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"etiology": "<p>Возбудитель относится к семейству пикорнавирусов, к группе энтеровирусов (кишечным вирусам), куда входят также Коксаки- и ЕСНО-вирусы и существует в виде 3 независимых типов (I, II и III). Наиболее часто встречается 1 тип. </p>\r\n<p>Вирус устойчив во внешней среде (в воде сохраняется до 100 суток, в испражнениях — до 6 мес), хорошо переносит замораживание. Не разрушается пищеварительными соками. Разрушается при нагревании до 50 градусов Цельсия в течение 30 минут. Быстро погибает при кипячении, под действием ультрафиолетового облучения и при высушивании. Даже незначительные концентрации хлора инактивируют вирус. Источник инфекции — человек (больной или переносящий заражение бессимптомно); возбудитель выделяется через рот (несколько суток), а затем с испражнениями (несколько недель, а иногда и месяцев). Заражение может произойти воздушно-капельным путём, но чаще — при попадании в рот активного вируса (через загрязнённые руки, пищу). Механическим переносчиком вируса могут быть мухи. </p>\r\n<p>Заболеваемость полиомиелитом преобладает в летне-осенние месяцы. Чаще болеют дети от 6 месяцев до 5 лет. Большинство заболеваний связано с вирусом типа I. </p>",
"pathogenesis": "<p>Кишечная фаза </p>\r\n<p>Входными воротами для инфекции является слизистая оболочка носоглотки и тонкой кишки, в эпителии и лимфатических образованиях которых происходит первичная репродукция вируса. Затем вирус проникает в ток крови и обусловливает вирусемию. </p>\r\n<p>Фаза вирусемии </p>\r\n<p>Эта фаза характеризуется проникновением вируса во многие органы и ткани, такие как лимфатические узлы, селезенка, печень, легкие, сердечная мышца, жировая ткань, особенно бурый жир. </p>\r\n<p>Невральная фаза </p>\r\n<p>Следующим этапом развития патогенеза полиомиелита является проникновение вируса в различные органы, в частности в ЦНС. В ЦНС в патологический процесс чаще всего вовлекаются мотонейроны передних рогов спинного мозга, двигательные клетки черепных нервов. В тяжелых случаях могут поражаться нейроны задних рогов, клетки спинальных ганглиев и даже проксимальные отделы периферических нервов. В головном мозге повреждаются ретикулярная формация, вестибулярные ядра, глубинные структуры. </p>\r\n<p>Вирус действует на эндотелий сосудов, повышая их проницаемость. В результате чего происходит сдавление, отек здоровых участков нервной ткани, возникает клеточная инфильтрация, тигролиз - все это является морфологическим субстратом полиомиелита. Распространение вируса в организме человека может закончиться на любом этапе, что и определяет развитие той или иной формы полиомиелита. </p>",
"diagnostics": "<p>Лабораторные исследования: пробы крови для серологических исследований, общий анализ крови и мочи. </p>\r\n<p>Инструментальные исследования: </p>\r\n<ul>\r\n<li>Электромиография. При помощи ЭМГ регистрируются биоэлектрические потенциалы, возникающие на нервно-мышечной периферии. Поражение двигательных клеток в передних рогах спинного мозга выражается, прежде всего, четкими изменениями ритма. Это обусловлено тем, что пораженные мотонейроны возбуждаются одновременно (синхронно), что приводит с урежению колебаний потенциалов. Существует отчетливая связь между тяжестью поражения мышц и изменениями электромиограммы. ЭМГ тяжело пораженных мышц характеризуется «биоэлектрическим молчанием». </li>\r\n<li>Рентгенография конечностей для исключения вывихов, подвывихов, остеопороза.. </li>\r\n<li>Магниторезонансная томография спинного мозга - признаки атрофического процесса в передних рогах спинного мозга. </li>\r\n</ul>",
"treatment": "<p>Немедикаментозное лечение </p>\r\n<ol>\r\n<li>Лечебная физкультура занимает одно из ведущих мест в лечении больных с паралитическими формами полиомиелита. К ней необходимо приступить в раннем восстановительном периоде, то есть сразу после появления первых признаков движений в пораженных мышцах. Основная задача лечебных упражнений в раннем восстановительном периоде - тренировка основных параметров двигательной системы, которая заключается в постепенном и дозированном увеличении силы мышечного сокращения, амплитуды. На этом этапе лечения больному необходима помощь в овладении простыми движениями, а затем элементами утраченного сложного двигательного навыка. У больных с глубокими парезами при мышечной силе в пределах 1-0 балла, помимо лечения положением, применяют пассивные и пассивно-активные упражнения с переходом к активным упражнениям. </li>\r\n<li>Стимулирующий массаж пораженных конечностей, мышц спины. </li>\r\n<li>Физиолечение - магнитотерапия, биоптрон, УВЧ на пораженные сегменты спинного мозга, электростимуляция паретичных мышц импульсным током, озокеритовые или парафиновые аппликации на область паретичных мышц, суставы; электрофорез галантамина, прозерина по Вермелю. </li>\r\n<li>Иглорефлексотерапия. </li>\r\n<li>Ортопедическая профилактика паретичных конечностей с использованием шин, лонгет, валиков, мешков с песком, разработка контрактур. </li>\r\n</ol>\r\n<p> Медикаментозное лечение </p>\r\n<ol>\r\n<li>Стимулирующая терапия: антихолинэстеразные препараты - прозерин, галантамин. </li>\r\n<li>Витаминотерапия: аскорбиновая кислота, витамины группы В - В1, В6, В12. </li>\r\n<li>Последние годы в лечении полиомиелита используются анаболические стероиды (нерабол, ретаболил, метандростеналон). </li>\r\n<li>Лечение препаратами, действующими на сосудистую систему, улучшающими реологические свойства крови и микроциркуляцию, проводится в виде последовательных курсов, каждый из них длительностью 2-3 недели. </li>\r\n<li>Спазмолитическим, сосудорасширяющим, стимулирующим влиянием на спинной мозг обладает дибазол. Лечение продолжается в течение 3-4 недель, показаны повторные курсы лечения. </li>\r\n<li>Препараты, улучшающие метаболизм (ноотропы). </li>\r\n<li>Метаболические средства - фолиевая кислота, аевит, оротат калия. </li>\r\n</ol>",
"prevention": "<p>Неспецифическая направлена на общее укрепление организма, увеличение его устойчивости к различным инфекционным агентам (закаливание, правильное питание, своевременная санация хронических очагов инфекции, регулярные физические нагрузки, оптимизация цикла сон-бодровствание и др.), борьба с насекомыми, которые являются разносчиками патогенных микроорганизмов (различные виды дезинсекции), соблюдение правил личной гигиены (в первую очередь это мытье рук после улицы и после посещения туалета), тщательная обработка овощей, фруктов и других продуктов перед употреблением их в пищу. </p>\r\n<p>Специфическая профилактика заключается в проведении вакцинации против полиомиелита. </p>\r\n<p> </p>",
"clinical_picture": "<p>В зависимости от того, какую форму заболевания перенес человек, могут отличаться и последствия полиомиелита. Так абортивная форма проходит в среднем через 7 дней, не оставляя совершенно никаких последствий. Полное выздоровление наступает и после перенесенной менингиальной формы заболевания, но спустя значительно больший промежуток времени. </p>\r\n<p>Даже самая сложная, паралитическая форма может пройти абсолютно бесследно и все функции пораженной полиовирусом ЦНС будут восстановлены. Однако если параличи и парезы носили глубокий, стойкий характер, то добиться абсолютно полного восстановления пораженных отделов нервной системы будет невозможно. После тяжёлой паралитической формы остаются мышечные атрофии, остеопороз, деформации конечностей. В ряде случаев остаются суставные контрактуры с ограничением объёма активных и пассивных движений в них, привычные вывихи, паралитическое искривление позвоночного столба, деформации стоп, косолапость. Дети после перенесенного полиомиелита обычно сильно отстают в физическом развитии, часто у них наблюдается укорочение пораженной конечности. </p>\r\n<p>При возникновении у больного центральных и периферических изменений дыхания, нарушений сердечно-сосудистой системы, при парализации гладкой мускулатуры желудочно-кишечного тракта в большинстве случаев заболевание заканчивается смертельным исходом. </p>",
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"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;\">Возбудители патологии – различные виды пиявок. Практически повсеместно распространены пиявки рода Haemopis, Limnatis, Hirudo (медицинские), вида Tyrannobdella rex (королевская). Обитают паразиты во влажной траве, торфяных болотах, стоячих пресных водоемах. Являются гермафродитами и активными хищниками, питаются кровью зверей, птиц, человека, присасываясь с помощью хоботков или хитиновых челюстей. Нападают преимущественно в ночное время.</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;\">Факторы риска</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;\">Основные факторы риска гирудиноза связаны с профессиональной деятельностью, туризмом, проживанием в эндемичных регионах. Так, наиболее часто заражаются:</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;\">путешественники, проходящие маршруты по джунглям, заболоченной местности;</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;\">жители регионов с высокой влажностью, большим числом непроточных озер;</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;\">работники водоканалов;</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;\">ветеринары;</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;\">профессиональные рыболовы и охотники.</span></li>\r\n</ul>\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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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 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 момент присасывания пиявка прокусывает кожу человека, одновременно выделяя железистый секрет, являющийся сильным антикоагулянтом (гирудин), белки, гистаминоподобные вещества. Это приводит к капиллярному расширению, локальному кровотечению. Медицинская пиявка может высосать до 15 мл крови за полчаса, с учетом последующего кровотечения после удаления паразита организм теряет до 60 мл. Иногда кровоточивость места укуса продолжается до суток.</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;\">Во время питания пиявка значительно увеличивается в размере, перекрывая просвет полого органа. Образующаяся ранка приводит к механическому повреждению тканей, имеет звездчатую форму, диаметр до 2 мм, глубину до 1,5 мм. Возникает подкожное кровоизли­яние. Позднее область укуса приобретает желтый цвет, на месте ранки остает­ся треугольный рубчик, заметный в течение нескольких месяцев и лет.</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;\">Диагностика гирудиноза осуществляется врачами различных специальностей – это зависит от локализации возбудителя. Чаще всего больные попадают на прием к оториноларингологу, гинекологу и хирургу. Важен сбор анамнеза на предмет пребывания во влажных, заболоченных местностях, факты употребления воды из непроточных источников, колодцев. Дополнительно проводятся лабораторно-инструментальные и клинические исследования:</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;\">Физикальный осмотр. При наружном расположении возбудитель заметен и может быть удален. У пациента с внутренним гирудинозом объективный осмотр выявляет симптомы астении, бледность, сухость кожных покровов, нередко тахикардию, дисфонию, одышку. При пальпации живота отмечается урчание, вздутие, определяются диффузная или локальная болезненность, спленомегалия. Обязательна визуальная оценка рвоты, кала и 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;\">Эндоскопические исследования. Инструментальный осмотр полости носа (риноскопия), ротоглотки, органов дыхания (ларингоскопия, трахеобронхоскопия), а также различных отделов пищеварительного тракта (эзофагогастроскопия, колоноскопия) проводится по показаниям при подозрении на органный гирудиноз. Если в ходе исследования обнаруживается пиявка, производится ее удаление, прижигание места присасывания.</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;\">Лабораторные исследования. В общем анализе крови – нормохромная или гипохромная анемия, незначительный лейкоцитоз, редко эозинофилия, ускорение СОЭ. Может выявляться повышение активности СРБ, трансаминаз, нарушения свертывания крови, снижение ферритина. Общеклинический анализ мочи обнаруживает лейкоцитурию, эритроцитурию, гематурию.</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;\">Инструментальные методы. Для исключения новообразований проводится рентгенография (либо низкодозовая МСКТ) легких, МРТ гортани, глотки, пищеварительного тракта, ирригоскопия. Рекомендуется УЗИ органов брюшной полости, малого таза. В некоторых случаях выполняется диагностическая лапароскопия.</span></li>\r\n</ul>\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\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Удаление пиявки</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;\">Удаление пиявки при наружном присасывании нередко осуществляется самим пациентом либо врачом в амбулаторных условиях. Важным условием является полное избавление от паразита без оставления в ране ротового аппарата. Путем воздействия на видимую часть паразита крепкими солевыми, спиртовыми растворами, йодом пиявку заставляют прекратить присасывание, убирают пинцетом. На ранку накладывают давящую повязку.</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;\">Медикаментозная терапия</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;\">Больные с признаками осложнений должны быть госпитализированы. Пациенты с дыхательной недостаточностью, выраженной кровопотерей помещаются в палаты интенсивной терапии. После удаления возбудителя рекомендуется обогащение рациона белковой и железосодержащей пищей.</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;\">Важным этапом является восстановление кровопотери, коррекция железодефицитной анемии и ее последствий. Восстановление объема циркулирующей крови показано только в случае массивного кровотечения, проводится глюкозо-солевыми растворами, свежезамороженной плазмой, реже − эритроцитарной массой.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">Местно применяются кровоостанавливающие повязки, химическое, лазерное коагулирование раны. Антибактериальные средства при гирудинозе назначаются по показаниям. Фармакологического антидота к компонентам железистого секрета пиявок не существует.</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>",
"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;\">Специфической профилактики нет. Неспецифические меры – отказ от питья сырой воды из колодцев, озер, купания на необорудованных пляжах, в стоячих водоемах. Купальные костюмы должны быть закрытыми, необходимо надевать шапочку и очки, нельзя глотать воду.</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;\">В походах, особенно утренних, рекомендуется носить брюки, заправленные в обувь, носки, высокие резиновые сапоги, не расстегивать ворот рубашки. Можно использовать солевые повязки, химические вещества для отпугивания пиявок (инданол, диметилфолат), либо нанести на одежду, тело и обувь парфюм или жидкое мыло с резким запахом. Запрещается ходить босиком и в открытой обуви по влажной траве.</span></p>\r\n<p><span id=\"docs-internal-guid-3abf222f-7fff-3aaa-3c3c-862867b3e25c\"> </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;\">Инкубационный период зависит от длительности присасывания, локализации и вида возбудителя. Самые распространенные симптомы гирудиноза − проявления хронической анемии, вызванные кровопотерей: слабость, снижение работоспособности, сонливость. Нередко больные отмечают бледность кожи, шум в ушах, учащение пульса, дыхания, выраженные головокружения.</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;\">Наружное присасывание пиявок быстро обнаруживается самим пострадавшим. Вначале возникает умеренная острая боль в области укуса, которая вскоре стихает. Напитавшийся кровью паразит увеличивается в десятки раз. После удаления пиявки ранка может недолго кровоточить.</span></p>",
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"lead": "Нарушение здоровья, относящееся к группе педикулез, акариаз и другие инфестации",
"description": "Миазы – группа заболеваний, обусловленных паразитированием в тканях и полостях человека личинок некоторых видов мух. ",
"etiology": "<p>Основные возбудители миаза - личинки мухи тумбу (Cordylobia anthropophaga) и песчаная блоха (Tunga penetrans), самки которой проникают в кожу по сделанным ими ходам, где оплодотворённое животное раздувается от яиц до размеров горошины, вызывая развитие болезненных изъязвлений. В отечественной практике известны случаи паразитирования у человека личинок вольфартовой мухи (Wohlfahrtia magnifica) и различных оводов (обычно русского и овечьего). </p>\r\n<p>Личинки мух сравнительно стойки по отношению к различным факторам, в частности к химическим реагентам. Можно отметить способность личинки мухи Eristalis к обитанию в сточных водах и др. весьма загрязненных местах (скопление жидких фекалий и др.); личинки многих мух долго по сравнению с личинками других насекомых не гибнут в растворах формалина или спирта. Все эти особенности личинок мух определяют их способность жить тот или другой срок в необычной для них среде, например, в кишечнике человека, куда они могут попасть с пищей. </p>",
"pathogenesis": "<p>Развитие заболевания происходит преимущественно вследствие откладывания яиц насекомыми в глаза, нос, уши и раны человека. Часто личинки вводятся подкожно. Немного реже диагностируется висцеральная инвазия организма, при которой происходит случайное проникновение личинок в организм, заглатываемых вместе с осемененными продуктами. </p>",
"diagnostics": "<p>При кожном виде болезни личинки размером до 1–1.5 см обнаруживаются на поверхности раны или язвы. При кишечной форме паразиты можно увидеть в испражнениях и рвотных массах. С диагностической целью делают анализ кала на обнаружение паразитов. </p>\r\n<p>В общем анализе крови при заболевании выявляется эозинофилия. Иммунный анализ крови (ИФА) показывает увеличение в сыворотке IgE. Интрацеребральная форма болезни выявляется компьютерной томографией. </p>\r\n<p> </p>",
"treatment": "<p>Лечение миаза кожи заключается в удалении личинок из очага поражения путем промывания раны антисептическими растворами (калия перманганата, фурацилина и др.). Для облегчения удаления личинки в отверстие инфильтрата можно залить несколько капель стерильного масла; лишившись доступа воздуха, паразит показывается на поверхности кожи и может быть легко захвачен пинцетом или зажимом. После этого освободившаяся полость подвергается обработке дезинфицирующими средствами и закрывается асептической повязкой. При развитии гнойных осложнений применяются противомикробные мази или системные антибиотики. </p>\r\n<p>При кишечной форме миаза назначается промывание желудка, прием слабительных и противопаразитарных препаратов. Лечение мочеполового миаза заключается в промывании уретры для удаления личинок. Из конъюнктивальной полости личинки извлекаются остроконечными глазными иглами после инстилляциианестезирующих и антисептических капель. В остальных случаях личинки подлежат удалению хирургическим путем. </p>",
"prevention": "<p>Для предотвращения миазов кожи необходимо применение репеллентов, отпугивающих мух и оводов. С целью недопущения глубокого проникновения паразитов необходимо своевременное и рациональное лечение всех поражений кожи. Важное значение имеет уничтожение мух и очагов их выплода; хранение продуктов в местах, недоступных для мух; защита ран от инвазии личинками мух; предупреждение и лечение миазов у животных.</p>",
"clinical_picture": "<p>Поверхностный кожный миаз протекает доброкачественно. Личинки возбудителей поверхностных миазов питаются только гноем и разложившимися некротизированными тканями, поэтому больных беспокоит умеренный зуд в ране и ощущение «ползания мурашек». При осмотре очага поражения определяются белые копошащиеся островки в виде манных крупинок. После окончания цикла созревания личинки выпадают из раны и окукливаются вне человеческого организма. При глубоком миазе кожи у больного повышается температура тела, возникает слабость, головные боли. Нестерпимая острая боль в области раны, где паразитируют личинки, может приводить к обморокам. </p>\r\n<p>При локализации на конъюнктиве, в полости рта и носа личинки разъедают слизистые оболочки и мягкие ткани, проникая до фасций и надкостницы, разрушая хрящи и кости гортани, носоглотки, пазух носа, глазниц и т. д. </p>\r\n<p>Кишечный миаз развивается в результате случайного проглатывания личинок мухи с пищей. При паразитировании личинок в желудке основные проявления включают тошноту, рвоту, боль в эпигастральной области. Нахождение паразитов в кишечнике вызывает тифоидное состояние, симптомы длительно текущего энтерита и колита (абдоминальные боли, поносы, болезненные позывы к дефекации, примесь крови в испражнениях и др.). </p>\r\n<p>Тяжелое течение миаза наблюдается при паразитировании личинок на слизистой оболочке глаз, носа, ушей. Мочеполовой миаз возникает при попадании яиц на грязное нательное и постельное белье, с которого личинки проникают на слизистую гениталий и в уретру. При урогенитальном миазе может развиваться клиника вульвита, вагинита, уретрита, цистита. </p>\r\n<p>При глазной форме миаза (офтальмомиазе) личинки овода паразитируют в конъюнктивальном мешке, вызывая явления конъюнктивита, иридоциклита, образование язв роговицы. В особо тяжелых случаях они могут проникать в слезный мешок и внутрь глазного яблока, вызывая его разрушение. </p>\r\n<p>Паразитирование личинок в носовых ходах сопровождается повышением температуры, головной болью, слизисто-гнойным насморком. </p>\r\n<p>Отомиаз может сопровождаться перфорацией барабанной перепонки и проникновением паразитов к мозговым оболочкам. Возбудители полостных миазов могут паразитировать в полости рта, придаточных пазухах, анальном канале. </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 58,
"published": 2,
"parent": null,
"block_rubric": 18,
"standards": []
}
]
}
