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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Этиологическим агентом балантидиаза выступает ресничная инфузория Balantidium соli. Балантидии являются самыми крупными представителями кишечных простейших, паразитирующими в организме человека.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основным резервуаром возбудителей балантидиаза служат свиньи, среди которых инвазия достигает 60-80%; реже источником протозойной инфекции выступает человек. Механизм заражения балантидиазом – фекально-оральный. Передача балантидий (чаще цистных форм) происходит через грязные руки, контаминированную воду, фрукты, овощи. Чаще балантидиазом заболевают работники свиноводческих хозяйств, скотобоен, мясных цехов.</span></p>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В пищеварительном тракте человека из цист образуются вегетативные формы, которые паразитируют в тканях слепой, сигмовидной и прямой кишки. На месте их внедрения в слизистую толстой кишки, образуются участки гиперемии и отека, которые в дальнейшем трансформируются в эрозии и язвы. Дефекты слизистой оболочки имеют кратерообразную форму, неровные края, покрытое некротическими массами дно. Язвенно-деструктивные изменения в кишечнике, всасывание токсических веществ, а также питание паразитов за счет своего хозяина составляют основу патогенеза балантидиаза и определяют его клинические проявления.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Больные с подозрением на балантидиаз направляются к инфекционисту. Заболевание может быть заподозрено на основании положительных данных эпидемиологического анамнеза и клинических проявлений; окончательное подтверждение и верификация диагноза возможно после проведения эндоскопического исследования кишечника и лабораторных анализов.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В острой стадии балантидиаза при ректороманоскопии или колоноскопии обнаруживаются очаговые инфильтративно-язвенные изменения стенки кишки; при хроническом течении - катарально-геморрагические или язвенные поражения. Достоверным доказательством балантидиаза служит наличие вегетативных форм балантидий в свежевыделенных фекалиях или в соскобах с пораженных участков кишки. Выявление цист указывает на транзиторное носительство протозойной инфекции. </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациенты с подтвержденным балантидиазом подлежат госпитализации в инфекционный стационар. В качестве этиотропной терапии назначаются антибактериальные (мономицин, окситетрациклин, ампициллин) или противопротозойные препараты (метронидазол, тинидазол). Обычно проводится 2-3 пятидневных цикла терапии. Системная лекарственная терапия может быть дополнена клизмами с коллоидно-дисперсной солью норсульфазола. Одновременно показана дезинтоксикационная терапия, витаминотерапия, соблюдение рациональной диеты.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение носителей протозойной инфекции также строго обязательно. Критериями излечения балантидиаза считаются отсутствие колитического синдрома, отрицательное копрологическое исследование на балантидии, отсутствие язвенных изменений кишечной стенки.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика балантидиаза складывается из соблюдения мер индивидуальной безопасности (соблюдения личной гигиены, кипячения воды, мытья овощей и фруктов и пр.), а также охраны внешней среды от фекального загрязнения (защита водоемов, улучшение зоогигиенических условий содержания свиней, обезвреживание навоза, и т. д.). </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфическая профилактика балантидиаза не разработана.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">От момента заражения до манифестации балантидиаза проходит 1-З недели. По выраженности клинических проявлений различают бессимптомную (субклиническую) и манифестную форму балантидиаза, по характеру течения – острую, хроническую и рецидивирующую; по тяжести течения – легкую, среднетяжелую и тяжелую.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При субклинической форме дисфункция кишечника и интоксикация отсутствуют, а балантидиаз распознается на основании эндоскопической картины и лабораторных данных. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптоматика острой манифестной формы балантидиаза напоминает дизентерию. Больные жалуются на прогрессирующую слабость, головную боль, фебрильную лихорадку, тошноту и рвоту. Одновременно развиваются признаки колита: режущие боли в животе, диарея, тенезмы. Стул становится жидким, слизисто-гнойным, а затем кровянистым; учащается до 15-20 раз в сутки; испражнения имеют гнилостный запах. При тяжелой форме балантидиаза происходит стремительная потеря массы тела, вплоть до кахексии.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хронический балантидиаз протекает со слабо выраженным интоксикационным синдромом, учащенным (до 2-5 раз в сутки) жидким стулом, метеоризмом, болезненностью слепой и восходящей кишки при пальпации. Острое и непрерывно хроническое течение балантидиаза может привести к развитию кишечных и внекишечных осложнений: кровотечения, перфорации язв толстой кишки, выпадения прямой кишки, перитонита, абсцессов печени, гипохромной анемии. Без специфического этиотропного лечения при острой форме балантидиаза очень высок риск летального исхода. Крайне тяжелое течение балантидиаза отмечается при его сочетании с гельминтозами и острыми кишечными инфекциями.</span></p>",
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},
"code": "A07.1",
"name": "Жиардиаз [лямблиоз]",
"icd_name": "Жиардиаз [лямблиоз]",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"2",
"7"
],
"periodicity": 1,
"slug": "a07.1_zhiardiaz_lyamblioz",
"lead": "заболевание, вызываемое простейшими - лямблиями, паразитирующими в тонкой кишке человека",
"description": "<p>Лямблиоз - это <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">инфекция тонкого кишечника, вызываемая одноклеточным простейшим паразитом лямблией.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заражение человека происходит оральным путем. Лямблии попадают в организм, преимущественно, при несоблюдении правил гигиены – грязные руки, употребление некипяченой воды, немытых овощей и фруктов в пищу. Переносчиками лямблий являются мухи, потому одной из эффективных мер профилактики лямблиоза остается истребление этих насекомых в помещении.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">После попадания цисты лямблии в организм человека, она превращается в трофозоит (активная форма размножения), начинает размножаться в огромных количествах, заселяя слизистую тонкой кишки (на 10 кв. см может находиться до 1 млн лямблий и более). Параллельно идет обратный процесс: превращение трофозоита в цисту. У цист нет способа прикрепиться к слизистой, поэтому они сразу выходят в толстую кишку и выводятся с фекалиями, длительно сохраняя жизнеспособность во внешней среде.</span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Попадая в пищеварительный тракт, цисты лямблий достигают 12-перстной кишки, где превращаются в вегетативные формы. Здесь, а также в проксимальном отделе тощей кишки лямблии прикрепляются к ворсинкам эпителия, вызывая механическое повреждение энтероцитов, раздражение нервных окончаний стенки тонкой кишки, нарушение процесса всасывания. Следствием этих процессов служит развитие воспаления ЖКТ. </span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Доказано, что в процессе жизнедеятельности лямблии выделяют токсин, обладающий тропностью к нервной ткани, что объясняет угнетающее действие на нервную систему. Вследствие сенсибилизации организма при лямблиозе могут развиваться различные аллергические проявления.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">С учетом причины заболевания и имеющихся симптомов врач может назначить следующие виды обследования:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общий и биохимический анализы крови;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общий анализ кала;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">копрограмму;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ИФА на антиген в кале;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">микроскопическое исследование кала;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">специфические пробы ДНК.</span></li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лямблиоз требует комплексного поэтапного, часто длительного лечения. В схему терапии могут входить следующие меры:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">1. Соблюдение диеты, создающей неблагоприятные условия для размножения лямблий (прежде всего, ограничение потребления углеводов — сладостей, мучного).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">2. Этиотропное лечение противопротозойными средствами.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">3. Прием желчегонных средств, проведение очистительных тюбажей.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">4. Назначение энтеросорбентов, ферментативных препаратов, антигистаминных средств.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">5. Устранение кишечного дисбактериоза с помощью пробиотиков.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">6. Иммуномодулирующая терапия, прием поливитаминных комплексов.</span></p>",
"prevention": "<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">соблюдение личной гигиены (тщательное мытье рук перед едой и приготовлением пищи, после туалета и возвращения с улицы);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">употребление гарантированно безопасной воды и напитков (кипяченая вода, напитки в фабричной упаковке);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">употребление в пищу термически обработанных продуктов, тщательное мытье овощей, фруктов, ягод, зелени и других продуктов, их обработка кипятком перед едой;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">обследование и лечение цистоносителей и больных лямблиозом. Это особенно актуально для членов семьи, где выявлен больной лямблиозом и для детских коллективов.</span></li>\r\n</ul>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кли­ничес­кая кар­ти­на лям­бли­оза разно­об­разна. Те­чение за­боле­вания за­висит от свой­ств па­рази­та и защитной ре­ак­ции ор­га­низ­ма. В большинс­тве слу­ча­ев ин­фекция протека­ет бес­сим­птом­но. За­боле­вание мо­жет на­чать­ся вне­зап­но или с постепен­но уси­лива­ющи­мися жалобами (при­мер­но 1-3 не­дели пос­ле за­раже­ния). В за­виси­мос­ти от поражён­ной об­ласти же­лудоч­но-кишечно­го трак­та и им­мунно­го ста­туса па­ци­ен­та кар­ти­на сим­пто­мов ме­ня­ет­ся.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На­ибо­лее рас­простра­нен­ны­ми симптомами яв­ля­ют­ся бо­ли в жи­воте (обыч­но пос­ле еды) и ди­арея (различной сте­пени тя­жес­ти). Мо­жет до­мини­ровать ре­ак­ция со сто­роны верхних от­де­лов ЖКТ — тош­но­та, рвота, от­рыжка, взду­тие жи­вота, высыпа­ния на ко­же. Ос­трая ста­дия болез­ни длит­ся око­ло не­дели с частыми ре­циди­вами. Хро­ничес­кий лям­бли­оз не всег­да име­ет ос­трую фа­зу за­боле­вания. Ди­арея воз­ни­ка­ет ред­ко, ча­ще па­ци­ен­ты жа­лу­ют­ся на жид­кий стул, по­вышен­ный ме­те­оризм с запахом се­ры, по­терю ве­са. В слу­чае по­раже­ния жел­чно­го пу­зыря мо­жет воз­никнуть жел­ту­ха. Хро­ничес­кое заболе­вание вы­зыва­ет на­руше­ние всасыва­ния, обез­во­жива­ние, по­терю ве­са, за­дер­жку рос­та у де­тей, в крайних слу­ча­ях, ле­таль­ный ис­ход.</span></p>",
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},
"code": "A00",
"name": "Холера",
"icd_name": "Холера",
"gender": 0,
"age_min": 0,
"age_max": 84,
"cause": [
"2",
"7"
],
"periodicity": 2,
"slug": "a00_holera",
"lead": "Острая кишечная антропонозная инфекция, вызываемая бактериями вида Vibrio cholerae",
"description": "<p>Холера – особо опасная кишечная инфекция, которая вызывается холерным вибрионом. Она поражает преимущественно тонкий кишечник, проявляется жидким стулом, рвотой и интоксикацией.</p>",
"etiology": "<p>Возбудитель холеры – холерный вибрион (Vibrio cholerae). Это бактерия, относится к роду кишечных бактерий, изогнутой формы (отсюда название - вибрион), подвижная, имеет жгутики, спор и капсул не образует. Существует 2 подвида холерного вибриона: </p>\r\n<p>классический - Vibrio cholerae classica; </p>\r\n<p>Ель-Тор - Vibrio cholerae eltor. </p>\r\n<p>Возбудитель холеры выделяет эндотоксин при гибели и разрушении бактериальной клетки и термолабильный экзотоксин – холероген, который вызывает обезвоживание организма. </p>\r\n<p> </p>",
"pathogenesis": "<p>Входными воротами инфекции является пищеварительный тракт. Часть вибрионов гибнет в кислой среде желудка под воздействием соляной кислоты. Если микроорганизмы преодолевают желудочный барьер, то они проникают в тонкий отдел кишечника, где, найдя благоприятную щелочную среду, начинают размножаться. У больных холерой возбудитель может быть обнаружен на всем протяжении желудочно-кишечного тракта, но в желудке при рН не более 5,5 вибрионы не обнаруживаются. </p>\r\n<p>Вибрионы колонизируют поверхность эпителия тонкого отдела кишечника, не проникая, однако, внутрь его и выделяют холерный токсин — белковый энтеротоксин. Под его воздействием происходит ряд химических процессов и, в конечном счете, приводит к выделению в просвет кишечника огромного количества изотонической жидкости с низким содержанием белка и высокой концентрацией ионов натрия, калия, хлоридов, гидрокарбонатов. Развивается диарея, рвота и обезвоживание. Потеря жидкости, гидрокарбонатов и калия ведёт к развитию метаболического ацидоза, снижению калия в крови. </p>",
"diagnostics": "<p>Тяжело протекающая холера диагностируется на основании данных клинической картины и физикального обследования. Окончательный диагноз устанавливают на основании бактериологического посева каловых или рвотных масс, кишечного содержимого (секционный анализ). Материал для посева необходимо доставить в лабораторию не позднее 3-х часов с момента получения, результат будет готов через 3-4 суток. </p>\r\n<p>Существуют серологические методики выявления заражения холерным вибрионом (РА, РНГА, виброцидный тест, ИФА, РКА), но они не являются достаточными для окончательной диагностики, считаясь методами ускоренного ориентировочного определения возбудителя. Ускоренными методиками для подтверждения предварительного диагноза можно считать люминисцентно-серологический анализ, микроскопию в темном поле иммобилизованных О-сывороткой вибрионов. </p>",
"treatment": "<p>При подозрении на холеру больных срочно госпитализируют в специальное отделение.[12] </p>\r\n<p>Восстановление и поддержание циркулирующего объёма крови и электролитного состава тканей </p>\r\n<p>Проводится в два этапа: </p>\r\n<ol>\r\n<li>Восполнение потерянной жидкости — регидратация (в объёме, соответствующем исходному дефициту массы тела). </li>\r\n<li>Коррекция продолжающихся потерь воды и электролитов. </li>\r\n</ol>\r\n<p>Может проводиться орально или парентерально. Выбор пути введения зависит от тяжести заболевания, степени обезвоживания, наличия рвоты. Внутривенное струйное введение растворов абсолютно показано больным с обезвоживанием III и IV степени. </p>\r\n<p>Для начальной внутривенной регидратации у больных с выраженным обезвоживанием лучше всего подходит раствор Рингера. Гипокалиемия коррегируется дополнительным введением препаратов калия. </p>\r\n<p>Лечение антибиотиками позволяет сократить течение болезни на 1-3 дня и снизить выраженность симптомов. Как правило, при восполнении потерянной жидкости у больных холерой происходит выздоровление и без применения антибиотиков, поэтому Всемирная организация здравоохранения рекомендует их применение только в случаях с тяжелым обезвоживанием. Против холерной палочки оказались эффективными такие антибиотики, как азитромицин, ко-тримоксазол, эритромицин, тетрациклин, доксициклин, ципрофлоксацини фуразолидон. </p>",
"prevention": "<ol>\r\n<li>Предупреждение заноса инфекции из эндемических очагов </li>\r\n<li>Соблюдение санитарно-гигиенических мер: обеззараживание воды, мытьё рук, термическая обработка пищи, обеззараживание мест общего пользования и т. д. </li>\r\n<li>Раннее выявление, изоляция и лечение больных и вибрионосителей </li>\r\n<li>Специфическая профилактика холерной вакциной и холероген-анатоксином. Холерная вакцина имеет короткий (3—6 мес.) период действия. </li>\r\n</ol>",
"clinical_picture": "<p>Инкубационный период длится от нескольких часов до 5 дней. Зависит от количества, попавших в организм бактериальных клеток холерного вибриона. Самыми характерными симптомами инфекции являются рвота, диарея и обезвоживание. </p>\r\n<p>Особенности рвоты, позволяющие заподозрить холеру: </p>\r\n<ul>\r\n<li>возникает внезапно, без предшествующей тошноты; </li>\r\n<li>не облегчает состояние больного; </li>\r\n<li>рвота большим количеством жидкости без запаха и пищевых остатков (могут быть в самом начале заболевания) – «рвота фонтаном». </li>\r\n</ul>\r\n<p>Также диарея при холере имеет отличительные особенности: </p>\r\n<ul>\r\n<li>диарея развивается без боли в животе (основное отличие от других кишечных инфекций); </li>\r\n<li>нет каловых испражнений (могут быть только в начале заболевания), стул представляет собой прозрачную жидкость без запаха; </li>\r\n<li>на 2-3-й день (иногда и на 1-й) заболевания стул приобретает характерный вид «рисового отвара» - прозрачная жидкость с комочками белой слизи (погибшие клетки эпителия слизистой оболочки тонкой кишки). </li>\r\n</ul>\r\n<p>Проявления обезвоживания при холере такие: </p>\r\n<ul>\r\n<li>снижение тургора и эластичности кожи – при собирании кожи в складку, она расправляется в течение 0,5 – 1 минуты (в норме – сразу); </li>\r\n<li>«руки прачки» - морщинистость кожи ладоней рук (бывает у прачек при длительном нахождении рук в воде); </li>\r\n<li>нарушения работы центральной нервной системы (связано с потерей солей) – проявляется нарушением сознания, вплоть до комы; </li>\r\n<li>резкое снижение диуреза – редкое мочеиспускание со сниженным количеством мочи, моча при этом темная, концентрированная. </li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 2,
"danger": 77,
"published": 2,
"parent": null,
"block_rubric": 1,
"standards": [
5056,
5057,
5058
]
},
{
"id": 6013,
"symptoms": [
{
"id": 2740,
"synonyms": [
{
"name": "Болит голова"
},
{
"name": "Боль в висках"
},
{
"name": "Голова болит"
},
{
"name": "Мигрень "
},
{
"name": "Боль в голове при наклоне"
},
{
"name": "Боль головная у детей"
},
{
"name": "Боль при повороте головы"
},
{
"name": "Височная боль"
},
{
"name": "Колющая боль в голове"
},
{
"name": "Покалывание в голове"
},
{
"name": "Жжение в голове "
},
{
"name": "Боль в лобной части головы "
},
{
"name": "Прострелы в голове"
}
],
"body_points": [
{
"x": 452,
"y": 881,
"r": 300
}
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},
"code": "A01",
"name": "Тиф и паратиф",
"icd_name": "Тиф и паратиф",
"gender": 0,
"age_min": 0,
"age_max": 79,
"cause": [
2,
7
],
"periodicity": 1,
"slug": "a01_tif_i_paratif",
"lead": "заразная болезнь, характеризующаяся сильным лихорадочным состоянием.",
"description": "Брюшной тиф и паратифы A и B относят к группе острых кишечных инфекционных заболеваний, обусловленных бактериями Salmonella typhi и Paratyphi A и B и проявляющихся лихорадкой, интоксикацией, кожными высыпаниями в виде розеол.",
"etiology": "<p>Возбудители брюшного тифа и паратифа относятся к роду сальмонелл, семейству кишечных бактерий. Имеют форму палочек, не образуют спор и капсул, подвижны, имеют жгутик. Растут на питательных средах, содержащих желчь. Содержат эндотоксин, который освобождается при разрушении бактериальной клетки. Возбудитель имеет антигенную структуру и содержит О-антиген, в состав которого входит Vi-антиген и Н-антиген. Различия в антигенной структуре бактерий брюшного тифа положены в основу подразделения их на серологические группы и типы. В связи с этим выделяют возбудителей паратифа А и В, которые не имеют Vi-антигена, однако не различающихся по морфологическим свойствам. Во внешней среде брюшнотифозные бактерии относительно устойчивы. В воде и почве они могут сохраняться от нескольких дней до нескольких месяцев. Бактерии хорошо переносят низкие температуры, но при нагревании быстро погибают. Дезинфицирующие средства в обычных концентрациях убивают возбудителя в течение нескольких минут. </p>",
"pathogenesis": "<p>Проникнув в кишечник, возбудитель брюшного тифа внедряется в лимфоидные образования тонкой кишки - одиночные и групповые (пейеровыбляшки) фолликулы, а затем проникают в регионарные (мезентериальные) лимфатические узлы, вызывая их воспаление – лимфаденит. Из лимфатических образований возбудитель попадает вкровеносное русло - начинается бактериемия, которая соответствует первым клиническим проявлениям болезни. Циркулирующие в крови микроорганизмычастично погибают, высвобождается эндотоксин, обусловливающий интоксикационный синдром, а при массивном разрушении могут вызвать инфекционно-токсический шок.</p>\r\n<p>Эндотоксин непосредственно, а также через активацию простагландинов оказывает выраженное нейротропное действие с токсическим поражением нервных центров и развитием в них процессов торможения. Клинически это проявляется в своеобразной заторможенности больных, затуманенное сознание, которые наиболее выражены при тяжелой форме болезни и получили название тифозного статуса – «status typhosus». Токсическое поражение ведет к нарушению циркадного ритма сна и бодрствования (бессонница ночью, сонливость днем), угнетению аппетита, трофическим изменениям в коже и ее придатках.</p>\r\n<p>Проникновение бактерий в паренхиматозные органы сопровождается образованием в них брюшнотифозных гранулем инарушением их функций. Одновременно с этим происходит массивное выделение возбудителя из организма с испражнениями, азатем и мочой (выделительная фаза). В течение всего заболевания в кишечнике больных происходят стадийные изменения со стороны его лимфоидныхобразований. Так, на первой неделе от начала заболевания наблюдается мозговидное набухание лимфоидных образований подвздошной кишки, на второй – ихнекротизация, на третьей - отторжение некротизированных масс, на четвертой - период «чистых язв» и на пятой-шестой неделях - заживление язв. Последнемупериоду (5-6-я неделя) соответствует фаза формирования специфического иммунитета, восстановления гомеостаза и освобождения организма от возбудителя,что характеризует развитие ранней реконвалесценции.</p>\r\n<p>Патогенез паратифов А, В, С и брюшного тифа существенно не различается.</p>",
"diagnostics": "<p>Диагностика выявления брюшного тифа и паратифов А и В едина. При брюшном тифе наиболее важна диагностика в первые 5-7 дней болезни. Это связано с эпидемиологическими требованиями. Для диагностики имеют значения как клинико-эпидемиологические, так и лабораторные данные.</p>\r\n<p>В лабораторной диагностике используют бактериологический и серологические методы исследования. На 1-2-й неделе заболевания возбудителя легче всего выделить из крови, со 2-3-й недели - из испражнений и мочи, а в течение всего заболевания - из содержимого 12-перстной кишки. Можно выделить возбудителя при посеве соскоба розеол, костного мозга, гноя, экссудата, мокроты.</p>\r\n<p>Для серологической диагностики брюшного тифа используется с 5-7-го дня заболевания РНГА (реакция непрямой гемагглютинации) с эритроцитарными диагностикумами (О, Н, Vi-антигенами). Положительной считается реакция в титре 1 : 200 и выше. Учитываются результаты в парных сыворотках, взятых в динамике заболевания, диагностически значимым считается четырехкратное и большее нарастание титра антител. Для выявления бактерионосителей используют РИГА с Vi-антигеном.</p>",
"treatment": "<p>Лечение и исход брюшного тифа (паратифа) зависят от правильного ухода, диеты и своевременного назначения антибактериальных и патогенетических средств. Больные подлежат обязательной госпитализации.</p>\r\n<p>Режим в острый период болезни и в течение 7 дней нормальной температуры тела постельный, с 7-8 дня отсутствия температуры разрешается сидеть, с 10-11 дня – ходить (при отсутствии противопоказаний). При развитии осложнений показан строгий постельный режим. Диета должна быть щадящей, калорийной, легкоусвояемой.</p>\r\n<p>Этиотропная терапия (направленная на возбудителя) назначается всем больным вне зависимости от формы и тяжести брюшного тифа. Выбор препарата проводят с учетом чувствительности сальмонелл к антибиотикам. Основным препаратом для лечения является левомицетин, используются также аминопенициллины, цефалоспорины 3 поколения, доксициклин, фуразолидон. Курс антибиотикотерапии продолжается до 10 дня нормальной температуры.</p>\r\n<p>Патогенетическая терапия включает дезинтоксикацию, коррекцию нарушений свертывающей системы крови, восстановление водно-электролитного баланса и кислотно-основного равновесия, профилактику и лечение осложнений. Всем больным назначают антиоксиданты, стимулирующие репаративные процессы.</p>\r\n<p> </p>",
"prevention": "<p> </p>\r\n<p>Основные меры профилактики - улучшение качества водоснабжения, канализации, контроль за приготовлением пищи, санитарная очистка населенных мест. Имеют значение санитарно-просветительная работа с населением, воспитание гигиенических навыков. По эпидемиологическим показаниям некоторым контингентам населения (работники канализации, лица в окружении хронических бактериовыделителей и др.) проводят вакцинацию. В очаге брюшного тифа проводится заключительная дезинфекция. За лицами, имевшими контакт с больным и, устанавливается медицинское наблюдение с обязательной термометрией в течение 25 дней и бактериологическим исследованием кала и мочи. Дети дошкольных учреждений, работники пищевых предприятий и лица, к ним приравниваемые, до получения результатов бактериологического обследования не допускаются в коллективы.</p>",
"clinical_picture": "<p>Инкубационный период — от 7 дней до 23 дней, в среднем 2 нед.</p>\r\n<p>Начальный период (время от момента появления лихорадки до установления её постоянного типа) — продолжается 4-7 дней и характеризуется нарастающими симптомами интоксикации. Наблюдается бледность кожи, слабость, головная боль, брадикардия, снижение аппетита, обложенность языка белым налетом, метеоризм, запоры, поносы.</p>\r\n<p>Период разгара — 9-10 дней. Температура тела держится постоянно на высоком уровне. Симптомы интоксикации резко выражены. Больные заторможены, негативны к окружающему. При осмотре на бледном фоне кожи можно обнаружить бледно-розовые единичные элементы сыпи — розеолы, слегка выступающие над поверхностью кожи, исчезающие при надавливании, располагающиеся на коже верхних отделов живота, нижних отделов грудной клетки, боковых поверхностях туловища, сгибательных поверхностях верхних конечностей. Отмечаются глухость тонов сердца, брадикардия, гипотония. Язык обложен коричневатым налетом, с отпечатками зубов по краям. Живот вздут, имеется склонность к запорам. Увеличивается печень и селезенка.</p>\r\n<p>При тяжелом течении может развиться тифозный статус — резкая заторможенность, нарушение сознания, бред, галлюцинации. Другим проявлением тяжести болезни является инфекционно-токсический шок.</p>\r\n<p>Период разрешения болезни. Температура падает, уменьшается интоксикация — появляется аппетит, нормализуется сон, постепенно исчезает слабость, улучшается самочувствие.</p>\r\n<p>В период реконвалесценции у 3-10 % больных может наступить рецидив болезни. Предвестниками рецидива являются субфебрилитет, отсутствие нормализации размеров печени и селезенки, сниженный аппетит, продолжающаяся слабость, недомогание. Рецидив сопровождается теми же клиническими проявлениями, что и основная болезнь, но протекает менее продолжительно.</p>\r\n<p>Брюшной тиф может протекать в легкой, среднетяжелой и тяжелой формах. Выделяют атипичные формы болезни — абортивные и стертые.</p>\r\n<p>В настоящее время в клинической картине брюшного тифа произошли большие изменения. Это связано с повсеместным применением антибиотиков, а также с иммунопрофилактикой. Вследствие этого стали преобладать стертые и абортивные формы заболевания. Лихорадка может длиться до 5-7 дней (иногда 2-3 дня). Чаще встречается острое начало (без продромального периода - в 60-80% случаев). </p>\r\n<p>Паратифы А и В очень сходны по своим клиническим признакам и имеют некоторые клинические особенности. Дифференцировать их между собой и от брюшного тифа практически возможно только бактериологически - по выделению возбудителя. Отмечают лишь некоторые признаки паратифов, отличающие их от брюшного тифа. Так, для паратифа В характерна более обильная розеолезная сыпь, чем при брюшном тифе. При паратифе А отмечается гиперемия лица, инъкция сосудов склер (покраснение глаз), можно наблюдать герпетические высыпания на губах и крыльях носа. Температурная реакция не столь постоянна, как при брюшном тифе, часто принимает неправильный характер, а длительность её меньше. </p>\r\n<p> </p>",
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{
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{
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},
"code": "A02",
"name": "Сальмонеллезные инфекции",
"icd_name": "Другие сальмонеллезные инфекции",
"gender": 0,
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"lead": "острая зоонозная инфекционная болезнь с фекально-оральным механизмом передачи возбудителя.",
"description": "<p>Сальмонеллёз — острая зоонозная инфекционная болезнь с фекально-оральным механизмом передачи возбудителя, характеризующаяся преимущественным поражением ЖКТ, развитием интоксикации и обезвоживания.</p>",
"etiology": "<p>Сальмонеллы — грамотрицательные палочки рода Salmonella семейства Enterobacteriaceae.</p>\r\n<p>Выделяют два вида сальмонелл — S. enterica и S. bongori, не патогенный для человека.</p>\r\n<p>Сальмонеллы длительно сохраняются в окружающей среде: в воде — до 5 мес, в почве — до 18 мес, в мясе — до 6 мес, в тушках птиц — больше года, на яичной скорлупе — до 24 дней. Низкую температуру переносят хорошо, при 100 °С гибнут мгновенно.</p>",
"pathogenesis": "<p>В просвете тонкой кишки сальмонеллы прикрепляются к мембранам энтероцитов, достигают собственной пластинки слизистой оболочки. Это приводит к дегенеративным изменениям энтероцитов и развитию энтерита.</p>\r\n<p>При разрушении бактерий высвобождается липополисахаридный комплекс (эндотоксин), который играет основную роль в развитии синдрома интоксикации.</p>\r\n<p>Основную роль в развитии диареи и обезвоживания играет энтеротоксин, активирующий синтез цАМФ аденилатциклазой энтероцитов, благодаря чему усиливается секреция ионов Na+ , Cl– и воды в просвет кишки. Следствием дегидратации и интоксикации является нарушение деятельности сердечно-сосудистой системы, что выражается тахикардией и снижением АД.</p>",
"diagnostics": "<p>Клиническая</p>\r\n<p>Характерно острое начало с повышением температуры тела, тошнотой, рвотой, диареей, болью в животе.</p>\r\n<p>Эпидемиологическая</p>\r\n<p>Приём пищи, приготовленной и хранившейся с нарушением санитарных норм, употребление сырых яиц, групповые вспышки. В мегаполисах выявление групповых случаев заболевания представляет большие трудности, если контаминированный сальмонеллами продукт реализуется через торговую сеть или предприятия общественного питания. </p>\r\n<p>Специфическая и неспецифическая лабораторная диагностика</p>\r\n<p>Бактериологическое исследование кала (одно- или двукратно), рвотных масс, крови, мочи, жёлчи, промывных вод желудка, остатков подозрительных продуктов.</p>\r\n<p> </p>",
"treatment": "<p>Постельный режим назначают при выраженной интоксикации и потере жидкости. Палатный — при среднетяжёлом и лёгком течении. Диета — стол № 4. Из рациона исключают пищевые продукты, раздражающие желудок и кишечник, молочные продукты, а также тугоплавкие жиры.</p>\r\n<p>Этиотропная терапия</p>\r\n<p>Среднетяжёлая и тяжёлая локализованная форма заболевания — энтерикс.<br />Генерализованная форма — ципрофлоксацин; цефтриаксон. </p>\r\n<p>Патогенетические средства</p>\r\n<p>Регидратационная терапия, дезинтоксикационная терапия, эубиотики и биопрепараты, сорбенты, ферментотерапия, антидиарейные препараты, спазмолитики.</p>\r\n<p>Дополнительные методы лечения (хирургические, физиотерапевтические, санаторно-курортные)</p>",
"prevention": "<p>Специфическая профилактика отсутствует.</p>\r\n<p>Неспецифические меры профилактики</p>\r\n<p>Ветеринарно-санитарный надзор за убоем скота и птицы, технологией обработки туш, приготовлением и хранением мясных блюд. Соблюдение санитарно-гигиенических и противоэпидемических норм на предприятиях торговли и общественного питания.</p>",
"clinical_picture": "<p>Инкубационный период от 6 ч до 3 сут (чаще 12–24 ч); при внутрибольничных вспышках удлиняется до 3–8 дней.</p>\r\n<p>Классификация сальмонеллеза</p>\r\n<p>• Гастроинтестинальная (локализованная) форма:<br />- гастритический вариант;<br />- гастроэнтеритический вариант;<br />- гастроэнтероколитический вариант.<br />• Генерализованная форма:<br />- тифоподобный вариант;<br />- септический вариант.<br />• Бактериовыделение:<br />- острое;<br />- хроническое;<br />- транзиторное.</p>\r\n<p>Для гастритического варианта характерны острое начало, повторная <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a> и боль в эпигастрии. Синдром интоксикации выражен слабо. Небольшая продолжительность заболевания.</p>\r\n<p>Гастроэнтеритический вариант наиболее распространён. Болезнь начинается остро, с симптомов интоксикации: повышения температуры тела, головной боли, озноба, чувства ломоты в мышцах, схваткообразной .</p>\r\n<p>Присоединяются <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a>. Испражнения вначале носят каловый характер, но быстро становятся водянистыми, пенистыми зловонными, иногда с зеленоватым оттенком и имеют вид «болотной тины». Отмечают бледность кожного покрова, в более тяжёлых случаях — . Язык сухой, обложен налётом.</p>\r\n<p>Живот вздут, при пальпации болезнен во всех отделах, больше в эпигастрии и в правой подвздошной области, урчит под рукой. Тоны сердца приглушены, АД снижено. Уменьшено выделение мочи. Возможны судороги.</p>\r\n<p>При гастроэнтероколитическом варианте клиническая картина та же, но уже на 2–3-й день болезни уменьшается объём испражнений. В них появляется примесь слизи, иногда крови.</p>\r\n<p>Генерализованной форме болезни, как правило, предшествуют гастроинтестинальные расстройства. При тифоподобном варианте температурная кривая приобретает постоянный или волнообразный характер. Кожа бледная, к 6–7-му дню болезни на коже живота появляется розеолёзная. Наблюдают небольшую брадикардию. Над лёгкими выслушивают сухие рассеянные. Живот вздут. К концу первой недели болезни отмечают и селезёнки. Длительность лихорадки составляет 1–3 нед. Рецидивы возникают редко.</p>\r\n<p> </p>",
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"image_alt": "Сальмонеллез",
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"parent": null,
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4912,
5001,
5053
]
}
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}
