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"lead": "Глубокий микоз, вызываемый Cryptococcus neoformans (син. С. hominis, Torula histolytica); встречается у людей и животных. ",
"description": "Инфекционное грибковое заболевание.",
"etiology": "<p>Возбудитель - Cryptococcus neoformans. В патологическом материале имеет вид дрожжевых клеток округлой формы диаметром 3-10 мкм, окруженных прозрачной желатинообразной капсулой шириной до 50 мкм. Мицелия не образует. Патогенен для лабораторных животных (белые мыши, крысы). Устойчив во внешней среде.</p>\r\n<full></full>\r\n<p><br /><br />Криптококк широко распространен в природе, его обнаруживают в помете голубей, воробьев и других птиц, при этом сами птицы не болеют. В высушенном состоянии криптококк может сохраняться в течение многих месяцев. Криптококк обнаруживали на слизистых оболочках здоровых людей в качестве сапрофита. Инфицирование человека происходит воздушно-пылевым путем.</p>",
"pathogenesis": "<p>Воротами инфекции в большинстве случаев являются верхние дыхательные пути и легкие, реже наблюдается первичный криптококкоз кожи, возможно эндогенное развитие инфекции у здоровых носителей при снижении у них иммунной защиты (ВИЧ-инфицированные и др.). Заболевание чаше встречается у лиц 40-60 лет, мужчины болеют чаще, нередко криптококкоз развивался у больных лимфогранулематозом, что обусловлено также развивающимся иммунодефицитом</p>",
"diagnostics": "<ul>\r\n<li>Общий анализ крови.</li>\r\n<li>Общий анализ мочи.</li>\r\n<li>Биохимические исследования (общий и прямой билирубин, общий белок и его фракции, уровень трансаминаз – АЛТ, АСТ, щелочная фосфатаза, тимоловая проба).</li>\r\n<li>Инструментальные методы исследования:\r\n<ul>\r\n<li>Рентгенография легких: при первых проявления заболевания на рентгене выявляют очаги затемнения легочной ткани с нечеткими контурами, увеличение прикорневых лимфатических узлов. При прогрессировании инфекции очаги начинают сливаться, поражая полностью все доли легких, в плевральной полости появляется жидкость, уровень которой начинает расти.</li>\r\n<li>Бронхоскопия с последующей биопсией.</li>\r\n<li>Пункция спинного мозга с исследованием спинномозговой жидкости: повышение уровня белка, лимфоцитов, снижение уровня глюкозы. При изучении спинномозговой жидкости под микроскопом обнаруживаются окруженные капсулой дрожжевые клетки.</li>\r\n</ul>\r\n</li>\r\n<li>Специфические методы обследования: изучение мазков взятых из поверхности пораженной кожи, крови, мочи, мокроты, спинномозговой жидкости, биопсии легких и костной системы и обнаружении в них Cryptococcus neoformans.</li>\r\n</ul>",
"treatment": "<p>Этиотропная терапия</p>\r\n<p>Амфотерицин В 0,5 – 0,1 мг на кг массы тела внутривенно 1 раз в сутки 2 -3 недели, а затем переход на флуканозол по 400мг 1 раз в сутки внутрь до 8 недель либо итраконазол 200мг 2 раза в сутки.</p>\r\n<p>Симптоматическая терапия</p>\r\n<ul>\r\n<li>Жаропонижающие и противовоспалительные средства (парацетамол, ибупрофен, нимисулид);</li>\r\n<li>Мочегонные при скоплении жидкости в легких, отеке головного мозга (торасемид, спиронолактон);</li>\r\n<li>Препараты, снижающие внутричерепное давления и спазмолитики (папаверин, винпоцетин);</li>\r\n<li>При присоединении вторичной микрофлоры и развитии гнойных процессов (цефалоспорины 3,4 поколения, фторхинолоны 2го поколения);</li>\r\n<li>Глюкокортикостероиды;</li>\r\n<li>Антиагрегантные препараты (гепарин, фраксипарин).</li>\r\n</ul>\r\n<p>Подтверждение полного излечения происходит тогда, когда в мазках перестает встречаться Cryptococcus neoformans и на рентгенограмме легкие не будет видно очаговых образований.</p>",
"prevention": "<p>Лицам, которые находятся в группе риска следует избегать сельско-хозяйственной работы, контакта с птицей. Если этого нельзя избежать назначают флуконазол в дозе 200 мг внутрь 1 раз в сутки. ВИЧ-инфицированным рекомендуют пожизненный прием этого препарата.</p>",
"clinical_picture": "<p>Длительность инкубационного периода не установлена. Наиболее характерным проявлением криптококкоза является менингоэнцефалит. Описывали его и под названием торулезного менингита. Заболевание характеризуется постепенным, малозаметным началом в виде приступов головной боли, чаще в лобной области, которые постепенно усиливаются, становятся нестерпимыми, перемещаются в затылочную область. Появляются менингеальные признаки, птоз, <a title=\"Перейти на страницу симптома Нистагм\" href=\"../../../symptom/nistagm/\">нистагм</a>, <a title=\"Перейти на страницу симптома Гемиплегия\" href=\"../../../symptom/gemiplegiya/\">гемиплегия</a>. Сознание нарушено, <a title=\"Перейти на страницу симптома Бред\" href=\"../../../symptom/bred/\">бред</a>. Характерная особенность заболевания при тяжелом состоянии температура тела остается субфебрильной. Течение болезни медленно прогрессирующее, ведущее к истощению, затем коматозному состоянию, смерть наступает от паралича дыхания через 4-6 мес от начала болезни. У 30% больных, кроме поражения центральной нервной системы, развивается криптококкоз легких.</p>\r\n<full></full>\r\n<p><br /><br />Криптококкоз легких протекает в виде пневмонии, мало чем отличающейся от пневмоний другой этиологии, температура тела чаще субфебрильная, <a title=\"Перейти на страницу симптома Влажный кашель\" href=\"../../../symptom/vlazhnyy_kashel/\">мокрота</a> скудная, процесс чаще двухсторонний. При диссеминированной форме криптококкоза могут поражаться самые различные органы (печень, почки, селезенка и др.). Поражения кожи и слизистых оболочек протекают относительно легко. <br /><br />У ВИЧ-инфицированных криптококкоз протекает почти исключительно в виде тяжелого менингита и менингоэнцефалита. <br /><br />При менингеальной форме и диссеминированном криптококкозе прогноз плохой. При поражении кожи и слизистых оболочек благоприятный. Лечение амфотерицином В улучшает прогноз.</p>",
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},
"code": "B44",
"name": "Аспергиллез",
"icd_name": "Аспергиллез",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
4,
7
],
"periodicity": 1,
"slug": "b44_aspergillez",
"lead": "Болезнь, вызываемая различными видами плесневых грибов рода Aspergillus. Чаще протекает с преимущественным поражением легких, улиц с иммунодефицитами принимает тяжелое септическое (генерализованное) течение.",
"description": "Инфекционное грибковое заболевание.",
"etiology": "<p>Возбудители — различные виды рода Aspergillus. Наибольшее значение в патологии человека имеют A. niger, A. flavus, встречаются и другиевиды (A. fumigatus, A. nidulans). Морфологически состоят из однотипного мицелия (шириной 4—6 мкм), иногда обнаруживаются “головки” с конидиями.</p>\r\n<full></full>\r\n<p>Аспергиллы обладают большой биохимической активностью, образуют различные ферменты (протеолитический, сахаролитический, липолитический), а некоторые виды содержат эндотоксины, при введении которых экспериментальным животным развиваются параличи и наступает их гибель. Обладают аллергизирующим действием. Из дезинфицирующих средств на аспергиллы наиболее активно действуют растворы карболовой кислоты и формалин. Аспергиллы широко распространены в природе. Их постоянно можно обнаружить в почве, зерне, муке, сене (особенно заплесневелых),в пыли помещений, где обрабатываются шкуры, шерсть, пенька. Обнаруживались аспергиллы даже в пыли лечебных учреждений, что обусловливало внутрибольничное инфицирование. Возбудитель проникает в организм, как правило, через воздух с пылью. Из профессиональных групп чаще поражаются работники сельского хозяйства, работники ткацких и бумагопрядильных предприятий. Заболевание у ослабленных лиц может возникнуть и как эндогенная инфекция, так как на слизистой оболочке зева здоровых людей иногда обнаруживаются аспергиллы.</p>",
"pathogenesis": "<p>Возбудитель аэрогенным путем попадает на слизистые оболочки верхних дыхательных путей. Может наступать инфицирование через кожу, обычно измененную каким-либо другим патологическим процессом. Ведущую роль в патогенезе аспергиллеза играет снижение иммунной защиты организма. Аспергиллез осложняет различные патологические процессы кожи, слизистых оболочек, внутренних органов. В частности, легочные формы аспергиллеза возникали на фоне бронхоэктатической болезни, абсцессов легкого, туберкулеза легких, рака легких, хронического бронхита и др. В последние годы аспергиллез стал особенно часто наблюдаться у лиц с иммунодефицитами (врожденные иммунодефициты, лица, получающие противоопухолевую химиотерапию, иммунодепрессанты, а также ВИЧ-инфицированные). Он встречается значительно чаще, чем другие глубокие микозы. У ослабленных лиц вначале поражаются грибом легкие, затем в процесс вовлекаются плевра, лимфатические узлы.</p>\r\n<full></full>\r\n<p>Током крови аспергиллы могут заноситься в другие органы, образуя там специфические гранулемы, которые обычно абсцедируют. Из легочного аспергиллез превращается в генерализованный (септический) и нередко (свыше 50%) заканчивается гибелью больного. Спасти удается тех больных, у которых сохранились в какой-то мере функции иммунной системы. При массивной ингаляции спор аспергилл у лиц с нормальной иммунной системой может возникнуть острая диффузная пневмония, заканчивающаяся самовыздоровлением.</p>",
"diagnostics": "<p>При подозрении на аспергиллез берут на анализ мокроту и бронхоальвеолярный смыв. Проводят ее микроскопическое исследование и посев на питательную среду. Для выявления аспергиллов используют метод полимеразной цепной реакции и реакцию преципитации. Также берут кровь на общий и биохимический анализы крови, анализ на ВИЧ.</p>\r\n<p>Для выяснения степени поражения легких делают рентгенографию грудной клетки.</p>\r\n<p>Для получения бронхоальвеолярного смыва проводят бронхоскопию.</p>\r\n<p>В некоторых случаях для микроскопии и посева требуется биоптат пораженного органа. В этом случае проводят его биопсию.</p>",
"treatment": "<p>Лечат аспергиллез противогрибковыми препаратами. Однако при легочном аспергиллезе такая терапия не всегда эффективна, поэтому часто прибегают к хирургическому вмешательству – удаляют пораженную часть легкого. Параллельно назначают кортикостероидные препараты для устранения закупорки бронхов слизью.</p>\r\n<p>При генерализованном аспергиллезе лекарственную терапию сочетают с хирургическим лечением.</p>\r\n<p>При поражениях кожи противогрибковые препараты применяют местно.</p>\r\n<p>При аллергической реакции на аспергиллы назначают антигистаминные препараты.</p>\r\n<p>Прогноз при генерализованной форме неблагоприятный. При поражениях легких летальность – 20-35 %. При поражениях кожи и глаз прогноз благоприятный.</p>",
"prevention": "<p>Профилактика аспергиллеза заключается в своевременном выявлении страдающих этим заболеванием и их правильном лечении, а также предотвращении внутрибольничных инфекций. Изолировать пациента не нужно, так как заразиться от него невозможно. Однако при наличии в доме страдающего аспергиллезом стоит уделить больше внимания влажной уборке.</p>\r\n<full></full>\r\n<p>В отделениях для пациентов с пониженным иммунитетом не должно быть пыли и цветов. При появлении спор аспергиллов необходимо обрабатывать помещение дезинфекционными препаратами.</p>\r\n<p>Следует регулярно чистить кондиционеры и увлажнители воздуха, регулярно делать влажную уборку.</p>\r\n<p>Обязательно нужно укреплять иммунитет, так как при его снижении резко возрастает вероятность развития этого заболевания. Для этого нужно закаляться, принимать витамины. Необходимо своевременно лечить инфекционные заболевания.</p>\r\n<p>Нельзя употреблять в пищу несвежие плесневелые продукты.</p>",
"clinical_picture": "<p>Инкубационный период заболевания точно не установлен. Симптомы зависят от того, какой орган поражен.</p>\r\n<p>Бронхолегочный аспергиллез сначала протекает как бронхит или трахеобронхит. Пациент жалуется на <a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Кашель\" href=\"../../../symptom/kashel/\">кашель</a> с серой мокротой, в которой иногда обнаруживаются прожилки крови и комочки – колонии аспергиллов.</p>\r\n<full></full>\r\n<p>Однако если болезнь не лечить, то развивается аспергиллезная пневмония. Процесс может быть острым и хроническим. При острой аспергиллезной пневмонии у страдающего наблюдается высокая температура, <a title=\"Перейти на страницу симптома Одышка\" href=\"../../../symptom/odyshka/\">одышка</a>, боли в груди, <a title=\"Перейти на страницу симптома Кашель\" href=\"../../../symptom/kashel/\">кашель</a> с вязкой слизисто-гнойной мокротой с прожилками крови и серо-зелеными комочками. В комочках при микроскопии можно обнаружить аспергиллы. Ночью пациент обильно потеет. Постепенно <a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a> нарастает, страдающий теряет вес.</p>\r\n<p>Хронические формы аспергиллезной пневмонии развиваются на фоне какого-либо поражения легких. Поэтому пациент жалуется на симптомы основного заболевания, а также на зеленоватые комочки в мокроте и запах плесени изо рта.</p>\r\n<p>Аспергиллома легкого может никак не проявляться и обнаруживаться только при рентгенологическом исследовании. А может проявляться и повторяющимся кровохарканьем, и даже легочными кровотечениями.</p>\r\n<p>Аспергиллез лор-органов развивается, если поражены уши, слизистая оболочка носа или гортани. При поражении ушного канала пациента беспокоит <a title=\"Перейти на страницу симптома Зуд\" href=\"../../../symptom/zud/\">зуд</a> в ухе, иногда боль в нем. По ночам из уха может вытекать жидкость. Это можно заметить по пятнам на подушке, которые она оставляет.</p>\r\n<p>Аспергиллез глаз проявляется конъюнктивитом. Пациенты жалуются на <a title=\"Перейти на страницу симптома Зуд\" href=\"../../../symptom/zud/\">зуд</a> в глазах, <a title=\"Перейти на страницу симптома Слезотечение\" href=\"../../../symptom/slezotechenie/\">слезотечение</a>, гноение. Конъюнктива при этом красная, отечная. Возможно <a title=\"Перейти на страницу симптома Снижение зрения\" href=\"../../../symptom/snizhenie_zreniya/\">снижение зрения</a> и пелена перед глазами.</p>\r\n<p>При поражении кожи на ней образуются различные узелки.</p>\r\n<p>При поражении желудочно-кишечного тракта заболевание проявляется тошнотой, рвотой, жидким пенистым стулом, запахом плесени изо рта.</p>\r\n<p>Аспергиллы могут поражать и сердце, вызывая эндокардит. Особенно часто это бывает у пациентов с искусственными клапанами сердца. Это заболевание проявляется лихорадкой, кашлем, одышкой, слабостью, постоянной усталостью, ночным потом, снижением веса.</p>\r\n<p>Генерализованный аспергиллез развивается у пациентов с угнетенной иммунной системой. При этой форме споры гриба разносятся с током крови по всему организму, образуя метастазы в различных органах. При этом у пациента повышается температура, это состояние сопровождается ознобом, бредом. Дыхание часто затруднено. Может развиться почечная или печеночная недостаточность, появиться <a title=\"Перейти на страницу симптома Кровь в моче\" href=\"../../../symptom/krov_v_moche/\">кровь в моче</a>. Часто у пациентов с генерализованной формой образуются тромбы. Эта форма довольно часто приводит к летальному исходу.</p>",
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},
"code": "B43.9",
"name": "Хромомикоз неуточненный",
"icd_name": "Хромомикоз неуточненный",
"gender": 0,
"age_min": 5,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 3,
"slug": "b43.9_hromomikoz_neutochnennyy",
"lead": "хроническое грибковое заболевание человека, поражающее главным образом кожу",
"description": "<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;\">Хромомикоз – это хроническое инфекционное заболевание из группы глубоких микозов, вызываемое грибами определенных видов и характеризующееся длительным течением.</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;\">Учёные выделяют 3 вида возбудителей болезненного состояния:</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;\">Fonseacae pedrosoi;</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;\">Fonseacae compacta;</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;\">Phyaiophora verrucosa.</span></li>\r\n</ul>\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;\">Эти грибы дают похожие колонии и различаются по видам спороношения.</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;\">Гриб является диморфным и встречается в 2 формах:</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;\">тканевая форма представляет собой светло-коричневые или бурые круглые или продолговатые клетки;</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;\">вторая форма являет собой тонкие нити, по цвету напоминающие оливки.</span></li>\r\n</ul>\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;\">Грибы обитают в почве, на растениях, в сене или соломе. Человек инфицируется в случае попадания спор гриба на травмированные кожные покровы: порезы, проколы, трещины и т.д. Болезненное состояние не передаётся от больного человека к здоровому.</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;\">В группу риска входят люди следующих профессий:</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;\">работники сельского хозяйства;</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;\">шахтёры;</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;\">жители тропиков и субтропиков, которые привыкли ходить и обрабатывать землю без обуви.</span></li>\r\n</ul>\r\n<p> </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;\">Человек инфицируется во время травмирования кожных покровов, и заражение не зависит от состояния его иммунной системы. В большинстве случаев поражается исключительно кожа ног, но могут инфицироваться руки, кожа лица, плеч, живота. Заболевание при отсутствии лечения медленно прогрессирует и переходит в хроническую стадию. Известны случаи, когда при болезненном состоянии поражался мозг и внутренние органы.</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;\">В месте, где возбудитель внедрился в кожу через её повреждение со временем образуется шелушащееся утолщение или узелок тёмно-красного цвета. Через несколько недель и месяцев, иногда и лет, появляются новые узлы, они увеличиваются в размере и превращаются в бляшки с веррукозно-папилломатозными образованиями. Между этими поражёнными участками могут располагаться участки неповреждённых тканей. Бляшки покрываются корками и чешуйками, образовавшимися после выделения гноя.</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 большинстве случаев разрастания по внешнему виду напоминают цветную капусту, они постоянно травмируются, из ран выделяется кровь, гной и экссудат. Трамированная кожа нагнаивается, на ней постояяно образуются эрозии и язвы. Со временем раны заживают, кожа покрывается грубыми рубцами, похожими на келоидные. Инфекция распространяется по организму больного аутоинокуляционным путём. Бляшки могут достигать 20 см в диаметре и покрывать всю стопу и голень.</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;\">На начальной стадии заболевания поставить правильный диагноз только на основе осмотра затруднительно. Пациенту назначают исследования:</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 анализ крови и мочи;</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;\">анализ крови на глюкозу;</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;\">биохимический анализ крови.</span></li>\r\n</ul>\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;\">Исследуются также корочки из поражённого очага: их обрабатывают специальным раствором и под микроскопом различают тёмные крупинки и коричневые нити грибка. С помощью культурологического исследования производят посев пораженных тканей на питательную среду. Через полтора месяца в результате посева вырастают полукруглые, мохнатые колонии темного зелёного или чёрного цвета.</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;\">Консервативная терапия</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;\">Хромомикоз относится к инфекциям, трудно поддающимся терапии. Полное излечение наступает редко, характерно частое рецидивирование. По различным данным, клиническое выздоровление и полная элиминация возбудителя возникает в 15-80% случаев. Назначается длительный прием противогрибковых препаратов. Жесткие временные стандарты отсутствуют, в зависимости от вида медикаментов курс длится от 2 месяцев до полного излечения. Используют интраконазол, амфотерицин В, кетоконазол, тербинафин.</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;\">Хирургическое лечение</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;\">Терапия должна быть комплексной. С целью предупреждения рецидивов прием препаратов дополняется удалением наростов. Небольшие поражения могут иссекаться хирургическим путем с широкими полями. Возможна криодеструкция очагов, однако глубина воздействие не стандартизирована. Применяют термотерапию с локальным нагреванием выростов до 42-24° С. Выскабливание не рекомендуется из-за риска повреждения лимфатических структур.</span></p>\r\n<p><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;\"> </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;\">При проведении сельскохозяйственных работ необходимо защищать кожные покровы нижних и верхних конечностей резиновой обувью и перчатками, соблюдать правила гигиены. При травмировании кожи нужно обработать поражённые участки йодом. Если через несколько дней после травмы на коже появились бугорки или папулы, необходимо срочно обратиться к дерматологу.</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;\">Симптомы заболевания зависят от вида болезненного состояния.</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;\">узелковое болезненное состояние, характеризующееся появлением эритематоидных папул, покрытых чешуйками; это начальная стадия заболевания;</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;\">опухолевидный вид проявляется большими образованиями в виде узелков, с поверхностью в виде долек или папиллом, покрытых корками;</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;\">веррукозное заболевание – поражения кожных покровов идентичны поражением бородавками;</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;\">чешуйчатый вид – области поражения плоские, их размер и форма могут быть различными; иногда появляются папилломатозные разрастания;</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;\">рубцовое болезненное состояние – кожные покровы атрофируются в центре поражения, форма поражённых областей круглая или дугообразная.</span></li>\r\n</ul>\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;\">Иногда у больного могут одновременно развиваться и со временем трансформироваться несколько видов поражения кожных покровов.</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;\">Скрытый период болезненного состояния может длиться до нескольких месяцев.</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;\">Сначала в месте инфицирования появляется покраснение, по виду напоминающее псориатические бляшки. Потом происходит трансформация образования и проявляется одна из форм заболевания:</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;\">папилломатозно-язвенная – появляются овальные или продолговатые области в диаметре около 10 см и более и высотой до 1 см, с резко очерченными границами; верх покрыт корками, при их удалении видны язвочки и бородавчатые разрастания, из которых выделяются кровь и гной; образование напоминает соцветия капусты кольраби;</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;\">бугорковая форма – на коже появляются бугорки ядовито-красного цвета конусовидной формы; со временем бугорки темнеют, покрываются корочкой, возле них появляются новые образования, сливаются в круг плотных бляшек; со временем образования размягчаются, покрываются язвами и папилломами;</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;\">узловатая форма – на кожных покровах появляются небольшие плотные узлы, расположенные на плотном инфильтрате; узлы со временем становятся мягкими, покрываются язвами, корками и папилломатозными образованиями; эта форма прогрессирует медленно и в большинстве случаев имеет доброкачественное течение.</span></li>\r\n</ul>\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;\">Больного беспокоит общая слабость, головные боли, у него пропадает аппетит, он быстро утомляется, температура тела субфебрильная. Кожные покровы поражаются через несколько дней после инфицирования, появляется красный или бордовый бугорок. Со временем бугорок разрастается и поражает большие участки до 20 см в диаметре.</span></p>",
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