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"description": "По клиническим проявлениям врожденная герпетическая инфекция подразделяется на: генерализованную (диссеминированную) форму с церебральными и висцеральными повреждениями; локализованную форму (энцефалит, поражение кожи (везикулез), слизистых полости рта, глаз); висцеральную (поражение легких, печени, селезенки, надпочечников); преимущественное поражение нервной системы.",
"etiology": "<p>Источником заражения является больной человек, у которого вирус присутствует на эпителии слизистых оболочек. При контакте с партнёром (заражение вирусом ВПГ-2 обычно происходит при половом контакте, ВПГ-1 при оральногенитальном и половом контактах) вирус проникает через эпителий слизистой оболочки партнёра и через повреждённую кожу. Для вируса герпеса характерна склонность к обитанию в нервных клетках. По чувствительным нервам он приникает в нервные ганглии (скопления крупных нервных клеток, отростками которых и являются нервы), где инфекция приобретает скрытое течение.</p>",
"pathogenesis": "<p>Размножение происходит в ядре поражённой клетки. Внедряясь в клетку, вирус <a href=\"/symptom/obmetyvanie_gub/\" title=\"Перейти на страницу симптома Обметывание губ\">герпес</a> использует её структурные компоненты в качестве строительного материала, а также подчиняет себе синтезирующие системы клетки, \"заставляя\" вырабатывать вещества, необходимые для построения новых вирусов. После инфицирования клетки синтез новых вирусных белков начинается через 2 часа, а число их достигает максимума примерно через 8 ч. Наиболее быстрые темпы клонирования вирионов происходят в клетках эпителия и слизистых оболочек, крови и лимфатических тканей.</p>\r\n<p>Полностью сформированные и готовые к последующей репродукции “дочерние“ инфекционные вирионы появляются внутри инфицированной клетки через 10 ч, а их число становится максимальным через 15 ч. За все время своей жизни первичная (“материнская”) вирусная частица воспроизводит от 10 до 100 “дочерних” вирусных частиц, а в 1 мл содержимого герпетического пузырька находится от 1000 до 10 миллионов вирусных частиц. Вирионы чрезвычайно термостабильны – инактивируются (разрушаются) при 50-52 градусах в течение 30 мин, при 37,5 градусах – в течение 20ч, устойчивы при 70 град., длительно сохраняются в тканях,. На металлических поверхностях (монеты, дверные ручки, водопроводные краны) выживает в течение 2 ч, на пластике и дереве – до 3 ч, во влажных медицинских вате и марле в течение всего времени их высыхания при комнатной температуре (до 6 ч). Уникальным биологическим свойством вирусов является пожизненное сохранение вирусов в видоизмененной форме в нервных клетках регионарных (по отношению к месту внедрения вируса) ганглиев чувствительных нервов. Наиболее активны в этом отношении вирусы простого герпеса (лабиальный и генитальный), наименее – вирус Эпштейн-Барр.</p>",
"diagnostics": "<p>Диагноз врожденной герпетической инфекции ставится на основании данных анамнеза, характерной клинической симптоматики, данных лабораторно-инструментальных исследований (во время беременности – УЗИ, исследование мазков из уретры, цервикального канала и влагалища методом световой микроскопии).</p>",
"treatment": "<p>На сегодня не существует лекарств, которые бы полностью уничтожали вирус герпеса в организме человека. Однако существует группа специальных противовирусных средств, эффективно подавляющих размножение ВПГ-I.</p>\r\n<p>Рецидивы, поражающие губы или слизистую носа, неплохо поддаются местному лечению кремом или мазью. В более тяжелых случаях врач может порекомендовать таблетки.</p>\r\n<p>Необходимо помнить, что раннее начало лечения герпеса – залог успеха. Перед появлением пузырьков губы становятся очень чувствительными, возникает <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> и <a href=\"/symptom/onemenie_kozhi/\" title=\"Перейти на страницу симптома Онемение кожи\">покалывание</a>. И если заболевание начать лечить на стадии этих предвестников, то <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> могут и не появиться, а выздоровление наступит в кратчайшие сроки.</p>\r\n<p>Если противовирусный крем начать использовать при уже имеющихся высыпаниях, заживление наступает быстрее, чем при лечении другими способами.</p>\r\n<p>Памятка при заболевании</p>\r\n<p>Нужно помнить, что при появлении высыпаний человек становится остро заразным. Причем могут пострадать не только окружающие, но и сам больной человек. Например, с очага на губах грязными руками вирус герпеса может быть занесен в глаза или на половые органы.</p>\r\n<p>Поэтому важно соблюдать следующие правила</p>\r\n<ul class=\"ulpoint\">\r\n<li>Не трогайте губы, пораженные высыпаниями. Если вы к ним прикоснулись, тщательно мойте руки.</li>\r\n<li>Пользуйтесь личным полотенцем и посудой.</li>\r\n<li>Если у вас поражены губы, не выдавливайте пузырьки и не отрывайте <a href=\"/symptom/korochki/\" title=\"Перейти на страницу симптома Корочки\">корочки</a>. Это может вызвать дополнительное инфицирование кожи.</li>\r\n<li>Воздержитесь от поцелуев и орально-генитальных контактов.</li>\r\n<li>Если вы пользуетесь контактными линзами, не смачивайте их слюной для увлажнения.</li>\r\n<li>Противовирусный крем на губы наносите не пальцами, а косметическими палочками.</li>\r\n</ul>",
"prevention": "<p>Профилактика герпеса заключается, прежде всего, в укреплении иммунитета. Желательно соблюдать режим сна и отдыха, не забывать про закаливание. В период эпидемий ОРВИ и гриппа важно избегать пребывания в людных местах.</p>\r\n<p>Вирус передается главным образом контактным путем:</p>\r\n<ul class=\"ulpoint\">\r\n<li>прямой контакт (в том числе половой путь передачи),</li>\r\n<li>воздушно капельным,</li>\r\n<li>через предметы обихода и гигиены (общие полотенца, носовые платки и т.п.)</li>\r\n<li>вертикальным путями (от матери к плоду). Такое заражение может произойти во время родов (контакт с родовыми путями матери), трансплацентарно или же вирус проникает в полость матки через цервикальный канал шейки матки (восходящий путь).</li>\r\n</ul>\r\n<p>Тем, у кого часто бывают обострения герпеса, рекомендуется проверить состояние иммунитета и пройти обследование, в том числе на наличие других скрытых инфекций.</p>\r\n<p> </p>",
"clinical_picture": "<p>«Простуда на губах» возникает из-за заражения человека вирусом простого герпеса I типа (ВПГ-I). Как правило, впервые человек сталкивается с герпетической инфекцией в раннем детстве, заражаясь от больного при поцелуях или использовании общих столовых приборов. Возможно также заражение от родственников воздушно-капельным путем при чихании и кашле.</p>\r\n<p>Наиболее частой формой инфекции, вызванной ВПГ-I, является <a href=\"/symptom/obmetyvanie_gub/\" title=\"Перейти на страницу симптома Обметывание губ\">герпес</a> лица, то есть «простуда на губах». Причем при первом эпизоде ВПГ у ребенка нередко поражаются не только губы, но и кожа в области носогубного треугольника, и слизистая носа. Бывают также герпетический стоматит и герпетическая ангина. Затем вирус распространяется по нервам и навсегда «селится» в нервных ганглиях. По статистике, вирусом ВПГ-I заражены до 90-95% людей. Но проявляется эта инфекция по-разному. Более чем у 80% инфицированных вирус находится в неактивной форме и не дает о себе знать.</p>\r\n<p>Однако у 17—20% людей вирус ВПГ-I периодически «просыпается» и начинает активно размножаться. Этот процесс называется рецидивом и сопровождается появлением высыпаний на лице.</p>\r\n<p>К наиболее частым факторам, способным спровоцировать рецидив герпеса, относятся:</p>\r\n<ul class=\"ulpoint\">\r\n<li>переохлаждение;</li>\r\n<li>простуда и другие вирусные или бактериальные инфекции;</li>\r\n<li>переутомление;</li>\r\n<li><a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">Тревожность</a> \">стресс</a>;</li>\r\n<li>травма;</li>\r\n<li>менструация;</li>\r\n<li>«жесткие» диеты, гиповитаминоз и <a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">истощение</a>;</li>\r\n<li>чрезмерное увлечение загаром.;</li>\r\n</ul>\r\n<p>Вирус при этом может поражать любой участок кожи или слизистых оболочек организма. Но чаще всего при рецидиве мишенью становятся губы и слизистая носа. У некоторых <a href=\"/symptom/obmetyvanie_gub/\" title=\"Перейти на страницу симптома Обметывание губ\">герпес</a> на лице возникает лишь изредка, являясь в основном косметическим недостатком. Но для людей с резко сниженным иммунитетом наличие в организме вируса может стать серьезной проблемой. Так, к примеру, у больных СПИДом, онкологических пациентов, людей, перенесших трансплантацию органов, обычный вирус герпеса может вызвать поражение внутренних органов.</p>",
"image": "http://api.symptomd.ru/storage/62f38b356a42e16c4b3020c575f56ae0_yevZpXT.png",
"image_alt": "Герпес на губах",
"standard_type": 1,
"danger": 31,
"published": 1,
"parent": null,
"block_rubric": 11,
"standards": [
5021,
5104,
5358
]
},
{
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"code": "A98",
"name": "Геморрагическая лихорадка",
"icd_name": "Другие вирусные геморрагические лихорадки, не классифицированные в других рубриках",
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"lead": "Термином \"геморрагическая лихорадка\" объединяется группа заболеваний вирусного происхождения со сходными проявлениями, при которых ведущая роль отводится поражению сосудов с развитием тромбозов или кровоточивости",
"description": "",
"etiology": "<p>Геморрагическую лихорадку могут вызывать пять основных видов вируса - тогавирусы, филовирусы, флавивирусы, аренавирусы, буньявирусы.</p>\r\n<p>Это группа инфекций, характеризующихся природной очаговостью, то есть распространением в местностях, где много диких животных, носителей вирусов и переносчиков из разряда клещей или комаров. Основные животные, которые могут быть источниками данных лихорадок это белки, летучие мыши, домашние грызуны и обезьяны.</p>\r\n<p>Для некоторых видов геморрагических лихорадок характерны и другие пути распространения. Выделяют воздушно-пылевой путь, парентеральный (через кровь и другие биологические жидкости), пищевой, водный, через контакты с зараженными животными.</p>\r\n<p>Чаще всего болеют люди, работа которых связана с животными, дикой природой и сельхозугодиями. Городские жители при заболевании в основном имеют контакты с грызунами. </p>\r\n<p> </p>",
"pathogenesis": "<p>В упрощенном виде механизмы повреждения при геморрагических лихорадках можно представить таким образом:</p>\r\n<ul>\r\n<li>повреждение сосудов вирусами или продуктами их метаболизма,</li>\r\n<li>нарушение целостности стенок сосудов, их , выделение в просвет биологически активных веществ,</li>\r\n<li>формирование из-за дефицита кровоточивости и развития так называемого ДВС-синдрома (массивного одновременного свертывания крови в одних сосудах и параллельного кровотечения из-за низкой свертываемости в других).</li>\r\n</ul>\r\n<p>В результате формируется гипоксия тканей (нехватка кислорода) и нарушения в работе сердца, легких, почек и головного мозга, происходит массивная потеря крови. При этом тяжесть болезни будет зависеть от вида лихорадки, степени активности иммунитета и особенностей организма человека. Зачастую геморрагические лихорадки протекают тяжело и заканчиваются высокой летальностью.</p>",
"diagnostics": "<p>Основа диагностики – это клиническая картина с указаниями на пребывание в неблагоприятном районе, укусы насекомых или контакт с животными. Но для подтверждения диагноза необходимо обнаружение вирусов в крови или антител к ним. Проводится:</p>\r\n<ul>\r\n<li>общий анализ крови,</li>\r\n<li>общий анализ мочи (особенно для лихорадок с почечным синдромом),</li>\r\n<li>биохимический анализ крови и мочи,</li>\r\n<li>серологические пробы,</li>\r\n<li>иммунохимические и ПЦР методы выделения вируса или антител к нему,</li>\r\n<li>при необходимости проводят выделение и исследование вирусов.</li>\r\n</ul>\r\n<p>Геморрагические лихорадки стоит различать с тяжелым капилляро-токсическим гриппом, риккетсиозами и менингококковой инфекцией – все они сопровождаются кровоточивостью и похожи по проявлениям. Кроме того, необходимо отличать эти инфекции от болезней крови с кровоточивостью (болезнь Шенляйна-Геноха или Верльгофа).</p>",
"treatment": "<p>Диагностикой и лечением занимаются врачи-инфекционисты, а иногда и реаниматологи.</p>\r\n<p>Все люди с подозрением на геморрагическую лихорадку подлежат госпитализации в боксированное отделение инфекционной больницы.</p>\r\n<p>В период острых проявлений показано парентеральное питание, в период выздоровления – легкая растительно-молочная диета с обогащением витаминами, особенно укрепляющими сосудистые стенки – витаминами РР, С или К.</p>\r\n<p>Кроме того, применяют внутривенные вливания растворов глюкозы, переливания крови, препараты железа, антигистаминные средства. При необходимости вводят тромбоцитарную массу, факторы свертывания.</p>\r\n<p>Постельный режим в изоляторе соблюдается до полного выздоровления. В дальнейшем пациент наблюдается еще достаточно длительно у инфекциониста и терапевта.</p>",
"prevention": "<p>К основным методам борьбы с геморрагическими лихорадками относят:</p>\r\n<ul>\r\n<li>уничтожение грызунов и насекомых-переносчиков,</li>\r\n<li>тщательная очистка участков жилых застроек от травы и кустарников, заболоченных мест,</li>\r\n<li>при работе в полях и лесах необходимо ношение защитной одежды, применение репеллентов,</li>\r\n<li>для профилактики некоторых видов геморрагических лихорадок разработаны вакцины – желтой лихорадки и омской геморрагической лихорадки.</li>\r\n</ul>",
"clinical_picture": "<p>Геморрагическая - это классическая инфекционная болезнь со стадийностью течения. Выделяют следующие стадии:</p>\r\n<ul>\r\n<li>инкубационную – она, в зависимости от вида вируса, может длиться от нескольких суток до трех недель,</li>\r\n<li>начальную стадию или период продрома, длящийся от суток до недели,</li>\r\n<li>период разгара болезни с проявлением всех типичных признаков геморрагической лихорадки и длящийся от одной до двух недель,</li>\r\n<li>период реконвалесценции или выздоровления (или в некоторых случаях - летальный исход).</li>\r\n</ul>\r\n<p>Выздоровление может длиться до нескольких месяцев, особенно в случае тяжелого течения и остаточных явлений.</p>\r\n<p>В начальном периоде симптомы геморрагической лихорадки обычно неспецифические. Обычно проявляются:</p>\r\n<ul>\r\n<li>симптомы общей интоксикации,</li>\r\n<li>высокая температура,</li>\r\n<li>расстройства сознания вплоть до бреда,</li>\r\n<li>точечные кровоизлияния на коже в зоне шеи и лица, склер и в области рта,</li>\r\n<li>нарушения ритма сердца с учащением или замедлением частоты,</li>\r\n<li>снижение давления,</li>\r\n<li>в анализах крови выявляется воспалительная реакция (лейкоцитоз, может быть со сдвигом) с незначительным снижением тромбоцитов.</li>\r\n</ul>\r\n<full></full>\r\n<p>В период разгара может быть:</p>\r\n<ul>\r\n<li>временное снижение температуры,</li>\r\n<li>общее улучшение состояния, после чего вновь наступает ухудшение,</li>\r\n<li>нарастает токсикоз,</li>\r\n<li>прогрессируют нарушения сознания,</li>\r\n<li>развиваются мелкие тромбозы и из мест инъекций, с поверхностей слизистых, пищеварительного и мочеполового тракта,</li>\r\n<li>нарушаются функции легких, почек, сердца.</li>\r\n</ul>\r\n<p>В периоде выздоровления постепенно все симптомы исчезают, работа органов восстанавливается.</p>",
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5067
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},
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