Disease List

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{
    "count": 11794,
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        {
            "id": 6030,
            "symptoms": [
                {
                    "id": 2746,
                    "synonyms": [
                        {
                            "name": "Астения"
                        },
                        {
                            "name": "утомляемость"
                        },
                        {
                            "name": "Снижение работоспособности"
                        },
                        {
                            "name": "Недомогание"
                        },
                        {
                            "name": "Усталость"
                        }
                    ],
                    "body_points": [
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                            "r": 0
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                    ],
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                    "name": "Утомляемость",
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                    "age_min": 1,
                    "age_max": 100,
                    "slug": "utomlyaemost",
                    "lead": "Если вы быстро утомляетесь обязательно проверьтесь у врача   ",
                    "image": null,
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                },
                {
                    "id": 3003,
                    "synonyms": [
                        {
                            "name": "Температура 37-38°"
                        },
                        {
                            "name": "Субфебрильная температура"
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                    "name": "Повышенная температура 37-38°",
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                    "age_min": 0,
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                    "slug": "povyshennaya_temperatura_37-38",
                    "lead": "Температура 37-38 °, при продолжительном повышении температуры следует обратиться к врачу",
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                {
                    "id": 2954,
                    "synonyms": [
                        {
                            "name": "Потеря аппетита"
                        },
                        {
                            "name": "Недоедание"
                        },
                        {
                            "name": "Отказ от пищи"
                        }
                    ],
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                    ],
                    "disease_count": 119,
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                    "name": "Снижение аппетита",
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                    "slug": "snizhenie_appetita",
                    "lead": "Частичный или полный отказ от приема пищи. Проявляется снижением общего аппетита (не хочется ничего), изменением аппетита (нарушаются вкусовые потребности в отношении какой либо группы продуктов),  полным отсутствием аппетита (анорексия).",
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                },
                {
                    "id": 2878,
                    "synonyms": [
                        {
                            "name": "Дрожь"
                        },
                        {
                            "name": "Холод"
                        },
                        {
                            "name": "Знобит"
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                    ],
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                            "r": 0
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                    ],
                    "disease_count": 73,
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                    "name": "Озноб",
                    "gender": 0,
                    "age_min": 1,
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                    "slug": "oznob",
                    "lead": "Вызывается спазмом кожных кровеносных сосудов ощущение холода, сопровождающееся мышечной дрожью",
                    "image": null,
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                },
                {
                    "id": 2848,
                    "synonyms": [
                        {
                            "name": "мышечная боль"
                        },
                        {
                            "name": "боль в мышцах"
                        },
                        {
                            "name": "мышцы болят"
                        },
                        {
                            "name": "Миалгия"
                        },
                        {
                            "name": "ломота"
                        },
                        {
                            "name": "боль в мышцах рук"
                        },
                        {
                            "name": "боль в мышцах ног"
                        },
                        {
                            "name": "боль в мышцах после тренировки"
                        },
                        {
                            "name": "боль в мышцах спины"
                        },
                        {
                            "name": "боль икроножная"
                        }
                    ],
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                        {
                            "name": "Боль в спине"
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                        {
                            "name": "Спина внизу болит"
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                        {
                            "name": "Боль в крестце"
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                        {
                            "name": "Боль в области крестца"
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                            "name": "Боль в пояснице справа"
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                            "name": "Боль в суставах ног"
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                            "name": "Боль в суставах у ребенка"
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                            "name": "Боль в суставах при беременности"
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            },
            "code": "A23",
            "name": "Бруцеллез",
            "icd_name": "Бруцеллез",
            "gender": 0,
            "age_min": 0,
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            "cause": [
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            "slug": "a23_brucellez",
            "lead": "инфекционное заболевание, которое передается человеку от больного животного",
            "description": "<p>Бруцеллез - это&nbsp;<span style=\"color: #202122; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">зоонозная инфекция, передающаяся от больных животных человеку, характеризующаяся множественным поражением органов и систем организма человека.</span></p>",
            "etiology": "<p>Возбудитель заболевания &ndash; бруцеллы. Источником бруцелл являются сельскохозяйственные животные &ndash; мелкий и крупный рогатый скот, свиньи. Человек инфицируется при уходе за ними или при употреблении инфицированных продуктов. Входными воротами для проникновения инфекции являются пищеварительный тракт, трещины, царапины и другие повреждения на коже или слизистой оболочке. Проникнув в организм, бруцеллы с лимфотоком проникают в регионарные лимфоузлы, где вызывают воспалительные изменения. В дальнейшем бруцеллы поступают из первичных очагов в кровь и разносятся по всему организму, обусловливая образование гранулем во внутренних органах, <a title=\"Перейти на страницу симптома воспаление\" href=\"/symptom/vospalenie/\">воспаление</a> мелких кровеносных сосудов, поражение синовиальных оболочек, слизистых сумок суставов, сухожильных соединений, фасций, периферических нервов.</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;\">Входные ворота инфекции &mdash; слизистая оболочка желудочно-кишечного тракта и верхних дыхательных путей, механически повреждённая кожа, конъюнктива глаза. Инфицирующая доза &mdash; 10-100 бактерий.</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;\">После попадания в организм патогенные бактерии движутся к регионарным лимфоузлам. Там они размножаются, а затем проникают в кровь, выделяя токсины и приводя к появлению первых признаков заболевания.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Дальнейшее развитие и размножение бруцелл происходит в лимфатических узлах, откуда они периодически проникают в кровоток, приводя при неоднократных атаках к распространению инфекции по всему организму. В ответ на инфицирование происходит выработка антител, стимуляция фагоцитоза (поглощение иммунными клетками крови), что ведёт к исчезновению возбудителя бруцеллёза из крови и изменению клинической картины болезни (сглаживанию симптомов). Однако часто бактерии сохраняются в некоторых органах и тканях, где они избегают пагубного воздействия иммунной системы хозяина. Это приводит к хронизации болезни.</span></p>\r\n<p>&nbsp;</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;\">Также при длительном течении болезни повышается чувствительность к чужеродным агентам в первую очередь за счёт развития аллергической реакций к бруцеллёзному антигену. Это в корне меняет ход иммунного процесса &mdash; на этом фоне наступает повторная генерализация, при которой бруцеллы выходят из метастатических очагов, вновь попадают в кровь, приводя к развитию рецидива.</span></p>",
            "diagnostics": "<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;\">клинический анализ крови: аномально высокий уровень нейтрофилов со сдвигом влево, повышение СОЭ, низкий уровень тромбоцитов и лимфоцитов, низкая концентрация гемоглобина;</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;\">общий анализ мочи: уменьшение количества или отсутствие мочи, появление в ней белка, цилиндрических телец, лейкоцитов и эритроцитов;</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;\">биохимический анализ крови;</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;\">бактериальный посев биоматериала (крови, мочи, спинномозговой жидкости) на среды Терского или Фервольд &mdash; Вольфа с добавлением сыворотки кролика, барана (сыворотка улучшает рост бактерий бруцеллёза);</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;\">иммунологические серологические реакции (ИФА): необходимы двукратные тесты с интервалом в 2-4 недели для оценки нарастания титра антител в острый период;</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;\">ПЦР-диагностика (полимеразная цепная реакция) &mdash; высокоточный метод, особенно в период острой инфекции и обострения;</span></li>\r\n<li><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;\">пассажи на животных &mdash; микробиологическая операция, осуществляемая с лабораторными животными при внедрении в их ткани бактерий</span></li>\r\n</ul>",
            "treatment": "<p>Назначается антибактериальная терапия при остром бруцеллезе и обострении хронического бруцеллеза. Симптоматическое лечение включает прием обезболивающих, противовоспалительных средств. В стадии ремиссии и при стихании острого процесса показаны физиотерапевтические процедуры, бальнеологическое лечение.</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;\">К мерам профилактики бруцеллёза относятся следующие мероприятия:</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;\">употребление в пищу только кипяченого молока;</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;\">строгий ветеринарный контроль животных;</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;\">информирование населения о возможности заражения бруцеллёзом;</span></li>\r\n<li><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;\">проведение вакцинации среди группы риска (прививка действует на протяжении 2-х лет).</span></li>\r\n</ul>",
            "clinical_picture": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Длительность инкубационного периода &ndash; от 1 до 8 недель, в среднем &ndash; 2-4 недели. Она зависит от формы заболевания, при острой форме инкубационный период короче, при латентном носительстве &ndash; может достигать 3 месяцев.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для всех форм бруцеллеза в начальной стадии характерны следующие симптомы:</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- Общая инфекционная интоксикация &ndash; слабость, недомогание, головная боль, бессонница.</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- Гипертермия или лихорадка &ndash; длительное повышение температуры тела до субфебрильных цифр (до 38 &deg;C) или волнообразная лихорадка с резкими подъемами и падениями. Продолжительность лихорадки &ndash; до нескольких месяцев, она сопровождается ознобом и сильным потоотделением.&nbsp;</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- Артралгии и миалгии &ndash; суставные и мышечные боли, чаще поражающие нижние конечности. Эти боли &ndash; характерный симптом бруцеллеза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">По мере развития заболевания у пациентов могут появляться гепатолиенальный синдром &ndash; увеличение размеров печени и селезенки, генерализованная микролимфаденопатия &ndash; увеличение лимфатических узлов в несмежных областях, различные поражения нервной системы &ndash; от нарушения чувствительности и потери сознания до паралича конечностей, психических расстройств. При разных формах бруцеллеза присоединяются различные симптомы.</span></p>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">&nbsp;</span></p>",
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                    "lead": "Состояние, при котором у больного наблюдается учащённая (более 3 раз в сутки) дефекация, при этом стул становится жидким",
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                        {
                            "name": "Боль головная у детей"
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                        {
                            "name": "Боль при повороте головы"
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                        {
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            },
            "code": "A22",
            "name": "Сибирская язва",
            "icd_name": "Сибирская язва",
            "gender": 2,
            "age_min": 0,
            "age_max": 100,
            "cause": [
                4,
                5,
                7
            ],
            "periodicity": 1,
            "slug": "a22_sibirskaya_yazva",
            "lead": "Острая сапрозоонозная инфекционная болезнь с преимущественно контактным механизмом передачи возбудителя. ",
            "description": "Чаще всего протекает в доброкачественной кожной форме, реже — в генерализованной. Относят к опасным инфекциям. Возбудитель сибирской язвы рассматривают в качестве биологического оружия массового поражения (биотерроризм).",
            "etiology": "<p>Возбудитель — крупная грамположительная неподвижная палочка Bacillus anthracis рода Bacillus семейства Bacillaceae.</p>\r\n<p>Резервуар инфекции — почва, в которой вследствие повторения биологических циклов (спора–вегетативная клетка) возбудитель длительно сохраняется и накапливается. Такая особенность B. anthracis способствует созданию долговременно активных почвенных очагов («проклятые» поля) и потенциально опасных территорий. Это приводит к периодическим эпизоотиям и случаям сибирской язвы у людей. Болезнь развивается при попадании в организм вегетативных клеток или спор возбудителя. Источники B. anthracis для человека — крупный (буйволы, коровы) и мелкий (козы, овцы) рогатый скот, лошади, верблюды, а также (в редких случаях) дикие животные (зайцы, волки, медведи, песцы и др.).</p>\r\n<full></full>\r\n<p>Больные животные выделяют возбудитель с мочой, калом и другими выделениями. Заболеваемость людей зависит от степени распространения этой инфекции среди животных. Механизмы передачи возбудителя к человеку — контактный (при нарушении правил личной гигиены при уходе за больными животными, забое и разделке туш, снятии шкур, контакте с шерстью, шкурой и другими продуктами животноводства, контаминированными B. anthracis), аспирационный (воздушно-пылевым путём при вдыхании инфицированной пыли, костной муки), фекально-оральный (пищевой путь при употреблении мяса заражённого животного) и трансмиссивный (через укусы слепней, мух-жигалок, комаров). Факторы передачи — почва, вода, воздух, пища, предметы быта, животные и продукты их жизнедеятельности, эктопаразиты.</p>",
            "pathogenesis": "<p>Заражение происходит при попадании как вегетативной формы, так и спор возбудителя в организм человека, где они благодаря капсуле защищены от фагоцитоза и продуцируют экзотоксин, вызывающий повреждение эндотелия сосудов. Микроциркуляторные нарушения и повышение проницаемости сосудов — важное звено патогенеза сибирской язвы. В результате этих изменений в местах размножения возбудителя (кожа, лимфатические узлы, лёгкие, кишечная стенка) развиваются серозно-геморрагическое , периваскулярные кровоизлияния, геморрагические инфильтраты, резкий . При заражении аэрозольным и алиментарным путями возбудитель легко преодолевает лимфатический барьер, распространяется гематогенно. Инфекция принимает генерализованный характер с массивным обсеменением органов (септицемия), сопровождаясь развитием инфекционно-токсического шока, тромбогеморрагического синдрома и полиорганной недостаточности. При перкутанном заражении генерализацию инфекции наблюдают редко.  ограничивается кожей, носит локальный характер, однако токсины вызывают повышенную проницаемость сосудов с развитием обширного отёка и местной анестезией.</p>",
            "diagnostics": "<p>Диагноз кожной формы болезни устанавливают на основании характерных местных изменений: наличия чёрного струпа с венчиком гиперемии («чёрный уголёк на красном фоне»), студенистого безболезненного отёка и регионарного лимфаденита, появления общих симптомов после формирования карбункула.</p>\r\n<p>Особое значение для диагностики имеют эпидемиологические данные (профессия, уход за скотом, забой, разделка туш, работа с кожами, шкурами и т.д., ношение изделий из кожи и меха нефабричной выделки, употребление мяса, не прошедшего ветеринарно-санитарного контроля, особенно при вынужденном забое больных животных). При генерализованной форме болезни установить диагноз без эпидемиологических и лабораторных данных сложно.</p>\r\n<p>Разработаны тест-системы для определения генетического материала возбудителя сибирской язвы методом ПЦР. Применяют кожно-аллергическую пробу с антраксином, которая с 3-го дня болезни становится положительной в 82% случаев. При исследовании животноводческого сырья (шкуры, шерсть) применяют реакцию термопреципитации по Асколи и другие методы.</p>",
            "treatment": "<p>Лечение сибирской язвы включает этиотропную и патогенетическую терапию, проводимую в зависимости от формы болезни и имеющихся клинико-лабораторных синдромов.</p>\r\n<p>Одновременно с этиотропной терапией однократно вводят специфический противосибиреязвенный иммуноглобулин в дозе 20–100 мл внутримышечно (доза зависит от тяжести состояния). Местная терапия заключается только в обработке поражённых участков кожи растворами антисептиков. Повязки не накладывают.</p>",
            "prevention": "<p>Профилактические мероприятия подразделяются на ветеринарные и медико-санитарные.</p>\r\n<p>Ветеринарная служба осуществляет выявление, своевременную диагностику, забой больных животных, эпизоотологическое обследование очага, обеззараживание трупов, уничтожение мяса, шкур, шерсти павших животных, текущую и заключительную дезинфекцию в очаге, разрабатывает мероприятия, направленные на оздоровление скотомогильников, пастбищ, неблагополучных по сибирской язве территорий, а также плановую иммунизацию живой сибиреязвенной вакциной сельскохозяйственных животных в неблагополучных пунктах. Комплекс медико-санитарных мероприятий включает:</p>\r\n<ul>\r\n<li>контроль за соблюдением общесанитарных норм при заготовке, хранении, транспортировке и переработке сырья животного происхождения;</li>\r\n<li>вакцинопрофилактику живой споровой сухой бескапсульной вакциной — двукратно планово (на неблагополучных по сибирской язве территориях) и внеплановую (по эпидемическим показаниям с последующей ревакцинацией ежегодно);</li>\r\n<li>своевременную диагностику, госпитализацию и лечение больных;</li>\r\n<li>эпидемиологические обследования очага, текущую и заключительную дезинфекцию (4% хлорамином); · запрещено проводить посмертное вскрытие больных из-за возможности заражения спорами.</li>\r\n</ul>\r\n<p>Лицам, соприкасающимся с больными людьми или животными, в целях профилактики вводят противосибиреязвенный иммуноглобулин и антибактериальные препараты в течение 5 дней (табл. 17-28, 17-29). Наблюдение за контактными ведётся в течение 14 дней.</p>",
            "clinical_picture": "<p>Инкубационный период зависит от пути проникновения и инфицирующей дозы возбудителя. Выделяют кожную (наружную, локализованную) и генерализованную (внутреннюю, висцеральную, септическую) формы сибирской язвы.</p>\r\n<p>Генерализованные формы могут быть первичными (карбункул отсутствует) и вторичными (при наличии карбункула). Кожная форма подразделяется на карбункулёзный, эдематозный, буллёзный, рожистоподобный и глазной варианты, а генерализованная форма — на лёгочный, кишечный и септический варианты.</p>\r\n<p>Наиболее часто (95–98% всех случаев сибирской язвы) встречается кожная форма. Инкубационный период при кожной форме болезни составляет от 2 до 14 сут. При своевременной антибактериальной терапии заболевание протекает относительно доброкачественно и заканчивается выздоровлением. Чаще наблюдается карбункулёзный вариант.</p>\r\n<p>В месте внедрения возбудителя (обычно на руках или голове) появляется красноватое или синеватое пятнышко, похожее на укус насекомого. Через несколько часов оно трансформируется в папулу медно-красного цвета, затем (в течение суток) в пузырёк, заполненный серозно-геморрагическим содержимым. Больных беспокоят жжение и . При расчёсывании или спонтанно пузырёк вскрывается с образованием язвочки, покрытой тёмно-коричневым струпом, формируется сибиреязвенный карбункул. Он расположен на плотном инфильтрированном основании, окружён венчиком яркой гиперемии. Образующиеся вокруг дочерние пузырьки также вскрываются, поэтому размеры струпа увеличиваются до 0,5–3,0 см в диаметре и более. Вокруг карбункула развивается резкий распространённый  мягких тканей, имеющий желеобразную консистенцию. Болевая чувствительность в области карбункула и отёка из-за воздействия токсина на нервные окончания резко снижена или полностью отсутствует. Кожа в зоне отёка бледная. Регионарные лимфатические узлы плотные, подвижные, умеренно увеличены, слегка чувствительны при пальпации. При локализации карбункула в области кисти или предплечья возможен лимфангит. После уменьшения отёка (8–10-й день болезни)  возвышается над поверхностью кожи, под ним идут процессы рубцевания и эпителизации язвы. Через 10–30 дней  отторгается, язва полностью рубцуется. Карбункулы могут быть единичными и множественными (до десяти и более).</p>\r\n<full></full>\r\n<p>При кожной форме болезни общее состояние больного в первый день болезни остаётся удовлетворительным, на 2–3-й день появляются  с ознобом\">Озноб\"> с ознобом\"><a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>, , \">, температура тела поднимается до 38–40 °С, отмечают тахикардию, артериальную гипотензию. Температура тела остаётся повышенной в течение 3–7 дней, затем критически падает до нормы, общее состояние пациента быстро улучшается, уменьшается  в области карбункула, а потом  отторгается и наступает полное выздоровление.</p>\r\n<p>Значительно реже после кратковременного улучшения внезапно появляется  с ознобом\">Озноб\"> с ознобом\"><a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>, резко ухудшается общее состояние и развивается генерализованная инфекция. В настоящее время при современной антибиотикотерапии заболевание протекает относительно доброкачественно и заканчивается выздоровлением. Летальность при кожной форме болезни не превышает 2–3% при лечении, без антибиотикотерапии достигает 20%.</p>\r\n<p>Первичная генерализованная форма сибирской язвы развивается при аэрогенном или алиментарном пути заражения и крайне редко — при внедрении возбудителя через кожу или слизистую оболочку (например, губ). При этом в месте внедрения возбудителя карбункул не формируется. Генерализованная форма характеризуется бурным началом, потрясающим ознобом, гипертермией, резко выраженными симптомами интоксикации, головной болью, рвотой, тахикардией, прогрессирующей гипотензией, глухостью тонов сердца. Часто увеличиваются печень и селезёнка, появляются геморрагическая  на коже, , симптомы поражения центральной нервной системы. При лёгочном варианте в первый день болезни возможны \">, боли в мышцах, катаральные явления, поэтому часто диагностируют ОРЗ или грипп, но уже через несколько часов развивается интоксикационный синдром, температура достигает 39–41 °С и на первый план выступают такие симптомы, как <a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">чувство удушья</a>, боли в грудной клетке при дыхании, ,  с пенистой кровянистой мокротой, которая быстро сворачивается в виде желе. Кожа становится бледной, возникают , глухость тонов сердца, быстро прогрессирует \"><a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">падение</a> АД. Стремительно нарастают симптомы дыхательной недостаточности. Смерть наступает на 2–3-й день болезни от инфекционно-токсического шока и дыхательной недостаточности.</p>\r\n<p>Летальность составляет 80–100%. Положительный прогноз возможен при начале комплексной терапии до развития картины шока.</p>\r\n<p>Для кишечного варианта болезни, помимо общих симптомов, с первого дня болезни характерны режущие боли, преимущественно в нижней части живота, \">Рвота\">\">рвота\">кровавая \">Рвота\">\"><a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>, частый жидкий стул с примесью крови, быстро развивающиеся  кишечника и перитонит. Исход также неблагоприятный. При всех вариантах болезни возможны осложнения: инфекционно-токсический , , менингит, острая дыхательная недостаточность.</p>",
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                            "name": "мышечная боль"
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                            "name": "боль в мышцах"
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                            "name": "мышцы болят"
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                        {
                            "name": "Миалгия"
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                        {
                            "name": "ломота"
                        },
                        {
                            "name": "боль в мышцах рук"
                        },
                        {
                            "name": "боль в мышцах ног"
                        },
                        {
                            "name": "боль в мышцах после тренировки"
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                        {
                            "name": "боль в мышцах спины"
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                        {
                            "name": "Мышцы сводит"
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                        {
                            "name": "Постоянный тонус мышц"
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            },
            "code": "A21",
            "name": "Туляремия",
            "icd_name": "Туляремия",
            "gender": 0,
            "age_min": 0,
            "age_max": 100,
            "cause": [
                "4",
                "5",
                "6",
                "7"
            ],
            "periodicity": 1,
            "slug": "a21_tulyaremiya",
            "lead": "Туляремия  — острая зоонозная бактериальная природно-очаговая инфекционная болезнь с разнообразными",
            "description": "<p>Характеризуется лихорадкой, интоксикацией, воспалительными изменениями в области входных ворот инфекции, регионарным лимфаденитом.</p>",
            "etiology": "<p>Возбудитель &mdash;грамотрицательная полиморфная (преимущественно кокковидная) неподвижная палочка, не образующая спор и капсул.</p>\r\n<p>Туляремия &mdash; классическая природно-очаговая болезнь, облигатный зооноз. Источником возбудителя инфекции служат около 150 видов животных, включая 105 видов млекопитающих, 25 видов птиц, несколько видов рыб, лягушек, других гидробионтов. На территории России основной резервуар и источник инфекции &mdash; грызуны (мышевидные, кролики, зайцы, водяные крысы, ондатры, хомяки и др.). Выделения и трупы павших животных содержат большое количество возбудителей, которые обсеменяют объекты окружающей среды, в том числе и водные, и длительно в них сохраняются. Между грызунами передача инфекции осуществляется алиментарным путём. Среди домашних животных резервуаром инфекции могут быть овцы, свиньи, крупный рогатый скот, лошади, но заражение людей чаще всего происходит в природных очагах при прямом и косвенном контакте с грызунами. Больной человек не может быть источником инфекции для окружающих.</p>\r\n<p>Переносчики инфекции, поддерживающие существование возбудителя в природных очагах, &mdash; кровососущие насекомые (иксодовые и гамазовые клещи, комары, слепни).</p>\r\n<p>В организм человека возбудитель может проникать через микротравмы кожного покрова и неповреждённую слизистую оболочку миндалин, ротоглотки, желудочно-кишечный тракт, дыхательных путей, глаз.</p>",
            "pathogenesis": "<p>F. tularensis проникает в организм человека через кожу (даже внешне не повреждённую) и слизистые оболочки глаз, дыхательных путей, миндалин и ЖКТ. При инфицировании через кожу или аэрогенным путём для развития болезни достаточно пятидесяти жизнеспособных микроорганизмов, а при алиментарном заражении &mdash; более 108 микробных клеток.</p>\r\n<p>В месте входных ворот инфекции происходит размножение возбудителя с развитием некротически-воспалительной реакции и первичного аффекта (кожная язва, проходящая стадии <a title=\"Перейти на страницу симптома Папулы\" href=\"/symptom/papuly/\">папулы</a>, везикулы и <a title=\"Перейти на страницу симптома Пустулы\" href=\"/symptom/pustuly/\">пустулы</a>; на миндалинах &mdash; некротическая ангина, в лёгких &mdash; очаговая некротическая пневмония, на конъюнктиве &mdash; конъюнктивит). Затем возбудитель проникает в регионарные лимфатические узлы, вызывая развитие специфического лимфаденита &mdash; первичного бубона. Здесь происходит частичная гибель бактерий, сопровождаемая выделением эндотоксина (ЛПС-комплекс), усиливающего местный воспалительный процесс и вызывающего развитие интоксикации при поступлении в кровь.</p>",
            "diagnostics": "<p>Диагностика туляремии основана на клинических, эпидемиологических и лабораторных данных.</p>\r\n<p>В общем анализе крови в начальном периоде обнаруживают нормоцитоз или небольшой лейкоцитоз, увеличение СОЭ. Периоду разгара болезни свойственна лейкопения с лимфо- или моноцитозом. Нейтрофильный лейкоцитоз отмечают только при нагноении бубонов.</p>\r\n<p>Для специфической диагностики туляремии применяют серологические и аллергические тесты, бактериологическое исследование и биологическую пробу.</p>",
            "treatment": "<p>Больных с подозрением на туляремию госпитализируют по клиническим показаниям. Окна в палатах должны быть закрыты сеткой, чтобы не допустить трансмиссивного пути распространения инфекции.</p>\r\n<p>В остром периоде больным необходимы постельный режим и полноценное питание, обогащённое витаминами. Большое значение имеет уход.</p>\r\n<p>Основные этиотропные препараты &mdash; аминогликозиды и тетрациклины (стандарт лечения).</p>\r\n<p>Патогенетическую терапию, включающую дезинтоксикацию, антигистаминные и противовоспалительные препараты (салицилаты), витамины и сердечно-сосудистые средства, проводят по показаниям.</p>",
            "prevention": "<p>Основа специфической профилактики &mdash; вакцинация лиц старше семи лет, пребывающих или работающих на территории, эндемичной по туляремии. Применяют живую сухую туляремийную вакцину.</p>\r\n<p>Неспецифическая профилактика предусматривает контроль за природными очагами туляремии, своевременное выявление эпизоотий среди диких животных, проведение дератизационных и дезинсекционных мероприятий.</p>\r\n<p>При водной вспышке запрещают употреблять некипячёную воду и купаться, а при заражении колодезной воды принимают меры к очистке колодца от трупов грызунов и проводят дезинфекцию воды.</p>\r\n<p>При угрозе трансмиссивного заражения рекомендуется применять репелленты, защитную одежду, ограничивается въезд непривитого населения на неблагополучные территории.</p>\r\n<p>Для профилактики промысловых заражений целесообразно использовать перчатки при снятии шкурок с убитых грызунов и дезинфицировать руки. Проводят мероприятия по дезинсекции и дезинфекции на складах хранения шкурок. Необходима тщательная термическая обработка мяса (например, заячьего) перед употреблением в пищу.</p>\r\n<p>При скирдовании сена и обмолоте хлеба употребляют очки-консервы и защитные маски.</p>\r\n<p>Среди населения районов, неблагополучных по туляремии, необходимо проводить систематическую разъяснительную и санитарно-просветительную работу.</p>\r\n<p>Лиц, контактировавших с больным, не изолируют, так как заболевшие не &nbsp;заразны. В жилье больного осуществляют дезинфекцию.</p>",
            "clinical_picture": "<p>Инкубационный период составляет от нескольких часов до 3 нед (в среднем 3&ndash;7 дней).</p>\r\n<p>По тяжести инфекционного процесса различают лёгкие, средней тяжести и тяжёлые формы туляремии.</p>\r\n<p>По длительности течения выделяют острую (до 3 мес), затяжную (до 6 мес), рецидивирующую формы туляремии и, кроме того, инаппарантную (бессимптомную, латентную) туляремию, которую обнаруживают преимущественно во время эпидемических вспышек при лабораторном исследовании.</p>\r\n<p>Туляремия протекает циклически. Выделяют следующие периоды заболевания: инкубационный, начальный, период разгара и выздоровления.</p>\r\n<p>Симптомы начального периода одинаковы при всех клинических формах. Типично острое начало: с озноба, лихорадки и симптомов интоксикации. Температура в течение нескольких часов поднимается до 38&ndash;40 &deg;С и выше. Одновременно возникают <a title=\"Перейти на страницу симптома Головная боль\" href=\"/symptom/golovnaya_bol/\">головная боль</a>, <a title=\"Перейти на страницу симптома Головокружение\" href=\"/symptom/golovokruzhenie/\">головокружение</a>, <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a>, разбитость, мышечные боли (особенно в поясничной области и икроножных мышцах), ухудшение аппетита, нарушения сна, повышенная <a title=\"Перейти на страницу симптома потливость\" href=\"/symptom/potlivost/\">потливость</a>. Возможны <a title=\"Перейти на страницу симптома Брадикардия\" href=\"/symptom/bradikardiya/\">брадикардия</a>, <a title=\"Перейти на страницу симптома Низкое давление\" href=\"/symptom/nizkoe_davlenie/\">гипотония</a>, гепатоспленомегалия.</p>\r\n<p>Продолжительность начального периода 2&ndash;3 дня. Позже возникают признаки, характерные для той или иной клинической формы, но общие симптомы для всех форм &mdash; <a title=\"Перейти на страницу симптома Высокая температура 38-42&deg; \" href=\"/symptom/vysokaya_temperatura_38-42/\">лихорадка</a>, характерный внешний вид больного и интоксикация.</p>\r\n<p>Продолжительность лихорадочного периода 2&ndash;3 нед (от 5&ndash;7 до 30 дней), но иногда, при рецидивирующем течении или присоединении осложнений, он может удлиняться до нескольких месяцев.&nbsp;</p>\r\n<p>Характерен внешний облик больных: лицо одутловато и гиперемировано, в тяжёлых случаях &mdash; синюшно-багрового цвета (особенно вокруг глаз, губ, мочек ушей). Нередко вокруг подбородка отмечают бледный треугольник, обнаруживают признаки конъюнктивита, инъекцию сосудов склер, точечные кровоизлияния на слизистой оболочке полости рта. Возможны носовые кровотечения. Больные эйфоричны.</p>\r\n<p>На кожных покровах с третьего дня болезни может возникать <a title=\"Перейти на страницу симптома Сыпь\" href=\"/symptom/syp/\">сыпь</a> эритематозного, папулёзного или петехиального характера, которая разрешается пластинчатым и(или) отрубевидным шелушением, пигментацией. У лиц пожилого возраста бывают узловатые эритемы.</p>\r\n<p>Осложнения чаще отмечаются при генерализованной форме туляремии. Возможно развитие инфекционно-токсического шока, менингита, менингоэнцефалита, перикардита, миокардиодистрофии, полиартрита, вегетативных неврозов, перитонита (вследствие нагноения и самопроизвольного вскрытия мезентериальных лимфатических узлов при абдоминальной форме), перфорации роговицы, бронхоэктазий, абсцесса и гангрены лёгких (при пневмонической форме). Течение любой формы может осложниться туляремийной пневмонией.</p>",
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