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"code": "A84",
"name": "Клещевой вирусный энцефалит",
"icd_name": "Клещевой вирусный энцефалит",
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"slug": "a84_kleschevoy_virusnyy_encefalit",
"lead": "Нарушение здоровья, относящееся к группе вирусные инфекции центральной нервной системы",
"description": "<p>Клещевой энцефалит – это вирусное, природно-очаговое (характерное только для определенных территорий) заболевание с преимущественным поражением центральной нервной системы.</p>",
"etiology": "<p>Вирус клещевого энцефалита — нейротропный, РНК-содержащий. Относится к семейству Flaviviridae экологической группы арбовирусов. Возбудитель способен длительно сохранять вирулентные свойства при низких температурах, но нестоек к высоким температурам (при кипячении погибает через 2-3 мин), дезинфицирующим средствам и ультрафиолетовому излучению. </p>\r\n<p>Основным резервуаром, поддерживающим существование возбудителя, являются иксодовые клещи — Ixodes persulcatus (преимущественно в азиатском регионе России) и Ixodes ricinus (преимущественно в европейском регионе). </p>\r\n<p>Кроме человека, вирус может поражать диких и домашних животных, в том числе коров и коз. Поэтому заражение может происходить как напрямую – при укусе человека клещом или случайном раздавливании насекомого при попытках его извлечь, так и при употреблении молока и молочных продуктов, не прошедших термическую обработку и полученных от больных животных.</p>",
"pathogenesis": "<p>Вирус попадает в организм человека двумя путями: через укус клеща и алиментарно. Алиментарное заражение происходит при употреблении сырого молока, а также молочных продуктов, приготовленных из молока зараженных коров и коз. При укусе клеща вирус сразу попадает в кровь. Однако при обоих способах заражения вирус проникает в нервную систему гематогенно и по периневральным пространствам. Вирус обнаруживается в ткани мозга через 2-3 дня после укуса, а максимальная концентрация его отмечается уже к 4-му дню. </p>",
"diagnostics": "<p>Серологический метод. Материалом являются парные сыворотки больного. Определение диагностического нарастания титра антител в реакциях РТГА(реакция торможения гемагглютинации) и ИФА (иммуноферментный анализ). </p>\r\n<p>Молекулярно-биологический метод. Материалом является клещ. Клеща исследуют на наличие антигена вируса клещевого энцефалита, реже с помощью ПЦР (полимеразно-цепная реакция) выявляют вирусную РНК (клеща). Для исследований на наличие антигена используют живой материал, ПЦР диагностика возможна по фрагментам клеща. </p>\r\n<p>Вирусологический метод. Выделение вируса из крови и спинномозговой жидкости путём введения материала в мозг новорожденным белым мышам. </p>",
"treatment": "<p>Лечение включает специфическую (направленную на возбудителя), патогенетическую (блокирующую механизмы развития заболевания) и симптоматическую терапию. Больному назначается строгий постельный режим. Схема специфического лечения зависит от времени, прошедшего с момента появления первых симптомов. В самом начале заболевания (первая неделя) высокую эффективность показало назначение больным противоклещевого иммуноглобулина. Его вводят в течение 3 дней. Также при ранней диагностике хорошие результаты дает применение противовирусных препаратов: рибонуклеазы, рибавирина, интерферона, экстракт побегов картофеля. </p>\r\n<p>Все эти препараты неэффективны на поздних стадиях заболевания, когда вирус уже поразил центральную нервную систему. В этом случае лечение направлено не на борьбу с возбудителем болезни, а на патологические механизмы, угрожающие жизни пациента. Для этого используют подачу кислорода через маску, ИВЛ при нарушении дыхания, мочегонные средства для снижения внутричерепного давления, препараты, увеличивающие устойчивость мозга к кислородному голоданию, нейролептики, глюкокортикоиды. </p>",
"prevention": "<p>В качестве специфической профилактики применяют вакцинацию, которая является самой надежной превентивной мерой. Обязательной вакцинации подлежат все лица, проживающие в эндемичных районах или въезжающие в них. Население в эндемичных районах составляет примерно половину всего населения России. </p>\r\n<p>Неспецифические меры профилактики сводятся к предупреждению присасывания клещей, а также к их раннему удалению. </p>\r\n<p>Избегать посещения мест обитания клещей (лесные биотопы с высокой травой, кустарником) в апреле-июле. Энцефалитные клещи нападают, цепляясь за проходящих мимо теплокровных животных и людей, как репейник. Местом для поджидания жертвы они избирают запачканые потовыми следами теплокровных травинки и веточки в тенистых травянистых местах. С учетом этого в походах следует держаться подальше от троп животных, и домашнего скота. На дорожках и широких тропах держаться середины троп,избегая контакта со свешивающейся на тропу растительностью. </p>\r\n<p>Применять репелленты, содержащие ДЭТА или перметрин. </p>\r\n<p>Следует надевать одежду с длинными рукавами и штанинами без дыр и отверстий, штанины желательно заправлять в длинные носки, рубашку в брюки. Волосы следует прятать под головной убор. Чтобы клещей было легче заметить, предпочтительно надевать светлую одежду. </p>\r\n<p>Во время пребывания в лесу рекомендуется регулярно осматривать одежду и контролировать открытые участки кожи (шею, запястья рук). При соблюдении правил носки одежды, указанной пунктом выше, клещи, не снятые с одежды, неизбежно попадают на шею, где их легко обнаружить. </p>\r\n<p>По возвращении из леса производится осмотр одежды и тела. Поскольку некоторые участки тела недоступны самоосмотру, следует прибегнуть к посторонней помощи для осмотра спины и волосистой части головы. </p>\r\n<p>Поскольку личиночные формы клещей очень мелки, их можно не заметить на одежде. Во избежание их присасывания одежду рекомендуется простирать в горячей воде. </p>\r\n<p>При обнаружении присосавшегося клеща его следует немедленно удалить. Чем раньше клещ удален, тем меньше вероятность заражения. Удалять клеща можно маникюрным пинцетом или нитью, обвязав её вокруг головы паразита. Клещ удаляется раскачивающе-выкручивающими движениями. Избегайте раздавливания клеща! Ранку можно обработать любым дезинфицирующим раствором (хлоргексидин, раствор йода, спирт, и т. п.). </p>",
"clinical_picture": "<p>Выделяют пять клинических форм клещевого энцефалита: </p>\r\n<ol>\r\n<li>лихорадочную (стертую); </li>\r\n<li>менингеальную; </li>\r\n<li>менингоэнцефалитическую; </li>\r\n<li>полиомиелитическую; </li>\r\n<li>полирадикулоневритическую. </li>\r\n</ol>\r\n<p>Лихорадочная форма клещевого энцефалита характеризуется благоприятным течением с быстрым выздоровлением. Продолжительность лихорадки - 3-5 дней. Основными клиническими признаками ее являются токсико-инфекционные проявления: головная боль, слабость, тошнота - при слабо выраженной неврологической симптоматике. Показатели ликвора без отклонений от нормы. </p>\r\n<p>Менингеальная форма является наиболее частой формой клещевого энцефалита. Больные жалуются на сильную головную боль, усиливающуюся при малейшем движении головы, головокружение, тошноту, однократную или, многократную рвоту, боли в глазах, светобоязнь. Они вялы и заторможены. Определяется ригидность мышц затылка, симптомы Кернига и Брудзинского. Менингеальные симптомы держатся на протяжении всего лихорадочного периода. Иногда они определяются и при нормальной температуре. Продолжительность лихорадки в среднем 7-14 дней. В спиномозговой жидкости изменения, характерные для вирусного мнгингита. </p>\r\n<p>Менингоэнцефалитическая форма клещевого энцефалита отличается более тяжелым течением. Нередко наблюдаются бред, галлюцинации, психомоторное возбуждение с утратой ориентировки в месте и во времени. Могут развиваться эпилептические припадки. </p>\r\n<p>При диффузном менингоэнцефалите выражены общемозговые нарушения (глубокие расстройства сознания, эпиприпадки вплоть до эпилептического статуса) и рассеянные очаги органического поражения мозга в виде псевдобульбарных расстройств (нарушение дыхания в виде урежения или учащения частоты, появление патологического дыхания), неравномерности глубоких рефлексов, асимметричных патологических рефлексов, центральных парезов мимической мускулатуры и мышц языка. </p>\r\n<p>При очаговом менингоэнцефалите быстро развиваются парезы, эпилептические припадки, реже - подкорковые и мозжечковые синдромы. В редких случаях может развиваться синдром желудочного кровотечения с кровавой рвотой. Характерны очаговые поражения черепных нервов. </p>\r\n<p>Полиомиелитическая форма клещевого энцефалита наблюдается почти у трети больных. Характеризуется продромальным периодом (1-2 дня), в течение которого отмечаются общая слабость и повышенная утомляемость. Затем выявляются периодически возникающие подергивания мышц. Внезапно может развиться слабость в какой-либо конечности или появление чувства онемения в ней (в дальнейшем в этих конечностях нередко развиваются выраженные двигательные нарушения). В последующем на фоне фебрильной лихорадки и общемозговых симптомов развиваются вялые парезы шейно-плечевой (шейно-грудной) локализации, которые могут нарастать в течение нескольких дней, а иногда до 2 нед. Наблюдаются следующие симптомы: \"свисающая на грудь голова\", \"горделивая осанка\", \"согбенная сутуловатая поза\". вялые парезы рук и спастические - ног, комбинации амиотрофий и гиперфлексии в пределах одной паретической конечности. В первые дни болезни у больных этой формой клещевого энцефалита часто резко выражен болевой синдром. Наиболее характерная локализация болей в области мышц шеи, особенно по задней поверхности, в области надплечий и рук. В конце 2-3-й недели болезни развивается атрофия пораженных мышц. </p>\r\n<p>Полирадикулоневритическая форма клещевого энцефалита характеризуется поражением периферических нервов и корешков. У больных появляются боли по ходу нервных стволов, парестезии (чувство \"ползания мурашек\", покалывание). Появляются расстройства чувствительности в дистальных отделах конечностей. Могут возникнуть вялые параличи, которые начинаются с ног и распространяются на мускулатуру туловища и рук. Восхождение может начинаться и с мышц плечевого пояса, захватывать шейные мышцы. </p>",
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},
"code": "A90",
"name": "Лихорадка денге [классическая лихорадка денге]",
"icd_name": "Лихорадка денге [классическая лихорадка денге]",
"gender": 0,
"age_min": 1,
"age_max": 84,
"cause": [
2,
6
],
"periodicity": 1,
"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>",
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