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"code": "A91",
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"description": " Лихорадка денге представляет собой острое вирусное заболевание с интоксикационными признаками, сопровождающееся мышечно-суставными болями, высокой температурой, а также мелкой сыпью в виде кровоизлияний точечного характера различной степени выраженности. ",
"etiology": "<p>Причиной развития тропической лихорадки является арбовирус рода Flavivirus, который проникает в кровь человека через укус зараженной самки комара. Вирус денге обладает резистентностью к низким температурам и высушиванию. Не выдерживает нагревания до 60°С, воздействия ультрафиолетовых лучей, обработку формалином или эфиром. </p>\r\n<p>Вирус денге имеет четыре серотипа: DEN-I, DEN-II, DEN-III, DEN-IV. Зависимость формы и тяжести протекания болезни от заражения определенным типом вируса не установлены. </p>\r\n<p>Источником инфекции является больной человек, обезьяны и летучие мыши. Передачу инфекции от больного человека осуществляют комары рода Aedes (A. albopictus и A. Aegypti, A. Polinesiensis, A. Cutellaris). Комары становятся заразными на 8-12 день после кровососания и сохраняют пожизненную способность к передаче вируса. В большей степени к лихорадке денге восприимчивы дети до 2-х лет, пожилые и ослабленные люди, а также приезжие лица, в т. ч. туристы. </p>",
"pathogenesis": "<p>После укуса москита в течение 3-5 дней происходит размножение вируса в регионарных лимфоузлах и эндотелии сосудов. По истечении периода первичной репликации вирусные частицы проникают в кровь, обусловливая развитие вирусемии, которая клинически проявляется лихорадочно-интоксикационным синдромом. Вторая волна лихорадки связана с проникновением вирусов в органы и ткани. Купирование клинической симптоматики наступает по мере накопления в крови вируснейтрализующих и комплемент-связывающих антител. При геморрагической форме лихорадки денге происходит поражение преимущественно мелких сосудов, нарушение агрегатного состояния крови с развитием множественных кровоизлияний в оболочках сердца, плевре, слизистой ЖКТ, головном мозге. </p>",
"diagnostics": "<p>Критерии, разработанные ВОЗ, позволяют заподозрить лихорадку денге в случае развития: лихорадочного синдрома, сохраняющегося 2-7 дней; тромбогеморрагического синдрома; увеличения печени и шокового синдрома. Также учитывается наличие эпидемиологических предпосылок (посещение эндемичных регионов, укусов москитов, вспышек инфекции) и типичных клинических симптомов (двухволновой лихорадки, артралгии, миалгии, экзантемы). Дополнительным критерием может служить положительная «проба жгута» (внутрикожное кровоизлияние после наложения жгута или манжеты в области локтевого сгиба). </p>\r\n<p>Лабораторные методы исследования: </p>\r\n<ul>\r\n<li>общий анализ крови - снижение тромбоцитов, увеличение гематокрита. </li>\r\n<li>выявление антител (реакция связывания комплемента, реакция торможения гемагглютинации, реакция нейтрализации) </li>\r\n<li>выявление РНК вируса лихорадки Денге методом ПЦР (позволяет дифференцировать вирус различных типов)</li>\r\n</ul>",
"treatment": "<p>При геморрагической форме заболевания назначают: </p>\r\n<ul>\r\n<li>инфузионную терапию; </li>\r\n<li>введение плазмы и плазмозаменителей (в тяжёлых случаях); </li>\r\n<li>глюкокортикоиды (в тяжёлых случаях); </li>\r\n<li>кислородотерапию; </li>\r\n<li>препараты, повышающие свертываемость крови (коагулянты). </li>\r\n</ul>",
"prevention": "<p>Для предупреждения инфицирования в регионах, эндемичных по развитию лихорадки денге, необходимо использовать репелленты и фумигаторы, отпугивающие комаров, противомоскитные сетки. Особую актуальность имеет уничтожение комаров-переносчиков вируса денге, применение инсектицидов, борьба с заболоченностью и засорением территории, хранение запасов воды в закрытых емкостях. </p>",
"clinical_picture": "<p> Геморрагическая форма возникает при многократном инфицировании разными штаммами вируса и проявляется следующими симптомами: </p>\r\n<ul>\r\n<li>повышение температуры тела до 39—40 °С </li>\r\n<li>кашель </li>\r\n<li>анорексия </li>\r\n<li>тошнота </li>\r\n<li>рвота </li>\r\n<li>боли в животе </li>\r\n<li>увеличение лимфатических узлов </li>\r\n<li>увеличение печени </li>\r\n<li>выраженная слабость </li>\r\n<li>петехиальная сыпь (кровоизлияния на коже) </li>\r\n<li>десневое, желудочно-кишечное кровотечения </li>\r\n<li>рвота кровью </li>\r\n<li>снижение артериального давления, учащение пульса </li>\r\n<li>бледность, синюшность кожи </li>\r\n</ul>",
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"code": "A90",
"name": "Лихорадка денге [классическая лихорадка денге]",
"icd_name": "Лихорадка денге [классическая лихорадка денге]",
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"cause": [
2,
6
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"slug": "a90_lihoradka_denge_klassicheskaya_lihoradka_denge",
"lead": "Нарушение здоровья, относящееся к группе вирусные лихорадки, передаваемые членистоногими, и вирусные геморрагические лихорадки",
"description": "Лихорадка денге представляет собой острое вирусное заболевание с интоксикационными признаками, сопровождающееся мышечно-суставными болями, высокой температурой, а также мелкой сыпью в виде кровоизлияний точечного характера различной степени выраженности. ",
"etiology": "<p>Причиной развития тропической лихорадки является арбовирус рода Flavivirus, который проникает в кровь человека через укус зараженной самки комара. Вирус денге обладает резистентностью к низким температурам и высушиванию. Не выдерживает нагревания до 60°С, воздействия ультрафиолетовых лучей, обработку формалином или эфиром. </p>\r\n<p>Вирус денге имеет четыре серотипа: DEN-I, DEN-II, DEN-III, DEN-IV. Зависимость формы и тяжести протекания болезни от заражения определенным типом вируса не установлены. </p>\r\n<p>Источником инфекции является больной человек, обезьяны и летучие мыши. Передачу инфекции от больного человека осуществляют комары рода Aedes (A. albopictus и A. Aegypti, A. Polinesiensis, A. Cutellaris). Комары становятся заразными на 8-12 день после кровососания и сохраняют пожизненную способность к передаче вируса. В большей степени к лихорадке денге восприимчивы дети до 2-х лет, пожилые и ослабленные люди, а также приезжие лица, в т. ч. туристы. </p>",
"pathogenesis": "<p>После укуса москита в течение 3-5 дней происходит размножение вируса в регионарных лимфоузлах и эндотелии сосудов. По истечении периода первичной репликации вирусные частицы проникают в кровь, обусловливая развитие вирусемии, которая клинически проявляется лихорадочно-интоксикационным синдромом. Вторая волна лихорадки связана с проникновением вирусов в органы и ткани. Купирование клинической симптоматики наступает по мере накопления в крови вируснейтрализующих ант</p>\r\n<p>Инкубационный период составляет в среднем 3—15 дней (чаще 5—7 дней). </p>\r\n<p>Классическая лихорадка денге (заболевает человек при первичном инфицировании): </p>\r\n<p>повышение температуры до 39—40 °С (к концу 3-х суток температура резко снижается, а через 1—3 дня вновь повышается, далее опять снижается через 2—3 дня) </p>\r\n<p>учащение пульса в начале заболевания, а через 2—3 дня он сильно урежается </p>\r\n<p>озноб </p>\r\n<p>боли в костях (чаще в позвоночнике) </p>\r\n<p>боли в суставах (особенно в коленных суставах) </p>\r\n<p>боли в мышцах </p>\r\n<p>анорексия (отказ от еды из-за отсутствия аппетита) </p>\r\n<p>адинамия (резкий упадок сил) </p>\r\n<p>тошнота </p>\r\n<p>головокружение </p>\r\n<p>бессонница </p>\r\n<p>покраснение и отёчность лица </p>\r\n<p>покраснение глаз </p>\r\n<p>покраснение горла </p>\r\n<p>различная зудящая сыпь (сначала сыпь появляется на туловище, затем распространяется на конечности и сохраняется 3—7 дней): </p>\r\n<p>петехиальная — точечные кровоизлияния </p>\r\n<p>скарлатиноподобная — покраснение кожи, на фоне которого определяются пятнышки величиной с просяное зерно. </p>\r\n<p>уртикарная — возвышающиеся над поверхностью кожи отёчные волдыри ярко-розового цвета размером от 0,5 до нескольких сантиметров, сильно зудящие. </p>\r\n<p> </p>\r\n<p>ител. </p>",
"diagnostics": "<p>Критерии, разработанные ВОЗ, позволяют заподозрить лихорадку денге в случае развития: лихорадочного синдрома, сохраняющегося 2-7 дней; тромбогеморрагического синдрома; увеличения печени и шокового синдрома. Также учитывается наличие эпидемиологических предпосылок (посещение эндемичных регионов, укусов москитов, вспышек инфекции) и типичных клинических симптомов (двухволновой лихорадки, артралгии, миалгии, экзантемы). </p>\r\n<p>Лабораторные методы исследования: </p>\r\n<ul>\r\n<li>общий анализ крови - снижение тромбоцитов, увеличение гематокрита. </li>\r\n<li>выявление антител (реакция связывания комплемента, реакция торможения гемагглютинации, реакция нейтрализации) </li>\r\n<li>выявление РНК вируса лихорадки Денге методом ПЦР (позволяет дифференцировать вирус различных типов). </li>\r\n<li> </li>\r\n</ul>",
"treatment": "<p>Больных госпитализируют в стационар. </p>\r\n<p>При классической форме заболевания назначают: </p>\r\n<ul>\r\n<li>болеутоляющие препараты; </li>\r\n<li>витамины; </li>\r\n<li>антигистаминные препараты. </li>\r\n</ul>\r\n<p>Показаны строгий постельный режим и обильное питьё: не менее 200 гр. каждые 2 часа, или более 2 литров в день. ВОЗ рекомендует свежевыжатые соки, молоко. Употребление только воды может привести к сдвигу электролитического баланса. Предпочтительны витамины С, К, B. </p>",
"prevention": "<p> Для предупреждения инфицирования в регионах, эндемичных по развитию лихорадки денге, необходимо использовать репелленты и фумигаторы, отпугивающие комаров, противомоскитные сетки. Особую актуальность имеет уничтожение комаров-переносчиков вируса денге, применение инсектицидов, борьба с заболоченностью и засорением территории, хранение запасов воды в закрытых емкостях.</p>",
"clinical_picture": "<p>Инкубационный период составляет в среднем 3—15 дней (чаще 5—7 дней). </p>\r\n<p>Классическая лихорадка денге (заболевает человек при первичном инфицировании): </p>\r\n<ul>\r\n<li>повышение температуры до 39—40 °С (к концу 3-х суток температура резко снижается, а через 1—3 дня вновь повышается, далее опять снижается через 2—3 дня) </li>\r\n<li>учащение пульса в начале заболевания, а через 2—3 дня он сильно урежается </li>\r\n<li>озноб </li>\r\n<li>боли в костях (чаще в позвоночнике) </li>\r\n<li>боли в суставах (особенно в коленных суставах) </li>\r\n<li>боли в мышцах </li>\r\n<li>анорексия (отказ от еды из-за отсутствия аппетита) </li>\r\n<li>адинамия (резкий упадок сил) </li>\r\n<li>тошнота </li>\r\n<li>головокружение </li>\r\n<li>бессонница </li>\r\n<li>покраснение и отёчность лица </li>\r\n<li>гиперемия (покраснение) глаз </li>\r\n<li>гиперемия (покраснение) зева</li>\r\n<li>различная зудящая сыпь (сначала сыпь появляется на туловище, затем распространяется на конечности и сохраняется 3—7 дней): </li>\r\n</ul>\r\n<ol>\r\n<li>петехиальная — точечные кровоизлияния </li>\r\n<li>скарлатиноподобная — покраснение кожи, на фоне которого определяются пятнышки величиной с просяное зерно. </li>\r\n<li>уртикарная — возвышающиеся над поверхностью кожи отёчные волдыри ярко-розового цвета размером от 0,5 до нескольких сантиметров, сильно зудящие. </li>\r\n</ol>",
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"lead": "Повышение температуры тела человека более 38° С может быть опасно для здоровья и требует медицинской помощи",
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"code": "A89",
"name": "Вирусная инфекция центральной нервной системы неуточненная",
"icd_name": "Вирусная инфекция центральной нервной системы неуточненная",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
2,
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5,
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],
"periodicity": 1,
"slug": "a89_virusnaya_infekciya_centralnoy_nervnoy_sistemy_neutochnennaya",
"lead": "Нарушение здоровья, относящееся к группе вирусные инфекции центральной нервной системы",
"description": "Энцефалит - острое воспалительное заболевание головного мозга, вызванное прямым внедрением в него вируса или реакцией гиперчувствительности в ответ на проникновение в организм вируса или иного чужеродного белка.\r\nЭнцефаломиелит - заболевание той же природы, поражающее не только головной, но и спинной мозг.\r\nАсептический менингит - воспаление мозговых оболочек, для которого характерны лихорадка, менингеальные симптомы и изменения в спиномозговой жидкости.\r\n",
"etiology": "<p>Вирусные инфекции, вызывающие первичное поражение ЦНС, могут быть эпидемическими (возбудители арбо-, полно-, ЕСНО-вирусы, вирусы Коксаки) или спорадическими (вирусы простого герпеса, ветряной оспы, эпидемического паротита). Арбовирусные энцефалиты, переносчиками которых в США служат москиты (энцефалит Сент-Луис, восточный и западный лошадиный, калифорнийский) поражают людей только в теплое время года.</p>\r\n<p>Вторичные поражения ЦНС - это обычно осложнения вирусных инфекций, обусловленные, как полагают, иммунологическими механизмами. Примерами могут служить энцефалиты, возникающие после кори, ветряной оспы, краснухи, после вакцинации против натуральной оспы, а также энцефалиты, связанные с неспецифическими инфекциями. Эти параинфекционные или постинфекционные энцефалиты (иногда определяемые как острый диссеминированный энцефаломиелит) в типичном случае возникают через 5-10 дней после начала инфекционного заболевания, и для них характерна (по данным аутопсии) периваскулярная демиелинизация; вирус в этом случае редко удается выделить из вещества мозга.</p>\r\n<p>При эпидемическом паротите (свинке) может развиваться как первичное, так и постинфекционное поражение ЦНС.</p>",
"pathogenesis": "<p>Пути проникновения вируса в организм различны. Путь распространения чаще всего гематогенный (с током крови). При комарином и клещевом энцефалитах вирус, попадая при укусе в сосудистое русло, поступает с током крови в различные органы, в том числе и в мозг. В головном мозге наиболее ранимыми оказываются структуры на дне III желудочка, подкорковые узлы, кора большого мозга, клеточные образования в мозговом стволе и спинном мозге. Возможны также контактный, алиментарный, воздушно-капельный пути передачи инфекции от человека или от животного человеку.</p>\r\n<p>Нейротропные вирусы имеют сродство (тропизм) к нервной ткани, что обеспечивается специфическими рецепторами структуры вируса. Проявления заболевания, тяжесть и особенности его течения зависят от способности организма отвечать на воздействие инфекционного агента, а также от биологической природы вируса. Иммунный ответ определяется рядом факторов, в том числе антигенными свойствами вируса, генетически детерминированной силой иммунного ответа организма человека, его реактивностью в данный момент. В этом ответе участвуют механизмы клеточного и гуморального иммунитета.</p>\r\n<p>Патогенез определяется, кроме непосредственного разрушения нейронов вирусом, токсическим действием, а также неспецифическими изменениями: поражением сосудистой стенки с повышением ее проницаемости, развитием отека, ликвородинамических нарушений.</p>",
"diagnostics": "<p>Диагностика обычно основывается на данных исследования СМЖ, важное значение при этом имеет нормальное содержание глюкозы и отрицательные результаты посева. Из СМЖ или тканей мозга иногда удается выделить вирус, однако даже в идеальных условиях вирусы, вызывающие асептический менингит и энцефалит, можно идентифицировать менее чем в половине случаев. Для точной диагностики обычно требуются парные сыворотки; диагноз подтверждается, если при повторном исследовании титр специфических антител возрастает.</p>\r\n<p>Могут быть полезны посевы из периферических органов (например, из носоглотки) и посевы кала, а также сведения о возбудителях, часто вызывающих эпидемии в данной местности.</p>\r\n<p>МРТ позволяет определить воспалительные изменения в височной доле до того, как выявятся какие-либо нарушения при ЭЭГ, КТ или сцинтиграфии мозга; полученные при МРТ данные дают возможность начать противовирусную терапию раньше, чем возникнут выраженные неврологические расстройства.</p>",
"treatment": "<p>Одним из направлений специфической терапии вирусных нейроинфекций следует считать воздействие непосредственно на вирус, находящийся в стадии активного размножения и лишенный защитной оболочки, ферментами, расщепляющими нуклеиновую кислоту вируса и тормозящими его дальнейшую репликацию. Нуклеазы назначают с учетом структуры вирусов. Рибонуклеазу применяют при заболеваниях, вызываемых РНК-содержащими вирусами (вирусы эпидемического паротита, энтеровирусы, вирусы гриппа и парагриппа, клещевого энцефалита). Дезоксирибонуклеаза показана при заболеваниях, вызываемых ДНК-содержащими вирусами (вирус простого герпеса, вирус ветряной оспы, аденовирусы). Продолжительность курса составляет 10-14 дней.</p>\r\n<p>Патогенетическая терапия включает в себя ряд направлений.</p>\r\n<ol>\r\n<li>Дегидратация и борьба с отеком мозга: осмотические диуретики, салуретики.</li>\r\n<li>Обеспечение дыхания (поддержание проходимости дыхательных путей, оксигеногерапия, гипербарическая оксигенация, при дыхательных нарушениях - интубация или трахеотомия, ИВЛ).</li>\r\n<li>Десенсибилизация (тавегил, супрастин, диазолин, димедрол).</li>\r\n<li>Поддержание гомеостаза и водно-электролитного баланса (парентеральное и энтеральное питание, хлорид калия, полиглюкин, 200 мл 4% раствора гидрокарбоната натрия).</li>\r\n<li>Устранение сердечно-сосудистых расстройств, нормализация микроциркуляции.</li>\r\n<li>Гормональная терапия.</li>\r\n<li>Восстановление метаболизма мозга).</li>\r\n</ol>\r\n<p>Симптоматическая терапия: антиконвульсанты, жаропонижающие препараты, витамины.</p>",
"prevention": "<p>Противоэпидемические мероприятия проводят в соответствии с особенностями этиологии и эпидемиологии заболевания. При возникновении заболевания предупреждение новых случаев заболевания с учетом путей распространения инфекции.</p>\r\n<p> </p>",
"clinical_picture": "<p>Вирусные инфекции ЦНС могут проявляться в трех формах. При одной из них - асимптомной - возможны лихорадка и общее недомогание, но без менингеальных явлений. Тем не менее в СМЖ могут выявляться изменения, прежде всего лимфоцитарный плеоцитоз, реже из СМЖ можно бывает выделить вирус.</p>\r\n<p>Вторая форма - менингит, для которого характерны лихорадка, головная боль, упорная рвота, общая слабость, ригидность шейных мышц и мышц спины.</p>\r\n<p>Третья форма - энцефалит - может проявляться генерализованной или очаговой дисфункцией мозга (нарушение сознания, психические изменения, эпилептические припадки, парезы) и поражением черепных нервов. Асептический менингит и энцефалит отличаются друг от друга по степени выраженности мозговой дисфункции, в то время как менингеальные симптомы одинаково свойственны обоим заболеваниям.</p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 83,
"published": 2,
"parent": null,
"block_rubric": 9,
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},
{
"id": 6087,
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{
"id": 2866,
"synonyms": [
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"name": "гипертермия"
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{
"name": "повышение температуры"
},
{
"name": "лихорадка"
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{
"name": "жар"
}
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},
"code": "A87",
"name": "Вирусный менингит",
"icd_name": "Вирусный менингит",
"gender": 0,
"age_min": 0,
"age_max": 84,
"cause": [
2,
4,
5,
7
],
"periodicity": 2,
"slug": "a87_virusnyy_meningit",
"lead": "Нарушение здоровья, относящееся к группе вирусные инфекции центральной нервной системы",
"description": "Вирусный менингит — воспаление серозных оболочек головного мозга, реже спинного, вызываемое инфекцией вирусной природы. Причиной возникновения в 80% являются энтеровируc. Вирусный менингит сопровождается серозным воспалительным процессом. Для серозного воспаления характерно образование серозного выпота, который пропитывает оболочки головного мозга, приводя к их утолщению. Отек мозговых оболочек вызывает нарушение оттока цереброспинальной жидкости и приводит к повышению внутричерепного давления.",
"etiology": "<p> В 80% случаев вирусный менингит обусловлен энтеровирусной инфекцией, реже причиной становится вирус эпидемического паротита, вирус Эпштейна-Барр (возбудитель инфекционного мононуклеоза), аренавирусы, цитомегаловирус, герпетическая инфекция, аденовирусы, ВИЧ.</p>",
"pathogenesis": "<p></p>\r\n<p>Возбудителями вирусных менингитов могут выступать различные вирусы, которые попадают в мозговые оболочки гематогенным, лимфогенным или периневральным путем. В зависимости от типа вируса вирусный менингит может возникнуть при контактном или воздушно-капельном заражении. К патогенетическим механизмам клинических проявлений менингита относятся воспаление и отек мозговых оболочек и нередко прилегающих тканей мозга, нарушение циркуляции в мозговых и оболочечных сосудах, гиперсекреция цереброспинальной жидкости и задержка ее всасывания, что приводит к развитию водянки мозга и повышению внутричерепного давления; перераздражение оболочек головного мозга, а также общее воздействие интоксикации.</p>",
"diagnostics": "<p>Заподозрить менингит позволяют характерные жалобы пациента, острое начало заболевания и наличие менингеальных симптомов. Для установления вирусного характера воспаления мозговых оболочек проводят люмбальную пункцию с исследованием цереброспинальной жидкости, ПЦР-исследования и выделение возбудителя.</p>\r\n<p>Анализ цереброспинальной жидкости при вирусном менингите показывает незначительное увеличение белка, нормальное содержание глюкозы и лейкоцитоз. В первые 1-2 сутки вирусный менингит может сопровождаться нейтрофильным лейкоцитозом ликвора, что более характерно для бактериального воспаления. Однако отсутствие возбудителя при микроскопии различно окрашенных мазков цереброспинальной жидкости свидетельствует в пользу вирусной этиологии заболевания. Для ее подтверждения необходимо повторное исследование ликвора спустя 12ч, при котором в случае вирусного менингита наблюдается уменьшение числа нейтрофилов и нарастание количества лимфоцитов.</p>\r\n<p>Анализ цереброспинальной жидкости позволяет дифференцировать вирусный менингит от других видов серозного воспаления мозговых оболочек (например, туберкулезного).</p>\r\n<p>Основным современным методом диагностики возбудителя при вирусном менингите является ПЦР- исследование цереброспинальной жидкости, позволяющее обнаружить геном вируса (ДНК или РНК).</p>\r\n<p>Серологические реакции для диагностики вирусного менингита показательны только в случае сравнения их результатов в начале заболевания и спустя 2-3 недели. Из-за большой длительности такой диагностики она может носить лишь ретроспективный характер.</p>\r\n<p>Пациентам, имеющим вирусный менингит, дополнительно проводят клинический анализ крови, биохимические пробы печени, определение электролитного состава крови, содержание в ней глюкозы, креатинина, липазы и амилазы. При атипичном течении вирусного менингита и сомнениях при его диагностике возможно проведение электромиографии, ЭЭГ, МРТ и КТ головного мозга.</p>",
"treatment": "<p>В отношении вирусного менингита в большинстве случаев проводится симптоматическая терапия. Пациенту рекомендован покой, постельный режим, нахождение в затемненном помещении. Для купирования головной боли назначают анальгетики. Но зачастую она значительно уменьшается после снижения внутричерепного давления в результате диагностической люмбальной пункции. Температура тела выше 38°C является показанием к приему жаропонижающих препаратов (парацетамол, ибупрофен и др.).</p>\r\n<p>Специфическая и неспецифическая противовирусная терапия вирусного менингита необходима у пациентов с ослабленным состоянием иммунной системы и у грудных детей. В таких случаях проводится внутривенное введение иммуноглобулина. Если вирусный менингит вызван вирусом герпеса или вирусом Эпштейн-Барр, то возможно применение ацикловира.</p>",
"prevention": "<p>Специфическая профилактика (вакцины) для вирусного менингита не разработана. В повседневности необходимо ограничивать контакт с больными респираторными инфекциями, гриппом, эпидемическим паротитом и другими вирусными инфекциями. Обеззараживание питьевой воды, мытье фруктов и овощей обеззараженной водой, запрет купания в водоемах важные пункты профилактики менингита.</p>\r\n<p>Важна ранняя диагностика и последующая изоляция больных на две недели. В очаге возникновения проводят дезинфекцию. Если заболевший ребенок посещал детский сад, заведение закрывают на двухнедельный карантин.</p>\r\n<p>Людям, контактировавшим с больными, в качестве профилактики внутривенно вводят иммуноглобулин, закапывают интерферон в течение недели.</p>",
"clinical_picture": "<p>Как правило, начало болезни острое, температура тела повышается до фебрильных цифр (40 С). Развивается головная боль, тошнота, многократная рвота. Наблюдается выраженная общая слабость, сопровождающаяся сонливостью, иногда оглушенностью. В более тяжелых случаях появляется спутанность сознания вплоть до его потери. Может возникать миалгия — боль в мышцах тела. Часто болезнь сопровождается диспепсическими расстройствами по типу гастроэнтерита: спастические боли в животе, жидкий стул. Аппетит отсутствует. Кожные покровы шеи и лица красные, горячие на ощупь. Сосуды склер инъецированы (красные глаза).</p>\r\n<p>При осмотре ротовой полости обнаруживается покраснение стенок глотки, дужек неба, слизистой оболочка мягкого неба, миндалин. При ощупывании затылочные, шейные, подчелюстные лимфатические узлы могут быть увеличены, чаще если возбудитель болезни вирус эпидемического паротита, цитомегаловирус, ВЭБ.</p>\r\n<p>Менингеальные симптомы (признаки, позволяющие поставить диагноз менингит) проявляются болью в затылке и по ходу позвоночника, ригидностью мышц затылка (неспособность согнуть голову вперед), характерной позой больного (поза «легавой» собаки) – в положении на боку, голова запрокинута, ноги поджаты к груди. Часто развиваются симптомы Кернига (неспособность разогнуть согнутую в колене ногу) и Брудзинского (верхний, средний, нижний). У детей может наблюдаться симптом Лесажа (подвешивания) – при поднимании за подмышечные ямки ребенок подтягивает ноги к животу.</p>\r\n<p>Вирусный менингит отличается относительно коротким течением. Уже на 3-5 сутки температура тела падает до нормальных цифр, хотя в некоторых случаях наблюдается вторая волна лихорадки. Весь период заболевания длится от 7 до 14 дней, в среднем около 10 дней.</p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 79,
"published": 2,
"parent": null,
"block_rubric": 9,
"standards": [
5032
]
},
{
"id": 8385,
"symptoms": [
{
"id": 2848,
"synonyms": [
{
"name": "мышечная боль"
},
{
"name": "боль в мышцах"
},
{
"name": "мышцы болят"
},
{
"name": "Миалгия"
},
{
"name": "ломота"
},
{
"name": "боль в мышцах рук"
},
{
"name": "боль в мышцах ног"
},
{
"name": "боль в мышцах после тренировки"
},
{
"name": "боль в мышцах спины"
},
{
"name": "боль икроножная"
}
],
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{
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"y": 3325,
"r": 0
}
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},
"code": "A87.9",
"name": "Вирусный менингит неуточненный",
"icd_name": "Вирусный менингит неуточненный",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"2",
"4",
"5"
],
"periodicity": 1,
"slug": "a87.9_virusnyy_meningit_neutochnennyy",
"lead": "воспаление оболочек головного и спинного мозга, а также заполненного жидкостью пространства между мозговыми оболочками (субарахноидального пространства), вызванное вирусами",
"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;\">Вирусный менингит является инфекционным заболеванием. Его возбудителями могут выступать различные вирусы, которые попадают в мозговые оболочки гематогенным, лимфогенным или периневральным путем. В зависимости от типа вируса вирусный менингит может возникнуть при контактном или воздушно-капельном заражении. Попадая в организм, вирусы проникают в подпаутинное пространство и инфицируют паутинную и мягкую мозговые оболочки. Распространение вирусов в вещество мозга с развитием энцефалита наблюдается в крайне редких случаях.</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;\">В 75-80% случаев вирусный менингит обусловлен энтеровирусной инфекцией (вирусами Коксаки и ЕСНО). Реже причиной вирусного менингита становится вирус эпидемического паротита, вирус Эпштейна-Барр (возбудитель инфекционного мононуклеоза), аренавирусы, цитомегаловирус, герпетическая инфекция, аденовирусы. ВИЧ-инфекция также может приводить к развитию вирусного менингита. Однако чаще при ней отмечаются лишь изменения в цереброспинальной жидкости, а вирусный менингит имеет бессимптомное течение. Вирусный менингит имеет сезонную заболеваемость зависящую от вида возбудителя. Большинство случаев заболевания приходится на летнее время, для вируса эпидемического паротита характерен пик заболеваемости зимой и весной.</span></p>\r\n<p><span id=\"docs-internal-guid-c535911a-7fff-08f9-d8c5-a7290b56875e\"> </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;\">В патогенезе вирусного менингита играет роль комплекс факторов, таких как:</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;\">характеристика возбудителя;</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;\">реакция организма человека;</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;\">фон, на котором происходит взаимодействие конкурирующих организмов.</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;\">Серьёзную роль играет вирулентность возбудителя вирусного менингита (степень способности вируса вызывать заболевание), его нейротропность (способность вируса избирательно проникать в нервную ткань и вызывать её поражение) и другие особенности. В реакции человеческого организма значительную роль имеет возраст, характер питания, социально-бытовые условия, имеющиеся заболевания, проведённое ранее лечение, иммунологическая реактивность и др. Условия окружающей среды предполагают наличие физических факторов, например влажности, повышения или понижения температуры, солнечной радиации, контактов с живыми существами и растениями, переносчиками возбудителей инфекционных заболеваний 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;\">Инфекционный агент может вторгаться в оболочки мозга разными путями:</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;\">через кровь;</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;\">лимфогенно;</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;\">периневрально (через щелевидную полость, расположенную вокруг нервного ствола);</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;\">контактно (при наличии гнойного очага, расположенного неподалёку от мозговых оболочек — отита, гайморита, абсцесса мозга)</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;\">При вирусных менингитах отмечается гиперпродукция цереброспинальной жидкости, нарушение внутричерепной гемодинамики, непосредственное токсическое действие возбудителя на вещество мозга. В результате этих процессов повышается проницаемость барьера между кровеносной системой и центральной нервной системой, повреждается эндотелий (внутренняя оболочка) мозговых капилляров, нарушается микроциркуляция, развиваются метаболические расстройства, усугубляющие гипоксию мозга (недостаток кислорода). Как следствие возникает отёк мозга, в случае прогрессирования отёка может произойти смещение одних структур мозга относительно других. Возможен летальный исход от остановки дыхания и сердечной деятельности.</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;\">Для диагностики вирусного менингита делают спинномозговую пункцию, чтобы исследовать ликвор. При выполнении процедуры прозрачная жидкость вытекает под давлением. Сразу после выведения ликвора больному становится легче. В пунктате определяется большое количество клеток лимфоцитов, а также на фоне нормального количества сахара повышенное содержание белка. Вирус в цереброспинальной жидкости обнаружить невозможно, он содержится только в серозных оболочках. Косвенным признаком вирусного менингита при характерной клинической картине будет отсутствие в ликворе бактерий, появление которых свидетельствует о бактериальном менингите.</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;\">Кроме того:</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;\">В клиническом анализе крови обнаруживаются лейкоциты. В биохимическом анализе крови, как правило, высокое содержание белков, а именно глобулиновой фракции.</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;\">Возможно выделение культуры энтеровирусов из испражнений, смывов носоглотки, посредством высеивания.</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;\">Для определения специфического возбудителя болезни делают серологический анализ, который выявит род и класс вируса на основании компонентов РНК (полимеразно-цепная реакция). Это важно для исключения специфического менингита.</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;\">В отношении вирусного менингита в большинстве случаев проводится симптоматическая терапия. Пациенту рекомендован покой, постельный режим, нахождение в затемненном помещении. Для купирования головной боли назначают анальгетики. Но зачастую она значительно уменьшается после снижения внутричерепного давления в результате диагностической люмбальной пункции. Температура тела выше 38°C является показанием к приему жаропонижающих препаратов (парацетамол, ибупрофен и др.).</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;\">Специфическая и неспецифическая противовирусная терапия вирусного менингита необходима у пациентов с ослабленным состоянием иммунной системы и у грудных детей. В таких случаях проводится внутривенное введение иммуноглобулина. Если вирусный менингит вызван вирусом герпеса или вирусом Эпштейн-Барр, то возможно применение ацикловира.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-d37fc9cd-7fff-6804-f64f-bb11957f9610\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Вакцинация обеспечивает надежную профилактику менингитов и других неврологических осложнений, вызываемых вирусом полиомиелита, вирусом эпидемического паротита и вирусом кори.</span></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;\">Как правило, инкубационный период вирусного менингита занимает от 2 до 4 дней. Характерно острое начало с подъема температуры тела до высоких цифр, общего недомогания и интоксикационного синдрома. Могут наблюдаться боли в мышцах, тошнота и рвота, анорексия, понос и боли в животе. </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;\">Пациент может жаловаться на насморк, боли в горле и/или кашель. У грудных детей наблюдается напряжение или выбухание родничка. При вирусном менингите нередко отмечаются легкие нарушения сознания: сонливость или оглушенность. В некоторых случаях наоборот возможно беспокойство и возбуждение больного. При возникновении более тяжелых расстройств сознания (сопор, кома) необходимо проведение повторного обследования пациента и пересмотр диагноза.</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;\">Вирусный менингит сопровождается ярко выраженным менингеальным синдромом, который может проявляться с первого дня заболевания или манифестировать на вторые сутки. Он характеризуется постоянной мучительной головной болью, плохо снимаемой приемом анальгетиков, повторными рвотами, повышенной чувствительностью кожи (гиперестезией) и болезненным восприятием внешних раздражителей (шума, резких звуков, яркого света и т. п.). Характерно положение больного в постели: лежа на боку, голова запрокинута назад, колени приведены к животу, руки прижаты к груди.</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 осмотре пациента, имеющего вирусный менингит, отмечается избыточное напряжение (ригидность) разгибательной группы мышц шеи, затрудняющее приведение подбородка к груди; положительные менингеальные симптомы. Симптомы Брудзинского: верхний — при пассивном сгибании головы происходит непроизвольное сгибание ног; нижний — разгибание согнутой под прямым углом ноги приводит к сгибанию второй ноги. Симптом Кернига — затруднение пассивного разгибания ноги согнутой под прямым углом. У детей грудного возраста показательным является симптом Лесажа (симптом подвешивания): если ребенка поднять, держа под мышки, то наблюдается сгибание ног и подтягивание их к животу.</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;\">Вирусный менингит отличается относительно коротким течением. Уже на 3-5 сутки температура тела падает до нормальных цифр, хотя в некоторых случаях наблюдается вторая волна лихорадки. Весь период заболевания длится от 7 до 14 дней, в среднем около 10 дней.</span></p>",
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},
"code": "A87.2",
"name": "Лимфоцитарный хориоменингит",
"icd_name": "Лимфоцитарный хориоменингит",
"gender": 0,
"age_min": 20,
"age_max": 50,
"cause": [
"4",
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],
"periodicity": 1,
"slug": "a87.2_limfocitarnyy_horiomeningit",
"lead": "острое вирусное инфекционное заболевание центральной нервной системы",
"description": "<p><span id=\"docs-internal-guid-03875101-7fff-c935-f0e9-f120f455597b\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Лимфоцитарный хориоменингит - это острое вирусное заболевание, передающееся человеку от мышевидных грызунов, с серозным воспалением мозговых оболочек и вещества мозга с доброкачественным течением.</span></span></p>",
"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 болезни – одноименный аренавирус. Источником и резервуаром инфекции являются обезьяны, мыши, крысы, морские свинки, собаки, кролики, цыплята. Во внешнюю среду вирус выделяется с испражнениями, слюной. Пути передачи: воздушно-пылевой, трансплацентарный, алиментарный (при заражении пищи и воды), иногда контактный – во время нарушения целостности кожных покровов, и трансмиссивный, при укусах комаров, клопов, москитов, клещей и вшей.</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;\">Основные факторы риска – профессии, связанные с истреблением переносчиков, уходом за декоративными грызунами (хомяки), в пылевых условиях, зернохранилищах, вирусологических лабораториях, проживание в сельскохозяйственных районах. Для клинической инфектологии лимфоцитарный хориоменингитактуален тем, что распространенность среди людской популяции достигает 5%; это означает высокую вероятность бессимптомного течения и врожденной инфекционной патологии.</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;\">Патогенез до конца не изучен; исследования проводились преимущественно на животных. Проникая в организм, аренавирус не оставляет первичного аффекта, а лимфогенно переносится в регионарные скопления лимфоидной ткани, где происходит его репликация и накопление. В дальнейшем возбудитель с током крови разносится по органам, размножаясь в клетках ретикуло-эндотелиальной системы, тропен к оболочке и веществу головного мозга.</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;\">Одномоментно возникает длительная персистенция циркулирующих иммунных комплексов. Патогистологически обнаруживаются воспалительные изменения в оболочке, эпендиме и сосудистых сплетениях головного мозга, характерна выраженная лимфоцитарная инфильтрация. При хроническом течении лимфоцитарного хириоменингита обнаруживаются признаки облитерации субарахноидального пространства с инфильтрацией мозговых оболочек и серого вещества.</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;\">Верификация диагноза вирусной инфекции и лечение осуществляется совместно инфекционистами и неврологами. Другие медицинские специалисты привлекаются по показаниям. Важен сбор эпидемиологического анамнеза, включая особенности проживания и профессии больного. Основные клинические, инструментальные и лабораторные признаки лимфоцитарного хориоменгита:</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;\">Физикальные данные. При объективном исследовании у пациентов определяются менингеальный синдром, жалобы на ухудшения зрения, реже гиперемия зева, сухие хрипы в легких, гепатоспленомегалия. При офтальмоскопии у 20-50% заболевших лимфоцитарным хориоменингитом выявляются признаки застойных явлений диска зрительного нерва, расширение и извитость вен.</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. Общеклинический анализ крови выявляет лейкоцитоз, сдвиг формулы влево, ускорение СОЭ. В общем анализе мочи могут быть следы белка, эритроциты. Ликворограмма при данном хориоменингите: лимфоцитарный плеоцитоз, повышение содержания белка, снижение концентрации глюкозы, резко положительная проба Панди.</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;\">Выявление инфекционных агентов. Верификация диагноза осуществляется с помощью метода ПЦР (моча, кровь, ликвор), реже биопробой на мышах. Серологическое исследование (ИФА, РСК) проводится дважды, с интервалом в 10-14 дней, необходимо возрастание титра антител не менее чем в 4 раза.</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. Рентгенография органов грудной клетки, черепа проводится при лимфоцитарном хориоменингите с целью дифференциального диагноза. ЭЭГ – признаки гипертензии, диффузные нарушения биоэлектрической активности. На ЭКГ возможно выявление симптомов миокардита.</span></li>\r\n</ul>\r\n<p> </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>",
"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;\">Пациенты с симптомами заболевания подлежат обязательной госпитализации в инфекционный стационар; при тяжелом поражении ЦНС рекомендовано лечение в палате интенсивной терапии, иногда требуется ИВЛ. Больные с иммунодефицитами любого генеза нуждаются в незамедлительном назначении лечения – большинство летальных случаев приходится на долю именно этих заболевших.</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;\">Назначается постельный режим до нормализации показателей ликвора, в среднем, сроком до 2-3 недель, даже при нормальной температуре тела. При менингеальных симптомах необходимо обеспечить покой, отсутствие резких шумов, яркого света. Диета заключается в ограничении тяжелой, трудноперевариваемой пищи, алкоголя. Питьевой режим увеличивают за счет воды и других жидкостей, сопоставляя с клиникой поражения головного мозга.</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;\">Консервативная 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;\">Стандартизированных протоколов лечения пациентов, имеющих клинику лимфоцитарного хориоменингита, в настоящее время не существует; разрабатываются новые этиотропные противовирусные формулы. Чаще всего клиническое улучшение наступает через 3-5 суток; в неосложненных случаях лечение ограничивается симптоматическими мерами. Наиболее часто терапия заболевания осуществляется следующими препаратами:</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;\">Этиотропными. Рибавирин рассматривается в качестве возможного противовирусного средства для лечения лимфоцитарного хориоменингита, однако убедительной доказательной базы не имеет. Доказано, что при применении в субингибиторных концентрациях препарат способен вызывать мутации возбудителя и усиливать его репликативную активность.</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;\">Патогенетическими. Важная роль отводится дезинтоксикации с помощью внутривенных инфузий хлосоля, сукцинат-содержащих, глюкозо-солевых растворов. Кортикостероиды применяются ограниченно, поскольку увеличивают вероятность развития рецидивов.т Используются седативные, мочегонные, противосудорожные, жаропонижающие средства, антигипоксанты.</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;\">Симптоматическими. Для купирования возникающих симптомов применяются средства, улучшающие микроциркуляцию, местные антисептические спреи, противокашлевые, противорвотные препараты. При доказанной вторичной бактериальной инфекции с учетом чувствительности флоры подбираются антибиотики. 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"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;\">Специфической профилактики не разработано. Некоторые исследователи считают перспективным использование векторных вакцин против аденовируса, бешенства, гриппа для формирования клеточного иммунитета к лимфоцитарному хориоменингиту. Основное значение отводится неспецифическим мерам: дератизации, защите питьевых источников, продуктов от грызунов, соблюдении правил работы с вирусами в лабораториях, личной и профессиональной гигиены.</span></p>",
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"name": "Другие вирусные энцефалиты, не классифицированные в других рубриках",
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}
]
}
