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"code": "I09",
"name": "Другие ревматические болезни сердца",
"icd_name": "Другие ревматические болезни сердца",
"gender": 0,
"age_min": 5,
"age_max": 94,
"cause": [
3,
1,
4,
9
],
"periodicity": 1,
"slug": "i09_drugie_revmaticheskie_bolezni_serdca",
"lead": "Нарушение здоровья, относящееся к группе хронические ревматические болезни сердца",
"description": "Ревмокардит — это основное клиническое проявление ревматизма, относящегося к системным заболеваниям соединительной ткани, при котором патологический процесс локализуется преимущественно в сердце. Ревматизм поражает чаще детей в возрасте 7—15 лет, реже встречается в дошкольном возрасте. ",
"etiology": "<p>Ревматической атаке обычно предшествует стрептококковая инфекция, вызываемая β-гемолитическим стрептококком группы А: скарлатина, тонзиллит, родильная горячка, острый отит, фарингит, рожа. У 97% пациентов, перенесших стрептококковую инфекцию, формируется стойкий иммунный ответ. У остальных лиц стойкого иммунитета не вырабатывается, и при повторном инфицировании β-гемолитическим стрептококком развивается сложная аутоиммунная воспалительная реакция. </p>\r\n<p>Развитию ревматизма способствуют сниженный иммунитет, молодой возраст, большие коллективы (школы, интернаты, общежития), неудовлетворительные социальные условия (питание, жилье), переохлаждение, отягощенный семейный анамнез.</p>",
"pathogenesis": "<p> В патогенезе ОРЛ также можно говорить о ревматической патогенетической триаде: </p>\r\n<ol>\r\n<li>Прямое повреждение миокарда факторами патогенности стрептококка </li>\r\n<li>Аутоиммунный механизм - повреждение миокарда циркулирующими иммунными комплексами (антиген-антитело). </li>\r\n<li>Сосудистый механизм (поражение сосудов миокарда по вышеописанным механизмам ведет к нарушению циркуляции в миокарде — ишемии, ацидозу, — способствуя развитию воспаления, с одной стороны, и реактивному фиброзу, с другой). </li>\r\n</ol>",
"diagnostics": "<p>Клинико-диагностические критерии ОРЛ Киселя-Джонса: </p>\r\n<p>Большие: </p>\r\n<ul>\r\n<li>ревмокардит (преимущественно поражения миокарда в виде миокардита и эндокардит с пороками сердца и без); </li>\r\n<li>полиартрит (преимущественно крупных суставов, мигрирующий характер, без остаточных деформаций, рентгенологически негативный); </li>\r\n<li>малая хорея; </li>\r\n<li>ревматические узелки (подкожные узловатые уплотнения); </li>\r\n<li>анулярная эритема (кольцевидные покраснения кожи туловища и проксимальных отделов конечностей). </li>\r\n</ul>\r\n<p>Малые: </p>\r\n<ul>\r\n<li>клинические: лихорадка, боли в суставах; </li>\r\n<li>лабораторно-инструментальные: </li>\r\n</ul>\r\n<p>а) лабораторные (С-реактивный белок, антистрептолизин-О, ревматоидный фактор); </p>\r\n<p>б) инструментальные (ЭКГ, электромиография, УЗИ сердца). </p>",
"treatment": "<p> Активная фаза ревматизма требует госпитализации пациента и соблюдения постельного режима. Лечение проводится ревматологом и кардиологом. Применяются гипосенсибилизирующие и противовоспалительные препараты, кортикостероидные гормоны, нестероидные противовоспалительные препараты, иммунодепрессанты.</p>",
"prevention": "<p>Первичная: своевременная санация стрептококковых инфекций (ангины, стрептодермии, лечение болезней полости рта, болезней ЛОР-органов, правильная гигиена и т. д.), закаливание и т. д. </p>\r\n<p>Вторичная (бициллинопрофилактика): экстенциллин 2,4 млн единиц раз в 3 недели: </p>\r\n<ul>\r\n<li>стандартно — в течение 5 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате без порока сердца — до 18 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате с пороком сердца — до 25 лет. </li>\r\n</ul>\r\n<p>Текущая: обязательное назначение при интеркуррентных заболеваниях пенициллинов и НПВС. </p>",
"clinical_picture": "<p>Поражение сердца при ревматизме отмечается у 70-85% пациентов. При ревмокардите воспаляются все или отдельные оболочки сердца. Чаще происходит одновременное поражение эндокарда и миокарда (эндомиокардит), иногда с вовлеченностью перикарда (панкардит), возможно развитие изолированного поражения миокарда (миокардит). Во всех случаях при ревматизме в патологический процесс вовлекается миокард. </p>\r\n<p>При диффузном миокардите появляются одышка, сердцебиения, перебои и боли в сердце, кашель при физической нагрузке, в тяжелых случаях – недостаточность кровообращения, сердечная астма или отек легких. Пульс малый, тахиаритмичный. Благоприятным исходом диффузного миокардита считается миокардитический кардиосклероз. </p>\r\n<p>При эндокардите и эндомиокардите в ревматический процесс чаще вовлекается митральный (левый предсердно-желудочковый) клапан, реже аортальный и трикуспидальный (правый предсердно-желудочковый) клапаны. Клиника ревматического перикардита аналогична перикардитам иной этиологии. </p>",
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"etiology": "<p>Причиной развития этого заболевания является дефицит кальция в организме и как следствие нарушение биологических процессов в организме, в регуляции которых принимает участие кальций.</p>",
"pathogenesis": "<p>Кальций (Ca++) – один из биогенных элементов, который необходим для нормального протекания жизненных процессов. Кальций необходим для образования ряда клеточных структур (костной ткани), поддержания нормальной проницаемости наружных клеточных мембран. Ионы Ca++ передают возбуждение на мышечное волокно, активизируя его сокращение, усиливают силу сердечных сокращений, увеличивают фагоцитарную функцию лейкоцитов, активируют систему защитных белков крови, участвуют в ее свертывании. В клетках почти весь Ca++ (99 %) находится в виде соединений с белками, нуклеиновыми кислотами, фосфолипидами и органическими кислотами. В плазме крови только 40 % Ca++ связано с белками. Содержание Ca++ в крови человека регулируется гормонами паращитовидных и щитовидной желез. Важную роль в этих процессах играет витамин D. Всасывание Ca++ происходит в переднем отделе тонкого кишечника. Усвоение Ca++ ухудшается при снижении кислотности в кишечнике и зависит от соотношения Ca++, фосфора и жира в пище. Желчные кислоты ускоряют всасывание Ca++. При дефиците витамина D и при высоком содержании фосфора в пище всасывание Ca++ уменьшается. При недостаточном поступлении Ca++ с пищей (алиментарной недостаточности) нарушаются биологические процессы в организме, в регуляции которых принимает участие кальций, в том числе происходит нарушение формирования скелета и структуры костей (у детей развивается рахит, у взрослых – остеомаляция или нарушение скелета, у стариков – остеопороз, повышенная ломкость костей).</p>",
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"treatment": "<p>Требуется богатая кальцием диета, введение медицинских препаратов кальция.</p>",
"prevention": "<p>Для профилактики гипокальциемии необходимо употреблять в пищу продукты, богатые кальцием и витамином D. Наибольшее количество этого микроэлемента содержится в кунжутном семени, твердых и плавленых сырах, пшеничных отрубях, дрожжах, миндале, фундуке, бобовых. Содержание кальция в молочных продуктах значительно ниже, чем, например, в кунжутном семени, однако их нужно употреблять в достаточном количестве, поскольку из них кальций хорошо усваивается организмом. Продукты питания, богатые витамином D, также должны в достаточном количестве присутствовать в рационе каждого человека. Большое количество этого витамина содержится в кисломолочных продуктах, в растительных маслах, яичных желтках, морепродуктах, особенно в рыбьем жире и печени рыб. Кроме того, витамин D присутствует в овсяной крупе, картофеле и зелени. Кроме поступления с пищей витамин D может синтезироваться в нашем организме самостоятельно под влиянием солнечного света, поэтому в теплое время года необходимо проводить как можно больше времени под солнечными лучами (разумеется, в безопасные часы) с открытой кожей. Помимо витамина D для усвоения кальция необходимы другие витамины (витамины С, К, группы В) и минералы (магний, фосфор, железо, цинк и др.), поэтому рацион каждого человека должен быть сбалансирован. По рекомендации врача можно принимать дополнительно к пище витаминно-минеральные комплексы, содержащие кальций (Витрум, Биомакс, Компливит и др.). Повышена потребность в кальции у детей, беременных и кормящих женщин, а также у людей после 35 лет. Разработаны специальные поливитаминные комплексы для беременных женщин и кормящих матерей, учитывающие повышенную потребность в кальции у женщин в этот период. Для профилактики недостатка кальция и, как следствие, остеопороза, особенно в период менопаузы у женщин, а также у всех людей старше 35–40 лет, рекомендуется прием комбинированных препаратов, содержащих кальций и витамин D (Кальций-D3 Никомед, Кальцемин и др.). Детям препараты кальция назначаются только педиатром. Прием витамина D в профилактической дозе (АкваДетрим) рекомендуется в осенне-зимний период, особенно в областях, где в это время недостаточно солнечного света.</p>",
"clinical_picture": "<p>Общими симптомами, указывающими на возможный дефицит кальция в организме, являются <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a> и повышенная <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>. Кожа становится сухой, шелушится, ногти теряют блеск и становятся ломкими. Ухудшается состояние зубов, начинается кариес. Из-за дефицита кальция страдает нервно-мышечная система, сначала появляется чувство онемения пальцев и вокруг рта, затем присоединяются судороги и появляются боли в костях. При продолжительном дефиците кальция развивается остеопороз, повышенная склонность к деформации и переломам костей, особенно у пожилых людей. Наблюдаются и кардиологические проблемы, поскольку кальций необходим для нормального сокращения сердца, в тяжелых случаях может развиться сердечная недостаточность, которая не поддается медикаментозной терапии. При хронической нехватке кальция может развиться субкапсулярная катаракта, степень выраженности которой зависит от длительности гипокальциемии и ее степени. Кроме того, при недостатке этого микроэлемента снижается уровень иммунитета, нарушается свертываемость крови и появляется повышенная <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровоточивость</a>. Недостаток кальция у детей особенно опасен, поскольку он крайне необходим для нормального роста и развития ребенка. При его дефиците нарушается формирование костей и зубов, происходят патологические изменения в хрусталике глаза. Дети страдают нервными расстройствами, повышенной нервной возбудимостью, нередко возникают судороги. Плохая свертываемость крови у ребенка считается одним из самых опасных проявлений гипокальциемии в детском возрасте. У взрослых, которые в детстве испытывали дефицит кальция, повышен риск развития рассеянного склероза.</p>",
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"etiology": "<p>Причиной малой хореи является перенесенная инфекция β-гемолитического стрептококка группы А. </p>\r\n<p>Этот вид стрептококка может поражать верхние дыхательные пути с развитием ангины и тонзиллита; кожные покровы с развитием рожи, стрептодермии, скарлатины. </p>",
"pathogenesis": "<p>Организм борется с возбудителем, вырабатывая против него антитела, которые уничтожают стрептококк. У ряда людей одновременно антитела вырабатываются и к базальным ганглиям головного мозга. Это называется перекрестным аутоиммунным ответом. Антитела атакуют нервные клетки базальных ганглиев. Таким образом, возникает воспалительная реакция в подкорковых образованиях головного мозга, которая проявляет себя специфическими симптомами (гиперкинезами). </p>",
"diagnostics": "<p>Клинико-диагностические критерии ОРЛ Киселя-Джонса: </p>\r\n<p>Большие: </p>\r\n<ul>\r\n<li>ревмокардит (преимущественно поражения миокарда в виде миокардита и эндокардит с пороками сердца и без); </li>\r\n<li>полиартрит (преимущественно крупных суставов, мигрирующий характер, без остаточных деформаций, рентгенологически негативный); </li>\r\n<li>малая хорея; </li>\r\n<li>ревматические узелки (подкожные узловатые уплотнения); </li>\r\n<li>анулярная эритема (кольцевидные покраснения кожи туловища и проксимальных отделов конечностей). </li>\r\n</ul>\r\n<p>Малые: </p>\r\n<ul>\r\n<li>клинические: лихорадка, боли в суставах; </li>\r\n<li>лабораторно-инструментальные: </li>\r\n</ul>\r\n<p>а) лабораторные (С-реактивный белок, антистрептолизин-О, ревматоидный фактор); </p>\r\n<p>б) инструментальные (ЭКГ, электромиография) </p>\r\n<p> </p>",
"treatment": "<p>Лечение малой хореи комплексное и направлено, в первую очередь, на ликвидацию ревматического процесса в организме, то есть на прекращение выработки антител против клеток собственного организма и борьбу со стрептококком. Немаловажную роль играет ликвидация гиперкинезов. </p>\r\n<p>В остром периоде рекомендован постельный режим, необходимо создать условия с минимальным воздействие раздражителей (света, звуков). Питание должно быть максимально витаминизированным, с небольшим ограничением углеводов. </p>\r\n<p>Назначается антибактериальная терапия - бициллин-1 или бициллин-5. В случае непереносимости пенициллина назначают эритромицин. </p>\r\n<p>Если малая хорея сопровождается выраженными изменениями в крови (повышенное СОЭ, высокие титры антистрептолизина-О, повышение С-реактивного белка и так далее) и поражением других органов и систем, то таким больным показана терапия противоревматическими препаратами. Это могут быть нестероидные противовоспалительные средства и глюкокортикостероиды. </p>",
"prevention": "<p>Первичная: своевременная санация стрептококковых инфекций (ангины, стрептодермии, лечение болезней полости рта, болезней ЛОР-органов, правильная гигиена и т. д.), закаливание и т. д. </p>\r\n<p>Вторичная (бициллинопрофилактика): экстенциллин 2,4 млн единиц раз в 3 недели: </p>\r\n<ul>\r\n<li>стандартно — в течение 5 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате без порока сердца — до 18 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате с пороком сердца — до 25 лет. </li>\r\n</ul>\r\n<p>Текущая: обязательное назначение при интеркуррентных заболеваниях пенициллинов и НПВС. </p>",
"clinical_picture": "<p>Заболевание может возникнуть остро, но чаще отмечается постепенное развитие патологического процесса. Дети становятся несобранными, раздражительными, изменяется их поведение, появляются непроизвольные движения (гиперкинезы) разной степени выраженности. Гиперкинетический синдром часто больше выражен с одной стороны, нередко только в одной правой или левой половине тела (гемихорея). Одновременно у большинства больных появляется гипотония мышц. У 20-30% больных хореей имеется поражение сердца. </p>",
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"code": "I01",
"name": "Ревматическая лихорадка с вовлечением сердца",
"icd_name": "Ревматическая лихорадка с вовлечением сердца",
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3,
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"lead": "Нарушение здоровья, относящееся к группе острая ревматическая лихорадка",
"description": "Ревмокардит — это основное клиническое проявление ревматизма, относящегося к системным заболеваниям соединительной ткани, при котором патологический процесс локализуется преимущественно в сердце. Ревматизм поражает чаще детей в возрасте 7—15 лет, реже встречается в дошкольном возрасте. ",
"etiology": "<p>Ревматической атаке обычно предшествует стрептококковая инфекция, вызываемая β-гемолитическим стрептококком группы А: скарлатина, тонзиллит, родильная горячка, острый отит, фарингит, рожа. У 97% пациентов, перенесших стрептококковую инфекцию, формируется стойкий иммунный ответ. У остальных лиц стойкого иммунитета не вырабатывается, и при повторном инфицировании β-гемолитическим стрептококком развивается сложная аутоиммунная воспалительная реакция. </p>\r\n<p>Развитию ревматизма способствуют сниженный иммунитет, молодой возраст, большие коллективы (школы, интернаты, общежития), неудовлетворительные социальные условия (питание, жилье), переохлаждение, отягощенный семейный анамнез. </p>",
"pathogenesis": "<p>В патогенезе ОРЛ также можно говорить о ревматической патогенетической триаде: </p>\r\n<ol>\r\n<li>Прямое повреждение миокарда факторами патогенности стрептококка </li>\r\n<li>Аутоиммунный механизм - повреждение миокарда циркулирующими иммунными комплексами (антиген-антитело). </li>\r\n<li>Сосудистый механизм (поражение сосудов миокарда по вышеописанным механизмам ведет к нарушению циркуляции в миокарде — ишемии, ацидозу, — способствуя развитию воспаления, с одной стороны, и реактивному фиброзу, с другой). </li>\r\n</ol>",
"diagnostics": "<p>Клинико-диагностические критерии ОРЛ Киселя-Джонса: </p>\r\n<p>Большие: </p>\r\n<ul>\r\n<li>ревмокардит (преимущественно поражения миокарда в виде миокардита и эндокардит с пороками сердца и без); </li>\r\n<li>полиартрит (преимущественно крупных суставов, мигрирующий характер, без остаточных деформаций, рентгенологически негативный); </li>\r\n<li>малая хорея; </li>\r\n<li>ревматические узелки (подкожные узловатые уплотнения); </li>\r\n<li>анулярная эритема (кольцевидные покраснения кожи туловища и проксимальных отделов конечностей). </li>\r\n</ul>\r\n<p>Малые: </p>\r\n<ul>\r\n<li>клинические: лихорадка, боли в суставах; </li>\r\n<li>лабораторно-инструментальные: </li>\r\n</ul>\r\n<p>а) лабораторные (С-реактивный белок, антистрептолизин-О, ревматоидный фактор); </p>\r\n<p>б) инструментальные (ЭКГ, электромиография, УЗИ сердца) </p>",
"treatment": "<p>Активная фаза ревматизма требует госпитализации пациента и соблюдения постельного режима. Лечение проводится ревматологом и кардиологом. Применяются гипосенсибилизирующие и противовоспалительные препараты, кортикостероидные гормоны, нестероидные противовоспалительные препараты, иммунодепрессанты. <br class=\"SCXW182360504\" /> </p>",
"prevention": "<p>Первичная: своевременная санация стрептококковых инфекций (ангины, стрептодермии, лечение болезней полости рта, болезней ЛОР-органов, правильная гигиена и т. д.), закаливание и т. д. </p>\r\n<p>Вторичная (бициллинопрофилактика): экстенциллин 2,4 млн единиц раз в 3 недели: </p>\r\n<ul>\r\n<li>стандартно — в течение 5 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате без порока сердца — до 18 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате с пороком сердца — до 25 лет. </li>\r\n</ul>\r\n<p>Текущая: обязательное назначение при интеркуррентных заболеваниях пенициллинов и НПВС. </p>",
"clinical_picture": "<p>Поражение сердца при ревматизме отмечается у 70-85% пациентов. При ревмокардите воспаляются все или отдельные оболочки сердца. Чаще происходит одновременное поражение эндокарда и миокарда (эндомиокардит), иногда с вовлеченностью перикарда (панкардит), возможно развитие изолированного поражения миокарда (миокардит). Во всех случаях при ревматизме в патологический процесс вовлекается миокард. </p>\r\n<p>При диффузном миокардите появляются одышка, сердцебиения, перебои и боли в сердце, кашель при физической нагрузке, в тяжелых случаях – недостаточность кровообращения, сердечная астма или отек легких. Пульс малый, тахиаритмичный. Благоприятным исходом диффузного миокардита считается миокардитический кардиосклероз. </p>\r\n<p>При эндокардите и эндомиокардите в ревматический процесс чаще вовлекается митральный (левый предсердно-желудочковый) клапан, реже аортальный и трикуспидальный (правый предсердно-желудочковый) клапаны. Клиника ревматического перикардита аналогична перикардитам иной этиологии.</p>",
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"etiology": "<p>Ревматической атаке обычно предшествует стрептококковая инфекция, вызываемая β-гемолитическим стрептококком группы А: скарлатина, тонзиллит, родильная горячка, острый отит, фарингит, рожа. У 97% пациентов, перенесших стрептококковую инфекцию, формируется стойкий иммунный ответ. У остальных лиц стойкого иммунитета не вырабатывается, и при повторном инфицировании β-гемолитическим стрептококком развивается сложная аутоиммунная воспалительная реакция. </p>\r\n<p>Развитию ревматизма способствуют сниженный иммунитет, молодой возраст, большие коллективы (школы, интернаты, общежития), неудовлетворительные социальные условия (питание, жилье), переохлаждение, отягощенный семейный анамнез. </p>",
"pathogenesis": "<p>В патогенезе условно выделяются два периода: </p>\r\n<p>1. Непосредственное повреждающее и токсическое действие на организм, оказываемое персистирующими стрептококками и их антигенами.</p>\r\n<p>2. Развитие иммунного воспаления в соединительной ткани организма с преимущественным вовлечением в процесс сердца и сосудов в результате запуска механизма синтезааутоантител.</p>",
"diagnostics": "<p>Клинико-диагностические критерии ОРЛ Киселя-Джонса: </p>\r\n<p>Большие: </p>\r\n<p>ревмокардит (преимущественно поражения миокарда в виде миокардита и эндокардит с пороками сердца и без); </p>\r\n<p>полиартрит (преимущественно крупных суставов, мигрирующий характер, без остаточных деформаций, рентгенологически негативный); </p>\r\n<p>малая хорея; </p>\r\n<p>ревматические узелки (подкожные узловатые уплотнения); </p>\r\n<p>анулярная эритема (кольцевидные покраснения кожи туловища и проксимальных отделов конечностей). </p>\r\n<p>Малые: </p>\r\n<p>клинические: лихорадка, боли в суставах; </p>\r\n<p>лабораторно-инструментальные: </p>\r\n<p>а) лабораторные (С-реактивный белок, антистрептолизин-О, ревматоидный фактор); </p>\r\n<p>б) инструментальные (ЭКГ, электромиография, УЗИ сердца). </p>",
"treatment": "<p>Активная фаза ревматизма требует госпитализации пациента и соблюдения постельного режима. Применяются гипосенсибилизирующие и противовоспалительные препараты, кортикостероидные гормоны, нестероидные противовоспалительные препараты, иммунодепрессанты. <br class=\"SCXW246008330\" /> </p>",
"prevention": "<p>Первичная: своевременная санация стрептококковых инфекций (ангины, стрептодермии, лечение болезней полости рта, болезней ЛОР-органов, правильная гигиена и т. д.), закаливание и т. д. </p>\r\n<p>Вторичная (бициллинопрофилактика): экстенциллин 2,4 млн единиц раз в 3 недели: </p>\r\n<ul>\r\n<li>стандартно — в течение 5 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате без порока сердца — до 18 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате с пороком сердца — до 25 лет. </li>\r\n</ul>\r\n<p>Текущая: обязательное назначение при интеркуррентных заболеваниях пенициллинов и НПВС. </p>\r\n<p> </p>",
"clinical_picture": "<p>Симптомы ревматизма крайне полиморфны и зависят от степени остроты и активности процесса, а также вовлеченности в процесс различных органов. Типичная клиника ревматизма имеет прямую связь с перенесенной стрептококковой инфекцией (тонзиллитом, скарлатиной, фарингитом) и развивается спустя 1-2 недели после нее. Заболевание начинается остро с субфебрильной температуры (38—39 °С), слабости, утомляемости, головных болей, потливости. Одним из ранних проявлений ревматизма служат артралгии - боли в средних или крупных суставах (голеностопных, коленных, локтевых, плечевых, лучезапястных). </p>\r\n<p>При ревматизме артралгии носят множественный, симметричный и летучий (боли исчезают в одних и появляются в других суставах) характер. Отмечается припухлость, отечность, локальное покраснение и повышение температуры, резкое ограничение движений пораженных суставов. Течение ревматического полиартрита обычно доброкачественно: через несколько дней острота явлений стихает, суставы не деформируются, хотя умеренная болезненность может сохраняться в течение длительного времени. </p>\r\n<p>При ревматизме может поражаться центральная нервная система, специфическим признаком при этом служит, так называемая, ревматическая или малая хорея: появляются гиперкинезы – непроизвольные подергивания групп мышц, эмоциональная и мышечная слабость.</p>\r\n<p>Реже встречаются кожные проявления ревматизма: кольцевидная эритема (у 7–10% пациентов) и ревматические узелки. Кольцевидная эритема(аннулярная сыпь) представляет собой кольцевидные, бледно-розовые высыпания на туловище и голенях; ревматические подкожные узелки - плотные, округлые, безболезненные, малоподвижные, единичные или множественные узелки с локализацией в области средних и крупных суставов. </p>\r\n<p> </p>",
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"pathogenesis": "<p>Проникают трепанемы через поврежденные участки кожи и слизистые оболочки. Затем они локализуются преимущественно в роговом слое эпидермиса, где развивается гиперпигментация, утолщение кожи, межклеточный отек. Также происходит нарушение пигментной функции, так как наблюдается гибель меланоцитов. Поражаются регионарные лимфатические узлы. В поздней стадии развивается очаговая атрофия эпидермиса. </p>",
"diagnostics": "<p>Диагноз пинты основываются на появлении характерных пятен на коже и стадийности их изменений без нарушения общего состояния, за исключением кожного зуда. Диагноз подтверждается обнаружением в соскобах кожи трепонем; в поздних стадиях болезни становится положительной реакция Вассермана. </p>\r\n<p>Применяются серологические реакции, реакции иммунофлюоресценции - обнаруживаются специфические антитела к трепонеме. </p>",
"treatment": "<p>Лечение проводят дюрантным и препаратами пенициллина, типа бициллина, или новыми препаратами – экстенциллнн, ретарпен и др. Детям и взрослым, контактировавшим с больными, проводят профилактическое лечение бициллином.</p>",
"prevention": "<p> </p>\r\n<p>Профилактические мероприятия сводятся к выявлению и лечению больных и лиц, находящихся с ними в тесном контакте. Специфической профилактики не разработано. </p>",
"clinical_picture": "<p>Инкубационный период 7-20 дней. </p>\r\n<p>На месте внедрения трепонемы образуется эритематозная зудящая папула (узелок), размеры которой постепенно увеличиваются до нескольких сантиметров (примерно на 1 см в течение месяца). Вокруг папулы через 6-12 мес появляются мелкие пинтиды, зудящие, многочисленные, различного цвета (голубого, серого, бурого, желтого, фиолетового, красного и др.) разной величины и формы: круглые, овальные, неправильные; они шелушатся и напоминают чешуйчатый лишай или становятся лихеноидными (утолщенным). </p>\r\n<p>В поздней третьей стадии болезни - на коже обилие ахроматичных и пигментированных пятен; появляется утолщение подошв и ладоней, болезненные трещины, пигментные нарушения ногтей. </p>\r\n<p>Физическое состояние больных не нарушается, сохраняется трудоспособность, и заболевание продолжается неопределенно длительное время. </p>",
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]
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