Congenital toxoplasmosis is a parasitic pathology which arises at transplacentary infection of the child of Toxoplasma gondii. At most of children proceeds asymptomatically. Possible displays of a disease: intoksikatsionny syndrome, spotty and papular rash, limfadenopatiya, jaundice, gepatosplenomegaliya, hypostases of the lower extremities. Often provokes development of pathologies of an organ of vision, hearing, TsNS; more rare – a myocardium, lungs and a liver. Antenatalny diagnostics is based on carrying out a biopsy, post-natal – on set of anamnestichesky and clinical laboratory data (IFA, PTsR). Etiotropny treatment of congenital toxoplasmosis is carried out by means of schemes on the basis of medicines of a pirimetamin and sulfadimezin or spiramitsin.
Congenital toxoplasmosis – the disease in pediatrics and a neonatology resulting from transplacentary infection of a fruit against the background of a sharp form of a toksoplazmenny infection at mother. For the first time Toxoplasma gondii was described by French K. Nicole and L. Monso in 1908. In 1939 Americans E. Wolf, D. Cowen and B. Page confirmed the transplacentary mechanism of transfer of the activator. More than 400 animal species can act as intermediate owners. According to statistical WHO data, the number of the people infected with toxoplasma in the world makes about 1,5 billion people, in Russia – about 30% of all population. Frequency of a congenital form of 1,5:1000 newborns. Even against the background of treatment the average value of mortality at children up to 5 years makes 12%, complications arise almost at 90%.
Reasons of congenital toxoplasmosis
Congenital toxoplasmosis develops only at infection of mother of Toxoplasma gondii during incubation of the child. The mechanism of infection of the pregnant woman – fecal and oral. The most common causes: contact with animals from the cat family and the use of thermally raw food. The invasive form of the activator – an ootsist – is formed in intestines of animals and allocated with a stake then can keep for 12 and more months contageousness in environmental conditions. In extremely exceptional cases transplantation of kontaminirovanny bodies or blood transfusion can become an etiologichesky factor. Infection of a fruit of T. gondii occurs in the transplacentary way. After the birth of the child develops intensive , there are gemorragiya on mucous membranes, expansion of cameras of heart, pneumonia or interstitsialny hypostasis of lungs, a necrosis of a liver and spleen, increase in lymph nodes, an inflammation and hypostasis of tissues of brain, retinas. At a histologic research of directly struck fabrics the necrosis, granulematozny or diffusion proliferation of retikulotsit, infiltration of a plazmotsitama and lymphocytes, perifokalno – a set is defined. Subsequently on the place of nekrotizirovanny sites the fibrosis passing in is formed.
Classification of congenital toxoplasmosis
Depending on the period of infection of a fruit congenital toxoplasmosis can proceed in three forms:
- Chronic form. Infection occurs in the I-II trimesters of pregnancy. Risk of transfer of the activator – 13-18%. At such form the brain atrophy, hydrocephaly, deformation of ventricles of a brain, an anoftalmiya, a koloboma, a retina atrophy, congenital heart diseases and other bodies and systems can develop.
- Subsharp form. Infection – the III trimester. Risk of infection of the child – 75-85%. Manifestations can include encephalitis, an encephalomeningitis, a focal necrosis of a retina, uveit.
- Sharp form. Toxoplasma gets to the child's organism just before childbirth. Possible symptoms: hyperthermia, spotty and papular rash, intensive jaundice, gepatosplenomegaliya, anemia, myocarditis, pneumonia.
Symptoms of congenital toxoplasmosis
Congenital toxoplasmosis can be shown during various periods of life of the child – from the first days to several months. This disease has no specific symptoms. Often the present clinic indistinct also imitates other congenital pathologies. The most probable displays of congenital toxoplasmosis: deterioration in the general state, spotty and papular rash of various localization, generalized limfadenopatiya, increase in a liver and spleen, jaundice, hypostases of the lower extremities, subfebrilny temperature increase of a body. Weight of symptoms depends on extent of infection of a toksoplazmama, a pregnancy trimester in which there was an infection, and immune forces of mother. About 70-90% of children have no manifestations during the early periods of life, but almost all have complications after a while. Classical congenital toxoplasmosis is shown by Sebin's triad – obstructive hydrocephaly, horioretinit also massive intra cranial calcification. This complex no more than at 3% of children is observed. Besides a triad, often arise myocarditis, miozit, hepatitis and pneumonia. Clinical manifestations directly depend on the present pathological changes. The probability of development of late complications against the background of latent congenital toxoplasmosis makes about 90%. The period of emergence can be a miscellaneous – from several months to several years. Damage of eyes, an organ of hearing and TsNS is most often observed. The most widespread complication – retinit (about 85% of cases). Carry to other consequences of the postponed congenital toxoplasmosis to mental retardation, hydrocephaly, increase in intra cranial pressure, sharp and chronic encephalitis, epilepsy, full deafness and/or a blindness, , uveit, a chronic hyperthermia, it is rare – schizophrenia.
Diagnosis of congenital toxoplasmosis
Diagnosis of congenital toxoplasmosis can be carried out in the antenatalny and post-natal period. The Antenatalny research means use of invasive methods with further laboratory analyses. The absolute indication to their carrying out – sharp toxoplasmosis of mother in the sum with violations of development of a fruit by results of obstetric ultrasonography. The choice of a technique of a research depends on pregnancy term. At a gestation of 10 weeks the biopsy of a horion, of 16 weeks – amniocentesis, from 18 – is carried out. For verification of an infection the received material is investigated by means of PTsR. Post-natal diagnostics includes collecting anamnestichesky data and carrying out a clinical and laboratory trial. This measure is obligatory for all children entering into risk group of pre-natal infection. Nonspecific diagnostics and its results depend on the present symptoms and syndromes. The list of researches can include OAK (anemia, thrombocytopenia, ); X-ray analysis of OGK (signs of infiltration of lungs); neyrosonografiya and KT of a brain; biochemical blood test with measurement of ALT and nuclear heating plant, definition of SRB, level of bilirubin and its fractions (all indicators are higher than norm); oftalmoskopiya (retina necrosis); spinal puncture (inflammation signs). Specific methods mean serodiagnosis of biological liquids by IFA method at which increase of a caption of antibodies of IgG in 4 and more times and the high IgM level for 10-14 days is observed. If necessary PTsR for the purpose of toxoplasma DNA identification is carried out.
Treatment of congenital toxoplasmosis
Treatment of the newborn with the expressed clinical picture of congenital toxoplasmosis is carried out only in the conditions of a hospital, in office of pathology of newborns. Observance of the specific mode and diet is not required, their correction is carried out according to a condition of the child. In the presence of the burdened anamnesis of mother etiotropny therapy is begun with the moment of statement of the preliminary diagnosis. In other cases before an initiation of treatment it is required carrying out laboratory methods of a research. The used schemes: and for 1-1,5 months; or other macroleads for 4-6 weeks. In certain cases apply system glucocorticosteroids – Prednisolonum. Symptomatic treatment depends on the present symptoms and syndromes revealed by the pediatrician or neonatology. At permanent increase in intra cranial pressure or development of hydrocephaly surgical treatment is shown. If necessary further treatment can be carried out on an outpatient basis under control of the pediatrician, infectiologist and other experts. In the same conditions therapy of a subclinical and latent form of congenital toxoplasmosis is carried out. The decision on refusal of administration of drugs is made on the basis of the clinical laboratory indicators which are in limits of age norm, and the conclusion of all attending physicians.
Forecast and prevention of congenital toxoplasmosis
The forecast at congenital toxoplasmosis depends on a trimester in which there was an infection of a fruit and weight of clinical manifestations. At development of pathology in the I trimester spontaneous termination of pregnancy and an abortion or further development of severe forms of a disease can be observed, however anomalies of bodies at the same time do not arise. At adequate and timely therapy the forecast for life favorable, for recovery – doubtful. Nonspecific prevention of congenital toxoplasmosis includes restriction of contact of pets with the pregnant woman, respect for hygienic norms, inclusion in food of only thermally processed products, careful washing of vegetables and fruit. In the presence of the factors indicating possible infection of mother the specific diagnostics directed to identification of T. gondii is carried out. At confirmation of the diagnosis immediate performing etiotropny therapy is shown. Specific prevention of congenital toxoplasmosis it is not developed.