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"lead": "Нарушение здоровья, относящееся к группе протозойные болезни",
"description": "Малярия - группа трансмиссивных инфекционных заболеваний, передаваемых человеку при укусах самками комаров рода Anopheles («малярийных комаров») и сопровождающихся лихорадкой, ознобами, спленомегалией (увеличением размеров селезёнки), гепатомегалией (увеличением размеров печени), анемией. Характеризуется хроническим рецидивирующим течением. Вызывается паразитическими протистами рода Plasmodium . ",
"etiology": "<p>Возбудители малярии — простейшие рода Plasmodium falciparum . Передаётся самками комаров из рода Anopheles. Малярия, которая вызывается этим видом, иногда называется молниеносной или тропической и является самой опасной формой болезнис самым высоким уровнем смертности. </p>",
"pathogenesis": "<p>Человек заражается ими в момент инокуляции (впрыскивания) самкой малярийного комара одной из стадий жизненного цикла возбудителя (так называемых спорозоитов) в кровь или лимфатическую систему, которое происходит при кровососании. </p>\r\n<p>После кратковременного пребывания в крови спорозоиты малярийного плазмодия проникают в гепатоциты печени, давая тем самым начало доклинической печёночной (экзоэритроцитарной) стадии заболевания. В процессе бесполого размножения, называемого шизогонией, из одного бывшего спорозоита, который в клетке печени превращается в шизонта, в итоге образуется от 2000 до 40 000 печёночных мерозоитов. В большинстве случаев эти дочерние мерозоиты через 1—6 недель снова попадают в кровь. </p>\r\n<p>При инфекциях, вызываемых P.falciparum печёночная стадия развития паразитов на этом и заканчивается. </p>",
"diagnostics": "<p>Диагноз устанавливается на основе выявления паразитов в мазках крови. Традиционно используют два типа мазков — тонкий и толстый (или так называемую «толстую каплю»). Тонкий мазок позволяет с большей надёжностью определить разновидность малярийного плазмодия, поскольку внешний вид паразита (форма его клеток) при данном типе исследования лучше сохраняется. Толстый мазок позволяет микроскописту просмотреть больший объём крови, поэтому этот метод чувствительнее, но внешний вид плазмодия при этом изменяется, что не позволяет легко различать разновидности плазмодия. Поставить диагноз на основе микроскопического исследования зачастую бывает затруднительно, так как незрелые трофозоиты разных видов малярийного плазмодия плохо различимы, и обычно необходимо несколько плазмодиев, находящихся на разных стадиях созревания, для надёжной дифференциальной диагностики. </p>\r\n<p>В настоящее время используются также быстрые диагностические тесты с использованием иммунохимических наборов и ПЦР диагностика (определения генома паразита в крови). </p>",
"treatment": "<p>Режим: </p>\r\n<ul>\r\n<li>полупостельный (малярия без осложнений);</li>\r\n<li>постельный (при развитии осложнений).</li>\r\n</ul>\r\n<p> Диета (легкоусвояемая); </p>\r\n<ul>\r\n<li>диета №5</li>\r\n<li>диета №7 (при развитии нефротического синдрома).</li>\r\n</ul>\r\n<p>Обильное питье до 2,5-3,0 л жидкости. </p>\r\n<p>Медикаментозное лечение </p>\r\n<p>Лечение проводится препаратом хлорохином. Лечение хлорохином не гарантирует полного, радикального излечения трехдневной малярии, так как гематошизотропные препараты не действуют на гипнозоиты в печени, поэтому курс купирующего лечения должен дополняться назначением радикального лечения гистошизотропным препаратом Примахин. </p>\r\n<p>Лечение неосложненной тропической малярии, устойчивой к хлорохину проводится хинином. При устойчивости к хинину применяют артемизинин (экстракт полыни) и его производные. </p>\r\n<p>Лечение осложненной тропической малярии (церебральная малярия, малярийный алгид) проводят в отделении интенсивной терапии. </p>",
"prevention": "<p>Методы, которые используются для предотвращения распространения болезни или для защиты в областях, эндемичных для малярии, включают профилактические лекарственные средства, уничтожение комаров и средства для предотвращения укусов комаров. </p>\r\n<p>Современные лекарственные средства для профилактики включают мефлохин (Лариам), доксициклин и атовакуон-прогуанил гидрохлорид. </p>",
"clinical_picture": "<p>Инкубационный период около 10 дней с колебаниями от 8 до 16 дней. Тропическая малярия у неиммунных лиц характеризуется наибольшей тяжестью и нередко приобретает злокачественное течение. Без дачи противомалярийных препаратов летальный исход может наступить в первые дни болезни. </p>\r\n<p>У части лиц, впервые заболевших малярией, отмечаются продромальные явления - общее недомогание, повышенная потливость, снижение аппетита, подташнивание, послабление стула, двух-трехдневное повышение температуры тела до 38°С.</p>\r\n<p>У большинства неиммунных лиц начало болезни внезапное и характеризуется умеренно выраженным ознобом, высокой лихорадкой, возбуждением больных, выраженной головной болью, ломотой в мышцах, суставах. В первые 3-8 дней лихорадка постоянного типа, затем принимает устойчивый перемежающийся характер. В разгаре заболевания приступы лихорадки имеют некоторые особенности. Строгой периодичности начала приступов лихорадки нет. Они могут начинаться в любое время суток, но чаще возникают в первой половине дня. Снижение температуры тела не сопровождается резким потоотделением. Лихорадочные приступы длятся более суток (около 30 ч), периоды отсутствия лихорадки короткие (менее суток). </p>\r\n<p>В периоды озноба и жара кожа сухая. Характерны тахикардия и значительное снижение артериального давления. Частота дыханий нарастает, появляются сухой кашель, сухие и влажные хрипы, указывающие на развитие бронхита или бронхопневмонии. Часто развиваются диспепсические явления: анорексия, тошнота, рвота, разлитые боли в эпигастрии, энтерит, энтероколит. </p>\r\n<p>Селезенка увеличивается с первых дней заболевания, что проявляется болезненностью в левом подреберье, усиливающейся при глубоком вдохе. К 8-10-му дню болезни она легко прощупывается, край ее плотный, гладкий, болезненный. </p>\r\n<p>Часто развивается токсический гепатит, однако функции печени нарушаются незначительно, у 1/4 больных наблюдается поражение почек. </p>\r\n<p>С первых дней болезни выявляется гемолитическая анемия (повышенное разрушение эритроцитов). </p>\r\n<full></full>\r\n<p>Малярийная кома. Различают три периода малярийной комы. </p>\r\n<p>Первый период — сомноленции—характеризуется состоянием оглушенности, сонливостью. Контакт с больным затруднен, однако он может отвечать на вопросы. Сухожильные рефлексы нормальны или повышены. </p>\r\n<p>Второй период — сопора, спячки. Сознание возвращается к больному только временами. Сухожильные рефлексы повышены, выражены патологические рефлексы, нередко судорожные подергивания, спастическое состояние нижних конечностей. </p>\r\n<p>В третьем периоде— при полной коме —сознание отсутствует, сухожильные рефлексы высокие, патологические — резко выражены. Зрачки расширены, корнеальный рефлекс отсутствует. При глубокой коме рефлексы отсутствуют. </p>\r\n<p>Коматозное состояние чаще возникает при свежей малярия. В коматозном состоянии больной может находиться несколько часов. Иногда вместе со снижением температуры состояние больного может улучшиться, сознание вернуться. Однако обратное развитие наступает очень редко и только после неполной комы. </p>\r\n<p>Малярийный алгид. </p>\r\n<p>Алгидное состояние развивается также только при тропической малярии. В отличие от коматозной малярии сознание у больного сохранено. Больной находится в состоянии тяжелого коллапса, безучастен, черты лица заострены. Кожа бледна, холодна на ощупь, покрыта липким потом. Вместе с тем температура в подмышечной впадине и ректальная может быть повышена. Сухожильные рефлексы понижены, иногда отсутствуют. В крови обнаруживают все формы P. falciparum в большом количестве. Прогноз при алгидной форме тропической малярии очень тяжел. Нередко даже активное противомалярийное лечение и применение сердечно-сосудистых средств не могут вывести больного из состояния коллапса. </p>\r\n<p>Церебральная форма обычно развивается на фоне интенсивной паразитемии с инвазией значительной доли эритроцитов. Часто находят эритроциты, одновременно пораженные 2—3 паразитами и более. Характерна высокая лихорадка. Поражение центральной нервной системы проявляется сначала возбуждением, затем состоянием оглушенности, после чего больной может впасть в коматозное состояние. Могут возникать также менингиты, менингоэнцефалиты, эпилептиформные припадки, малярийные психозы и др. </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 62,
"published": 2,
"parent": null,
"block_rubric": 16,
"standards": []
}
]
}
