– Trichomonas vaginalis (vaginal), discovered in 1836 by A. Donna, and related Trichomonas - T. tenax (oral) And T. hominis (intestinal), living in the oral cavity and large intestine as commensals of the human body, belong to the subtype Mastigophora, class Zoomastigophora, order Trichomonadida.
Trichomonas vaginalis has an ovoid shape and a diameter from 10 to 25 microns. On its wide anterior part there are four flagella, a nucleus with a nucleolus and a blepharoblast.
The axostyle passing through its body comes out in the form of a point (Fig. 15).
Clinic and epidemiology.
Rice. 15. Trichomonas: 1 – blepharoblast; 2 – flagella; 3 – nucleus with nucleolus; 4 – axostyle
Trichomoniasis– a sexually transmitted disease, manifested in inflammatory processes in the vagina, urethra and bladder, and in men – damage to the prostate, testicles.
Trichomoniasis occurs chronically with periods of remissions and exacerbations. In women, itching and a burning sensation in the area of the external genitalia and perineum with foamy yellow discharge from the vagina predominate; in men, frequent painful urination occurs. The source of infection is sick people and carriers of Trichomonas. Infection occurs through sexual contact, as well as through toilet items, sponges, toilet bowls.
Laboratory diagnostics.
Diagnosis of trichomoniasis is carried out by microscopy of native preparations, as well as smears stained with methylene blue, according to P Omanovsky-Giemsa and modified Gram method. To detect trichomonas, ejaculate, prostate secretions, urine sediment from men and vaginal lavage from women are examined. Native preparations are prepared and examined immediately after taking the material. It should be delivered to the laboratory within the next 2 hours. The resulting suspension is covered with a cover glass and microscopically examined with a ×40 objective lens and a ×7–10 eyepiece.
The smear is stained with 1% aqueous solutions of methylene blue for 1 minute. Trichomonas in the preparation have a round or oval shape, with intensely blue colored nuclei; the cytoplasm of the cells is light blue, with a delicate mesh structure, vacuoles are colorless. When stained according to Romanovsky-Giemsa, the smear is fixed with Nikiforov’s mixture.
The azure-eosin solution is applied to the smear for 30–40 minutes.
In stained preparations, Trichomonas have an eccentrically located oval purple-violet nucleus.
The cytoplasm of the cells is painted light blue, the membrane is clearly contoured, the vacuoles remain colorless. To stain the smear, a modified Gram method is used (at the final stage, not aqueous fuchsin is used, but an aqueous solution of neutral red). The nuclei of Trichomonas cells are stained violet, the cytoplasm is stained red-orange of varying intensities.
Trichomonas are grown at a temperature of 36 oC in meat-peptone broth with 0.1% glucose and 10% horse or human serum, adding to it 30% units of penicillin and 200 units of streptomycin per 1 ml of MPB. They grow in the broth after 3–6 days, accumulating at the bottom of the test tube.
Immunity.
Humans have no natural immunity to Trichomonas. During the course of the disease, agglutinins and complement-fixing antibodies are produced to them, allergization of the body occurs, but these immunological changes do not prevent reinvasion.
Many patients who are diagnosed with trichomoniasis are surprised where they got it from. A large number of married couples begin to have disagreements precisely because one of the partners is diagnosed with an infection and the second accuses him of infidelity, unfairly believing that there is no other cause of the disease. Although those who have been diagnosed with trichomoniasis must be told by their doctor where it could have come from, since the cause of the infection is not necessarily the partner’s infidelity.
Trichomoniasis: causes
This term means a disease that is provoked by a pathogen - Trichomonas. To date, it has been established that there are about fifty species, three of which can live in the human body and harm it. This conclusion was made by doctors of the 19th century, and they also argued over whether the infection should be divided according to its location or not. However, trichomoniasis, the causes of which will be discussed a little below, still differs in its course, symptoms, and methods of treatment, depending on the type.
Modern medicine is absolutely sure that even a small child can be a carrier of Trichomonas. His infection appears due to infection from his mother, and in her, in turn, it occurs as a result of exposure to certain factors. At the same time, it is likely that a person will be tested for sexually transmitted infections more than once in his life and the results will be negative. And at the same time, such a carrier, being at sexually mature age, transmits the pathogen to each of his sexual partners, without suspecting it.
To more accurately understand what Trichomonas is, where the infection comes from and how to avoid it, you need to understand the very cause of the infection. This microorganism, belonging to the class of flagellates, can provoke only one of three types of disease:
The mechanism of transmission of infection does not involve the transfer of the pathogen from one species to another, i.e. if the carrier has a certain type of microorganism, then the same type will subsequently be found in his partner. The causes of trichomoniasis, therefore, should be distinguished from the causes of infection, since not every carrier is faced with the need to treat the infection that has arisen.
Where do Trichomonas come from?
Despite the many existing versions about the possible cause of the occurrence of trichomonas through domestic means, qualified doctors are unanimous in their opinion: the pathogen appears only in two cases:
- Unprotected sexual contact with a carrier of the infection causes illness in an adult;
- Transmission of the disease to a newborn from an infected mother is the cause of illness in the child.
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All theories that one can become infected by wiping a patient with a towel or swimming with him in the pool are not consistent with information about the life cycle of the pathogen: outside a suitable environment it dies within 10-15 minutes, and in physiological fluids (urine, semen) lives no more than an hour.
Thus, there is only one answer to the question of what causes Trichomonas: its appearance is possible only through transmission from a sick person to a healthy one. Therefore, you should take all necessary measures to avoid this: do not engage in casual sexual contact, especially during pregnancy, and before planning the latter, undergo a full examination for possible infections. If necessary, they should be treated before pregnancy - this way you are guaranteed to save your unborn child from the risk of infection.
What causes trichomoniasis?
So, the pathogen has entered the body. What happens to him next and why not everyone who has such a problem undergoes treatment? This is explained by the specific feature of trichomoniasis. First of all, we are talking about its possible asymptomatic course. Simply put, the patient does not develop any symptoms and is unaware of the need for treatment. In some cases, the infection is detected by chance, and those who do not undergo preventive examinations in a timely manner do not even suspect its occurrence.
The second feature is that, as already mentioned, the infected person can only be a carrier, and even if his partner becomes infected and tries to find out where he got the infection, the results of conventional tests will not show microorganisms in his blood. However, sooner or later the disease can still become active - this explains the fact when a person who has not had sexual intercourse for a long time suddenly develops an infection.
If you are diagnosed with trichomoniasis, the causes of the disease may be different. In fact, there are quite a lot of provoking factors, and the influence of even one of them can lead to the dormant infection becoming more active and beginning to negatively affect one or another system of the human body. There is a high probability of the disease occurring in those carriers who have any of the following changes in the body:
- The normal microflora has been disrupted. This can be a problem in both the vagina and the intestines. It doesn’t take many reasons for such problems to appear: often taking antibiotics or using local contraceptives is enough. Dysbacteriosis does not come out of nowhere - it is preceded by a number of factors that can be avoided, which means you can protect yourself from many problems.
- The epithelium lining the vagina is damaged. This condition usually occurs after an abortion. In addition, abortion also involves the use of antibiotics, and the combination of these two factors can awaken trichomoniasis, which has been dormant for a long time, and make a person wonder where such a disease came from.
- The body's defenses are weakened. Often, understanding the etiology of trichomoniasis, the patient cannot understand what causes the disease. As a result of the examination, it turns out that he has some kind of disease that causes a weakening of the body’s defenses, and this disease is not necessarily related to the genitourinary area.
Unfortunately, despite the fact that doctors and patients know where trichomoniasis comes from, this disease still remains one of the most common sexually transmitted infections. This is largely due to the dishonest attitude of patients towards the prescribed treatment, because if the partner is not treated, even if he does not have obvious signs, a recurrence of the infection cannot be ruled out. In addition, it is a proven fact that there is no immunity to trichomoniasis, which means that you can get sick with it many times, regardless of the quality of the therapy.
The reasons for the appearance of infection and its occurrence in a seemingly healthy person should be known to every person. This will help you realize that preventive examinations with a gynecologist for women or a urologist for men are the best way, if not to prevent the disease, then at least to begin its treatment in a timely manner. It is much easier to cope with one infection than to eliminate all the consequences that appear as a result of its long development in the human body.
Trichomoniasis is a urogenital infectious disease, mainly sexually transmitted.
The pathogens - Trichomonas vaginalis and Trichomonas homonis belong to the genus Trichomonas, family Trichomonadidae, class Flagellata, phylum Protozoa.
Morphology. Trichomonas, as representatives of protozoa, have a fairly high organization. They are most often oval-pear-shaped. The body consists of fine-grained protoplasm with numerous vacuoles, surrounded on the outside by a periplast - a thin shell, in the front part equipped with a hook-shaped slit - a cystostomy, which performs the function of a mouth. The nucleus is oblong, round, pear-shaped or bottle-shaped, containing five to six nucleoli. Near the nucleus there are several bodies in the form of grains - blepharoplasts. From them begins a straight axial thread - an axoneme, which is an elastic cord. It is located inside the protoplasmic body and protrudes outward in the form of a spine. Trichomonas move with the help of flagella and an inducing membrane; They reproduce mainly by longitudinal division.
Cultural and enzymatic properties. Pathogenic three homonads grow on artificial nutrient media only at a temperature of 36.5-37 °C. Their cultures are not capable of hemolysis and plasma coagulation; They decompose glucose, maltose, starch well, weakly - lactose, galactose, do not decompose arabinose, dulcite, mannitol, sucrose, rhamnose; do not form hydrogen sulfide and indole.
Resistance. Trichomonas vaginalis is sensitive to sunlight and dies when it dries out and is exposed to disinfectants - mercury dichloride, carbolic acid, chloramine B.
Pathogenic trichomonas are sensitive to elevated temperatures, dying after 30 seconds at 55 ° C and after 24 hours at 43 ° C, but at the same time relatively resistant to low temperatures.
Epidemiology. Trichomoniasis is an anthroponotic disease. It has been established that Trichomonas are detected in 10% of healthy women and in more than 30% of patients seeking venereological help. In tropical countries they are found in 15-40% of healthy women of childbearing age. Exacerbation of trichomoniasis is often accompanied by gonorrhea, chlamydia and other sexually transmitted diseases. With urogenital trichomoniasis in men, other pathogenic microorganisms are found in the discharge from the urethra, along with Trichomonas.
Pathogenesis. The main habitat of urogenital trichomonas in men is the urethra, through the mucous membrane of which they penetrate into the prostate gland and epididymis, bulbourethral glands, and paraurethral ducts;
prepuce glands and foreskin. Inflammatory changes are nonspecific. Trichomoniasis in women develops primarily in the urethra, vagina and cervical canal. Much less often, Trichomonas penetrate the glands of the vestibule of the vagina and very rarely - into the uterine cavity and fallopian tubes.
Clinic. With the development of an acute process, patients complain of discharge, itching and burning in the area of the external genitalia, which upon examination are swollen, hyperemic, and have individual areas of erosion. Characteristic is the presence of foamy serous-purulent discharge. Acute trichomonas urethritis is accompanied by a feeling of pain and pain when urinating. Chronic urethritis is asymptomatic. Asymptomatic Trichomonas carriage was established.
Immunity absent in trichomoniasis.
Laboratory diagnostics. The material for the study is urethral discharge and urine. In cases where patients have no discharge from the urethra, take the first stream of urine into a test tube, centrifuge it, and remove the sediment
(threads, flakes, crumbs) and applied to a glass slide, followed by staining with a 0.5-1% solution of methylene blue, according to Gram, Romanovsky - Giemsa or Leishman. The “crushed” drop method is also used. In some cases, a bacteriological research method is used.
Treatment. Antibiotics and sulfonamides are not effective in treating trichomoniasis. He is treated with Trichopolum and Flagym according to certain regimens. After acute inflammatory phenomena subside, instillations of the urethra with a solution of silver nitrate, mercury oxycyanide, and ethacridine lactate are used.
Prevention. There is no specific prevention.
CAUSES OF TRYPANOSOMOSIS
Trypanosomiasis is a group of protozoal transmissible blood infections. African (sleeping sickness) and American (Chagas disease) trypanosomiasis are known.
African trypanosomiasis (sleeping sickness) is a vector-borne infection characterized by irregular fever, rash, swelling, lymphadenopathy, and severe damage to the central nervous system.
Mentions of sleeping sickness are found in Arabic manuscripts of the 16th century. The pathogen was first discovered by P. M. Ford in the blood of a patient in 1901. The epidemiological role of trypanosomes and tsetse flies in the transmission of African trypanosomiasis was proven by D. Brutse and D. Nabarro (1903), and the life cycle of trypanosomes with a change of vertebrate and invertebrate hosts was studied by H. Kinghorn and W. York (1912-1913).
The causative agents of African trypanosomiasis belong to the family Trypanosomatidae, the genus Trypanosoma, the species Trypanosoma brucei gambiese (the causative agent of Gambian trypanosomiasis) and Trypanosoma brucei rhodesiese (the causative agent of Rhodesian trypanosomiasis).
Morphology. Differing in some biological properties, these species are practically indistinguishable by morphological characteristics. The blood forms - trypomastigotes - are characterized by polymorphism associated with the immune reaction: some forms, found at the height of the disease, have the appearance of a long spindle-shaped cell with a well-defined undulating membrane and a long flagellum at the end, 25-40 µm long and 1.2-2 µm wide, others, during the decline of the infection, are represented by short, wide cells with or without a short flagellum. Trypanosomes reproduce by binary longitudinal fission. Stained according to Romanovsky - Giemsa: the cytoplasm is blue, the nucleus, blepharoplast and flagella are red.
Cultural properties. Cultivated on media containing blood and blood substitutes, NNN medium.
Epidemiology. The source of African trypanosomiasis of the Rhodesian type in nature is antelopes and other species of ungulates. Under natural conditions, the infection is zoonotic in nature, and the circulation of the pathogen occurs along the chain: antelope - tsetse fly - antelope. Infection of a person is possible accidentally when entering natural foci. The permanent population of endemic areas is included in the epidemiological transmission: antelope - tsetse fly - human - tsetse fly - human. In this case, the source of infection can be not only humans, but also farm animals, primarily cattle.
The vector-borne mechanism of infection is associated with the habitat of blood-sucking tsetse flies belonging to the species Glossina morsitans, Glossina pallidipes, Glossina swynnertoni. They lay larvae in the soil, where all stages develop: larvae, pupae, adults. An adult lives three to nine months. In the body of the tsetse fly, the development cycle of trypanosomes lasts about 20 days, and then the parasite penetrates the salivary glands of the insect. The fly remains infected for six months. Transovarial transmission of the pathogen was not detected.
Gambian trypanosomiasis is an anthroponosis. The circulation of the pathogen is carried out according to the following scheme: man - tsetse fly - man. It mainly affects the rural population.
Pathogenesis. At the site of a tsetse fly bite in the subcutaneous tissue, trypanosomes persist for several days, causing a local acute inflammatory process (trypanosomal chancre), and then penetrate the bloodstream, causing hyperplasia of the lymphoid tissue of the spleen, Kupffer cells of the liver, and then affect the central nervous system, localizing in the frontal lobes , pons and medulla oblongata, causing meningitis.
Clinic. At the site of penetration of the pathogen, a so-called trypanosomal chancre is formed - an infiltrate in the form of a hard, painful nodule. Two weeks later he disappears without a trace.
The incubation period ranges from two weeks to two years. Extreme clinical signs include: enlarged lymph nodes (especially cervical) and fever of the wrong type with a temperature from 36.6 to 41 "C. Subsequently, trypanosomes penetrate into the spinal canal; this period is characterized by damage to the central nervous system - headache, lethargy, drowsiness. The disease proceeds chronically over months and years, attacks of fever alternate with periods of apparent recovery. Then depression sets in, progressive lethargy develops, drowsiness intensifies and the patient falls into a coma. Patients die from cachexia and associated infection
tions three to six years from the onset of the disease. If treatment is started in a timely manner, they recover in two to three years.
Immunity is cellular in nature, low-tension and short-lived.
Laboratory diagnostics. Microscopic method - detection of trypanosomes in blood and punctate from lymph nodes. Serological method - complement fixation reaction, formol reaction, determination of globulin fractions in human blood serum.
Treatment. Drugs can be divided into two groups. At the early stage of the disease, the following are used: suramin, pentamidine; in the second period of the disease, two or three courses of therapy with arsenic preparations (tripareamide, arbosal) are prescribed.
Prevention. This is ensured by a set of measures aimed at identifying and treating patients, protecting the population from tsetse fly bites (mosquito nets, protective clothing, repellents), as well as destroying biotopes of fly vectors.
CAUSES OF LEISCHMANIASIS
Leishmaniasis is a group of protozoal vector-borne diseases of humans and animals caused by Leishmania. There are two main forms of leishmaniasis: cutaneous and visceral.
Related information.
Table of contents of the topic "Flagellates. Trichomoniasis. Giardiasis. Leishmaniasis.":
The causative agent of trichomoniasis
Trichomoniasis (trichomoniasis) is a venereal disease manifested by complex inflammatory lesions of various parts of the genitourinary system. The causative agent is Trichomonas vaginalis, first isolated by A. Donnyo (1837). Trichomonas are isolated from the vagina and urethra of women, and the urethra and prostate gland of men (humans are the only natural host).
The human body also contains Trichomonas-commensals. In the oral cavity - T. tenax (71 elongata), isolated from tartar and carious dental defects; in the large intestine - T. hominis, isolated in dyspeptic disorders. Trichomoniasis is widespread. Up to 25% of women who are sexually active are infected with Trichomonas. The risk of infection correlates with the frequency of sexual intercourse. The incidence of trichomoniasis is the same in men and women.
Morphology and cultural properties of the causative agent of trichomoniasis
The causative agent of trichomoniasis has a pear-shaped body 14-30 µm long, an elongated nucleus displaced to the anterior end, and vacuolated cytoplasm (Fig. 37-3). At the anterior end there are four flagella and an undulating membrane, reaching only to the middle of the body. An axial thread passes through the entire body - the axostyle, protruding at the posterior end in the form of a spine. T. vaginalis can be cultivated on nutrient media, on cell cultures and chicken embryos. The most suitable medium for cultivation is liver medium with cysteine, peptone and maltose. Trichomonas prefer anaerobic conditions, pH 5.5-6.0, cultivation temperature 35-37 "C.
The causative agent of trichomoniasis is the simplest single-celled organism - Trichomonas. This microorganism has the ability to live and develop even in the absence of oxygen; the vital activity of protozoal bacteria occurs in the human body.
A urogenital pathogen can be identified using instrumental and laboratory diagnostic measures. It is impossible to make an accurate diagnosis based on symptoms and medical examination alone. Trichomoniasis can be confirmed using the following studies:
- Laboratory examination of a smear taken from the urethral opening;
- Conducting microbiological research;
- Immunological analysis;
- PCR method.
Since such a disease can develop without pronounced symptoms, it is necessary to make a reliable diagnosis only with the help of laboratory tests.
Clinical manifestations in men
Trichomoniasis in men affects the following organs of the reproductive system: urethra, spermatic cords, prostate and testicles. Sometimes the symptoms manifest themselves in a subtle way, in which case the man is a carrier of the pathogen, which is transmitted during intimacy. If Trichomonas remains in the body for a long time, complications may arise that manifest themselves as non-gonococcal urethritis, an inflammatory process in the prostate and testicles.
The duration of the incubation process can vary from 2 to 200 days. Symptoms do not appear immediately. Typically, clinical signs begin to appear when the immune system is weakened or due to chronic infectious processes in the body. Symptoms are determined by the form of the pathological process. The development of urogenital trichomoniasis can occur in acute or chronic form.
Symptoms in men include a burning sensation when emptying the bladder. Discomfort extends to all areas of the external genitalia - penis, perineum, lower back, rectal area. If complications develop, the following signs appear - hyperemia of the foreskin, redness, swelling, abrasions and wounds. Additional symptoms that accompany the development of the disease include: hyperthermia, pain in the testicles.
Another consequence of the advanced form of trichomoniasis is the inflammatory process in the tissues of the prostate gland. This disease is accompanied by heaviness, pain in the rectal area and in the perineal area.
Clinical manifestations in females
According to statistics, representatives of the fair sex suffer more often than men. In this case, Trichomonas vaginalis is located in the uterine cavity. But the symptoms are expressed on the external organs of the reproductive system. Their redness, itching and hyperemia are noted. As the invasion develops, symptoms appear such as: copious mucus, ulcers, the appearance of slight bloody, foamy and watery discharge that has a strong fishy odor, painful sensations during sexual intercourse, the uterus and lower abdomen may increase in size.
The discharge is white or yellowish in color, its appearance is accompanied by intense itching, which is localized not only in the vagina, but also on the inner thighs. There is often pain or pain when emptying the bladder. In advanced forms of the disease, there is severe swelling of the external genitalia and severe itching. Timely diagnosis and treatment of the disease is very important, since its development is fraught with complications, including difficulties in conceiving.
Transmission routes
Trichomonas can be transmitted not only during intimate contacts. Other routes of infection may include contact with personal hygiene items. This happens rarely, but cases of domestic infection are recorded.
With ordinary contacts, for example, during hugs, it is impossible to become infected. Also, the disease is not transmitted by pets or birds.
Therapeutic measures
It is possible to get rid of urogenital trichomoniasis only with a correctly designed treatment algorithm. It is important to first undergo all the necessary diagnostic measures that will allow you to make an accurate diagnosis. It is impossible to get rid of pathology using dubious folk remedies. Treatment should be carried out under the strict supervision of a physician. The prescription of medications is determined by the severity of the disease, its stage, and the severity of clinical signs.
For therapy, anti-trichomonas drugs are used, the action of which is aimed at combating the causative agent of the pathology. For treatment, systemic and local medications are prescribed that fight the pathogen in the body and eliminate external symptoms. To achieve a lasting positive effect, a comprehensive approach is very important. Traditionally, doctors prescribe a course of antibacterial drugs that helps cure the infectious process. It is important not to stop the course of treatment, even if the symptoms completely disappear.
You can recover from trichomoniasis, which develops without complications, within a few weeks. If the pathology is complicated by other infectious processes, the duration of therapy is significantly delayed. It is important to adhere to all medical recommendations and undergo the prescribed course of treatment even in the absence of severe symptoms.
When you have completed taking the last drug, it is very important to undergo repeated laboratory diagnostics, thanks to which you can assess the patient’s condition and determine the presence of a pathogen or antibodies to it in his body. It is very important to adhere to the following recommendations of doctors: exclude sexual relations for the entire duration of therapy, remove too spicy, fried, spicy, smoked and pickled foods from the diet, and do not drink ethanol-containing drinks. A prerequisite is compliance with the rules of personal hygiene.
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