Toksoplazmenny encephalitis

Description:

Toksoplazmozny encephalitis serves as the main reason for incidence and mortality at patients with AIDS.

Symptoms of Toksoplazmenny encephalitis:

Toksoplazmozny encephalitis serves as the main reason for incidence and mortality at patients with AIDS. Incidence of toksoplazmozny encephalitis among the patients of this category having antibodies to toksoplazma fluctuated from 6 to 12%. On the basis of it believe that there were about 170 cases of toksoplazmozny encephalitis among 7000 patients with AIDS about whom it was reported in 1984, and development of 150 more cases is expected among 7000 patients who have to get sick with AIDS according to the forecast for 1985.

Frequency of cases of toksoplazmozny encephalitis at patients with AIDS and encephalitis as was reported, fluctuated from 25 to 80%. The diagnosis of toksoplazmenny encephalitis should be meant at the persons with a disease of the central nervous system which are not belonging to risk group on AIDS as heterosexual transfer of a virus of a leukosis of T-cells of the person (HTLV III) leads to development of AIDS in the persons which are not belonging to typical groups of the increased risk.

At patients with AIDS carry a fever, fever, a headache, attacks, a depression and neurologic disturbances to external symptoms and symptoms of toksoplazmenny encephalitis; these manifestations can arise in combination with a chorioretinitis. Most of patients with AIDS and toksoplazmozny encephalitis in serum has no specific antibodies indicating existence of an acute toxoplasmosis. Demonstration of increase in an antiserum capacity to toksoplazma in cerebrospinal fluid, but not in serum testifies to toksoplazmozny encephalitis at patients with AIDS.

Reasons of Toksoplazmenny encephalitis:

The activator - Toxoplasma gondii concerns to protozoa. Protozoa type. The Sporozoa subtype (usually form disputes; cilia, flagellums or pseudopodiums are absent). The class Telosporea (there is a syngenesis phase). Coccidea subclass (trofozoita are located intracellularly, have "an apical complex"). Eucoccideia group (a life cycle includes alternation of sexless - a schizogony and a syngenesis - a sporogony). Eimeriina suborder (a sexual stage in a gut epithelium at vertebrate animals; one owner or alternation of two owners; sporozoita are in "dispute"). Type of Toxoplasma gondii. Exists in three main forms: trofozoita (endozoita), cyst and oocyst. Trofozoita have the sizes of 4-7 microns in length and 2-4 microns width, in a form remind a half moon, are well painted across Romanovsky. They breed intracellularly in all cells of mammals except for nuclear-free (erythrocytes) and are found in fabrics in an acute stage of an infection. Accumulation of trofozoit in one cell is called a pseudo-cyst. Trofozoita are actively influenced by various himiopreparata (Chloridinum, streptocides, macroleads, etc.), they are unstable out of a cell and in external environment, quickly perish during the drying, warming up, under the influence of disinfectants.

Cysts form in the owner's organism, have own dense cover. Their sizes to 100 microns, 3000-5000 parasites and more inside contain. Through a dense cover of cysts neither antibodies, nor medicines get. They are very steady against various influences and in an organism of the owner decades remain. Their most part is localized in skeletal muscles, a myocardium, central nervous system.

Oocysts represent formations of an oval form with a diameter of 10-12 microns. They form in a mucous membrane of a small bowel of some representatives of the cat family and are allocated with excrements. Terms of emergence of oocysts in excrements of a cat depend on the nature of infection and make from 3 to 24 days. Excretion from 7 to 20 days proceed, per day with excrements it can be allocated up to 10 million oocysts. Sporulation in the emitted excrements occurs in 2-3 days (at a temperature of 24 °C); it is not implemented at a temperature below 4 °C and above 37 °C. Oocysts under favorable conditions remain in external environment till 1 year and more. They play the main role in transmission of infection.
Are cultivated toxoplasma by infection of laboratory animals (white mice, Guinea pigs, rabbits, hamsters), in the developing chicken embryos, and also in culture of fabrics. There are various strains токсоплазм, some of them differ in high virulence (RH strain) and quickly lead to death of laboratory animals, others - low-virulent (avirulent) usually do not cause noticeable clinical displays of a disease.

Treatment of Toksoplazmenny encephalitis:

At establishment of the diagnosis of encephalitis of the patient it has to be hospitalized in a specialized (infectious) or neurology unit. Appoint a high bed rest. The patient needs constant observation.

At a pre-hospital stage use of dehydrational means (lasixum, Diacarbum) is shown.

At the expressed meningeal and encephalitic symptoms (a severe headache, muscle pain, toxicosis, vomiting, focal symptoms) enter isotonic solution of sodium of chloride, Solution Ringer-Locke. At the same time subcutaneously or intramusculary enter group B vitamins, ascorbic acid (not less than 1,5 g a day).

If the standard scheme of treatment using Chloridinum (on 25 mg a day), a trisulfapirimidina (on 6 - 8 g) or a sulfadizina is inefficient, it is necessary to increase a daily dose of Chloridinum to 50 mg. In case of development in the patient of adverse reaction to sulfanamide drug it is recommended to use only Pyrimethaminum in a dose of 50 mg a day. It is necessary to apply folic acid in a dose to 15 mg a day, especially when the marrow depression as a result of influence of Chloridinum is noted. However if the marrow depression at patients with AIDS is caused by immune mechanisms, preventive reception of folic acid does not eliminate a leukopenia.