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"code": "A98",
"name": "Геморрагическая лихорадка",
"icd_name": "Другие вирусные геморрагические лихорадки, не классифицированные в других рубриках",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5,
6,
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],
"periodicity": 1,
"slug": "a98_gemorragicheskaya_lihoradka",
"lead": "Термином \"геморрагическая лихорадка\" объединяется группа заболеваний вирусного происхождения со сходными проявлениями, при которых ведущая роль отводится поражению сосудов с развитием тромбозов или кровоточивости",
"description": "",
"etiology": "<p>Геморрагическую лихорадку могут вызывать пять основных видов вируса - тогавирусы, филовирусы, флавивирусы, аренавирусы, буньявирусы.</p>\r\n<p>Это группа инфекций, характеризующихся природной очаговостью, то есть распространением в местностях, где много диких животных, носителей вирусов и переносчиков из разряда клещей или комаров. Основные животные, которые могут быть источниками данных лихорадок это белки, летучие мыши, домашние грызуны и обезьяны.</p>\r\n<p>Для некоторых видов геморрагических лихорадок характерны и другие пути распространения. Выделяют воздушно-пылевой путь, парентеральный (через кровь и другие биологические жидкости), пищевой, водный, через контакты с зараженными животными.</p>\r\n<p>Чаще всего болеют люди, работа которых связана с животными, дикой природой и сельхозугодиями. Городские жители при заболевании в основном имеют контакты с грызунами. </p>\r\n<p> </p>",
"pathogenesis": "<p>В упрощенном виде механизмы повреждения при геморрагических лихорадках можно представить таким образом:</p>\r\n<ul>\r\n<li>повреждение сосудов вирусами или продуктами их метаболизма,</li>\r\n<li>нарушение целостности стенок сосудов, их , выделение в просвет биологически активных веществ,</li>\r\n<li>формирование из-за дефицита кровоточивости и развития так называемого ДВС-синдрома (массивного одновременного свертывания крови в одних сосудах и параллельного кровотечения из-за низкой свертываемости в других).</li>\r\n</ul>\r\n<p>В результате формируется гипоксия тканей (нехватка кислорода) и нарушения в работе сердца, легких, почек и головного мозга, происходит массивная потеря крови. При этом тяжесть болезни будет зависеть от вида лихорадки, степени активности иммунитета и особенностей организма человека. Зачастую геморрагические лихорадки протекают тяжело и заканчиваются высокой летальностью.</p>",
"diagnostics": "<p>Основа диагностики – это клиническая картина с указаниями на пребывание в неблагоприятном районе, укусы насекомых или контакт с животными. Но для подтверждения диагноза необходимо обнаружение вирусов в крови или антител к ним. Проводится:</p>\r\n<ul>\r\n<li>общий анализ крови,</li>\r\n<li>общий анализ мочи (особенно для лихорадок с почечным синдромом),</li>\r\n<li>биохимический анализ крови и мочи,</li>\r\n<li>серологические пробы,</li>\r\n<li>иммунохимические и ПЦР методы выделения вируса или антител к нему,</li>\r\n<li>при необходимости проводят выделение и исследование вирусов.</li>\r\n</ul>\r\n<p>Геморрагические лихорадки стоит различать с тяжелым капилляро-токсическим гриппом, риккетсиозами и менингококковой инфекцией – все они сопровождаются кровоточивостью и похожи по проявлениям. Кроме того, необходимо отличать эти инфекции от болезней крови с кровоточивостью (болезнь Шенляйна-Геноха или Верльгофа).</p>",
"treatment": "<p>Диагностикой и лечением занимаются врачи-инфекционисты, а иногда и реаниматологи.</p>\r\n<p>Все люди с подозрением на геморрагическую лихорадку подлежат госпитализации в боксированное отделение инфекционной больницы.</p>\r\n<p>В период острых проявлений показано парентеральное питание, в период выздоровления – легкая растительно-молочная диета с обогащением витаминами, особенно укрепляющими сосудистые стенки – витаминами РР, С или К.</p>\r\n<p>Кроме того, применяют внутривенные вливания растворов глюкозы, переливания крови, препараты железа, антигистаминные средства. При необходимости вводят тромбоцитарную массу, факторы свертывания.</p>\r\n<p>Постельный режим в изоляторе соблюдается до полного выздоровления. В дальнейшем пациент наблюдается еще достаточно длительно у инфекциониста и терапевта.</p>",
"prevention": "<p>К основным методам борьбы с геморрагическими лихорадками относят:</p>\r\n<ul>\r\n<li>уничтожение грызунов и насекомых-переносчиков,</li>\r\n<li>тщательная очистка участков жилых застроек от травы и кустарников, заболоченных мест,</li>\r\n<li>при работе в полях и лесах необходимо ношение защитной одежды, применение репеллентов,</li>\r\n<li>для профилактики некоторых видов геморрагических лихорадок разработаны вакцины – желтой лихорадки и омской геморрагической лихорадки.</li>\r\n</ul>",
"clinical_picture": "<p>Геморрагическая - это классическая инфекционная болезнь со стадийностью течения. Выделяют следующие стадии:</p>\r\n<ul>\r\n<li>инкубационную – она, в зависимости от вида вируса, может длиться от нескольких суток до трех недель,</li>\r\n<li>начальную стадию или период продрома, длящийся от суток до недели,</li>\r\n<li>период разгара болезни с проявлением всех типичных признаков геморрагической лихорадки и длящийся от одной до двух недель,</li>\r\n<li>период реконвалесценции или выздоровления (или в некоторых случаях - летальный исход).</li>\r\n</ul>\r\n<p>Выздоровление может длиться до нескольких месяцев, особенно в случае тяжелого течения и остаточных явлений.</p>\r\n<p>В начальном периоде симптомы геморрагической лихорадки обычно неспецифические. Обычно проявляются:</p>\r\n<ul>\r\n<li>симптомы общей интоксикации,</li>\r\n<li>высокая температура,</li>\r\n<li>расстройства сознания вплоть до бреда,</li>\r\n<li>точечные кровоизлияния на коже в зоне шеи и лица, склер и в области рта,</li>\r\n<li>нарушения ритма сердца с учащением или замедлением частоты,</li>\r\n<li>снижение давления,</li>\r\n<li>в анализах крови выявляется воспалительная реакция (лейкоцитоз, может быть со сдвигом) с незначительным снижением тромбоцитов.</li>\r\n</ul>\r\n<full></full>\r\n<p>В период разгара может быть:</p>\r\n<ul>\r\n<li>временное снижение температуры,</li>\r\n<li>общее улучшение состояния, после чего вновь наступает ухудшение,</li>\r\n<li>нарастает токсикоз,</li>\r\n<li>прогрессируют нарушения сознания,</li>\r\n<li>развиваются мелкие тромбозы и из мест инъекций, с поверхностей слизистых, пищеварительного и мочеполового тракта,</li>\r\n<li>нарушаются функции легких, почек, сердца.</li>\r\n</ul>\r\n<p>В периоде выздоровления постепенно все симптомы исчезают, работа органов восстанавливается.</p>",
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"diagnostics": "<p>Диагноз сложно поставить на ранних стадиях инфекции. Необходимо использовать серологические тесты.</p>",
"treatment": "<p>Лечение патогенетическое и симптоматическое. Специфических методов терапии нет. Летальность в зависимости от характера эпидемии колеблется от 1 до 25 %. В целях профилактики заболеваний лиц, выезжающих за рубеж в местности, неблагополучные по желтой лихорадке, вакцинируют. Во время пребывания на такой территории используют средства защиты от комаров – репелленты, защитные сетки.</p>",
"prevention": "<p>Вакцинация — основной способ профилактики желтой лихорадки. В районах с высоким риском заболевания, для которых характерен слабый охват прививками, важнейшим условием предотвращения эпидемий является своевременное выявление и подавление вспышек болезни посредством массовой вакцинации населения. При этом, чтобы не допустить дальнейшего распространения заболевания в регионе, где зафиксирована вспышка, важно обеспечить большой охват иммунизацией подверженного риску населения (не менее 80%).</p>\r\n<full></full>\r\n<p>Для предотвращения вспышек применяется ряд стратегий: плановая иммунизация детей грудного возраста; проведение кампаний по массовой вакцинации для расширения охвата в странах, где существует риск вспышек болезни; вакцинация лиц, совершающих поездки в районы, эндемичные по желтой лихорадке.</p>\r\n<p>Вакцина от желтой лихорадки является безопасной и недорогостоящей. При этом одна доза вакцины достаточна для формирования пожизненного иммунитета без необходимости ревакцинации.</p>\r\n<p>В редких случаях сообщается о серьезных побочных эффектах вакцины против желтой лихорадки. Показатель частоты таких «неблагоприятных проявлений после иммунизации» (НППИ), когда после введения вакцины наблюдаются поражения печени, почек и нервной системы, что делает необходимой госпитализацию, составляет от 0,4 до 0,8 на 100 000 вакцинированных.</p>\r\n<p>Уровень риска выше у лиц старше 60 лет, пациентов с тяжелым иммунодефицитом, связанным с симптоматическим ВИЧ/СПИДом или другими факторами, а также лиц с нарушениями вилочковой железы. Вакцинацию людей старше 60 лет следует проводить после тщательной оценки потенциального риска и пользы иммунизации.</p>\r\n<p>Как правило, к числу лиц, не подлежащих вакцинации, относятся:</p>\r\n<ul class=\"disc\">\r\n<li>дети грудного возраста младше 9 месяцев (кроме случаев эпидемии, когда вакцинации подлежат дети грудного возраста от 6 до 9 месяцев в районах с высоким риском инфекции);</li>\r\n<li>беременные женщины (кроме случаев вспышки желтой лихорадки и высокого риска инфекции);</li>\r\n<li>лица с тяжелыми формами аллергии на яичный белок;</li>\r\n<li>лица с тяжелым иммунодефицитом, связанным с симптоматическим ВИЧ/СПИДом или другими факторами, а также лица с нарушениями вилочковой железы.</li>\r\n</ul>\r\n<p>В соответствии с Международными медико-санитарными правилами (ММСП) страны имеют право требовать от лиц, совершающих поездки, представить свидетельство о вакцинации против желтой лихорадки. При наличии медицинских противопоказаний к вакцинации необходимо предоставить соответствующую справку от компетентных органов. ММСП — это юридически обязательный механизм, предназначенный для предотвращения распространения инфекционных заболеваний и других источников угрозы для здоровья населения. Применение к лицам, совершающим поездки, требования по предоставлению свидетельства о вакцинации оставлено на усмотрение каждому государству-участнику и в настоящее время практикуется не всеми странами.</p>",
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