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"code": "A77",
"name": "Пятнистая лихорадка",
"icd_name": "Пятнистая лихорадка [клещевые риккетсиозы]",
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"age_min": 10,
"age_max": 70,
"cause": [
2,
6
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"periodicity": 1,
"slug": "a77_pyatnistaya_lihoradka",
"lead": "Пятнистая лихорадка передается при укусе насекомых (клещей), характеризуется доброкачественным течением, наличием первичного аффекта и распространённой макулопапулёзной сыпью.",
"description": "",
"etiology": "<p>Возбудитель — палочковидная грамотрицательная бактерия Rickettsia conorii. Облигатный внутриклеточный паразит; размножается в культуре тканей (в желточном мешке куриного эмбриона) и при заражении лабораторных животных (в клетках мезотелия). Патогенен для морских свинок, обезьян, кроликов, сусликов, белых мышей и белых крыс. По антигенным свойствам близок к другим возбудителям группы клещевых пятнистых лихорадок. Может паразитировать в цитоплазме и ядрах клеток хозяина. У больных возбудитель выявляют в крови в первые дни лихорадочного периода, в первичном аффекте и в розеолах кожи.</p>",
"pathogenesis": "<p>Возбудитель проникает через кожу или слизистые оболочки носа и конъюнктивы. На месте внедрения формируется первичный аффект («чёрное пятно»), выявляемый вскоре после укуса клещом (за 5–7 сут до возникновения симптомов заболевания). Через лимфатическую систему риккетсии сначала попадают в регионарные лимфатические узлы (вызывают лимфоаденит), а затем в кровь (поражают эндотелий капилляров и венул). При этом возникают изменения, схожие с выявляемыми при эпидемическом сыпном тифе, однако количество гранулём (узелков) меньше и некротические изменения выражены слабее.</p>",
"diagnostics": "<p>При диагностике данного заболевания учитывают эпидемиологические предпосылки (пребывание в эндемичной местности, сезон, контакт с собаками, укусы клещами и др.). В клинической картине наибольшее значение имеет триада симптомов:</p>\r\n<p>· первичный аффект («чёрное пятно»);<br />· регионарный лимфаденит;<br />· раннее появление обильной полиморфной сыпи по всему телу, включая ладони и подошвы.</p>\r\n<p>Учитывают умеренную выраженность общей интоксикации и отсутствие тифозного статуса.</p>\r\n<p>Лабораторное подтверждение диагноза основано на серологических реакциях: реакции связывания комплемента со специфическим антигеном (параллельно проводят реакцию и с другими риккетсиозными антигенами), РНГА.</p>\r\n<p> </p>",
"treatment": "<p>Как и при других риккетсиозах, наиболее эффективен тетрациклин.</p>\r\n<p>Патогенетическое лечение направлено на устранение интоксикации и геморрагических проявлений.</p>",
"prevention": "<p>Специфической профилактики не разработано.</p>\r\n<p>В эпидемических очагах проводят обработку возможных мест обитания клещей инсектицидами (например, собак, собачьих будок), отлов бродячих собак.</p>",
"clinical_picture": "<p>Инкубационный период относительно короткий (3–7 сут).</p>\r\n<p>Классификация</p>\r\n<p>Выделяют четыре периода:</p>\r\n<p>· инкубационный;<br />· начальный (до появления сыпи);<br />· разгара;<br />· выздоровления.</p>\r\n<p>Особенность лихорадки — наличие первичного аффекта, выявляемого у большинства пациентов до начала заболевания. Первичный аффект сначала представляет собой очаг воспаления кожи с покрытым тёмной корочкой участком некроза диаметром 2–3 мм в центре. Размеры первичного аффекта постепенно увеличиваются до 5–10 мм к началу лихорадочного периода. Корочка отпадает лишь на 5–7-е сут после установления нормальной температуры. Открывшаяся небольшая язвочка постепенно эпителизируется (в течение 8–12 сут), после чего остаётся пигментированное пятно. Локализация первичного аффекта разнообразна (обычно на участках кожи, закрытых одеждой); может быть 2–3 очага. На субъективные ощущения в области первичного аффекта больные не жалуются. Примерно у трети из них возникает регионарный лимфаденит с небольшим увеличением и болезненностью лимфатических узлов. Начало заболевания острое, с быстрым повышением температуры до 38–40 °С. постоянного типа (реже ремиттирующая) сохраняется в течение 3–10 сут и сопровождается ознобом, сильной головной болью, общей слабостью, выраженной миалгией, а также артралгией и бессонницей. Возможна \">Рвота</a>\">\">рвота</a></a>. При осмотре выявляют гиперемию и некоторую одутловатость лица, инъекцию сосудов склер и слизистых оболочек зева.</p>\r\n<p>Для разгара заболевания характерно появление экзантемы (на 2–4-е сутки его течения), выявляемой у всех больных. возникает сначала на груди и животе, затем распространяется на шею, лицо, конечности; почти у всех больных её обнаруживают на ладонях и подошвах. обильные (особенно на конечностях), состоят из пятен и папул, часть элементов подвергается геморрагическому превращению. У многих больных на месте папул возникают везикулы. На ногах наиболее обильна; её элементы ярче и крупнее, чем на других участках кожи.</p>\r\n<p> исчезают через 8–10 сут, оставляя после себя пигментацию кожи, сохраняющуюся иногда до 2–3 мес.</p>\r\n<p>Выявляют брадикардию, небольшое снижение АД. Существенной патологии органов дыхания не развивается. Живот мягкий или (у некоторых больных) умеренно вздут, при пальпации безболезненный. У 50% больных в лихорадочном периоде выявляют задержку стула и очень редко жидкий стул. У некоторых пациентов выражено и, реже, селезёнки. Снижается суточный диурез и возникает протеинурия (особенно в первую неделю). В период реконвалесценции улучшается общее состояние и угасают все симптомы.</p>",
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},
"code": "A78",
"name": "Лихорадка Ку",
"icd_name": "Лихорадка Ку",
"gender": 0,
"age_min": 10,
"age_max": 75,
"cause": [
2,
4,
5,
7
],
"periodicity": 1,
"slug": "a78_lihoradka_ku",
"lead": "Лихорадка Ку- острый природно-очаговый зоонозный риккетсиоз с разнообразными механизмами передачи возбудителя, характеризующийся развитием распространённого ретикулоэндотелиоза. ",
"description": "Заболеванию свойственны лихорадка, интоксикация, полиморфная симптоматика, поражение органов дыхания, в отдельных случаях — склонность к затяжному и хроническому течению.",
"etiology": "<p>Возбудитель (Coxiella burnetii) — мелкий полиморфный грамотрицательный неподвижный микроорганизм размером 200–500 нм, способный к образованию L-формы.</p>",
"pathogenesis": "<p>Патогенез ку-лихорадки описан в виде ряда последовательных фаз:<br />· внедрение риккетсий без реакции в месте входных ворот;<br />· лимфогенная и гематогенная диссеминация риккетсий (первичная или «малая» риккетсиемия) с внедрением их в макрофаги и гистиоциты;<br />· размножение риккетсий в макрофагах и гистиоцитах, выход большого количества возбудителей в кровь (повторная или «большая» риккетсиемия);<br />· токсемия с формированием вторичных очагов инфекции во внутренних органах;<br />· аллергическая перестройка и формирование напряжённого (с элиминацией возбудителя и выздоровлением) или ненапряжённого (с повторной риккетсиемией и развитием затяжных и хронических форм процесса) иммунитета.</p>",
"diagnostics": "<p>В связи с полиморфизмом симптомов клиническая диагностика ку-лихорадки чрезвычайно затруднительна и возможна только в эндемичных очагах при наличии эпидемической заболеваемости.</p>\r\n<p> </p>",
"treatment": "<p>Лечение ку-лихорадки включает этиотропную, патогенетическую и симптоматическую терапию. Для этиотропного лечения применяют антибиотики тетрациклиновой группы и левомицетины. </p>",
"prevention": "<p>Больных ку-лихорадкой или лиц с подозрением на это заболевание госпитализируют в палаты-боксы инфекционного отделения. В очаге осуществляют текущую и заключительную дезинфекцию хлорсодержащими растворами. Лицам из очага инфекции проводят экстренную антибиотикопрофилактику.</p>\r\n<p>Проводят комплекс ветеринарных, противоэпидемических и санитарно-гигиенических мероприятий: противоклещевую обработку пастбищ, охрану животноводческих хозяйств от заноса в них возбудителей и др. Молоко из неблагополучных хозяйств можно употреблять только в кипячёном виде (пастеризации недостаточно).</p>\r\n<p>Лицам из группы риска (животноводы, рабочие мясокомбинатов, ветеринары, зоотехники, рабочие по обработке животноводческого сырья) проводят активную специфическую профилактику вакциной ку-лихорадки М-44 живой сухой накожной. Её вводят методом скарификации в дозе 0,05 мл однократно. Ревакцинация — через один год. Возможна общая и местная реакция на введение вакцины.</p>",
"clinical_picture": "<p>В отличие от других риккетсиозов ку-<a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a> характеризуется выраженным полиморфизмом симптомов, что зависит от механизма передачи возбудителя, инфицирующей дозы риккетсий и состояния макроорганизма. Наиболее тяжёлые формы болезни возникают при аэрогенном заражении, тем не менее это цикличная инфекция, в течении которой различают следующие периоды: инкубационный, начальный (3–5 дней), разгара (4–8 дней) и реконвалесценции.</p>\r\n<p>Выделяют следующие формы болезни:<br />· острую (длительность заболевания 2–4 нед) — у 75–80% больных;<br />· подострую или затяжную (1–3 мес) — у 15–20% больных;<br />· хроническую (от нескольких месяцев до одного года и более) — у 2–30% больных;<br />· стёртую.</p>\r\n<p>Острые, подострые и хронические формы подразделяют на лёгкие, среднетяжёлые, тяжёлые и очень тяжёлые. Критерии степени тяжести — уровень лихорадки, выраженность интоксикации и органной патологии.</p>\r\n<p>Инкубационный период при ку-лихорадке 3–30 сут (в среднем 12–19 сут).</p>\r\n<p>В 95% случаев начало заболевания острое: <a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>, быстрое <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">повышение температуры</a> до 39–40 °С и общетоксический синдром. Возникает сильная, упорная, не снимающаяся анальгетиками диффузная, реже — локализованная (лоб, затылок) <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>. Возможны <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>, <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома потливость\">потливость</a> (вплоть до профузного пота), разбитость, артралгия, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">миалгия</a>, болезненность при пальпации мышц. С первых дней болезни у большей части больных наблюдают гиперемию лица и шеи, инъекцию сосудов склер, гиперемию зева.</p>\r\n<p>Очень характерна <a href=\"/symptom/kolika/\" title=\"Перейти на страницу симптома Колика\">резкая боль</a> в глазницах и глазных яблоках, усиливающаяся при их движении. У некоторых больных возникают сухой <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>, носовые кровотечения, ухудшается аппетит.</p>\r\n<p>Основной и наиболее постоянный симптом — <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a>, продолжительность которой варьирует от нескольких дней до месяца и более (в среднем 7–10 дней).</p>\r\n<p>Для ку-лихорадки характерно поражение органов дыхания. Могут возникать трахеиты, бронхиты, пневмонии. Частота пневмоний, по данным разных авторов, варьирует от 5 до 70% и зависит от путей инфицирования. Они развиваются преимущественно при аэрогенном заражении; единичные случаи пневмонии могут быть обусловлены вторичной бактериальной инфекцией. Больные жалуются на <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a> (сухой, затем — продуктивный, с вязкой серозно-гнойной мокротой), чувство дискомфорта и саднения за грудиной; иногда возникает <a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">одышка</a>.</p>\r\n<p>Со стороны органов пищеварения отмечают ухудшение аппетита, при выраженной интоксикации — тошноту и рвоту; возможен <a href=\"/symptom/zapor/\" title=\"Перейти на страницу симптома Запор\">запор</a>. Некоторые больные предъявляют жалобы на <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">метеоризм</a> и <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боли в животе</a> (вследствие поражения вегетативной нервной системы), иногда сильные, различной локализации. Язык увеличен в объёме, обложен грязно-серым налётом (края и кончик чистые), с отпечатками зубов по краям (схожие изменения отмечают при брюшном тифе). Очень характерна умеренная гепато- и <a href=\"/symptom/uvelichenie_slezenki/\" title=\"Перейти на страницу симптома Увеличение слезенки\">спленомегалия</a>.</p>\r\n<p>В периоде разгара ку-лихорадки нередко усиливаются симптомы поражения ЦНС, обусловленные интоксикацией. Отчётливо манифестируют вегетативные расстройства. Возможны <a href=\"/symptom/skovannost_shei/\" title=\"Перейти на страницу симптома <a href=\"/symptom/skovannost_dvizheniya/\" title=\"Перейти на страницу симптома Скованность движения\">Скованность</a> шеи\">менингизм</a>, серозный менингит, менингоэнцефалит, неврит, полиневрит, инфекционный <a href=\"/symptom/psihoz/\" title=\"Перейти на страницу симптома Психоз\">психоз</a> с бредом и галлюцинациями. В периоде реконвалесценции обычно сохраняется выраженный психоастенический синдром.</p>\r\n<p>Период реконвалесценции начинается с нормализации температуры, но уже за несколько дней до этого больные отмечают улучшение самочувствия, сна и аппетита. У 3–7% больных регистрируют рецидивы болезни через 4–15 дней после основной волны.</p>",
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"code": "A80",
"name": "Острый полиомиелит",
"icd_name": "Острый полиомиелит",
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"slug": "a80_ostryy_poliomielit",
"lead": "Нарушение здоровья, относящееся к группе вирусные инфекции центральной нервной системы",
"description": "Полиомиелит - острое вирусное заболевание, характеризующееся поражением нервной системы (преимущественно серого вещества спинного мозга), а также воспалительными изменениями слизистой оболочки кишечника и носоглотки. ",
"etiology": "<p>Возбудитель относится к семейству пикорнавирусов, к группе энтеровирусов (кишечным вирусам), куда входят также Коксаки- и ЕСНО-вирусы и существует в виде 3 независимых типов (I, II и III). Наиболее часто встречается 1 тип. </p>\r\n<p>Вирус устойчив во внешней среде (в воде сохраняется до 100 суток, в испражнениях — до 6 мес), хорошо переносит замораживание. Не разрушается пищеварительными соками. Разрушается при нагревании до 50 градусов Цельсия в течение 30 минут. Быстро погибает при кипячении, под действием ультрафиолетового облучения и при высушивании. Даже незначительные концентрации хлора инактивируют вирус. Источник инфекции — человек (больной или переносящий заражение бессимптомно); возбудитель выделяется через рот (несколько суток), а затем с испражнениями (несколько недель, а иногда и месяцев). Заражение может произойти воздушно-капельным путём, но чаще — при попадании в рот активного вируса (через загрязнённые руки, пищу). Механическим переносчиком вируса могут быть мухи. </p>\r\n<p>Заболеваемость полиомиелитом преобладает в летне-осенние месяцы. Чаще болеют дети от 6 месяцев до 5 лет. Большинство заболеваний связано с вирусом типа I. </p>",
"pathogenesis": "<p>Кишечная фаза </p>\r\n<p>Входными воротами для инфекции является слизистая оболочка носоглотки и тонкой кишки, в эпителии и лимфатических образованиях которых происходит первичная репродукция вируса. Затем вирус проникает в ток крови и обусловливает вирусемию. </p>\r\n<p>Фаза вирусемии </p>\r\n<p>Эта фаза характеризуется проникновением вируса во многие органы и ткани, такие как лимфатические узлы, селезенка, печень, легкие, сердечная мышца, жировая ткань, особенно бурый жир. </p>\r\n<p>Невральная фаза </p>\r\n<p>Следующим этапом развития патогенеза полиомиелита является проникновение вируса в различные органы, в частности в ЦНС. В ЦНС в патологический процесс чаще всего вовлекаются мотонейроны передних рогов спинного мозга, двигательные клетки черепных нервов. В тяжелых случаях могут поражаться нейроны задних рогов, клетки спинальных ганглиев и даже проксимальные отделы периферических нервов. В головном мозге повреждаются ретикулярная формация, вестибулярные ядра, глубинные структуры. </p>\r\n<p>Вирус действует на эндотелий сосудов, повышая их проницаемость. В результате чего происходит сдавление, отек здоровых участков нервной ткани, возникает клеточная инфильтрация, тигролиз - все это является морфологическим субстратом полиомиелита. Распространение вируса в организме человека может закончиться на любом этапе, что и определяет развитие той или иной формы полиомиелита. </p>",
"diagnostics": "<p>Лабораторные исследования: пробы крови для серологических исследований, общий анализ крови и мочи. </p>\r\n<p>Инструментальные исследования: </p>\r\n<ul>\r\n<li>Электромиография. При помощи ЭМГ регистрируются биоэлектрические потенциалы, возникающие на нервно-мышечной периферии. Поражение двигательных клеток в передних рогах спинного мозга выражается, прежде всего, четкими изменениями ритма. Это обусловлено тем, что пораженные мотонейроны возбуждаются одновременно (синхронно), что приводит с урежению колебаний потенциалов. Существует отчетливая связь между тяжестью поражения мышц и изменениями электромиограммы. ЭМГ тяжело пораженных мышц характеризуется «биоэлектрическим молчанием». </li>\r\n<li>Рентгенография конечностей для исключения вывихов, подвывихов, остеопороза.. </li>\r\n<li>Магниторезонансная томография спинного мозга - признаки атрофического процесса в передних рогах спинного мозга. </li>\r\n</ul>",
"treatment": "<p>Немедикаментозное лечение </p>\r\n<ul>\r\n<li>Лечебная физкультура занимает одно из ведущих мест в лечении больных с паралитическими формами полиомиелита. К ней необходимо приступить в раннем восстановительном периоде, то есть сразу после появления первых признаков движений в пораженных мышцах. Основная задача лечебных упражнений в раннем восстановительном периоде - тренировка основных параметров двигательной системы, которая заключается в постепенном и дозированном увеличении силы мышечного сокращения, амплитуды. На этом этапе лечения больному необходима помощь в овладении простыми движениями, а затем элементами утраченного сложного двигательного навыка. У больных с глубокими парезами при мышечной силе в пределах 1-0 балла, помимо лечения положением, применяют пассивные и пассивно-активные упражнения с переходом к активным упражнениям. </li>\r\n<li>Стимулирующий массаж пораженных конечностей, мышц спины. </li>\r\n<li>Физиолечение - магнитотерапия, биоптрон, УВЧ на пораженные сегменты спинного мозга, электростимуляция паретичных мышц импульсным током, озокеритовые или парафиновые аппликации на область паретичных мышц, суставы; электрофорез галантамина, прозерина по Вермелю. </li>\r\n<li>Иглорефлексотерапия. </li>\r\n<li>Ортопедическая профилактика паретичных конечностей с использованием шин, лонгет, валиков, мешков с песком, разработка контрактур. </li>\r\n</ul>\r\n<p> Медикаментозное лечение </p>\r\n<ul>\r\n<li>Стимулирующая терапия: антихолинэстеразные препараты - прозерин, галантамин. </li>\r\n<li>Витаминотерапия: аскорбиновая кислота, витамины группы В - В1, В6, В12. </li>\r\n<li>Последние годы в лечении полиомиелита используются анаболические стероиды (нерабол, ретаболил, метандростеналон). </li>\r\n<li>Лечение препаратами, действующими на сосудистую систему, улучшающими реологические свойства крови и микроциркуляцию, проводится в виде последовательных курсов, каждый из них длительностью 2-3 недели. </li>\r\n<li>Спазмолитическим, сосудорасширяющим, стимулирующим влиянием на спинной мозг обладает дибазол. Лечение продолжается в течение 3-4 недель, показаны повторные курсы лечения. </li>\r\n<li>Препараты, улучшающие метаболизм (ноотропы). </li>\r\n<li>Метаболические средства - фолиевая кислота, аевит, оротат калия. </li>\r\n</ul>",
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"clinical_picture": "<p>Инкубационный период при различных формах полиомиелита в среднем составляет 8–12 дней. </p>\r\n<p>Инаппарантная форма полиомиелита представляет собой носительство вируса, которое никак не проявляется клинически и может быть обнаружено только лабораторным путем. </p>\r\n<p>Абортивная (висцеральная) форма полиомиелита составляет более 80% всех случаев болезни. Клинические проявления неспецифичны; среди них преобладают общеинфекционные симптомы – лихорадка, интоксикация, головная боль, умеренные катаральные явления, боли в животе, диарея. Болезнь заканчивается через 3-7 дней полным выздоровлением; остаточных неврологических симптомов не отмечается. </p>\r\n<p>Менингеальная форма полиомиелита протекает по типу доброкачественного серозного менингита. При этом отмечается двухволновая лихорадка, головные боли, умеренно выраженные менингеальные симптомы (Брудзинского, Кернига, ригидность затылочных мышц). Через 3-4 недели наступает выздоровление. </p>\r\n<p>Паралитическая форма полиомиелита имеет наиболее тяжелое течение и исходы. В препаралитическом периоде преобладает общеинфекционная симптоматика: повышение температуры, диспепсия, ринит, фарингит, трахеит и др. Вторая волна лихорадки сопровождается менингеальными явлениями, болью в мышцах, болями в позвоночнике и конечностях, выраженной болевой чувствительностью, потливостью, спутанностью сознания и судорогами. </p>\r\n<p>Примерно на 3-6 день заболевание вступает в паралитическую фазу, характеризующуюся внезапным развитием парезов и параличей чаще нижних конечностей при сохранной чувствительности. Для параличей при полиомиелите характерны асимметричность, неравномерность, преимущественное поражение проксимальных отделов конечностей. Несколько реже при полиомиелите развиваются парезы и параличи верхних конечностей, лица, мышц туловища. Через 10-14 дней наблюдаются первые признаки мышечной атрофии. Поражение жизненно важных центров продолговатого мозга может вызвать паралич дыхательных мышц и диафрагмы и послужить причиной гибели ребенка от острой дыхательной недостаточности. </p>\r\n<p>В восстановительном периоде полиомиелита, который длится до 1 года, происходит постепенная активизация сухожильных рефлексов, восстанавливаются движения в отдельных мышечных группах. Мозаичность поражения и неравномерность восстановления обусловливает развитие атрофии и мышечных контрактур, отставание пораженной конечности в росте, формирование остеопороза и атрофии костной ткани. </p>\r\n<p>В резидуальном периоде отмечаются остаточные явления полиомиелита – стойкие вялые параличи, контрактуры, паралитическая косолапость, укорочение и деформации конечностей, вальгусная деформация стоп, кифосколиозы и пр. </p>",
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