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Investigación
Virus Respiratorios y Gripe
Líneas de investigación
Contenidos con Investigacion .
Virus Respiratorios y Gripe
• Gripe humana y animal. Vigilancia de su circulación. Antigripales, resistencias virales. Vacunas
• Infecciones víricas respiratorias en pacientes pediátricos
• Diagnóstico, referencia y Nuevos procedimientos basados en la metagenómica viral para el estudio de virus respiratorios.
• Epidemiologia de Virus respiratorios: Gripe, Virus Respiratorio Sincitial, Adenovirus, Metapneumovirus humano, Coronavirus (MERS, 229E, OC43, HKU1, NL63), Parainfluenzavirus, Rinovirus, Bocavirus humano
• Virus respiratorios emergentes • Biodefensa y virus
Proyectos de investigación
Contenidos con Investigacion .
PROYECTOS EN ACTIVO: Concesión del Proyecto de la Convocatoria 2019 de RETOS-COLABORACIÓN: Desarrollo de kits diagnósticos mediante PCR multiplex en tiempo real en formato líquido y gelificado para la detección de enfermedades víricas y sepsis.
Referencia: RTC2019-007023-1 / MPY 292/20. Proyecto financiado por el Ministerio de Ciencia e Innovación y la Agencia Estatal de Investigación (MCIN/AEI/10.13039/501100011033).
IP: Inmaculada Casas y Giovanni Fedele.
Fechas de ejecución: 2020-2023.
Cantidad financiada: 442.653 €.
Colaborador: Francisco Pozo
Publicaciones destacadas
Rapid profiling of RSV antibody repertoires from the memory B cells of naturally infected adult donors
6. Gilman MS, Castellanos CA, Chen M, Ngwuta JO, Goodwin E, Moin SM, et al. Rapid profiling of RSV antibody repertoires from the memory B cells of naturally infected adult donors. Sci Immunol. 2016;1(6).
PUBMED DOICharacterization of a Prefusion-Specific Antibody That Recognizes a Quaternary, Cleavage-Dependent Epitope on the RSV Fusion Glycoprotein.
8. Gilman MS, Moin SM, Mas V, Chen M, Patel NK, Kramer K, et al. Characterization of a Prefusion-Specific Antibody That Recognizes a Quaternary, Cleavage-Dependent Epitope on the RSV Fusion Glycoprotein. PLoS Pathog. 2015;11(7):e1005035.
PUBMED DOIPolyclonal and monoclonal antibodies specific for the six-helix bundle of the human respiratory syncytial virus fusion glycoprotein as probes of the protein post-fusion conformation.
9. Palomo C, Mas V, Vazquez M, Cano O, Luque D, Terron MC, et al. Polyclonal and monoclonal antibodies specific for the six-helix bundle of the human respiratory syncytial virus fusion glycoprotein as probes of the protein post-fusion conformation. Virology. 2014;460-461:119-27.
PUBMED DOIBiophysical properties of single rotavirus particles account for the functions of protein shells in a multilayered virus
Jiménez-Zaragoza M., Yubero M.L., Martín-Forero E., Castón J.R., Reguera D., Luque D.*, de Pablo P.J., Rodríguez J.M. 2018. Biophysical properties of single rotavirus particles account for the functions of protein shells in a multilayered virus. eLife 7: e37295. *Corresponding author.
PUBMED DOIAcquisition of functions on the outer capsid surface during evolution of double-stranded RNA fungal viruses
Mata C.P., Luque D., Gómez-Blanco J., Rodríguez J.M., González J.M., Suzuki N., Ghabrial S.A., Carrascosa J.L., Trus B.L., Castón J.R. 2017. Acquisition of functions on the outer capsid surface during evolution of double-stranded RNA fungal viruses. PLoS Pathog. 13(12):e1006755.
PUBMED DOIStructural Insights into the Assembly and Regulation of Distinct Viral Capsid Complexes
Sarker S., C. Terrón M., Khandokar Y., Aragão D., Hardy J.M., Radjainia M., Jiménez-Zaragoza M., de Pablo P.J., Coulibaly F., Luque D., Raidal D.R., Forwood J.K. 2016. Structural Insights into the Assembly and Regulation of Distinct Viral Capsid Complexes. Nat. Commun. 7:13014. IF: 12.124; D1.
PUBMED DOIHeterodimers as the structural unit of the T=1 capsid of the fungal dsRNA Rosellinia necatrix quadrivirus 1
Luque D., Mata C.P., González-Camacho F., González J.M., Gómez-Blanco J., Alfonso C., Rivas G., Havens W.M., Kanematsu S., Suzuki N., Ghabrial S.A., Trus B.L., Castón J.R. 2016. Heterodimers as the structural unit of the T=1 capsid of the fungal dsRNA Rosellinia necatrix quadrivirus 1. J Virol. 90(24):11220-11230. IF: 4.666, Q1.
PUBMED DOISelf-assembly and characterization of small and monodisperse dye nanospheres in a protein cage
Luque D., de la Escosura A., Snijder J., Brasch M., Burnley R.J, Koay M.S.T., Carrascosa J.L., Wuite G.J.L., Roos W.H., Heck A.J.R., J.J.L.M Cornelissen, Torres T., Castón J.R. 2014. Self-assembly and characterization of small and monodisperse dye nanospheres in a protein cage. Chem. Sci.,5, 575-581. IF: 9.211, D1.
DOICryo-EM near-atomic structure of a dsRNA fungal virus shows ancient structural motifs preserved in the dsRNA viral lineage.
Luque D., Gómez-Blanco J., Garriga D., Brilot A.F., González J.M., Havens W.M., Carrascosa J.L., Trus B.L., Verdaguer N., Ghabrial S.A., Castón J.R. 2014. Cryo-EM near-atomic structure of a dsRNA fungal virus shows ancient structural motifs preserved in the dsRNA viral lineage. Proc Natl Acad Sci U S A 111(21):7641-7646. IF: 9.674, D1
PUBMED DOINew insights into rotavirus entry machinery: stabilization of rotavirus spike conformation is independent of trypsin cleavage
Rodríguez J.M., Chichón F.J., Martín-Forero E., González-Camacho F., Carrascosa J.L., Castón J.R., Luque D*. 2014. New insights into rotavirus entry machinery: stabilization of rotavirus spike conformation is independent of trypsin cleavage. PLoS Pathog. 10(5):e1004157. IF: 7.562, D1. * Corresponding autor.
PUBMED DOIEfficacy and safety assessment of a TRAF6-targeted nanoimmunotherapy in atherosclerotic mice and non-human primates.
3. Lameijer M, Binderup T, van Leent M, Senders M, Fay F. Seijkens T, Kroon J, Stroes E, Kjaer A, Ochando J, Reiner T, Pérez-Medina C, Calcagno C, Fischer E, Zhang B, Temel R, Swirski F, Nahrendorf M, Fayad Z, Lutgens E, Mulder W and Duivenvoorden R. Efficacy and safety assessment of a TRAF6-targeted nanoimmunotherapy in atherosclerotic mice and non-human primates. Nature Biomedical Engineering. 2018. 2: 279–292.
PUBMED DOINeutrophil derived CSF1 induces macrophage polarization and promotes transplantation tolerance.
4. Braza MS, Conde P, Garcia MR, Cortegano I, Brahmachary M, Pothula V, Fay F, Boros P, Werner SW, Ginhoux F, Mulder WJ, and Ochando J. Neutrophil derived CSF1 induces macrophage polarization and promotes transplantation tolerance. Am J Transplant. 2018.
PUBMED DOIInhibition of LpxC Increases Antibiotic Susceptibility in Acinetobacter baumannii
Inhibition of LpxC Increases Antibiotic Susceptibility in Acinetobacter baumannii. García-Quintanilla M, Caro-Vega JM, Pulido MR, Moreno-Martínez P, Pachón J, McConnell MJ. Antimicrob Agents Chemother. 2016 Jul 22;60(8):5076-9. doi: 10.1128/AAC.00407-16.
PUBMEDNew Panfungal Real-Time PCR Assay for Diagnosis of Invasive Fungal Infections.
4. Valero C, de la Cruz-Villar L, Zaragoza O, Buitrago MJ. New Panfungal Real-Time PCR Assay for Diagnosis of Invasive Fungal Infections. J Clin Microbiol. 2016 Dec;54(12):2910-2918. doi: 10.1128/JCM.01580-16. Epub 2016 Sep 14. PMID: 27629898.
DOIA Multiplex Real-Time PCR Assay for Identification of Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii in Samples from AIDS Patients with Opportunistic Pneumonia
6. Gago S, Esteban C, Valero C, Zaragoza O, Puig de la Bellacasa J, Buitrago MJ. A multiplex real-time PCR assay for identification of Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii in samples from AIDS patients with opportunistic pneumonia. J Clin Microbiol. 2014 Apr;52(4):1168-76. doi: 10.1128/JCM.02895-13. Epub 2014 Jan 29. PMID: 24478409.
PUBMED DOIAnalysis of strain relatedness using High Resolution Melting in a case of recurrent candiduria
7. Gago S, Lorenzo B, Gomez-Lopez A, Cuesta I, Cuenca-Estrella M, Buitrago MJ. Analysis of strain relatedness using high resolution melting in a case of recurrent candiduria. BMC Microbiol. 2013 Jan 23;13:13. doi: 10.1186/1471-2180-13-13. PMID: 23343107.
PUBMED DOIHigh-Resolution Melting Analysis for Identification of the Cryptococcus neoformans-Cryptococcus gattii Complex
8. Gago S, Zaragoza Ó, Cuesta I, Rodríguez-Tudela JL, Cuenca-Estrella M, Buitrago MJ. High-resolution melting analysis for identification of the Cryptococcus neoformans-Cryptococcus gattii complex. J Clin Microbiol. 2011 Oct;49(10):3663-6. doi: 10.1128/JCM.01091-11. Epub 2011 Aug 10. PMID: 21832024.
PUBMED DOIPerformance of Panfungal- and Specific-PCR-Based Procedures for Etiological Diagnosis of Invasive Fungal Diseases on Tissue Biopsy Specimens with Proven Infection: a 7-Year Retrospective Analysis from a Reference Laboratory
9. Buitrago MJ, Bernal-Martinez L, Castelli MV, Rodriguez-Tudela JL, Cuenca-Estrella M Performance of panfungal--and specific-PCR-based procedures for etiological diagnosis of invasive fungal diseases on tissue biopsy specimens with proven infection: a 7-year retrospective analysis from a reference laboratory. J Clin Microbiol. 2014 May;52(5):1737-40. doi: 10.1128/JCM.00328-14. Epub 2014 Feb 26.PMID: 24574295.
PUBMED DOIEpidemiología actual y diagnóstico de laboratorio de las micosis endémicas en España
11. Buitrago MJ, Cuenca-Estrella M. [Current epidemiology and laboratory diagnosis of endemic mycoses in Spain]. Enferm Infecc Microbiol Clin. 2012 Aug;30(7):407-13. doi: 10.1016/j.eimc.2011.09.014. Epub 2011 Nov 29. PMID: 22130575 Review. Spanish.
PUBMED DOIA matrix-assisted laser desorption/ionization time of flight mass spectrometry reference database for the identification of Histoplasma capsulatum
12. Buitrago MJ, Bernal-Martínez L, Castelli MV, Rodríguez-Tudela JL, Cuenca-Estrella M. Histoplasmosis and paracoccidioidomycosis in a non-endemic area: a review of cases and diagnosis. J Travel Med. 2011 Jan-Feb;18(1):26-33. doi: 10.1111/j.1708-8305.2010.00477.x. Epub 2010 Nov 28. PMID: 21199139.
PUBMED DOICopy Number Variation of Mitochondrial DNA Genes in Pneumocystis jirovecii According to the Fungal Load in BAL Specimens
13. Valero C, Buitrago MJ, Gago S, Quiles-Melero I, García-Rodríguez J. A matrix-assisted laser desorption/ionization time of flight mass spectrometry reference database for the identification of Histoplasma capsulatum. Med Mycol. 2018 Apr 1;56 (3):307-314. doi: 10.1093/mmy/myx047. PMID: 28992262.
PUBMED DOICopy Number Variation of Mitochondrial DNA Genes in Pneumocystis jirovecii According to the Fungal Load in BAL Specimens
14. Valero C, Buitrago MJ, Gits-Muselli M, Benazra M, Sturny-Leclère A, Hamane S, Guigue N, Bretagne S, Alanio A. Copy Number Variation of Mitochondrial DNA Genes in Pneumocystis jirovecii According to the Fungal Load in BAL Specimens. Front Microbiol. 2016 Sep 12;7:1413. doi: 10.3389/fmicb.2016.01413. eCollection 2016. PMID: 27672381.
PUBMED DOIIdentification of Off-Patent Compounds That Present Antifungal Activity Against the Emerging Fungal Pathogen Candida auris
2: de Oliveira HC, Monteiro MC, Rossi SA, Pemán J, Ruiz-Gaitán A, Mendes- Giannini MJS, Mellado E, Zaragoza O. Identification of Off-Patent Compounds That Present Antifungal Activity Against the Emerging Fungal Pathogen Candida auris. Front Cell Infect Microbiol. 2019 Apr 2;9:83. PMCID: PMC6454888.
PUBMED DOICryptococcus neoformans can form titan-like cells in vitro in response to multiple signals
Trevijano-Contador N, de Oliveira HC, García-Rodas R, Rossi SA, Llorente I, Zaballos Á, Janbon G, Ariño J, Zaragoza Ó. Cryptococcus neoformans can form titan-like cells in vitro in response to multiple signals. PLoS Pathog. 2018 May 18;14(5):e1007007. PMCID: PMC6454888.
PUBMED DOICell Wall Changes in Amphotericin B-Resistant Strains from Candida tropicalis and Relationship with the Immune Responses Elicited by the Host
5: Mesa-Arango AC, Rueda C, Román E, Quintin J, Terrón MC, Luque D, Netea MG, Pla J, Zaragoza O. Cell Wall Changes in Amphotericin B-Resistant Strains from Candida tropicalis and Relationship with the Immune Responses Elicited by the Host. Antimicrob Agents Chemother. 2016 Mar 25;60(4):2326-35. PMCID: PMC4808153.
PUBMED DOIThe production of reactive oxygen species is a universal action mechanism of Amphotericin B against pathogenic yeasts and contributes to the fungicidal effect of this drug
8: Mesa-Arango AC, Trevijano-Contador N, Román E, Sánchez-Fresneda R, Casas C, Herrero E, Argüelles JC, Pla J, Cuenca-Estrella M, Zaragoza O. The production of reactive oxygen species is a universal action mechanism of Amphotericin B against pathogenic yeasts and contributes to the fungicidal effect of this drug. Antimicrob Agents Chemother. 2014 Nov;58(11):6627-38. PMCID: PMC4249417.
PUBMED DOICapsule Growth in Cryptococcus neoformans Is Coordinated with Cell Cycle Progression
9: García-Rodas R, Cordero RJ, Trevijano-Contador N, Janbon G, Moyrand F, Casadevall A, Zaragoza O. Capsule growth in Cryptococcus neoformans is coordinated with cell cycle progression. mBio. 2014 Jun 17;5(3):e00945-14. PMCID: PMC4056547.
PUBMED DOIThe interaction between Candida krusei and murine macrophages results in multiple outcomes, including intracellular survival and escape from killing
12: García-Rodas R, González-Camacho F, Rodríguez-Tudela JL, Cuenca-Estrella M, Zaragoza O. The interaction between Candida krusei and murine macrophages results in multiple outcomes, including intracellular survival and escape from killing. Infect Immun. 2011 Jun;79(6):2136-44. PMCID: PMC3125833.
PUBMED DOIHuman IgM Inhibits the Formation of Titan-Like Cells in Cryptococcus neoformans
14: Trevijano-Contador N, Pianalto KM, Nichols CB, Zaragoza O, Alspaugh JA, Pirofski LA. Human IgM Inhibits the Formation of Titan-Like Cells in Cryptococcus neoformans. Infect Immun. 2020 Mar 23;88(4):e00046-20. PMCID: PMC7093138.
PUBMED DOIThe lymphocyte scavenger receptor CD5 plays a nonredundant role in fungal infection
15: Velasco-de-Andrés M, Català C, Casadó-Llombart S, Simões I, Zaragoza O, Carreras E, Lozano F. The lymphocyte scavenger receptor CD5 plays a nonredundant role in fungal infection. Cell Mol Immunol. 2020 Apr 24.
PUBMED DOIAlastruey-Izquierdo A, Alcazar-Fuoli L, Rivero-Menéndez O, Ayats J, Castro C, García-Rodríguez J, Goterris-Bonet L, Ibáñez-Martínez E, Linares-Sicilia MJ, Martin-Gomez MT, Martín-Mazuelos E, Pelaez T, Peman J, Rezusta A, Rojo S, Tejero R, Anza DV, Viñuelas J, Zapico MS, Cuenca-Estrella M; the FILPOP2 Project from GEMICOMED (SEIMC) and REIPI. Molecular Identification and Susceptibility Testing of Molds Isolated in a Prospective Surveillance of Triazole Resistance in Spain (FILPOP2 Study). Antimicrob Agents Chemother. 2018 Aug 27;62(9):e00358-18. doi: 10.1128/AAC.00358-18. PMID: 29941643; PMCID: PMC6125503.
Alastruey-Izquierdo A, Alcazar-Fuoli L, Rivero-Menéndez O, Ayats J, Castro C, García-Rodríguez J, Goterris-Bonet L, Ibáñez-Martínez E, Linares-Sicilia MJ, Martin-Gomez MT, Martín-Mazuelos E, Pelaez T, Peman J, Rezusta A, Rojo S, Tejero R, Anza DV, Viñuelas J, Zapico MS, Cuenca-Estrella M; the FILPOP2 Project from GEMICOMED (SEIMC) and REIPI. Molecular Identification and Susceptibility Testing of Molds Isolated in a Prospective Surveillance of Triazole Resistance in Spain (FILPOP2 Study). Antimicrob Agents Chemother. 2018 Aug 27;62(9):e00358-18. doi: 10.1128/AAC.00358-18. PMID: 29941643; PMCID: PMC6125503.
PUBMED DOIGonçalves SM, Lagrou K, Rodrigues CS, Campos CF, Bernal-Martínez L, Rodrigues F, Silvestre R, Alcazar-Fuoli L, Maertens JA, Cunha C, Carvalho A. Evaluation of Bronchoalveolar Lavage Fluid Cytokines as Biomarkers for Invasive Pulmonary Aspergillosis in At-Risk Patients. Front Microbiol. 2017 Nov 29;8:2362. doi:10.3389/fmicb.2017.02362. PMID: 29238334; PMCID: PMC5712575.
Gonçalves SM, Lagrou K, Rodrigues CS, Campos CF, Bernal-Martínez L, Rodrigues F, Silvestre R, Alcazar-Fuoli L, Maertens JA, Cunha C, Carvalho A. Evaluation of Bronchoalveolar Lavage Fluid Cytokines as Biomarkers for Invasive Pulmonary Aspergillosis in At-Risk Patients. Front Microbiol. 2017 Nov 29;8:2362. doi:10.3389/fmicb.2017.02362. PMID: 29238334; PMCID: PMC5712575.
PUBMED DOIAlcazar-Fuoli L, Buitrago M, Gomez-Lopez A, Mellado E. An alternative host model of a mixed fungal infection by azole susceptible and resistant Aspergillus spp strains. Virulence. 2015;6(4):376-84. doi: 10.1080/21505594.2015.1025192. PMID: 26065322; PMCID: PMC4601236.
Alcazar-Fuoli L, Buitrago M, Gomez-Lopez A, Mellado E. An alternative host model of a mixed fungal infection by azole susceptible and resistant Aspergillus spp strains. Virulence. 2015;6(4):376-84. doi: 10.1080/21505594.2015.1025192. PMID: 26065322; PMCID: PMC4601236.
PUBMED DOIAlcazar-Fuoli L, Cairns T, Lopez JF, Zonja B, Pérez S, Barceló D, Igarashi Y, Bowyer P, Bignell E. A modified recombineering protocol for the genetic manipulation of gene clusters in Aspergillus fumigatus. PLoS One. 2014 Nov 5;9(11):e111875. doi: 10.1371/journal.pone.0111875. PMID: 25372385; PMCID:PMC4221250.
Alcazar-Fuoli L, Cairns T, Lopez JF, Zonja B, Pérez S, Barceló D, Igarashi Y, Bowyer P, Bignell E. A modified recombineering protocol for the genetic manipulation of gene clusters in Aspergillus fumigatus. PLoS One. 2014 Nov 5;9(11):e111875. doi: 10.1371/journal.pone.0111875. PMID: 25372385; PMCID:PMC4221250.
PUBMED DOIBertuzzi M, Schrettl M, Alcazar-Fuoli L, Cairns TC, Muñoz A, Walker LA, Herbst S, Safari M, Cheverton AM, Chen D, Liu H, Saijo S, Fedorova ND, Armstrong-James D, Munro CA, Read ND, Filler SG, Espeso EA, Nierman WC, Haas H, Bignell EM. The pH-responsive PacC transcription factor of Aspergillus fumigatus governs epithelial entry and tissue invasion during pulmonary aspergillosis. PLoS Pathog. 2014 Oct 16;10(10):e1004413. doi: 10.1371/journal.ppat.1004413.
Bertuzzi M, Schrettl M, Alcazar-Fuoli L, Cairns TC, Muñoz A, Walker LA, Herbst S, Safari M, Cheverton AM, Chen D, Liu H, Saijo S, Fedorova ND, Armstrong-James D, Munro CA, Read ND, Filler SG, Espeso EA, Nierman WC, Haas H, Bignell EM. The pH-responsive PacC transcription factor of Aspergillus fumigatus governs epithelial entry and tissue invasion during pulmonary aspergillosis. PLoS Pathog. 2014 Oct 16;10(10):e1004413. doi: 10.1371/journal.ppat.1004413.
DOIContenidos con Investigacion .
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Inmaculada Casas
Jefe de Grupo. Científico Titular de OPIs
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Mónica González-Esguevillas
Colaborador I+D+I de OPIs
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María de la Montaña Iglesias Caballero
Contratado Predoctoral PFIS
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Mar Molinero Calamita
Colaborador I+D+I de OPIs
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Francisco Pozo
Científico Titular de OPIs
Listado de personal
Información adicional
La Unidad de Virus Respiratorios y Gripe es el Centro de Gripe de la OMS más antiguo de nuestro país (1968), designado como Centro Nacional de Gripe por el Ministerio de Sanidad en 1971, es coordinador nacional de los laboratorios de las CCAA en la Red Nacional de Vigilancia de Gripe del Sistema de Vigilancia de la Gripe en España.
Su objetivo general es la vigilancia virológica, la detección y el control de la gripe en España.Desde el año 1992 junto con el Servicio de Pediatría del Hospital Severo Ochoa se desarrolla una línea de investigación basada en el estudio etiológico de las infecciones respiratorias virales en niños hospitalizados.
Desde 2015 además participan el Hospital Universitario Infantil La Paz y el Laboratorio de Inmunología del IIS-Fundación Jiménez Díaz ampliando el estudio a recién nacidos y las unidades neonatales.
Estudiar de manera integrada los virus respiratorios y la respuesta del sistema inmune en las infecciones respiratorias virales que afectan a recién nacidos y pacientes pediátricos.
Profundizar en el conocimiento de las propiedades biológicas de los virus implicados en la enfermedad: dependencia/facilitación, equilibrio entre los virus y su adaptación en infecciones múltiples, relación con la gravedad, existencia de desequilibrio del viroma.
La Unidad de Virus Respiratorios y Gripe es el Centro de Gripe de la OMS más antiguo de nuestro país (1968), designado como Centro Nacional de Gripe por el Ministerio de Sanidad en 1971, es coordinador nacional de los laboratorios de las CCAA en la Red Nacional de Vigilancia de Gripe del Sistema de Vigilancia de la Gripe en España.
Su objetivo general es la vigilancia virológica, la detección y el control de la gripe en España.Desde el año 1992 junto con el Servicio de Pediatría del Hospital Severo Ochoa se desarrolla una línea de investigación basada en el estudio etiológico de las infecciones respiratorias virales en niños hospitalizados.
Desde 2015 además participan el Hospital Universitario Infantil La Paz y el Laboratorio de Inmunología del IIS-Fundación Jiménez Díaz ampliando el estudio a recién nacidos y las unidades neonatales.
Estudiar de manera integrada los virus respiratorios y la respuesta del sistema inmune en las infecciones respiratorias virales que afectan a recién nacidos y pacientes pediátricos.
Profundizar en el conocimiento de las propiedades biológicas de los virus implicados en la enfermedad: dependencia/facilitación, equilibrio entre los virus y su adaptación en infecciones múltiples, relación con la gravedad, existencia de desequilibrio del viroma.