Toxoplasmosis ( toxoplasmosis ) - Causes, Symptoms and Treatment .MF .
Toxoplasmosis - a parasitic disease caused by the intracellular parasite Toxoplasma, and is characterized by a chronic course, with the defeat of the skeletal muscles, myocardium, eyes, central and peripheral nervous system, as well as development on this background lymphadenopathy (increase in regional lymph nodes) and hepatosplenomegaly (an increase in the spleenand liver).
Pathogen opened in 1908 at the same time by two different scientists who were apart from each other - and Nicolas Splendore.They found in the internal organs still unicellular parasites arc shape (Toxoplasma - arch arch) - which explains the origin of the name.1914 - Castellani set pathogenic significance for humans to find these parasites in the dead soldier.1916 - prof.F. these parasites found in the child during the examination of his malaria.1923 - German scientist Yankee described in detail the case of death at 11 months of a child who died from these parasites.1937-1955gg - American virologist Sabin described fe
causative agent - the parasite Toxoplasma gondii, is a type of protozoa.Conducts intracellular parasitism and reproduction phase acquires a shape of an arc (which is found discoverers).In nondividing form, the body is covered with a double shell (pellicle) - it explains the stable stability in the external environment.
Like any other parasite Toxoplasma have in the cycle of life from the owner change and the passage of the different phases of development.The development of the pathogen is carried in the intestinal epithelial cells of cats (cats are definitive hosts).Inside these cells form immature cysts (a form of existence, film-coated) that stand out with the feces of cats in the environment and are found in the soil.After 3-7 days, the oocysts are formed - can enter the human body (the person is the intermediate host) cysts fertilized with a stronger shell and ready for self-division, that persist in the soil for 1.5-2 years, and in this form.
The man Toxoplasma also falls into the intestinal epithelial and tissue macrophages cells and begins to pass the following stages of the life cycle: trofozoidy (breeding parasites - they fill the affected cells) and after - tissue cysts (this stable form, which for a long time stays in the body, withToxoplasma their destruction are released and there is a relapse of the disease).
For each form of development has its own range of stability and sensitivity, which has a value in the prevention and treatment of:
- cysts and oocysts are resistant to chemicals and physical and chemical factors, long stored in the soil (up to 2 years) at high and lowtemperatures.
- trofozoid sensitive pirimetatsinu, streptomycin, sulfonamides, tetracyclines;quickly perish under the influence of disinfectants, and drying and warming.
Causes infection toxoplasmosis
Pathogen is anthropozoonosis (affecting humans and animals).Source - cats, pigs, cows, sheep (in the muscle tissue of animals latter 3 are in the form of cysts of Toxoplasma).Transduction:
- Alimentary (getting oocysts with the soil in the digestive tract of man with unwashed fruits and vegetables, eating poorly processed meats);
- parenteral - ie through the blood (infected slaughterhouse workers, blood transfusions or organ transplants).Especially it concerns highly virulent strains (types of pathogen, the most dangerous to humans).
- vertical path (transplacental) - primary infection of the fetus during pregnancy due to the penetration of Toxoplasma through the placenta.
symptoms of toxoplasmosis
symptoms of toxoplasmosis are very diverse and very often take the guises of other diseases, ranging from inflammation and ending with a tumor, but may occur and completely asymptomatic.All symptoms will be explained tropic (directional lesion) to certain bodies and the nature of the flow, which depends on the immune status of the person infected.Target organs: lymph nodes, liver, spleen, skeletal muscle, myocardium, central nervous system and eyes.
incubation period (from the start of infection until the first symptoms appear) - up to 3 weeks.In this phase of oocysts get into the enterocytes (intestinal cells) of the lower small intestine → through the lymph and blood vessels to reach lymph nodes and target organs (listed above), there is their reproduction → further at these sites appear foci of necrosis, followed kaltsifekatsiey (salt deposition Ca2 +) and lymph node-specific granuloma formation (cell clusters of epithelioid cells, macrophages, plasma cells, lymphocytes and eosinophils) - their detection of diagnostically important in a punctate of limvouzlov.
Once the immune system takes over the disease, all the active toxoplasma die and only the tissue cysts that remain uncertain for a long time, but eventually they did die and dissolve.But immunodeficiency instead of destroying tissue cysts is their release and development of disease recurrence.By the nature of current symptoms may be: acute, chronic, latent.
forms of acquired toxoplasmosis will depend on which body struck:
1. Limfonodulyarnaya Form - swollen lymph nodes (usually neck and neck, but may be affected inguinal / axillary / mesenteric (in the stomach area)) to 1.5-3,5 cm in diameter, they are painless to the touch, flexible, and movable between a spayanny and surrounding tissues.Against this background, possible hepatosplenomegaly - enlarged liver and spleen.
2. meningoencephalitic - very varied neurological symptoms, so the only major changes are listed below.
• cerebral symptoms (encephalitis, meningoencephalitis, vasculitis) - in this case, a defeat of the meninges with serous inflammation and the development of hypertension CSF (ie, increased intracranial pressure), it can be accompanied by headaches, often diffuse nature arise false meningealsymptoms.When these manifestations of toxoplasmosis often think of brain tumors.
• common (meningoentsefaloradikulonevropatiya, dientsefalit) - to join vyshepredstavlennym symptoms and vascular crises, and lability of the psyche with personality changes.
• spinal - defeat posterior columns, which is characterized by symptoms of tension (pulling pain along the nerve fibers in the passive motion).
• peripheral nerve - pain and numbness in the limbs along the roots and peripheral nerves, tension symptom, disorders of pain sensitivity, vegetotroficheskie violations (violation of vascular innervation, which may lead to vascular dystonia).
3. Eye - horioritenit (inflammation of the vessel and the retina) and uveitis (choroid defeat uveal tract).
4. Heart shape - the development of focal or diffuse myocarditis or pericarditis.This form is manifested by weakness, fatigue, shortness of breath, palpitations, chest pain.
5. Generalizovannya form - a combination of the mentioned forms, against the background of fever, chills, muscle and joint pains.
6. Congenital toxoplasmosis allocated in a separate form, and has a number of symptoms, depending on the gestational age at the time of infection.
• Up to 2 weeks of pregnancy - the death of the embryo or blastopatii (system pathology, similar to genetic).
• 2 weeks -2 months - interruption or formation embriofetopaty (malformations in the organ or cellular level).
• 2-6 months - and the formation of early termination fetopathy (generalized inflammation with the outcome fibrosclerosis whole body or a portion thereof).
• 6- 7 months - acute or subacute form of the flow takes place in utero and ends before the development of the child after birth, toxoplasmosis occurs in the chronic form: the presence of hydrocephalus, intracranial calcification deposition, chorioretinitis, gaps in physical and mental development, spastic paralysis, convulsions, hepatosplenomegaly, prolonged jaundice, anemia.
• 7-8 months - the acute phase ends before birth, a child is born with a sub-acute form: the defeat of the central nervous system and eye, progressive hydrocephalus.
Toxoplasma defeat by 7-8 months pregnant
• 8-9mes - birth clinic with severe congenital toxoplasmosis - a serious condition characterized by severe intoxication, increased body temperature, abundant polymorphic rash, hepatosplenomegaly, jaundice, generalized lymphadenopathy,hemorrhagic syndrome, pneumonia, myocarditis, dyspepsia.
As you can see, the later the infection occurs, the more severe the further symptoms at birth.Some scientists attribute this to the permeability of the placenta (its "aging"), which increases the closer to birth.
After recovery for toxoplasmosis in a child can take the form of sluggish with the following manifestations:
• encephalitis (after 5-7 years)
• gepatolamichesky syndrome (in the form of neuroendocrine disorders in adolescence):
- increase in mass by 25-40kg by age norm,
- obesity uniform character,
- gipogenitalinizm in boys and premature maturation in girls,
- disturbance in emotional and volitional, with full preservation of mental abilities
• diencephalic epilepsy, is also evident in adolescence and is characterized by:urinary incontinence, visual hallucinations, night terrors, prolonged fever, enlarged lymph nodes, intelligence corresponds to the age on the background of emotional instability and reduced efficiency, the IRR (in violation of vascular innervation)
1. The hemogram: ↓ A ^ and Hf, the relativelymphocytosis, ↑ Uh, ESR normal - ie the blood only shows inflammation and the presence of Allergic readiness.
2. In likvorogramme she is under strict indications, in particular in the meningeal symptoms, resulting in a yellow stain found liquor, ↑ Lf and protein.
3. In the X-ray: increased vascular pattern, digital impressions, intercostals the expansion joints, the presence of intracranial kaltsifekatov (especially in the occipital region).
4. Laboratory diagnosis:
• Direct detection of Toxoplasma, their antigens and DNA:
- culture method (by bacteriological seeding blood smears, centrifuged cerebrospinal fluid, lymph node biopsies and other tissue and oragnov)
cells, the affected Toxoplasmamarked in red
Toxoplasma when immunofluorescence
- polymerase chain reaction (PCR) - detection of the DNA of Toxoplasma in the blood and cerebrospinal fluid
These methods can not apply is not often, of-this short stay pathogen in available biological tissues.
• Methods for determination of immune readiness: use of ELISA for the determination of immunoglobulin class G and M;Of IgM - appear to 2 weeks of primary infection and high titer maintained until 3 months, someone to 12 months - it is difficult to determine the timing of infection.But it is important that the IgM in exacerbations not infetsiruyutsya.IgG begin to be synthesized from 2 weeks after infection, with reactivation and congenital toxoplasmosis rate may increase, but not always, so diagnose not only the presence of IgG, but also the degree of avidity (binding strength Ig antigen) - the stronger the relationship, the old process of infection(ie there was a long time ago).
• Determining the degree of response with the help of samples with toksoplazminom (in children the first 2 years of life may be a false positive), and therefore more likely to spend diluted.It is considered positive if more than 10 mm infiltrate formed on day 2.
• For the diagnosis of congenital toxoplasmosis explore Am (antibodies) in the child and compare them with a titer of Al Mother:
- the absence of Al in the mother and the child avoids congenital toxoplasmosis
- the presence of IgM and G in the titer of greater than 4-fold titer mother AmHe speaks of congenital toxoplasmosis
- with the same performance as that of the mother and the baby - should double-check the results after 2-3 weeks
- titer reduction Am a baby in 2 times in match against the parent - then it's parent Al inherited baby
• Diagnostic confirmation with congenital toxoplasmosis:
- burdened obstetrical history (gestosis, infections during pregnancy, threat of termination)
- contact with cats, eating insufficiently cooked meat
- prolonged febrile or low-grade fever with symptoms of intoxication in child
- defeatCNS and / or
eye - hepatosplenomegaly, accompanied by prolonged jaundice
- polymorphic rash
- prematurity, retarded physical development
- confirmation of possible infection data;
treatment of toxoplasmosis
1. Etiotropic treatment.Only works on trofozoidy.Drug of choice: pirimetatsin, spiramycin, clarithromycin.Some of them are quite toxic, so must be administered only by a physician, taking into account the age of dosages and rigorous contraindications.
2. Pathogenetic treatment - toksoplazminoterapiya, antihistamines, immunomodulators and immunostimulants controlled immunograms.Assign probiotics for the prevention of dysbacteriosis, multivitamin preparations and metabolic therapy - a bracing, chelators, herbal adaptogens.
3. Symptomatic treatment is given depending on the predominant symptoms in various forms of flow toxoplasmosis
The duration of treatment depends on the severity of the disease and response to treatment can be from 4 weeks to 12 months.In the treatment of infected pregnant women raises the question of abortion, and, while maintaining the pregnancy, appoint spiromitsina course with antenatal diagnosis.This issue is very delicate and can be solved collectively.
Rehabilitation after treatment
Timing, frequency of follow-up survey and volume depend on the severity and form of clinical manifestations.Children who underwent acute toxoplasmosis watching a pediatrician for 10 years, 1 every 6 months, with the neurologist and ophthalmologist, and conduct EIA.Rehabilitation activities include: protective regime, health food, immunomodelyatory stimulants, multivitamins, herbal adaptogens and metabolic therapy.
brain dysfunction, cardiovascular collapse with the formation of arrhythmias, atrophy of the optic disc with the possibility of complete loss of vision, anemia, disbaktreioz etc, but heavy for a bad compensation of organs and systems can lead to death(especially at an early age and in congenital infection).
Prevention of toxoplasmosis
Specific preventive maintenance is not developed, so the need to observe good personal hygiene, to carry out the heat treatment of foods, limit contact with cats and periodic laboratory tests for toxoplasmosis (after prior consultation with the doctor).
therapists Shabanova I.E