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"description": "Для этого заболевания характерны тяжёлое циклическое течение, развитие генерализованного васкулита, розеолёзно-петехиальной сыпи и преимущественное поражение нервной и сердечно-сосудистой системы.",
"etiology": "<p>Возбудитель сыпного тифа — риккетсия Провачека (R. prowazekii) — полиморфный грамотрицательный микроорганизм размером от 0,5 до 1 мкм, облигатный внутриклеточный паразит.</p>",
"pathogenesis": "<p>Проникая через кожные покровы, риккетсии размножаются в месте внедрения. При некоторых риккетсиозах возникает местная воспалительная реакция с формированием первичного аффекта. Затем происходит гематогенная диссеминация возбудителя, вследствие чего развивается генерализованный бородавчатый васкулит (<a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\"><a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> на коже</a>, поражение сердца, оболочек и вещества головного мозга с формированием инфекционно-токсического синдрома).</p>",
"diagnostics": "<p>Диагноз устанавливают на основании клинико-эпидемиологических данных и подтверждают лабораторными тестами. Существенное значение имеют наличие педикулёза, характерный вид больного, интенсивная <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a> в сочетании с бессонницей, появление сыпи на 5-й день болезни, поражение ЦНС, гепатолиенальный синдром.</p>\r\n<p>Выделение возбудителя, как правило, не проводят из-за сложности культивирования риккетсий, возможного только в специально оборудованных лабораториях с высокой степенью защиты.</p>\r\n<p>Основной метод диагностики (стандарт диагностики) серологический: РСК, РНГА, РА, РНИФ, ИФА.</p>",
"treatment": "<p>Всех больных с подозрением на сыпной тиф необходимо госпитализировать в инфекционную больницу (отделение). Им назначают строгий постельный режим до 5–6-го дня нормализации температуры тела. Затем больным разрешают садиться, а с 8-го дня они могут ходить по палате, сначала под наблюдением медицинской сестры, а затем самостоятельно. У пациентов необходимо постоянно контролировать АД.</p>\r\n<p>Специальную диету не назначают. Пища должна быть щадящей, довольно калорийной и содержащей витамины в суточной потребности.</p>\r\n<p>Большое значение имеют туалет ротовой полости (профилактика гнойного паротита и стоматита) и гигиена кожи (профилактика пролежней).</p>\r\n<p>В соответствии со стандартом лечения больным назначают в качестве препаратов первого ряда антибиотики группы тетрациклинов.</p>\r\n<p>Для уменьшения интоксикации больному дают обильное питьё и внутривенно вводят 5% раствор глюкозы, изотонический раствор натрия хлорида, поляризующую смесь и тому подобные препараты, форсируя диурез. Для борьбы с сердечно-сосудистой недостаточностью назначают сердечные гликозиды, вазопрессоры, а также оксигенотерапию. При возбуждении, делирии проводят седативную терапию.</p>",
"prevention": "<p>Профилактика сыпного тифа направлена на борьбу с педикулёзом (приложение № 4 к приказу Минздрава РФ от 26.11.98 № 342).</p>\r\n<p>Лиц с повышенным риском заражения вакцинируют вакциной Е (сыпнотифозной комбинированной живой сухой) в дозе 0,25 мл подкожно однократно с ревакцинацией через 1 год или вакциной сыпнотифозной химической сухой в дозе 0,5 мл подкожно однократно с ревакцинацией через 4 мес.</p>",
"clinical_picture": "<p> </p>\r\n<p>Инкубационный период длится от 5 до 25, чаще 10–14 дней.</p>\r\n<p>Сыпной тиф протекает циклически:<br />· начальный период — первые 4–5 дней (от повышения температуры до появления сыпи);<br />· период разгара — 4–8 дней (от появления сыпи до окончания лихорадочного состояния);<br />· период выздоровления — со дня нормализации температуры до исчезновения всех клинических симптомов.</p>\r\n<p>Продромальные явления обычно отсутствуют, иногда в конце инкубационного периода возникают слабая <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">ломота</a> в теле, познабливание. Болезнь начинается остро — с прогрессивно нарастающих симптомов интоксикации (<a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, мышечные боли, <a href=\"/symptom/suhoy_rot/\" title=\"Перейти на страницу симптома Сухой рот \">сухость во рту</a>, <a href=\"/symptom/zhazhda/\" title=\"Перейти на страницу симптома Жажда\">жажда</a>, <a href=\"/symptom/snizhenie_appetita/\" title=\"Перейти на страницу симптома Снижение аппетита\">потеря аппетита</a>, <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>). Через 2–4 дня постоянная диффузная <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a> становится нестерпимой, усиливаясь при перемене положения тела, разговоре, малейшем движении. Возможна повторная <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>.</p>\r\n<p>Температура тела достигает максимума (38,5–40,5 °С и выше) ко 2–3-му дню болезни. <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">Повышение температуры</a> имеет постоянный, реже ремиттирующий характер (с кратковременными «врезами» на 4-й, 8-й и 12-й день болезни).</p>\r\n<p>Больные страдают от своеобразной бессонницы: сначала засыпают, но часто просыпаются от устрашающих, неприятных сновидений. В этот период регистрируют мышечные и суставные боли, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">беспокойство</a>, эйфорию, возбуждение или <a href=\"/symptom/zatormozhennost/\" title=\"Перейти на страницу симптома Заторможенность\">заторможенность</a>.</p>\r\n<p>Характерен внешний вид больных: лицо гиперемированное, одутловатое, глаза красные («кроличьи») вследствие инъекции сосудов склер. Отмечают умеренный <a href=\"/symptom/cianoz/\" title=\"Перейти на страницу симптома Цианоз\">цианоз</a> губ, гиперемию кожи шеи и верхней части грудной клетки. Кожа сухая на ощупь, горячая.</p>\r\n<p>Язык суховат, не утолщён, обложен белым налётом. С 3-го дня болезни можно наблюдать появление пятен, симптом Киари–Авцына — точечные кровоизлияния в переходные складки конъюнктивы, энантему на мягком нёбе (симптом Розенберга), положительные симптомы щипка и жгута, которые предшествуют появлению экзантемы.</p>\r\n<p>Характерны умеренная <a href=\"/symptom/tahikardiya/\" title=\"Перейти на страницу симптома Тахикардия\">тахикардия</a> и приглушённость тонов сердца, <a href=\"/symptom/nizkoe_davlenie/\" title=\"Перейти на страницу симптома Низкое давление\">гипотония</a>, умеренная <a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">одышка</a>. С 3–4-го дня отмечают <a href=\"/symptom/uvelichenie_pecheni/\" title=\"Перейти на страницу симптома Увеличение печени\">увеличение печени</a> и селезёнки. За сутки до появления сыпи возможен «врез» температурной кривой.</p>\r\n<p>На 4–6-й день заболевания наблюдают появление обильной полиморфной розеолёзно-петехиальной сыпи. Первые элементы определяют за ушами, на боковых поверхностях шеи с последующим распространением на кожу боковых поверхностей туловища, груди, живота, сгибательных поверхностей рук и внутренних поверхностей бёдер. На лице, ладонях и подошвах <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> бывает очень редко. Размеры элементов обычно не превышают 3–5 мм. Для болезни характерен полиморфизм сыпи. Различают розеолы, розеолы со вторичными петехиями, реже первичные петехии. Подсыпаний, как правило, не бывает. Появление новых петехий — плохой прогностический признак. Розеолы исчезают бесследно через 2–4 дня, а петехии — через 7–8 дней, оставляя бурую пигментацию («нечистота кожи»).</p>\r\n<p>У подавляющего большинства больных регистрируют относительную и абсолютную тахикардию, пульс слабого наполнения и напряжения. Границы сердца расширены, тоны глухие. Часто выслушивают систолический шум на верхушке.</p>\r\n<p>АД, особенно диастолическое, падает, что связано с сосудорасширяющим действием токсина риккетсий, угнетением деятельности вазомоторного центра, симпатического отдела нервной системы и надпочечников.</p>\r\n<p>Часто возникает <a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">одышка</a>. На высоте болезни выявляют трахеобронхит и очаговую пневмонию. Язык сухой, обложен густым серо-грязным налётом, может принимать бурую окраску, нередко возникают глубокие трещины. У большинства больных отмечают значительное ухудшение аппетита, жажду, задержку стула и <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">метеоризм</a>. Диурез уменьшен, но одновременно с «температурными кризами» возможно его увеличение. У некоторых больных отмечают парадоксальную ишурию, когда при переполненном мочевом пузыре происходит мочеиспускание каплями.</p>\r\n<p>Поражение нервной системы проявляется кроме головной боли и бессонницы изменением поведения больного. Характерны двигательное <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">беспокойство</a>, сменяемое адинамией, быстрая истощаемость, эйфория, суетливость, говорливость, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, иногда плаксивость. Возможен <a href=\"/symptom/bred/\" title=\"Перейти на страницу симптома Бред\">бред</a>, сопровождающийся галлюцинациями устрашающего характера. Психические расстройства бывают при тяжёлом течении болезни с проявлением энцефалита.</p>\r\n<p>С поражением ЦНС связаны и другие типичные для сыпного тифа симптомы: амимия или гипомимия, одно- или двусторонняя сглаженность носогубной складки, мышечный <a href=\"/symptom/drozhanie/\" title=\"Перейти на страницу симптома Дрожание \">тремор</a>, симптом Говорова–Годелье, дизартрия, <a href=\"/symptom/zatrudnenie_glotaniya/\" title=\"Перейти на страницу симптома Затруднение глотания\">дисфагия</a>, <a href=\"/symptom/nistagm/\" title=\"Перейти на страницу симптома Нистагм\">нистагм</a>, <a href=\"/symptom/snizhenie_sluha/\" title=\"Перейти на страницу симптома Снижение слуха\">снижение слуха</a>, <a href=\"/symptom/povyshennaya_chuvstvitelnost/\" title=\"Перейти на страницу симптома Повышенная чувствительность\">гиперестезия</a> кожи, менингеальные симптомы. В тяжёлых случаях на фоне высокой температуры тела у некоторых больных нарушается сознание, речь становится бессвязной, поведение немотивированным (status typhosus).</p>\r\n<p>Исследование цереброспинальной жидкости в ряде случаев свидетельствует о серозном менингите (незначительное повышение содержания белка, умеренный лимфоцитарный плеоцитоз) или менингизме (отклонения от нормы в СМЖ не обнаруживают).</p>\r\n<p>Характерных изменений гемограммы нет. Имеют место тромбоцитопения, умеренный лейкоцитоз, нейтрофильная реакция, чаще с палочкоядерным сдвигом, эозинопения, лимфопения, умеренное увеличение СОЭ.</p>\r\n<p>Первый признак выздоровления — нормализация температуры, обусловленная уменьшением интоксикации. При этом уменьшается выраженность тифозного статуса (просветление сознания) и признаков делирия. На 3–5-й день после снижения температуры восстанавливается частота пульса и дыхания, нормализуются АД, размеры печени и селезёнки. Постепенно угасает вся клиническая симптоматика. На 12-й день апирексии при отсутствии осложнений пациента можно выписывать. Полное выздоровление наступает примерно через месяц после нормализации температуры. Типичная <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a> сохраняется 2–3 мес.</p>\r\n<p> </p>",
"image": "http://api.symptomd.ru/storage/5f07ed34f441334ae1934dd4107deb5f_uSzzA2D.png",
"image_alt": "Сыпной тиф",
"standard_type": 1,
"danger": 31,
"published": 1,
"parent": null,
"block_rubric": 8,
"standards": []
},
{
"id": 8340,
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"complications": [],
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"who": [
{
"id": 13477,
"gender": 2,
"diseased": 620,
"deaths": 5380,
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{
"id": 13476,
"gender": 1,
"diseased": 1177,
"deaths": 1318,
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"hospital_days": 144,
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"diseased_65_69": 294,
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"disease": 6076
}
],
"thumbnail_100x100": null,
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"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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"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": "A79.0",
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