Clasa Sporozoare.trans. Ppt
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Clasa Sporozoare
Note de curs Dr. Ramona Stoicescu
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Definitie
• Protozoare parazite imobile localizate intra- si extracelular in diferite organe şi cavităţi ale gazdei
• În decursul îndelungatei existenţe parazitare s-au produs modificari degenerative în organele de locomoţie, digestie si excreţie, amplificându-se in schimb capacităţile reproducatoare
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Reproducerea: 2 moduri
• Asexuat: ciclul schizogonic• Sexuat: ciclul sporogonic
• CLASIFICARE: in functie de localizare• Sporozoare sanguine: genul Plasmodium• Sporozoare tisulare • a. Genul Toxoplasma : in sistemul
reticulohistiocitar• b. Genurile Isospora, Sarcocystis,
Cryptosporidium in celulele epiteliului intestinal
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Genul Toxoplasma
• Are ca specie tip Toxoplasma gondii, boala pe care o produce se numeste toxoplasmoza
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Morfologie 3 forme
• 1.Forma vegetativa: trofozoit• Forma semiluna, Lg 5-10/2-3 microni• Ovoid, piriform sau semilunar asimetric• Centru: nucleul inconjurat de cittoplasma
granulara• Sensibil la actiunea sucului gastric, de aceea
inghitirea parazitului in aceasta forma nu duce la infectie
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• Toxoplasma gondii in the bronchoalveolar lavage (BAL) material from an HIV infected patient. Numerous trophozoites (tachyzoites) can be seen, which are typically crescent shaped with a prominent, centrally placed nucleus. Most of the tachyzoites are free, some are still associated with bronchopulmonary cells. CDC
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2. Chistul tisular
• Aglomerare de forme vegetative • Poate fi localizat in orice ţesut dar are
predilectie pentru tesutul muscular, tesutul nervos, ochi unde se poate adaposti fara reactii inflamatorii
• Chistul apare dupa ce organismul gazda reactioneaza imunologic fata de agresiunea parazitara
• Chisturile tisulare pot persista toata viata gazdei fara sa duca la aparitia unor manifestari clinice
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• Chistul tisular poate atinge 100 microni si contine mii de bradizoiti sau hipnozoiti cu metabolismul redus la maximum
• Chistul e rezistent la temeperaturi de – 16 C pana la 60 C, la actiunea dezinfectantelor
• In mediu extern poate supravietui pana la 1 an
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Chist tisular
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Chisturi tisulare T. gondii (tahizoiti) in ficat
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Chist cerebral HE
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3. Oochist
• Ia nastere in intestinul felinei infectate• Initial multiplicare asexuata apoi sexuata rezultand
oochistul eliminat prin fecale• Oochistul sporuleaza in cateva zile (conditii de mediu,
umiditatea, temperatura)• Fiecare oochist coontine 2 sporochisti iar acestia contin
cate 4 sporozoiti=formele infectante• Dimensiune- aprox 12 microni• Infectios pentru om, alte mamifere inclusiv feline
( pisici)care nu au facut boala• Pisica face boala o singura data in viata boala dureaza
cca 2 saptamani timp in care poate excreta milioane de chisti
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Oochist contine 2 sporochisti
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Ciclu de viata
• Felinele se infecteaza prin consum de carne cruda sau insuficient prelucrata termic care contine tahizoiti sau chisturi tisulare sau ingerand oochisturi eliberate in mat fecale ale unei feline
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Omul
• Se infecteaza prin consumul de carne in sange sau insuficient prelucrata termic care contine tahizoiti sau chisturi tisulare
• Ingera oochisturi eliminate in materiile fecale de pisca ce contamineaza fructe, legume, apa
• Transmitere congenitala de la mama la fat• Mai rar: transplant de organ de la donator infectat la
receptor neinfectat in antecedente• Persoana fara imunitate anti toxo prin contaminare
accidentala in laborator
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• Parazitii patrunsi in gazda umana (sporozoiti din oochisturi sau bradizoiti din chisturile tisulare) patrund si se multiplica in macrofage
• Macrofagul se distruge, elibereaza trofozoitii, trec in sange si infecteaza alte macrofage si in final orice celula nucleata: stadiul acut al bolii sau primoinfectia (parazitul se multiplica rapid, produce distugeri tisualre)
• In urma aparitiei raspunsului imun eficient la gazda cu imunitate normala procesul de multiplicare al trofozoitilor se orpreste, se opreste atacul asupra celulelor nucleate, trofozoitii transformandu-se in bradizoiti sau hipnozoiti
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• Bradizoitii sau hipnozoitii (metabolism celular redus) in interiorul chisturilor tisulare: adapostesc mii de exemplare cu localizare preferentiala in CREIER, RETINA, MUSCHI fara reactii inflamatorii tisulare
• Daca imunitatea e normala, gazda e asimptomatica tot restul vietii
• Imunodepresie: bradizoitii se transforma in tahizoiti = paraziti activi, multiplicare activa- REACTIVARE INFECTIEI CU BOALA MANIFESTA
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Manifestari clinice
• Toxoplasmoza dobandita
Gazda imunocompetenta
Gazda imunodeprimata
• Transmiterea congenitala
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Toxoplasmoza dobandita
• Asimptomatic
• Semne minore: adenopatie cervicala nedureroasa (saptamani, luni)
• Febra 38C
• Astenie intensa si durabila
• Mialgii
• Prurit, urticarie
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Imnuodeprimati• SIDA; tratamente imunsupresoare, citostatice, etcPrimoinfectie: severa
• Forme meningiene• Encefalita, miocardita• Leziuni oculare
Reactivarea unei toxoplasmoze: reactivarea chisturilor toxoplasmice latente cu necroza tisulara si vasculita ( encefalita difuza cu cefalee si obnubilare progresiva sau forma pseudotumorala cu hemiplegii, hemipareze, tulburari vorbire)
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Encefalita
• Cefalee, febra, psihoza, tulburari de vedere, vorbire, miscare si tulburari gandire
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Toxoplasmoza congenitala
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Toxo congenitala
• Trim I• Forma grava, Triada Sabin: calcificari cerebrale,
hidrocefalie/microcefalie, retinocoroidita• avort spontan, fat mort intrauterin
• atingere pluriviscerala: hepatosplenomegalie, icter, encefalopatie
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Trimestrul II si III
• Forme atenuate
• Afectari oculare de tip retinita, retinocoroiditelor, cataractei
• Afectari neurologice hipotonie, somnolenta, convulsii, retard psihomotor, paralizii spastice
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Toxo congenitala tardiva
• Fat aparent normal, suspiciune de boala ( mama seronegativa devine seropozitiva T gondii in t sarcinii)
• Se urmareste in dinamica serologia n.n. pentru T. gondii in primul an viata
• NN sero+ trebuie tratati chiar daca sunt asimptomatici altfel dezvolta hidrocefalie, retard psihomotor, crize comitiale, corioretinite bilaterale care evolueaza in jurul varstei de 18 ani cu pierderea vederii
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Leziuni macula
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Meningoencefalocelul si ciclopia cu astomie (purcei din scroafa cu toxo), T.este teratogen si la
animale
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Diagnostic
• Metode directe evidentierea a parazitului: prelevari de la nivel ggl, muscular, LCR, cordon ombilical, placenta
• Examinare microscopica si cultivare
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Metode indirecte: dg imunologic
• Detectia anticorpi sau antigene de T. gondii• ELISA, ISAGA (immunosorbent agglutination
assay)• Ag parazitare: Western Blott si PCR reactia de
amplificare genica
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T. gondii culturi celulare
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Dg femeia insarcinata• Statusul ar trebui detereminat inainte de sarcina
( nu se intampla)• Ac de tip IgG si absenta IgM: infectie cronica, fatul
protejat• Ac in in dinamica• Lipsa IgM titru mare de IgG care creste indica
reactivarea bolii• Efectuarea concomitenta a doua teste cu principii
diferite sau antigene diferite• Ac de tip IgM, IgA, IgE: primoinfectie cu risc major
fetal• Prezenta ac IgM, IgA, IgE la nn dg toco congenitala
– nu ppt strabate BFP inseamna ca sunt sintetizati de fat
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Tratament
• Nu se administreaza persoanelor imunocompetente in faza acuta (boala autolimitata, de multe ori asimptomatica)
• Se adm persoanelor cu imunodepresie sau imunocompetente cu atingere viscerala
• Scop: oprirea multiplicarii si distrugerea sporozoitilor in stadiul acut al bolii
• Chisturile sunt rezistente la tratament• Terapie antiparazitara 1-3 cicluri de 21 zile
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• Pirimetamina 25mg/zi si Sulfadiazina -2 g/zi 1- 3 cure de 21 zile separate de cate 2 saptamani de trataemnr cu spiramicina 3 mil UI la 8 ore
• Se mai pot administra: azitromicina, clindamicina, claritromicina
• La gravide spiramicina• La HIV clindamicina
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Profilaxie: f importanta la imunodeprimati si femei gravide
• Prelucrarea termica carnii• Spalarea fructelor, legumelor• Atentie la transfuzii de la persoane cu ac
a-Toxo• Evitarea contactului cu pisica
nedeparazitata pentru femeia gravida cu status serologic negativ pentru Toxo.