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"pathogenesis": "<p>Стафилококк созержит токсин эксфолиатин, вызывает отслойку эпидермиса непосредственно под зернистым слоем.</p>",
"diagnostics": "<p>-Лабораторные исследования крови и мочи, для опредения интенсивности воспалительного процесса и состояния организма</p><p> - Цитологическое исследования содержимого пузыря (при наличии пузырей)</p><p> - гистологическое исследование кожи</p>",
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Заражение происходит через кожные покровы и слизистые.</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;\">Повышают риск развития заболевания:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">микротравмы (ссадины, царапины, укусы и др.);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">несвоевременная обработка ран;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">мацерация кожи;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">несоблюдение правил личной гигиены;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">тактильный контакт с носителем инфекции;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общие предметы быта;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">анемия;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сниженный иммунитет;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">высокая влажность климата;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сахарный диабет, атеросклероз.</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\"><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;\">Группы риска развития импетиго:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">климатические условия: повышенная влажность и температура воздуха;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">снижение защитного барьера организма, в том числе при беременности, при наличии сопутствующих соматических патологий;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">наличие кожных заболеваний, сопровождающихся зудом (ветрянка, экзема, педикулез и др.);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">нарушенный обмен веществ;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">нарушение целостности кожных покровов (ссадины, царапины, порезы, микротрещины, эрозии);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">люди с повышенным потоотделением.</span></li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">На коже постоянно находится большое количество стафилококков и стрептококков. Это - представители так называемой транзиторной флоры, способные заражать кожу, даже не размножаясь на её поверхности. Латентность их существования обусловлена защитной функцией кожи. При нарушении целостности кожных покровов в результате травмы, мацерации (разбухания дермы при длительном контакте с жидкостью), дисфункции потовых и сальных желёз, изменения нормальной кислотности кожи открываются входные ворота для проникновения инфекции. Усугубляется этот момент нарушением правил личной гигиены, снижением иммунитета.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Затем в дерме развивается воспаление, направленное на уничтожение инфекционного антигена с восстановлением дефекта кожи. Воспаление начинается на участке соединительной ткани – гистионе, состоит из фаз альтерации, экссудации, пролиферации. Альтерация - выброс в кожу из повреждённых клеток медиаторов воспаления. Медиаторы включают фагоцитоз, увеличивают проницаемость стенки сосудов, начинают за счёт бактерицидных свойств обеззараживать участок воспаления. Кроме того, они вызывают вторичную альтерацию (гистолиз), подключают к воспалению иммунные механизмы, регулируют пролиферацию за счёт работы макрофагов. Причём весь этот процесс действует по принципу обратной связи. Фаза экссудации наступает почти мгновенно вслед за альтерацией, включает в себя ряд процессов: изменяет вязкость крови, повышает проницаемость капилляров, вызывая миграцию составных частей крови в очаг воспаления с образованием экссудата, воспалительного клеточного инфильтрата. Пролиферация завершает процесс. В результате последовательного осуществления всех фаз воспаления кожа восстанавливается полностью или рубцуется (в зависимости от величины и глубины первоначального дефекта).</span></p>\r\n<p> </p>",
"diagnostics": "<div style=\"text-align: start;\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">Диагноз ставит дерматолог на основании анамнеза, клинических проявлений. При наличии сомнений в диагнозе проводят дерматоскопию. Дополнительно применяют специфические методы исследования: окрашивание мазков экссудата по Граму (видны кокки под микроскопом), посев отделяемого булл на флору и антибиотикограмму.</span></p>\r\n</div>",
"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;\">Лечение неосложнённых форм импетиго проводят в амбулаторных условиях. Терапия преследует две цели: устранить причину патологии и улучшить общее самочувствие пациента. Обычно для купирования процесса достаточно наружных средств: очаг поражения обрабатывают 2% камфорным спиртом, пузыри после вскрытия – фукорцином, мазями с антибиотиком. Фоново назначают витаминотерапию, иммуностимуляторы, натрия дезоксирибонуклеат. Запрещаются все водные процедуры. Курс лечения - 10 дней. Если заболевание продолжает распространяться, подключают антибиотики по индивидуальным схемам: внутрь или в/м в инъекциях. Назначается диета с отсутствием сахаросодержащих продуктов, так как глюкоза является благоприятной питательной средой для распространения микробов. </span></p>\r\n<p><span id=\"docs-internal-guid-570d5c20-7fff-75ea-920d-673d17a07c7f\"> </span></p>",
"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;\">Для исключения повторного инфицирования важно знать и соблюдать основные меры профилактики. Загрязнения кожи – один из основных факторов, повышающих риск заражения. Поэтому соблюдение правил личной и трудовой гигиены – основное профилактическое мероприятие. Важно также укреплять иммунитет, вести активный образ жизни, правильно питаться, поддерживать баланс витаминов и минералов в организме. </span></p>",
"clinical_picture": "<p>Различают импетиго стафилококковое, стрептококковое и стрептостафилококковое. <br /> <br />Стрептококковое импетиго начинается с образования мало возвышающихся, склонных к периферическому росту фликтен - полостных элементов типа пузырей размером от 2 до 10 мм и более в диаметре. рассеяны или скучены группами, окружены узким ободком гиперемии. Содержимое фликтен сначала прозрачное, затем мутнеет и быстро ссыхается в светло-желтые корки, отпадающие через 5-7 дней, после чего остается депигментация. <br /> <br />К разновидностям стрептококкового импетиго относится простой лишай лица или сухая пиодермия - очаги мелкопластинчатого шелушения с незначительным покраснением кожи. <br /> <br />Другая разновидность стрептококкового импетиго - стрептококковые заеды, которые чаще встречаются у детей. Начинаются они с появления в углу рта пузыря с вялой тонкой покрышкой, на его месте быстро образуется щелевидная эрозия, после удаления которой, обнаруживается красная влажная легко кровоточащая поверхность с трещиной в центре. Спустя 1-2 часа заеда вновь покрывается коркой. Процесс может сопровождаться небольшой болезненностью при открывании рта. Процесс часто распространяется на слизистую оболочку полости рта. Иногда импетиго возникает изолированно во рту, где на месте быстро вскрывающихся фликтен образуются болезненные , покрывающиеся гнойным налетом. <br /> <br />Разновидностью пузырного импетиго является и поверхностный панариций, при котором фликтена возникает на ногтевом валике дугообразно вокруг ногтя на месте заусениц при травмах (например, во время маникюра), уколе иглой и т.д. При травмировании такая фликтена вскрывается и образуется мокнущая эрозия в большим количеством стрептококков в отделяемом. <br /> <br />Стафилококковое импетиго (фолликулит) <br />Фолликулит - это воспалительное поражение волосяного мешочка, вызванное стафилококками. Фолликулит может быть поверхностным или глубоким. Поверхностный фолликулит характеризуется образованием множественных небольших (1-2 мм, отдельные могут достигать 5 мм) гнойничков, пронизанных в центре волосом и окруженных узкой розовой каймой. На 3-4 день их содержимое подсыхает, появляются желтые , после отпадения которых, на коже не остается следов. <br /> <br />При глубоком фолликулите на коже образуются болезненные узелки красного цвета величиной 5 мм и больше в диаметре, иногда с гнойничком посредине. Через несколько дней узелок рассасывается или нагнаивается, а затем вскрывается. После заживления такого узелка часто остается рубчик. <br /> <br />Смешанное (стрептостафилококковое) импетиго <br />При сочетании стрептококковой и стафилококковой инфекции развивается смешанное (вульгарное) импетиго, при котором содержимое фликтен бывает гнойным, а корки - массивными. При снятии корок обнажается влажная эрозированная поверхность. <br />Располагается вульгарное импетиго обычно на лице и других открытых участках кожи. К заболеванию склонные дети, подростки и молодые женщины. Без лечения рядом с бывшими высыпаниями или на отдаленных участках кожи возникают новые фликтены, процесс нередко принимает распространенный характер. Имеет значение перенос инфекции на новые участки через руки и белье. <br /> <br />Осложнения импетиго <br />Чаще всего заболевание заканчивается без последствий, но могут быть и осложнения. Одними из самых неприятных осложнений являются осложнения на почки (нефриты) и на сердце (миокардиты). <br /> <br />Стафилококковое импетиго может осложниться распространенными гнойными процессами - абсцессами и флегмонами.</p>",
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"code": "A98",
"name": "Геморрагическая лихорадка",
"icd_name": "Другие вирусные геморрагические лихорадки, не классифицированные в других рубриках",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
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6,
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],
"periodicity": 1,
"slug": "a98_gemorragicheskaya_lihoradka",
"lead": "Термином \"геморрагическая лихорадка\" объединяется группа заболеваний вирусного происхождения со сходными проявлениями, при которых ведущая роль отводится поражению сосудов с развитием тромбозов или кровоточивости",
"description": "",
"etiology": "<p>Геморрагическую лихорадку могут вызывать пять основных видов вируса - тогавирусы, филовирусы, флавивирусы, аренавирусы, буньявирусы.</p>\r\n<p>Это группа инфекций, характеризующихся природной очаговостью, то есть распространением в местностях, где много диких животных, носителей вирусов и переносчиков из разряда клещей или комаров. Основные животные, которые могут быть источниками данных лихорадок это белки, летучие мыши, домашние грызуны и обезьяны.</p>\r\n<p>Для некоторых видов геморрагических лихорадок характерны и другие пути распространения. Выделяют воздушно-пылевой путь, парентеральный (через кровь и другие биологические жидкости), пищевой, водный, через контакты с зараженными животными.</p>\r\n<p>Чаще всего болеют люди, работа которых связана с животными, дикой природой и сельхозугодиями. Городские жители при заболевании в основном имеют контакты с грызунами. </p>\r\n<p> </p>",
"pathogenesis": "<p>В упрощенном виде механизмы повреждения при геморрагических лихорадках можно представить таким образом:</p>\r\n<ul>\r\n<li>повреждение сосудов вирусами или продуктами их метаболизма,</li>\r\n<li>нарушение целостности стенок сосудов, их , выделение в просвет биологически активных веществ,</li>\r\n<li>формирование из-за дефицита кровоточивости и развития так называемого ДВС-синдрома (массивного одновременного свертывания крови в одних сосудах и параллельного кровотечения из-за низкой свертываемости в других).</li>\r\n</ul>\r\n<p>В результате формируется гипоксия тканей (нехватка кислорода) и нарушения в работе сердца, легких, почек и головного мозга, происходит массивная потеря крови. При этом тяжесть болезни будет зависеть от вида лихорадки, степени активности иммунитета и особенностей организма человека. Зачастую геморрагические лихорадки протекают тяжело и заканчиваются высокой летальностью.</p>",
"diagnostics": "<p>Основа диагностики – это клиническая картина с указаниями на пребывание в неблагоприятном районе, укусы насекомых или контакт с животными. Но для подтверждения диагноза необходимо обнаружение вирусов в крови или антител к ним. Проводится:</p>\r\n<ul>\r\n<li>общий анализ крови,</li>\r\n<li>общий анализ мочи (особенно для лихорадок с почечным синдромом),</li>\r\n<li>биохимический анализ крови и мочи,</li>\r\n<li>серологические пробы,</li>\r\n<li>иммунохимические и ПЦР методы выделения вируса или антител к нему,</li>\r\n<li>при необходимости проводят выделение и исследование вирусов.</li>\r\n</ul>\r\n<p>Геморрагические лихорадки стоит различать с тяжелым капилляро-токсическим гриппом, риккетсиозами и менингококковой инфекцией – все они сопровождаются кровоточивостью и похожи по проявлениям. Кроме того, необходимо отличать эти инфекции от болезней крови с кровоточивостью (болезнь Шенляйна-Геноха или Верльгофа).</p>",
"treatment": "<p>Диагностикой и лечением занимаются врачи-инфекционисты, а иногда и реаниматологи.</p>\r\n<p>Все люди с подозрением на геморрагическую лихорадку подлежат госпитализации в боксированное отделение инфекционной больницы.</p>\r\n<p>В период острых проявлений показано парентеральное питание, в период выздоровления – легкая растительно-молочная диета с обогащением витаминами, особенно укрепляющими сосудистые стенки – витаминами РР, С или К.</p>\r\n<p>Кроме того, применяют внутривенные вливания растворов глюкозы, переливания крови, препараты железа, антигистаминные средства. При необходимости вводят тромбоцитарную массу, факторы свертывания.</p>\r\n<p>Постельный режим в изоляторе соблюдается до полного выздоровления. В дальнейшем пациент наблюдается еще достаточно длительно у инфекциониста и терапевта.</p>",
"prevention": "<p>К основным методам борьбы с геморрагическими лихорадками относят:</p>\r\n<ul>\r\n<li>уничтожение грызунов и насекомых-переносчиков,</li>\r\n<li>тщательная очистка участков жилых застроек от травы и кустарников, заболоченных мест,</li>\r\n<li>при работе в полях и лесах необходимо ношение защитной одежды, применение репеллентов,</li>\r\n<li>для профилактики некоторых видов геморрагических лихорадок разработаны вакцины – желтой лихорадки и омской геморрагической лихорадки.</li>\r\n</ul>",
"clinical_picture": "<p>Геморрагическая - это классическая инфекционная болезнь со стадийностью течения. Выделяют следующие стадии:</p>\r\n<ul>\r\n<li>инкубационную – она, в зависимости от вида вируса, может длиться от нескольких суток до трех недель,</li>\r\n<li>начальную стадию или период продрома, длящийся от суток до недели,</li>\r\n<li>период разгара болезни с проявлением всех типичных признаков геморрагической лихорадки и длящийся от одной до двух недель,</li>\r\n<li>период реконвалесценции или выздоровления (или в некоторых случаях - летальный исход).</li>\r\n</ul>\r\n<p>Выздоровление может длиться до нескольких месяцев, особенно в случае тяжелого течения и остаточных явлений.</p>\r\n<p>В начальном периоде симптомы геморрагической лихорадки обычно неспецифические. Обычно проявляются:</p>\r\n<ul>\r\n<li>симптомы общей интоксикации,</li>\r\n<li>высокая температура,</li>\r\n<li>расстройства сознания вплоть до бреда,</li>\r\n<li>точечные кровоизлияния на коже в зоне шеи и лица, склер и в области рта,</li>\r\n<li>нарушения ритма сердца с учащением или замедлением частоты,</li>\r\n<li>снижение давления,</li>\r\n<li>в анализах крови выявляется воспалительная реакция (лейкоцитоз, может быть со сдвигом) с незначительным снижением тромбоцитов.</li>\r\n</ul>\r\n<full></full>\r\n<p>В период разгара может быть:</p>\r\n<ul>\r\n<li>временное снижение температуры,</li>\r\n<li>общее улучшение состояния, после чего вновь наступает ухудшение,</li>\r\n<li>нарастает токсикоз,</li>\r\n<li>прогрессируют нарушения сознания,</li>\r\n<li>развиваются мелкие тромбозы и из мест инъекций, с поверхностей слизистых, пищеварительного и мочеполового тракта,</li>\r\n<li>нарушаются функции легких, почек, сердца.</li>\r\n</ul>\r\n<p>В периоде выздоровления постепенно все симптомы исчезают, работа органов восстанавливается.</p>",
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},
"code": "Q05",
"name": "Spina bifida [неполное закрытие позвоночного канала]",
"icd_name": "Spina bifida [неполное закрытие позвоночного канала]",
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"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "q05_spina_bifida_nepolnoe_zakrytie_pozvonochnogo_kanala",
"lead": "",
"description": "",
"etiology": "",
"pathogenesis": "",
"diagnostics": "",
"treatment": "",
"prevention": "",
"clinical_picture": "",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 1,
"parent": null,
"block_rubric": 176,
"standards": [
4937
]
}
]
}
