Toxoplasmosis refers to parasitic diseases that suffer from both animals and humans.
The infection is characterized by a multiplicity of transmission mechanisms, diverse clinical picture, in addition, it can occur in a latent (hidden), acute or chronic form.
Toxoplasmosis is detected in different climatic and geographical areas. Seasonality of the disease is not expressed.
Causes
Toxoplasma causes the disease, which is the simplest organism lives in cages. In other words, Toxoplasma - is an intracellular parasite.
The ultimate bearer of Toxoplasma are cats, as well as some other members of the family cat and intermediate - people, birds, at least - some mammals (livestock, dogs).
There are several ways of human infection:
- through the digestive tract (e.g., in contact with contaminated soil, with cat feces, with eating unwashed vegetables and fruits, roasted or poorly cooked meat and possibly cow milk);
- or transmissible through blood (contact with infected meat in the presence of cuts and abrasions to the hands, through the saliva of infected dogs when they are licking their wounds, at least - in blood transfusions and transplants authorities);
- vertical (from mother to fetus through the placenta) on the condition of women infected with toxoplasmosis during pregnancy.
Kinds
It is generally accepted division of toxoplasmosis congenital and acquired.
The disease can occur in acute, subacute, chronic, subclinical, inapparatnoy (absence of symptoms and immunity formation) forms and in the form of a carrier.
Toxoplasmosis may be mild, moderate and severe.
symptoms of toxoplasmosis
The incubation period for infection ranges from 3 to 21 days, and according to some authors, it can last for several months.
Acute acquired toxoplasmosis
The acute form of the disease is rarely detected.
Toxoplasma first fall in regional lymph nodes, where they cause hyperplasia (enlargement). Lymph nodes are soft to the touch, they are soldered to surrounding tissues and painless. Most often affects the occipital and cervical lymph nodes, but possible involvement in the process of inguinal, axillary and lymph nodes located in the bowel mesentery.
May experience roseolous-papular rash (in the form of specks and inflammatory nodules), and an enlarged liver and spleen (hepatosplenomegaly).
Of the lymphatic system Toxoplasma penetrate into the bloodstream and spread to organs.
When brain damage is noted various neurological clinical picture (motor and visual disturbances, sensory disturbances, dizziness).
Cerebral symptoms are observed in encephalitis, Meningoencephalitis and ependimoentsefalite (these conditions may develop on the background of toxoplasmosis). The pathological process involved meninges, resulting in inflammation and their intracranial hypertension.
The following are typical symptoms occur in these cases:
- tension neck;
- complexity bend his head to his chest;
- vomiting, accompanied by headache and not bringing relief. At the same time complaints of headaches, usually diffuse, diffuse character.
These symptoms often cause a doctor to assume the existence of a brain tumor.
To the listed manifestations can be added vascular crises, instability of the psyche with the nature of the change.
If the affected rear columns of the spinal cord, there is a nagging pain at random motion along nerves. In the case involving the peripheral nerves observed pain and numbness in hands and feet along the nerves, changes in pain sensitivity.
Chronic acquired toxoplasmosis
Typically, this takes the form either asymptomatic or subclinical picture. In patients observed:
- weakness;
- fatigue;
- low temperature (not higher than 38 ° C);
- sometimes pain in the head.
In severe often involved in the process the central nervous system and eyes. Patients complain:
- headaches;
- dizziness;
- irritability;
- memory loss and vision;
- sleep disturbances.
May occur and various disorders of the visual analyzer:
- inflammation of various parts of the choroid (manifested misting, occurrence of "flashes" and the "points", decrease in visual acuity, but may extend asymptomatic)
- atrophy of the optic nerve (the main symptom - a stable visual impairment, can not be corrected).
It is also possible occurrence:
- myocarditis;
- pneumonia;
- hepatitis A;
- lesions of the musculoskeletal system.
Chronic acquired toxoplasmosis is characterized by long-term trend, constant aggravation, and occurs more frequently in people with reduced immunity.
congenital toxoplasmosis
About congenital toxoplasmosis in a child say when the mother contracted an infection during pregnancy.
Manifestations of the disease depend on the gestational age at the time of infection. In the period from 2 to 24 weeks of pregnancy, usually spontaneously aborted, or perhaps the birth of a child with gross malformations. The most common - jaundice, deafness, enlargement of the spleen and liver, in the case of infection of the mother during the period from 24 to 40 weeks of pregnancy there is a progressive hydrocephalus.
Once passed the treatment of toxoplasmosis becomes sluggish form, which is characterized by:
- encephalitis;
- obesity;
- sexual infantilism;
- labile (unstable) mental with preservation of mental abilities.
Toxoplasmosis in pregnancy
All pregnant when registering you must undergo immunological studies:
- or skin test with toksoplazminom;
- or reaction with serological determination of the titer of immunoglobulin G and M (IgM and IgG).
If the test is positive, it means that a pregnant had contact with Toxoplasma in the past, but further observation about this infection it does not need, as has already received proof immunity. With a negative result of tests repeated in the second and third trimester, and in case of positive reactions about speak infected pregnant. Women are prescribed treatment, but not earlier than in the second trimester.
If the infection occurred in the first trimester, the pregnancy should be terminated for medical reasons.
Diagnostics
It should differentiate toxoplasmosis and diseases such as:
- megakaryoblastoma;
- tuberculosis;
- listeria;
- infectious mononucleosis;
- pathology of organs of vision;
- brain diseases of different origin;
- various causes of miscarriage.
Of the diagnostic methods of examination are used:
- KLA (general blood analysis), In which there is a decrease leukocyte level with the relative increase in the number of lymphocytes, the increasing number of eosinophils and normal ESR;
- spinal puncture strictly by indications (increased lymphocytes and protein);
- X-rays of the skull, which draws attention to the enhanced vascular pattern, marked digital impressions, extended interosseous joints, visualization of intracranial calcification;
- test with toksoplazminom (positive reaction indicates the transferred or chronic infection);
- Ultrasound of internal organs if necessary.
The most common analysis - serological tests (enzyme immunoassay or reaction immunofluorescence) performed twice, with an interval of 2-3 weeks to determine the titer rise IgM and IgG.
Immunoglobulin class M in the blood are detected two weeks after the infection, the titers gradually grow and begin to fall to 8-10, the second week of illness. These antibodies indicate an acute infection (ie at the moment a person is infected with Toxoplasma).
If the blood found the G class immunoglobulins, it is said that people in the past have been ill and had recovered (or a chronic toxoplasmosis).
In the case of detection and IgMand IgG It confirmed by the fact that the infection occurred within the last year.
Diagnosis of congenital toxoplasmosis
Neonates compare them with a titer of antibody titre in the mother. In the absence of immunoglobulin in both subjects excluded the diagnosis of congenital toxoplasmosis.
If immunoglobulin M and G are in the blood of a child in an amount that exceeds 4 times the titer of these antibodies in the woman can talk about congenital toxoplasmosis.
Under the same terms of immunoglobulins necessary to repeat the study in 14-21 days.
In case the child antibodies, the number of which is less than the parent 2 times, it is concluded the transfer of maternal immunoglobulin to the child.
toxoplasmosis treatment
Treatment of toxoplasmosis can lead doctors of different specialties: in acute acquired form - infectious diseases, with congenital - a pediatrician, in the presence of ocular pathology - ophthalmologist, etc.
During treatment parasiticidally used drugs, such as hloridin (daraprim, tindurin, pirematamin). It is prescribed in conjunction with sulfanilaminadami, as they reinforce the effect hloridin. The latter is used in case of intolerance or clindamycin with aminohol piremetaminom.
For pregnant women prescribed spiramycin.
Parallel to appoint:
- antiallergic agents;
- toksoplazminoterapiyu;
- immune stimulant.
When brain lesions and eye requires reception of glucocorticoids (prednisolone, hydrocortisone).
The duration of treatment depends on the severity, the severity and form of the disease and can range from four weeks to one year.
Complications and prognosis
In patients without immunodeficiency (HIV infection, cancers, etc.) the prognosis is usually favorable.
Complications of toxoplasmosis in the absence of treatment or improper treatment are:
- disorders of brain functions;
- the development of cardiovascular disease (arrhythmia);
- blindness;
- anemia.
