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},
"code": "A43",
"name": "Нокардиоз",
"icd_name": "Нокардиоз",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"4"
],
"periodicity": 1,
"slug": "a43_nokardioz",
"lead": "глубокий псевдомикоз, возбудитель которого вызывает гнойно-гранулематозное поражение легких, кожи и внутренних органов",
"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;\">Заражение у людей вызывают несколько видов Nocardia. Nocardia asteroides обычно вызывает инфекции легких и всего организма. Другие виды обычно вызывают кожные инфекции, особенно у людей, живущих в тропическом климате.</span></p>\r\n<p><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;\">Люди заражаются, когда:</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;\">они вдыхают пыль, содержащую бактерии Nocardia, что приводит к инфекции 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;\">почва или вода, содержащая бактерии, попадает в кожу через порез или царапину, что приводит к инфекции кожи.</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;\">Нокардиоз редко передается от человека к человеку.</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;\">Бактерии Nocardia могут распространиться на соседние ткани или через кровоток, заражая любой орган. Они чаще всего заражают мозг, кожу, почки, кости или мышцы. Абсцессы (скопления гноя) могут образовываться в инфицированных органах.</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;\">Нокардиоз встречается во всем мире у людей всех возрастов. Но чаще всего он встречается среди пожилых людей, особенно мужчин, и у людей с ослабленной иммунной системой. Любое из следующих нарушений, ослабляющих иммунную систему, увеличивает риск заражения нокардиозом:</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;\">наличие определенных онкологических заболеваний (таких как ходжкинская лимфома);</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;\">наличие пересаженного органа;</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;\">прием высоких доз кортикостероидов и/или других препаратов, подавляющих иммунную систему;</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;\">болезнь 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;\">поздняя стадия ВИЧ /СПИД.</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;\">Нокардиоз считается оппортунистической инфекцией, потому что происходит у людей с ослабленной иммунной системой. Однако около 20–30% людей с нокардиозом не имеют нарушения или заболевания, повышающего риск заражения.</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>",
"pathogenesis": "<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;\">Входные ворота инфекции – слизистая оболочка дыхательных путей, кишечника, конъюнктивы глаза, раны. Нокардиоз обычно развивается на фоне сниженной резистентности макроорганизма: при хронических заболеваниях крови, онкологических процессах, длительном лечении кортикостероидами, иммунодепрессантами, противоопухолевыми антибиотиками. Обычно нокардиоз начинается как легочная инфекция, для которой характерно образование мелких бугорков, напоминающих туберкулезные. Далее процесс может развиваться местно (образуются каверны, абсцессы, свищи) или происходит диссеминация возбудителя лимфогенным или гематогенным путем. В этом случае могут наблюдаться абсцессы мозга, почек, других органов и тканей.</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;\">Подтверждение диагноза возможно при сопоставлении клинической картины нокардиоза с лабораторно-инструментальными данными. При легочной форме рентгенография легких обнаруживает картину сливной бронхопневмонии с полостями распада. При диссеминированной форме с помощью КТ и МРТ выявляются внутримозговые абсцессы и вторичные гнойные очаги во внутренних органах.</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;\">Выделение возбудителя нокардиоза из клинического материала (мокроты, бронхиальных смывов, экссудата, крови, мочи, гноя, цереброспинальной жидкости, биоптатов) производится с помощью микроскопии, бактериологического посева, ПЦР. Дополнительно могут применяться серологические исследования (реакция агглютинации, преципитации, связывания комплемента), кожные аллергические пробы.</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;\">Лечение нокардиоза должно включать пролонгированную химиотерапию и хирургическое дренирование гнойных очагов. Для этиотропной химиотерапии нокардиоза применяются сульфани­ламидные препараты (сульфадимидин, сульфадиазин – в течение нескольких месяцев), сульфаметоксазол+триметоприм, антибиотики (имипенем, амикацин, цефотаксим, цефтриаксон, тетрациклины – курс 4-6 недель). При нокардиозе может встать вопрос о дренировании плевральной полости, оперативном лечении абсцессов головного мозга, вскрытии абсцессов мягких тканей и т. д.</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;\">При легочном нокардиозе летальность составляет около 10%, при септической форме инфекции – 50%. Изолированная кожная форма нокардиоза протекает доброкачественно. Иммунопрофилактика нокардиоза не разработана. Избежать заражения патогенными микроорганизмами позволяет предупреждение травм кожи, ношение защитной одежды и обуви при контакте с землей, повышение иммунной реактивности.</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;\">Принципы профилактики прежде всего сводятся к избеганию попадания земли в раны, а также к повышению уровня иммунной защиты. Кроме этого, по возможности следует защищать себя от вдыхания запыленного воздуха.</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;\">Большинство случаев нокардиоза начинаются с легочных инфекций, которые развиваются в абсцессы легких. 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Приблизительно у одной трети зарегистрированных случаев развиваются абсцессы головного мозга, если их не лечить или если лечение задерживается. Симптомы, связанные с абсцессами головного мозга, могут включать сильную головную боль и очаговые, сенсорные и моторные нарушения.</span></p>\r\n<p><strong style=\"font-weight: normal;\"> </strong></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;\">Кожные абсцессы встречаются примерно в одной трети всех случаев нокардиоза и обычно обнаруживаются разбросанными по всей руке, грудной стенке и ягодицам. У пациентов, иммунная система которых угнетена из-за ВИЧ-инфекции или кортикостероидов или цитотоксических препаратов, язвенного колита, злокачественной опухоли лимфатической системы или ряда других заболеваний, прогрессирование заболевания может быть очень быстрым.</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;\">Нокардиоз может длиться от нескольких месяцев до лет. Важно, чтобы инфекция была диагностирована и дифференцирована от туберкулеза и пневмонии.</span></p>",
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"code": "D40",
"name": "Новообразование неопределенного или неизвестного характера мужских половых органов",
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"block_rubric": 38,
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}
]
}