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},
"code": "B42",
"name": "Споротрихоз",
"icd_name": "Споротрихоз",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"3",
"5"
],
"periodicity": 1,
"slug": "b42_sporotrihoz",
"lead": "инфекция кожи, вызываемая сапрофитной плесенью Sporothrix schenckii",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Споротрихоз – это инфекционное заболевание кожных покровов, подкожного жирового слоя и неглубоко расположенных лимфатических узлов. </span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возбудитель инфекции – гриб споротрихумов Sporothrix schenkii. Его споры можно обнаружить в почве, соломе, сене, культурных растениях, особенно цветах (чаще всего шипах роз и барбарисов). При контакте поврежденного участка кожи со спорами гриба происходит заражение. Развитие инфекции может происходить локально, только в месте контакта, или же распространяться по лимфатической системе.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Данное заболевание не передается от зараженного другим людям.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выделяют несколько факторов развития споротрихоза:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижение иммунитета (особенно ВИЧ, СПИД);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">алкогольная зависимость;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">хронические заболевания эндокринной системы (диабет, гипотериоз);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">онкозаболевания;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушение гормонального фона;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">люди, которым был пересажен орган.</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возбудитель проникает в слои кожных покровов или слизистых при травматическом контакте (царапина, прокол). Компоненты клеточной стенки грибков имеют рецепторы для иммунокомпетентных клеток Т-хелперов первого порядка, однако белковые составляющие рецепторов увеличивают сцепление споротрихий с эпителием, усугубляя инвазию. Воспалительные процессы протекают не только в коже, но и в лимфатических узлах, с током лимфы споротрихии распространяются по организму и попадают в систему кровообращения, следствием чего является контаминация внутренних органов.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гранулемы могут образовываться в любых органах и тканях, чаще всего страдают суставы, кости, головной мозг и легкие. Патогистологически выявляются признаки диффузного хронического гранулематозного дерматита с множественными центральными абсцессами, очагами акантоза и гиперкератоза, интраэпидермальными микроабсцессами. В центре гранулемы преобладают нейтрофилы и эозинофилы, далее обнаруживается слой мононуклеаров, наружная область состоит из плазмоцитов и лимфоцитов.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагноз споротрихоза верифицируется врачом-инфекционистом. Чаще всего врачу требуется консультативная помощь дерматовенеролога, в зависимости от имеющихся симптомов (поражения костно-суставного аппарата, легких и пр.) могут назначаться осмотры пульмонолога, хирурга и других специалистов. Диагностический поиск проводится с использованием следующих клинических, лабораторных и инструментальных методов:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Физикальное исследование. В ходе осмотра оценивается тяжесть состояния больного. Поражение при кожной форме споротрихоза выглядит как папулонодулярный очаг с тенденцией к изъязвлению, нередко со свищевым ходом и отделяемым. Регионарные лимфатические узлы увеличены, чувствительны, болезненны при пальпации. Суставная форма обычно проявляется моноартритом. Другие органные поражения носят неспецифический характер.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лабораторные исследования. Общеклинические анализы крови и мочи при споротрихозе не имеют патогномоничных признаков. Биохимические параметры изменяется соразмерно органной недостаточности. При гистологическом исследовании пораженных тканей могут определяться астероидные тельца или феномен Сплендора-Хоппли. В анализе синовиальной жидкости выявляется высокое содержание полиморфноядерных лейкоцитов и белка, низкий уровень глюкозы.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выявление инфекционных агентов. Основным методом обнаружения грибка в организме является ПЦР биологических жидкостей и тканей организма. Обязательна микроскопия биоптатов, мокроты и отделяемого свищей, посев на питательные среды. Кожная аллергопроба со споротрихином применяется ограниченно. Серологические исследования (ИФА) преимущественно служат для диагностики генерализованной инфекции и рецидивов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лучевая диагностика. Рентгенография органов грудной клетки при легочной форме свидетельствует о поражении верхних долей легких в виде инфильтрации, фиброза, иногда – полостей распада. На рентгенограммах суставов при костно-суставной форме визуализируются свищевые ходы и признаки остеопороза. УЗИ мягких тканей и лимфатических узлов назначается для выявления воспалительных изменений.</span></p>\r\n</li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Характер лечения, его длительность и подбор медикаментов зависят от формы споротрихоза, тяжести течения болезни, и определяются для каждого больного отдельно.</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">назначение противогрибковых препаратов в виде таблеток или инъекций</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">перевязки и местная обработка кожных очагов заболевания</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">прием обезболивающих, дезинтоксикационных и других симптоматических препаратов</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">удаление пораженных тканей методами криохирургии, электрохирургии, классического оперативного вмешательства</span></li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфическая профилактика (вакцина) не разработана, проводятся испытания новых препаратов. Важность поиска профилактических средств обусловлена появлением устойчивых видов грибка. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К неспецифическим мерам борьбы со споротрихозом относят использование перчаток и защитной одежды, предупреждение травм во время работ с почвой и растениями, ухода за домашними животными. Трупы больных животных рекомендуется подвергать кремации.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инкубационный период болезни составляет около 12 недель, а первая клиническая симптоматика может проявляться уже на 3 – 4 недели, после инфицирования.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Далее болезнь проявляется в зависимости от формы протекания.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При поверхностном заражении на коже возникают акне, папулы, бляшки, микроабсцессы, папилломатозная или веррукозная сыпь на коже. Сюда также можно отнести и поражение слизистых: эритематозные, язвенные поражения полости рта, глотки, гортани, носа и носоглотки.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Локализованный подкожный: в начале заболевания под кожей определяется небольшой, не спаянный с кожей инфильтрат, размером от 0,5 до 1 см. Далее он спаивается с кожей, увеличивается в размерах, а кожа над ним имеет синюшный оттенок. Далее этот узел некротизируется, на его месте образуется язва – споротрихозный шанкр, от которого, по ходу лимфатического сосуда, тянется, подобный нити, тяж с множеством этих инфильтратов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При диссеминированном кожном виде будут образовываться абсцессы, язвы и другие образования.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Висцеральный вид характеризуется поражением легких, желудочно-кишечного тракта, печени, селезенки, суставов. При поражении легких симптомы похожи на легочный туберкулез, при поражении суставов – например, остеомиелит, периостит. Эта форма данного микоза протекает с высокой температурой, гемодинамическими изменениями, нарушением общего состояния больного.</span></p>",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возбудители патологии – различные виды пиявок. Практически повсеместно распространены пиявки рода Haemopis, Limnatis, Hirudo (медицинские), вида Tyrannobdella rex (королевская). Обитают паразиты во влажной траве, торфяных болотах, стоячих пресных водоемах. Являются гермафродитами и активными хищниками, питаются кровью зверей, птиц, человека, присасываясь с помощью хоботков или хитиновых челюстей. Нападают преимущественно в ночное время.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Факторы риска</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основные факторы риска гирудиноза связаны с профессиональной деятельностью, туризмом, проживанием в эндемичных регионах. Так, наиболее часто заражаются:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">путешественники, проходящие маршруты по джунглям, заболоченной местности;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">жители регионов с высокой влажностью, большим числом непроточных озер;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">работники водоканалов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ветеринары;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">профессиональные рыболовы и охотники.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На момент присасывания пиявка прокусывает кожу человека, одновременно выделяя железистый секрет, являющийся сильным антикоагулянтом (гирудин), белки, гистаминоподобные вещества. Это приводит к капиллярному расширению, локальному кровотечению. Медицинская пиявка может высосать до 15 мл крови за полчаса, с учетом последующего кровотечения после удаления паразита организм теряет до 60 мл. Иногда кровоточивость места укуса продолжается до суток.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Во время питания пиявка значительно увеличивается в размере, перекрывая просвет полого органа. Образующаяся ранка приводит к механическому повреждению тканей, имеет звездчатую форму, диаметр до 2 мм, глубину до 1,5 мм. Возникает подкожное кровоизли­яние. Позднее область укуса приобретает желтый цвет, на месте ранки остает­ся треугольный рубчик, заметный в течение нескольких месяцев и лет.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностика гирудиноза осуществляется врачами различных специальностей – это зависит от локализации возбудителя. Чаще всего больные попадают на прием к оториноларингологу, гинекологу и хирургу. Важен сбор анамнеза на предмет пребывания во влажных, заболоченных местностях, факты употребления воды из непроточных источников, колодцев. Дополнительно проводятся лабораторно-инструментальные и клинические исследования:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Физикальный осмотр. При наружном расположении возбудитель заметен и может быть удален. У пациента с внутренним гирудинозом объективный осмотр выявляет симптомы астении, бледность, сухость кожных покровов, нередко тахикардию, дисфонию, одышку. При пальпации живота отмечается урчание, вздутие, определяются диффузная или локальная болезненность, спленомегалия. Обязательна визуальная оценка рвоты, кала и мочи.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эндоскопические исследования. Инструментальный осмотр полости носа (риноскопия), ротоглотки, органов дыхания (ларингоскопия, трахеобронхоскопия), а также различных отделов пищеварительного тракта (эзофагогастроскопия, колоноскопия) проводится по показаниям при подозрении на органный гирудиноз. Если в ходе исследования обнаруживается пиявка, производится ее удаление, прижигание места присасывания.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лабораторные исследования. В общем анализе крови – нормохромная или гипохромная анемия, незначительный лейкоцитоз, редко эозинофилия, ускорение СОЭ. Может выявляться повышение активности СРБ, трансаминаз, нарушения свертывания крови, снижение ферритина. Общеклинический анализ мочи обнаруживает лейкоцитурию, эритроцитурию, гематурию.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инструментальные методы. Для исключения новообразований проводится рентгенография (либо низкодозовая МСКТ) легких, МРТ гортани, глотки, пищеварительного тракта, ирригоскопия. Рекомендуется УЗИ органов брюшной полости, малого таза. В некоторых случаях выполняется диагностическая лапароскопия.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Удаление пиявки</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Удаление пиявки при наружном присасывании нередко осуществляется самим пациентом либо врачом в амбулаторных условиях. Важным условием является полное избавление от паразита без оставления в ране ротового аппарата. Путем воздействия на видимую часть паразита крепкими солевыми, спиртовыми растворами, йодом пиявку заставляют прекратить присасывание, убирают пинцетом. На ранку накладывают давящую повязку.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Медикаментозная терапия</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Больные с признаками осложнений должны быть госпитализированы. Пациенты с дыхательной недостаточностью, выраженной кровопотерей помещаются в палаты интенсивной терапии. После удаления возбудителя рекомендуется обогащение рациона белковой и железосодержащей пищей.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Важным этапом является восстановление кровопотери, коррекция железодефицитной анемии и ее последствий. Восстановление объема циркулирующей крови показано только в случае массивного кровотечения, проводится глюкозо-солевыми растворами, свежезамороженной плазмой, реже − эритроцитарной массой.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Местно применяются кровоостанавливающие повязки, химическое, лазерное коагулирование раны. Антибактериальные средства при гирудинозе назначаются по показаниям. Фармакологического антидота к компонентам железистого секрета пиявок не существует.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфической профилактики нет. Неспецифические меры – отказ от питья сырой воды из колодцев, озер, купания на необорудованных пляжах, в стоячих водоемах. Купальные костюмы должны быть закрытыми, необходимо надевать шапочку и очки, нельзя глотать воду.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В походах, особенно утренних, рекомендуется носить брюки, заправленные в обувь, носки, высокие резиновые сапоги, не расстегивать ворот рубашки. Можно использовать солевые повязки, химические вещества для отпугивания пиявок (инданол, диметилфолат), либо нанести на одежду, тело и обувь парфюм или жидкое мыло с резким запахом. Запрещается ходить босиком и в открытой обуви по влажной траве.</span></p>\r\n<p><span id=\"docs-internal-guid-3abf222f-7fff-3aaa-3c3c-862867b3e25c\"> </span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инкубационный период зависит от длительности присасывания, локализации и вида возбудителя. Самые распространенные симптомы гирудиноза − проявления хронической анемии, вызванные кровопотерей: слабость, снижение работоспособности, сонливость. Нередко больные отмечают бледность кожи, шум в ушах, учащение пульса, дыхания, выраженные головокружения.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наружное присасывание пиявок быстро обнаруживается самим пострадавшим. Вначале возникает умеренная острая боль в области укуса, которая вскоре стихает. Напитавшийся кровью паразит увеличивается в десятки раз. После удаления пиявки ранка может недолго кровоточить.</span></p>",
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},
"code": "I00",
"name": "Ревматическая лихорадка без упоминания о вовлечении сердца",
"icd_name": "Ревматическая лихорадка без упоминания о вовлечении сердца",
"gender": 0,
"age_min": 1,
"age_max": 94,
"cause": [
3,
2,
4,
9
],
"periodicity": 1,
"slug": "i00_revmaticheskaya_lihoradka_bez_upominaniya_o_vovlechenii_serdca",
"lead": "Нарушение здоровья, относящееся к группе острая ревматическая лихорадка",
"description": "Согласно международной классификации болезней, острая ревматическая лихорадка (ОРЛ) — системное заболевание соединительной ткани с преимущественной локализацией процесса в сердечно-сосудистой системе, развивающееся в связи с острой А-стрептококковой инфекцией у предрасположенных к нему лиц, главным образом в возрасте 7–15 лет.",
"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>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 82,
"published": 2,
"parent": null,
"block_rubric": 90,
"standards": []
},
{
"id": 8209,
"symptoms": [
{
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{
"name": "назойливый кашель"
}
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