Congenital toxoplasmosis - treatment
Congenital toxoplasmosis develops during transplacental infection of Toxoplasma gondii. Clinical manifestations, if any, include prematurity, intrauterine growth retardation, jaundice, hepatoma splenomegaly, myocarditis, pneumonitis, rash, chorioretinitis, hydrocephalus, intracranial calcifications. It is recommended to use aqueous penicillin G 50 000 units / kg intravenously after 12 hours in the first 7 days of life and 8 hours further up to a general course of 10 days, or penicillin G on procaine 50 000 U / kg intramuscularly once a day for 10 days . This scheme is also used in children who are considered likely to have syphilis if the mother has not received treatment or is not known whether she received treatment if the treatment was prescribed 4 weeks or less before the birth or the treatment was not adequate.
Children with probable syphilis, whose mothers received adequate treatment, in good condition, clinically can receive a single injection of benzylpenicillin 50,000 units / kg intramuscularly.If it is possible to regularly monitor the child’s condition, some doctors instead carry out a non-routine diagnosis every month for 3 months and then at 6 months and treat with a full course of antibiotics if the titer increases or remains positive at 6 months.
Children after six months and older with newly diagnosed congenital syphilis. Before the start of treatment, liquor should be examined. The CDC recommends that any child with a late congenital syphilis should be treated with aqueous crystalline penicillin G 50 000–75 000 U / kg intravenously in 4-6 hours for 10 days. Many patients do not return to seronegativity, however, they have a decrease in the titer of reactive antibodies by 4 times. Interstitial keratitis is usually treated with glucocorticoidoids and atropine in drops under the supervision of an ophthalmologist. In patients with neurosensory hearing loss, an effect can be obtained by administering penicillin and glucocorticoids, for example, prednisolone 0.5 mg / kg orally once a day for a week, then 0.3 mg / kg once a day. for 4 weeks, after which the dose is gradually reduced over 2-3 months. and direct agglutination reaction.An acute infection in the mother can be assumed in case of seroconversion or an increase in titers 4 or more times between the acute period and the period of reconva- lestation. IgG maternal antibodies can be detected in a child during the first year of life. PCR analysis of cerebrospinal fluid and amniotic fluid can be considered the best method. Methods for isolating the pathogen include infecting mice and isolation on tissue culture.
If a congenital toxoplasmosis is suspected, a serological examination, an MRI or CT scan of the brain, an analysis of cerebrospinal fluid, and a thorough ophthalmologic examination should be performed. Changes in the cerebrospinal fluid include xanthochrome, pleocytosis, and increased protein content. The placenta is examined to identify the characteristic signs of toxoplasmosis. Non-specific laboratory findings include thrombocytopenia, lymphocytosis, monocytosis, eosinophilia, and increased transaminase levels.
Prognosis and treatment of congenital toxoplasmosis
Some have a fulminant course with an early death, while others develop long-term neurological consequences.Sometimes neurological manifestations appear years later in children who at birth seemed healthy. Accordingly, children with congenital toxoplasmosis should be regularly examined after the period of the newborn.
Separate research data suggest that the treatment of infected women during pregnancy may be beneficial for the fetus. Spiramycin has been used to prevent transplacental infection. Pyrimethamine and sulfonamides were used in the later stages of pregnancy to treat an infected fetus.
Treatment of newborns with manifest and asymptomatic toxoplasmosis can improve the outcome. Therefore, treatment with pyrimethamine, sulfadiazine and leucovorin is recommended. After the first 6 months of treatment, sulfadiazine and leucovorin continue to be given as before, and pyrimethamine is prescribed less often. All treatment must be carried out under the supervision of a specialist. The use of gluco-corticoids is controversial and must be determined for each specific case individually.
Prophylaxis of congenital toxoplasmosis
Pregnant women should avoid contact with cat litter and other places highly contaminated with cat feces.Meat should be thoroughly cooked before consumption, and hands should be thoroughly washed after contact with raw meat or unwashed foods. Women at high risk of primary infection should be screened during pregnancy. When infected between the 1st and 2nd trimesters, the woman should be consulted to evaluate the possible treatment.
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