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},
"code": "N18",
"name": "Хроническая почечная недостаточность",
"icd_name": "Хроническая почечная недостаточность",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"0",
"3"
],
"periodicity": 3,
"slug": "n18_hronicheskaya_pochechnaya_nedostatochnost",
"lead": "внезапное или постепенное, частичное или полное угасание фильтрационной, секреторной и выделительной функций почек",
"description": "<p><span id=\"docs-internal-guid-0f389a65-7fff-742f-3319-86405b95b3c8\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Почечная недостаточность — состояние, при котором одна или обе почки не могут в полном объеме выполнять свои функции. </span></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;\">Хроническая почечная недостаточность развивается в результате разрушения тканей почки. Произойти это может из-за следующих причин:</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;\">Различных патологий почек – пиелонефрита, гломерулонефрита и других;</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;\">Сердечно-сосудистых заболеваний, сопровождающихся повышенным АД;</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;\">Заболеваний эндокринного характера;</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;\">Токсического поражения организма;</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;\">Генетической предрасположенности;</span></li>\r\n<li><span style=\"background-color: transparent; font-size: 7pt; font-family: Verdana; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Опухолей в мочевыделительной системе;</span></li>\r\n<li><span style=\"background-color: transparent; font-size: 7pt; font-family: Verdana; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Системных заболеваний – васкулитов, волчанки;</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;\">Острой почечной недостаточности.</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;\">Особенно осторожными и внимательными к своему здоровью должны быть люди, находящиеся в группе повышенного риска. Необходимо ежегодно проходить обследования, если имеется артериальная гипертензия, сахарный диабет, необходимость принимать лекарства, которые могут навредить почкам.</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;\">Хроническая болезнь почек на ранних стадиях описывают как снижение почечного резерва или почечную недостаточность, которая может прогрессировать. Изначально, потеря функции почечной ткани почти не имеет явных патологических проявлений, потому что оставшаяся ткань усиленно работает.</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;\">Снижение функции почек коррелирует со способностью почек поддерживать водный и электролитный гомеостаз. На ранних стадиях нарушается способность почек концентрировать мочу, а затем присоединяется снижение способности экскретировать избыток фосфатов, кислоты и калия. При выраженной почечной недостаточности теряется способность эффективно разбавлять или концентрировать мочу.</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;\">Диагностикой ХПН занимается врач-нефролог. Заподозрить наличие болезни можно по снижению скорости клубочковой фильтрации. На первом приеме специалист проводит подробный опрос, который помогает определить симптомы и условия их появления.</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;\">Далее диагностика включает:</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 анализ 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 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 по Нечипоренко, по Зимницкому;</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;\">УЗИ почек;</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;\">Эходопплерография;</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;\">Биопсия почки;</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;\">ЭКГ, Эхо-КГ.</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;\">Рентгеновское исследование с применением контраста проводят редко. Препараты для рентген-диагностики обладают нефротоксичностью, могут вызвать осложнения.</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;\">Тактика лечения хронической почечной недостаточности подбирается исходя из причины, спровоцировавшей развитие болезни. Пациентам необходимо постоянно контролировать уровень артериального давления и не допускать его повышения. На ранних стадиях развития ХПН показано медикаментозное лечение. Оно включает прием:</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;\">Препаратов эритропоэтина – гормона, который стимулирует образование эритроцитов;</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;\">Препаратов железа – показаны при развитии анемии;</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;\">* Витамина Д – улучшает костный обмен, связывает избыток фосфора в 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;\">Мочегонные препараты – облегчают работу почек.</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;\">Полностью вылечиться от хронической почечной недостаточности невозможно. Основная цель: остановить прогрессирование и не допустить развития осложнений. Очень важно соблюдать диету, которая ограничивает употребление белков, соли и продуктов с высоким содержанием калия. При выраженной дисфункции почек показан гемодиализ либо пересадка органа.</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 острой почечной недостаточности заключается в своевременном лечении других заболеваний и по возможности исключения ситуаций-провокаторов (например, отравления ядами или лекарствами). Желательно ежегодно проходить комплексные профилактические обследования и как можно раньше обращаться за медицинской помощью при появлении любых подозрительных симптомов. Важно отказаться от самолечения хронических заболеваний и следовать рекомендациям лечащего врача.</span></p>",
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"lead": "Нарушение здоровья, относящееся к группе сахарный диабет",
"description": "Сахарный диабет, обусловленный недостаточностью питания — по рекомендации Всемирной организации здравоохранения в 1985 году, в дополнение к ранее выделенным типам сахарного диабета, в классификацию была включена ещё одна клиническая форма, обусловленная недостаточностью питания, главным образом в тропических странах у пациентов 10—50 лет. ",
"etiology": "<p>Выделяют панкреатическую и панкреатогенную формы сахарного диабета, обусловленного недостаточностью питания. </p>\r\n<p>Возникновение панкреатической формы сахарного диабета связывают с избыточным употреблением в пищу продуктов, содержащих цианиды (бобы, маниока, сорго, просо) на фоне дефицита белка (фиброкалькулезный подтип). </p>\r\n<p>Протеин-дефицитный подтип панкреатической формы сахарного диабета обусловлен низким содержанием в принимаемой пище белка и насыщенных жиров, возникает в возрасте 20—35 лет. </p>\r\n<p>Панкреатогенная форма связана с избыточным поступлением железа в организм и его отложением в поджелудочной железе. </p>",
"pathogenesis": "<p>Патогенез панкреатической формы связывают с избыточным употреблением в пищу продуктов, содержащих цианиды (бобы, маниока, сорго, просо) на фоне дефицита белка. Отмечается весьма низкая секреция инсулина, глюкагона и синдром нарушения внутрикишечного всасывания. При патогистологическом исследовании в протоках поджелудочной железы пациентов выявляются кальцинаты (отложение солей кальция) и диффузный фиброз железы (замещение соединительной тканью) без признаков наличия воспалительного процесса. </p>\r\n<p>При панкреатогенном диабете отложение железа в поджелудочной железе возникает, например, при лечении талассемии (частые переливания крови), употребление жидкостей (в том числе алкоголя) из железных ёмкостей распространено среди народа банту в Южной Африке) и другими факторами, приводящими к развитию вторичного гемохроматоза (накоплению железа в крови). </p>",
"diagnostics": "<p>Диагностика включает: </p>\r\n<ul>\r\n<li>Определение содержания глюкозы в плазме капиллярной крови натощак и через 2 часа после теста толерантности к глюкозе (прием внутрь 75 г глюкозы, разведенной в 300 мл воды). </li>\r\n<li>Проводится патогистологическое исследование поджелудочной железы и ее протоков. </li>\r\n<li>Определение уровня железа в переферической крови. </li>\r\n<li>Биохимическое исследование крови с определением уровня белка. </li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>Лечение включает в себя: </p>\r\n<ul>\r\n<li>инсулинотерапию; </li>\r\n<li>сбалансированное питание; </li>\r\n<li>исключение из рациона продуктов, содержащих цианиды (бобы, маниока, сорго, просо); </li>\r\n<li>применение антидота железа (десферала) - препарата, образующего комплексное соединение с железом, способствующего удалению железа из организма с мочой. </li>\r\n</ul>",
"prevention": "<p>Профилактика заболевания включает в себя рациональное сбалансированное питание, своевременное выявление повышения уровня глюкозы крови, контроль уровня железа в крови. </p>",
"clinical_picture": "<p>Течение данной формы сахарного диабета характеризуется отсутствием кетоза при наличии клинической картины 1-го типа сахарного диабета, резистентностью (устойчивостью) к инсулинотерапии. </p>\r\n<p>Проявляется повышением уровня сахара крови, повышенным мочевыделением, похудением при повышенном аппетите, сухостью во рту, слабостью. </p>\r\n<p>Течение данного подтипа диабета зачастую осложняется тяжёлой периферической соматической полинейропатией (множественное поражение периферических нервов). </p>",
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},
"code": "A58",
"name": "Паховая гранулема",
"icd_name": "Паховая гранулема",
"gender": 0,
"age_min": 20,
"age_max": 40,
"cause": [
"2",
"5",
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],
"periodicity": 1,
"slug": "a58_pahovaya_granulema",
"lead": "инфекционное заболевание, вызываемое бактериями вида Klebsiella granulomatis",
"description": "<p><span id=\"docs-internal-guid-b60682b0-7fff-cdbd-f559-1ede3db56f0d\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Паховая гранулема – медленно прогрессирующее инфекционное венерическое заболевание, характеризующееся обширными изъязвлениями кожи и поражением лимфатических узлов генитальной и перианальной области.</span></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;\">Возбудитель венерической гранулемы – Calymmatobacterium granulomatis, также его называют тельцами Донована.</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;\">Заразиться этим заболеванием можно не только половым путем, но и бытовым. Инфекция может проникнуть через микродефекты на коже и слизистых. Микроорганизмы, которые приводят к развитию донованоза, обладают повышенной устойчивостью к воздействию окружающей среды и могут выживать вне человеческого организма. Распространению инфекции благоприятствуют влажный климат и жара.</span></p>",
"pathogenesis": "",
"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;\">Диагноз устанавливается после проведения комплекса лабораторных исследований:</span></p>\r\n<ul>\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;\">исследование полученной из язвы серозной жидкости на бледную трепонему в темном поле микроскопа;</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;\">исследование мазков отделяемого из язв (окрашенных по Граму препаратов) на стрептобациллы Дюкрея;</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;\">исследование возбудителя в окрашенных по Лейшману или Романовскому-Гимзе мазках, приготовленных путем раздавливания кусочков ткани краев язв между двумя предметными стеклами.</span></li>\r\n</ul>\r\n<p> </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;\">Назначают один из следующих антибиотиков: стрептомицин, тетрациклин, эритромицин, хлорамфеникол или ко-тримоксазол. В течение 6 месяцев после лечения пациент должен наблюдаться у врача, чтобы удостовериться, что заболевание вылечено.</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;\">Если паховая гранулема оставлена без лечения, инфекция может распространяться на кости, суставы или печень; вызывать значительное снижение веса, повышение температуры тела и анемию.</span></p>",
"prevention": "<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;\">Защитить себя от заболеваний, передающихся половым путем, можно при соблюдении простых правил безопасности:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\" dir=\"ltr\">\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;\">Старайтесь избегать многочисленных и случайных сексуальных связей.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\" dir=\"ltr\">\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;\">Обязательно пользуйтесь презервативом при сексуальных отношениях с малознакомым человеком или с тем, кто имеет нескольких половых партнеров.</span></p>\r\n</li>\r\n</ul>",
"clinical_picture": "<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;\">Симптомы заболевания появляются приблизительно через 1-12 недель после инфицирования. Первый симптом – появление безболезненного красного узелка, который медленно превращается в круглое приподнятое образование. Инфекция поражает половой член, мошонку, пах и бедра у мужчин, и вульву, влагалище и окружающую кожу – у женщин. Как у мужчин, так и у женщин могут быть инфицированы задний проход, ягодицы и лицо. Приподнимающиеся над кожей узелки постепенно покрывают половые органы. Заживление медленное, с формированием рубцовой ткани. Обычно узелки инфицируются другими микроорганизмами.</span></p>",
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{
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{
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{
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{
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{
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