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},
"code": "B58",
"name": "Токсоплазмоз",
"icd_name": "Токсоплазмоз",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5,
7,
9
],
"periodicity": 1,
"slug": "b58_toksoplazmoz",
"lead": "Паразитарное заболевание, характеризующееся преимущественно латентным или хроническим течением, поражением нервной системы, органов ретикулоэндотелиальной системы, мышц, миокарда и глаз.",
"description": "Инфекционное заболевание.",
"etiology": "<p>Возбудитель - Toxoplasma gondii относится к простейшим.Токсоплазмоз относится к зоонозам с природной очаговостью. Окончательным хозяином являются домашние кошки и некоторые дикие представители семейства кошачьих (рысь, пума, оцелот, бенгальский кот, ягуар и др.). Ооцисты, выделяющиеся с их испражнениями, могут приводить к инфицированию как человека, так и многих других животных (свыше 200 видов), которые служат промежуточными хозяевами. Заражение наступает лишь при употреблении в пищу сырого мяса (мясного фарша) этих животных. Контакт с промежуточными хозяевами (собаками, сельскохозяйственными животными) к инфицированию людей не приводит. Больной человек не выделяет возбудителя во внешнюю среду и никакой опасности для окружающих не представляет.</p>\r\n<full></full>\r\n<p>У человека возможны три пути передачи инфекции: пероральный (заглатывание ооцист или цист), трансплацентарный, а также возможно инфицирование при переливании крови и пересадке органов.</p>\r\n<p>Пероральное инфицирование происходит при употреблении недостаточно термически обработанного мяса (мясного фарша), содержащего цисты. Баранина и свинина, также как и мясо других животных, часто содержат цисты токсоплазм (от 10 до 25%). Заражение может наступить и при проглатывании ооцист (контакт с загрязненными кошачьими испражнениями, землей, песком и др.). Около 1% домашних кошек с испражнениями выделяют ооцисты, однако - только на протяжении 2-3 недель за время жизни, так как после первичного инфицирования у животных развивается иммунитет, предохраняющий их от повторного заражения.</p>\r\n<p>Трансплацентарное заражение плода может происходить при инфицировании матери во время беременности. При заражении матери в I триместре беременности врожденный токсоплазмоз наблюдается в 15-20% и протекает тяжело. При инфицировании в III триместре инфицированными оказываются 65% новорожденных, но у некоторых инфекция может протекать без выраженных клинических проявлений. Если женщина инфицирована до беременности (за 6 мес и более), внутриутробного поражения плода не наступает, а если заражение произошло незадолго до наступления беременности, риск инфицирования плода очень мал.</p>\r\n<p>Инфицированность доноров токсоплазмами такая же, как клинически здоровых лиц, однако достоверных случаев передачи токсоплазмоза реципиентам не наблюдалось. Такая возможность становится реальной при переливании крови лицам с резко ослабленным иммунитетом (больные СПИДом, лейкемией и др.), а также при пересадке органов. В этих случаях доноры не должны быть инфицированными.</p>",
"pathogenesis": "<p>Воротами инфекции чаще служат органы пищеварения, хотя известны случаи внутрилабораторных заражений высоковирулентными штаммами токсоплазм при повреждении кожи (пипеткой или шприцем с культурой токсоплазм). Внедрение возбудителя происходит в нижних отделах тонкой кишки, затем с током лимфы токсоплазмы достигают регионарных (мезентериальных) лимфатических узлов. Здесь развиваются воспалительные изменения с формированием инфекционных гранулем, напоминающих по клеточному составу туберкулезные или бруцеллезные гранулемы. Мезентериальные лимфатические узлы значительно увеличиваются.</p>\r\n<full></full>\r\n<p>Затем токсоплазмы попадают в кровь, разносятся по всему организму и фиксируются в различных органах и тканях (печень, селезенка, лимфатические узлы, нервная система, глаза, миокард, скелетные мышцы). В этих органах образуются скопления паразитов в виде цист, которые могут сохраняться в организме десятки лет и даже пожизненно. В местах фиксации возникают воспалительные очаги, а в некоторых органах (нервная система, скелетные мышцы) - очажки некроза, в которых затем откладываются соли кальция и образуются кальцинаты.</p>\r\n<p>В результате жизнедеятельности паразита и выделения антигенов и аллергенов наступает аллергическая перестройка организма (по типу реакций гиперчувствительности замедленного типа) и вырабатываются антитела, которые выявляются в различных иммунных реакциях (РСК, реакция с красителем Сэбина-Фельдмана, РПГА, ИФА и др.). В развитии иммунитета большое значение имеют как клеточные, так и гуморальные факторы. Наличие антител предохраняет от нового заражения даже высоковирулентными штаммами токсоплазм и обусловливает бессимптомное (латентное) течение токсоплазмоза у большинства инфицированных лиц. При ослаблении защитных сил организма и снижении напряженности иммунитета может наступить обострение заболевания (переход латентной формы в манифестную). Обострение хронического токсоплазмоза, как правило, провоцируется интеркуррентными заболеваниями (грипп, ОРЗ, пневмонии и др.) и может наблюдаться иногда спустя длительное время (до 10-20 лет) после инфицирования. Описаны обострения с развитием тяжелого токсоплазмозного энцефалита после лечения лиц с латентным токсоплазмозом цитостатиками и иммунодепрессантами. В последние годы важное значение приобрела проблема генерализации латентного токсоплазмоза у ВИЧ-инфицированных. В этих случаях токсоплазмоз приобретает острое злокачественное течение с развитием некротического локализованного или диффузного менингоэнцефалита, в процесс вовлекаются глаза и многие органы (сердце, печень, легкие). На фоне развернутой картины СПИДа наслоившееся обострение (генерализация токсоплазмоза) может приводить к гибели больных.</p>",
"diagnostics": "<p>Диагноз ставят по результатам анализа крови, в ходе которого в крови выявляют наличие антител против токсоплазмы. При серьезных нарушениях используется компьютерная томография (КТ) или магнитно-резонансная томография (МРТ) головного мозга.</p>",
"treatment": "<p>При остром токсоплазмозе используются химиотерапевтические препараты. <br /><br />Делагил (по 0,5г 2 раза в сутки) в сочетании с сульфаниламидами (по 0,5г 2 раза в сутки) в течение 10 дней. Фансидар назначается в количестве 5 таблеток на курс: по 1 табл. через 2 дня или в виде внутримышечных инъекций по 1 ампуле в 2,5 мг один раз в 2 дня в количестве 5 инъекций. Проводится один или два курса лечения. <br /><br />Из антибиотиков назначаются: линкомицина гидрохлорид (по 0,5г 2 раза в сутки); метациклина гидрохлорид (по 0,3г 2 раза в сутки) в течение 5-7 дней в сочетании с сульфаниламидами; ровамицин. <br /><br />Лечение хронического токсоплазмоза во много раз труднее, чем острого, так как химиопрепараты не оказывает значительного эффекта. Главное место занимает гипосенсибилизирующая и иммуномодулирующая терапия. В комплекс лечения включают витамины, десенсибилизирующие средства, лидазу, церебролизин и пр. <br /><br />Имеются данные о положительном действии левамизола в терапии хронического токсоплазмоза. Левамизол назначается по 150 мг 3 дня подряд с перерывами 1 нед между циклами, всего 2 - 3 цикла.</p>",
"prevention": "<p>Профилактика инфицирования токсоплазмами заключается в употреблении в пищу только хорошо термически обработанного мяса и мясопродуктов, чисто вымытых овощей, фруктов и ягод. В процессе приготовления пищи запрещается пробовать на вкус сырой мясной фарш. Необходимо тщательно мыть руки после обработки сырых мясопродуктов, работе в саду, огороде, детям после игры на детской площадке и, особенно, в песочнице. Следует тщательно соблюдать санитарно-гигиенические правила содержания в квартире домашних животных, не забывая мыть руки после контактов с ними. <br /><br />При наступлении беременности каждая женщина должна быть обследована на токсоплазмоз в женской консультации. При выявлении у беременной клинических проявлений токсоплазмоза, а также обнаружение антител к токсоплазмам класса IgM, следует решить вопрос о необходимости лечения или прерывания беременности.</p>",
"clinical_picture": "<p>Симптомы легкого лимфатического токсоплазмоза сходны с проявлением инфекционного мононуклеоза. Происходит <a title=\"Перейти на страницу симптома Увеличение лимфатических узлов\" href=\"../../../symptom/uvelichenie_limfaticheskih_uzlov/\">увеличение лимфатических узлов</a> шеи и подмышечных областей, наблюдается чувство общего недомогания, боль в мышцах, периодическое <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"../../../symptom/vysokaya_temperatura_38-42/\">повышение температуры</a>. Возможны легкая анемия, снижение артериального давления, увеличение числа лимфоцитов и снижение уровня лейкоцитов в крови.</p>\r\n<p>При хроническом токсоплазмозе наблюдается <a title=\"Перейти на страницу симптома воспаление\" href=\"../../../symptom/vospalenie/\">воспаление</a> внутренних структур глаза.</p>\r\n<full></full>\r\n<p>Острый диссеминированный токсоплазмоз проявляется в виде сыпи, повышенной температуры и выраженного истощения. Чаще всего эта форма токсоплазмоза встречается у людей со сниженным иммунитетом. В худшем варианте эта форма проявляется у больных СПИДом, у которых токсоплазмы могут распространиться по всему организму. При этом развивается <a title=\"Перейти на страницу симптома воспаление\" href=\"../../../symptom/vospalenie/\">воспаление</a> мозга (энцефалит), что приводит к параличу, судорогам, головным болям и коме.</p>",
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}
]
}
