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},
"code": "A37",
"name": "Коклюш",
"icd_name": "Коклюш",
"gender": 0,
"age_min": 0,
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"2",
"4"
],
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"slug": "a37_koklyush",
"lead": "острая инфекционная болезнь преимущественно детского возраста, характерным признаком которой является приступообразный спазматический кашель",
"description": "<p>Коклюш - это <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">бактериальная инфекция дыхательных путей, передающаяся воздушно-капельным путём от больного человека.</span></p>",
"etiology": "<p>Возбудителем является грамм-отрицательная палочка Борде – Жангу. Возбудитель коклюша неустойчив в окружающей среде, стремительно погибает под воздействием высокой температуры, солнечного света, высушивания и дезинфицирующих средств.</p>\r\n<p>Источник инфекции – больной коклюшем, особенно контагиозный в катаральный и в начале спазматического периода. Заражение происходит воздушно-капельным путем. Длительность заразного периода – 4–5 недель. Восприимчивость велика начиная с периода новорожденности.</p>",
"pathogenesis": "<p>Входными воротами являются верхние дыхательные пути. Гемофильная палочка заселяет слизистую оболочку гортани, бронхов, бронхиол, легочные альвеолы и воздействует на организм своим токсином. Под влиянием токсина развивается выраженная склонность к генерализованному сосудистому спазму мелких бронхов, голосовой щели со спастическим нарушением дыхания и тоническими судорогами поперечных мышц. В возникновении осложнений играет роль вторичная бактериальная флора.</p>",
"diagnostics": "<p>Для уточнения диагноза проводится бактериологический посев мокроты или мазок из зева. Для более быстрого установления окончательного диагноза может быть проведен серологический анализ крови на предмет наличия специфических антител. Изучается реакция агглютинации. На ранней стадии выявить патологию помогает метод внутрикожной пробы.</p>",
"treatment": "<p>Детей до 1 года и больных с осложнениями (как то ложный круп, бронхиты, пневмонии, ателектаз легкого) госпитализируют. Назначают антигистаминные препараты (димедрол, супрастин). В катаральном периоде применяют антибиотики (левомицетин, ампициллин, гентамицин). В спазматическом периоде в основном проводят патогенетическую и симптоматическую терапию с использованием нейролептиков, антигистаминных и противосудорожных препаратов.</p>",
"prevention": "<p>Коклюш у детей до года представляет собой серьезную угрозу для жизни малыша. Отмечается молниеносная форма инфекции, при которой инкубационный период может отсутствовать, а катаральный период сводится к нескольким часам. Быстро возникают нарастающие спазмы дыхательных путей. Присоединяется сердечнососудистая патология. На фоне судорожного синдрома может наступить клиническая смерть. Требуется экстренное помещение малыша в специализированный стационар.</p>\r\n<p>Очень часто коклюш у грудных детей протекает в так называемой маскированной форме. Отсутствуют выраженные репризы при приступах кашля. Вместо них наблюдается внезапная остановка дыхания после длительного приступа крика и истерики после нескольких кашлевых толчков. Наблюдается нарушение кровоснабжения мозговых структур и сердечной мышцы. Возникает судорожный синдром, лицо младенца синеет.</p>\r\n<p>Профилактика коклюша у детей до года — это важнейшее мероприятие в деле предупреждения детской смертности от различных инфекций.</p>\r\n<p>Прежде всего, следует позаботиться об ограничении контактов младенца с посторонними лицами. При обнаружении инфекции в детском дошкольном учреждении провидится тотальная диагностика всех контактных лиц и удаление возможного источника коклюшной палочки. Срок карантина составляет не менее 2-х недель с момента возникновения последнего случая инфекции. При отсутствии предварительной вакцинации контактные лица подлежат экстренной вакцинации с помощью специфического глобулина, который стимулирует выработку противовоклюшных антител.</p>\r\n<p>Наиболее эффективным средством профилактики коклюша у детей до года и в более старшем возрасте является вакцинация в строгом соответствии с национальным прививочным календарем. Первичная вакцинация проводится в возрасте 3-х месяцев. Затем необходима 3-хкратная ревакцинация с интервалом в 45 дней. Для восстановления специфического иммунитета против коклюша требует еще одной ревакцинации в возрасте 2 — 2,5 лет.</p>",
"clinical_picture": "<p>Инкубационный период длится от 3 до 15 дней. Первое клиническое проявление болезни – <a title=\"Перейти на страницу симптома Кашель\" href=\"/symptom/kashel/\">кашель</a>, не имеющий в начальном периоде характерных особенностей. Общее состояние обычно не нарушено, возможно появление насморка и субфебрильной температуры. <a title=\"Перейти на страницу симптома Кашель\" href=\"/symptom/kashel/\">Кашель</a> постепенно нарастает, приобретая упорный, приступообразный характер. В этот период приступы становятся типичными. Они состоят из ряда следующих друг за другом выдыхательных толчков, сменяющихся судорожным свистящим вдохом, вслед за которым снова следуют выдыхательные толчки. Число их может быть от 2–3 до 20 и более. Во момент спазматического кашля лицо больного краснеет, в тяжелых случаях синеет, вены шеи набухают, глаза слезятся, как бы наливаются кровью, голова вытягивается вперед, язык высовывается до предела. При этом уздечка языка у детей, имеющих зубы, травмируется нижними резцами, на ней может появиться язвочка. <a title=\"Перейти на страницу симптома Кашель\" href=\"/symptom/kashel/\">Приступ кашля</a> заканчивается выделением тягучей вязкой мокроты.</p>\r\n<p>При легкой форме коклюша общее состояние не нарушается, приступы кашля не превышают 10–15 раз в сутки.</p>\r\n<p>При среднетяжелой форме больной раздражителен, вялый, нарушается сон, аппетит. Температура тела может повышаться до 38° С. Приступы кашля – 20–30 раз в сутки, длительные, сопровождаются цианозом. В легких выслушиваются сухие и влажные <a title=\"Перейти на страницу симптома Хрипы\" href=\"/symptom/hripy/\">хрипы</a>.</p>\r\n<p>При тяжелой форме характерно значительное нарушение состояния. Температура выше 38°С. Отмечаются расстройство сна, <a title=\"Перейти на страницу симптома Анорексия\" href=\"/symptom/anoreksiya/\">отсутствие аппетита</a>, безучастие, резкая бледность, одутловатость лица, отечность век. В легких выслушиваются разнокалиберные сухие и влажные <a title=\"Перейти на страницу симптома Хрипы\" href=\"/symptom/hripy/\">хрипы</a>. Приступы кашля – 40–50 раз в сутки. Нарушается дыхательная функция. Иногда у детей до года может наступить апноэ. Во время приступа наблюдаются носовые кровотечения, кровоизлияния в склеры, непроизвольное мочеиспускание и дефекация.</p>\r\n<p>При стертой форме отмечаются легкие покашливания в течение 4–6 недель, общее состояние не страдает.</p>",
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