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"lead": "Болезнь, вызываемая различными видами плесневых грибов рода Aspergillus. Чаще протекает с преимущественным поражением легких, улиц с иммунодефицитами принимает тяжелое септическое (генерализованное) течение.",
"description": "Инфекционное грибковое заболевание.",
"etiology": "<p>Возбудители — различные виды рода Aspergillus. Наибольшее значение в патологии человека имеют A. niger, A. flavus, встречаются и другиевиды (A. fumigatus, A. nidulans). Морфологически состоят из однотипного мицелия (шириной 4—6 мкм), иногда обнаруживаются “головки” с конидиями.</p>\r\n<full></full>\r\n<p>Аспергиллы обладают большой биохимической активностью, образуют различные ферменты (протеолитический, сахаролитический, липолитический), а некоторые виды содержат эндотоксины, при введении которых экспериментальным животным развиваются параличи и наступает их гибель. Обладают аллергизирующим действием. Из дезинфицирующих средств на аспергиллы наиболее активно действуют растворы карболовой кислоты и формалин. Аспергиллы широко распространены в природе. Их постоянно можно обнаружить в почве, зерне, муке, сене (особенно заплесневелых),в пыли помещений, где обрабатываются шкуры, шерсть, пенька. Обнаруживались аспергиллы даже в пыли лечебных учреждений, что обусловливало внутрибольничное инфицирование. Возбудитель проникает в организм, как правило, через воздух с пылью. Из профессиональных групп чаще поражаются работники сельского хозяйства, работники ткацких и бумагопрядильных предприятий. Заболевание у ослабленных лиц может возникнуть и как эндогенная инфекция, так как на слизистой оболочке зева здоровых людей иногда обнаруживаются аспергиллы.</p>",
"pathogenesis": "<p>Возбудитель аэрогенным путем попадает на слизистые оболочки верхних дыхательных путей. Может наступать инфицирование через кожу, обычно измененную каким-либо другим патологическим процессом. Ведущую роль в патогенезе аспергиллеза играет снижение иммунной защиты организма. Аспергиллез осложняет различные патологические процессы кожи, слизистых оболочек, внутренних органов. В частности, легочные формы аспергиллеза возникали на фоне бронхоэктатической болезни, абсцессов легкого, туберкулеза легких, рака легких, хронического бронхита и др. В последние годы аспергиллез стал особенно часто наблюдаться у лиц с иммунодефицитами (врожденные иммунодефициты, лица, получающие противоопухолевую химиотерапию, иммунодепрессанты, а также ВИЧ-инфицированные). Он встречается значительно чаще, чем другие глубокие микозы. У ослабленных лиц вначале поражаются грибом легкие, затем в процесс вовлекаются плевра, лимфатические узлы.</p>\r\n<full></full>\r\n<p>Током крови аспергиллы могут заноситься в другие органы, образуя там специфические гранулемы, которые обычно абсцедируют. Из легочного аспергиллез превращается в генерализованный (септический) и нередко (свыше 50%) заканчивается гибелью больного. Спасти удается тех больных, у которых сохранились в какой-то мере функции иммунной системы. При массивной ингаляции спор аспергилл у лиц с нормальной иммунной системой может возникнуть острая диффузная пневмония, заканчивающаяся самовыздоровлением.</p>",
"diagnostics": "<p>При подозрении на аспергиллез берут на анализ мокроту и бронхоальвеолярный смыв. Проводят ее микроскопическое исследование и посев на питательную среду. Для выявления аспергиллов используют метод полимеразной цепной реакции и реакцию преципитации. Также берут кровь на общий и биохимический анализы крови, анализ на ВИЧ.</p>\r\n<p>Для выяснения степени поражения легких делают рентгенографию грудной клетки.</p>\r\n<p>Для получения бронхоальвеолярного смыва проводят бронхоскопию.</p>\r\n<p>В некоторых случаях для микроскопии и посева требуется биоптат пораженного органа. В этом случае проводят его биопсию.</p>",
"treatment": "<p>Лечат аспергиллез противогрибковыми препаратами. Однако при легочном аспергиллезе такая терапия не всегда эффективна, поэтому часто прибегают к хирургическому вмешательству – удаляют пораженную часть легкого. Параллельно назначают кортикостероидные препараты для устранения закупорки бронхов слизью.</p>\r\n<p>При генерализованном аспергиллезе лекарственную терапию сочетают с хирургическим лечением.</p>\r\n<p>При поражениях кожи противогрибковые препараты применяют местно.</p>\r\n<p>При аллергической реакции на аспергиллы назначают антигистаминные препараты.</p>\r\n<p>Прогноз при генерализованной форме неблагоприятный. При поражениях легких летальность – 20-35 %. При поражениях кожи и глаз прогноз благоприятный.</p>",
"prevention": "<p>Профилактика аспергиллеза заключается в своевременном выявлении страдающих этим заболеванием и их правильном лечении, а также предотвращении внутрибольничных инфекций. Изолировать пациента не нужно, так как заразиться от него невозможно. Однако при наличии в доме страдающего аспергиллезом стоит уделить больше внимания влажной уборке.</p>\r\n<full></full>\r\n<p>В отделениях для пациентов с пониженным иммунитетом не должно быть пыли и цветов. При появлении спор аспергиллов необходимо обрабатывать помещение дезинфекционными препаратами.</p>\r\n<p>Следует регулярно чистить кондиционеры и увлажнители воздуха, регулярно делать влажную уборку.</p>\r\n<p>Обязательно нужно укреплять иммунитет, так как при его снижении резко возрастает вероятность развития этого заболевания. Для этого нужно закаляться, принимать витамины. Необходимо своевременно лечить инфекционные заболевания.</p>\r\n<p>Нельзя употреблять в пищу несвежие плесневелые продукты.</p>",
"clinical_picture": "<p>Инкубационный период заболевания точно не установлен. Симптомы зависят от того, какой орган поражен.</p>\r\n<p>Бронхолегочный аспергиллез сначала протекает как бронхит или трахеобронхит. Пациент жалуется на <a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Кашель\" href=\"../../../symptom/kashel/\">кашель</a> с серой мокротой, в которой иногда обнаруживаются прожилки крови и комочки – колонии аспергиллов.</p>\r\n<full></full>\r\n<p>Однако если болезнь не лечить, то развивается аспергиллезная пневмония. Процесс может быть острым и хроническим. При острой аспергиллезной пневмонии у страдающего наблюдается высокая температура, <a title=\"Перейти на страницу симптома Одышка\" href=\"../../../symptom/odyshka/\">одышка</a>, боли в груди, <a title=\"Перейти на страницу симптома Кашель\" href=\"../../../symptom/kashel/\">кашель</a> с вязкой слизисто-гнойной мокротой с прожилками крови и серо-зелеными комочками. В комочках при микроскопии можно обнаружить аспергиллы. Ночью пациент обильно потеет. Постепенно <a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a> нарастает, страдающий теряет вес.</p>\r\n<p>Хронические формы аспергиллезной пневмонии развиваются на фоне какого-либо поражения легких. Поэтому пациент жалуется на симптомы основного заболевания, а также на зеленоватые комочки в мокроте и запах плесени изо рта.</p>\r\n<p>Аспергиллома легкого может никак не проявляться и обнаруживаться только при рентгенологическом исследовании. А может проявляться и повторяющимся кровохарканьем, и даже легочными кровотечениями.</p>\r\n<p>Аспергиллез лор-органов развивается, если поражены уши, слизистая оболочка носа или гортани. При поражении ушного канала пациента беспокоит <a title=\"Перейти на страницу симптома Зуд\" href=\"../../../symptom/zud/\">зуд</a> в ухе, иногда боль в нем. По ночам из уха может вытекать жидкость. Это можно заметить по пятнам на подушке, которые она оставляет.</p>\r\n<p>Аспергиллез глаз проявляется конъюнктивитом. Пациенты жалуются на <a title=\"Перейти на страницу симптома Зуд\" href=\"../../../symptom/zud/\">зуд</a> в глазах, <a title=\"Перейти на страницу симптома Слезотечение\" href=\"../../../symptom/slezotechenie/\">слезотечение</a>, гноение. Конъюнктива при этом красная, отечная. Возможно <a title=\"Перейти на страницу симптома Снижение зрения\" href=\"../../../symptom/snizhenie_zreniya/\">снижение зрения</a> и пелена перед глазами.</p>\r\n<p>При поражении кожи на ней образуются различные узелки.</p>\r\n<p>При поражении желудочно-кишечного тракта заболевание проявляется тошнотой, рвотой, жидким пенистым стулом, запахом плесени изо рта.</p>\r\n<p>Аспергиллы могут поражать и сердце, вызывая эндокардит. Особенно часто это бывает у пациентов с искусственными клапанами сердца. Это заболевание проявляется лихорадкой, кашлем, одышкой, слабостью, постоянной усталостью, ночным потом, снижением веса.</p>\r\n<p>Генерализованный аспергиллез развивается у пациентов с угнетенной иммунной системой. При этой форме споры гриба разносятся с током крови по всему организму, образуя метастазы в различных органах. При этом у пациента повышается температура, это состояние сопровождается ознобом, бредом. Дыхание часто затруднено. Может развиться почечная или печеночная недостаточность, появиться <a title=\"Перейти на страницу симптома Кровь в моче\" href=\"../../../symptom/krov_v_moche/\">кровь в моче</a>. Часто у пациентов с генерализованной формой образуются тромбы. Эта форма довольно часто приводит к летальному исходу.</p>",
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}
]
}