Clinic, diagnosis and treatment of toxoplasmosis

Toxoplasmosis: symptoms in humans, treatment and prevention

Toxoplasmosis is a congenital or acquired disease of a parasitic nature that affects the nervous system, organs of the reticuloendothelial system, visual apparatus, skeletal muscles and myocardium.

To this day, this parasitic invasion does not lose its relevance and every year, according to WHO, tens of thousands of people become infected with it. The extremely frequent registration of the disease is due to the fact that the causative agent of toxoplasmosis is distributed almost everywhere, and every year the risk of infection increases by 0.5-1%.

In the case when a small amount of the pathogen enters the body of a healthy person, it does not pose a great danger, since it becomes covered with a dense shell and turns into a cyst. According to experts, about half a billion people on the globe have antibodies to the causative agent of this disease.

What it is?

Toxoplasmosis is an infectious disease caused by Toxoplasma gondii. The disease can be asymptomatic, with manifestations of lymphadenopathy, mononucleosis-like symptoms, up to damage to the central nervous system in immunocompromised individuals.

Newborns may have chorioretinitis, seizures, and mental retardation. The diagnosis is confirmed serologically, HCC and histologically. Treatment is with perimethamine in combination with sulfadiazine or clindamycin. Glucocorticoids are used for chorioretinitis simultaneously with the main therapy.

The causative agent of toxoplasmosis

The causative agent of the disease is Toxoplasma gondii. This is the protozoan of the order Coccidia. It is mobile and has an arched shape. If you look at this living organism under a microscope, it resembles an orange slice.

The parasite can reproduce sexually and asexually. As a result of the sexual process occurring in the intestines, cysts are formed. These forms are very resistant to environmental factors: they are not afraid of low and high temperatures or drying. Together with feces, these cysts are released and lead to infection of other organisms. Asexual reproduction does not lead to the formation of persistent forms of the parasite.

Can you get toxoplasmosis from pets? Yes, because toxoplasmosis affects about 60 species of birds and 300 species of mammals (domesticated and wild). However, the sexual process occurs only in the intestines of felines. During 2 weeks of illness, a cat can secrete up to 2 billion cysts, which live in the external environment for up to 2 years.

Screening for toxoplasmosis during pregnancy

If during pregnancy a pregnant woman develops symptoms that may indicate the development of acute toxoplasmosis, it is necessary to establish the level of specific immunoglobulins using serological methods.

The enzyme-linked immunosorbent assay (ELISA) is best suited to detect the acute stage of the disease. It most accurately shows the concentration of IgM, an increase in the level of which indicates ongoing or recently present acute toxoplasmosis.

Determining IgG levels is less informative since these antibodies persist long after infection and indicate carriage rather than recent infection or exacerbation. Women who have been infected with toxoplasma before pregnancy are insured against infection of the fetus and are not at risk.

It is also important to obtain an immunological picture over time, for which specific tests are carried out at least once every 2 weeks. Studying the dynamics of changes in antibody titers allows us to establish a diagnosis with greater accuracy.

It should be taken into account that the serological picture indicating infection with Toxoplasma is not a 100% indication for termination of pregnancy. In this case, additional tests will be required by taking fetal blood from the umbilical cord and samples of amniotic fluid by puncture.

Forms of the disease

Toxoplasmosis can be congenital or acquired; it affects men less often. In type 2 disease, there are three forms of progression, which are described in more detail in the table:

Symptoms of toxoplasmosis

The latent period of infection is up to two weeks. Symptoms of toxoplasmosis in humans in the initial period of the disease hardly appear or pass unnoticed. The pathogenesis of the disease determines its nature - acquired or congenital, manifesting itself as acute, chronic and latent.

1. The acute course of the disease is characterized by a sudden onset with severe symptoms of intoxication of the body and fever, possible manifestations of hepatomegaly (enlarged liver) and splenomegaly (enlarged spleen). Skin rashes and signs of encephalitis and meningoencephalitis are sometimes observed.
2. The current is severe. Complicated by focal or widespread inflammatory reactions of the myocardium, symptomatic manifestations of psychoneurological and cognitive functional disorders (memory, mental functions, etc.), often with fatal outcome.

The chronic course is characterized by a long, sluggish pattern. Sometimes with an asymptomatic course, or with gradually increasing symptoms.

1. Chronic course of intoxication.
2. Prolonged low-grade fever (a month or more).
3. Violation of visual functions – development of progressive myopia.
4. Symptoms of central nervous system damage (convulsions, fits, hysteria, imbalance and suspiciousness).
5. Failure in endocrine functions - impotence, decreased function of the thyroid and adrenal glands, changes in the menstrual cycle.
6. Cardiac disorders include signs of tachycardia, heart pain, and decreased blood pressure.
7. Symptoms of central nervous system damage (convulsions, fits, hysteria, imbalance and suspiciousness).
8. In more than half of patients with chronic toxoplasmosis, hepatomegaly and splenomegaly are diagnosed. The liver responds to palpation with pain. Its functional pathology is significantly manifested.
9. Enlargement of a large group of peripheral and mesenteric lymph nodes. When palpated, they are initially soft and painful; over time, the pain goes away, they decrease in size, but their structure becomes dense.
10. Muscle and joint pain - with muscle lesions, in addition to inflammatory processes, painful compacted areas caused by the formation of calcifications can be felt in the muscle tissues.
11. Disorders of the gastrointestinal tract with the manifestation of intoxication, xerostamia (dry mouth), apathy to food, pain in the epigastric area, constipation and weight loss.

With a latent course, even a thorough diagnosis can reveal only residual old signs of sclerotic foci of lymph nodes or calcifications in muscle tissue. The diagnosis can only be confirmed by a PRC study or an intradermal test for antibodies to toxoplasmosis.

Clinic, diagnosis and treatment of toxoplasmosis

Toxoplasmosis is a widespread zoonotic parasitic infection, characterized by polymorphism of clinical manifestations and significant variability in the course of the process: from healthy, asymptomatic carriage to severe, lethal forms of the disease.

Etiology

The causative agent of toxoplasmosis, Toxoplasma gondii, belongs to the phylum Protozoa, subphylum Sporozoa, order Eucoccidia. T.gondii is an intracellular parasite, 4–7 µm in size.

In the human body, T.gondii can parasitize in the form of proliferative forms—endosites, in the form of pseudocysts, and in the form of true tissue cysts. In cats and other representatives of the feline family, toxoplasmosis can also be present in the intestines in the form of oocysts, which, when excreted with feces into the external environment, remain viable and invasive for 1.5–2 years. Toxoplasma cysts found in meat and meat products can remain viable at a temperature of 2–5°C for up to a month, but quickly die when heat treated or frozen at –20°C. The least resistant to environmental factors are endosites, which remain viable outside the body from 30 minutes to several hours.

Epidemiology

Toxoplasma or traces of its presence have been found in more than 200 species of mammals and 100 species of birds. The prevalence or infection rate of the population of the Russian Federation with Toxoplasma is on average about 20.0%. Infection rates are higher in regions with warm climates; among persons of a number of professional groups (epidemiological observations have proven an increased infection and incidence of toxoplasmosis in people who have professional contact with sources of toxoplasmosis infection (workers of meat processing plants and fur farms, livestock breeders, veterinarians, etc.). The infection rate in women is usually 2–3 times higher than men.

The incidence of toxoplasmosis is many times lower than infection rates, but diagnostic difficulties, despite mandatory registration, do not allow us to judge the true level of infection.

Susceptibility to toxoplasmosis is almost universal. The spread of infection is widespread in the form of carriage and sporadic diseases.

The main source of infection for toxoplasmosis is stray, wild and domestic cats, in whose bodies the pathogen goes through a full development cycle (tissue and intestinal) and is excreted in the form of oocysts with their feces. Cats shed the pathogen for an average of three weeks from the moment of infection. During this time, up to 1.5 billion toxoplasma enters the environment.

The main transmission factor is raw or insufficiently heat-treated meat, meat products with toxoplasma cysts in it. Additional factors for transmission of infection include poorly washed greens, vegetables, fruits (from the ground), dirty hands with pathogen oocysts on them.

The main and most common route of transmission of infection is oral; much less often, human infection can be carried out by transplacental (blood transfusion), percutaneous and transplantation routes.

A person with toxoplasmosis does not pose an epidemiological danger either to others or to medical personnel, which makes it possible to treat these patients both on an outpatient basis and in any somatic hospital.

Immunity. Immunity for toxoplasmosis is non-sterile and infectious. The immune state of the body is preserved simultaneously with the presence of the pathogen in the body, most often in the form of cysts. Antigenic metabolites produced by cysts maintain a certain level of humoral immunity and also cause the development of delayed-type hypersensitivity.

Pathogenesis

The pathogens released from cysts or oocysts invade the epithelial cells of the small intestine, where they multiply, forming a primary affect and then penetrating into the regional lymph nodes, and from them, with the lymph flow, into the blood. Dissemination of the pathogen leads to damage to a wide variety of organs and tissues.

Toxoplasma has a cytopathogenic effect on the cell, and inflammatory granulomas are formed at the sites of their penetration. Necrosis develops, in place of which lime salts fall out—calcifications characteristic of toxoplasmosis are formed. The degree of damage to a particular organ further determines the clinical symptoms of the disease.

The formation of immunity leads to the disappearance of the pathogen from the blood, and its reproduction in cells stops. True tissue cysts are formed, which can remain intact in the body for a long time, for decades (carriage of Toxoplasma). In humans, infection, as a rule, has a benign course, without the development of septic conditions.

Clinic

Most infected people have no clinical manifestations of the disease. In the vast majority of cases of toxoplasmosis, a healthy carriage of the parasite is observed, accompanied by a consistently low level of specific antibodies in the blood. Carriage does not require any therapeutic measures, and the carrier should be regarded as a practically healthy person.

At the same time, clinically pronounced variants of the course of the infection are possible, requiring careful diagnosis and specific treatment.

According to the nature of its course, acquired toxoplasmosis is divided into acute and chronic. In addition, depending on the duration of the disease and the severity of clinical symptoms, a subacute as well as inapparent (subclinical) course of the infection is possible, which is characterized by certain dynamics or a high level of specific antibodies in the blood, in the absence of clinical manifestations of the disease. Thus, the most convenient for practical healthcare, from our point of view, is the following classification of acquired toxoplasmosis: acute, subacute, chronic, inapparent and carriage.

The incubation period for toxoplasmosis lasts on average up to 2 weeks, although sometimes it can last up to several months. The disease, as a rule, begins gradually: general weakness, malaise, muscle pain, chilling appear, performance decreases, and the temperature rises to low-grade levels. The lymph nodes become enlarged: cervical, occipital, and less commonly, axillary and inguinal. Lymph nodes are soft, slightly painful on palpation. The size of the nodes is 1–1.5 cm, they are not fused with the surrounding tissues, do not form conglomerates, and the skin over them is not changed. Sometimes the mesenteric lymph nodes are significantly enlarged, which can simulate the picture of an acute abdomen.

An acute onset, with a rise in temperature to 38°C and above, involving in the process, in addition to the lymphatic, nervous system, internal organs, muscle tissue, and organs of vision, is observed much less frequently. Patients may develop encephalitis, myocarditis, myositis, uveitis (chorioretinitis). In some cases, a short-term roseolous-papular rash and hepatolienal syndrome are observed. In patients with immunological disorders (especially in patients with AIDS), pneumonia, enterocolitis, severe central nervous system disorders of a cystic-necrotic nature, and a septic condition may develop.

Chronic toxoplasmosis is a long-term process with a general infectious syndrome and the presence of organ lesions of varying severity. The most characteristic signs of chronic toxoplasmosis are prolonged low-grade fever, intoxication and asthenia; fever can last for months, with slight temperature fluctuations, sometimes short periods of apyrexia, which is not amenable to conventional means of therapy. A common manifestation of toxoplasmosis is a generalized enlargement of the lymph nodes - occipital, cervical, inguinal and others.

Damage to the central nervous system in chronic toxoplasmosis most often occurs in the form of cerebral, basal arachnoiditis; Hypertensive and diencephalic syndromes develop, vegetative-vascular disorders are detected, and episyndrome is noted. Sluggish myocarditis, myocardial dystrophy and myositis may be observed. Women may have specific inflammatory diseases of the genitals - toxoplasma salpingo-oophoritis (adnexitis); primary and secondary infertility develop.

Eye damage, both in acute and chronic acquired toxoplasmosis, occurs as posterior uveitis (focal chorioretinitis). Chorioretinitis is usually central, bilateral, and recurrent. The development of conjunctivitis, keratitis, iridocyclitis, central exudative retinitis, optic neuritis with outcome in dystrophy, complicated myopia is possible.

X-ray examination of a patient with toxoplasmosis allows in some cases to reveal the presence of calcifications in the soft tissues of the brain. Calcifications are usually small, multiple, round in shape, often with smooth contours.

In both acute and chronic toxoplasmosis, there are no special changes in the peripheral blood. Leukocytosis observed at the onset of the disease is replaced by normocytosis, relative lymphocytosis is detected, ESR is within normal limits.

It should be emphasized that with chronic toxoplasmosis there is no isolated damage to any one organ or system; we can talk about predominant organ damage against the background of the general process.

Diagnostics

Differential diagnosis. Toxoplasmosis should be differentiated from infectious mononucleosis, benign lymphoreticulosis, tuberculosis, brucellosis, listeriosis, mycoplasmosis, chlamydia, cytomegaly, herpes and a number of other bacterial, viral and parasitic infections. Oncological and systemic diseases should be excluded (for example: lymphogranulomatosis, rheumatism, etc.).

Laboratory diagnostics. For laboratory diagnosis of toxoplasmosis, serological methods are most often used: complement fixation test (CFR), indirect immunofluorescence reaction (IRIF), enzyme-linked immunosorbent assay (ELISA). The diagnosis is confirmed by a significantly increasing dynamics of the indicators of these tests, their high level or the presence of IgM class antibodies.

When giving a clinical assessment of the results of a serological examination of a patient, it is necessary to take into account that RNIF becomes positive from the first week of the disease and reaches its maximum values ​​(1:1280–1:5000) usually by the second to fourth month of the disease; in low titers it can persist from a year to 15 years. RSC becomes positive from the second week of the disease, reaches maximum values ​​(1:160–1:320) by the second to fourth month of the disease, but after 2–3 years it can disappear or decrease to values ​​of 1:5–1:10. The interpretation of ELISA results is more objective, since it is focused on the WHO International Standard. Positive results may be indicated by indicators expressed in optical density units (OD ≥1.5); enzyme-linked immunosorbent units (EIU) ≥60; International units (IU) ≥125 and antibody titres (TA) ≥1:1600. The basic principle of serological diagnostics—the dynamics of the increase in indicators—is also applicable to this method. Of significant importance in the diagnosis of toxoplasmosis, especially in differentiating acute and chronic processes, is the determination of immunoglobulin classes, in particular IgM class antibodies. Toxoplasma infection can be reliably diagnosed only by comparing the results of serological reactions over time. Antibodies of all classes increase significantly by the end of the second - beginning of the third week from the moment of infection and reach a diagnostic level.

The diagnosis of toxoplasmosis, in the presence of an appropriate clinic, can be made with a positive serological conversion, when the second serum test becomes positive. When treating patients with already established positive reactions to toxoplasmosis, the question of diagnosis and activity of the infectious process can be resolved in the dynamics of serological studies. With fresh infection and disease, serological reactions are often positive with high titers of antibodies, and specific IgM is detected. When latent toxoplasmosis is reactivated, the IgM concentration may increase, but in this case the severity of the IgM response will be much less than during the primary infection. Positive RNIF in a low titer may indicate chronic toxoplasmosis or asymptomatic carriage of the pathogen. It should be noted that in ocular pathology, the presence of a fresh focus of inflammation, even with low antibody titers, indicates toxoplasmosis. In case of lymphadenopathy, even with high antibody titers, the diagnosis of toxoplasmosis is made only after histological examination of the lymph nodes and consultation with an oncologist. Based on the results of a single study, it is impossible to establish the duration of the infectious process and the exact correspondence to one or another of its stages, whereas this question is fundamental for assessing the risk of intrauterine infection of the fetus. Women who have had an infection before conception and women with chronic toxoplasmosis are practically immune from the risk of intrauterine infection of the fetus, while pregnant women infected in the first and early second trimester of pregnancy constitute the main risk group. However, it must be remembered that identifying and confirming the presence of IgM antibodies is not a clear indicator of termination of pregnancy. It is necessary to use additional methods to reduce the risk of inaccurate diagnosis.

Formation of diagnosis. When forming a detailed diagnosis of toxoplasmosis, the following should be indicated:

• form of toxoplasmosis (acquired, congenital);
• the nature of the process (acute, subacute, chronic, inapparent);
• organ or systemic pathology;
• severity of the current.

For example: acute acquired toxoplasmosis, lymphadenopathy, mild course; chronic acquired toxoplasmosis with primary damage to the eyes, chorioretinitis without exacerbation; pregnancy 24–26 weeks, inapparent toxoplasmosis.

When forming a diagnosis of toxoplasmosis, it is inappropriate to base the diagnosis of toxoplasmosis only on systemic or organ pathology (lymphadenopathic, cerebral, myocardial, ocular form, etc.), because toxoplasmosis must be considered as a general process involving many organs and systems.

When toxoplasmosis is excluded and a patient with positive reactions to toxoplasmosis is given another diagnosis, the medical history should also note the existing carriage of toxoplasma.

Treatment

The choice of treatment tactics depends on the form and nature of the disease, the severity of clinical symptoms, the severity of the course, the presence of complications and the predominant organ-systemic lesions.

The absolute indications for treatment are acute and subacute toxoplasmosis. Treatment of chronic toxoplasmosis is carried out depending on the severity of clinical symptoms and the nature of the predominant lesions. Inapparent toxoplasmosis detected in pregnant women also requires treatment.

The drugs Fansidar, Rovamycin and Biseptol are prescribed. Fansidar contains sulfadoxine 500 mg and pyrimethamine 25 mg. Etiotropic therapy consists of 2–3 cycles. Prescribed 1 tablet 1 time in 3 days (No. 8 tablets). Folic acid is prescribed between cycles. In case of intolerance to drugs of the pyrimethamine group, Rovamycin is prescribed, 1 tablet of which contains 3 million IU of spiromycin. Prescribe 3 million IU 3 times a day with a seven-day break. Rovamycin is well tolerated by patients, lack of drug interactions, and high efficiency allow it to be prescribed for the treatment of toxoplasmosis in all age groups.

It is possible to use combination drugs; Poteseptil (trimethoprim + sulfadimezine), Biseptol (trimethoprim + sulfamethoxazole), which are prescribed 1 tablet 2 times a day for 10 days (cycle), in the amount of 2-3 cycles (course). If these drugs are intolerant when taken orally, it is possible to prescribe Biseptol intravenously or drip: 10 ml per day, for 5 days (course). In the intervals between cycles (courses) of etiotropic therapy, folic acid is prescribed, on average up to 0.01 g per day.

If an immunodeficiency state is detected, immunotropic drugs are prescribed together with etiotropic therapy: Likopid, Cycloferon, Vitamedin-M, as well as natural calf thymus hormones and their synthetic analogues: Taktivin, Timamin, Thymogen, Dekaris.

Systemic enzyme therapy (SET) drugs, in particular Wobenzym and Phlogenzyme, are also used in complex therapy. To preserve the intestinal microbiocenosis, it is recommended to prescribe pro- and prebiotics.

Treatment and further follow-up of patients should be carried out by specialists depending on the nature of the prevailing pathology - infectious disease doctors, neurologists, ophthalmologists, obstetricians-gynecologists, etc. Hospitalization is carried out in a hospital of the appropriate profile (infectious diseases, neurological, ophthalmological, obstetric -gynecological, children's, etc.). This is due to the peculiarities of organ pathology, the specifics of the examination and the prescription of additional treatments.

Clinical examination

Dispensary observation is carried out by doctors according to the profile of the predominant pathology, in each individual case individually. After suffering from acute (inapparent) toxoplasmosis, patients are examined and examined every 3–4 months for a year, then 1–2 times a year. Patients with chronic toxoplasmosis are consulted 2 times a year.

Prevention

Prevention of acquired toxoplasmosis includes: eating only well-heat-treated meat products; eliminating the habit of tasting raw minced meat or raw meat; eating clean washed vegetables, herbs and fruits (from the ground); thorough hand washing after handling raw meat, raw meat products, after working in the garden, or for children - after playing on the playground, especially in the sandbox; fight against stray cats; treatment of patients with toxoplasmosis in domestic cats, prevention of infection of the latter. Specific prevention of toxoplasmosis has not been developed.

Diagnosis, clinical picture and treatment of toxoplasmosis in pregnant women

Diagnosis of toxoplasmosis in pregnant women includes the entire range of necessary clinical, paraclinical and special (immunobiological) studies that are used to diagnose toxoplasmosis in general.

A mandatory condition for examining a pregnant woman for toxoplasmosis should be a consultation with an infectious disease specialist to confirm or exclude a current infectious manifest or asymptomatic (inapparent) toxoplasma process. If the diagnosis is confirmed and the need for treatment is carried out, the latter is carried out by an obstetrician-gynecologist either on an outpatient basis (in a antenatal clinic) or in an obstetrics-gynecology hospital (maternity hospital). Considering the epidemiological safety of patients with toxoplasmosis for others, a pregnant woman with an uncomplicated obstetric history, but with a diagnosis of toxoplasmosis, can be hospitalized for examination, treatment and delivery in any (physiological) department of the maternity hospital. Pregnant women with a burdened obstetric history and diagnosed with toxoplasmosis are hospitalized in pregnancy pathology departments.

Screening of pregnant women for toxoplasmosis should be carried out by antenatal clinics when the pregnant woman first visits there. When conducting this examination, the obstetrician-gynecologist must remember that in our country, depending on the region, the percentage of infected women of childbearing age is on average 20–30%, i.e. every third of them can react positively to toxoplasmosis. As a rule, pregnant women with positive immunological reactions are healthy carriers of the pathogen and do not require any therapeutic, much less surgical measures. These women have virtually no complaints or objective manifestations of infection. Levels of specific antibodies remain stably at the same, usually low levels; there are no specific antibodies of the IgM class. 70–80% of women are free from infection and react negatively to toxoplasmosis. These women represent a “risk” group for congenital toxoplasmosis, since 0.5–1% of them become infected with toxoplasmosis during pregnancy. Of women primarily infected during pregnancy (high-risk group), 30–40% transmit the infection to the fetus. Consequently, non-immune (immunonegative) women are subject to dispensary observation for the prevention of congenital toxoplasmosis and dynamic examination (once every 1-2 months) during pregnancy in order to identify a fresh infection.

Clinical manifestations of toxoplasmosis in pregnant women do not have any significant differences. Acute toxoplasmosis is accompanied by an increase in temperature to febrile (usually subfebrile) levels, lymphadenitis is detected (usually posterior cervical and occipital), and possible disorders of the central nervous system, internal organs, eyes and muscles. When women become infected shortly before pregnancy or in the early stages of pregnancy, Toxoplasma may damage the fetal egg, usually leading to miscarriage. The obstetrician-gynecologist also needs to remember about the possible inapparent (asymptomatic) course of acute toxoplasmosis in women during pregnancy, when the development of the disease is recorded either by the significantly increasing dynamics of the level of specific antibodies, or by the detection of immunoglobulins of the IgM class in ELISA, which dictates the need for serological control (screening). ) for uninfected pregnant women throughout pregnancy.

Chronic toxoplasmosis in pregnant women is characterized by a general infectious syndrome (low-grade fever, generalized lymphadenopathy, chilling, decreased ability to work, etc.) with possible predominant organ damage from the internal organs, eyes, central nervous system and genitals.

The indication for prescribing etiotropic anti-Toxoplasma therapy to pregnant women is acute, subacute and inapparent toxoplasmosis. Treatment of chronic toxoplasmosis should be carried out strictly according to clinical indications either before or after pregnancy.

In the absence of complaints and clinical indications, women who have had toxoplasmosis before pregnancy do not need treatment. These women are regarded as practically healthy individuals who do not require special medical supervision.

Thus, the question of the time of infection of a pregnant woman is practically important: long before, immediately before or during pregnancy. The duration of infection is determined based on anamnesis and a comprehensive examination of the woman (cordocentesis and amniocentesis). Treatment of pregnant women should be carried out no earlier than 12–16 weeks of pregnancy (from the second trimester of pregnancy). Treatment is usually carried out with Rovamycin, Fansidar.

Rovamycin is prescribed in a daily dose of 3 million 2 times a day, the duration of administration is 7 days, the number of cycles is 2, the break between cycles is 1 month.

The concentration of Rovamycin in the placenta is 5 times higher than in the blood serum, which ensures cure. Rovamycin is the first macrolide used to treat toxoplasmosis in pregnant women. Rovamycin is well tolerated by patients, lack of drug interactions, and high efficiency allow it to be prescribed for the treatment of toxoplasmosis in all age groups.

Fansidar is prescribed 1 tablet 1 time every 3 days (No. 8 tablets). The break between cycles is one month. 3 such cycles are prescribed.

Considering the possible inhibition of hematopoiesis under the influence of etiotropic drugs, it is recommended to prescribe folic acid in medium therapeutic doses, as well as conduct general blood and urine tests.

In practical work, the question of indications for artificial termination of pregnancy during toxoplasma infection and recommendations for subsequent pregnancies is of particular importance.

Summarizing all of the above, it should be emphasized that only when infected in the first trimester of pregnancy and in the presence of clinical and immunological signs of acute acquired or inapparent toxoplasmosis, when the risk of giving birth to a child with gross organic lesions of the central nervous system and visual organs is greatest, the question of terminating the pregnancy for medical reasons can be raised ! Women infected during the second and third trimesters of pregnancy are subject to treatment. Termination of pregnancy for medical reasons is not indicated for women with chronic toxoplasmosis, and even more so with carriage of the pathogen, since in these cases there is no danger of infection of the fetus, because even an exacerbation of the process in pregnant women does not lead to repeated parasitemia and, therefore, to damage to the placenta, but through her and the fetus.

When giving recommendations for subsequent pregnancies, it is necessary to take into account that the same woman can have a child with congenital toxoplasmosis only once in her life (due to acute acquired or inapparent toxoplasmosis during pregnancy). During subsequent pregnancies, this woman may not be afraid of giving birth to a child with toxoplasmosis.

Prevention of congenital toxoplasmosis

Prevention of congenital toxoplasmosis should take into account the fact that only primary infection of a woman during pregnancy can lead to infection of the fetus. As mentioned above, out of the total number of non-immune women, up to 1% of pregnant women become infected during pregnancy. At the same time, infection of fetuses occurs in only 30–40% of them. According to the literature, the number of newborns with congenital toxoplasmosis is 1–8 per 1000 live newborns. Most often, the process in a child is asymptomatic, although the manifestation of the disease in the future cannot be ruled out. This can occur under the influence of immunosuppressive factors during the period of development of immunity, i.e. during the first 5–7–10 years of life.

Optimally, prevention of congenital toxoplasmosis should include screening women of childbearing age for toxoplasmosis before or, in extreme cases, during pregnancy. This examination is necessary to identify among them those who react negatively to this disease, i.e. non-immune women. The latter constitute the “risk” group for possible primary infection during pregnancy.

Non-immune pregnant women must be taken for clinical observation and examined for toxoplasmosis, but with the help of serological tests (RSK, RNIF, ELISA, etc.) throughout pregnancy, if possible, once every 1-2 months or at least 1 once every trimester.

If pregnant women at risk switch from negative serological reactions to positive ones and an increasing (3-4-fold) dynamics in the level of specific antibodies is detected, they need emergency preventive treatment. Treatment is carried out both in the manifest course of the infection and in the case of an in-apparatus course of the process. Children born to these women are subject to mandatory clinical and serological examination for toxoplasmosis and, if indicated, specific treatment. Children born to mothers with a clearly established primary infection during pregnancy are monitored until the age of 10, including regular clinical and immunological examinations in order to identify symptoms of congenital toxoplasmosis, which could be asymptomatic at birth.

Provided that at the last examination of pregnant women in the “risk” group, serological reactions remain negative, women (without clinical indications) do not need further special examination for toxoplasmosis and are dropped out of observation after childbirth. Children born to these women should be tested for toxoplasmosis only if clinically indicated. Pregnant women with negative immunological reactions are advised to strictly follow the basic rules for the prevention of toxoplasmosis.

Literature

1. On the detection and prevention of toxoplasmosis in Moscow. Methodological recommendations (No. 25). M., 2007.
2. Borisov B. A., Dzutseva F. K., Moroz B. V. Clinical and neurological manifestations of toxoplasma invasion. Tutorial. M., 2003.
3. Bartlett J., Galant J. Clinical aspects of HIV infection. Johns Hopkins University School of Medicine. 2005–2006

F.K. Dzutseva , doctor of the highest category, head. City Center for Toxoplasmosis G. Yu. Nikitina , Candidate of Medical Sciences Yu. V. Borisenko , Candidate of Medical Sciences L. P. Ivanova *, Candidate of Medical Sciences, Associate Professor of the City Clinical Hospital named after. S. P. Botkina, *RMAPO, Moscow

Diagnostics

If alarming symptoms occur, it is necessary to consult a doctor as soon as possible in order to make an accurate diagnosis in time and block the disease before microorganisms cause irreparable harm to the body. You need to tell the specialist about all the existing signs of toxoplasmosis and about your lifestyle.

The doctor should palpate the liver, spleen and lymph nodes - with acute toxoplasmosis they become enlarged. Listening to the heart will show arrhythmia, and measuring blood pressure will show hypotension. If there is a risk of toxoplasmosis, it is necessary to donate venous blood for parasites. Using a centrifuge, serum (the liquid part of the blood) will be obtained, which will be tested for the presence of specific antibodies. In case of a previous process, immunoglobulin with marker G will be detected, in case of an acute process - with marker M.

Additionally, the following instrumental diagnostic studies are prescribed:

• electrocardiogram;
• Ultrasound of the abdominal cavity;
• refractometry (eye examination);
• X-ray of soft tissues and lungs.

Treatment can be selected only after all necessary diagnostic methods have been carried out and the diagnosis has been confirmed.

Examination of patients with HIV infection

Diagnosis consists of regular monitoring of immunoglobulin G titers using serological methods. Titration of immunoglobulin M is not informative since in most HIV-positive people the level of antibodies of this group is extremely variable.

Direct detection of the pathogen by microscopy of tissue samples or infection of laboratory animals is usually not necessary. The diagnosis can be established quite accurately through serological diagnosis and the presence of a specific clinical picture of toxoplasmosis. In HIV-positive patients it is more pronounced, which greatly simplifies the diagnosis.

Consequences of toxoplasmosis

The most life-threatening and severe consequences for the patient’s health with toxoplasmosis are observed with the congenital genesis of the disease. Often, infection of a pregnant woman with Toxoplasma in the initial period of pregnancy becomes the cause of antenatal mortality. Congenital toxoplasmosis is characterized by the development of pathomorphological changes, primarily in the brain, manifested by necrotizing encephalitis. Due to the fact that toxoplasma infection is prone to hematogenous and lymphogenous generalized spread, pathological changes and complications of the disease can be projected in almost any part of the human body.

A tendency to a complicated course of toxoplasmosis is observed in individuals suffering from one or another form of immunodeficiency, and is due to the activation and attachment of a secondary bacterial component. This course of toxoplasmosis most often occurs in a specific category of HIV-infected patients who develop a severe chronic form of the disease that requires prolonged drug correction.

In relatively healthy individuals, toxoplasmosis does not cause severe consequences and even occurs in a latent asymptomatic form. After an active or asymptomatic clinical period, persistent immune defense mechanisms are formed in the human body, preventing the likelihood of re-infection with Toxoplasma, which is especially important for women planning to have a child.

Material for research

To detect specific antibodies to Toxoplasma, blood is drawn from a vein; the procedure does not require any special preparation. Any biological material is suitable for carrying out a PCR reaction - blood, saliva, tissue samples, other biological fluids (cerebrospinal fluid, urine).

If there is a need to diagnose toxoplasmosis in the fetus, blood sampling from the umbilical cord is possible. The procedure is rarely prescribed because it is associated with a high risk of complications and premature termination of pregnancy. A more gentle method is to take amniotic fluid for analysis by puncture. These methods are used when the results of specific tests on a pregnant woman with suspected toxoplasmosis do not provide sufficient clarity of the diagnosis.

Indications for the use of various laboratory tests and features of interpretation of results in different categories of subjects

Depending on the category of the patient (age group, risk group), the use of different sets of diagnostic techniques is indicated. The correct choice of diagnostic methods is especially important in cases of suspected toxoplasmosis in pregnant women.

How to treat toxoplasmosis?

For each patient, the course of treatment for toxoplasmosis is prescribed strictly individually and lasts until all clinical manifestations of the disease that worsen the person’s quality of life are eliminated.

In order to cope with the disease, antiparasitic drugs are required, which are most often prescribed in combination:

• Pyremethamine;
• Spiramycin;
• Azithromycin;
• Daraprim;
• Sulfadimezin;
• Clindamycin.

Medicines are used in courses at certain intervals over a long period of time. Hormonal drugs (glucocorticoids) are prescribed to patients with damage to the visual organs and nervous system.

Infection with this disease poses a serious threat to persons suffering from immunodeficiencies of various origins (for example, HIV infection) or receiving suppressive drug therapy. Such patients have a significantly worse prognosis, are difficult to cure, and require special treatment regimens.

In case of primary infection of a pregnant woman under 17 weeks, abortion is recommended for medical reasons; not only the parasite itself is dangerous for the fetus, but also the medications used to combat it. If this occurs after this period, the patient is treated with antiparasitic drugs.

Modern methods of treatment

Unfortunately, it is very difficult to completely eliminate the parasite from the body. Toxoplasma forms cysts in which they can persist in tissues for a long time. They are resistant to medications. Patients with compromised immune status require especially intensive treatment.

Antibacterial agents, chemotherapy drugs, and their combinations are used. Also, treatment is aimed at increasing immunity.

During pregnancy, treatment is carried out no earlier than 12-16 weeks. Chemotherapy drugs are used. For sufficient effect, two courses are carried out with a break of 1-1.5 months. If the patient became infected before pregnancy and has no clinical signs of pathology, treatment is not carried out. The intake of medications is controlled not only by the infectious disease specialist, but also by the doctor who is managing the pregnancy.

Forecast

Acquired toxoplasmosis, with adequate treatment and normal functioning of the immune system, tends to gradually regress. Recovery occurs in 1-4 months. After an illness, the functions of the affected organs may not be fully restored, since scarring zones form at the site of inflammatory foci. A slight scar deformation of the retina remains in the vitreous body.

Recurrence of damage to the eyes and nervous system has a 50% chance. Long-term follow-up and prevention are required.

In general, the prognosis for acquired toxoplasmosis remains favorable, ensuring recovery in 95% of patients. With congenital toxoplasmosis, the survival rate of newborns is less than 40%.

Examination in Medart

At the Medart Medical Center, a full range of serological tests are performed to detect toxoplasma in the patient’s body. An immunological test to identify specific immunoglobulins is part of comprehensive STD tests intended for couples planning to have a child. It is possible to take blood and other biological fluids to determine the presence of toxoplasma and clarify the clinical picture of the disease.

High-precision modern equipment allows you to obtain accurate research results in the shortest possible time.

Advantages of Medart Medical Center:

• Qualified specialists.
• The ability to quickly obtain accurate research results.
• Affordable price.

The medical center provides a full range of services, from preliminary appointments and consultations to establishing and clarifying the diagnosis and prescribing effective treatment regimens and prevention of toxoplasmosis and other diseases.

Prevention

Prevention of toxoplasmosis is as follows:

• compliance with personal hygiene rules;
• decreased contact with cats;
• if you have a cat at home, it is recommended to regularly examine the animal for toxoplasmosis;
• when planning pregnancy, a woman should be tested for toxoplasmosis;
• exclusion of eating raw, as well as poorly fried or boiled meat or minced meat;
• when consuming vegetables, fruits or berries that come into contact with the ground, they should be washed thoroughly;
• strengthening the body's defenses (regular hardening, good nutrition, maintaining a healthy lifestyle).