Toxoplasmosis

Description:

Toxoplasmosis is the zoonotic parasitic disease of the person and animals proceeding in an acute or chronic form and dangerous by development of heavy disturbances, first of all from a nervous system.

Toxoplasmosis reasons:

For the first time the causative agent of toxoplasmosis (Toxoplasma gondii) it was found in rodents of a gonda, and later – in rabbits. Further the activator was found at the most various farm animals.
The causative agent of toxoplasmosis belongs to type of protozoa. Toxoplasma gondii represents a one-celled microorganism, in a form reminds a semilunum or a segment of orange with one pointed, and other zaourglenny end. The sizes can vary it from 4-7 мк in length and 2-4 мк in width till 10-12 мк in length and 5 мк in width. Are not painted by the Gram method. When coloring by Romanovsky-Gimza's method cytoplasm of a parasite gains blue tone, and a kernel – ruby-red. Special organellas of movement at them are not revealed. The movements at them sliding, and at penetration into a cell – rotary.
The causative agent of toxoplasmosis is quite eurysynusic in the nature, and the main object of its dwelling are the most different types of animals. The most important role in the antropurgichesky center as the main source of an infection is played by a cat. Considering extremely wide circulation of cats in the world and accepting in attention their way of life (hunting for small rodents and birds, contacts with farm and domestic animals, food kitchen waste of meat), it is possible to consider that they completely provide circulation of a look in synanthropic conditions and in life.
The transplacental mechanism of transmission of infection to a fruit from mother, the bearer токсоплазм is eurysynusic.  Very close to a transplacental way of transfer токсоплазм will be infections at hemotransfusion or a transfusion of leukocytic weight. Transfer of a toksoplazmenny infection can arise from patients, is more often than women  with the burdened obstetric pathology when their menstrual allocations, suckers, amniotic liquid can become a transfer factor токсоплазм to the medical personnel servicing them.

Pathogeny:

Toxoplasmosis can be inborn and acquired.  Infection of the person at the acquired toxoplasmosis at animals can happen through the injured skin and the unimpaired mucous membranes. The big frequency of adenoid diseases noted at patients with a toxoplasmosis with repeated quinsies, allocation токсоплазм from remote almonds, and also increase in submaxillary and cervical lymph nodes suggest that implementation of the activator at the person is possible through mucous an oral cavity and a pharyngeal ring. The possibility of infection through mucous digestive tract is not excluded.
To cause development of the disease heavy sharply able even death, or the long asymptomatic carriage at the person and animals depends on virulence of the infecting strain, massiveness of an infection, the place of implementation, macroorganism resilience.
Usually the place of implementation and formation of primary, local center at infection of the person remains to unknown. From the place of implementation (on skin or mucous membranes) on lymphatic ways of toxoplasma get into regional lymph nodes where there is their reproduction. At rather high body resistance parasites can die, without having caused a disease. Otherwise they break in blood. Their hematogenous dissimination on all organism is characteristic of an acute toxoplasmosis. The person in the acute period, at a recurrence and aggravations has a parasitemia and distribution by an infection blood flow on various bodies where can be found in a large number breeding toxoplasma in the form of extracellular forms. The parasites who got into cells continue to breed and form large accumulations – the pseudo-cysts which do not have the expressed cover. In breeding grounds and their accumulations in fabrics are defined focal or diffusion inflammatory and necrotic changes. At chronic forms around intracellular accumulations токсоплазм, especially cysts, inflammatory changes in fabrics usually do not develop. In that case cysts can is long to be in tissues of a brain, an eye, in internals and to these to cause a possibility of long persistent infection.

Ideas of immunity at a toxoplasmosis can be noted in such basic provisions:
1. The organism of the owner who had infection with one strain токсоплазм becomes immune to repeated infection its homogeneous or close to it other strains.
2. Immunity develops at trofozoitama infection, the cysts and sporozoita which arose at a sexless way of development.
3. In an organism of the definitivny owner, immune to toksoplazma, – cats – process of a gametogonium does not happen.
4. At an immunitas non sterilisans in an organism of animals cysts, and in serum of their blood – specific antibodies can be found.
5. At infection earlier immunizirovanny two strains can latentno exist cysts токсоплазм white mice of a trofozoitama of a strain of RH in their organism: virulent in the form of trofozoit and avirulent in the form of cysts, i.e. animals will be in a condition of an immunitas non sterilisans. At their infection – carriers of cysts – a dose by 1000 times bigger (1 million trofozoit), there came "break" of immunity with acute disease and death.
6. Immunity to toksoplazma is generally caused by cellular factors with the participation of humoral. Effect of the protivotoksoplazmozny serum applied with the preventive purpose was very weak.
7. Opsono-fagotsitarnaya the system at the infected animals is shown by increase of a phagocytal condition of an organism.

Toxoplasmosis symptoms:

Acute toxoplasmosis with damage of lymph nodes. The disease proceeds with the high temperature expressed by the general intoxication (strong weakness, the suppressed mood, head and muscular pain) or with good health, subfebrile or even normal temperature. The correct and timely recognition of easy ferruterous forms of an acute toxoplasmosis is especially important at pregnant women at whom pregnancy comes to an end with the child's birth with a severe form of an inborn toxoplasmosis. More often there is a unilateral or bilateral increase in cervical lymph nodes, swell up axillary, inguinal less often. Lymph nodes happen size from haricot to walnut – in the beginning painful, then become painless – dense, not soldered to skin. Necroses are in some cases described, but suppuration is never observed. Changes from blood are usually shown by a moderate leukocytosis, a lymphocytosis to 50%, and also manifestation of the lymphomonocytes characteristic of an infectious mononucleosis.

The exanthematous form of the acute acquired toxoplasmosis begins sharply, is followed by a fever, temperature increase to 40C, the general weakness and weakness. Temperature can remain high up to 2-3 weeks. For 4-7 day there is plentiful makulezno-papular rash covering all body except the head, palms, soles. It remains within 2 weeks. The disease often is followed by atypical intersticial pneumonia, myocarditis, the encephalomeningitis phenomena. The liver and lymph nodes are sometimes increased.

The cerebral form of an acute toxoplasmosis proceeds hard, with high temperature, usually without rashes, with the expressed severe damages of the central nervous system, especially a brain. Is followed by an inflammation of a meninx, damages of a spinal cord join less often.
Besides, allocate an acute form of a toxoplasmosis with damage of internals, and also subclinical option.


As the majority of protozoan infections, in many cases it is inclined to give a long, chronic current. A recurrence at the acquired toxoplasmosis can be through very long periods – months and even years.
Damages of the central nervous system are one of the most frequent displays of the chronic acquired toxoplasmosis. With the phenomena of encephalitis adult and even elderly people can have toxoplasmosis recurrence, sometimes many years later after the beginning of a disease. Quite often chronic toksoplazmenny encephalitis is followed to vovlecheniye in process of a meninx and proceeds as an encephalomeningitis. Chronic toksoplazmozny defeats it is central a nervous system often are followed in various degree by epileptiform syndromes. Also other disturbances – neuralgia, vegetative polyneuralgias, a neurangiosis, neurosises and psychoneuroses are noted.
Other frequent symptom of a chronic toxoplasmosis is the damage of muscles which is shown in the form of muscular pains which usually happen average degree of manifestation, but can sometimes be strong and painful. Both widespread mialgiya, and miozita, focal inflammatory changes in muscles meet. Quite often disturbances in work of hemadens are found.

Damage of eyes at the acquired toxoplasmosis more often happens at young people though maybe at more elderly. Preferential back uveites, the disseminated chorioretinites, exudative and proliferative retinites meet. The disease begins a picture of an acute serous retinitis, more rare than the eye located on the periphery. In more typical cases on a back pole it is found various size light, gray-green color, a little приподымающийся and unsharply limited center. Form its roundish. Near the center hemorrhages – in a retina or under it are visible. Depending on localization of the centers sight to a greater or lesser extent suffers. If the area of a macula lutea is surprised, sharpness of the central sight is lost.
At a toxoplasmosis increase in peripheral lymph nodes which are usually not soldered, mobile is noted. However in certain cases the hyperadenosis is stated in a mediastinum that gives a reason for the wrong diagnosis of tuberculosis. Sometimes there is a significant increase and morbidity of mezenterialny nodes. Even the case when operation for appendicitis was made is described.

Inborn toxoplasmosis:

Toxoplasmosis is one of the main reasons of reduction of birth rate, increase in number of abortions, still births, children's incidence and mortality. At the women infected with toksoplazma tendency to oppression of menstrual function is noted. A toxoplasmosis can be one of etiological factors of an amenorrhea. As showed widely conducted examinations of newborns, positive serological tests are observed soon after the birth at 50% of children, however it not always indicates existence of an inborn toxoplasmosis as positive serological tests can be caused by passive transfer of antibodies from mother with blood. In case of absence of infection of a fruit within the first 6 months after the birth antiserum capacities quickly become lower, and serological tests negative. If infection of a fruit came, then positive serological tests in a high caption remain a long time and more or less expressed clinical displays of a disease develop.
At newborns, especially in the first months, an acute toxoplasmosis can proceed as a serious septic illness with the phenomena of the general intoxication, with the high and long temperature, falling of weight, makulezno-papular and hemorrhagic rashes. During generalization of an infection in the acute period of toxoplasma are carried by a blood flow on all bodies and fabrics that can cause the damages of internals and a nervous system expressed in various degree. At damage of a liver the disease can proceed in rather easy form with short jaundice or with the heavy jaundice expressed gepato-and a splenomegaly with considerable abnormal liver functions. Slightly less often damages of intestines come to light.
Depending on expressiveness and localization of defeats, and also from age of the patient clinical manifestations can be various. At babies the motive concern, psychomotor frustration, increase in a muscle tone, convulsive attacks are noted, there can be paralyzes  paresis. Development of hydrocephaly is characteristic of an inborn toxoplasmosis. Also the nanocephalia which can be formed owing to a growth inhibition of the brain affected with toksoplazma or thanks to excessively early closing of seams, development of the craniostenosis which is often followed by a hypertensive syndrome is observed. However it is necessary to emphasize that at an inborn toxoplasmosis there can be not only rough focal defeats of a nervous system (meningoentsefalita, encephalomyelitis, epilepsy), but there are often functional disturbances: asthenoneurotic syndromes, vegetovascular, can meet also liquorodynamic the phenomena of slight cerebral hypertensia. Are rather less often described at an inborn toxoplasmosis of defeat of a peripheral nervous system, roots of a spinal cord, neuralgia.

Treatment of the Toxoplasmosis:

Therapy of a toxoplasmosis depending on prescription, character and localization of defeats has to be complex and individual.
At a toxoplasmosis, as well as at others of infectious diseases, use of chemotherapeutic drugs cannot guarantee liberation of an organism against an infection  lack of a possibility in the future of a recurrence and aggravations. However these drugs – fixed assets of the choice at a toxoplasmosis. We provide the widespread scheme of treatment of a toxoplasmosis Chloridinum: within 10 days adults have to receive 2 times a day 0,025 g of a hloridn (a daily dose – 0,05 g) and 2-3 times a day on 2 tablets of Sulfadimezinum (a daily dose – 2-3 g). After a ten-day break the course is repeated by 3-4 times. More favorable results of treatment are observed at acute forms of the acquired toxoplasmosis, especially at limfaglandulyarny.
At an acute toxoplasmosis of eyes under the influence of specific therapy sometimes very quickly there occurs improvement and a stop of further development of process. Less expressed success can be at a chronic toxoplasmosis. Rough cicatricial and dystrophic changes in a brain, eyes, internals will not respond to treatment.
The opinion on lack of effect of treatment at an inborn toxoplasmosis is wrong. Of course, at rough malformations, uglinesses, the cicatricial changes in a brain which remained after postponed in the antenatal life of encephalitis expressed to degree of hydrocephaly, moronity and also at trophic disturbances at the bottom of an eye after the chorioretinitis postponed till the birth cannot be waited for success from specific therapy. However, when the inflammatory and dystrophic process which began in an antenatal life continues also after the birth, persistently carried out specific therapy can provide considerable improvement and, the main thing, to stop further progressing a disease.
Except the specified drugs purpose of corticosteroids is shown. At chronic, torpid cases of a toxoplasmosis of an eye it is possible to apply except specific therapy monthly courses of fabric therapy – extracts of an aloe, placenta. Wide use of vitamin therapy is of great importance.