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},
"code": "P37.0",
"name": "Врожденный туберкулез",
"icd_name": "Врожденный туберкулез",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
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"slug": "p37.0_vrozhdennyy_tuberkulez",
"lead": "инфекционное заболевание, вызываемое микобактериями туберкулеза при их попадании от инфицированной матери к плоду во время беременности",
"description": "",
"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 заболевания – микобактерия туберкулеза. Инфицирование плода происходит внутриутробно. Как правило, сама женщина заболевает во время беременности, более редки случаи врожденного туберкулеза, когда мать перенесла инфекцию незадолго до беременности. Входными воротами для микобактерий является только плацента. Туберкулезная палочка проникает через сосуды плаценты и так оказывается в кровотоке плода. С кровью бактерии попадают в печень, где и формируется первичный очаг инфекции, часто с поражением регионарных лимфатических узлов. Оттуда возбудитель распространяется по всем тканям.</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;\">Врожденный туберкулез также может развиться при аспирации околоплодных вод, в которых присутствуют микобактерии, если инфильтраты на плаценте вскрываются непосредственно в амниотическую жидкость. Для аспирационного пути инфицирования характерно формирование первичного очага в легких, кишечнике, среднем ухе. Риск заражения врожденным туберкулезом повышается, если у матери имеются сопутствующие патологии, особенно снижающие иммунитет, например, ВИЧ-инфекция, а также при наличии неблагоприятных социальных факторов (плохие жилищные и санитарные условия, асоциальный образ жизни и др.).</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;\">Если появляются первые признаки туберкулеза врожденного типа, то необходимо обратиться к врачу. При первом осмотре он может обнаружить, что у ребенка дыхание учащенное. Размеры печени увеличены. То же самое касается и селезенки. Возможно незначительное увеличение показателей температуры. Также появляется желтуха. При пальпации лимфатических узлов врач замечает, что они больше нормы. Это касается особенно тех, которые располагаются под ключицей, под мышками и др.</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;\">Для диагностики назначают такие процедуры:</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;\">анализ крови. После исследования крови врач может заметить в ней признаки воспалительных процессов и гипербилирубинемию. Также часто обнаруживается анемия;</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;\">рентгенография органов грудной клетки. На полученной рентгенограмме будут заметны затемненные очаги. Они указывают на то, что в этих местах скапливаются микобактерии в полости легких;</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;\">туберкулиновые пробы;</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 внутренних органов;</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;\">нейросонография;</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;\">спинномозговая пункция (если есть подозрения на менингит).</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;\">Терапия заболевания начинается с момента постановки точного диагноза, но здесь есть исключения. При тяжелых формах врожденного туберкулеза туберкулиновые пробы могут давать отрицательные результаты, однако если диагноз подтвержден у матери, возможно начало лечения ребенка без лабораторного подтверждения, необходимо только согласие родителей. Во всех случаях врожденного туберкулеза показана госпитализация, консультация фтизиатра. Формы заболевания с выраженной органной недостаточностью и неврологическими нарушениями требуют лечения в условиях отделения детской реанимации.</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;\">Проводится этиотропная терапия, назначаются противотуберкулезные препараты: изониазид, рифампицин, пиразиномид, этамбутол, канамицин. Химиотерапия при врожденном туберкулезе состоит из нескольких этапов. Сначала назначаются 3-4 препарата одновременно сроком на несколько месяцев с последующими контрольными анализами. Дозировки рассчитываются строго по весу ребенка. Далее оставляют 1-2 препарата еще на 4-5 месяцев. Общая продолжительность специфической терапии врожденного туберкулеза может составлять до 8-9 месяцев. После окончания фазы интенсивной терапии ребенок переводится в противотуберкулезный диспансер, где и наблюдается до окончания всего курса лечения.</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;\">Одновременно со специфической терапией назначаются десенсибилизирующие и антигистаминные препараты, иммунотерапию и витамины группы B. При выраженной дыхательной недостаточности показана кислородотерапия. Если присоединяется вторичная бактериальная инфекция, в частности менингит, проводится антибиотикотерапия. В зависимости от локализации очагов инфекции к лечению врожденного туберкулеза подключаются узкие специалисты: невролог, оториноларинголог, гастроэнтеролог.</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 при туберкулезе врожденного типа предполагает раннюю диагностику и обнаружение инфекций еще во время беременности. Когда подтвердилось наличие заболевание у женщины, то назначают специальное лечение, которое проводится еще до родов.</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;\">Если плод заражен микобактериями в первые 3 месяца беременности женщины, то обычно происходит либо выкидыш, либо ребенок будет мертворожденным. В остальных случаях малыш будет либо мало весить, либо родится недоношенным.</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;\">Специфические симптомы туберкулеза у детей в первые дни не проявляются. Однако признаки начинают возникать примерно через 3 недели или месяц после рождения. У малыша нарастает дыхательная недостаточность. Если патология проявляется в тяжелой форме, то развивается также респираторный дистресс-синдром. Ребенок вялый, ведет себя беспокойно, у него плохой аппетит. Может незначительно повышаться температура тела.</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;\">На фоне туберкулеза врожденного типа может развиваться желтуха и гепатоспленомегалия. У 40% всех детей с таким заболеванием от рождения также диагностируют лимфаденопатию. В 30% параллельно развивается менингит. Также будет заметна ригидность мышц затылка. Ребенок начнет запрокидывать голову к спине. Также может быть как чрезмерное возбуждение центральной нервной системы, так и ее угнетение. В 20% случаев при врожденной форме туберкулеза у детей обнаруживают выделения из ушей. Крайне редко диагностируется геморрагический синдром, сыпь на кожных покровах (она может быть в виде папул).</span></p>",
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{
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