Definition:
A disease caused by a single cell parasite called toxoplasmosis Alguendah Toxoplasma gondii, spread throughout the world and in all climates and estimated incidence in Syria about 60 - 90% and for this disease are two forms two Sreryan:
Figure syndrome: usually passes without bed and cautioned phenomena generally sound.
Congenital form: cause serious injuries when the fetus, giving it great importance.
The form of the pathogen:
There Mqosat Alguendah three forms:
Alotarev Trophozoite: crescent-shaped measuring 5-10 × 1-3 microns, has a large rounded end where the nucleus is located, and the front end more accurately contain a seat installation for breach tissue, see Alotarev within cells, macrophages Macrophages when the host is resistant to digestion of cellular mechanism did not know After, and multiply, including a proliferation asexually in two different ways: the first is binary fission, and the second Balbrama internal Endodyogenie which you do not see except in toxoplasmosis, as treaded cell nucleus arched mother is divided into two parts and the remaining cytoplasm without fission, then shaped membrane Sitoblasmi new inside the mother cell forming Mqostin The Ftitin, tear after the mother cell membrane editor of the new cells.
Bags Cysts: a spherical or oval Shilluk measure of 30-300 microns, and containing several hundred Alotarev resulting from asexual reproduction and that colonize gradually entire cell الثوي and be compressed on each other and surrounded by a membrane thick and resistant, and turns to the so-called Balabuag slow Bradizoite because breeding Slow البرعمة brokered the Interior is responsible for the increase in the size of the bag with the times.
Oocyte Oocyste: oval surrounded by thick and resistant casing, measuring 9.14 microns, resulting from sexual reproduction, which is in Alkhlaa under is Alzaraah intestine cats, containing oocyte inside four Boaúg divided into eight Mqosat.
Epidemiology and Infection:
See toxoplasmosis when all warm-blooded animals, and infection occurs in two ways, either eat the meat raw or poorly cooked and Mkhmuj bags or as a result of eating human and herbivorous animals such as cattle contaminated vegetables or fruits egg cell.
And is the mechanism of infection first ruptured casing bag ulcer digestive infectious and liberate spores slow resistance to sap infectious for 3-6 hours, and resist these bags temperature of 45 m for a period of one hour and 60 C for 20 minutes while you die mainly 66 m and remain alive for two months mainly 4 p.m. and are destroyed freezing - 20 m within 18-24 hours.
The infection cell ovale resistance to hydrochloric acid gastro are Ptzk cover in the intestine and edit Alboaúg eight existing including, resist oocyte mature for more than a year in the aqueous medium and more than a month in the humidity 100% and a week in the humidity 50%.
Irresistible also Alotarev acidity where are destroyed rapidly in gastric hydrochloric acid so you do not swallow lead to injury.
Life cycle:
It is divided into two sessions of sexual اجنسية and within several hosts of.
Session asexual: There toxoplasmosis in bags in woven herbivores that form الثوي mediator, and Humans result bush meat these infected animals, where liberated Alotarev them and multiply divide asexually to form bags inside human cells or carnivores, do not exist in this session Thuy final , as it is a human Thwaia intermediary and life cycle be blocked while suffering because it can not be eaten by animals.
Session Nationality: infected cat capturing the meat infected animal, was freed Alotarev of bags and intervention in the cells under epithelial to intestine where it multiplies division asexual giving cells Wedding memorandum small and mobile brokered three whips and Wedding feminine large immobile, resulting from mating these Aersin oocyte (sexual reproduction) which poses with the cat's stool to the middle and outer after 3 - 5 days of infection and continue for 1 - 3 weeks, and is matured oocyte in the middle and outer within 3 - 5 days, if the percentage of moisture and oxygen enough, the problem oocyte mature and infectious contain eight Mqosat.
Physiology and pathogenesis:
Develop toxoplasmosis Alguendah in the cells of the tissue web, which could incite form lesions in all tissues poor antibodies and particularly the central nervous system and retina and lymph glands and muscles.
Multiply toxoplasmosis Alguendah in Figure syndrome during a very short time since the toxoplasmosis girls resulting from asexual reproduction undergoing free outside the cells and for a short time span between the blast cell الثوي infected and access to another cell intact, then formed after 7-10 from the beginning of infection antibodies roving Blood stop the spread and multiplication toxoplasmosis Vtaatdf Alotrovat some tissue to form bags therefore not only keeps the shape fibrosis live inside the cells.
The survival bags live distinguishes injury slow and chronic for this disease, because of continuous production of antigens that express membrane these bags and incite form lasting immunity and protective, preventing injury following is toxoplasmosis disease parasite only constitute the immune system and can these bags inherent in tissue poor antibody such as textiles and nervous retina rupture editor spores that are slow cause recurrent injury when the patient himself.
Formed the primary lesion Mqosat granuloma identical in all tissues and turns of this tumor in some cases to focus Tnkria later Taatkls.
The congenital form resulting in the injury of the fetus toxoplasmic Alguendah through the placenta from an infected mother is rare because it:
Must be the mother can develop toxoplasmic for the first time after the start of pregnancy, and there is a very short period (7-10) days during which allows the passage of toxoplasmosis, which are free in the mother's blood to the fetus before its transformation into bags difficult passage through the placenta, and do not forget that an infected mother before pregnancy are toxoplasmosis encysted then.
In the first four months of pregnancy: prevent the placenta sound holes minute passage of toxoplasmosis to the fetus because Qatar parasite greater than Thagoppea, and if there is traffic because of the potential for fetal malformation be great.
In the next four months of pregnancy becomes placental barrier less effective and Msamath largest allowed then over toxoplasmosis to the fetus, leading to his lightly or with clinical symptoms of clinical late to appear or do not show any symptoms until birth, and explains the two points: first that the fetus has been completed indistinguishable, and the second antibody, which entered with toxoplasmosis from the mother to the fetus quickly limit the spread of the parasite in the body of the fetus is less incidence of deformity.
Clinical symptoms:
Figure syndrome: is caused by toxoplasmosis infection in humans after eating infected meat or vegetables contaminated bags egg cells.
And tend to this pattern forms or under clinical phenomenon, and that can not be diagnosed by asking the patient or examined clinically accurate.
In cases which show clinical symptoms, form lumpy is the most watch and usually affects children and young people, pretending to three major symptom is: fever - the magnitude of a lymphocyte - they, as the temperature rises 38.5 for several weeks and then return to natural state spontaneously, and swells the contract cervical Background often large medium and pain mild, can also be infected lymph nodes other (axillary - حالبية) has become the decade of deep (abdominal and mediastinal), but weakness remains long after the demise of the magnitude of the lymph nodes, develops this form towards spontaneous without treatment and without leaving sequelae.
The acquired forms are rare and serious infection occurs enter toxoplasmosis directly to the body in the course of laboratory work or tick bite infected When immune heterosexual or see when you Mthbti blind immunity such as AIDS who were infected traditional and pretend these forms on three clinical patterns:
First: exanthematous forms with injuries of meningiomas or heart attack or a pulmonary sometimes fatal evolution.
Second: Meningitis single Mqosj where cerebrospinal fluid serene, and automatically recover in most cases, but can develop encephalitis or symptoms in kind.
Third: the shapes in kind: like lesions seen in the bottom of what is happening in the eye inflammation of the retina and choroid congenital, with injuries in the home front of the eye.
Congenital form: the fetus is infected from his mother, who was hit for the first time during pregnancy, and pretending to four clinical forms, namely:
Great shape: very rare and is caused by toxoplasmosis transmission from the pregnant mother to the fetus in early pregnancy and clinical notes symptoms since the first hours of birth in the form of encephalitis toxoplasmic cerebrospinal meningitis, and pretending four main symptoms:
Change the shape and size of the skull: the magnitude and hydrocephalus, front تقبب and cranial expansion Druze.
Various neurological signs: controlled generalized convulsions and muscle booster disorders (increase or decrease), and disorder in the tendon reflexes, and dysphagia and irregular breathing, and thermal balance disorder.
In the soles of intracranial calcifications: a hallmark of congenital toxoplasmosis great, you see on the form of a contract either isolated or combined blocks in a lobar brain, and sometimes curved like an egg shell about Albtiniat.
Signs in kind: eye Ksgr and squint and nystagmus, cataracts and inflammation of the retina and choroid pigmentary macular reveals examine the bottom of the eye, which is either a single side or on both sides (which is very distinctive mark for toxoplasmosis).
Develops this form cerebral spinal meningitis towards death usually within the first few weeks of a newborn's life, and if there is no death case moves to chronicity, and a child is late spiritual development of motor where it is difficult to teach.
Forms visceral: and caused an infection inside the uterus in the second trimester of pregnancy, and is characterized by either the occurrence jaundice and the Valley with enlarged liver and spleen and bleeding in the mucous membranes, or injury digestive sharp sore Marri, or ulcerative colitis recreation, and evolving forms of visceral usually about death.
Forms late or isolated: They infection inside the uterus in the last third of pregnancy, and can be diagnosed immediately after birth or do not reveal only after several years of a child's life and includes a following symptoms: late spiritual and kinesthetic, or increase perimeter skull faster than normal , or convulsions, or pigmentary retinitis placental late.
Phenomenon shapes or under clinical: It is most common in congenital toxoplasmosis and constitute 80% of the form, and serological tests reveal only, and should be exposed and treated early to avoid late transformation into shapes.
Can congenital toxoplasmosis cause miscarriage or preterm birth.
Diagnostic bio:
Diagnosis Prompt:
And relies on the observation clinical signs such as fever and the magnitude of the lymph nodes and weakness in the disease syndrome, and retinitis and placental and debris in the bottom of intracranial in disease congenital, diagnosis is made in most cases to detect immunity acquired when a young woman to avoid the dangers of congenital toxoplasmosis, and in these cases being asked Find Antibodies routinely at every young maiden.
Diagnosis is certain:
Investigating the parasite by direct examination: detect the parasite either in the pathology biopsy or perhaps pathological sample injection in experimental animals the White كالفأر, and these methods are of the most proven ways to diagnose routine but rarely used to the difficulty of the application.
Antibody screening examination is direct: it looks for antibodies in the serum of the patient number of serological tests, include the following:
Test Sabine - Feldman Sabin-Feldman test or pigment dye-test or test decay: The tenet of decay qualitative Mqosat live there serum impervious (حاو antibodies specific) where change cytoplasm toxoplasmosis and become non-staining Bzarkh Almtelin, measured result titre quality loneliness International ml, and this becomes a positive test starting on day 4 - 20 after infection.
Test indirect immunofluorescence: reveals specific IgM antibodies in the first months of pregnancy that indicate a recent injury, measured titre when international unity in ml Also, starts Zarōha in serum after 7 - 10 days after exposure.
Test hemagglutination indirect: This test positive starting from titre 64:1, and in order to differentiate infection effective modern injury old (having immunity) we can have the test before and after the addition of 2 - Over Kaptwightanol that damage antibody IgM in injury confirmed must be the difference between bullets Ptdhaafhma at least twice, and there other tests that can be used in the detection of antibodies Kalachtbar immune enzymatic ELISA and agglutination test direct and test latex, which is a quick way to detect infection within minutes but should be calibrated serum ways previous to know caliber and focus antibodies.
Development of antibodies in toxoplasmosis acquired or congenital and interpretation of the results:
Develop IgG antibodies in disease syndrome as follows: begin to appear between days seventh and tenth of infection, a period in which the parasite free outside the cells, and then they get concentrated to quickly reach of 3 - 400 IU / ml after a month of injury, and rises in the month third to reach its peak of 600 - 3200 IU / ml, begin antibodies after the third month decline rapidly up to 1000 IU / ml, and continue positive interaction this value until the end of the first year of infection, after the first year remain IgG antibodies positive life worth ranging between 4 - 5 IU / ml, and this explains the presence of eternal immunity against toxoplasmosis.
IgM antibodies develop in the disease syndrome in the following form.
Begin to appear at the beginning of the infection, peaking after a month and a half and remain positive during the first three months of injury. (Figure 5)
Difficult to interpret the results of serological tests in the newborn suspect his disease toxoplasmosis Congenital: If negative it confirmed the absence of an injury, but if positive must distinguish between antibodies from the mother to the fetus and antibodies liberated by fetal himself as the antibodies that crossed the placenta to the fetus decreases to half a month after birth and disappear public after 4 - 5 months including, but this theoretically, we wait until the month the fourth or fifth after birth where disappear antibodies from the mother and the remaining antibodies liberated by Alwaleed himself, but this time delay treatment if the child was injured actually, so you must practice that Nair antibodies specific IgM, which indicates the presence of his disease toxoplasmosis Congenital because these antibodies do not pass through the placenta from mother to fetus, and can in injury-kind look for these antibodies quality in cerebrospinal fluid and in the aqueous humor of the eye, but the way difficult application and interpretation of the results is not accurate.
Treatment:
Normal in Figure syndrome: given Sbaramesan Spiramycin while having weakness and the magnitude of the lymph nodes and by 50 mg / kg of body weight daily for a month and could be involved with Ascorbic Acid ascorbic acid, and it is rarely given cortisone derivatives when the continuation of the magnitude of the lymph nodes.
In Figure kind relapsing: handles for one month as in the previous form, but added to address derivatives cortisone road year, being blood count in twice a month to monitor the side effects of treatment, and follow up treatment observation clinical signs and the evolution titre serological especially in neonates and young children.
Prevention:
Before pregnancy: being investigated antibodies toxoplasmosis in women before pregnancy, if titre has more than 8 units tested immunofluorescence indirect or more of the 64/1 test hemagglutination indirect indicates that the existence of immunity acquired permanent has, there is no need to re-tests serological in the future, but if negative serological reactions must retest worshiper of women every year and at the beginning of every pregnancy.
During pregnancy: It can encounter three types of results are:
If serological tests negative antibodies, advises pregnant not to eat raw meat or undercooked, washing raw vegetables well, splitting from the cat if she has a cat, unless fed meat canning because it sterile, and to make sure these precautions should monitor serum conduct serological tests every month until birth.
If the antibody positive strongly any more than 800 IU test immunofluorescence indirect or found antibodies IgM quality this indicates injury pregnant, there is no need for abortion, but treated by giving Sbaramesan by 3 g per day until delivery, and stress to say that the mother is toxoplasmic Do not be a medical reason to terminate the pregnancy.
If positive serological tests poorly re-made after 2-3 weeks to determine if the injury was old and women Mmnah, or that a modern and effective injury.
At birth:
Given Alwaleed proper clinically positive mother Mdaoh chemical Sbaramesan for two months, and given newborn if proven injury clinical examination and serological tests and radiographs preventive treatment for a year: Balsberamesan, and derivatives sulfa post with folinic acid, allow prevention therapeutic chemical avoiding thirds of the cases, which delayed the appearance of Clinical symptoms and must be conducted serological surveillance, and examine the bottom of the eye and brain electrical layout until the tenth year of age.
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