Toxoplasmosis refers to parasitic diseases, which affect both animals and humans.
This infection is characterized by a multiplicity of transmission mechanisms, a diverse clinical picture, in addition, it can occur in a latent (latent), acute or chronic form.
Toxoplasmosis is detected in various climatic and geographical zones. Seasonality of the disease is not expressed.
It causes a disease of toxoplasm, which is the simplest microorganism and lives in cells. In other words, toxoplasm is an intracellular parasite.
The final carrier of toxoplasma are cats, as well as some other members of the cat family, and intermediate – a person, birds, rarely – some mammals (farm animals, dogs).
There are several ways of infecting a person:
Through the digestive tract (for example, in contact with infected land, with cat feces, when eating unwashed vegetables and fruits, poorly fried or boiled meat and possibly cow’s milk);
Transmissible or through blood (contact with infected meat in the presence of cuts and abrasions on the hands, through the saliva of infected dogs, when they lick their wounds, less often – with blood transfusions and organ transplants);
Vertical (from mother to fetus through the placenta) provided that the woman is infected with toxoplasmosis during pregnancy.
It is generally recognized that toxoplasmosis is divided into congenital and acquired.
The disease can occur in acute, subacute, chronic, subclinical, and apparatus (the absence of symptoms and the formation of immunity) forms and in the form of carrier.
Toxoplasmosis can be mild, moderate and severe.
Symptoms of toxoplasmosis:
The incubation period of infection is from 3 to 21 days, and according to some authors, it can last for several months.
Acute acquired toxoplasmosis
Acute forms of the disease are rarely recognized.
First, toxoplasm enters the regional lymph nodes, where they cause their hyperplasia (increase). Lymph nodes to the touch are soft, they are soldered to surrounding tissues and painless. Most often affected by the occipital and cervical lymph nodes, but it is possible to involve inguinal, axillary and lymph nodes in the mesentery of the intestine.
Perhaps the emergence of rose-papular papular rash (in the form of nodules and inflammatory spots), as well as an increase in the liver and spleen (hepatosplenomegaly).
From the lymphatic system, toxoplasma penetrates into the blood and is carried to the organs.
When the brain is damaged, there is a different neurological clinical picture (motor and visual disorders, sensitivity disorders, dizziness).
Cerebral symptoms are observed with encephalitis, meningoencephalitis and ependymoencephalitis (these conditions can develop against the background of toxoplasmosis). The pathological process involves the meninges, which leads to their inflammation and increased intracranial pressure.
In these cases, the following characteristic symptoms occur:
Tension of the occipital muscles;
The difficulty of bending the head to the chest;
Vomiting accompanied by a headache and not bringing relief. In this case, complaints of headaches are usually diffuse, diffuse nature.
These symptoms often cause the doctor to assume the presence of a brain tumor.
To the listed manifestations may be added vascular crises, instability of the psyche with changes in character.
If the posterior columns of the spinal cord are affected, there is a drawing pain with accidental movement along the nerves. In the case of involvement of peripheral nerves, pain and numbness of the hands and legs along the nerves, pain sensitivity change are observed.
Chronic acquired toxoplasmosis
As a rule, this form is either asymptomatic or with a subclinical picture. Patients are observed:
Low temperature (does not exceed 38 ° C);
Sometimes pain in the head.
In severe cases, the central nervous system and the eyes are often involved in the process. Patients complain:
Weakening memory and vision;
There may be various disorders of the visual analyzer:
Inflammation of various parts of the choroid of the eye (manifested by blurring, the appearance of “flashes” and “points,” a decrease in visual acuity, but can pass asymptomatically)
Atrophy of the optic nerve (the main symptom is a stable visual impairment that can not be corrected).
It is also possible the occurrence of:
Lesions of the musculoskeletal system.
Chronic acquired toxoplasmosis is characterized by long-term course, constant exacerbations and is observed more often in people with decreased immunity.
Congenital toxoplasmosis in a child is spoken in cases when the mother has 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 pregnancy, as a rule, spontaneously interrupts, or it is possible to have a child with the grossest developmental anomalies. The most frequent ones are jaundice, deafness, enlarged spleen and liver, in the case of mother infection within 24 to 40 weeks of pregnancy, progressive hydrocephalus is observed.
After the passed treatment, toxoplasmosis passes into a slow form, which is characterized by:
Labile (unstable) psyche with the preservation of intellectual abilities.
Toxoplasmosis in pregnancy.
All pregnant women when registering should undergo immunological studies:
Or a skin test with toxoplasmin;
Or serological reactions with the determination of the titre of immunoglobulins of class G and M (IgM and IgG).
If the samples are positive, this means that the pregnant woman has had contact with toxoplasma in the past, but in the future, she does not need to be monitored for this infection, as she has already received stable immunity. If the result is negative, the samples are repeated in the second and third trimester, and in the case of a positive reaction, they talk about becoming infected with a pregnant woman. A woman is prescribed treatment, but not earlier than the second trimester.
If the infection occurred in the first trimester, pregnancy should be interrupted for medical reasons.
It should differentiate toxoplasmosis and diseases such as:
Pathology of the organs of vision;
Diseases of the brain of another origin;
Various reasons for miscarriage.
Diagnostic methods of examination are used:
UAC (general blood test), in which there is a decrease in the level of leukocytes with a relative increase in the number of lymphocytes, an increase in the number of eosinophils and normal ESR;
Puncture of the spinal cord strictly according to indications (increase in the number of lymphocytes and protein);
Radiography of the skull, where attention is drawn to the enhanced vascular pattern, pronounced finger impressions, widened interosteal sutures, visualization of intracranial calcifications;
Test with toxoplasmin (positive reaction indicates a previous or chronic infection);
Ultrasound of internal organs if necessary.
The most common analysis – serological reactions (enzyme immunoassay or immunofluorescence reaction) is carried out twice, with an interval of 2-3 weeks to determine the growth of IgM and IgG titer.
Immunoglobulins of class M in the blood are found two weeks after infection, with the titers gradually increasing and begin to decline by the 8th-10th week of the disease. These antibodies indicate an acute infection (that is, at the moment a person is infected with toxoplasma).
If immunoglobulins of class G are found in the blood, this indicates that the person has already recovered in the past and recovered (or about chronic toxoplasmosis).
In the case of detection of both IgM and IgG, the fact that infection occurred within the last year is confirmed.
Diagnosis of congenital toxoplasmosis
In newborns, their antibody titre is compared with the titre of the mother. In the absence of immunoglobulins, both subjects are excluded from the diagnosis of congenital toxoplasmosis.
If immunoglobulins of classes M and G are present in a child in the blood in an amount that exceeds by 4 times the titer of these antibodies in a woman, one can speak of congenital toxoplasmosis.
With the same indices of immunoglobulins, it is necessary to repeat the test after 14-21 days.
In the case of the presence of antibodies in the child, the number of which is less than the parent 2 times, a conclusion is drawn on the transfer of maternal immunoglobulins to the child.
Treatment of toxoplasmosis.
Treatment of toxoplasmosis can be carried out by doctors of different specialties: with acute acquired form – infectious diseases, with congenital – pediatrician, in the presence of ocular pathology – ophthalmologist, etc.
During treatment, parasiticidal drugs are used, for example, chloridine (daraprim, tindurine, piromatamine). It is prescribed together with sulphonylamines, since they enhance the action of chloridine. If the latter is intolerant, aminochloride or clindamycin with pyremetamine is used.
For pregnant women spiramycin is prescribed.
In parallel appoint:
Stimulants of immunity.
When the brain and eyes are affected, glucocorticoids are required (prednisolone, hydrocortisone).
The duration of treatment depends on the severity, severity and form of the disease and can range from four weeks to a year.
Complications and prognosis.
In patients without immunodeficiency (HIV infection, cancer, and others), the prognosis is usually favorable.
Complications of toxoplasmosis in the absence of treatment or ill treatment include:
Disorders of brain functions;
Development of cardiovascular insufficiency (arrhythmias);