COVID-19 grave en una paciente con exposición crónica al humo de leña: reporte de caso
DOI:
https://doi.org/10.61286/e-RPM.2026.376Palabras clave:
COVID-19; Biomasa; Exposición a humo de leña; Insuficiencia respiratoria; Informes de casos.Resumen
Introducción: La exposición crónica al humo de biomasa es un factor de riesgo ambiental crítico para enfermedades respiratorias, aunque su rol específico en la severidad de la COVID-19 en pacientes sin comorbilidades clásicas ha sido poco documentado a nivel de reporte de caso. Presentación del caso: Mujer de 53 años, procedente de Lima, Perú, con antecedente de exposición al humo de leña por >30 años (Índice de exposición: 150 horas - años). Sin diagnósticos previos registrados. Ingresó con insuficiencia respiratoria aguda grave (PaO2/FiO2: 125 mmHg), niveles críticos de reactantes de fase aguda (PCR: 330 mg/L) y alta carga viral por SARS-CoV-2 (Ct = 22). La tomografía evidenció neumonía intersticial bilateral severa. Requirió soporte con sistema Venturi y pulsos de metilprednisolona logrando una recuperación progresiva tras 11 días de hospitalización. Discusión: La ausencia de factores de riesgo tradicionales sugiere que la inflamación crónica basal y las alteraciones epigenéticas inducidas por la biomasa predispusieron a una respuesta inmune desregulada (tormenta de citocinas). Este caso respalda la evidencia epidemiológica que vincula la contaminación intradomiciliaria con desenlaces adversos en COVID-19. Conclusión: La exposición a biomasa debe ser integrada sistemáticamente en la evaluación de riesgo de COVID-19. La reducción de la contaminación del aire interior es una estrategia de salud pública esencial para fortalecer la resiliencia ante futuras pandemias virales.
Citas
- 1. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-160. https://doi.org/10.23750/abm.v91i1.9397
- 2. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
- 3. Sheppard N, Carroll M, Gao C, Lane T. Particulate matter air pollution and COVID-19 infection, severity, and mortality: A systematic review and meta-analysis. Sci Total Environ. 2023; 880:163272. https://doi.org/10.1016/j.scitotenv.2023.163272
- 4. Yu K, Zhang Q, Wei Y, Chen R, Kan H. Global association between air pollution and COVID-19 mortality: A systematic review and meta-analysis. Sci Total Environ. 2024; 906:167542. https://doi.org/10.1016/j.scitotenv.2023.167542
- 5. Bonjour S, Adair-Rohani H, Wolf J, Bruce NG, Mehta S, Prüss-Ustün A, et al. Solid fuel use for household cooking: country and regional estimates for 1980-2010. Environ Health Perspect. 2013;121(7):784-90. https://doi.org/10.1289/ehp.1205987
- 6. Ramírez-Venegas A, Montiel-Lopez F, Pérez Lara-Albisua JL, Aranda-Chávez A, Perea-Gutiérrez H, Falfán-Valencia R, et al. Association between chronic obstructive pulmonary disease and biomass smoke in rural areas. Int J Tuberc Lung Dis. 2022;26(12):1191-1193. https://doi.org/10.5588/ijtld.22.0337
- 7. Laumbach RJ, Kipen HM, Ko S, Kelly-McNeil K, Cepeda C, Pettit A, et al. A controlled trial of acute effects of wood smoke exposure in healthy subjects: oxidative stress, inflammation, and microvascular function. Am J Respir Crit Care Med. 2022;205(3):321-330. https://doi.org/10.1164/rccm.202105-1154OC
- 8. Deering-Rice CE, Romero EG, Shapiro D, Hughen RW, Light AR, Yost GS, et al. Activation of TRPV3 by wood smoke particles and roles in pneumotoxicity. Chem Res Toxicol. 2018; 31(5):291-301. https://doi.org/10.1021/acs.chemrestox.7b00336
- 9. Centers for Disease Control and Prevention. Interim guidelines for collecting, handling, and testing clinical specimens for COVID-19 [Internet]. Atlanta (GA): CDC; 2020 [citado 25 may 2024]. Disponible en: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html
- 10. Organización Mundial de la Salud. Manejo clínico de la COVID-19: orientaciones evolutivas, 25 de enero de 2021 [Internet]. Ginebra: OMS; 2021 [citado 30 mar 2024]. Disponible en: https://apps.who.int/iris/handle/10665/340629
- 11. Welch J, Dean J, Hartin J. Using NEWS2: an essential component of reliable clinical assessment. Clin Med (Lond). 2022 Nov;22(6):509-513. https://doi.org/10.7861/clinmed.2022-0435
- 12. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid 19. N Engl J Med. 2021;384(8):693 704. https://doi.org/10.1056/NEJMoa2021436
- 13. World Health Organization. Corticosteroids for COVID 19: living guidance. Geneva: WHO; 2020. Disponible en: https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1
- 14. Organización Panamericana de la Salud. Manejo clínico de la infección respiratoria aguda grave cuando se sospecha infección por COVID 19. Washington, DC: OPS; 2020. Disponible en: https://www.paho.org/sites/default/files/OMS-Manejo-clinico-IRAG-Coronavirus-2012.pdf
- 15. Fuentes S, Chowdhury YS. Fraction of Inspired Oxygen. [Updated 2022 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK560867/
- 16. Pott-Junior H, Bittencourt NQP, Chacha SFG, Luporini RL, Cominetti MR, Anibal FF. Elevations in Liver Transaminases in COVID-19: (How) Are They Related? Front Med (Lausanne). 2021;8:705247. https://doi.org/10.3389/fmed.2021.705247
- 17. Shi Y, Wang M, Wu L, Li X, Liao Z. COVID-19 associated liver injury: An updated review on the mechanisms and management of risk groups. Liver Res. 2023;7(3):207-215. https://doi.org/10.1016/j.livres.2023.07.001
- 18. Houweling L, Maitland-Van der Zee AH, Holtjer JCS, Bazdar S, Vermeulen RCH, Downward GS, et al. The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis. Environ Res. 2024;240(Pt 2):117351. https://doi.org/10.1016/j.envres.2023.117351
- 19. Wu X, Nethery RC, Sabath BM, Braun D, Dominici F. Air pollution and COVID-19 mortality in the United States. Sci Adv. 2020;6(45): eabd4049. https://doi.org/10.1126/sciadv.abd4049
- 20. Teschke R, Méndez-Sánchez N, Eickhoff A. Liver Injury in COVID-19 Patients with Drugs as Causatives: A Systematic Review of 996 DILI Cases Published 2020/2021 Based on RUCAM as Causality Assessment Method. Int J Mol Sci. 2022;23(9):4828. https://doi.org/10.3390/ijms23094828
- 21. Qiu D, Cao W, Zhang Y, Hao H, Wei X, Yao L, et al. COVID-19 Infection, Drugs, and Liver Injury. J Clin Med. 2025;14(20):7228. https://doi.org/10.3390/jcm14207228
- 22. Paital B, Panda AK, Hati AK, Mohanty B, Mohapatra PK, Sahoo S, et al. Long-term environmental metal exposure is associated with hypomethylation of CpG sites in NFAT5 and LTA genes in healthy individuals and modifies the expression of ACE2 and inflammatory genes: a potential link to COVID-19 severity. Sci Total Environ. 2023; 872:162195. https://doi.org/10.1016/j.scitotenv.2023.162195
- 23. Bourdrel T, Annesi-Maesano I, Alahmad B, Maesano CN, Bind MA. The impact of outdoor air pollution on COVID-19: a review. Eur Respir Rev. 2021;30(159):200242. https://doi.org/10.1183/16000617.0242-2020
- 24. Bowe B, Xie Y, Gibson AK, Cai M, van Donkelaar A, Martin RV, et al. Ambient fine particulate matter air pollution and the risk of hospitalization among COVID-19 positive individuals: a cohort study. Environ Health Perspect. 2022;130(12):127003. https://doi.org/10.1289/EHP10730
- 25. Montiel-López F, Rodríguez-Ramírez D, Miranda-Márquez MC, Cassou-Martínez M, Perea-Gutiérrez H, Hernández-Pérez A, et al. Prevalence, attitude, knowledge, and risk perception towards COVID-19 in COPD patients associated to biomass exposure. Int J Environ Health Res. 2023;33(2):170-179. https://doi.org/10.1080/09603123.2021.2013449
- 26. Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ. 2020;369:m1443. https://doi.org/10.1136/bmj.m1443
- 27. Nor NSM, Yip CW, Ibrahim N, Jaafar MH, Rashid ZZ, Mustafa N, et al. Particulate matter (PM2.5) as a potential SARS-CoV-2 carrier. Sci Rep. 2021;11(1):2508. https://doi.org/10.1038/s41598-021-81935-9
- 28. Jaganath D, Miranda JJ, Gilman RH, Wise RA, Diette GB, Miele CH, et al.; CRONICAS Cohort Study Group. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru. Respir Res. 2015;16(1):40. https://doi.org/10.1186/s12931-015-0198-2
- 29. Sana A, Somda SMA, Meda N, Bouland C. Chronic obstructive pulmonary disease associated with biomass fuel use in women: a systematic review and meta-analysis. BMJ Open Respir Res. 2018;5(1):e000246. https://doi.org/10.1136/bmjresp-2017-000246
- 30. Pérez-Padilla R, Menezes AMB. Chronic Obstructive Pulmonary Disease in Latin America. Ann Glob Health. 2019;85(1):7. https://doi.org/10.5334/aogh.2418
