Diseases of the genitourinary sphere are a great danger, especially for women of childbearing age. The microflora of the vagina is the first aggressor a child encounters when passing through the birth canal.
Mycoplasmosis and ureaplasmosis are common diseases that require a serious approach to treatment and diagnosis.
What are ureaplasmosis and mycoplasmosis?
Mycoplasmas and ureaplasma are members of the Mycoplasmataceae subfamily. They lack a cell wall, which is unusual for bacteria. This determines their insensitivity to most antibiotics (the effectiveness of drugs is determined by their effect on enzymes involved in the construction of the cell wall).
When bacteria enter the host's body, they release substances that destroy the membranes of human cells, such as hydrogen peroxide. After that, mycoplasmas attach to the membrane surface. If the disease is in the active phase, the cell dies after 6 days.
Ureaplasma in the human body secretes the enzyme protease A. This compound breaks down class A antibodies, which serve for an effective immune response. Strong immunity against these diseases is not formed. This means that you can become infected with mycoplasma or ureaplasma more than once during your life.
How is mycoplasmosis in women?
The incubation period of the disease is 50 to 60 days. At this time, no clinical manifestations are observed. After it, the disease enters its acute phase.
Symptoms can be expressed with varying degrees: erased, or vice versa, very clearly. The acute phase can last from several days to several weeks.
If at this stage the disease is not diagnosed, then it becomes chronic. Pathogenic bacteria are present in the human body and, with a decrease in immunity, are activated, affecting new and new cells of the mucous membrane of the urinary tract.
How is mycoplasmosis and ureaplasmosis transmitted?
The main source of genital mycoplasma and ureaplasma is the person infected with them. It releases bacteria into the environment. The entrance gate of infection is the mucous membranes of the genitals.
There are three main ways of transmission of mycoplasmas:
- Sexual. It is transmitted through both normal and homosexual contacts, including oral sex;
- Vertical (from mother to child). The bacteria are able to cross the transplacental barrier and infect the fetus in the womb;
- Infection when babies pass the birth canal.
In rare cases, mycoplasmas and ureaplasmas are transmitted by contact. This requires periodic joint use of personal hygiene products and linen with the sick person.
Symptoms and signs of mycoplasmosis and ureaplasma in women
There are no specific symptoms of this disease. Rarely in women, the following manifestations are possible:
- itching in the groin area;
- discomfort during urination, burning;
- irritation on the mucous membrane of the genital tract after sexual contact;
- a slight (within 2 degrees) increase in temperature in the morning.
Ureaplasma during pregnancy: consequences and complications
Ureaplasma is often called a conditionally pathogenic organism due to the frequency of its occurrence and the absence of any symptoms of the disease. Such carrier does not necessarily require treatment.
Determination of infections in pregnant women must necessarily include confirmation of the actual fact of the inflammatory process.
A direct link between the presence of ureaplasma DNA in the blood or smear of pregnant women and congenital anomalies in a child has not yet been proven.
In order for the infection of others or the fetus to occur, the microorganism must be in the active stage of its life cycle.
The very fact of carriage does not affect the health of the expectant mother and her baby.
If during pregnancy, along with positive tests, a woman has clinical manifestations of the disease, then we are talking about a disease.
In such cases, ureaplasma can cause the following complications:
- miscarriage;
- premature birth.
In children whose mothers suffered from ureaplasmosis during pregnancy, neonatal pneumonia is more often found. It is pneumonia that is easy to treat but undesirable in the first year of life. Congenital pneumonia in premature babies can be dangerous.
Video: "What is the danger of ureaplasmosis during pregnancy?"
Diagnostic methods and necessary analyzes
- The most common test prescribed for suspected mycoplasma or ureaplasma is the PCR method. PCR stands for polymerase chain reaction. It allows you to detect the genetic material of bacteria, which indicates their presence in the body. PCR detects not only living and active microorganisms, but also dead or singly hitting the surface of the mucous membrane.
PCR is not a sufficient basis for the diagnosis
- The culture method or sowing is the application of biological material to a nutrient medium. The formation of a colony of mycoplasmas or ureaplasmas will indicate a positive test result. This method is rarely used, since bacteria do not grow well outside a living organism. But it is bacteriological inoculation that makes it possible to determine exactly what it is about: a disease or a carrier.
For this, a special kind of "Duo" technique is used. It is based on a change in the color of the medium in which microorganisms are placed. In order to distinguish between the concepts of the inflammatory process and carriage, a certain threshold for the concentration of microorganisms (or titer) is adopted, up to which the diagnosis of ureaplasmosis or mycoplasmosis is not made. It is 10⁴ units per ml. When this value is exceeded, the medium changes color due to the ammonia released by a large number of bacteria. At low concentrations, the color remains the same.
- The enzyme immunoassay is also used to diagnose ureaplasmosis and mycoplasmosis. In this case, the level of antibodies (these are special substances that are produced in the body in response to an infection or toxin) in the patient's blood is determined. This method is indirect and can indicate the presence of bacteria only indirectly.
The use of phytoestrogens during menopause has a positive effect on the woman's body, since these substances are very similar to female sex hormones. Which plants contain estrogens? / preparati-pri-klimakse
Treatment of mycoplasmosis and ureaplasmosis in women: drugs and schemes
In the treatment of mycoplasmosis and ureaplasmosis, antibiotics, local preparations of bactericidal action and immunostimulants are used. Regardless of the method of infection, treatment of both partners is mandatory if the woman is sexually active.
Both types of microorganisms are highly resistant to most antibiotics used. For their therapy, only modern drugs of the latest generation are used:
- Clindamycin... It acts on the synthesis of protein in the microbial cell, stopping this process and thereby preventing its reproduction and vital activity. The course of taking clindamycin is 7 days. The dose of the drug is 200-400 mg every 6 hours. It performs well in the treatment of diseases caused by multiple infections;
- Ofloxacin... The drug acts on the genome of bacteria and destroys the internal contents of their cells. Reception is carried out one-time, the dosage is from 200 mg;
- Azithromycin... Suppresses protein synthesis in a bacterial cell. There are two possible dosage regimens: one-time 1 g of the drug or within 2-5 days from 0.25 to 1 g.
Treatment of ureaplasmosis during pregnancy
Treatment of infections is not carried out at the initial stages due to the fact that the risk from taking drugs and their effect on the fetus is higher than the potential benefit. From 20 weeks, pregnant women are prescribed vilprofen. In difficult situations, azithromycin or rovamycin can be used.
When breastfeeding, certain medications (such as azithromycin) can have harmful effects on your baby. In this case, it is recommended to interrupt lactation for several days.
Consequences of ureaplasmosis in women
Acute and chronic forms of infection can lead, if untreated, to the following consequences:
- Cystitis... Inflammation of the epithelium of the bladder. It manifests itself acutely, characterized by severe pain;
- Urethritis... It is an inflammation of the urethra (urethra);
- Pyelonephritis... Occurs when bacteria enter the kidneys. Caused by an inflammatory process in the renal pelvis;
- The formation of adhesions of the fallopian tubes and subsequent infertility.
The detection of ureaplasma or mycoplasma in the vaginal microflora during a diagnostic study is not yet the reason for the diagnosis. Clinical signs or a high titer of microorganisms are indisputable evidence of the presence of the disease.
Prescribing treatment, especially for a pregnant or lactating woman, is possible only if the benefits of taking drugs outweigh the risk of complications for the mother and baby.
Video: "What is mycoplasmosis and ureaplasmosis? Ways of infection, diagnosis and treatment of the disease"
And mycoplasmas are not absolute pathogens, and their detection in analyzes does not require treatment, but not in the case of planning a pregnancy. When planning, everything is very difficult: (Doctors themselves cannot agree on the need to treat these pathogens.
Therefore, the question of the need treatment of ureaplasma and mycoplasma should be discussed with a trusted personal physician.
Our personal opinion is that "treating analyzes" is still not correct. And you should not drink antibiotics, provided there are no complaints from the woman, with a normal smear on the flora and in the complete absence of clinical symptoms.
Ureaplasmas and mycoplasmas have no clinical significance in obstetrics and gynecology... These are causative agents of nonspecific urethritis, more often in men. In 30% of cases and more - representatives of the normal microflora of the genital tract. Their detection by the PCR method is not an indication for their targeted treatment, even if there are symptoms of the inflammatory process - more frequent pathogens must be treated, and since they are chlamydia, and the drugs used against them and urea- and mycoplasmas are the same, then the question of the treatment of myco- and ureaplasmosis is removed. Even if we accept that they exist and have a meaning, they are still treated with the same drugs, therefore it makes no sense to define them.
Is it necessary to donate the culture for mycoplasma and ureaplasma
Diagnosis of myco- and ureaplasmosis is not needed. There is no need to be tested for them - neither blood for antibodies, nor culture (especially since only in a few metropolitan laboratories it is really done, and the determination of sensitivity to antibiotics is technically unrealistic, in ordinary places they write the results of PCR as a culture), nor PCR.
If, for some reason, an analysis is made, you should not pay attention to its results, it is not a criterion for either making a diagnosis, much less prescribing treatment.
Pregnancy planning and pregnancy itself is not an indication for PCR diagnostics in general, and even more so for PCR diagnostics of urea- and mycoplasmas. Management in this case does not differ from management of non-pregnant women - complaints and smear.
They do not treat tests, but complaints. If there are no complaints, and a normal smear on flora shows a normal number of leukocytes, no further examination and treatment is needed. If an additional examination is nevertheless done, and something is found in the PCR, this is not a criterion for prescribing treatment. In addition to the lack of clinical significance of urea- and mycoplasmas, it is necessary to remember the high frequency of false-positive PCR results. To prescribe this analysis in the absence of complaints at all, and in the presence of complaints - before or instead of a smear - incompetence and divorce for money.
If there are complaints, but a smear taken in a good laboratory is good, there are no indications for antibiotics, one should look for other causes of complaints - dysbiosis, concomitant diseases, hormonal imbalance, papillomatosis.
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If there are complaints and signs of an inflammatory process in the genitourinary system, antibiotic therapy is prescribed - either according to the results of additional examinations (PCR and culture with determination of sensitivity) - for various pathogens (chlamydia, gonococcus, Trichomonas, streptococcus, E. coli, etc., etc.), but not on urea and mycoplasma, or "blindly" - against the main causative agents of such diseases (gonococci and chlamydia). An anti-chlamydial drug is prescribed necessarily, in any case, regardless of the test results, since this is the most common pathogen, and since it does not have resistance to anti-chlamydial antibiotics (culture with the determination of the sensitivity of chlamydia is also a profanation). All myco- and ureaplasmas are sensitive to anti-chlamydial drugs (the exception is a certain proportion of ureaplasmas are resistant to doxycycline). Therefore, even if after some time the pathogenicity and clinical role of these microorganisms is proved, anyway adequate treatment of inflammatory diseases without their identification eliminates them, together with chlamydia. Therefore, again, there is no point in defining them. Contrary to what is said now in many commercial centers, the treatment in this case does not depend on the test results, the scheme is the same.
This scheme is very simple and inexpensive, a multi-component list of antibiotics on two sheets against a positive PCR for ureaplasma is incompetence and money scam. Doxycycline is an old drug, but the main causative agents of inflammatory diseases in gynecology are still sensitive to it. However, the duration of treatment is not shorter than 10 days. Equivalent in effectiveness against the main pathogens is a single dose of 1 g of sumamed. For those who continue to fear ureaplasma, this is the drug of choice, since those ureaplasmas that are genetically insensitive to doxycycline are sensitive to sumamed. Scientific studies have proven the equivalence of a course of treatment to a single dose of 1 g. Fast, simple, cheap.
Malyarskaya M.M. gynecologist
Mycoplasmosis and ureaplasmosis
The question of the clinical significance of genital mycoplasmas is difficult to give an unambiguous answer, at least at this point in time. The fact is that studies of their etiological role in various pathological conditions of both female and male urogenital systems began relatively recently.
If there is a clinic of cervicitis and / or urethritis in women or urethritis in men, then at the initial stage, economically examination for genital mycoplasmas is not advisable... Even if gonococci and chlamydia are not detected by available methods for these diseases, then they need to be treated in any case. It is recommended to prescribe an anti-gonococcal drug (single dose of ceftriaxone or ciprofloxacin) in combination with an anti-chlamydial drug (single dose of azithromycin or a 7-day course of other drugs). If the treatment is ineffective, then it is necessary to re-examination by cultural methods for gonorrhea and chlamydia. If gonococci are found, re-treatment after determining the sensitivity or, if it is impossible to determine it, with a drug from another group. In chlamydia, no clinically significant resistance to specific drugs (tetracyclines, erythromycin, azithromycin) has yet been identified.
Antichlamydia drugs are effective against genital mycoplasmas in the same doses... Tetracyclines act on both myco- and ureaplasmas. However, recently it has been established that about 10% of ureaplasmas are resistant to tetracyclines, therefore, if the treatment of urethritis using doxycycline is ineffective, it is necessary to prescribe erythromycin or azithromycin or ofloxacin.
The Ureaplasma urealyticum species consists of 14 or more serovars, which are divided into 2 biovars. Previously they were called biovar 1 or parvo and biovar 1 or T960. These biovars are currently classified as 2 different species: U.parvum and U.urealyticum, respectively. They vary in prevalence. U. parvum occurs in 81-90%, U.urealyticum in 7-30% of women, and sometimes they are combined - 3-6% of cases. U.urealyticum species, i.e. the former biovar 2 (T960) prevails in women with inflammatory diseases of the pelvic organs, complications of pregnancy, and is also more often resistant to tetracyclines. The determination of these biovars is conducted for research purposes and is not necessary and economically feasible in routine clinical practice.
Pregnant should be screened for gonorrhea, genital chlamydia, trichomoniasis, bacterial vaginosis and, if detected, receive antibiotic therapy. There is no reason for a targeted examination of them for genital mycoplasmas and the eradication of these microorganisms. You should not routinely prescribe antibiotics to prolong pregnancy with the threat of termination, except when gonorrhea, trichomoniasis or bacterial vaginosis are detected.
S.V. Sekhin, Research Institute of Antimicrobial Chemotherapy
Ureaplasma and mycoplasma. Questions and answers / h2\u003e What are ureaplasmas and mycoplasmas?
- Mycoplasma causing pneumonia (Mycoplasma pneumoniae), living in the oropharynx and upper respiratory tract of humans
- and three genital (genital) mycoplasmas that inhabit the genitourinary system: Human mycoplasma (Mycoplasma hominis)
- Ureaplasma (Ureaplasma species), which is divided into 2 subspecies (Ureaplasma urealyticum and Ureaplasma parvum)
- Genital mycoplasma (Mycoplasma genitalium)
Recently, pathogenicity (harmful to the body) has been discovered in two more mycoplasmas found in humans. it
- Enzymatic mycoplasma (Mycoplasma fermentans) found in the oropharynx
- Penetrating mycoplasma (Mycoplasma penetrans), which lives in the human urogenital system.
How common are mycoplasmas in humans?
Ureaplasma (Ureaplasma sp.), Is detected in 40-80% of sexually active women who do not make complaints. In men, the detection rate of ureaplasmas is less and is 15-20%. About 20% of newborns are infected with ureaplasmas.
Human mycoplasma (Mycoplasma hominis) is detected in 21-53% of sexually active women and 2-5% of men.
About 5% of children over 3 months of age and 10% of non-sexually active adults are infected with genital (sexual) mycoplasmas
How can you get infected with mycoplasmas?
Genital mycoplasmas (M. hominis, M. genitalium, Ureaplasma sp., M. penetrans) can be infected in only three ways:
- during sexual intercourse (including oral-genital contact)
- when transmitted from mother to fetus through an infected placenta or during childbirth
- with organ transplant (transplant)
Respiratory mycoplasmas (M. pneumoniae, M. fermentans) are transmitted by airborne droplets. Genital mycoplasmas cannot be infected when visiting swimming pools, toilets and through bedding.
What diseases can mycoplasmas cause?
Mycoplasmas are often found in healthy people. The reasons why mycoplasmas cause diseases in some people infected with them are still completely unknown. Naturally, most often mycoplasmas cause diseases in persons with immunodeficiency caused by HIV infection and with hypogammaglobulinemia (a decrease in the number of certain antibodies), but often mycoplasmas cause diseases in people without immunodeficiency and with normal antibody levels.
In women, mycoplasmas can cause the following diseases:
- Cervicitis (inflammation of the cervix) in women is caused by genital mycoplasma (Mycoplasma genitalium)
- Vaginitis (inflammation of the vagina) - there is no proven evidence that genital mycoplasmas cause vaginitis, but ureaplasma and M. hominis are often found in women with bacterial vaginosis
- Pelvic inflammatory disease (PID) in women - 10% of women with salpingitis have M. hominis, there is also evidence of a possible role in the development of PID Ureaplasma sp. and M. genitalium
- Postpartum and post-abortion fever - in approximately 10% of sick women, M. hominis and (or) Ureaplasma sp.
- Pyelonephritis - in 5% of women with pyelonephritis, M. hominis is considered the cause of the disease
- Acute urethral syndrome (frequent and uncontrollable urination) in women is often associated with Ureaplasma sp.
In pregnant women, mycoplasma can lead to the following consequences: infection of the placenta is possible, which leads to premature termination of pregnancy, premature birth and the birth of newborns with low birth weight.
In both sexes, mycoplasmosis can lead to sexually related reactive arthritis (joint damage) caused by M. fermentans, M. hominis and Ureaplasma sp.
There is evidence of a possible causal role for M. hominis and Ureaplasma sp. in the development of subcutaneous abscesses and ostiomyelitis.
Some studies show a link between ureaplasma infection and the development of urolithiasis.
Mycoplasmas in newborns
Diseases caused by mycoplasmas in newborns are especially dangerous. Infection of a newborn occurs either with intrauterine infection during pregnancy or during childbirth.
Associated with genital mycoplasmas in newborns are:
- Acute pneumonia (pneumonia) in newborns
- Chronic lung disease
- Bronchopulmonary dysplasia (underdevelopment)
- Bacteremia and sepsis (blood poisoning)
- (inflammation of the lining of the brain)
How are diseases associated with genital mycoplasmas diagnosed?
In the presence of a disease that can be caused by genital mycoplasmas, a culture study (bacteriological inoculation for mycoplasma) and a PCR study are performed.
Determination of the presence and amount of antibodies in the blood is not used for diagnosis.
How are diseases associated with genital mycoplasmas treated?
Various antibiotics are used to treat diseases associated with mycoplasmas. The most commonly used tetracyclines (doxycycline), macrolides (erythromycin, clarithromycin), azalides (azithromycin), fluoroquinolones (ofloxacin, levofloxacin, moxifloxacin). It should be borne in mind that different types of mycoplasmas have different sensitivity to different groups of antibiotics.
The effectiveness of the use of drugs affecting immunity, enzymes, vitamins, local and physiotherapeutic treatment in the treatment of diseases caused by mycoplasmas has not been proven and is not used in developed countries of the world.
How can you protect yourself from infection with genital mycoplasmas?
If you are not infected with mycoplasmas, then you need to take certain measures to prevent infection. The most effective method of contraception is using a condom.
Ureaplasma (mycoplasma) was detected by PCR, but I have no signs of the disease. Do I need treatment for ureaplasma (mycoplasma) before conception?
If your sexual partner has no signs of a disease caused by mycoplasmas and (or) you are not going to change him and (or) do not plan to become pregnant in the near future, then no treatment is prescribed.
I am pregnant and have ureaplasma (mycoplasma). Do I need to treat ureaplasma during pregnancy?
Numerous studies have shown that intrauterine infection and damage to the placenta can occur during pregnancy, which can lead to premature birth and low birth weight newborns, as well as their infection and the development of bronchopulmonary diseases and other complications. Therefore, many doctors prescribe treatment in these cases.
I was diagnosed with a disease associated with ureaplasma (mycoplasma), and my sexual partner has no signs of the disease and the pathogen identified in me is not determined. Does my partner need to be treated for ureaplasma?
There is no need. In such cases, some doctors recommend re-examination of sexual partners after a certain period of time (from 2 weeks to a month). During this period, sexual intercourse is prohibited.
I underwent a course of treatment for a disease associated with ureaplasma (mycoplasma) and the pathogen was not detected on control examinations. However, after a while, the symptoms of the disease appeared again and the pathogen was discovered. How can this be if during this period I have not had any sexual intercourse?
Most often, re-detection of ureaplasma is due to the fact that there was no complete eradication (disappearance) of the pathogen and its amount after treatment decreased to a minimum, which cannot be determined by modern diagnostic methods. After a certain amount of time, the pathogen multiplied, which was manifested by a relapse of the disease.
I passed a quantitative analysis for ureaplasma (mycoplasma) and they were found in me in an amount (titer) of less than 10x 3. My doctor says that I do not need to be treated, since the treatment is prescribed at a higher titer - more than 10x3? Is it true?
The need for treatment is determined not by the amount (titer) of the detected microorganism, but by the presence or absence of the disease caused by it. If there are signs of illness, you should receive treatment. Treatment is also recommended, regardless of the titers detected in quantitative analysis and whether you have signs of the disease, in the following cases: if your sexual partner has signs of a disease caused by ureaplasma (mycoplasmas) and (or) you are going to change your sexual partner and (or) you are planning pregnancy soon.
The article used materials from the reviews
Ken B Waites, MD, Director of Clinical Microbiology, Professor, Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham
Summary of the link to pregnancy:The disease is considered the appearance of IgM or IgG, if they have not yet been present, or a fourfold increase in the IgG titer in 2-3 weeks. Only in this case is infection of the fetus possible. If the previous examination was a long time ago, the definition of IgM does not mean an acute infection, because these antibodies circulate in the blood for several months up to 2 years
The presence of IgG in a constant or decreasing titer is not a disease and is not dangerous from the point of view of infection.
Illness during pregnancy (later than 1 trimester) - TREATED
Toxoplasma gondii is a ubiquitous pathogen belonging to the type of protozoa (Protozoa), the class of sporozoans (Sporozoa), the order of coccidia (Cossidia). In humans, T. gondii is dangerous only for pregnant women, since in 40% of cases this means vertical transmission of the pathogen to the fetus with subsequent severe lesions in the majority. However, the prevalence of toxoplasmosis among various groups of people with immunodeficiencies and its clinical significance should be reviewed.
If the mother is infected during pregnancy, transplacental transmission of the infection to the fetus is possible. The incidence of congenital toxoplasmosis ranges from 1 in 1000 to 1 in 10,000 live births... At the same time, toxoplasmosis can be transmitted through blood and during organ transplantation, which is facilitated by deep immunosuppression. Cases of infection through damaged skin are described.
Congenital toxoplasmosis is a rare but potentially dangerous condition. According to the latest epidemiological studies, the incidence of congenital toxoplasmosis in the United States is 1 in 10,000 newborns, 400-4,000 cases of the disease are recorded per year. In other geographic regions, these rates vary greatly. For example, in Belgium and France they reach 2-3 per 1000 newborns, i.e. 20 times higher. In Russia, the incidence of congenital toxoplasmosis varies within 1 in 1000-8000, and Toxoplasma infection in women of childbearing age is 20-30%. The seroconversion rate in pregnancy is 1-2 / 1000. In about 1/3 of cases (up to 60%), fetal infection occurs: a third of newborns have clinical forms, 2/3 - subclinical forms of the disease. The level of fetal infection increases with the growth of the gestation period in which the infection occurred, being minimal in the period shortly after conception: for the first trimester - 14% (clinical forms about 11%), for the second trimester - 29%, for the third trimester - 59% ( lower numbers can be found in the literature). However, the severity of the infection in the fetus and perinatal mortality are higher with the disease of a pregnant woman in the first trimester. The risk of congenital T. is during pregnancy (after menstruation): 0-2 weeks - 0%, 3-10 weeks - 2%, 27-30 weeks - 22%, 31-34 weeks - 67%. Each specific woman can have only one child. Despite 20 years of research, the role of T. as a possible cause of repeated abortions remains unclear.
Clinical manifestationsIn 70-90% of cases of congenital toxoplasmosis in newborns, there are no symptoms, the disease begins to manifest itself after months and years. Symptoms of congenital toxoplasmosis at birth may include rash, generalized lymphadenopathy, enlarged liver, spleen, jaundice, and thrombocytopenia. As a result of intrauterine meningoencephalitis, microcephaly, hydrocephalus, choreoretinitis, convulsive syndrome and deafness develop. Calcification foci in the brain can be detected by X-ray, ultrasound, computed tomography.
In 1985, the United States spent more than $ 221 million on the treatment, upbringing and education of these children (about 3300 people). In 2000, this amount has already exceeded $ 1 billion. It has been shown that the introduction in Finland of a national prolonged screening program to determine the likelihood of having a child with congenital toxoplasmosis would save up to $ 2.1 million annually.
Infection acquired after birth is usually asymptomatic. The incubation period ranges from 4 to 21 days and averages 7 days. In a small percentage of cases, an active process may develop, manifested by such nonspecific symptoms as fever, malaise, myalgia, lymphadenopathy. Also, patients may experience a mononucleosis-like syndrome in combination with maculopapular rash and hepatosplenomegaly. The clinical course is favorable, as a rule, this symptomatology is resolved without treatment. Complications such as myocarditis, pericarditis, pneumonitis rarely occur.
Ocular toxoplasmosis often develops with a congenital form of the disease, but also occurs in a small percentage of cases with infection during life. Signs of involvement of the eyes in the infectious process are blurred vision, characteristic retinal infiltrates that develop in 85% of young people after congenital toxoplasmosis. Ocular toxoplasmosis may reactivate several years after the primary infection.
In patients with chronic immunodeficiency conditions, including HIV infection, reactivation of chronic infection can lead to encephalitis, pneumonitis, and generalized toxoplasmosis. Newborns born to mothers with HIV infection or other immunodeficiency conditions and chronic T. gondii infection may acquire toxoplasmosis in utero as a result of reactivation of the maternal infection.
Diagnostics1. Histological examination of the lymph nodes with the identification of the pathogen: laborious and insensitive
2. Isolation of Toxoplasma in culture: tissue culture (mouse fibroblasts) - faster, and intraperitoneal inoculation in mice (6 weeks with subsequent determination of specific antibodies) - a more sensitive method
3. Determination of Toxoplasma antigen by immunofluorescence (sensitivity is limited)
4. Serological tests (8 methods). Ig G appears 1-2 months after infection and is determined in low titers for several years, Ig M appears within 1 week of infection and is determined within several weeks. The absence of Ig M and the presence of Ig G in titers above 1: 1000 indicates the presence of infection in the past... The diagnosis of acute Toxoplasmosis in a pregnant woman is based on the appearance of specific Ig G in the blood (seroconversion) or an increase in its titer after 3 or more weeks.
5. Determination of the DNA of the pathogen: PCR in amniotic fluid is an accurate and fast method for diagnosing fetal infection
6. Nonspecific tests (in a newborn): leukocytosis, ultrasound, liver enzymes. Ultrasound: expansion of the ventricles of the brain, increased echogenicity of brain tissue, liver, thickening and increased echogenicity of the placenta, hepatomegaly, ascites, pericardial and pleural effusion.
The main diagnostic method is serological. Immunoglobulins G (determined by indirect fluorescence or enzyme-linked immunosorbent assay) reach peak levels 1–2 months after infection and remain positive indefinitely. In patients with seroconversion or a fourfold increase in IgG titer, specific IgM should be determined to confirm acute infection. The presence of IgM confirms an acute or recent infection. The enzyme immunoassay is more sensitive in detecting IgM. IgM are detected 2 weeks after infection, reaching a peak concentration after 1 month, and usually disappear after 6-9 months, but can persist in some cases for more than 2 years, making it difficult to differentiate between acute and previous infections. Determination of IgA and IgE, the level of which rises faster than IgM, is useful in diagnosing congenital toxoplasmosis and examining patients, in particular pregnant women, for whom information about the duration and stage of the infectious process is extremely important.
If toxoplasmosis is suspected in newborns, a study of the visual, auditory and nervous systems, lumbar puncture, and computed tomography of the head should be performed. You should also try to isolate the pathogen from the placenta, umbilical cord, blood by infecting mice. An alternative would be to isolate the pathogen from the cerebrospinal or amniotic fluid using PCR. Transplacentally transmitted IgG ceases to be detected after 6-12 months. Patients with HIV infection may have variability in the IgG titer and the absence of IgM, therefore, with seroconversion and an increase in the IgG titer by 4 times, an active infection should be diagnosed. In toxoplasma-seropositive individuals infected with HIV, the diagnosis of encephalitis is established clinically, and only if therapy against T. gondii is ineffective, antigens or DNA should be isolated from a biopsy material or cerebrospinal fluid.
Isolation of the pathogen is possible when laboratory animals are infected, but the conclusion that Toxoplasma was found in this preparation does not carry any positive information, except that this patient was infected with them. Also, the absence of a pathogen in the preparation cannot serve as a basis for excluding toxoplasmosis, since it could simply not get into the material under study.
Features of diagnosis in pregnant womenSerological screening of pregnant women is carried out by determining antibodies in the blood - IgM and IgG. As a rule, the Sabin-Feldman test is used to determine IgG, and the immunofluorescence test (ELISA-IgM) is used to determine IgM. The absence of IgM in the blood makes it possible to exclude toxoplasmosis infection; the presence is not an absolute criterion for infection. Of great concern is the possibility of false-positive results, as they lead to serious consequences (termination of pregnancy, intensive diagnostic and therapeutic procedures, which can also lead to the termination of a normal pregnancy). All cases of positive results should be carefully studied in laboratories with experience in the diagnosis of toxoplasmosis, titers should be determined over time. Positive serologic test results should be complemented by fetal examination, including ultrasound, amniocentesis, and umbilical cord puncture.
Polymerase chain reaction (PCR) based on the detection of Toxoplasma gondii DNA in the amniotic fluid, considered to be the most reliable and safe method for the time being diagnostics, has now almost completely replaced the study of fetal blood. The sensitivity of the PCR reaches 64%, the predictive value of a negative result is 87.8%, the specificity is 100% and the predictive value of a positive result is 100%. Studies show that the sensitivity of the reaction is significantly increased if the infection occurs between 17 and 22 weeks of pregnancy. PCR allows diagnostics earlier in pregnancy (18 weeks of gestation), while the test for the detection of IgM in the blood of the fetus becomes positive only by 22 weeks, and allows early treatment or termination of pregnancy up to 24 weeks. A negative PCR result at any gestational age completely excludes the presence of congenital toxoplasmosis.
The main criteria for interpreting the results of serological screening for Toxoplasma gondii are presented in the table:
| IgG | IgM | Interpreting Analysis Results |
| negative | negative | No serological confirmation of Toxoplasma gondii infection |
| negative | doubtful | |
| negative | positive | Early acute infection or false positive IgM. Re-examination is necessary if the results remain the same, the patient is most likely not infected |
| doubtful | negative | |
| doubtful | doubtful | Undefined: retest needed |
| doubtful | positive | Early acute infection with Toxoplasma gondii is possible. Re-examination required |
| positive | negative | Toxoplasma gondii infection for more than 1 year |
| positive | doubtful | Infection with Toxoplasma gondii for more than 1 year or false positive IgM test. Re-examination required |
| positive | positive | Toxoplasma gondii infection for less than 1 year |
In 1948, J. Frenkel proposed to use an assessment of the response to intradermal administration of toxoplasmin (a complex of toxoplasma cell wall structures, mainly SAG1) for the diagnosis of toxoplasmosis. The principle of the reaction and its accounting are similar to the tuberculin test. It has been proven that the test is highly specific, it is not positive for other diseases. In foreign countries, this method is not used due to the complexity of drug standardization.
TreatmentMost cases of acquired infection in immunocompetent individuals resolve without specific therapy. For choreoretinitis or damage to vital organs, a combination of pyrimethamine with sulfadiazine is prescribed. An alternative may be the combination of pyrimethamine with clindamycin if sulfadiazine is poorly tolerated. In the treatment of choreoretinitis and CNS lesions, glucocorticoids are used. HIV-infected patients with encephalitis should receive lifelong suppressive therapy to prevent recurrence of infection.
For severe and asymptomatic congenital infections, a combination of pyrimethamine with sulfadiazine and folic acid is recommended as initial therapy. Therapy is usually long-term, sometimes up to 1 year.
Management and treatment If the mother is sick with toxoplasmosis in the first trimester, it is necessary to diagnose toxoplasmosis in the fetus and, if the result is positive, suggest termination of pregnancy. Treatment of toxoplasmosis that occurs during pregnancy, including in HIV-infected women, should be carried out with spiramycin... When a woman is infected in the third trimester or a fetus is infected after 17 weeks of gestation, a combination of pyrimethamine with sulfadiazine, folic acid is used. The appointment of spiramycin does not exclude fetal infection. In the treatment of acute toxoplasmosis, 77% of children are born without signs of the disease, and the clinical picture of the disease is manifested in 5% of newborns. In the absence of treatment, these figures are 39% and 14%, respectively. Nevertheless, the treatment of the mother remains controversial: incomplete efficacy, teratogenicity of some medications (pyrimethamine). But treatment of newborns with confirmed toxoplasmosis is mandatory: pyrimethamine, sulfadiazine, folic acid, possibly spiramycin... Treatment and observation continues throughout the year. Without treatment, lesions of the eyes and the central nervous system were observed in 40% of infected newborns, with treatment - only in 2%.
Role of catsThe main source of Toxoplasma in industrialized countries is meat products that have undergone insufficient heat treatment. Thus, 25% of lamb, 25% of pork and 1% of beef are contaminated with Toxoplasma cysts. Research in Norway, Italy and France has shown that eating raw or undercooked meat, unwashed vegetables and fruits, using unwashed knives after cutting raw meat, poor personal hygiene and cleaning street cat litter are risk factors Toxoplasma infection. Children under the age of 5 years and persons with immunodeficiency states of various origins are at the greatest risk of infection. There is no evidence that direct contact with cats, their presence in the home, or working with these animals increases the risk of Toxoplasma infection..
Thus, despite popular belief, cats are not the main source of infection. This fact also confirms the decrease in the incidence of toxoplasmosis over the past 50 years, despite the increase in the number of domestic cats.
Thus, the window period during which the animal is contagious is very short. If the cat is kept at home and eats only ready-made food, there is practically no risk of its infection with Toxoplasma. Animals that go outside and eat home-cooked food or trapped rodents can be infected, but their feces must remain in the cat litter for 1-5 days during the 2 week window period to become infectious... The greatest risk of infection is in garden soil or sandpits, which can be contaminated with cat feces for a long time.
Preventioncook the meat in such a way that its inner layers are heat-treated at least 60 ° C (with a characteristic color change);
do not taste meat during cooking;
wash kitchen utensils and hands when preparing food;
wash fruits and vegetables before eating;
close unused sandboxes and change sand when it is contaminated with excrement;
do not let domestic cats go outside;
feed cats only ready-made food, do not give them samples of raw meat;
at least once a day, clean and disinfect the "cat litter" (with gloves);
always practice good personal hygiene.
Pregnant women whose serostatus (presence of antibodies to toxoplasma) is unknown or seronegative should avoid contact with the ground and other objects that may be contaminated with feline feces, or use gloves and wash their hands after work.
Should pregnant women be screened for total toxoplasmosis? In countries with a high incidence of toxoplasmosis, secondary prevention programs have been introduced and are successfully operating - serological screening of pregnant women is widespread; in other countries, such as the United States, it was not economically viable to conduct a serological examination of all pregnant women, serological tests are carried out when possible signs of fetal infection are detected (usually with ultrasound).
J.A. Pinard, N.S. Leslei, P.J. Irvine, Maternal Serologic Screening for Toxoplasmosis., J Midwifery Womens Health 2003; 48: 308-16, http://web.yaroslavl.ru/obstandgyn/metod5.shtml?e
Connelly K.P. Pets and pests: Misconceptions about Zoonotic infections. Infect Med 2004; 21 (11): 557-65,
Urogenital mycoplasma infection belongs to the group of acute infectious diseases in humans and is characterized by a pronounced polymorphism of the clinical picture, moderate symptoms of intoxication, as well as involvement of the urinary tract in the process of inflammation.
Often, mycoplasmosis is latent or malosymptomatic, and is also combined with other infections of the genitourinary organs and, in the absence of timely therapy, can lead to serious complications, up to the development of infertility.
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1. Characteristics of mycoplasmas
The causative agents of infection are mycoplasmas, which are in an intermediate position between viruses and bacterial cells. The cell size of this pathogen is approximately 0.4-0.85 microns, and the average diameter is 0.40 microns.
Most microorganisms of the presented species lead to infection not only in humans, but also infect birds and animals. Of the large number of mycoplasmas, pathogenic for humans are:
- 1 M. Pneumoniae - the causative agent of mycoplasmosis of the respiratory system;
- 2 M. Hominis, M. Genitalium and U. urealiticum - causative agents of urinary tract infections;
- 3 M. Incognita is a poorly studied causative agent of generalized mycoplasma inflammation.
Urogenital mycoplasmas are minimal in size and free-living prokaryotic cells, which have some features:
Among other things, mycoplasmas have a wide genetic heterogeneity, and adaptation to new hosts leads to changes in the genetic code of the pathogen.
1.1. Participation in inflammation of the genitourinary organs
The causative agents of urogenital mycoplasmosis are widespread and most studied. To date, the question of the importance of these types of microorganisms in the development of infection of the genitourinary tract has not been finally resolved.
There are different points of view on the participation of mycoplasmas in the inflammation of the urogenital area. In connection with the widespread identification of them in healthy individuals, some scientists attribute them to conditionally pathogenic flora. However, from another point of view, a lot of ongoing studies prove their unconditional pathogenicity.
For example, M. Hominis and U. Urealyticum belong to the group of microorganisms constantly present in the human body and associated with genital infections. Precise evidence of their significant role in the development of inflammation of the urogenital tract has not yet been established.
They do not belong to unconditionally pathogenic microorganisms and only under certain conditions can cause an infectious and inflammatory process in the genitourinary organs, often only when associated with other sexual infectious agents.
It is shown that the frequency of sowing M. Hominis directly depends on the presence of concomitant inflammation in the genital tract. So in healthy individuals, it is sown in 5-15% of cases, and in case of inflammation of the genitourinary sphere in 50-80% of cases. In other words, the presence of M. Hominis is a marker of vaginal dysbiosis.
Of the entire Mycoplasmataceae family, in the last few years, M. Genitalium has played the most pathogenic role. For the first time, this type of pathogen was identified in 1981 in London in a patient with non-gonococcal urethritis, and was named Genitalium because of its characteristic localization in the urinary tract.
Subsequently, the study of this microorganism presented some difficulties due to the difficulty of cultivation and high demands on the quality of nutrient media. Sensitivity to the choice of a nutrient medium for the growth of mycoplasmas is associated with the small size of the mycoplasma genome and, as a result, with a small number of genes involved in the enzymatic decomposition of nutrient media.
In addition to all of the above, M. Genitalium can perform specific sliding movements that allow it to penetrate into the mucous layer lining the epithelial cells, and subsequently penetrate into these cells.
Tight adhesion or penetration into cells leads to a pronounced cytopathic effect with the formation of an immune inflammatory response. It has been proved that M. Genitalium, unlike other types of mycoplasmas (M. Hominis and U. Urealiticum), practically does not correlate with the number of sexual partners and the existing vaginal dysbiosis.
The undoubted pathogenic role of M. Genitalium was proved in experiments on chimpanzees, when the introduction of the pathogen into the urethra of the studied individuals led to the appearance of symptoms of urethritis and the appearance of specific antibodies in the blood serum of animals.
2. The role of vaginal microflora in the development of the disease
For the reproduction of mycoplasmas on the mucous membrane of the genital tract, certain conditions must be met. So, the optimal pH for the reproduction of mycoplasma infection is 6.5-8.2.
Normally, the pH of the vagina ranges from 3.8 to 4.3. Lactic acid is responsible for maintaining the acidic environment, which is synthesized from glycogen with the help of lactobacilli of normal microflora.
Normally, more than 90% of the vaginal microflora are lactobacilli, the rest of the bacteria (diphtheroids, streptococci, staphylococci, gardnerella, Escherichia coli) account for only 5-10%.
Under various adverse environmental influences (antibiotic therapy, hormone therapy, radiation, development of immunodeficiency, a sharp weight loss, deficiency of nutrients and vitamins), as well as in stressful situations, dysbiosis occurs in the vagina, the number of opportunistic microorganisms increases.
For example, such an opportunistic bacterium as G. Vaginalis in the process of metabolism secretes succinic acid, which serves as an energy source for other opportunistic bacteria, which leads to a shift in the pH of the vagina from 3-4.4 to 6.5-8.
This creates predisposing conditions for the colonization of the genitourinary tract by any types of mycoplasmas. Urea and mycoplasmas, in turn, actively absorb oxygen during metabolism, which causes the growth of anaerobic bacteria. This explains the frequent combination of mycoplasmosis and ureaplasmosis with other infections of the genitourinary tract and vaginal dysbiosis.
3. Ways of transmission
The source of the infection is a sick person or a carrier without clinical manifestations of the disease. The main route of transmission is sexual, and contact-household is not excluded - through hygiene items.
Childhood infection can be carried out through bedding, household items or toys. The possibility of the contact-household route of spreading the infection is significantly limited due to the instability of the pathogen in the external environment.
Primary infection of the upper parts of the genitourinary tract can be carried out through spermatozoa, carriers of mycoplasmas. Intrauterine infection of the fetus occurs vertically and during the passage of the newborn through the maternal birth canal.
With the sexual transmission of infection, the entrance gate is the cells of the vaginal mucosa (vulvovaginitis) or the urethra (urethritis). As a result of the interaction of the infectious agent with the host cell membrane, a change in the antigenic profile of cell membranes occurs and, as a result, the launch of a cascade of immunopathological reactions.
The absence of a cell wall in mycoplasmas creates conditions for the absence of an adequate immune response, which leads to a long persistence of the pathogen. With the development of mycoplasmosis, the secondary bacterial microflora and the stability of the microbiocenosis in the genitourinary system play an important role.
After the transferred infection, an unstable immunity is formed, the severity of the intensity of which depends on the severity of the disease, and the duration is up to 2 months.
The features of the course of the infection are:
- 1 Long-term chronic course with a tendency to relapse;
- 2 Systemic nature of the lesion;
- 3 Frequent resistance to antibiotic therapy.
4. Symptoms of mycoplasmosis
Urogenital mycoplasmosis is ubiquitous and often accompanies chlamydial, Trichomonas and gonococcal lesions of the urogenital tract, as well as various acute and chronic inflammation of the female genital area of \u200b\u200bunknown etiology.
The main clinical manifestations of the disease are nonspecific. The disease proceeds subacutely, without actively expressed symptoms.
4.1. Features of mycoplasma infection in women
Most often, women with mycoplasmosis have the following symptoms:
- 1 Slightly pronounced itching in the genital area;
- 2 Burning or cramps when urinating, dysuric disorders;
- 3 Inflammation of the vaginal mucosa (vaginitis);
- 4 Scanty cloudy or serous-purulent secretion of the vagina (urethra), irritating the surrounding tissues.
In women, depending on the localization of the pathological focus, mycoplasmosis is divided into two types:
- 1 External genitourinary organs - inflammation of the vagina, urethra, paraurethral zone, Bartholin gland.
- 2 Internal urogenital organs - inflammation of the uterine appendages, endometrium, ovaries, bladder, kidneys.
Most often in women, mycoplasma infection is localized in the vagina, urethra (urethra), glands of the vestibule of the vagina and Bartholin's gland. Mycoplasma vaginitis is often combined with concomitant opportunistic or completely pathogenic microorganisms.
Clinically, vaginitis is characterized by slight redness in the urethra and the hymenal ring, as well as slight cloudy (sometimes purulent) discharge.
On examination, the vaginal mucosa is edematous and hyperemic, with scanty cloudy discharge in the posterior fornix. The patient may complain of pain during intercourse, lack of sexual desire, deterioration in the quality of vaginal lubrication.
The defeat of the urethra of mycoplasma etiology in women often occurs latently, with little symptoms and for a long time. Patients are characterized by the appearance of mild pain or burning sensation during urination, as well as the phenomenon of scanty mucopurulent discharge from the urethra, more abundant in the morning hours.
The outer ring of the urethra is hyperemic when viewed, the first portion of urine is visually turbid, and specific mucous threads can be detected in it. If not properly treated, urethritis can lead to the development of cystitis (inflammation of the bladder wall).
The predisposition to the transition of inflammation from the urethral zone to the bladder is explained by the anatomical and physiological features of the functioning of the female genitourinary system: a short and wide urethra, as well as its approximate location to the entrance to the vagina and anus. All this creates favorable conditions for the constant vegetation of microflora and colonization of the urethral lumen and urinary bladder.
Often, mycoplasmosis of urogenital localization in women has no pronounced symptoms at all and proceeds latently. However, under the influence of negative environmental factors (disruptions in the hormonal system, hypothermia, decreased general immunity, etc.), vivid symptoms of vulvovaginitis or urethritis may appear, often leading to complications.
The main complications of urogenital mycoplasmosis are:
- 1 Abscess formation of the Bartholin gland, located in the vestibule of the vagina and responsible for the production of vaginal secretions;
- 2 Ascending lesions of the female genital organs, with the development of endometritis, salpingitis, ovarian inflammation;
- 3 Ascending damage to the renal CSF with the development of pyelonephritis;
- 4 Infertility, recurrent miscarriage.
4.2. Features of mycoplasmosis in men
In men, mycoplasma lesions are often latent and asymptomatic, which is dangerous in terms of carriage and transmission of infection to a sexual partner. Most often, mycoplasma urethritis develops, and mycoplasma cystitis, on the contrary, develops much less frequently.
A man may be bothered by symptoms such as a burning sensation when urinating, especially pronounced in the morning hours, clouding of urine, minor discharge from the urethra. On examination, redness and swelling of the external urethral opening can be noted.
In the absence of treatment and pronounced immune disorders, urethritis can be complicated by the symptoms of balanitis or balanoposthitis. The patient develops itching and discharge from the preputial sac (the space between the foreskin and the inner layer of the penis).
After pushing back the foreskin, intense inflammation and redness of the epithelium can be detected. The surface of the head when viewed is swollen, loose, hyperemic or macerated.
In the future, erosion, abrasions and small ulcers may appear on the head. Long-term current balanitis can lead to phimosis - a narrowing of the foreskin and difficulty in opening the head.
Complications of mycoplasmosis of the urogenital region in men are also chronic prostatitis and epididymitis (inflammation of the epididymis). The ability of mycoplasmas to adhere to sperm walls can also lead to infertility.
4.3. Effects on pregnancy
The course of pregnancy in the presence of mycoplasma infection in 50-70% of cases is complicated by the threat of termination of pregnancy, starting from the first weeks. Infection of the endometrium and ovum leads to impaired implantation of the embryo and activation of autoimmune mechanisms, which often causes abortion and the development of uteroplacental insufficiency.
As a rule, while maintaining pregnancy, it is often complicated by gestosis, oligohydramnios, hypercoagulability. Characterized by early development of gestosis, starting from 24-25 weeks of pregnancy.
The most common complications of pregnancy are:
- 1 Disorders of intrauterine development of the fetus, the formation of congenital malformations;
- 2 Lack of uteroplacental blood flow;
- 3 Stillbirth;
- 4 Increase in perinatal morbidity;
- 5 Intrauterine fetal infection;
- 6 Infection of the fetus during the passage of the maternal birth canal.
4.4. Intrauterine fetal infection
With mycoplasmosis of the urogenital tract, even in the absence of clinical signs of infection, laboratory diagnostics can reveal an increase in the level of IL-8 in the amniotic fluid, which can cause the development of bronchopulmonary dysplasia in the fetus. Subsequently, this threatens the development of interstitial pneumonia of the newborn, accompanied by severe microcirculation disorders.
Intrauterine mycoplasma infection can cause spontaneous abortion or fetal death shortly after delivery. Such a newborn is often premature and low in body weight. The phenomena of fetal malnutrition are noted in 30-40% of cases of proven mycoplasma infection.
The skin of a newborn baby is often pale with a grayish tinge. There is acrocyanosis or general cyanosis of the skin, severe jaundice, respiratory tract damage. By the end of the first seven days of a child's life, signs of meningoencephalitis and hemorrhagic syndrome may join.
Often, the low-symptom and latent course of mycoplasmosis is activated during pregnancy, decreased immunity, hypothermia, in stressful situations and can cause such severe complications as septic spontaneous abortions, various types of inflammation in newborns, inflammation in the organs of the urogenital tract. In about 30% of cases, disorders in the development of the fetal nervous system, malformations of the kidneys and heart can be observed.
5. Indications for examination
The main indications for examination for the presence of mycoplasmas are:
- 1 Infertility with the exclusion of all other possible causes;
- 2 Chronic inflammation of the organs of the urogenital tract with a tendency to frequent relapses;
- 3 Inflammation of the genital tract in a partner;
- 4 History of frozen pregnancy, hemostasis disorders, spontaneous abortion;
- 5 Complications of the course of pregnancy;
- 6 Detection of autoimmune antibodies to hCG or phospholipids;
- 7 Changes in the coagulogram, chronic disseminated intravascular coagulation syndrome.
6. Diagnostic methods
The diagnosis of mycoplasmosis is established on the basis of a characteristic clinical picture, anamnesis of the disease, patient examination data and the results of additional research methods (cultural and immunological examination).
The causative agent of infection can be found in vaginal smears, scrapings from the cervical canal, prostate secretions, and semen. The sampling of material for bacteriological research should be carried out before the start of antibiotic therapy for infection.
The following microbiological methods are used to detect colonies of mycoplasmas:
- 1 Cultural - has 100% specificity, and allows you to establish not only the presence of the pathogen, but also to determine its titer. The disadvantage is low sensitivity associated with the inadequacy of nutrient media, a large number of strains and the frequent inability of mycoplasmas to grow in the absence of living cells for cultivation. To carry out bacteriological inoculation, it is necessary to take a smear from the urethral canal or vagina, which is subsequently placed in a special nutrient medium, where mycoplasma colonies grow. When detecting mycoplasmas and ureaplasmas in a titer of no more than 10x4, they indicate the carrier of the infection, and the likelihood that mycoplasma could cause inflammation of the urogenital tract is negligible. An excess of this titer is an indication for antibiotic therapy. It should be noted that when M. Genitalium is detected in smears, treatment is carried out to all patients, regardless of the number of bacteria detected, which is associated with its unconditional pathogenicity;
- 2 Immunological, the essence of which is the detection of mycoplasma antigens and developed antibodies to them. Immune diagnostic methods play a significant role in the diagnosis of mycoplasmosis and are used everywhere. In this case, it is important to pay attention to the increase in the titer of specific antibodies in the patient's blood. An increase in antibody titer in dynamics by four times or more is diagnostically significant. during an immunological study, one should also pay attention to the nature of antibodies, which are of two types - M and G. The detection of type G antibodies, without the concomitant detection of M, indicates a previous infection with the formation of immunity to it. The presence of type M antibodies indicates an acute process.
- 3 Molecular biological, aimed at high-quality detection of the pathogen. For this, PCR or a combination of PCR with an immunological study is used. This type of research is by far the most accurate (99% specificity). For PCR, you can use the patient's blood serum or scraping from the mucous membranes of the genitourinary tract. The disadvantage of the method is the absence of a quantitative determination of the pathogen's DNA, which does not allow the doctor to make a choice about the need for a study. However, with the help of this method, M. Genitalium, which is often not diagnosed by culture, can be detected.
It is also possible to study the placenta, where specific changes of the same type are characteristic:
- 1 Dystrophic changes present in all layers of the placenta, with a predominant vascular lesion (swelling of the endothelium, narrowing of the lumen, formation of microthrombi) and the basal lamina;
- 2 Severe stromal fibrosis, deformation of chorionic villi;
- 3 Presence of foci of lymphocytic-plasmacytic infiltration in the basal plates and septa.
Sometimes, with urogenital localization of mycoplasmosis, laboratory diagnostic methods may be of little informative due to the fact that mycoplasmas are weak antigenic irritants, and the immune system is often suppressed by the presence of concomitant infection.
7. Indications and principles of treatment
Most scientists believe that certain criteria must exist for the appointment of antibiotic therapy, the main of which are:
- 1 Clinical signs of inflammation of the genitourinary tract, confirmed by laboratory research;
- 2 Qualitative detection by culture of M. Genitalium (without the need for quantitative diagnostics) or detection of antibodies to M. Genitalium in any diagnostic titer;
- 3 Qualitative and quantitative identification of M. Hominis during culture research at a concentration of more than 10x4 CFU / ml;
- 4 Planned surgery or invasive procedures on the organs of the urogenital tract;
- 5 History of infertility, when all the causes leading to it, except mycoplasmosis, are excluded;
- 6 High risk of developing pathology of pregnancy and impaired gestation.
For etiotropic therapy of mycoplasmosis, antibiotics are used that affect the synthesis of protein and DNA of the pathogen cell. These are drugs of a number of tetracyclines and macrolides.
When determining the sensitivity of mycoplasmas to antibacterial drugs in vitro, it was determined that the most effective are josamycin, doxycycline, azithromycin, ofloxacin. Clinical studies of efficacy have only been conducted in the past ten years, and are few, including a small number of patients.
Antibiotics with stable and high effectiveness are josamycin, doxycycline, ofloxacin. Thus, they are the drugs of choice for the treatment of urogenital mycoplasmosis.
The advantages of josamycin include its low toxicity, the possibility of use during pregnancy, wide distribution in the body, high efficiency and a small percentage of resistance of urogenital mycoplasmas.
If eradication therapy is ineffective, alternative regimens are used, mainly based on the latest generations of fluoroquinolones.
It is advisable to combine antibiotic therapy with the intake of systemic enzyme preparations (wobenzym, phlogenzym), which potentiate the effect of antibiotics.
Given the inhibitory effect of antibiotics on the intestinal microflora, it is also necessary to include drugs in the treatment regimen aimed at normalizing the normal intestinal microflora. It also contributes to the normalization of the vaginal microbiocenosis and the creation of negative conditions for the reproduction of mycoplasmas.
Can you please tell me if it is possible to contract toxoplasmosis from a person with whom you are in constant contact (colleagues at work), or are only feline carriers of this disease?
Toxoplasma can be contracted practically from humans. The source is feline. Especially dangerous for the fetus. As you can see, there is still a mechanism - mother - fetus. A person, carrier or patient with toxoplasmosis, is not
I'm 21 weeks pregnant. To be on the safe side, I was tested for toxoplasmosis. The result is IgM 1:50 1.5 positive, IgG 34.6 positive. Please tell me how dangerous it is for the fetus, whether there is a need for treatment. Now I am treating ureaplasma, is it possible to combine treatment?
the presence of IgM indicates recent infection. can have an adverse effect on the fetus, but with timely treatment, the consequences can be avoided. toxoplasmosis is treated by an infectious disease doctor. Treat this infection with antibiotics of the same groups that are used for treatment, so that a combination of treatment for both infections is possible.
When I came to register at the hospital at 12 weeks of pregnancy, the doctor said that I had cervical erosion. After giving birth, the doctor made a biopsy and said that it was not erosion and sent a smear for ureaplasma, mycoplasma, chlamydia, herpes virus and blood from a vein for toxoplasmosis and cytoplasmovirus. I've passed. Then it turned out that instead of a smear for ureaplasma, they took a smear for Trichomonas vaginalis. But the doctor said that if there is no Trichomonas vaginali, then most likely there will be no ureaplasma. And she said I can not take it at all for toxoplasmosis, since it most likely will not be (since I did not have a miscarriage during this pregnancy, everything is in order with the child and nothing bad happened to him). As a result, chlamydia, mycoplasma, herpes virus, Trichomonas vaginalis and toxoplasma were not found. But I have something on the cervix (similar in appearance to erosion, but not erosion). The doctor believes that this is against the background of hormonal disorders during pregnancy.
QUESTIONS:
1. What can I have?
2. Is it true that since there is no Trichomonas vaginalis, then there is no ureaplasma?
3. Is it true that there should not be Toxoplasma, because the child is healthy and was born normal?
4. Can it be caused by staphylococcus aureus in me (it was found in a child after birth, but it is not in milk) and how to determine its presence in me (a simple smear was taken from me after childbirth, colpitis was found, I have already cured it): Would they find him with an ordinary smear, if he was or need to do a special analysis for staphylococcus?
1. What is and what is the essence of treatment. With erosion of the cervix, the cylindrical epithelium (mucous membrane) of the inner part of the cervical canal is located on the vaginal part of it, where the squamous epithelium (the mucous membrane of the outer part of the cervix) should be. The reason may be the youthful structure of the cervix. In women over 24 years old, such a structure is considered pathological. The cause of erosion in adulthood is most often an inflammatory process in the cervix, and in second place - hormonal disorders. With its cure, erosion, if it is small, can heal itself. During childbirth, tears and ruptures form in the cervix, as a result of which the cervix turns out a little. In this case, the mucous membrane of the cervical canal is turned inside out into the vagina. This is no longer called erosion, but ectropion. The cervix becomes loose and easily vulnerable. At the same time, various pathological processes can develop in it. The risk of developing pathology is higher with a large amount of erosion. With a large size of erosion or pathological changes, treatment is necessary. Erosion therapy consists in the destruction of the pathological epithelium, then a normal one is formed in its place. Women who have not given birth or who have given birth, but with very little erosion, are not cauterized, unless it has passed into leukoplakia, dysplasia, etc. It is recommended to see a gynecologist every 6 months. If treatment is still necessary. Erosion is cauterized with a laser, cryodestruction (freezing) and diathermocoagulation are also used. The latter is less preferable due to side effects. In addition, when viewed for erosion, you can take inflammation of the cervix - cervicitis. If the biopsy does not reveal pathological changes, the most common of which are dysplasia and leukoplakia. That can be simply observed once every 6 months. at the doctor, you have nothing to worry about. Otherwise, it is necessary to be treated.
2. Ureaplasma in 30% of men and women are representatives of the normal microflora of the genital tract. They are most often found in sexually active people. If they do not cause inflammation in partners, then no treatment is required. In the presence of inflammation, appropriate therapy is carried out. is a sexually transmitted infection. So the absence of one absolutely does not exclude the presence of the other.
3. If you have pets, especially cats, that walk down the street, then there is a possibility that you have toxoplasmosis. But since the child was born healthy, and the pregnancy proceeded without complications, then the disease is either in a dormant form, or it really does not exist.
4. In order to find out if you have Staphylococcus aureus, it is necessary to make a culture. Excretions are taken from the genital tract and placed on a nutrient medium. Within a week, microorganisms living in the vagina germinate, and then determine what kind of bacteria it is and to which antibiotics are sensitive. But keep in mind that in a small amount, Staphylococcus aureus may be normal in the genital tract.
I have a cat that does not go outside. Do I need to be tested for toxoplasmosis if I am planning a pregnancy? Is there a real possibility of infection?
Of course, if a cat was born from a domestic cat, and has not had contact with other animals since birth, then the probability of infection is extremely low. However, for your own peace of mind and for the health of the unborn child, I recommend that you pass this analysis.
Please tell us about toxoplasmosis during and after pregnancy and the impact of this infection on the development and health of the baby after birth.
Infection with this disease during pregnancy often leads to either spontaneous miscarriages, or to fetal damage and developmental defects, or the child is born with symptoms of this. Treating the disease during pregnancy reduces the risk of adverse effects on the fetus. The disease is treated by infectious disease doctors and pediatricians. When planning pregnancy, the mother should be absent in the blood of Ig M, and Ig G should not exceed the value "4".
I was found to have Toxoplasma on the 4th month. IgG-\u003e 100IU / mL IgM- (if I read the tests correctly) then-2000 IU My doctor told me that I need to donate blood for toxoplasma again and if it does not rise higher .. then they will take the baby's "water" .. for analysis .. whether the child is infected or not. Please answer me .. what awaits me and my child?
Judging by the research results, you have acute toxoplasmosis. Infection with this disease during pregnancy often leads to fetal damage and developmental defects, or the child is born with symptoms of this disease. However, if the amniocentesis (examination of the amniotic fluid) shows that the baby is not affected, then everything will probably be fine. Treating an illness during pregnancy also reduces the risk of adverse effects on the fetus.
In November 1998. on the 5th month pregnancy was discovered toxoplasmosis. The analysis was submitted at 8 weeks, but they paid attention to it only at this time. IgG \u003d 400. Abortion was recommended and done. An immunologist prescribed the following treatment: revomycin, 3 ml x 3 r for 7 days; nizoral 1t x 2p 10 days; fentorol 1t x2r 10 days; calcium D3 1t x1r 1 month; Trinsin 10 ml / m No. 10; 2nd stage: lactobacterin - 5 doses x1p per day; 3rd stage - as 1st, only instead of revomycin - doxycycline, 0.1 x 3p 7d \u003d tarivid 0.2 x 2p; 4th stage: as 2nd; after 1.5 months: tindurin 0.025 x 2p per day. In conclusion - 4-5 weeks - "Narine". On August 7, 1999, after treatment, the result was as follows: IgG \u003d 220. Biseptol and fenkorol were prescribed. 01/20/2000 - JgG \u003d 200. We have the following questions: A young woman, 20 years old, very much with her husband want children, but they are afraid. At what result of the analysis can you try to have a child? How to be treated further? There is an opportunity to go to Moscow in April. In which center can you consult, get tested, etc.
with the indicators available to you, it is too early to think about the child. A lack of IgM and a decrease in IgG are good signs indicating a healing process. But in order to have a child, IgM should not be at all. And the total Ig, to which, as a rule, IgG is equated, should not exceed the value "4". At this stage, you should periodically take a blood test for antibodies. After their normalization, you should see an infectious disease specialist. If suddenly the indicators begin to grow, you will need to see a doctor immediately. In Moscow, you can go to the maternity hospital at the infectious diseases hospital No. 2.
I had a 6-8 weeks undeveloped pregnancy. After examination, the following viruses were found: CMVI - JgG -1: 50; AI \u003d 39% (past infection); toxoplasmosis JgM - sample, JgG - 1: 800, D titer\u003e 1: 400, ureaplasmosis, mycoplasmosis. Please consult me \u200b\u200bon the effective treatment of these diseases, as well as the possibility and effectiveness of the drug "polyoxidonium".
Your data indicate that you have active toxoplasmosis. Apparently this was the reason for the frozen pregnancy. Therapy for this disease is carried out by an infectious disease doctor. CMV infection does not require treatment because it is in an inactive (dormant) form. and ureaplasma refers to sexually transmitted infections. However, in 10% of women, and ureaplasma are representatives of the normal flora of the vagina. If, in the presence of these microorganisms in the smear, there is no inflammatory process in the cervix and vagina, then treatment is not required.
I have a deadline of 9 weeks. I took tests in the clinic. The doctor said that the results for toxoplasmosis, CMV and rubella are negative. Reading the previous questions, I realized that the tests include antibody levels and titers. Do I need to know this data? Or the concept of "negative analysis" already suggests that the analysis was considered in detail for all components.
Answer options "safe" during pregnancy:
IgM-neg, IgG - neg and IgM-neg, IgG - titer for CMV and Toxoplasma; at - IgM-neg, IgG - titer.
Please help me figure out the test result for toxoplasmosis: IgM not detected, IgG sand. 30 IU / ml at N IgG< 25 ме/мл. Как это может повлиять на будущую беременность.
You had this infection more than 2 years ago. (In Holland, 80% of the population carries toxoplasmosis in their lifetime). The infection is dangerous only when a pregnant woman becomes infected for the first time. The transferred infection does not affect the future pregnancy.
