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},
"code": "B83.4",
"name": "Внутренний гирудиноз",
"icd_name": "Внутренний гирудиноз",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "b83.4_vnutrenniy_girudinoz",
"lead": "заражение кровососущими пиявками внутренних полостей тела, открытых для проникновения паразитов",
"description": "",
"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 style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">путешественники, проходящие маршруты по джунглям, заболоченной местности;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; 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: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">работники водоканалов;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ветеринары;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">профессиональные рыболовы и охотники.</span></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;\">Выделяя гирудин, являющийся сильным антикоагулянтом, а также гистаминоподобное вещество, расширяющее капилляры, пиявки вызывают кровотечение в месте присасывания. Возможны развитие анемии, головные боли и другие симптомы в зависимости от локализации паразита. Наиболее опасно присасывание пиявки к голосовым складкам или к стенке трахеи, т.к. это может привести к асфиксии.</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;\">Другой фактор патогенеза - механические повреждения, связанные с движением пиявки и травмированием ею нежных тканей. Последний фактор обычно проявляет себя при внутреннем гирудинозе, когда пребывание червя в полостях тела, протоках и внутренних органах может вызвать закупорку ходов, раздражение, спазматические явления и т. д.</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;\">Данные патологические процессы отягчают протекание гирудиноза. Наиболее тяжело гирудиноз протекает у лиц, предрасположенных или страдающих нарушениями механизма свертываемости крови.</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> </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>",
"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;\">Лечение висцерального гирудиноза, как правило, включает удаление пиявки при эндоскопическом исследовании. В стационарных условиях манипуляция проводится только при наличии отягощенного по нарушениям свертывания анамнеза. Во время эндоскопии пиявку обрабатывают тампоном, смоченным спиртово-йодным раствором, заставляя прекратить присасывание, и удаляют. Ранку ушивают или коагулируют.</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: 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;\">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>",
"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> </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>",
"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;\">При носовом гирудинозе первые симптомы – назальные кровотечения, ощущение инородного тела, зуд, иногда нарушения обоняния и чувство заложенности. Поражение ротоглотки и гортани проявляется изменениями голоса, осиплостью, лающим приступообразным кашлем, а также сухостью, чувством «комка в горле», першением.</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;\">Нахождение пиявки внутри трахеи, нижних дыхательных путей вызывает нарастающие симптомы нехватки воздуха, одышку. При тяжелом течении пациенты принимают вынужденную позу для облегчения вдоха и выдоха, отмечают эпизоды кровохарканья и горлового кровотечения.</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 локализации пиявок в пищеводе возникают боли за грудиной, затруднения проглатывания пищи, тошнота, рвота с кровью. Гирудиноз ЖКТ практически сразу проявляется рвотой типа «кофейной гущи», дегтеобразным стулом либо наличием прожилок крови в испражнениях. Поражение мочеполовой системы (уретры, влагалища, мочевого пузыря) манифестирует с появления кровянистых выделений из половых путей, болезненных ощущений в промежности и над лобком, мочи красного цвета.</span></p>",
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},
"code": "B81.1",
"name": "Кишечный капилляриоз",
"icd_name": "Кишечный капилляриоз",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"7"
],
"periodicity": 1,
"slug": "b81.1_kishechnyy_kapillyarioz",
"lead": "паразитарное заболевание, в основе возникновения которого лежит проникновение в организм специфических круглых червей, называющихся капилляриями",
"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;\">Кишечный капилляриоз — зоонозный гельминтоз из группы нематодозов с фекально-оральным механизмом передачи возбудителя, характеризующийся диспептическим синдромом, снижением массы тела и кахексией.</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 – круглый червь капиллярия, взрослые особи которого достигают 2-4 мм. Источниками инфекции могут служить больные люди и животные (млекопитающие, рыбы), в организме которых происходит размножение паразита. Попадая в окружающую среду с фекалиями, мочой, рвотой, мокротой, а также вследствие разложения тела организма-хозяина в случае естественной либо насильственной смерти, яйца гельминта в течение 30-45 дней превращаются в личиночную форму и сохраняют жизнеспособность более года. Промежуточными хозяевами выступают рыбы и дождевые черви.</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;\">Путь заражения преимущественно алиментарный (немытые ягоды, овощи и фрукты), реже инфицирование происходит путем непосредственного контакта с больным (при поцелуях, чихании, кашле, во время игр и ухода за бездомными и домашними котами и собаками). Группами риска являются рыбаки, работники рыбоперерабатывающих комбинатов, пищевой промышленности, дети, ветеринары, сотрудники служб по отлову бездомных животных.</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;\">После попадания в организм человека личинки оседают преимущественно в тонкой (тощей) кишке. Прикрепляясь к слизистой оболочке, капиллярии нарушают естественное всасывание питательных веществ, оказывают механическое повреждающее воздействие, вызывают воспалительные изменения слизистой оболочки. При попадании в кровеносные сосуды кишечника гельминты могут распространяться по организму, обладая тропизмом к печеночной и легочной тканям.</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;\">Вызываемые некротические изменения в тканях приводят к нарушению функции органов; при длительной инвазии поврежденные участки могут замещаться соединительной тканью. Фиброзные изменения способствуют снижению воздушности легких и нарушению газообмена; в печени процесс фиброзирования снижает способность органа к регенерации, элиминации продуктов жизнедеятельности и выработке компонентов свертывающей системы крови.</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;\">Диагностические манипуляции, позволяющие верифицировать диагноз, включают в себя:</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;\">Объективный осмотр. Физикальное обследование может выявить увеличение печени и селезенки, ослабление дыхания в легких, притупление перкуторного звука. Могут быть кожные высыпания различного характера, желтуха, отеки конечностей и лица, снижение сухожильных рефлексов. При пальпации живота обнаруживается также вздутие, урчание, диффузная или локальная болезненность. Необходимо оценить стул пациента (количество, консистенцию, наличие крови, гноя, слизи).</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. Общий анализ крови при данном гельминтозе демонстрирует лейкоцитоз (за счет эозинофилии), анемию, ускорение СОЭ. Биохимические маркеры болезни – увеличение активности АЛТ, АСТ, общего и прямого билирубина, снижение общего белка, изменения электролитного состава крови. Копрограмма показывает наличие креатореи, биливердина, стеатореи, внеклеточного (свободного) крахмала.</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;\">Выявление инфекционных агентов. Микроскопия испражнений, мокроты, смывов со стенок бронхиального дерева больного проводится для выявления яиц капиллярий, личинок, взрослых гельминтов. При исследовании биоптата возможно обнаружение зрелых особей. Серологическая диагностика не разработана, ИФА проводится с антигенами других нематод и паразитов (трихинеллы, власоглава, аскариды, эхинококка, токсокары и других).</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;\">Лучевые методы. При рентгенографии лёгких можно обнаружить усиление легочного рисунка и очаговые затемнения. С целью дифференциальной диагностики может назначаться РХПГ, КТ и МРТ печени с контрастированием. УЗИ брюшной полости выявляет наличие локальных гиперэхогенных образований в печени диаметром до 1-2 мм, гепатомегалию, реже – увеличение размеров селезёнки.</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;\">Биопсия. Проведение чрескожной тонкоигольной пункционной биопсии печени показано при подозрении на поражение этого органа и позволяет исследовать печеночную ткань на наличие паразита. Забор материала рекомендуется проводить под УЗ-контролем. Реже применяется бронхоскопия с биопсией легочной ткани.</span></li>\r\n</ul>\r\n<p> </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>",
"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;\">Стационарному лечению подлежат пациенты с тяжелым течением болезни, декомпенсацией хронических патологий, дети, беременные, а также больные, проживающие в неблагополучных социально-бытовых условиях. Главным является возмещение потерь жидкости и электролитов – с целью восстановления баланса пациенту назначается соблюдение водного режима. Диета при капилляриозе играет важную роль, щадящее гипоаллергенное питание позволяет снизить повреждающее воздействие на кишечник и печень.</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;\">Постельный режим необходим до нормализации температуры в течение 1-2 суток. В качестве этиотропной терапии используется мебендазол и его аналоги, преимущественно в виде таблетированных форм. Симптоматическое лечение включает в себя оральные регидранты и инфузионные электролитные растворы (дисоль, ацесоль, хлосоль), жаропонижающие (парацетамол), спазмолитики (дротаверин), сорбенты (полиметилсилоксана полигидрат, смектит), ферментные (панкреатин) препараты.</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;\">С целью профилактики заражения следует тщательно мыть овощи и фрукты, следить за гигиеной рук, избегать употребления в пищу сырой рыбы.</span></p>\r\n<p><span id=\"docs-internal-guid-bc4cc7e1-7fff-b052-d750-760488729938\"> </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;\">При кишечном капилляриозе симптомы появляются постепенно спустя 4 и более недель после заражения. Хотя в некоторых случаях болезнь длительное время может не проявлять себя, что опасно переходом в более тяжелую стадию, когда лечение уже является затруднительным.</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;\">Первыми неспецифическими признаками кишечного капилляриоза являются часто повторяющееся урчание в животе и периодически появляющиеся боли в области кишечника.</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;\">Такие симптомы наблюдаются в течение пары-тройки недель, после чего болезнь разворачивается в полную силу. 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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;\">частая рвота,</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; 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;\">ухудшение аппетита вплоть до полного его отсутствия,</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; 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;\">потеря веса,</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; 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; 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