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},
"code": "A03",
"name": "Шигеллез",
"icd_name": "Шигеллез",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"2",
"7"
],
"periodicity": 1,
"slug": "a03_shigellez",
"lead": "инфекционное кишечное заболевание. Встречается по всему миру у людей всех возрастов, но особенное распространение получает в жаркий сезон",
"description": "<p>Шигеллез - <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">инфекционное заболевание человека, которое вызывается бактериями, относящимися к роду шигелл и протекающее с преимущественным вовлечением в воспалительный процесс нижнего отдела толстого кишечника и признаками общей интоксикации.</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\"> </span></p>",
"etiology": "<p>Шигелла – неподвижная бактерия, напоминающая по форме палочку размером 2-3 мкм. Она не образует спор, поэтому не очень устойчива в окружающей среде, хотя некоторые виды бактерий могут длительно сохранять свою жизнеспособность в воде и молочных продуктах.<br /> <br /> Шигеллы разделены на группы (Григорьева—Шига, Штуцера— Шмитца, Ларджа — Сакса, Флекснера и Зонне), а те в свою очередь на серовары, которых насчитывается около 50. Их отличают по территории обитания, свойствам токсинов и, выделяемых ими, ферментов.</p>\r\n<p>Шигеллы живут только в организме человека. Попав из кишечника больного или носителя в окружающую среду они остаются жизнеспособными на протяжении 5-14 дней. Прямой солнечный свет убивает бактерии на протяжении 30-40 минут, на фруктах и молочных продуктах они могут сохраняться до 2-х недель.<br /> <br /> Мухи могут быть переносчиком болезни. На лапках насекомых бактерии остаются жизнеспособны до 3-х дней. Сев на пищевые продукты, мухи инфицируют их. Даже небольшого количества шигелл достаточно, чтобы вызвать болезнь.</p>",
"pathogenesis": "<p>Первая фаза. Попав в организм с пищей или водой, шигеллы преодолевают ротовую полость и желудок. Бактерии спускаются в тонкий кишечник и прикрепляются к его клеткам – энтероцитам. Здесь они размножаются и выделяют токсины, вызывающие интоксикацию организма.<br /> <br /> Вторая фаза включает несколько этапов.</p>\r\n<ul>\r\n<li>Количество шигелл увеличивается, и они заселяют нижние отделы толстого кишечника. На поверхности бактерий есть особые белки, которые обеспечивают прикрепление к клеткам эпителия. Они воздействуют на рецепторы и побуждают клетку захватить бактерию. Таким образом, возбудитель проникает внутрь эпителия.</li>\r\n<li>Шигеллы выделяют фермент муцин. С его помощью они растворяют клеточные мембраны и заселяют глубокие слои кишечной стенки. Начинается <a title=\"Перейти на страницу симптома воспаление\" href=\"/symptom/vospalenie/\">воспаление</a> подслизистого слоя.</li>\r\n<li>Бактерии нарушают связи между клетками кишечника, что способствует их распространению по здоровым участкам. Кишечная стенка разрыхляется, процесс всасывания нарушается, в просвет кишечника выделяется большое количество жидкости.</li>\r\n<li>Развивается язвенный колит. На слизистой кишечника образуются кровоточащие <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\">эрозии</a> и язвы. На этом этапе бактерии активно выделяют токсины.</li>\r\n</ul>",
"diagnostics": "<p>Диагноз дизентерии ставится врачом-инфекционистом по совокупности симптомов. Дополнительно назначают исследования, позволяющие уточнить возбудителя и применить антибиотики направленного действия, — посевы кала.</p>",
"treatment": "<p>Лечение шигеллеза можно проводить на дому, если состояние больного удовлетворительное. Для госпитализации существует перечень показаний:</p>\r\n<ul>\r\n<li>среднетяжелое и тяжелое течение болезни</li>\r\n<li>тяжелые сопутствующие заболевания</li>\r\n<li>лица декретированных групп, работающие с детьми или на предприятиях питания</li>\r\n<li>дети до года</li>\r\n</ul>\r\n<p><br /> Режим. При легком течении болезни нет необходимости соблюдать строгий постельный режим. Больной может вставать и ходить по палате (квартире). Однако стоит избегать физических нагрузок и соблюдать правила гигиены.<br /> <br /> Диета при шигеллезе помогает нормализовать стул и избежать истощения. В остром периоде болезни необходимо придерживаться диеты №4, а после прекращения поноса диета №4А.<br /> <br /> В дни, когда в кале присутствуют кровь и слизь, блюда должны быть максимально щадящими, чтобы не раздражать пищеварительный тракт. Это: рисовый отвар, протертый манный суп, кисели, нежирные бульоны, сухари.<br /> <br /> По мере улучшения состояния рацион можно расширить. В меню включают: протертый творог, супы на бульонах, вареное перетертое мясо, рисовую кашу, черствый белый хлеб.<br /> <br /> Через 3 дня после прекращения поноса можно постепенно возвращаться к нормальному питанию.</p>",
"prevention": "<ul>\r\n<li>использовать для питья только кипяченую воду или бутилированную</li>\r\n<li>не пить воду из водопровода, непроверенных колодцев или родников</li>\r\n<li>тщательно мыть овощи и фрукты перед едой</li>\r\n<li>не потреблять подпорченные фрукты, в которых бактерии размножаются в мякоти</li>\r\n<li>не покупать разрезанные арбузы и дыни</li>\r\n<li>тщательно мыть руки после посещения туалета</li>\r\n<li>не допускать мух к пищевым продуктам</li>\r\n<li>не потреблять продукты с истекшим сроком хранения</li>\r\n<li>в странах с повышенным риском заражения шигеллами не покупать блюда, не подвергшиеся термической обработке</li>\r\n<li>вакцинация дизентерийным бактериофагом троекратно с интервалом в 3 дня</li>\r\n</ul>",
"clinical_picture": "<p>Инкубационный период. С момента заражения до появления первых симптомов шигеллеза (бактериальной дизентерии) может пройти 1-7 дней. Чаще 2-3 дня.</p>\r\n<ul>\r\n<ul>\r\n<li><a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">Повышение температуры</a>. Начало заболевания острое. Резкое <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">повышение температуры</a> до 38-39 градусов – реакция иммунитета на появление в крови токсинов шигелл. Больные жалуются на <a title=\"Перейти на страницу симптома Озноб\" href=\"/symptom/oznob/\">озноб</a> и чувство жара.<br /> </li>\r\n<li>Интоксикация. Признаки отравления головного и спинного мозга токсинами: <a title=\"Перейти на страницу симптома Снижение аппетита\" href=\"/symptom/snizhenie_appetita/\">потеря аппетита</a>, <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Боль в мышцах\" href=\"/symptom/bol_v_myshcah/\">ломота</a> в теле, <a title=\"Перейти на страницу симптома Головная боль\" href=\"/symptom/golovnaya_bol/\">головная боль</a>, <a title=\"Перейти на страницу симптома Апатия\" href=\"/symptom/apatiya/\">апатия</a>. Развивается в первые часы болезни.<br /> </li>\r\n<li>Учащение стула (<a title=\"Перейти на страницу симптома Диарея\" href=\"/symptom/diareya/\">понос</a>). <a title=\"Перейти на страницу симптома Диарея\" href=\"/symptom/diareya/\">Диарея</a> развивается на 2-3 день болезни. Сначала выделения имеют каловый характер. Со временем становятся более скудными, жидкими, с большим количеством слизи. При развитии эрозий в кишечнике, в кале появляются прожилки крови и гноя. Больной опорожняется 10-30 раз в сутки. Дефекация сопровождается мучительной болью при напряжении воспаленной прямой кишки.<br /> </li>\r\n<li><a title=\"Перейти на страницу симптома Боль в животе\" href=\"/symptom/bol_v_zhivote/\">Боли в животе</a> появляются при внедрении шигелл в слизистую оболочку кишечника и развитии воспаления. Это происходит через 2 дня после начала заболевания. Первые часы боль носит разлитый характер. Когда повреждается нижний отдел кишечника, боль становится резкой, режущей схваткообразной. Преимущественно ощущается в левой половине живота. Неприятные ощущения усиливаются непосредственно перед дефекацией и ослабевают после опорожнения кишечника.<br /> </li>\r\n<li><a title=\"Перейти на страницу симптома Тошнота\" href=\"/symptom/toshnota/\">Тошнота</a>, иногда повторная <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a> – результат воздействия токсина на рвотный центр в головном мозге.<br /> </li>\r\n<li>Ложные болезненные позывы к дефекации – тенезмы. Признак раздражения нервных окончаний кишечника.</li>\r\n</ul>\r\n</ul>\r\n<p> </p>\r\n<ul>\r\n<li><a title=\"Перейти на страницу симптома Тахикардия\" href=\"/symptom/tahikardiya/\">Тахикардия</a> и снижение давления – количество сердечных сокращений более 100 в минуту. Артериальное давление снижено из-за интоксикации и потери жидкости.</li>\r\n</ul>",
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"code": "A03",
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"lead": "инфекционное кишечное заболевание. Встречается по всему миру у людей всех возрастов, но особенное распространение получает в жаркий сезон",
"description": "<p>Шигеллез - <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">инфекционное заболевание человека, которое вызывается бактериями, относящимися к роду шигелл и протекающее с преимущественным вовлечением в воспалительный процесс нижнего отдела толстого кишечника и признаками общей интоксикации.</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\"> </span></p>",
"etiology": "<p>Шигелла – неподвижная бактерия, напоминающая по форме палочку размером 2-3 мкм. Она не образует спор, поэтому не очень устойчива в окружающей среде, хотя некоторые виды бактерий могут длительно сохранять свою жизнеспособность в воде и молочных продуктах.<br /> <br /> Шигеллы разделены на группы (Григорьева—Шига, Штуцера— Шмитца, Ларджа — Сакса, Флекснера и Зонне), а те в свою очередь на серовары, которых насчитывается около 50. Их отличают по территории обитания, свойствам токсинов и, выделяемых ими, ферментов.</p>\r\n<p>Шигеллы живут только в организме человека. Попав из кишечника больного или носителя в окружающую среду они остаются жизнеспособными на протяжении 5-14 дней. Прямой солнечный свет убивает бактерии на протяжении 30-40 минут, на фруктах и молочных продуктах они могут сохраняться до 2-х недель.<br /> <br /> Мухи могут быть переносчиком болезни. На лапках насекомых бактерии остаются жизнеспособны до 3-х дней. Сев на пищевые продукты, мухи инфицируют их. Даже небольшого количества шигелл достаточно, чтобы вызвать болезнь.</p>",
"pathogenesis": "<p>Первая фаза. Попав в организм с пищей или водой, шигеллы преодолевают ротовую полость и желудок. Бактерии спускаются в тонкий кишечник и прикрепляются к его клеткам – энтероцитам. Здесь они размножаются и выделяют токсины, вызывающие интоксикацию организма.<br /> <br /> Вторая фаза включает несколько этапов.</p>\r\n<ul>\r\n<li>Количество шигелл увеличивается, и они заселяют нижние отделы толстого кишечника. На поверхности бактерий есть особые белки, которые обеспечивают прикрепление к клеткам эпителия. Они воздействуют на рецепторы и побуждают клетку захватить бактерию. Таким образом, возбудитель проникает внутрь эпителия.</li>\r\n<li>Шигеллы выделяют фермент муцин. С его помощью они растворяют клеточные мембраны и заселяют глубокие слои кишечной стенки. Начинается <a title=\"Перейти на страницу симптома воспаление\" href=\"/symptom/vospalenie/\">воспаление</a> подслизистого слоя.</li>\r\n<li>Бактерии нарушают связи между клетками кишечника, что способствует их распространению по здоровым участкам. Кишечная стенка разрыхляется, процесс всасывания нарушается, в просвет кишечника выделяется большое количество жидкости.</li>\r\n<li>Развивается язвенный колит. На слизистой кишечника образуются кровоточащие <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\">эрозии</a> и язвы. На этом этапе бактерии активно выделяют токсины.</li>\r\n</ul>",
"diagnostics": "<p>Диагноз дизентерии ставится врачом-инфекционистом по совокупности симптомов. Дополнительно назначают исследования, позволяющие уточнить возбудителя и применить антибиотики направленного действия, — посевы кала.</p>",
"treatment": "<p>Лечение шигеллеза можно проводить на дому, если состояние больного удовлетворительное. Для госпитализации существует перечень показаний:</p>\r\n<ul>\r\n<li>среднетяжелое и тяжелое течение болезни</li>\r\n<li>тяжелые сопутствующие заболевания</li>\r\n<li>лица декретированных групп, работающие с детьми или на предприятиях питания</li>\r\n<li>дети до года</li>\r\n</ul>\r\n<p><br /> Режим. При легком течении болезни нет необходимости соблюдать строгий постельный режим. Больной может вставать и ходить по палате (квартире). Однако стоит избегать физических нагрузок и соблюдать правила гигиены.<br /> <br /> Диета при шигеллезе помогает нормализовать стул и избежать истощения. В остром периоде болезни необходимо придерживаться диеты №4, а после прекращения поноса диета №4А.<br /> <br /> В дни, когда в кале присутствуют кровь и слизь, блюда должны быть максимально щадящими, чтобы не раздражать пищеварительный тракт. Это: рисовый отвар, протертый манный суп, кисели, нежирные бульоны, сухари.<br /> <br /> По мере улучшения состояния рацион можно расширить. В меню включают: протертый творог, супы на бульонах, вареное перетертое мясо, рисовую кашу, черствый белый хлеб.<br /> <br /> Через 3 дня после прекращения поноса можно постепенно возвращаться к нормальному питанию.</p>",
"prevention": "<ul>\r\n<li>использовать для питья только кипяченую воду или бутилированную</li>\r\n<li>не пить воду из водопровода, непроверенных колодцев или родников</li>\r\n<li>тщательно мыть овощи и фрукты перед едой</li>\r\n<li>не потреблять подпорченные фрукты, в которых бактерии размножаются в мякоти</li>\r\n<li>не покупать разрезанные арбузы и дыни</li>\r\n<li>тщательно мыть руки после посещения туалета</li>\r\n<li>не допускать мух к пищевым продуктам</li>\r\n<li>не потреблять продукты с истекшим сроком хранения</li>\r\n<li>в странах с повышенным риском заражения шигеллами не покупать блюда, не подвергшиеся термической обработке</li>\r\n<li>вакцинация дизентерийным бактериофагом троекратно с интервалом в 3 дня</li>\r\n</ul>",
"clinical_picture": "<p>Инкубационный период. С момента заражения до появления первых симптомов шигеллеза (бактериальной дизентерии) может пройти 1-7 дней. Чаще 2-3 дня.</p>\r\n<ul>\r\n<ul>\r\n<li><a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">Повышение температуры</a>. Начало заболевания острое. Резкое <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">повышение температуры</a> до 38-39 градусов – реакция иммунитета на появление в крови токсинов шигелл. Больные жалуются на <a title=\"Перейти на страницу симптома Озноб\" href=\"/symptom/oznob/\">озноб</a> и чувство жара.<br /> </li>\r\n<li>Интоксикация. Признаки отравления головного и спинного мозга токсинами: <a title=\"Перейти на страницу симптома Снижение аппетита\" href=\"/symptom/snizhenie_appetita/\">потеря аппетита</a>, <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Боль в мышцах\" href=\"/symptom/bol_v_myshcah/\">ломота</a> в теле, <a title=\"Перейти на страницу симптома Головная боль\" href=\"/symptom/golovnaya_bol/\">головная боль</a>, <a title=\"Перейти на страницу симптома Апатия\" href=\"/symptom/apatiya/\">апатия</a>. Развивается в первые часы болезни.<br /> </li>\r\n<li>Учащение стула (<a title=\"Перейти на страницу симптома Диарея\" href=\"/symptom/diareya/\">понос</a>). <a title=\"Перейти на страницу симптома Диарея\" href=\"/symptom/diareya/\">Диарея</a> развивается на 2-3 день болезни. Сначала выделения имеют каловый характер. Со временем становятся более скудными, жидкими, с большим количеством слизи. При развитии эрозий в кишечнике, в кале появляются прожилки крови и гноя. Больной опорожняется 10-30 раз в сутки. Дефекация сопровождается мучительной болью при напряжении воспаленной прямой кишки.<br /> </li>\r\n<li><a title=\"Перейти на страницу симптома Боль в животе\" href=\"/symptom/bol_v_zhivote/\">Боли в животе</a> появляются при внедрении шигелл в слизистую оболочку кишечника и развитии воспаления. Это происходит через 2 дня после начала заболевания. Первые часы боль носит разлитый характер. Когда повреждается нижний отдел кишечника, боль становится резкой, режущей схваткообразной. Преимущественно ощущается в левой половине живота. Неприятные ощущения усиливаются непосредственно перед дефекацией и ослабевают после опорожнения кишечника.<br /> </li>\r\n<li><a title=\"Перейти на страницу симптома Тошнота\" href=\"/symptom/toshnota/\">Тошнота</a>, иногда повторная <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a> – результат воздействия токсина на рвотный центр в головном мозге.<br /> </li>\r\n<li>Ложные болезненные позывы к дефекации – тенезмы. Признак раздражения нервных окончаний кишечника.</li>\r\n</ul>\r\n</ul>\r\n<p> </p>\r\n<ul>\r\n<li><a title=\"Перейти на страницу симптома Тахикардия\" href=\"/symptom/tahikardiya/\">Тахикардия</a> и снижение давления – количество сердечных сокращений более 100 в минуту. Артериальное давление снижено из-за интоксикации и потери жидкости.</li>\r\n</ul>",
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}
]
}
