Toxoplasmosis refers to parasitic diseases that affect both animals and people.
This infection is characterized by a multiplicity of transmission mechanisms, a diverse clinical picture, in addition, it can occur in a latent (hidden), acute or chronic form.
Toxoplasmosis is detected in different climatic and geographical zones. Seasonality of the disease is not pronounced.
It causes the disease Toxoplasma, which is the simplest microorganism and lives in cells. In other words, Toxoplasma is an intracellular parasite.
The final carrier of Toxoplasma are cats, as well as some other members of the cat family, and the intermediate carrier is humans, birds, less often, some mammals (farm animals, dogs).
There are several ways of infecting a person:
- through the digestive tract (for example, when in contact with contaminated land, with cat feces, by eating unwashed vegetables and fruits, poorly roasted or cooked 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 the woman is infected with toxoplasmosis during pregnancy.
It is generally accepted division of toxoplasmosis into congenital and acquired.
The disease can occur in acute, subacute, chronic, subclinical, inapparative (absence of symptoms and the formation of immunity) forms and in the form of carriage.
Toxoplasmosis can be mild, moderate and severe.
The incubation period of infection ranges from 3 to 21 days, and according to some authors, it can last several months.
Acute Acquired Toxoplasmosis
Acute forms of the disease are rarely recognized.
First, Toxoplasma enters the regional lymph nodes, where they cause hyperplasia (enlargement). Lymph nodes are soft to the touch, they are soldered to the surrounding tissues and painless. The occipital and cervical lymph nodes are most often affected, but involvement of the inguinal, axillary, and lymph nodes in the intestinal mesentery is possible.
It may cause roseolous papular rash (in the form of nodules and inflammatory spots), as well as enlarged liver and spleen (hepatosplenomegaly).
From the lymphatic system, Toxoplasma penetrates the bloodstream and spreads through the organs.
With brain damage, a different neurological clinical picture is noted (motor and visual disorders, sensitivity disorders, dizziness).
Cerebral symptoms are observed with encephalitis , meningoencephalitis and ependimoencephalitis (these conditions can develop against the background of toxoplasmosis). The meninges are involved in the pathological process, which leads to their inflammation and increase intracranial pressure.
In these cases, the following characteristic symptoms occur:
- neck tension;
- difficulty bending the head to the chest;
- vomiting, accompanied by headache and not bringing relief. In this case, complaints of headaches, as a rule, diffuse, diffuse nature.
These symptoms often cause the doctor to suggest a brain tumor.
Vascular crises, mental instability with changes in character can be added to the listed manifestations.
If the posterior columns of the spinal cord are affected, there is a pulling pain in case of accidental movement along the nerves. If peripheral nerves are involved, pain and numbness of the arms and legs along the nerves, a change in pain sensitivity are observed.
Chronic Acquired Toxoplasmosis
As a rule, this form is either asymptomatic or with a subclinical picture. Patients observed:
- increased fatigue;
- low temperature (does not exceed 38 ° C);
- sometimes pain in the head.
In severe cases, the central nervous system and eyes are often involved in the process. Patients complain:
- for headaches;
- impaired memory and vision;
- sleep disorders.
Various disorders of the visual analyzer can also occur:
- inflammation of various parts of the choroid (manifested by misting, the appearance of “flashes” and “points”, decreased visual acuity, but may be asymptomatic)
- atrophy of the optic nerve (the main symptom – a stable deterioration of vision, not amenable to correction).
It may also occur:
- myocarditis ;
- pneumonia ;
- hepatitis ;
- lesions of the musculoskeletal system.
Chronic acquired toxoplasmosis is characterized by a long-term course, constant exacerbations and is more common in people with reduced immunity.
About congenital toxoplasmosis in a child speak in cases where the mother contracted the infection during pregnancy.
Manifestations of the disease depend on the duration of pregnancy at the time of infection. In the period from 2 to 24 weeks, pregnancy, as a rule, is spontaneously interrupted, or the birth of a child with severe developmental disabilities is possible. The most frequent – jaundice, deafness, an enlarged spleen and liver, in case of infection to the mother in the period from 24 to 40 weeks of pregnancy, there is a progressive hydrocephalus.
After the treatment, the toxoplasmosis turns into a sluggish form, which is characterized by:
- obesity ;
- sexual infantilism;
- labile (unstable) psyche with preservation of intellectual abilities.
Toxoplasmosis during pregnancy
All pregnant women, upon registration, should undergo immunological studies:
- or skin test with toxoplasmin;
- or serological reactions with determination of the titer of immunoglobulins of class G and M (IgM and IgG).
If the samples are positive, it means that the pregnant woman had contact with Toxoplasma in the past, but she does not need further observation about this infection, as she has already received strong immunity. With a negative result, the samples are repeated in the second and third trimester, and in the event of a positive reaction, they say that the pregnant woman is infected. Women are prescribed treatment, but not earlier than from the second trimester.
If the infection occurs in the first trimester, the pregnancy should be terminated for medical reasons.
Toxoplasmosis should be differentiated from such diseases as:
- infectious mononucleosis;
- eye pathology;
- brain diseases of other origin;
- various causes of miscarriage.
From diagnostic examination methods are used:
- OAK (complete blood count ), 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 ;
- spinal cord puncture 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 digital indentations, extended interosseous sutures, visualization of intracranial calcifications;
- a test with toxoplasmin (a positive reaction indicates a postponed or chronic infection);
- Ultrasound of the internal organs if necessary.
The most common analysis — serological reactions (enzyme-linked immunosorbent assay or immunofluorescence reaction) are performed twice, with an interval of 2-3 weeks to determine the increase in IgM and IgG titer.
Class M immunoglobulins are detected in the blood two weeks after infection, while the titers gradually increase and begin to decline by the 8-10th week of illness. These antibodies indicate an acute infection (that is, at the moment a person is infected with Toxoplasma).
If immunoglobulins of class G are detected in the blood, this indicates that a person has already had been ill and had recovered in the past (or about chronic toxoplasmosis).
In the case of detection and Igm and Igg confirms the fact that the infection occurred in the last year.
Diagnosis of congenital toxoplasmosis
In newborns, their antibody titer is compared to that of the mother. In the absence of immunoglobulins in both subjects, the diagnosis of congenital toxoplasmosis is excluded.
If the immunoglobulins of classes M and G are present in a child in the blood in an amount that is 4 times the titer of these antibodies in a woman, we can speak of congenital toxoplasmosis.
With the same immunoglobulin values, it is necessary to repeat the study after 14-21 days.
In the case of the presence of antibodies in the child, the number of which is less than maternal by 2 times, it is concluded that the transfer of maternal immunoglobulins to the child.
Toxoplasmosis treatment can be carried out by doctors of different specialties: in acute acquired form, an infectious disease specialist, in congenital, a pediatrician, in the presence of ocular pathology, an ophthalmologist, etc.
During treatment, parasiticidal preparations are used, for example, chloridine (daraprim, tindurin, pyremamine). It is prescribed in conjunction with sulfanylamides, as they enhance the action of chloridine. In case of intolerance of the latter, aminohol or clindamycin is used with pyromethamine.
For pregnant women prescribed spiramycin.
In parallel, appoint:
- antiallergic agents;
- toxoplasmin therapy;
- immunity stimulants.
With damage to the brain and eyes, glucocorticoids (prednisone, hydrocortisone) should be taken.
The duration of treatment depends on the severity, severity and form of the disease and can range from four weeks to a year.
In patients without immunodeficiency (HIV infection, cancer, etc.), the prognosis is usually favorable.
Complications of toxoplasmosis in the absence of treatment or incorrect therapy include:
- brain function disorders;
- development of cardiovascular insufficiency ( arrhythmias );