Toxoplasmosis of the brain is a serious pathological process. Its development is provoked by the penetration of Toxoplasma eggs into the body. are pets, including cats.

When ingested, the pathogen has a negative effect on the nervous system, internal organs and muscles.

Toxoplasmosis of the brain- This is a serious pathological deviation due to the penetration of Toxoplasma eggs into the body.

Infection occurs in the following ways:

• alimentary;
• drip;
• contamination;
• transmissive;
• congenital.

Toxoplasmosis of the brain

More likely to get the disease through contamination. This method involves infection through blood transfusion. A sick person is an indirect carrier of the disease. A similar situation can develop upon contact with someone else's blood.

congenital path- most common among newborns. The infection comes from the mother.

Cerebral toxoplasmosis- This is a serious disease that can lead to serious complications. High level the danger remains for newborns who were infected while still in the womb. Such an impact is fraught with irreversible consequences.

Clinical manifestations of pathology

Affecting the brain, it has an extensive clinical picture. The disease can be either acquired or congenital. The first form is characterized by an incubation period, which is 3-14 days.

A person is pestered by a mild clinical picture. The main symptoms are chills, fever and general malaise. Often there is pain in the joints and muscles.

Brain changes in congenital toxoplasmosis

Meningoencephalitis is considered a typical manifestation of the disease.. It is accompanied by paresis of the limbs, impaired coordination of movement and eyes. Often there are convulsions of a tonic-clinical nature. The standard symptom of the disease is clouding of consciousness, memory problems and loss of spatial orientation.

At this stage, MRI of the brain helps to determine toxoplasmosis. This type of research is widely used in various forms of the disease. In some cases, the pathology is characterized by an acute onset. This condition is characterized by the manifestation of all the above symptoms at the same time.

If timely treatment is not started, the disease becomes latent or chronic. These types are characterized by a periodic increase in general symptoms.

With toxoplasmosis, a person is constantly irritable, he suffers from acute memory problems. Disturbances from the organs of the gastrointestinal tract are not excluded. The patient complains of constant bloating, constipation and nausea. All these symptoms are easily eliminated through effective treatment.

Congenital toxoplasmosis- the most dangerous form of the disease. It entails serious violations. The newborn has a triad of signs: brain damage, chorioretinitis and hydrocephalus.

The latter condition is characterized by a significant increase in the size of the skull and thinning of the bones. Congenital pathology is fraught with serious mental disorders and psychotic conditions.

Diagnostic measures

Diagnostic measures allow you to determine the form of the pathology and select the appropriate treatment tactics. Standard diagnostics is carried out in several stages. To start, the disease must be differentiated from tuberculosis, chlamydia and other viral infections. The specialist must exclude oncological diseases and systemic damage to the body.

Following differentiation, laboratory diagnostics is carried out. Often a person suffers from toxoplasmosis of the brain with HIV. To determine the general condition of the patient, a blood test is performed for the binding reaction, indirect immunofluorescence and enzyme immunoassay. Confirmation of the diagnosis is carried out through these studies.

Particular attention is paid to antibodies of all classes. With a fresh study, IgM components are detected. If their concentration increases, then the pathology is actively progressing. With a decrease in antibodies, a chronic form of the disease is often detected.

According to the results of a single study, it is impossible to determine the duration of the infectious process. To do this, the specialist conducts an additional examination, after 2-3 weeks.

Women who have had the disease before conception are insured against the risk of intrauterine damage to the fetus. High probability a negative course is observed in the absence of a primary focus of the disease. In this case, the risk of infection during pregnancy remains.

If the study did not provide a complete picture of what is happening, additional instrumental techniques are assigned. These include MRI and CT of the brain. Magnetic resonance therapy allows you to assess the condition of a person and identify lesions. Based on the data obtained, complex treatment is prescribed.

Medical tactics

Biseptol

If a person has HIV of the brain, this carries a mortal danger. This pathology is characterized by a negative effect on the immune system. This significantly increases the risk of developing irreversible processes in the body.

The choice of treatment tactics depends entirely on the nature of the disease and the severity of its course. The predominant deviations of certain organs and systems also affect the drug effect.

The absolute indication for immediate treatment is the acute and subacute form of toxoplasmosis.

The chronic type of pathology is eliminated depending on the clinical manifestations. In most cases, experts recommend using drugs such as Fansidar and Biseptol.

Etiotropic therapy includes several main cycles. Between them, it is appropriate to use folic acid. For this purpose, Rovamycin is prescribed. In most cases, it is well tolerated by patients. The high efficiency of the drug makes it popular among people of any age category.

AT severe cases the doctor prescribes a combination therapy. It is based on the use of several drugs at once. It can be Biseptol, Trimethoprim and Sulfamethoxazole. The optimal course of therapy is 10 days.

If a person additionally suffers from immunodeficiency syndrome, in addition to standard etiotropic therapy, immunotropic agents are prescribed. The most popular drugs are Cycloferon, Lipokid and Taktivin. To reduce the negative impact on the intestinal microflora, probiotics are additionally used.

Cycloferon

Treatment and further monitoring is carried out by specialists. The frequency of examinations is completely dependent on the form of pathology and the nature of its course. In most cases, a person must visit infectious disease specialists, neuropathologists, ophthalmologists and obstetrician-gynecologists.

Toxoplasmosis, which affects the brain, is a serious disease. In the absence of timely treatment tactics, the disease can lead to the development of severe abnormalities. A special danger remains for children, they may develop mental retardation and mental disorders.

In contact with

Brain toxoplasmosis develops with HIV; in patients with normal immunity, this form of the disease is rare. In India, it has been reported in only 15 non-immunodeficient patients in 10 years, and even then it was due to poor nutrition.

The causative agent of toxoplasmosis, entering the body, causes the appearance of volumetric formations in the central nervous system, brain damage occurs, and primary epilepsy develops. But sometimes, when cerebral toxoplasmosis occurs with HIV, there are no volumetric formations in the central nervous system.
There are many cases when toxoplasmosis is combined with inflammation of the choroid and retina.

Congenital cerebral toxoplasmosis proceeds in an acute form. It often ends in the death of the newborn.
But in any case, congenital toxoplasmosis of the brain leads to impaired development of the child.

Symptoms

Early detection of pathology, diagnosis and treatment is important, many narrow specialists are involved in it: an infectious disease specialist, an ophthalmologist, a neurologist, since the symptoms and signs of toxoplasmosis are diverse.

Clinical signs appear 2 weeks after infection.

Symptoms of toxoplasmosis in humans are initially mild. There is weakness, muscle and joint pain. The development of cerebral toxoplasmosis is characterized by a rapid increase in symptoms.

The following symptoms appear:

• Temperature rise;
• Headache;
• Enlarged lymph nodes;
• Rashes appear all over the body, they may not be on the scalp, palms and feet.
• In the later stages of the disease, there are signs of inflammation of the liver, kidneys, heart muscle, meningitis, encephalitis, meningoencephalitis.

The characteristic signs of the disease are lesions of the central nervous system:

• memory problems;
• loss of orientation;
• Paralysis;
• convulsions;
• Violation of coordination of movement;
• Speech disorder, inability to understand it;
• Weakening of vision;
• epileptic seizures;
• Loss of sensation in the limbs;
• The act of swallowing is disturbed.

The sluggish course of toxoplasmosis of the brain has periods of remission.

For chronic form signs of intoxication of the body, pain in the joints and muscles, subfebrile temperature are characteristic, the child has lags and numerous developmental disorders.

Diagnostics

There are several accurate serological methods for diagnosing infection. They allow you to identify foreign substances and organisms to which the human immune system reacts and produces antigens or antibodies to them. When infected with toxoplasmosis in the human body, the formation of IgG and IgM antibodies begins. IgM immunoglobulins appear in the first week after infection, they remain in the blood from 21 days to 2 years, then disappear. A little later, IgG immunoglobulins are formed in the body, which bind to the microorganisms Toxoplasma gondii, which leads to lifelong immunity.

When antibodies are detected in the blood, their value should increase. If the dynamics of antibody titers is not observed and there are no signs of the disease, then carriage may take place.

Important information! The analysis for toxoplasmosis during pregnancy is especially important, which allows you to assess the likelihood of a child being affected and decide whether to have an abortion or you can give birth. Therefore, it is better if the study was carried out at the planning stage of conception. In case of risk of primary infection, pregnancy is recommended no earlier than after 6 months.

It is possible to determine changes in the brain in patients with toxoplasmosis using magnetic resonance and computed tomography, using a contrast agent. These methods make it possible to identify in patients numerous pathological zones with annular enhancement, perifocal edema, but in some patients there is only one focus.

A brain biopsy is done only if the diagnosis is in doubt. In biopsy specimens, a vegetative form of toxoplasma is found.

In most patients diagnosed with HIV infection, when toxoplasmic encephalitis occurs, antibodies to the pathogen do not appear in the blood serum. In this case, the cerebrospinal fluid is taken for examination, in which a large number of leukocytes and protein are found, while the glucose level is normal. If the cerebrospinal fluid is centrifuged, then Toxoplasma trophozoites can be detected in the smear.

Another way to help determine whether encephalitis is caused by this pathogen is the appointment of Pyrimethamine in combination with sulfa drugs. When within 10 days there is an improvement in the well-being of AIDS patients, this indicates that inflammation of the brain is caused by toxoplasma.

Transmission routes

Infection occurs in humans through contact with infected cats.

The pet has no symptoms of the disease, and the owners may not be aware that their pet is sick. Even if a cat never goes outside, it can still be a source of infection, as a person could bring the pathogen on shoes or feed the animal with infected raw meat or grass with cysts.

The infection may be caused by eating raw and undercooked meat, a blood transfusion, or an organ transplant from a person infected with toxoplasmosis. It is also possible to transmit the disease from mother to fetus through the blood.

How infection occurs

Doctors distinguish 2 ways of transmission of infection:

• Acquired;
• Congenital.

With a congenital disease, infection occurs in utero. If infection occurs in the first trimester, then there is a high probability of abortion. Infection in the second trimester can also cause spontaneous abortion and congenital malformations of the fetus, provoke visual impairment, hearing loss, dysfunction of the central nervous system in the newborn or his death.

The acquired route of infection is considered less safe if a person has normal immunity, but in combination with toxoplasmosis and HIV, it often causes complications.

A person can become infected through the alimentary route:

• When eating meat dishes that have not undergone sufficient heat treatment such as tartar, steak with blood;
• Some patients become infected by eating poorly washed vegetables and fruits;
• Eating raw goat or cow's milk, tap water, from natural reservoirs.
• Another way to spread the disease is subcutaneous or percutaneous. In this case, Toxoplasma enters the human body through damaged skin during cooking, contact with soil and sand.

Prevention

To reduce the likelihood of contracting toxoplasmosis, you need to follow a number of rules:

When the immune system is weakened in patients with HIV, when the number of CD4 lymphocytes is less than 100 cells / μl and IgG antibodies to toxoplasma are found in them, Trimethoprim and Sulfamethoxazole are prescribed to prevent infection. They are canceled only when the number of CD 4 lymphocytes is more than 200 cells / μl is observed for 3 months.

Treatment of toxoplasmosis

Treatment of toxoplasmosis of the brain in HIV-infected patients is selected by a doctor depending on the size, number, localization of lesions, the clinical picture and the state of immunity, the presence of contraindications and tolerability of therapy.

The most effective treatments are those that combine oral antibiotics and folic acid.

Pyrimethamine and Sulfadiazine are prescribed, with such a scheme, positive dynamics are noted already during the first week, but despite this, therapy should last at least 1.5 months. Since both medicines can lead to allergies, it is advisable to spend a few days in the hospital at the beginning of treatment. Due to the fact that Sulfadiazine often causes allergies, clindamycin is prescribed in combination with it, which is taken orally and injected into a vein. Some doctors do not prescribe sulfadiazine due to the large number of side effects.

After all signs of the disease subside, suppressive therapy is prescribed, which includes 25 mg of Pyrimethamine and 10 mg of vitamin B9, which you need to drink every day. If within 3 months there are no signs of the disease, then the frequency of their intake is reduced to 3 times a week, and after six months it is canceled. Since sulfonamides and pyrimethamine inhibit the biosynthesis of the enzyme that converts folic acid to folate, doctors recommend calcium folinate. It is better absorbed and more effective than folic acid, as it is already a metabolite of folic acid.

Trimethoprim may also be prescribed in combination with Sulfamethoxazole, Pyrimethamine with Azithromycin or Atovaquone, Lincomycin, Rovamycin and other antibiotics.

Forbidden use folk remedies, the search for drugs should be carried out by a doctor, since inadequate methods of therapy can lead to the death of the patient.

Consequences of the disease

The consequences of the disease due to a decrease in immunity in HIV infection can be very different, including quite severe.

Acute and chronic course toxoplasmosis of the brain can cause the following complications:

• Inflammation of the choroid and retina, weakening of vision and progression of myopia;
• Violations of brain activity;
• Decreased hemoglobin levels;
• Violations of the intestinal microflora;
• Complications of pregnancy;
• Cardiac arrhythmias, development of heart failure.

In some patients, the manifestation of cerebral toxoplasmosis are epileptic seizures.

Forecast

This disease can cause immunocompromised patients to develop encephalitis with lesions nervous system. And with intrauterine infection, it can provoke severe fetal developmental disorders.

In HIV-infected patients, due to the disease, death can occur.

Attention! You can not self-medicate, be sure to consult a doctor ...

Shoshina Vera Nikolaevna

Therapist, education: Northern medical University. Work experience 10 years.

Articles written

What is toxoplasma

Most often, two categories of people face the concept of toxoplasmosis - pregnant women or women planning to conceive and owners, breeders of domestic cats. This disease is dangerous for the fetus if a woman becomes infected with it, and the primary host is a cat - wild or domestic, small or large.

In most cases, toxoplasmosis is not severe. But in the event that a woman becomes infected with toxoplasmosis during gestation, this can have serious consequences for the health of the unborn child. Toxoplasmosis is just as dangerous for a person with a low level of immunity, for example, after a serious illness, surgery, with AIDS and other manifestations of immunodeficiency.

Entry into the human body

In most cases, infection occurs by ingestion human body oocysts - covered with a dense shell dormant forms of toxoplasma. Oocysts can accidentally end up in the human body if he is untidy and does not wash his hands after contact with animals, especially cats and their waste products, fecal trays. At the same time, the cat does not have to be a stray - you can also get infected from a domestic purr if it is not vaccinated. The same can happen in contact with other warm-blooded animals, including birds.

Oocysts can also be introduced from undercooked, undercooked meat, poultry, or fish, sometimes through infected eggs. For the most part, the cause of infection is non-observance of the simplest hygiene standards or an accident.

From person to person, toxoplasmosis is extremely rare, since the oocyst needs to get on the mucous membranes. Introducing into the body, the pathogen loses a strong shell and settles in the lymphatic vessels. Of these, by the flow of lymph and blood, it settles throughout the body and enters the brain, where it causes maximum harm.

Damage caused by toxoplasma

Any form of toxoplasmosis poses a huge threat to the pregnant woman and the fetus if the infection occurred at the time of bearing the child. At the same time, there is a threat directly to the very process of pregnancy, since toxoplasma can provoke an abortion, and the health of the fetus. The child may be born with a severely weakened immune system, premature, with various defects.

If the patient develops toxoplasmosis of the brain , this can lead to the following consequences:

1. Seizures.
2. Visual and hearing impairments.
3. Lesions of the gastrointestinal tract.
4. Meningitis and.
5. Arachnoiditis.
6. Microcephaly and hydrocephalus in newborns.
7. Foci of calcification in various parts of the brain.

If toxoplasmosis, even with its cerebral form, is detected quickly, treatment is successful. The neglected forms are incurable, but with constant therapy they do not disturb the patient much. However, if left untreated, the disease can be fatal.

Symptoms of toxoplasmosis

The defeat of the meninges and various parts of the brain initially manifests itself with symptoms similar to the flu. In this case, the patient may notice the following symptoms:

1. A sharp rise in temperature to very high values.
2. Feverish state.
3. Severe headaches.
4. Confused consciousness.
5. Nausea, vomiting.
6. Seizures.
7. Increasing symptoms of neurological disorders, which can be manifested by a decrease in hearing, speech, vision, the appearance of pupils of different sizes, nystagmus (high-frequency trembling movements of the eyeballs), pathologies of perception.
8. Jaundice, damage to the liver and pancreas.

If a person keeps a cat at home or has ever been in contact with any members of the feline family, testing for toxoplasmosis is vital for him, especially if there is even a hint of signs of infection. It is especially important to do this with HIV . Such patients have a weakened immune system in the strongest way, their body is more susceptible to attacks by harmful microorganisms than others.

When obtaining results in such patients, their condition must be taken into account, so they may differ from the usual ones.

Diagnostics is performed by the following methods:

1. Linked immunosorbent assay.
2. Reaction of indirect agglutination of blood.
3. Immunofluorescence reaction.

In case of brain damage, (magnetic resonance imaging) or (computed tomography) is used to identify the localization of damaged areas. Conducting accurate and timely diagnosis is very important, since brain damage is very dangerous for the health and life of the patient. Signs of a brain disease can be similar in different diseases that require different, sometimes radically diametrical treatment. Therefore, it is especially important to pay attention to alarming signs and consult a doctor in time for examination and help.

Treatment of the disease

The worst thing a person can do , is to try to treat the disease yourself. Self-medication can lead to extremely serious consequences, especially when it comes to the cerebral form of toxoplasmosis. You only need to seek medical help.

After a full examination, analysis and diagnostics, the specialist will be able to conclude that the following drugs should be prescribed:

• Biseptol;
• Sulfadiazine;
• Pyrimethamine;
• Spiramycin for the treatment of pregnant women;
• calcium preparations;
• Brewer's yeast.

In some cases, the use of chemotherapeutic agents - Fansidar and Delagil - is recommended. These are complex drugs, so the dose is selected individually for the patient. The consequences of introducing a pest into the brain are treated with powerful antibiotics - Metacycline and Lincomycin. It must be remembered that they are needed not to destroy the pathogenic microorganism, but to eliminate the inflammatory process in the brain tissue, therefore, if taken separately, they will not be able to cope with the cause of the disease.

Immunocompromised patients who are being treated for toxoplasmosis should continue to take their usual antiretroviral drugs.

Of particular danger is toxoplasmosis of the brain for the fetus and newborn. Very often it leads to irreversible consequences in the form of mental retardation and numerous developmental pathologies.

Timely treatment gives good results and in most cases ensures a complete recovery.

Between people, toxoplasmosis of the brain cannot be transmitted, except when transmission occurs from a pregnant woman to her fetus and during organ transplants. Infection can occur from representatives of the cat family and by eating raw or undercooked (roasted) meat.

Symptoms for this pathology

Toxoplasmosis in acute form can develop in only 0.2% of patients. Statistics report that half of all cases of development of the acute form of toxoplasmosis has a cerebral form. Cerebral toxoplasmosis can only develop in patients with impaired immune systems.

In people without immunity deficiency, cerebral toxoplasmosis of the brain develops only in exceptional cases. For example, in India, only 15 cases of cerebral toxoplasmosis infection in immunocompetent people have been described in 10 years. In each case described, the disease developed as a result of a lack of normal nutrition.

Toxoplasmosis manifests itself characteristic symptoms encephalitis, meningoencephalitis. In addition, cases of appearance in the brain of volumetric formations are not uncommon.

Symptoms that indicate damage to toxoplasmosis of the brain are as follows:

How does this disease begin?

Cerebral toxoplasmosis begins suddenly. The patient has a sharp increase in temperature, there is confusion, an epileptic seizure, visual impairment occurs. In addition, paralysis of half of the body or one limb may occur. Along with this, coordination of movements, speech, swallowing is disturbed.

Patients with symptoms of toxoplasmosis of the brain must be hospitalized in the neurological department of the hospital.

Diagnosis of cerebral toxoplasmosis

Provoked disorders can be diagnosed using MRI, computed tomography.

In comparison with MRI of toxoplasmosis of the brain, the dose of contrast agent should be doubled in CT. Both diagnostic methods make it possible to establish a diagnosis, and the accuracy will reach 80%.

Risks for patients with HIV infection in this disease

Toxoplasmosis of the brain ranks second in the ranking of opportunistic infections. Such infections include transmissible diseases that almost never develop in people with normal immunity. However, they are deadly for AIDS patients with poor immunity.

In HIV-infected people, toxoplasma gondii can infect absolutely any tissue and organ, but, as a rule, its target is the brain. In 60% of patients with cerebral toxoplasmosis, the formation of space-occupying formations in the central nervous system is observed, approximately 28% suffer from epileptic seizures.

On average, 20% of those infected with HIV are infected with cerebral toxoplasmosis. In AIDS-infected people, toxoplasmosis encephalitis occurs in 12% of cases.

Toxoplasmosis of the central nervous system is manifested by the development of fever, headache, mental, neurological pathologies. In patients with HIV, toxoplasmic encephalitis is often accompanied by inflammatory processes in the vascular membranes of the eye and retina.

How is cerebral toxoplasmosis treated?

For the purpose of treating cerebral toxoplasmosis, the use of oral forms of antimicrobial drugs, for example, Sulfadiazine, Pyrimethamine, in various combinations is indicated.

Against the background of the use of Sulfadiazinine, allergic reactions often develop, and therefore it is recommended to supplement therapy with oral and intravenous use of Clindamycin. Many doctors are sure that this medicine should not be used, since all its benefits are offset by the resulting negative manifestations.

When treating with Pyrimethamine, doctors often change the duration of the course and dose. For example, on the first day of therapy, it is indicated to take 200 mg of the drug, and in the following days it is necessary to calculate the dose based on weight - up to 75 mg / kg. In some cases, Pyrimethamine therapy is the only possible option.

Against the background of the use of "Pyrimethamine" and sulfonamides, the production of an enzyme is blocked, under the influence of which folic acid is converted into folinate. In this regard, the therapy of toxoplasmosis must be supplemented with the use of calcium folinate. Undoubtedly, folic acid is a cheaper drug, but its effectiveness is much lower, since the main drug does not allow it to turn into folinate and be absorbed.

An alternative to the combination of drugs "Sulfadiazine" + "Pyrimethamine" is the combination of "Sulfamethoxazole" + "Trimethoprim", which shows high efficiency.

If the patient has an allergic reaction to Clindamycin and Sulfadiazine, he is recommended to use Pyrimethamine and Atovaquone, or Pyrimethamine in combination with Azithromycin.

Positive dynamics in this pathology

In the treatment of toxoplasmosis of the brain with the use of these medications, a positive trend is noted daily. The patient is discharged after two weeks of therapy. As a rule, by this time only minor physiological and mental manifestations of the disease persist, which later completely disappear. After a few months, the patient can return to labor activity.

Prognosis for toxoplasmosis of the brain

When a disease is detected at an early stage of development, therapy is successful in almost all cases. In advanced forms, toxoplasmosis is incurable, but constant therapy can stop its manifestations. Lack of therapy can lead to death. In addition, it can provoke the development of the consequences of cerebral toxoplasmosis in the form of hemiparesis, ataxia, aphasia, severe mental illness.

In this regard, it is important to consult a doctor when the first signs of this disease are detected, because the initial stages of the disease are successfully treated. The main thing is to follow all the recommendations.

Toxoplasmosis in AIDS (HIV)

Among the various clinical manifestations of toxoplasma encephalitis the most common headache, impaired consciousness, epileptic seizures, drowsiness, fever, focal neurological symptoms. CSF shows increased protein concentration and mild cytosis, but may not be affected. More than 80% of patients have IgG antibodies to Toxoplasma gondii in serum and CSF. IgM antibodies are almost never present, which is to be expected in a reactivated infection. Contrast-enhanced CT usually reveals multiple, bilateral, annularly enhanced low-density lesions and structural displacement or cerebral edema (predominantly in the frontal lobes, basal ganglia, and at the cortex-white matter interface). In 25% of cases, the foci are solitary, in 5-10% they are not contrasted. Gadolinium MRI is more sensitive (particularly in patients without focal neurologic symptoms) and often detects lesions not detected by contrast-enhanced CT.

Diagnosis of toxoplasmosis usually put on the basis of the clinical picture and the results of CT or MRI.

Antimicrobial therapy assigned empirically. Seronegative patients with a single lesion detected during MRI or an atypical clinical picture, as well as those in whom empiric therapy was ineffective, undergo stereotaxic brain biopsy under CT control. To increase the effectiveness of treatment and reduce the toxic effects of drugs, endolymphatic therapy may be prescribed. Improvement in 85% of patients occurs after 2 weeks of treatment, but the x-ray picture begins to change only after 4-6 weeks. Less than 5% of patients die. Empiric antimicrobial therapy is highly effective, so if there is no improvement, another diagnosis is possible, primarily lymphoma.