l i nlCCl!C 1 CC'OC|CC|C p C!vC, pC
' IC|| y CIC|CnCC hC CClul CC|C!C CC nI
CuCpC |!C l l nlCCiIC b pCCuCIC|C CC ' CpuC!
CC nICuCpC CCpCnCCn!C (!uCCCpCnC|CnIC) C
' CC' zn Cn lC IC' 'Cu' C ' nICCC CC ' C gng' C y Cn
uCCu' CC.
l CCCpCCCn 1b C CIO'CCC uC|CCC ' ppC' CC lC
l l nlCClIC b CCuC CC' ul pCCnICC| CC Ag (ClA) cC
l lnlCCl!C b, CpCC'CC p| un Cpl!CpC, I CCCnCCC| Cl
Ag CCn u lC CC upChCC, CnCCCl!n !CCC C' nI'gCnC,
' C pCCCn (CCgCCCn y CCnIu|l2CCn) y pn
CxpC pCpICC CC' n!'gCnC Cn u uCuOn, un CC
' uC' CCu' Cl CC ClC ' '
cC l l nlCCl!C 1 ClpC z, CCn un HC1 Cpz CC CCCnCCC
C' nIlgCnC unCC l C` CC ClC ll, C unCn C' y C
C!vn, !|nulICnCC u vCz CnlC CC C!vC|Cn l
' nICC!C b
ll4 pCuuCvC ' pC'ICCCn CC |C ' nICCIC b C!l
vCC, ' CCuC l CICCnClCCn CC 'C ' i nICCi!C b quC
CIn pClllCnCC
ll CIu pCuCvlCnCC l CIC|CnCCCn.
lnIC|CClCn C40 (CC' u' b) CCn C40l (C! '4) CC '
CC' u' 1 C' pC
CCuC Cu'ICC l n' CC ' CpuCI 1 CCpCnC Cn!C, C
gCnC un gn nuuCC CC CC' u' CCC!C CC n!lCuC|
pC CpCC'CC quC pCuIn l CpuCI CCunC|
!| uO guCn!C CCn!C!C CCn C' u uC nI'gCnC.
HI|g0HOS I|HO0Q0HO|0HI0S
y un pCquCnO nuuCC CC u!nC, CCnCCiC CCuC
n!'gCnC 1i nCCpCnCCn!C, quC Cn CpCC CC nCuC
' |CpuCI CC n!lCuCpC n nCCCCC CC ' CCCpC-
CiCn CC 'C ' nICCIC 1cn!C C' ' C C!n.
cpCpCllC|iCC (c`b) CC ' CnCC!Cxn OCIC n CC
Cu ().
'l gC' l n pC' |uCC uCCOn
lCllClCC. CCx!nC, lCvnC, CIC
lClluCC CC cu nCC CC
bC CC!Czn pC| C| CIuCIu pClluCC Cn l quC
l C CC!C|unnIC nIgCnCC C |Cp!Cn uuC vCCC
y pC C| Cl!CnIC l CCgCClCn uCIOClC. | pC-
O' C nCCuCnI ' nuunCgCnCCC CC 'C nIlgCnC
pClC|CC CCnjugnCCC CCn un ClC pCICCC, CC
uCCC quC C CCng un CpuC! 1-CCpCnCCn!C. c!
CI!Cgl C l quC lguCn ' nuCv vCun CCnI| lC
uCn ngCCCCC (M| K UJU4, Jb). l|CnIC CIC nI'gCnC,
l CpuCI Cup|C IlCnC CC!C'IlC CC CpuCI p|l
u|, unquC C yn !CnCC CCn!C!C pCvC CCn C'
n!'gCnC. C p|CCuCCn ClC n!CuCpC ' gM y nC Cx!C
uCuC l nuunC (M| K VdVV, Z4). c uyC| p!C CC 'C
l nlCClIC b p|CCuC!C|C CC nICuC|pC CCn!| nI'gCnC 1
nCCpCnCCn!C C CnCuCnI|n Cn Cl OzC. 1 un CplC-
nCCICul, C p|CCuCCn CpuCI CCCCn!C ICn!C CC
!|pC CC nI'gCnC
0.J. 00 |88
08|0|88 |00X|0|080
cIC IpC CC |CpuCI Cn CCnCl l C Cn l CCICn CCn
I| v| |u y Cn ' C' u nC Cn CC CIC u CCCgnuC
nICC'ulC. CnClC, `nCuuCCyI, 1CxCp' u, uyCC
OC!Ci C!C
L8 f08008D
l000
0r|t6It|6 Nh
Lomo e| tem 3, tmb|n ste h s|do uno M
de |os ms p|eguntdos en |os u|t|mos os.
Debes estud|||o y Comp|ende||o. Ls neCe-
s||o que te Cent|es en |s d|e|enC|s ent|e
|espuest p||m|| y seCund||.
AtpttIt Ett6t||tt [||
L|espuest |nmune (|nmun|dd dqu|||d
o espeC|hC) Cons|ste en e| Conjunto de C
C|ones espeC|hCs ConduCentes | e||m|n-
C|On de | |nkCC|On o s|tuC|On de pe||gro
p| e| o|gn|smo.
L|espuest |nmune se puede d|V|d|| en V-
||s m,ent|e |s que destCn. e| |eCono
C|m|ento de| nt|geno ext|o, | expns|On
de |os ||no|to eqos p| ese nt
no, y e| desrro||o de | |espuest eCto|
pmente d|Ch.
Lx|sten dos t|pos de |espuest ekCtor: 1). M
Humo|| (nt|Cue|pos), des||o||d po| |os
||nmC|tos yCoom|nd po| |os 1H2. J). Le
|u||, des||o||d bs|Cmente po| |os ||no
C|tos 1C|totOx|Cos.
L |espuest p||mr| (t|s e| p||me| Con
tCto Con e| nt|geno) t|ene un t|empo de
|tenC|, ent|e su |n|C|o y | |espuest ekC
to|, de |go menos de un semn. A| hn|
de | |espuest pr|m|| se gene|n C|u|s
de memo||.
L |espuest seCund|| (t|s suCes|Vos Con- M
tCtos Con e| ntgeno) E ||eVd Cbo po|
|s C|u|s de memor| yt|eue un t|empo de
|tenC| muy Co|to (ho|s).
Ln | |espuest p||m|| de nt|Cue|pos, l qM
e|bo|d es | |gM. Ln | |espuest seCun
d||, |os nt|Cue|pos e|bo|dos son |gG,
|gA e |gL yse p|ouCe | mdu|C|On de |
hn|dd, po| |o que, dems de se| ms rp|
d, es ms CC.
Apt| E4tl| [|||
L myO|| de |espuests de Dt|Cuefps
sOD 1-depeDd|eDtes.
Lx|ste uD t|pO de |espuest de Dt|Cue|pOs
que DO DeCes|t | CO|OC|C|D de |Os ||D-
lOC|tOs 2: | |espuest -|DdepeDd|eDte.
COmO VeDt], destC que t|eDe uD |teD-
C| ms CO|!, pe|O COmO |DCODVeD|eDte DO
se p|OduCeD C|u|s de memO|| D| CmO|O
de C|se de |g.
Ls VCuD8 COD|ugds estD lO|mds p|
DtgeDOs pC||8Ct|dOs y p|Ote|Ds que u-
meDtD | | DmuDOgeD|C|dd pm OOteDe|
uD |espuest 1 deped|eDte.
ML|O||eCt|V|dd CODs|ste eD que |Os ||DlO
C|tOs 1 de uD |Dd|V|duO |eCODOeD, s|D DeCe-
s|dd de |DmuD|ZC|D p|eV|, |s C|u|s de
Ot| pe|sOD geDt|CmeDte d|8t|Dt (mO|-
Cu|s L|H |D|Cs).
M
AuDque |Os ||DlCC|tOs LUb+ y |Os NK t|eDeD
d|le|eDtes mOdOs de |deDt|Cf |s C|u-
|s d|D, e| meC|smO de e||m|DC|0D es
e| m|smO: |DduCC|D de pCptOs|s eD d|Ch
C|u|.
MLtO|e|DC| COns|ste eD | l|t de fespues-
t l|eDte Dt|geDOs p|Op|Os O |DOleDs|VOs
|||meDtOs, etC.).
P|4| M|B
M|R J-04,J5
M|R 2-J, 1J9
M|R -1, 2J4
M|R -1, 2J5
M|R 00-0T F, 22
M| R 9b-99, 247
O O||4lt Bp|4||lr
MNO hy CsOs C||D|COs |ep|eseDtt|VOs
tn ' a |eue!a Ce C'!C!CxCCaC eeC'l'Ca, 'C ' ' OICC'!C '
juegan un ae' IunCanen!a' CCnC CC'u'a CCCe|aCC|a
,1mi ) 'a IunC'Cn CCCe|aCC|a CeenCe, en u nayC| a|!e,
Ce 'a aCC'Cn Ce 'a 'n!e|'euqu'Oa ,''z, '' ganna, e!C) que
aC'uan CO|e 'a CC'u'a eIeC!C|a y CO|e 'C naC|CIagC,
CanCC luga| a 'a |eaCC'Cne Ce ' e|en'O'''CaC |e!a|CaCa.
|IOIOX|O|O8O O|u|8|
|SI||H]|O8 O| |8S O|Ou|8S |h O O|8S |
'C ' | nICC'!C 1 C'!C'Cx'CC ,!)|eCCnCCeO e' an!igenC en
aCC'aC'Cn CCn 'a nC' CCu' a C| Ce C'ae ' en 'a nen
O|ana Ce' u' a| Ce C!|a CC' u'a y, una vez aC!'vaCa, ' ' an
C' Ca CC' u' a ,CC' u' a C' ana).
t' |' nC' a' ae' O' C' Cg' CC Ce C ' ' nCC'!C ! e 'n!e|
ven'| eO ' a e' ' n' naC'Cn Ce 'a CC' u' a ' nIeC!aCa C| v' |u
y CCl u' a nC ' nIeC!aCa, e|C ue Cn Ce!eC!aCa CCnC
ex!|ana, !a' e CCnC ' a !unC|a' e C ' a Ce 'C C|ganC
!|a' an!aCC |Ml R 95-9|, T J9). 'a nayC| a|!e Ce 'C
' ' OCC|!C ! Cn C.o+, e|C !anC'Cn ex'!e C' e|!a |C
C|CiCn Ce ' ' nICC'!C 1 C.4+ C|!C!Cx'CC CCn eeC'hC'
CaC |e!|' ng' Ca a nC' CCu a C| Ce C' ae ' ' .
ene|aC|Cn Ce ' ' nICC'!C 1 Ci!C!CxCC A' ' gua' que ' a |e
ue!a Ce an!'CueC, COeCeCe a 'C n' JC |' nC' ' C
v'!C CCn an!e|' C|' CaC.
'e'eCC|Cn C| e' Ag Ce ' C eCaC ' ' nICC'!C eeC'hCC
ex'!en!e an!e Ce' e!nu' C an!'gCn'CC.
An' 'hCaC'Cn C' Cna' Ce 'C ' ' nICC'!C e'eCC'CnaCC ne
C' an!e un |CCeC Ce |C 'Ie|aC'Cn e' eC!'va. |' nune|C
' nC|enen!aCC Ce ' OCC!C 1 Cco+ eeC'hCC ga|aO!'za
ue 'a |eue!a eCunCa'a ea n C!en!e y |' Ca.
'a |eue!a C'!C!Cx'Ca, e Cea|C' ' a en !|e e!aa.
HeCCnCC'n'en!C Ce' Ag. 'C ' O'CC'!C 1 Cco C'!C!Cx'CC,
|eCCOCCen e| Ag un' CC a nC' CCu' a C| Ce C' ae ' |C
'a C O'en |eCCnCCen exC' u'vanen!e nC' CCu' C| Ce
C' ae | |een!e en CC u' a a' CgCn' Ca
AC!'vaC' Cn 'e aC!'van y ex|ean |eCe!C|e Ce ' 'z |a|a
que ueCen |C' 'Ie|a| y nan'Ie!a| u unC'CO C'!C''!'Ca,
|eu|e|eO ue C'|a CC' u' a 'C e!'nu'en CCn ''/ ,ue' en
e| ' ' OICC'!C 1mi |Cx'nC).
ce!|uCC'Cn Ce ' a CC' u' a C' ana CCnC |eue!a a ' a
' 'z, 'C ' ' nICC'!C: C|!C!Cx|CC |C 'Ie|an y e aC!'van Ce
nCCC que, CuanCC en!|an en CCn!aC!C CCn ' a CC' u' a
C' ana que ex|ean e' an!|genC, ' a ' ' an. Una vez aO
Ce!|u' CC ' a CC' u' a, ueCen egu' | eje|C'enCC u eIeC!C
C'!C!Cx'CC CO|e C!|a, ya que 'a aCC'Cn ''!'Ca e eeC'hCa
CCn!|a 'a C' ana y nC exi!e CanC CCn!|a ' a |C'a CC' u' a
eIeC!C|a Ce 'a |eue!a.
YO8H|SOS O OlIOIOX|O|O8O
C'!C!Cx' C' CaC CeenC'en!e Ce an!|Cue|C.
'a aC!'v'CaC C'!C!Cx'Ca ,6' ' 'e|) |eu'ee ' a un' Cn Ce un
an!'Cue|C ' g a 'a CC' u' a C' ana 'a hjaC'Cn Ce' an!'Cue|
C COe a CC' u' a e |eCCnCC'Ca C| e' |eCe!C| aa ' a
' Ce ' a ' g Ce ' a CC' u' a 'LN ,CcI o) |M| K 00-01 , 2Jb)
0.4. A|0||cI|v|00
'a a' C||eaC!'v'CaC ,C a' C||eCCnCC' n' en!C) e e' eCC Ce
que una g|an |CC|C'Cn Ce 'C ' ' nICC'!C 1 Ce un ' nC'
v' CuC |eCCnCCeO, 'n neCe'CaC Ce ' nnun' 2aC'CO
l
|ev'a,
'a nC' CCu' a C| a' CgCn' Ca ,Ce C!|C OC| v' CuC geOC!'
Canen!e C' !'O!C Ce ' a n'na eeC'e), e CeCi |, ' a va
|'an!e C' ' nC|hCa ex|eaCa C| C!|a e|COa.
NC e! Ce n |eCC|Ca| una ve2 n, 0C| u ' nC|!an
C'a, ue 'C ' ' nICC'!C 1 Cco+ eCCnCCen ' a nC' CCu' a
C| Ce C' ae ' y C ' ' nICC'!C 1 Cc4+ ' a Ce C' ae ' ' .
NC e CCnCCen ' C neCaO' nC exaC!C Ce' a' C||eCCOC
C'n'en!C 'e CCO'Ce|aO va|'a C' O' ' CaCe Ce ieCCnCC'
n'en!C Ci a|!e Cel HC1.
'a |egiCne C' i nC|l'Ca Ce |a nC' CCu' a C| a' CgCn'
Ca, nC |eeO!e eO el i OCi v' CuC |eCe!C|, Cn |eCCOCC'
Ca CCnC e' ClH |C'C CCO uO Ag ' nCC|C|aCC .
|C!iCC eOCCgenC un' CC a C' Ca nC' CCu' a.
'a ex'!enCla Ce uOa g|an |CC|CiCn Ce ' | nICC'!C 1 a' C
||eaCI'vC CeIe|n' na ue la |eue!a a e!C aO!'genC
!|a uOa e!' nu' aCi CO |i na|' a ea ya nuy CCn'Ce|aO' e
0.0. T0||0c|
'e !|a!a Ce un eIaCC Ce aueOC' a Ce |eaC!|v'CaC eeC'
hCa a|a aO!'geOC CCnC|eIC que e aCqu' e|e Ce IC|na
aC!'va. 'a n i nC|!aO!e e la au!C!C' e|anC'a, que e|
n'!e que e' '!ena ' OnuOe Ce un ' nC' v| CuC nC a'aque a
'a CC' u' a Ce u |C'C C|gaO|nC.
'C neCan' nC Ce !C' e|anC' a ueCen e!aO'eCe|e a
n've' CeO!|a', Cu|anIe 'a gCne' y C'Ie|enC|aC'Cn Ce 'a
CC' u' a ,!inC eO CC' u' a y nCCu' a Cea eO CC' u' a J) y a
n' vel e|'IC|iCC, CO|e CC' u' a aCu'!a.
'a !C'e|aOC'a e!aO'eCiCa a n' vel Cen!|a' CO|e 'C OCC'
!C J en ' a nCCu' a Cea e nenC eIeC!'va que ' a |ea''za
Ca CO|e ' C ' ' nICC'!C 1 en !' nC
8FCUF8DA D ngre
'e CCO' Ce|a que |a |eeC'a Ce
per|fr|ca, no puede
ex|st|r nngn ||nfo|toT un euenC nune|C Ce ' ' nICC'
autorreac|vo.
IC J 'evenen!e au!C||eaC!'vC
e OC|na' . NC CO!an!e, C!C
e|naneCeO ' naCIivC C| la Ia'!a Ce CC' aOC|aC'Cn Ce 'C
' ' nICC'!C 1m2 |M| K 00-0T , 2J4, Ml K02-0J, T J9). 'e CCnC
Cen va|'C neCani nC a|a e!aO' eCe| ' a !C' e|anC' a
I . Le|eC|OD C| OD| . 'e elln' naO ' a CC' u' a au!C||eaC!'va.
t e' |' nC' al neCaninC Ce ' a !Cle|anC' a a O've' Cen
!|a' . |aC'a a C', e ga|anI'za que 'C ' ' nICC'!C naCu|C
que Cejan ' C C|gaOC ' ' OIC' Ce y van aC'a !ej 'CC e|'
IC|'CC nC |eCnCan a an!igeOC |C'C.
2. ADe|g| C|O|. |C|C' Ca Ce ' a CaaC'CaC Ce |eue!a
a u an!'genC Ce CCl ul a CCOC|e!a. 'e |CCuCe CuanCC
' a CC' u' a |eenIaCC|a Ce anI'enC CCnhe|e e!'nu' aC'Cn
an!' gCn' Ca al l i OICCi!C 1h ,I e

a' ) eO auenC' a Ce CCe!'

nu'aC' CO an!igCn' Ca lZ'enal )
3. 5up|es|OD CI|V. ' Ohi O' Ci CO Ce la aC!'v'CaC Ce' u' a|
C| 'nIe|aCC'0n CCO C!|a CCl ul a, OiCaneO!e neC' an!e
eC|eC'CO Ce Ci!Cqui Oa i Ohi O'!C|'a CCnC 15-3 e ''I 0
,e|l'' 1o|)
4. LesV|C|OD de | |espuest. |C| ej en' C, a' CanO' a|
una |eue!a Ce 1mI a z
LHV]O||HIO |HUH|O8O
A' 'O'C'a|e la v'Ca aCulIa, CCnieOza una CininuC'Cn 'en!a
y e|nanen!e eO 'a iOnuniCaC. t' |'ne| CanO'C aa|eCe
en e' I'nC, C|ganC ue CCn'eO2a a a!|Cha|e CeuC Ce 'a
aCC'eCeOC'a y ue, en la niIaC Ce 'a eCaC aCu'!a, C'C !'eOe
un I b% Ce u !ananC C|'g'na' .
'a CaaCiCaC Ce Ce!eC!a| nC'0Cu'as ex!|ana C va e|C'en
CC CCn 'a eCaC, lC que CCnl' eva que la 'OC'CenCia Ce 'IeC
C'Cne y neCla'a e 'OC|eneOIe CCn 'a eCaC. 'C an!'Cue|
C e e'aOC|an Ce IC|na n" leOIa y neOC eIeC!'va, C|
'C que e' eIeC!C |C!eC!C| Ce vaCuna, CCnC 'a Ce 'a g|' e,
a veCe nC e |CCuCe y lC |eu'!aCC Ce 'a Canana Ce
vaCunaCiCn eO la !e|Ce|a eCaC OC ue'en e| 'C ee|aCC
|n el anC'anC, IanO'Cn e I|eCuen!e la aa|iC'Cn Ce au!Can
!'Cue|C a !'!u'C OajC. ''n enOa|gC, 'a nayC|'a Ce 'a
veCe e!C nC Cn a!Cg0O'CO ni CCnC'C'CnaO enIe|ne
CaC au!C'nnune, ue hay que |eCC|Ca| ue e!e !'C Ce
ene|neCaCe, CCn a' guna exCeC'Cn CCnC e' CnhgC y e'
enhgClCe, nC CO I'iCa Ce anC'aOC.
l' bitCn OC| Cnp' CnCO!C cCO!C Cn un ccC CC
c!vcCO COzn!c CC un cCnjun!C CC pCICln, cuy
l' CC pl nc pl C ' CC pCCuc ' ' l Oc!Cn. luC
CCc!C pC p|lnC vCz pC| ||'c Cn Cl lglC XlX. cC
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Ls!e es un !em muy |mpo|!n!e. Ln |os u|!| M
mos os, |s pregun!s de |nmuno|og| c||
n|c se hn conso||ddo, y |o c|er!o es que
|guns son !n c||n|cs que se conunden
con |s de o!rs s|gn!urs (|necc|oss,
Keum, e!c). |o| e||o, debes es!ud|r e|!em
con de!en|m|en!o, s|n ps||o por |!o.
AtpttIt Ett6ti|tt [||
L| es!ud|o de expres|On de mo|cu|s y |
cun!|hcc|On de |s pob|c|ones de ||no-
c|!os (b, 1CD4, 1CD8 y NK) ye| coc|en!e
CD4ICD8 med|n!e c|!ome!r| de |uo es
un de |s he||m:en!s ms u!|||2ds p|
v|o|| e| grdo de compe!enci |nmune.
Dun !mspn!e de O|gnos, | pr|me com-
p!|b|||dd qu dum| E | de g|up
ngu|m d | pOC | 0
d ks nbO m!ur|es ken!e ks GS.
L|n|uenc| de | comp!|b|||dd C|H en!|e M
donn!e y |eep!o| vr| de unos !rsp|n!es
o!ros, s|endo mx|mo B mdu| Ose y
poo |mp|!n!e en e| !|sp|n!e hep!|co.
Se h de!erm|ndo que | p||nc|p| comp
!|b|||dd de C|H, de cr | comp!|b|||-
dd de Orgno, es | de |os C|H de c|se l|,
concre!men!e DK.
Se hn desc||!o !|es !|pos de mecn|smo de M
|ech2o. h|pe|gudo (|nmun|dd humo||),
gudo (|nmun|dd ce|u||) y crOn|co (no 5e
conoce su cus).
L enermedd de |n]e|!o con!r sped M
(L|CH) es un s|!uc|On prec|d | rech
2o de O|gnos en | que e| rechzdo es e|
cuerpo de| |ecep!o| de| O|gno y |os !
cn!es |os || noc|!os Tde| donn!e. L cs|
!o!||dd de |os csos se producen !|s un
!rsp|n!e de mdu| Ose, y su c||n|c es
s|m||| un cudro u!o|nmune: |!erc|o
nes cu!nes, hep!|cs (co|ng|!|s con co-
|es!s|s), gs!ro|n!es!|n|es (m|bso|c|On),
r!||!|s y b|onqu|o||!|s ob||!ern!e.
b|OgO|CC. cCna|!e y |eCe!C| Cn gene' C 'CCn!|CC.
AuIO|CgC. ce CC' u| a C !ej| CC |CCeCen!e Cel |C'C
|eCe!C|
begun 'a !CC|Cga Ce' !a' an!e.
|ICIO|CC. c' ' nje|!C e CC'CCa en e' |eCe!C| en u ' u
ga| ana!Cn|CC C|' g| na' .
HCIC|CIOCC. 'a |CCa''zaC'Cn Cel ' nje|!C en el |eCe!C|
e CIe|e!e a u ' uga| anaICn'CC C|' g' na' .
..J. J|) 1e |et11t
hCChZC |C|gudC. Aa|eCe a 'a CCa C|a Ce'
!|a'an!e. t! CauaCC C| 'a ex|IenC'a Ce anI' Cue|C
|eICnaCC en ' a ang|e Ce' |eCe!C|, CCn!|a el C| Ce'
CC|an!e que han CCn' enenIC CO|e 'a CCl u' a Ce' | n
je|!C, Ce!|uyCnCC' a iCa y nalvanen!e (Ml K 9-97|,
242) t u|a Ce ' a eC|e CCn' |CaClCne Ce un !|a' an
!e, e|C ueCe e| |even' Ca |ea' ' 2anCC una |ueOa C|u
?aCa CCn ue|C Ce' |eCe!C| y l l nICC'!C Ce' CCnan!e.
hCChZC gudC. Aa|eCe a l a CCa enana Cel !|a
' a!e Ce un C|ganC C| nC CCna!' O' e la Caua e
'a a' C||eaCI' v' CaC Ce ' C l ' nICCl!C a !|avC Ce una |e
ue!a |' na|| a Ce l C l ' nICCl!C enl Ol ' l2aCC CCn!|a
' a nC' CCu' a C|' Ce C' ae ' Ce' l nje|IC, ai CCnC C| ' a
aC!' vaC' Cn Ce ' C ' ' nICC'!C TCc4 CCn!|a ' a nC' CCu' a
C|H Ce C' ae | ' ex|eaCa C| ' a CCl u' a CenC|'!'Ca y
nCnCC| !C que e al ' an |een
8ECUE8DA A mayor
expres|n de 87 por
!e en el !ej ' CC I|a' anIaCC.
|s cc|u|as present-
doras de antgeno deI
|C l ' nICC'!C Cc4, aCen Ce
donante mayor es Ia
d g
d
|CC|C' Cna| una Iuen!e Ce ' '.
W e rec azo agu o
(M|8 05, 24).
a 'C ' ' nICC'IC CcB a|a u |C
' 'Ie|aClCn, Cn CaaCe Ce Caua|
'e'Ce a' a!|ae| y aC!' va| a ' C nCnCC' IC aC' a e' l uga|
Ce' ' je|!C, C| uO neCanl nC Ce' !l C Ce hle|en' O| l '
CaC |e!a|CaCa. |n ' a aC!ua' ' CaC e C|ee que e!e ae' Ce
' C ' ' nICC'!C CClaOC|aCC|e ueCe e| Ian l nC|Ian!e,
O 0, que e' Ce 'C ' ' nICC'!C C'!C!Cx|CC (Ml K 05-0,
244 t' |eCa2C aguCC aCe'e|aCC CCu||e unC C'a Ce
uC Ce' !|a'an!e, y e CeOe a |eaC!|vaC' Cn Ce CClu'a 1
en'O'''2aCa ,|eueIa eCunCa|' a)
hCChZC C|OO|CC. Aa|eCe anC CeuC Cel I|a' an!e
y e ve OajC ' a C|na Ce una a|!e|' CC' e|Cl aCe' e|a
Ca eO e' C|ganC 'n|e|!aCC ,a|!e'! CO' '!e|an!e), C que
aCe que, C ' C gene|a' , e envejeC' n'en!C Ce ' C C|ga
nC !|a' an!aCC !enga ' uga| Ce una IC|na ' e!e veCe
n || Ca que e' que e CeeOCaCena Ce IC|na na!u
|a' . 'a Caua e! CCC C' a|a y nC e CCnCCen I|naCC
a|a CCn!|C' a|' C (MlK 0J-04, 2Jb)
||VO|O O| |OH8lO
t' C|ganC ' Cea a|a !|a an!e e aquC' que CCna|!e
!CCa ' a nC' CCu' a C| |een!e en e' |eCe!C|. t!a
' !uaC' Cn e ex!|enaCanen!e
8ECUE8DA Las
d|ferenc|as entre |as mo-
|a|a y e CeOe enCCn!|a| 'a na
|cu|as ML de c|ase l l yC CCna!' O' ' ' CaC C ' O' e.
|nducen a una respuesta
a|ogn|ca ms fuene
que |a |nduc|da por |as
d|ferenc|as en c|ase |
(M|8 02-03, J 33).
tn !|a' an!e Ce C|gaOC C
' CC, ' a CCna!' O' ' ' CaC CeOe
e!aO eCe|e, en |' ne| ' uga|, a
O' ve' Ce ' a nC' CCu' a C|' Ce
C' ae ' ' , eeC' a' nen!e .H, ya que C' Ca nC' CCu' a
e!n C' |eC!anen!e ' n' ' CaCa en ' a aC!' vaC' Cn Ce ' a
CO' aC' Cn nayC| !a|' a Ce ' C ' ' nICC'!C e e| ,' C
Cc4+)
..4. I|1)|11Ie 1e T1|1 ce1
CCn'!e en aCn' O' !a| a |eCe!C| Ce' !|a'an!e ' a ' OIu
' Cn |n!|avenCa Ce nCCu' a Cea a|aCa Ce' CCnan!e.
|ueCeO |CCuC'|e va|'a CCn' 'CaC'Ce |' nC' a' neO!e
e' |eCazC Ce a nCCu'a Cea !|an'aO!aCa y 'a enIe|ne
CaC Ce ' nje|!C CCn!|a uCeC, en CCa'Cne a!a' . AnOC
enCnenC e CeOen a a eeC!'va C|IeenC'a genC!'
Ca que ueCan ex'!'| en!|e e' CCnan!e y e |eCe!C |C
e''C, 'a a|eja CCnan!e|eCe!C| 'CCnea e ' a IC|naCa C|
CC e|nanC 'A'CCn!'CC.
A ea| Ce el' C, en e!a CCnCCCne !anO' Cn e |CCu
Cen |eCa2C y, en nayC| C nenC| neC'Ca, CuaC|C Ce
enIe|neCaC Ce ' nje|!C CCn!|a uCeC, ' C que ug' e|e
'a ex'!enC'a Ce C!|C '!ena Ce ' !CCCna!| O' ' ' CaC
nenC|e.
t' nejC| !e! unC' COa' C Cn' O' e a|a ev'CenC'a| ' ex'
!e CCna!' O' ' ' CaC en!|e CCOaO!e y eCe!C| e e' Cu' !'vC
n'x!C Ce ' ' nICC'!C, CCnCe e CCCu'!'van ' nICC'!C Ce an
OC. ' c!'vc'Cn y |C' 'I6|c' C C6 'C Oc'!C ' n' 'c
que e an |eCCnCC'CC CC' u' a ex!|ana y, (C| !an!C, lay
' nCCna! O' ' ' CaC
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ene|nC CCn al a' a neCu' a| g|ave. CuanCC e' |eCe
!C| |een!a C'Ie|enC' a Cl CCn e' CCnan!e, e' Cx'!C
Ce' !|a' an!e e nuy ' nIe|lC|.
|n 'euCen'a, e ha COe|vaCC que |C !|a'an!e Ce
nCCu' a alCgCn'CC Can nejC| |eu' !aCC que ' C au!C!|a
'an!e, C|que 'a |eCl C'va Cn nenC I|eCuen!e. |a
ex' 'CaC'Cn que e ha CaCC e que aa|eCe una |eaCC'Cn
Ce ' nje|!C CCn!|a leuCeula ,IC|na 'eve y OenehC'Ca Ce
'a enIe|neCaC Ce l nje|!C CCn!|a uCeC), que |eCCnCCe
CCnC ex!|ana 'a CC' u' a nal l gna y 'a Ce!|uye.
7.2.4. I . LOC|mCdd dC| |OC|IC
CCOI| C| u8Cd (|lLH)
'e Cea||C''a CuanCC e I|alan!an CC' u' a ' nnunCCCn
e!en!e |CCeCen!e Cel CCnan!e a un ' nC'v'CuC ' nnu
nCCe|' n' CC 'A' nCCna!lO' e 'a CClu' a Ce' uje!C
!|a'an!aCC nC ueCen |eaCCi Cna| CCn!|a aque' ' a y |e
Ca2a|' a ,C| ' a ' nnunCCe|e'Cn), n' en!|a que 'a Ce'
CCnan!e |eCCnCCen a ' a Cel |eCe!C| CCnC ex!|ana y
a!aCan a' enCC!ellC vaCula|, !ejlCC y C|ganC.
CCn!|!uye una g|ave CCn' ' CaClCn Ce' !|a'an!e a'CgC
n'CC Ce nCCula Cea, au nque IanO'Cn ueCe aa|eCe|
en C!|C l nje|IC (M|K 0-0J, 1 59) 'a t'C nC aa|eCe
exC'u'vanen!e en 'C !|a' an!e Ce C|ganC 1anO'Cn
ueCe |eenIa|e CuanCC e |eallzan !|anIu'Cne Ce
ang|e a un aC'en!e l nmunCCe|' n' CC C CCn una 'n
nunCCehC'enCla |'na|'a g|ave. '' un aC'en!e |een!a
uO CCl'C'! ' nnun|!a|'C eve|C y |eCla una !|anIuiCn, 'a
Og|e que e 'e vy Cn| ni!|| CeOe e| |ev'ne!e
||aC' aCa CCn el hn Ce l meCl | que lC ' | nICC'!C a'C
||eaC!'vC |Cl'Ie|en y Cea||Cl' en la enIe|neCaC.
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nucCa.
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cCn!'enen nune|CC neC' aCC|e |eIC|naCC, cCnC
anl Oa vaCac!'va, |C!eCg' ' canC, |C!eaa neu!|a,
IacIC|e qu' n' C!c!'cC, ' CC' aa c'Ca y enzlna Cx'
Ca!'va.
H' !an' Oa, e 'a |' nc' a' an' na vaCac!'va en e' Cn
O|e. :n C!|a eec'e, ' C g|nu' C Ce 'C na!Cc'!C
!anL' Cn cCn!'enen e|C!Cn' na, e|C e!C nC Ccu||e en
na!Cc'!C unanC, 'a ' aque!a unana ' cCn!'e
nen e|C!Cn' na
'a ' !an' na ac!ua COie ' a e'|uc!u|a '!'ca a !|avC
Ce 'C |ece!C|e.
(cCn!|acc'Cn Ce 'a nucu' a!u|a 'a O|Cnqu' a' y ga
!|C' n!e!' na' , vaCC'|a!ac'Cn y aunen!C Ce 'a erneaO' ' '
CaC vacu' a|).
z (ec|ec'Cn Ce c'CC C| ' a cC' u' a a|' e!a' e g
!|'ca, e|neaO' ' ' CaC ' nc|enen!aCa Ce ' a Oa||ea e'
!e' ' a' e y aunen!C Ce ' a ec|ec'Cn Ce nCcC) |x' !e un
|ece!C| J Ce 'a '!an' na que e! | n' 'caCC, un'ca
nenIe, en 'a 'n!e| y ' Oe|ac'Cn Ce 'a n' na.
ea|' na. c e' |' nc| a' |C!eCg' ' canC.
l|C!eaa neu!|a 'a n cCnCc' Ca Ce 'C g|nulC Ce
lC na!Cc'!C unanC Cn |a qu' naa y ' a !|'!aa.
!//[/OSO !'ene ac!'v'CaC |C!eC ' '!'ca CO|e CJ, gene
|anCC CJO y CJa.
|ulOOSO. ' n v'!|C, cCOv'e!e 'a ang|C!en'na ' en an
g'C!en:' na ' | y !' ene ' a caac'CaC Ce Ceg|aCa| cCn
COen!e Ce ' a nenO|ana Oaa' Ce 'a un' Cne Ce|
Ce'CC|n'ca.
'C Iac!C|e qu' n'C!c''cC ' nc' uyen e' Iac!C| qu n'C
!c!|cC Ce 'C eC'nCh' C Ce 'a anah' ax' a (|C'A) y C!|C
Iac!C| cCn ac!'v'CaC qu' n'C'c!'ca e!|' ng' Ca a|a 'C
neu!|Cl' 'C (NC')
||]8O|OH O |8 |gc 8 OS|HO|||OS O8SO||OS 8SIOO|IOS
|a ' g| e ja en 'a nenO|ana Ce e!a cC' u' a a !|avC Ce
|ece!C|e Ce a'!a al' n' CaC a|a e' 'C Ce ' gc, a 'C que e
CenCn' na Ce !'C ' ('c' gc' ) a|a C' !' ngu' |' C Ce 'C Ce
Oaja ahn|CaC, C Ce ''C '', (Cc.J) |een!e en 'a nenO|a
na Ce l ' nICc'!C: J, nCnCc'!C:nac|CIagC:, eC:'nC
{
lC:, 'a
que!a y ' ' nICc'!C 1 ac!'vaCC. c| |ece!C| e! cCnue!C
C| OOa caCena a'Ia, una caCena Oe!a y CC caCena ga
nna 'CCn!'ca. na C'a cC' u' a ceOaCa ueCe un' | c'en!C
Ce nC' Ccu' a 'g| cCn eec'hc'CaCe C'!'n!a.
'a uO'Cn Ce 'a 'g| cCn J |ece!Ci en e' eC'nChlC ' ' eva a
una IC|na eec'a' Ce c'!C!Cx'c'CaC neC'aCa C| an!'cue|
C, neC' aCa C| ' a |C!e'na ca!'Cn'ca Ce' eCinCh'C, que
CeeOcaCeOa 'a nue|!e Ce ' a cC' u' a Ce 'C el n'n!C.
Ac!lvac' Cn Ce OaCh|C y na!Cc''C neC'aCa C| ' gc.
l ' Oe|ac'Cn Ce neC'aCC|e |M| K 0J-0, J) .
'a uOlCn Ce' a' e|genC cCO 'C an!' cueC 'g| l'j aCC en
'C OaCh'C y na!Cci!C CeencaCena ' a ac!'vaciCn Ce
e!a cC' u' a, ' C que cCnCuce a CC !' C Ce |eue!a
ce' u' a|.
ce|anu' ac' Cn, a' caOC Ce Jd4d egunCC e |CCuce
la exCc'!C' Ce 'C g|nu'C, cCn ' a ' ' Oe|ac'Cn Ce neC' a
CC|e |eIC|naCC (hl !an' na), |CCucen 'C eIec!C an
!e nenc' CnaCC.
||CCuc!C: Ce' ne!aOC' ' nC Ce' c' CC a|aqu' CCn' cC |'
en!|e'a2an'en!C Ce lC |ece!C|e 'c' g| ' Ce!e|n' na 'a
ac!'vac'Cn Ce 'a enz'na ICICl ' aa Az, que ' ' Oe|a c'CC
a|aqu'CCn'cC a a|!'| Ce 'C ICIC' ''CC 'a ne!aOC' '2a
c' Cn C| 'a v'a Ce la c'clCCx'genaa C. g' na |C!ag| an
C. Oa, |' nc' alnen!e |c. y !|CnOCxanC A., n|en!ia
que u ne!aOCllzac'Cn C| |a v'a Ce ' a ' ' CCx|geaa
gene|a 'eucCI|lenC (en cCnc|e!C 'C4) a a|!'| Ce cJa'
e CO!'enen C!|C cCnC lc4 y lb4. A ' C leucC!|'enC
(l14 y 'c4) e ' e ' ' anaOa u!anc' a Ce |eacc'Cn 'en!a
Ce ' a anah' ax' a (bHbA) la acclCn inllana!C|'a Ce e!C
ne!aOCl'IC ' nc' uye cCnI|acc|Cn Ce ' a nucu'a!u|a ' ' a,
vaCC' ' a!ac' Cn e l e|e|neaO' ' ' CaC vacu' a|, eCena e
' e|ec|ec'Cn nucCa, ai cCnC un C!en!e eIec!C qu'
n' C!c!'cC a|a lC neu!|ChlC ('b4).
|ac!C| ac!'vaCC| Ce ' aqueIa (lA'). 'C OaC!'lC y
na!Cc'!C ac!'vaCC Ce C've|a eec'e |CCJcen
Iac'C| ac!'vaCC| Ce l aqueIa (lAl), a a|!'| Ce un |e
cu|C| al nacenaCC, que cauSa ag|egac'Cn 'aque!a|'a
cCn IC|nac' Cn Ce n'c|C!|Cn|C y ec|ec'Cn Ce neC'a
CC|e cCn!en'CC (cCnC 'a e|CICn' na, en e' caC Ce 'a
'aque!a unana). |l |A' !l ene !anO'Cn |C'eCaCe
eanCgCnlca, que al lgua' que ' a Ce 'C 'eucC!|'enC,
Cn nucC n |C' CngaCa que ' a Ce ' a ' !an' na.
ACen, ' C 'eucCc'!C a!|a'CC a' ' uga| Ce 'a |eacc'Cn
C| 'C IacIC|e qu' nlC!c!'cC ' ' Oe|aCC C| 'C na!C
c'!C ueCen, a u ve2, ' ' Oe|a| neC'aCC|e que |eIue|2an
y |C' Cngan 'C cl!aCC eIec!C lnI' ana!C'C.
H8|||8X|8 gH|8||l8O8 O SHOOK 8H8|||JOI|OO
be !|a!a Ce una |eacc'Cn 'ICnica, a nenuCC ' nc' uC
Ce ca|c!e| ex'ClvC, que |eIleja la ' ' Oe|ac'Cn na|va Ce
neC' aCC|e, |' nc' al nen!e hl!an' na y 'eucC!|'enC
('H'A), C| Oa:ClC :anguinCC: y na:!Cc'!C: Ce nu'!'
'e !e||'!C|lC la nanlIe!ac' Cne cl 'n' ca aa|ecen cCn
g|an |a'Cez !|a ' a exClclCn a' a' e|genC en cue!'Cn.
'C |' ne|C 'nICna ueleO e| angu!'a y na' e!a|
|CIunCC, y nan'IeIaclCne Ce |' n' !' y cCnjJn!iv'!'
aguCa (e!C|nuCC, |lnC||ea, cCnge!' Cn naa', ' ag|' neC
y ecCzC| cCnjun!lva'), |u|l!C y e|'!ena gene|a' '2aCC,
egu' CC Ce u|I'ca|la y ang'CeCena en C've|a |eg'C
ne, e I|ecuen!e el eCena la|'ngeC. |n 'C caC n
g|ave, aa|ece O|CncCeanC, !aqu'ca|Cia, a||' 'n|a e
lC!en' Cn.
cC ' gnC Ce Cc< ueCen cCn!' !u' | 'a |'ne|a nan|
Ie:!ac' Cn y caua| ' a nue|!e eO ' C |l ne|C: nCnen!C:
'C |' ncl a' e a' e|genC ' n' lcaCC Cn neC' canen
!C, venenC ' nCcul aCC C| l nec!C, al i nen!C y, cCn
nenC| I|ecuenc' a, caa Ce anl na' e y ga Ce Cx'CC Ce
e!'' enC en ' a nenO|ana Ce lenCCl ' ' l .
'C 'n!Cna ue' en Ceaa|ece| a ' a z C|a, e|C ue
Cen |eaa|ece| a ' a o hC|a, mC!'vC C| el cua' e CeOe
' ng|ea| a lC ac'en!e Cu|an!e z4 C|a
7. 0. |0000|00 I000|l
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be cCnCce CeCe hace nucC IlenC e' IenCnenC Ce 'a
Ceaa|'c'Cn Ce algunC !unC|e nal l gnC Ce nCCC e
Cn!neC A |' ncl ' C Cel ' gl C ``,c|hl' c ug' |' C que ' a
cC' u' a nallgna CCian e| Ce!ec!aCa y e' ' n' naCa C|
e' '!ena l nnune. |l |l ncl l C Ce la ' nnunCv' g' ' anc' a
C!' ene que, cuanCC u|gen cCl ul a aOe||an!e, Cn |e
cCnCclCa y el l n' naCa C| ' a cClu' a Ce' '!ena ' nnu
ne (IunCanenIa' nenIe 'a cCl u' a y N). 'C Ia' ' C en
e!a |eue!a ' nnune lleva|'aO a ' a aa|'clCn Ce| !unC|
A' Cx':!'| |ecCnCcln'en!C C| a|!e Ce' ':!ena nnune,
e' ' C ' n' ' ca que CeOen exl!l| an!.genC en 'a

cC' u' a
na' ' gna que nC exl!en en e' |e!C Ce la cC' ul a Cel
C|gan' nC.
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| l |C|dS, EIC) C ydI|CQE|dS C| l ||UDCSU|ESC|ES || l |C
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|E| IU|C|ES CC|C E| Cd|Cl|C|d |EDd| y |E|d DC|d CC|
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|d |lIdC CE| ICId| CE| IU|C|.
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Cd UE E| E| | CS CEDE |dDE| dDI|QEDCS UE DC SE E|CUE|
I|d| E| IEl CCS |C||d|ES.
LCS CEI|dCIC|ES CE |d IEC||d CE | d | D|U|CVl Q| | dDCl d SCSI|E
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OC an OC>apa|Cc|OC lC> anI|cuCpC> JaIC|nC>. |>IC>
pac|C|IC> puCOCn paOCcC una a|I|iI|> |CuJaIC|OC ' | C
cau>aOa ICcuCnICJCnIC pC MycCp' a>Ja >p. I|C cua
OC uC inciOC Cn C>IC> CnICJC> C> un >lnO|CJC >i n| ' a
a la OC|JaICJiC>|I|>, uC CvC| uc| Cna ac| a una nCni n
gCCcCIaliIi> gCnCa' JCnIC IaIal, y uC C> p|COuciOC pC|
una inICcciCn pC| vi|u> LLH. bCn nuy ICcuCnIC> | a>
O|a|Ca> pC C. | anOl i a, pCC >Cl C C' ! 0% OC lC> paciCn
IC> OC>aCl ' an O| a|Ca> cCn|ca> uC, OaOa ' a COaO OC lC>
CnIC||IC>, puCOCn |acC| pCn>a| Cn una CnIC|nCOaO
cC'aca.
ApOx|aOaJCnIC C' '0% OC lC> pac|CnIC> caCcC OC
|>IC|a IaJ| ' ia|.
l8]OS|lOO
bC Cu|C|Cn lC> >| guiCnIC> OaIC>. >CxC Ja>cu' | nC, cC
iCn2C Cn 'a COaO |nIanI||, va'C|C> OC lgC >|iCa inlC|iC|C>
a z00 g/O', lgA C 'gM >ica> pcIlcaJCnIC i nOCICc
IaOlC>. L> ca|acIC||>I|ca 'a au>Cncia OC ' | nICc|IC> H c|cu-
laIC> y OC c'u'a> p' a>nI|ca> Cn 'C> ICji OC> (cCJC Cn
| nIC>IinC) |MlR 94-95, T 00). la i nJun| OaO JCOiaOa pC|
c' ul a> 1 C> nC|na' |M|R 0J-04, 1 9)
L' I|aIaJiCnIC OC ClCcciCn, cCJC paa ' a nayCa OC ' a>
OChciCncia> OC anI|cuCpC>, C> 'a aOJ| n|>Iac|Cn pC|COi
ca OC gaJJagl COul | na pC| va paCnICa'
|1T11el|t|e1t|1 \1||1|e tTc1
c> ' a >CgunOa 'l p|iJa|a n> ICcuCnIC. bC cCn>|OCa
uC, Cn Ca' |OaO, C> un >nOCnC uC agupa va|ia> Cn
ICnCOaOC>, ' a JayCla C>pCO|ca>, uC apa|CcCn OC>
pu> OC la | nIanc| a y cuya CxpC>|Cn pi Ja| a C> una p|C
8FCUF8DA Fs |a n|ca
OucC |Cn OC anIicuC|pC> alICaOa
|D pr|maria de ant|cuer-
|M|R 0T -0, ) Apa|CcC a pa|
ps que es adqu|rida, y Ii| OC la aOC'C>cCncia, >|CnOC 'a
est reIac|onada con |a
COaO OC cCJ|Cn2C n> ICcuCnIC
|nfecc|n por eI v|rus de
CnI|C 'C> z0 y lC> J0 aC> AICcIa
Fpsten-8an.
IanIC a vaCnC> cCnC a JujCC>
'C> a' l a2gC> | nJuOC' Cg|cC> >Cn
Juy va||aO|C>. 'a> c|Ia> OC ' gC >Cn Oaja>, puCOCn C>ci ' a
CnIC >u au>Cnc| a y '00 ng/O' , la ' gM C ' gA puCOCn ICnC
va' CC> Juy va|aOlC>, aunuC, pC ' C gCnCa', |C> nivC
lC> OC |gM C>In cCn>CvaOC> |C> ' | nICc|IC> b >uC'Cn >C
nC|na' C> Cn nunCC, aunuC un pCuCC pC|cCnIajC OC
paciCnIC> puCOC ca|CcC| OC CllC>.
la CIiClCgla C>, pC l C gCnCa', OC>cCnCc|Oa, Cxi>IC un OC
ICcIC | nI|ln>CcC OCl ' | nICc|IC b, uC C> incapa2 OC naOu
a a c| ul a p|a>JI|ca C, >| ' C acC, ' a> cl u' a> p' a>JI|ca>
nC >CgCgan ' a> ' C uC pCOucCn.
|l cuaO|C c'nicC cCC>pCnOC a' C>CaOC paa l a> OCh
c|Cnc|a> OC anI|cuC|pC> (OCnu|Ii> y >i nu>iI|> c|Cnica>,
nCuJCna> OC CpCI|c|Cn, CIc). 'a> inICcc|CnC> J> IC
cuCnIC> >Cn ' a> OC >CnC> paana>a' C> y pu|nCnaC>, >C
gui Oa> pC| la> |nIC>I|nalC>. la inciOCncia OC CnICnCOa
OC> auICinnunC> C> a'Ia. bCn nuy ICcuCnIC> la anCJi a
pCnic|C>a y ' a ac' C| Oi a g>I| ca uC, p|COaO' CJCnIC,
ICnga uC vC| cCn 'a a'Ia |nc|OCnc|a OC ca|c|nCna> g>
I|cC> Cn C>IC> CnIC|nC>. bCn IanOin ICcuCnIC> lC> |in
!Cna> (M|R 97-98|, 1; M| R 0-07, \ 8)
Ll pCnC>I|cC, O|Cn IaIaOa, C> C|aI|vaJCnIC OuCnC, pu
O|CnOC ' ' Cga a ' a CcIava OcaOa. |C> |jC> OC CnICJa>
nacCn cCn n| vC' C> OajC> OC i nnunCgl COul l na> uC pC
g|C>|vanCnIC van aunCnIanOC a>Ia 'lCga| a igua' a|>C
cCn lC> OC n| C> naciOC> OC naOC> nC|na' C>.
S|11|Te H|)e| |]M
|HlO8
|C> pac|CnIC> pC>CnIan un cuaOC clinicC OC Ohc|I OC
| nJun|OaO uJCa' (nCuJCna>, >| nu>|Ii>, CIiI|>, CIc)
1aJO|n >Cn Juy >Cn>|O'C> a ' a> | nICcciCnC> pC L|yp
IC>pC| O| uJ. lC> nivC'C> OC ' gM C ' gl C>In C'CvaOC>,
JiCnIa> uC |C> OC 'gC, ' gA C 'g| C>In nuy OajC>
8uS8
bC OCOC a una Cxp|C>|Cn OChciIa|a OC la JClcu|a cC
C>I|Ju' aOC|a L! '4 (L40L. ' | ganOC OC Ll40) Cn lC>
l i nICc|IC> , gCnC|alJCnIC OCOiOa a OClCciCOC> Cn C' gCn
cC||C>pCnO|CnIC 'Cca' |2aOC Cn C' c|CnC>CJa `(CCnc|a
l i gaOa a| `). 'a inIC|acc|Cn CnI|C L40 y L40l C> in
pC>c| nO| O' C paa uC 'a c' u' a Ca' |cC C' caJO|C OC c' a>C
OC>OC ' gM a CIa | nJunCg' COu| i na OC la C>puC>Ia >C
cunOa|ia ('gC, ' gA C lgc).
Uel|t|e1t|1 1e |A
UlHlOlOH
Un inOiviOuC C> OChc|CnIC OC 'gA cuanOC 'C> va' CC> >i-
cC> OC C>Ia |g >Cn inIC|iC|C> a ' ng/Oi. |a pCOucciCn, n|
vC'C> >angulnCC> y Iunc| Cna' | OaO OC| |C>IC OC i nnunCg
l COu' | na>, a> cCJC 'a i nnuni OaO cClu|a|, >Cn nC|na'C>.
bCgun |a> puOlicaciCnC> a' u>C, ' a I|CcuCnc|a C> OC ! /d00
Cn |nOiviOuC> cauc>icC> C inICiC Cn japCnC>C> y |a2a
nCga, y C> 'a 'l pi nai a n> I|CcuCnIC ic|C> C>IuO|C>
>C >uC' Cn CIC|i| a LLUU. Ln L>paa, al JCnC> Cn nuC>I|C
CnIC|nC, paCcC J> |a|a.
||HlO8
'a g|an nayC|la OC lC> CnICJC> C>In a>| nICJI|cC>,
pCC algunC> p|C>CnIan iOICcciCnC> C>p|aIC||a> C O|gC>
Iiva> OC CpCI|c|Cn, OC C||gCn gCnC|a' JCnIC OacIC|anC,
IaJOin puCOCn pC>CnIa un cuaOC paCciOC a ' a Cn
ICJCOaO cCl|aca. cn C>IC> paciCnIC> |ay JayC inc|OCn
cia OC Ia>ICnC> auICinJunC> (C>pCc|a'JCnIC O| aOCIC>
I|pC ), a|C|g|a y CnIC|nCOaO cC' aca uC Cn ' a pCO' ac|Cn
8FCUF8DA 5| cur con
gCnC|a' (! OC caOa z00 a' gicC>
c|n|ca de actacin
C> OChciCnIC Cn 'gA).
Q8L hay que consderar ApCx|JaOaJCnIC C' J0% OC
que e| dMc|t no es
C>IC> CnIC|JC> pC>CnIa Cn C'
`e-con
>uC|C anIicuCpC> anI|-' gA. bC
gammag|obu||na (5Q[Q
an OC>c|IC Cacc|CnC> g|avC>
FN F5F C). JCOi aOa> pC C>IC> Ac, pC| C' ' C
>C OCOCn Cv|Ia| ' a> I|an>Iu>iCnC>
>angunCa> y la aOn| n|>IaciCn OC ganJag' COu' | na, uC
puCOC cCnICnC| lgA (M|R 03-04, 5)
||OHOSIlOO
la CnIC|JCOaO >uClC pa>a| OC>apCc|OiOa. b| 'C> paciCn
IC> >Cn >inICnIicC>, Cl pCnC>IicC OCpCnOC OC |a> Cn
ICJCOaOC> a>CciaOa>.
l8]HOS|lOO Ol|HOl8
COC ICnC|>C Cn cuCnIa uC al gunC> anIicCnvu|>ivanIC>
cCJC la> | OanICna> >upi nCn la pCOucciCn OC 'gA
1|8I8lHIO
'a> i nICcc|CnC> OC CpCI|c|Cn >C I|aIa|n cCn anIiO|CI|cO,
nC OCOC CJp'Ca>C gan Jag' COul | na (puCOC Cca>|Cna
un >Cc anah' cI|cC). la> vacuna> cCnIa aCJCp|| ' u>
>p. y nCunCcCcC> puCOCn >C OC uI|' |OaO Cn pac|CnIC>
cCn >|nO|CJC |nICcciC>C OC CpCI|ciCn.
Uel|t|e1t|1 e|etI|\1 1e t|1e 1e |]
lHlOlOH
bC OChnC cCJC la Cxi>ICncia OC valC|C> inIC|CC> a 'C>
nCJa' C> OC una C J> >uOc|a>C> OC lgC, cCn nCJa' i
OaO OC ' a canIiOaO ICIa' OC lgC >ica.
HlO8
Ln lC> aOulIC>, 'a OChciCOcia uC >C OCICcIa cCn nayC|
I|CcuCncia C> ' a OC 'gCJ, y Cn 'C> ni C>, 'a OC 'gCz, uC
>C acCJpaa, nuy a JCOuOC, OC OChciCnc|a OC 'gA. 'a
' gC! y ' a |gCJ |CcCnCcCn gCnC|al JCnIC Ag p|CIClcC>,
JiCnIa> uC la |gCz CcCnCcC Ag pC'|>ac|OC>.
1|8|8lH|O
|' I|aIaJiCnIC OC |a OChc|Cncia OC 'gCz OCOC CICcIua>C
cCn gaJJag' COul i na, >| Cxi>IC una c' n| ca |nICcc|C>a >u
hc|CnICnCnIC gavC.
H|)]1TT1]|||1eT|1
I|11|I||1 1e |1 |1l11t|1
luanIC lC> ulIinC> nC>C> OC ' a gC>IaciCn, la ' gC naIC
na pa>a a Iav> OC ' a placCnIa JCO|anIC un JCcani>JC
acIivC y pC|>|>IC Cn 'a >ang|C OC' |Ccin nac|OC |a>Ia lC>
-d JC>C> OC viOa. |a p| JCa lg uC p|COucC C| niC C>
|d lQN, SEQUlOd C| lQL E lQP |d lQL dOQU|||Od dS|Vd
0EDIE SE CdIdDC| lZd, 0l E0I|dS QUE E| |dCId0IE | 0| C| d SU
[|C|d |COUCClD OE |QL. LC0C CC0SECUE0C|d, EDI|E |CS
Jy 0ESES OE VlOd EX|SIE U0d R| CQd00dQ| CDU| l 0E0l d
OSlC|QlCd, CC0 Vd|C|ES OE lQL DdjCS, d 0E0UOC E0I|E z
y 0QO. L0 d| QU0CS 0l 0CS, ESIE ODC|I DS|C|QlCC SE
LLULP OhM
00m uh vthI0 00 l
h0fml00.
|C|CDQd RdSId |CS 3 4dRCS, ED
CUyC CdSC SE Ol CE QUE dOECE0
UDd 0l CQd00dQ| CDU| l 0E0ld
I|d0SlIC|ld OE |d |DdDC|d. L| C||QE0
0E ESIE I|dSIC|0C DC ESId dC| d|dOC.
.d 0| CQd00dQ| CDU| | DE0| d I|dDSlIC||d |COUCE S|DIC
TdIC|CQ|d 0Uy |d|dS VECES. lC ESId |DO|CdOC dO0| D| SI|d|
Qd00dQ| CDU| l 0d, EXCEIC ED |CS CdSCS EXI|dC|O|Dd|lCS
ED QUE SE |COUCE0 l 0ECC|C0ES 0Uy Q|dVES y |EEIlOdS.
-USB0O|d 0B Dd0
;0 E| DdZC |dO|Cd0 |d 0dyC| d|IE OE |CS | l 0CClICS b ED
Cd|QdOCS OE |d |ESUESId OE d0Il CUE|CS | DOEE0Ol EDIE
OE C| U| dS T Ld dUSE0Cl d OE ESIE |QdDC, yd SEd CCDQ
0lId C dOQUl |l Od (ES|E0ECIC0|d), SUC0E UD CUdO|C OE
OEPClE0C|d 0U0C|d| CC0 UD 0dyC| ||ESQC OE |DECClC0ES
DdCIE||dDdS SE|ldS C| DdCIE|ldS E0CdSU| dOdS EXI|dCE|U
|d|ES (0EU0CCCCCS y ldE0CO||US).
.0. 0MJ0000|0|000|88
00M0|08088
hE|ESEDIdD CE|Cd OE| zb% OE | dS L || 0d|| dS. JCOdS SC0
0E|EOl Id|l dS y ESIdD CdUSdOdS C| | d dUSE0Cl d C C| U0d
d| IE|dC| D U0C| C0d| Q|dVE OE | CS | | 0CCl ICS 1 y b. LUdD
OC SE CCDCCE E| QE0 |ESCDSdD| E, ES CSl D| E SU O| dQ
0SI| CC ESIUO| dDOC E| QE0CI| C I|dS CDIE0E| C| U| dS
C| d0DlCCEDIESl S, y E0 d| QUDCS CdSCS SE 0d |Ed| lZdCC,
| 0C| USC, E| I|dId0| EDIC CCD I|dS| dDIE OE 0OU| d |0
I|dUIE|C. Ld dUSEDCl d C | d d| IE|dC|0 Q|dVE OE |d | D0U
mgJd|
1 Z
1


9
0l OdO 0EO|dOd C| | dS C| U| dS | dS| CC0C | d ESCdSd C
0U| d |COUCCl 0 OE PC, CCdS| CDd CUdO|CS C| |Dl CCS OE
EXI|E0d Q|dVEOdO, QUE, E0 dUSE0Cl d OE I|dId0| E0IC
CC||ECI|VC, SUE| ED CC0OUC| | d| d| | EC| 0lE0IC OU|d0IE | d
| 0d0Cl d. PU0QUE ESICS dCl E0IES SU|E0 ICOC Il C OE
l 0ECC|CDES, |dS 0dS |ECUEDIES SUE| E0 SE| |dS OE C|l
QED V|||CC, dS| CC0C |dS |COUCl OdS C| 0C0QCS y C|
DdCIE|| dS OE C|EC| 0l EDIC | DI|dCE| U| d|.
LCS OdICS QUE E|0| IE0 SCSEC0d| U0d L CC0D| DdOd
SCD.
Pd|| C| 0 IE0|dDd OE |DECCl C0ES Q|dVES |EEIlOdS
y OE O||Cl| CCDI|C|.
P0C|EX|d l DIE0Sd CCD d|C C |EI|dSC E0 E| OESd||C| | C
C0OE|CESIdIU|d| .
Ld0Ol Ol dS| S C|d| |ES|SIE0IE d| I|dId0| E0IC Il CC
lEU0C0|dS | 0IE|SI| C| d| ES.
ll SIC|ld d0l | | d| OE d| | ECl 0l EDICS IE0|dDCS.
P0IE | d SCSECOd (I||dOd. Cd0Ol Ol dS| S, Ol d||EdS, DEU0C
D|dS), OEDE EVlId|SE |d VdCU0dCl0 CCD Q|0EDES V|VCS.
L0 E| CdSC OE IE0E| QUE I|dDSUDO|||CS, y d|d EV|Id| | d ED
E|0EOdO OE| |D|E|IC CC0I|d E| 0USEO, | d Sd0Q|E C SUS
OE||VdOCS OEDED SE| |ESCCS y |EV|d0E0IE l||dO|dOCS CC0
CDEIC OE E| | 0| Dd| |d UDClC0d||OdO OE |CS | l DCClICS J (N|
9495, 98).
|00U000Bl|O|B0O|d O00D|0d0d SBB|d
LS UD S|0O|C0E QUE dQ|Ud d Vd|ldS E0E|0EOdOES CC0
Q0l IdS CCD dUSE0Cl d V||IUd| IdDIC OE l 00U0lOdO 0EO|d
Od C| C|U|dS J CC0C OE |COUCCl0 OE d0I|CUE|CS.
|8!OBH|8
Ld dICQED|d OE ESIE S|0O|C0E ES 0U| I| | E (0EIE|CQE0E|
OdO QEDIlCd), dU0QUE |EClEDIE0EDIE SE VdD |OE0IlCdD
OC 0UCDCS OE lCS QEDES |ESC0SdDlES y OE|0lE0OC, C|
Id0IC, EDIlOdOES C||DlCdS CC0C|EIdS. L0 |d 0dyC||d OE |CS
CdSCS, | CS | | DCClICS J ESIdD dUSEDIES C 0Uy O| S0| DU|OCS.
L| Il0C OE ESICS dClEDIES SUElE SE| OE EQUE0C Id0dHC
y 0C SE V| SUd| lZd ED |d |dO|CQ|d|d OE I|dX.
|8H0|OO
bE ESIdD|ECE d0IE UDd O|SIC|ld C| |0lCd SUQE|E0IE. LDI|E |CS
OdICS OE |dDC|dIC||C, OESIdCd.
ll CQd00dQ| CDU| | DE0| d |0IEDSd, dECId C| | C QEDE
|d| d ICOdS |dS l L (dU0QUE, ED d| QD CdSC, |d lQN UEOE
ESId| CCDSE|VdOd).
Ll 0CED|d, 0dS |DIEDSd d 0EO|Od QUE SE OEIE|lC|d E|
ESIdOC QEDE|d| OE| dC|EDIE.
PUSEDC|d OE | l DCC|ICS UDC|CDdDIES |UEOE0 Cd|ECE| OE
| l 0CClICS J C 0dDE||CS ED Dd|C DU0E|C. LUd0OC EX|SIE0
| l 0CClICS T,SICS |ESEDId0 |DCddC|OdO, |dCIlCd0E0IE
ICId|, OE |ESCDOE| CCD |C||E|dC|0 d 0|IQEDCS CC0C
IC0E0dQ| UI|D|Dd C CCDCd0dVd| | 0d.
1|8!8H|BH!O
1|8S|8H!B0BHB0U|80SB8
1. | HmUHDCPDCPHC CDmDHC SPVPf gC SPXD.
LS |d 0dS |ECUEDIE. bE OEDE d 0UIdClCDES E0 E| QE0 OE
ld CdOE0d Qd00d OE| |ECEIC| OE |d |Lz (SlIUdOC ED E|
C|C0CSC0d X).LCS | |DCC|ICS J OE Sd0Q|E E||||Cd ESId0
dUSE0IES C ED 00E|C 0Uy DdC, |CS | l DCC|ICS b SUE|ED
ESId| DC|0d|ES C E|EVdOCS.
2. HUHDCPDCPHC CDDHC SPVPf UIDSDmCD
fPCPSV. bCD UD Q|UC OE EDE|0EOdOES CCD OEIE|O
QEDE|OdO QEDIlCd. Ld C|0d 0dS |ECUEDIE |ESEDId
UDd OEPC|E0Cld ED |d |Ed|dC|D OE| PLl. LCS | l 0CClICS
1 ESId0 0Uy DdCS C dUSEDIES, |CS | | DCC|ICS b UEOE0 SE|
0C|0d|ES, 0Uy DdCS C ESId| dUSEDIES.
J Z J 4 b 6 7 8 Q 1 2 5 4 7 d 9 1 U 1 1 1 2
d80ImI00t0 M0808
AptI E4tl| [|||
Ln |8 | cCmO|nd8 de8IC e| l||C en |
|nmun|dd Ce|u|| (|nleCC|Cne8 pC| V||u8
hCnQC8, pI8|IC8 un|Ce|u||e8 y m|cCOc
Ie||8) que 8e CCmpn ImO|Cn de un
deC|enC| de nI|Cue|pC8 (de h| e| nCm-
O|e de CCmO|nd8).
L | p||m|| m8 l|ecuenIe e8 de nI|
Cue|pC8. e| dCC|I |8|dC de |QA, enle|me-
dd que nC 8ue|e p|e8enI| 8|nICm8 y que
nC p|ec|8 I|Im|enIC, | un|c p|eCuc|n
ICm| e8 eV|I| dm|n|8I|| 8nQ|e C he-
mCde||VdC8.
L | CCmO|nd m8 l|eCuenIe e8 | |
CCmO|nd 8eVe| ||Qd | X.
ML| I|Im|enIC de |8 dec|enC|8 de nI|
Cue|pC8 e8 dm|n|8I|| QmmQ|COu||n
p|enIe|| (exCepIC en del. de |QA).
ML| I|Im|enIC de |8 | CCmO|nd8 e8 e|
I|8p|nIe de mCdu| 8e.
ML| b|nd|Cme de bruICn e8 un dec|enc|
de nI|cue|pC8 (QmmQ|COu||nem| ||-
Qd | X)que 8e C|CIe||Z pC| | u8en
c| de ||nlCc|IC8 b en | 8nQ|e pe||lC||C.
MLl dCC|I de lcIC|es de| cCmp|emenIC
C||Q|n |nlecC|Cne8 de |epeI|c|n pC| Ne|8-
8e|t.
DeI|t|e1t|1 1e 11e1|1 1e1T|111 AOA}
t' CuaC|C C' 'n' CC Ce e!a enIe|neCaC e e' Ce a Onu
nCCehC' enC' a CCnO' naCa eve|a. 'a auenC' a Ce e!a
enz' na Ce| neIaOCl'nC Ce 'a u|' na C|'g' na 'a aCu
nul aC' Cn, en ' C ' ' nICC'!C 1 y b, Ce ne!aOC''!C (CA|),
C| ' C que e OlCquea 'a i!e' Ce cNA y 'C ' ' nICC'!C
'e|Cen u CaaC'CaC Ce |C'|e|a| 'a en!'CaC e aCC'a
CCn I|eCuenC' a a anCna' 'a en 'C Ca|!''agC.
be !|a!a Ce una enIe|neCaC au!CCnlCa |eCe'va que e
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