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},
"code": "B78",
"name": "Стронгилоидоз",
"icd_name": "Стронгилоидоз",
"gender": 1,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5,
7
],
"periodicity": 1,
"slug": "b78_strongiloidoz",
"lead": "Гельминтоз, в ранней стадии которого наблюдаются преимущественные симптомы аллергического характера со стороны кожи и легких, в поздней стадии преобладают поражения органов пищеварительной системы. ",
"description": "Инфекционное заболевание.",
"etiology": "<p>Возбудитель стронгилоидоза — круглый гельминт Strongyloides stercoralis — кишечная угрица. Самец длиной 0,7 мм, шириной 0,04—0,06 мм. На загнутом хвостовом конце тела имеется две спикулы и рулек. Самка длиной 2,2 мм, шириной 0,03—0,7 мм. Яйца прозрачные, овальной формы, размером 0,05 х 0,03 мм. Развитие паразитов протекает со сменой свободноживущих и паразитических поколений. Половозрелые самки паразитического поколения локализуются в организме человека в толще слизистой оболочки, главным образом в либеркюновых железах двенадцатиперстной кишки, при интенсивной инвазии проникают в желудок, слизистую тонкого кишечника, панкреатические и желчные ходы. Оплодотворенные самки откладывают яйца, из которых выходят личинки, достигающие в длину 0,2—0,3 мм.</p>\r\n<full></full>\r\n<p>Личинки выделяются с фекалиями во внешнюю среду, где либо превращаются в филяриевидные личинки (гомогения), либо в свободноживущих половозрелых самцов и самок (гетерогония), способных откладывать яйца. Филяриевидные личинки способны инвазировать человека, проникая через кожные покровы или через рот с водой и пищей. При перкутантном заражении личинки совершают миграцию, подобно личинкам аскарид и анкилостомид, и достигают кишечника через дыхательные пути, глотку, пищевод. Источник инвазии — больной стронгилоидозом человек. Заражение происходит из зараженной почвы. Особенно благоприятные условия имеются в странах с жарким и влажным климатом, а также в сырых с высокой температурой шахтах и туннелях. Распространен, в основном, в странах тропического и субтропического пояса. Спорадические случаи возможны на территории России.</p>",
"pathogenesis": "",
"diagnostics": "<p>Паразитологический диагноз устанавливается по обнаружению личинок (реже яиц) в дуоденальном содержимом и в кале, обработанных по методу Бермана, в миграционной стадии иногда удается выявить личинки и половозрелых паразитов в мокроте. Исследованию на стронгилоидоз подлежат все больные с высокой эозинофилией крови.</p>",
"treatment": "<p>Больные стронгилоидозом подлежат лечению в стационаре. Наиболее эффективными препаратами является минтезол (тиабендазол) и ивермектин (мектизан). Минтезол назначают из расчета 25-50 мг/кг массы тела в сутки в 3 приема 2 дня подряд. Ивермектин (мектизан) - по 200 мг/кг/сут в течение 2 дней. Могут быть использованы вермокс, альбендазол. Больным назначают десенсибилизирующие средства, при интоксикации проводят инфузионную терапию. Контроль эффективности лечения через 2 нед и затем ежемесячно в течение З меc.</p>",
"prevention": "<p>Профилактические мероприятия при стронгилоидозе направлены на выявление и оздоровление инвазированных и на охрану окружающей среды от загрязнения фекалиями. <br /><br />Обязательному обследованию на стронгилоидоз подлежат больные, страдающие заболеваниями органов пищеварения, гепатобилиарной системы, особенно при наличии у них эозинофилии или крапивницы, т. е. при наличии характерных для инвазии клинических показаний.</p>\r\n<full></full>\r\n<p><br /><br />Учитывая особенности эпидемиологии стронгилоидоза, наличие групп профессий повышенного риска заражения, обследованию методом Бермана подлежат землекопы, шахтеры, рабочие очистных сооружений, строители дорог, парниковых хозяйств, овощных баз и др., а также лица, находящиеся в больницах, интернатах, колониях для психических больных. <br /><br />Выявленные инвазированные подлежат дегельминтизации лучше в условиях стационара или полустационара с последующим диспансерным наблюдением на протяжении одного года: с обследованием специальным методом Бермана один раз в месяц в течение 6 месяцев и один раз в квартал следующие полгода. С диспансерного учета снимают через год после трехкратного обследования с интервалом 2-3 дня при получении отрицательных результатов анализов. <br /><br />Важным и решающим методом профилактики стронгилоидоза является охрана внешней среды от фекальных загрязнении и обеззараживание загрязненной почвы. Это, прежде всего меры по санитарному благоустройству населенных мест, организация плановой очистки дворовых туалетов, запрещению удобрение почвы огородов необезвреженными фекалиями.</p>",
"clinical_picture": "<p>В ранней миграционной стадии (до 10 суток) стронгилоидоза возникает <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"../../../symptom/vysokaya_temperatura_38-42/\">лихорадка</a>, кожный <a title=\"Перейти на страницу симптома Зуд\" href=\"../../../symptom/zud/\">зуд</a>, крапивница или папулезные <a title=\"Перейти на страницу симптома Сыпь\" href=\"../../../symptom/syp/\">высыпания</a>, местные отеки, в легких появляются эозинофильные инфильтраты. В поздней фазе инвазии, когда гельминты достигают половой зрелости, иногда могут наблюдаться тяжелые, летально заканчивающиеся клинические прояв-ления. В легких случаях течения заболевания отмечаются <a title=\"Перейти на страницу симптома Тошнота\" href=\"../../../symptom/toshnota/\">тошнота</a>, тупые боли в эпигастрии. Стул, как правило, не изменен, иногда запоры или чередование запоров с легкими поносами. Иногда ведущим синдромом является ал-лергический. При выраженных проявлениях <a title=\"Перейти на страницу симптома Тошнота\" href=\"../../../symptom/toshnota/\">тошнота</a> нередко сопровождается рвотой, возникают острые боли в эпигастрии или по всему животу.</p>\r\n<full></full>\r\n<p>Периодически появляются поносы до 5—7 раз в сутки. Печень у некоторых больных увеличена и уплотнена. В периферической крови у большинства боль-ных выявляется эозинофилия до 70—80%, при длительных инвазиях возникает вторичная анемия, обычно умеренно выраженная. При тяжелых формах стронгилоидоза поносы становятся постоянными, стул приобретает гнилостный запах и содержит много остатков непереваренной пищи. Наступает обезвоживание организма, тяжелая вторичная анемия, <a title=\"Перейти на страницу симптома Кахексия\" href=\"../../../symptom/kaheksiya/\">кахексия</a>. Со стороны нервной системы отмечаются <a title=\"Перейти на страницу симптома Головная боль\" href=\"../../../symptom/golovnaya_bol/\">головная боль</a>, головокружения, повышенная умственная <a title=\"Перейти на страницу симптома Утомляемость\" href=\"../../../symptom/utomlyaemost/\">утомляемость</a>, неврастенические и психастенические синдромы. Наблюдаются симптомы дуоденита, энтероколита, реже ангиохолита и гепатита. При отсутствии лечения гельминтоз приобретает длительное хроническое течение.</p>",
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},
"code": "B78",
"name": "Стронгилоидоз",
"icd_name": "Стронгилоидоз",
"gender": 1,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5,
7
],
"periodicity": 1,
"slug": "b78_strongiloidoz",
"lead": "Гельминтоз, в ранней стадии которого наблюдаются преимущественные симптомы аллергического характера со стороны кожи и легких, в поздней стадии преобладают поражения органов пищеварительной системы. ",
"description": "Инфекционное заболевание.",
"etiology": "<p>Возбудитель стронгилоидоза — круглый гельминт Strongyloides stercoralis — кишечная угрица. Самец длиной 0,7 мм, шириной 0,04—0,06 мм. На загнутом хвостовом конце тела имеется две спикулы и рулек. Самка длиной 2,2 мм, шириной 0,03—0,7 мм. Яйца прозрачные, овальной формы, размером 0,05 х 0,03 мм. Развитие паразитов протекает со сменой свободноживущих и паразитических поколений. Половозрелые самки паразитического поколения локализуются в организме человека в толще слизистой оболочки, главным образом в либеркюновых железах двенадцатиперстной кишки, при интенсивной инвазии проникают в желудок, слизистую тонкого кишечника, панкреатические и желчные ходы. Оплодотворенные самки откладывают яйца, из которых выходят личинки, достигающие в длину 0,2—0,3 мм.</p>\r\n<full></full>\r\n<p>Личинки выделяются с фекалиями во внешнюю среду, где либо превращаются в филяриевидные личинки (гомогения), либо в свободноживущих половозрелых самцов и самок (гетерогония), способных откладывать яйца. Филяриевидные личинки способны инвазировать человека, проникая через кожные покровы или через рот с водой и пищей. При перкутантном заражении личинки совершают миграцию, подобно личинкам аскарид и анкилостомид, и достигают кишечника через дыхательные пути, глотку, пищевод. Источник инвазии — больной стронгилоидозом человек. Заражение происходит из зараженной почвы. Особенно благоприятные условия имеются в странах с жарким и влажным климатом, а также в сырых с высокой температурой шахтах и туннелях. Распространен, в основном, в странах тропического и субтропического пояса. Спорадические случаи возможны на территории России.</p>",
"pathogenesis": "",
"diagnostics": "<p>Паразитологический диагноз устанавливается по обнаружению личинок (реже яиц) в дуоденальном содержимом и в кале, обработанных по методу Бермана, в миграционной стадии иногда удается выявить личинки и половозрелых паразитов в мокроте. Исследованию на стронгилоидоз подлежат все больные с высокой эозинофилией крови.</p>",
"treatment": "<p>Больные стронгилоидозом подлежат лечению в стационаре. Наиболее эффективными препаратами является минтезол (тиабендазол) и ивермектин (мектизан). Минтезол назначают из расчета 25-50 мг/кг массы тела в сутки в 3 приема 2 дня подряд. Ивермектин (мектизан) - по 200 мг/кг/сут в течение 2 дней. Могут быть использованы вермокс, альбендазол. Больным назначают десенсибилизирующие средства, при интоксикации проводят инфузионную терапию. Контроль эффективности лечения через 2 нед и затем ежемесячно в течение З меc.</p>",
"prevention": "<p>Профилактические мероприятия при стронгилоидозе направлены на выявление и оздоровление инвазированных и на охрану окружающей среды от загрязнения фекалиями. <br /><br />Обязательному обследованию на стронгилоидоз подлежат больные, страдающие заболеваниями органов пищеварения, гепатобилиарной системы, особенно при наличии у них эозинофилии или крапивницы, т. е. при наличии характерных для инвазии клинических показаний.</p>\r\n<full></full>\r\n<p><br /><br />Учитывая особенности эпидемиологии стронгилоидоза, наличие групп профессий повышенного риска заражения, обследованию методом Бермана подлежат землекопы, шахтеры, рабочие очистных сооружений, строители дорог, парниковых хозяйств, овощных баз и др., а также лица, находящиеся в больницах, интернатах, колониях для психических больных. <br /><br />Выявленные инвазированные подлежат дегельминтизации лучше в условиях стационара или полустационара с последующим диспансерным наблюдением на протяжении одного года: с обследованием специальным методом Бермана один раз в месяц в течение 6 месяцев и один раз в квартал следующие полгода. С диспансерного учета снимают через год после трехкратного обследования с интервалом 2-3 дня при получении отрицательных результатов анализов. <br /><br />Важным и решающим методом профилактики стронгилоидоза является охрана внешней среды от фекальных загрязнении и обеззараживание загрязненной почвы. Это, прежде всего меры по санитарному благоустройству населенных мест, организация плановой очистки дворовых туалетов, запрещению удобрение почвы огородов необезвреженными фекалиями.</p>",
"clinical_picture": "<p>В ранней миграционной стадии (до 10 суток) стронгилоидоза возникает <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"../../../symptom/vysokaya_temperatura_38-42/\">лихорадка</a>, кожный <a title=\"Перейти на страницу симптома Зуд\" href=\"../../../symptom/zud/\">зуд</a>, крапивница или папулезные <a title=\"Перейти на страницу симптома Сыпь\" href=\"../../../symptom/syp/\">высыпания</a>, местные отеки, в легких появляются эозинофильные инфильтраты. В поздней фазе инвазии, когда гельминты достигают половой зрелости, иногда могут наблюдаться тяжелые, летально заканчивающиеся клинические прояв-ления. В легких случаях течения заболевания отмечаются <a title=\"Перейти на страницу симптома Тошнота\" href=\"../../../symptom/toshnota/\">тошнота</a>, тупые боли в эпигастрии. Стул, как правило, не изменен, иногда запоры или чередование запоров с легкими поносами. Иногда ведущим синдромом является ал-лергический. При выраженных проявлениях <a title=\"Перейти на страницу симптома Тошнота\" href=\"../../../symptom/toshnota/\">тошнота</a> нередко сопровождается рвотой, возникают острые боли в эпигастрии или по всему животу.</p>\r\n<full></full>\r\n<p>Периодически появляются поносы до 5—7 раз в сутки. Печень у некоторых больных увеличена и уплотнена. В периферической крови у большинства боль-ных выявляется эозинофилия до 70—80%, при длительных инвазиях возникает вторичная анемия, обычно умеренно выраженная. При тяжелых формах стронгилоидоза поносы становятся постоянными, стул приобретает гнилостный запах и содержит много остатков непереваренной пищи. Наступает обезвоживание организма, тяжелая вторичная анемия, <a title=\"Перейти на страницу симптома Кахексия\" href=\"../../../symptom/kaheksiya/\">кахексия</a>. Со стороны нервной системы отмечаются <a title=\"Перейти на страницу симптома Головная боль\" href=\"../../../symptom/golovnaya_bol/\">головная боль</a>, головокружения, повышенная умственная <a title=\"Перейти на страницу симптома Утомляемость\" href=\"../../../symptom/utomlyaemost/\">утомляемость</a>, неврастенические и психастенические синдромы. Наблюдаются симптомы дуоденита, энтероколита, реже ангиохолита и гепатита. При отсутствии лечения гельминтоз приобретает длительное хроническое течение.</p>",
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},
"code": "B58",
"name": "Токсоплазмоз",
"icd_name": "Токсоплазмоз",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5,
7,
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],
"periodicity": 1,
"slug": "b58_toksoplazmoz",
"lead": "Паразитарное заболевание, характеризующееся преимущественно латентным или хроническим течением, поражением нервной системы, органов ретикулоэндотелиальной системы, мышц, миокарда и глаз.",
"description": "Инфекционное заболевание.",
"etiology": "<p>Возбудитель - Toxoplasma gondii относится к простейшим.Токсоплазмоз относится к зоонозам с природной очаговостью. Окончательным хозяином являются домашние кошки и некоторые дикие представители семейства кошачьих (рысь, пума, оцелот, бенгальский кот, ягуар и др.). Ооцисты, выделяющиеся с их испражнениями, могут приводить к инфицированию как человека, так и многих других животных (свыше 200 видов), которые служат промежуточными хозяевами. Заражение наступает лишь при употреблении в пищу сырого мяса (мясного фарша) этих животных. Контакт с промежуточными хозяевами (собаками, сельскохозяйственными животными) к инфицированию людей не приводит. Больной человек не выделяет возбудителя во внешнюю среду и никакой опасности для окружающих не представляет.</p>\r\n<full></full>\r\n<p>У человека возможны три пути передачи инфекции: пероральный (заглатывание ооцист или цист), трансплацентарный, а также возможно инфицирование при переливании крови и пересадке органов.</p>\r\n<p>Пероральное инфицирование происходит при употреблении недостаточно термически обработанного мяса (мясного фарша), содержащего цисты. Баранина и свинина, также как и мясо других животных, часто содержат цисты токсоплазм (от 10 до 25%). Заражение может наступить и при проглатывании ооцист (контакт с загрязненными кошачьими испражнениями, землей, песком и др.). Около 1% домашних кошек с испражнениями выделяют ооцисты, однако - только на протяжении 2-3 недель за время жизни, так как после первичного инфицирования у животных развивается иммунитет, предохраняющий их от повторного заражения.</p>\r\n<p>Трансплацентарное заражение плода может происходить при инфицировании матери во время беременности. При заражении матери в I триместре беременности врожденный токсоплазмоз наблюдается в 15-20% и протекает тяжело. При инфицировании в III триместре инфицированными оказываются 65% новорожденных, но у некоторых инфекция может протекать без выраженных клинических проявлений. Если женщина инфицирована до беременности (за 6 мес и более), внутриутробного поражения плода не наступает, а если заражение произошло незадолго до наступления беременности, риск инфицирования плода очень мал.</p>\r\n<p>Инфицированность доноров токсоплазмами такая же, как клинически здоровых лиц, однако достоверных случаев передачи токсоплазмоза реципиентам не наблюдалось. Такая возможность становится реальной при переливании крови лицам с резко ослабленным иммунитетом (больные СПИДом, лейкемией и др.), а также при пересадке органов. В этих случаях доноры не должны быть инфицированными.</p>",
"pathogenesis": "<p>Воротами инфекции чаще служат органы пищеварения, хотя известны случаи внутрилабораторных заражений высоковирулентными штаммами токсоплазм при повреждении кожи (пипеткой или шприцем с культурой токсоплазм). Внедрение возбудителя происходит в нижних отделах тонкой кишки, затем с током лимфы токсоплазмы достигают регионарных (мезентериальных) лимфатических узлов. Здесь развиваются воспалительные изменения с формированием инфекционных гранулем, напоминающих по клеточному составу туберкулезные или бруцеллезные гранулемы. Мезентериальные лимфатические узлы значительно увеличиваются.</p>\r\n<full></full>\r\n<p>Затем токсоплазмы попадают в кровь, разносятся по всему организму и фиксируются в различных органах и тканях (печень, селезенка, лимфатические узлы, нервная система, глаза, миокард, скелетные мышцы). В этих органах образуются скопления паразитов в виде цист, которые могут сохраняться в организме десятки лет и даже пожизненно. В местах фиксации возникают воспалительные очаги, а в некоторых органах (нервная система, скелетные мышцы) - очажки некроза, в которых затем откладываются соли кальция и образуются кальцинаты.</p>\r\n<p>В результате жизнедеятельности паразита и выделения антигенов и аллергенов наступает аллергическая перестройка организма (по типу реакций гиперчувствительности замедленного типа) и вырабатываются антитела, которые выявляются в различных иммунных реакциях (РСК, реакция с красителем Сэбина-Фельдмана, РПГА, ИФА и др.). В развитии иммунитета большое значение имеют как клеточные, так и гуморальные факторы. Наличие антител предохраняет от нового заражения даже высоковирулентными штаммами токсоплазм и обусловливает бессимптомное (латентное) течение токсоплазмоза у большинства инфицированных лиц. При ослаблении защитных сил организма и снижении напряженности иммунитета может наступить обострение заболевания (переход латентной формы в манифестную). Обострение хронического токсоплазмоза, как правило, провоцируется интеркуррентными заболеваниями (грипп, ОРЗ, пневмонии и др.) и может наблюдаться иногда спустя длительное время (до 10-20 лет) после инфицирования. Описаны обострения с развитием тяжелого токсоплазмозного энцефалита после лечения лиц с латентным токсоплазмозом цитостатиками и иммунодепрессантами. В последние годы важное значение приобрела проблема генерализации латентного токсоплазмоза у ВИЧ-инфицированных. В этих случаях токсоплазмоз приобретает острое злокачественное течение с развитием некротического локализованного или диффузного менингоэнцефалита, в процесс вовлекаются глаза и многие органы (сердце, печень, легкие). На фоне развернутой картины СПИДа наслоившееся обострение (генерализация токсоплазмоза) может приводить к гибели больных.</p>",
"diagnostics": "<p>Диагноз ставят по результатам анализа крови, в ходе которого в крови выявляют наличие антител против токсоплазмы. При серьезных нарушениях используется компьютерная томография (КТ) или магнитно-резонансная томография (МРТ) головного мозга.</p>",
"treatment": "<p>При остром токсоплазмозе используются химиотерапевтические препараты. <br /><br />Делагил (по 0,5г 2 раза в сутки) в сочетании с сульфаниламидами (по 0,5г 2 раза в сутки) в течение 10 дней. Фансидар назначается в количестве 5 таблеток на курс: по 1 табл. через 2 дня или в виде внутримышечных инъекций по 1 ампуле в 2,5 мг один раз в 2 дня в количестве 5 инъекций. Проводится один или два курса лечения. <br /><br />Из антибиотиков назначаются: линкомицина гидрохлорид (по 0,5г 2 раза в сутки); метациклина гидрохлорид (по 0,3г 2 раза в сутки) в течение 5-7 дней в сочетании с сульфаниламидами; ровамицин. <br /><br />Лечение хронического токсоплазмоза во много раз труднее, чем острого, так как химиопрепараты не оказывает значительного эффекта. Главное место занимает гипосенсибилизирующая и иммуномодулирующая терапия. В комплекс лечения включают витамины, десенсибилизирующие средства, лидазу, церебролизин и пр. <br /><br />Имеются данные о положительном действии левамизола в терапии хронического токсоплазмоза. Левамизол назначается по 150 мг 3 дня подряд с перерывами 1 нед между циклами, всего 2 - 3 цикла.</p>",
"prevention": "<p>Профилактика инфицирования токсоплазмами заключается в употреблении в пищу только хорошо термически обработанного мяса и мясопродуктов, чисто вымытых овощей, фруктов и ягод. В процессе приготовления пищи запрещается пробовать на вкус сырой мясной фарш. Необходимо тщательно мыть руки после обработки сырых мясопродуктов, работе в саду, огороде, детям после игры на детской площадке и, особенно, в песочнице. Следует тщательно соблюдать санитарно-гигиенические правила содержания в квартире домашних животных, не забывая мыть руки после контактов с ними. <br /><br />При наступлении беременности каждая женщина должна быть обследована на токсоплазмоз в женской консультации. При выявлении у беременной клинических проявлений токсоплазмоза, а также обнаружение антител к токсоплазмам класса IgM, следует решить вопрос о необходимости лечения или прерывания беременности.</p>",
"clinical_picture": "<p>Симптомы легкого лимфатического токсоплазмоза сходны с проявлением инфекционного мононуклеоза. Происходит <a title=\"Перейти на страницу симптома Увеличение лимфатических узлов\" href=\"../../../symptom/uvelichenie_limfaticheskih_uzlov/\">увеличение лимфатических узлов</a> шеи и подмышечных областей, наблюдается чувство общего недомогания, боль в мышцах, периодическое <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"../../../symptom/vysokaya_temperatura_38-42/\">повышение температуры</a>. Возможны легкая анемия, снижение артериального давления, увеличение числа лимфоцитов и снижение уровня лейкоцитов в крови.</p>\r\n<p>При хроническом токсоплазмозе наблюдается <a title=\"Перейти на страницу симптома воспаление\" href=\"../../../symptom/vospalenie/\">воспаление</a> внутренних структур глаза.</p>\r\n<full></full>\r\n<p>Острый диссеминированный токсоплазмоз проявляется в виде сыпи, повышенной температуры и выраженного истощения. Чаще всего эта форма токсоплазмоза встречается у людей со сниженным иммунитетом. В худшем варианте эта форма проявляется у больных СПИДом, у которых токсоплазмы могут распространиться по всему организму. При этом развивается <a title=\"Перейти на страницу симптома воспаление\" href=\"../../../symptom/vospalenie/\">воспаление</a> мозга (энцефалит), что приводит к параличу, судорогам, головным болям и коме.</p>",
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