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Clinical, diagnostic aspects and management of toxoplasmosis


Author: Natalia Pobedinschi-Mihnevici
Degree:doctor of medicine
Speciality: 14.00.10 - Infections Diseases
Year:2006
Scientific adviser: Constantin Andriuţă
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Constantin Eţco
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 22 February, 2006
Approved by NCAA on the 27 April, 2006

Abstract

Adobe PDF document0.44 Mb / in romanian

Thesis

CZU 616.993.192-07+614.2

Adobe PDF document 1.04 Mb / in romanian
174 pages


Keywords

toxoplasmosis, acquired, congenital, diagnostics, clinical, medico-social aspects, management

Summary

The present work represents the complex research of clinical, medico-social and diagnostic aspects of toxoplasmosis, performed on 215 adult patients, including 146 – with acquired toxoplasmosis and 69 – with congenital toxoplasmosis. The diagnosis of toxoplasmosis was based on well led anamnesis, epidemiological data and clinical manifestations completed by instrumental examinations. Specific methods: ELISA with determination of antitoxoplasma IgG, IgM and IgA, allergology method – intracutaneous test with toxoplasmic allergen were used for confirmation. Polymerase chain reaction (PCR) doesn’t have advantages in comparison with ELISA and intracutaneous test with toxoplasmic allergen for confirmation of diagnosis of chronic toxoplasmosis.

Chronic acquired toxoplasmosis developed in young persons being predominantly 21-35 years old, more frequently in females, has evolved prevalent in light form and was manifested by clinical polymorphism: syndrome of general intoxication, prolonged febrile syndrome, lymphadenopathy, hepatomegaly, functional affectation of central nervous system, in female – obstetrical-gynaecologic pathology. The clinical picture of chronic congenital toxoplasmosis was presented by following severe organic psychoneurologic syndromes: encefalopathy, intracranial hypertension, diencefalic, mental retardation, epileptiform, hydrocephalic, in combination with ocular pathology (in 71,0%), more frequently presented by bilateral chorioretinitis.

Results of ELISA with determination of antitoxo IgG were positive in all patients, at the same time very high values were detected in subacute acquired toxoplasmosis, and average values - in chronic one, but lower values of antitoxo IgG were registered in congenital chronic toxoplasmosis. Antitoxo IgA by ELISA were detected only in 3 cases of subacute acquired toxoplasmosis. Antitoxo IgM positive were determined in all patients with subacute acquired toxoplasmosis, relapsed chronic acquired and congenital toxoplasmosis. Intracutaneous test with toxoplasmic allergen was positive in all patients with toxoplasmosis.

Results of complex medico-social study of toxoplasmosis have revealed the actuality and medico-social importance of this disease for the Republic of Moldova. Prenatal acquired toxoplasmosis has an enormous importance, in which congenital form develops with severe consequences: intrauterin death, early infancy letality, organic sequelae at the level of central nervous system and eyes, which serves for causes of invalidity. The present study revealed involving the medico-social risk factors of toxoplasmosis, which were divided into 3 groups: epidemiological, socio-economic and medico-biological. The study of medico-social aspects of toxoplasmosis allowed to motivate scientifically and to elaborate the management for early diagnostics of this disease.