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},
"code": "B33.2",
"name": "Вирусный кардит",
"icd_name": "Вирусный кардит",
"gender": 0,
"age_min": 0,
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"slug": "b33.2_virusnyy_kardit",
"lead": "заболевание сердца, обусловленное вирусной инфекцией",
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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;\">Развивается у новорождённых и является последствием вирусной инфекции, перенесённой во время беременности (ранний и поздний врождённый вирусный кардит). Также может развиваться в более позднем возрасте как осложнение соответствующего инфекционного заболевания.</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;\">Имея первоначально вирусную причину патологический процесс в сердце быстро приобретает аутоиммунный характер. Такая трансформация сопровождается появлением и ростом числа антикардиальных антител, активацией клеточного иммунитета и обуславливает переход болезни в хроническую форму.</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;\">Выделяют несколько клинических вариантов болезни, в зависимости от преобладающих проявлений: малосимптомный, псевдокоронарный, декомпенсационный, протекающий с нарушением кровообращения, аритмический, тромбоэмболический и другие. </span></p>",
"pathogenesis": "<p><span id=\"docs-internal-guid-135374ba-7fff-0c00-fc5d-12a0aedfd4f2\"><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;\">Попадая в сердечную мышцу вирусы проникают в кардиомиоциты, где реплицируются. Клетки и продукты нарушенного белкового обмена в результате вирусного воздействия приобретают свойства антигенов, что сопровождается образованием антител, повреждающих ткань сердца. Развивается воспалительная реакция.</span></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 базируется на клинических проявлениях и результатах обследований. Проводятся:</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;\">биохимический анализ крови (маркёры воспаления, кардиоспецифические фракции изоферментов и др.),</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;\">серологические исследования (выявление антикардиальных, противовирусных антител).</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;\">Проводятся инструментальные 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;\">электрокардиография,</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;\">сцинтиграфия сердца с радиоактивным галлием.</span></li>\r\n</ul>\r\n<p> </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 остром периоде вирусного кардита (или при обострении хронического) больного следует госпитализировать. После купирования острой симптоматики пациент переводится на амбулаторное лечение и наблюдение; в дальнейшем – эффективно санаторно-курортное лечение.</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 остром состоянии ребенку необходим щадящий режим с минимальной физической активностью сроком, как минимум, 1-2 недели. Разрабатывается и назначается индивидуальная диета, которая обязательно включает богатые калием продукты при строгом исключении любых стимуляторов.</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;\">Основу терапевтической стратегии составляют нестероидные, а в некоторых случаях и гормональные противовоспалительные средства. Иногда показаны антикоагулянты, сердечные гликозиды, гипотензивные диуретики, антиаритмические препараты и т.д.</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;\">Очень важно соблюдать все меры профилактики, предписанные врачом во избежание тяжелых осложнений и рецидивов вирусного кардита.</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;\">Первичная профилактика предусматривает предупреждение инфицирования плода во время беременности, закаливание ребёнка, лечение острой и хронической очаговой инфекции, диспансерное наблюдение за детьми из группы риска по сердечно-сосудистым заболеваниям.</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;\">Вторичная профилактика направлена на предупреждение осложнений и рецидивирования процесса, достигаемое чётким соблюдением принципов диспансерного наблюдения больных.</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;\">Вирусным кардитам присуща как общевоспалительная, так и специфическая симптоматика.</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;\">К общим симптомам относятся недомогание, утомляемость, субфебрильная температура (реже встречается более выраженная гипертермия с лихорадочным компонентом), потливость, головная боль и т.д.</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;\">На поражение миокарда указывают боли в сердце (которые в данном случае могут широко варьировать как по характеру, так и по выраженности), иногда в степени стенокардического приступа, а также аритмия, одышка, усиленное и учащенное сердцебиение, цианотичность носогубного треугольника, ослабленный пульс.</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;\">В большинстве случаев сердечная недостаточность при вирусных кардитах не является жизнеугрожающей, однако при присоединении воспаления мозговых оболочек (энцефаломиокардит) состояние больного может значительно утяжелиться неврологической симптоматикой. Нередко специфической симптоматике сопутствуют также проявления нефрита, васкулита и т.д.</span></p>",
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},
{
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"code": "B48.1",
"name": "Риноспоридиоз",
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"lead": "хронический глубокий гранулематозный микоз, сопровождающийся поражением слизистой оболочки носа и носоглотки",
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"etiology": "<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;\">Возбудитель заболевания – дрожжеподобный гриб Rhinosporidium seeberi. Морфологически это крупные толстостенные сферические спорангии размером 50-350 мкм, заполненные овальными эндоспорами размером от 7 до 10 мкм. Среда обитания – почва, закрытые загрязненные водоемы в топической и субтропической климатической зоне. Существует теория, согласно которой водные ресурсы инфицируются птицами, страдающими болезнью Зеебера. Механизм заражения человека – контактный. Входными воротами служат слизистые оболочки, взаимодействующие с грунтом или водой. В связи с этим в группу риска входят сотрудники гидротехнических сооружений, сельские жители, занимающиеся рисоводством, использующие воду из застойных водоемов, контактирующие с домашними животными и скотом. Передача возбудителя от больного человека к здоровому не характерна.</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 риноспоридиоза окончательно не изучен. Считается, что патогенные грибы проникают в организм через травмированные слизистые оболочки. В этом месте формируется первичный очаг заболевания, возможна гематогенная и лимфогенная диссеминация. Далее в пораженных тканях возникает хронический воспалительный процесс, сопровождающийся отеком, кровоизлияниями, образованием телеангиэктазий и грануляционной ткани, насыщенной капиллярами и клеточными элементами. Инфильтрат характеризуется скоплением плазмоцитов, эозинофилов, лимфоцитов, фибробластов и гигантских клеток Пирогова-Лангханса. Одновременно в очаге развиваются спорангии, наполненные эндоспорами, и непосредственно сами споры. В некоторых случаях на слизистой оболочке появляются микроабсцессы с центральным некрозом.</span></p>\r\n<p><span id=\"docs-internal-guid-82b3dae4-7fff-fd7f-eabd-95aca6ab2272\"> </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;\">Постановка предварительного диагноза не вызывает затруднений у опытного отоларинголога или инфекциониста. Основными критериями при первичном осмотре служат данные анамнеза и физикального исследования. При опросе специалист обращает внимание на место жительства, профессию и условия работы пациента, динамику развития симптомов. Полная программа обследования включает:</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;\">Осмотр носовой полости и ротоглотки. Передняя риноскопия и мезофарингоскопия позволяют выявить характерные поражения слизистой оболочки – различное количество папилломатозных вегетаций и/или язвенных дефектов, сливающихся между собой. При механическом воздействии образования обильно кровоточат.</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;\">Общеклинические методы исследования. В общем анализе крови отображается умеренный лейкоцитоз со сдвигом лейкоцитарной формулы в сторону юных и палочкоядерных нейтрофилов, повышение СОЭ. Изменения в клиническом анализе мочи наблюдаются при развитии метастатического поражения мочеполовой системы, могут включать в себя мутность мочи, протеинурию, увеличение удельного веса, лейкоцитурию, смещение рН в кислую сторону.</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;\">Световую или люминесцентную микроскопию. В качестве материала для исследования используется мазок из ротоглотки или носоглотки. В нем обнаруживаются крупные толстые нити диаметром от 50 до 350 мкм, наполненные овальными спорами размером до 9 мкм.</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;\">Гистологическое исследование. Наиболее достоверный метод диагностики. При его проведении определяется большое количество эозинофилов, плазматических клеток, фибробластов, лимфоцитов в сочетании со спорангиями и спорами гриба.</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\"><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;\">Окончательный диагноз устанавливается после получения результатов гистологического исследования. </span></p>",
"treatment": "<p><span id=\"docs-internal-guid-2b4c99ef-7fff-69fc-a3f3-ce2cc5d9c1b3\"><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;\">Основная тактика – хирургическая. Лечение проводится в условиях отоларингологического или хирургического стационара. Его суть заключается в иссечении патологических образований при помощи проволочной петли, путем электро– или лазерной коагуляции с последующей обработкой пораженных участков слизистой оболочки антисептиками. Этиотропных фармакологических средств на данный момент не разработано. У части пациентов наблюдается положительная динамика при внутримышечном введении солянокислого эметина в течение 10 суток или внутривенных инъекций солюсурьмина на протяжении 20-27 дней.</span></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 заболевания не существует. Неспецифические превентивные мероприятия в отношении риноспоридиозной гранулемы состоят из оптимизации условий труда, предотвращения или ограничения продолжительности контакта с потенциально опасными водоемами и грунтом, использования защитных костюмов при работе на гидротехнических сооружениях в эндемичных регионах.</span></p>\r\n<p><span id=\"docs-internal-guid-fd30a045-7fff-8185-d7fd-e0f0f46aaa67\"> </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;\">Клинические проявления риноспоридиозной гранулемы довольно специфичны. Инкубационный период точно неизвестен. Характерная локализация – носовая полость, носоглотка, ротоглотка, реже слизистые рта, мягкого неба, гортани. Первыми симптомами обычно становятся очаги гиперемии, на поверхности которых постепенно формируются мелкие папилломатозные узелки светло- или бледно-розового цвета с желтым центром. При контакте они легко травмируются и кровоточат. При повторном инфицировании или интенсивном развитии возбудителя происходит деструкция этих образований. На их месте возникают папилломатозно-язвенные дефекты со слизистым содержимым и фестончатым краем.</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;\">По мере развития заболевания количество очагов возрастает, образуются новые вегетации различного размера, достаточно быстро увеличивающиеся за счет хорошей васкуляризации. Специфический симптом этой стадии риноспоридиоза – «ягоды малины» или «кочаны цветной капусты». Часто вторичные образования имеют ножку, обуславливают ухудшение носового дыхания, закрытую гнусавость, а при травматизации – обильные назофарингеальные и носовые кровотечения. В целом течение заболевания доброкачественное, продолжительность может составлять от 15 до 30 лет. В литературе описаны полипы, способные деформировать лицевую область – масса некоторых из них достигала 5-7 кг.</span></p>",
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"code": "B48.1",
"name": "Риноспоридиоз",
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"lead": "хронический глубокий гранулематозный микоз, сопровождающийся поражением слизистой оболочки носа и носоглотки",
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"etiology": "<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;\">Возбудитель заболевания – дрожжеподобный гриб Rhinosporidium seeberi. Морфологически это крупные толстостенные сферические спорангии размером 50-350 мкм, заполненные овальными эндоспорами размером от 7 до 10 мкм. Среда обитания – почва, закрытые загрязненные водоемы в топической и субтропической климатической зоне. Существует теория, согласно которой водные ресурсы инфицируются птицами, страдающими болезнью Зеебера. Механизм заражения человека – контактный. Входными воротами служат слизистые оболочки, взаимодействующие с грунтом или водой. В связи с этим в группу риска входят сотрудники гидротехнических сооружений, сельские жители, занимающиеся рисоводством, использующие воду из застойных водоемов, контактирующие с домашними животными и скотом. Передача возбудителя от больного человека к здоровому не характерна.</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 риноспоридиоза окончательно не изучен. Считается, что патогенные грибы проникают в организм через травмированные слизистые оболочки. В этом месте формируется первичный очаг заболевания, возможна гематогенная и лимфогенная диссеминация. Далее в пораженных тканях возникает хронический воспалительный процесс, сопровождающийся отеком, кровоизлияниями, образованием телеангиэктазий и грануляционной ткани, насыщенной капиллярами и клеточными элементами. Инфильтрат характеризуется скоплением плазмоцитов, эозинофилов, лимфоцитов, фибробластов и гигантских клеток Пирогова-Лангханса. Одновременно в очаге развиваются спорангии, наполненные эндоспорами, и непосредственно сами споры. В некоторых случаях на слизистой оболочке появляются микроабсцессы с центральным некрозом.</span></p>\r\n<p><span id=\"docs-internal-guid-82b3dae4-7fff-fd7f-eabd-95aca6ab2272\"> </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;\">Постановка предварительного диагноза не вызывает затруднений у опытного отоларинголога или инфекциониста. Основными критериями при первичном осмотре служат данные анамнеза и физикального исследования. При опросе специалист обращает внимание на место жительства, профессию и условия работы пациента, динамику развития симптомов. Полная программа обследования включает:</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;\">Осмотр носовой полости и ротоглотки. Передняя риноскопия и мезофарингоскопия позволяют выявить характерные поражения слизистой оболочки – различное количество папилломатозных вегетаций и/или язвенных дефектов, сливающихся между собой. При механическом воздействии образования обильно кровоточат.</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;\">Общеклинические методы исследования. В общем анализе крови отображается умеренный лейкоцитоз со сдвигом лейкоцитарной формулы в сторону юных и палочкоядерных нейтрофилов, повышение СОЭ. Изменения в клиническом анализе мочи наблюдаются при развитии метастатического поражения мочеполовой системы, могут включать в себя мутность мочи, протеинурию, увеличение удельного веса, лейкоцитурию, смещение рН в кислую сторону.</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;\">Световую или люминесцентную микроскопию. В качестве материала для исследования используется мазок из ротоглотки или носоглотки. В нем обнаруживаются крупные толстые нити диаметром от 50 до 350 мкм, наполненные овальными спорами размером до 9 мкм.</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;\">Гистологическое исследование. Наиболее достоверный метод диагностики. При его проведении определяется большое количество эозинофилов, плазматических клеток, фибробластов, лимфоцитов в сочетании со спорангиями и спорами гриба.</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\"><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;\">Окончательный диагноз устанавливается после получения результатов гистологического исследования. </span></p>",
"treatment": "<p><span id=\"docs-internal-guid-2b4c99ef-7fff-69fc-a3f3-ce2cc5d9c1b3\"><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;\">Основная тактика – хирургическая. Лечение проводится в условиях отоларингологического или хирургического стационара. Его суть заключается в иссечении патологических образований при помощи проволочной петли, путем электро– или лазерной коагуляции с последующей обработкой пораженных участков слизистой оболочки антисептиками. Этиотропных фармакологических средств на данный момент не разработано. У части пациентов наблюдается положительная динамика при внутримышечном введении солянокислого эметина в течение 10 суток или внутривенных инъекций солюсурьмина на протяжении 20-27 дней.</span></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 заболевания не существует. Неспецифические превентивные мероприятия в отношении риноспоридиозной гранулемы состоят из оптимизации условий труда, предотвращения или ограничения продолжительности контакта с потенциально опасными водоемами и грунтом, использования защитных костюмов при работе на гидротехнических сооружениях в эндемичных регионах.</span></p>\r\n<p><span id=\"docs-internal-guid-fd30a045-7fff-8185-d7fd-e0f0f46aaa67\"> </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;\">Клинические проявления риноспоридиозной гранулемы довольно специфичны. Инкубационный период точно неизвестен. Характерная локализация – носовая полость, носоглотка, ротоглотка, реже слизистые рта, мягкого неба, гортани. Первыми симптомами обычно становятся очаги гиперемии, на поверхности которых постепенно формируются мелкие папилломатозные узелки светло- или бледно-розового цвета с желтым центром. При контакте они легко травмируются и кровоточат. При повторном инфицировании или интенсивном развитии возбудителя происходит деструкция этих образований. На их месте возникают папилломатозно-язвенные дефекты со слизистым содержимым и фестончатым краем.</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;\">По мере развития заболевания количество очагов возрастает, образуются новые вегетации различного размера, достаточно быстро увеличивающиеся за счет хорошей васкуляризации. Специфический симптом этой стадии риноспоридиоза – «ягоды малины» или «кочаны цветной капусты». Часто вторичные образования имеют ножку, обуславливают ухудшение носового дыхания, закрытую гнусавость, а при травматизации – обильные назофарингеальные и носовые кровотечения. В целом течение заболевания доброкачественное, продолжительность может составлять от 15 до 30 лет. В литературе описаны полипы, способные деформировать лицевую область – масса некоторых из них достигала 5-7 кг.</span></p>",
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