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},
"code": "A75",
"name": "Сыпной тиф",
"icd_name": "Сыпной тиф",
"gender": 0,
"age_min": 10,
"age_max": 70,
"cause": [
2,
5
],
"periodicity": 1,
"slug": "a75_sypnoy_tif",
"lead": "Сыпной тиф- острый антропонозный риккетсиоз с трансмиссивным механизмом передачи возбудителя, способный к массовому распространению.",
"description": "Для этого заболевания характерны тяжёлое циклическое течение, развитие генерализованного васкулита, розеолёзно-петехиальной сыпи и преимущественное поражение нервной и сердечно-сосудистой системы.",
"etiology": "<p>Возбудитель сыпного тифа — риккетсия Провачека (R. prowazekii) — полиморфный грамотрицательный микроорганизм размером от 0,5 до 1 мкм, облигатный внутриклеточный паразит.</p>",
"pathogenesis": "<p>Проникая через кожные покровы, риккетсии размножаются в месте внедрения. При некоторых риккетсиозах возникает местная воспалительная реакция с формированием первичного аффекта. Затем происходит гематогенная диссеминация возбудителя, вследствие чего развивается генерализованный бородавчатый васкулит (<a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\"><a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> на коже</a>, поражение сердца, оболочек и вещества головного мозга с формированием инфекционно-токсического синдрома).</p>",
"diagnostics": "<p>Диагноз устанавливают на основании клинико-эпидемиологических данных и подтверждают лабораторными тестами. Существенное значение имеют наличие педикулёза, характерный вид больного, интенсивная <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a> в сочетании с бессонницей, появление сыпи на 5-й день болезни, поражение ЦНС, гепатолиенальный синдром.</p>\r\n<p>Выделение возбудителя, как правило, не проводят из-за сложности культивирования риккетсий, возможного только в специально оборудованных лабораториях с высокой степенью защиты.</p>\r\n<p>Основной метод диагностики (стандарт диагностики) серологический: РСК, РНГА, РА, РНИФ, ИФА.</p>",
"treatment": "<p>Всех больных с подозрением на сыпной тиф необходимо госпитализировать в инфекционную больницу (отделение). Им назначают строгий постельный режим до 5–6-го дня нормализации температуры тела. Затем больным разрешают садиться, а с 8-го дня они могут ходить по палате, сначала под наблюдением медицинской сестры, а затем самостоятельно. У пациентов необходимо постоянно контролировать АД.</p>\r\n<p>Специальную диету не назначают. Пища должна быть щадящей, довольно калорийной и содержащей витамины в суточной потребности.</p>\r\n<p>Большое значение имеют туалет ротовой полости (профилактика гнойного паротита и стоматита) и гигиена кожи (профилактика пролежней).</p>\r\n<p>В соответствии со стандартом лечения больным назначают в качестве препаратов первого ряда антибиотики группы тетрациклинов.</p>\r\n<p>Для уменьшения интоксикации больному дают обильное питьё и внутривенно вводят 5% раствор глюкозы, изотонический раствор натрия хлорида, поляризующую смесь и тому подобные препараты, форсируя диурез. Для борьбы с сердечно-сосудистой недостаточностью назначают сердечные гликозиды, вазопрессоры, а также оксигенотерапию. При возбуждении, делирии проводят седативную терапию.</p>",
"prevention": "<p>Профилактика сыпного тифа направлена на борьбу с педикулёзом (приложение № 4 к приказу Минздрава РФ от 26.11.98 № 342).</p>\r\n<p>Лиц с повышенным риском заражения вакцинируют вакциной Е (сыпнотифозной комбинированной живой сухой) в дозе 0,25 мл подкожно однократно с ревакцинацией через 1 год или вакциной сыпнотифозной химической сухой в дозе 0,5 мл подкожно однократно с ревакцинацией через 4 мес.</p>",
"clinical_picture": "<p> </p>\r\n<p>Инкубационный период длится от 5 до 25, чаще 10–14 дней.</p>\r\n<p>Сыпной тиф протекает циклически:<br />· начальный период — первые 4–5 дней (от повышения температуры до появления сыпи);<br />· период разгара — 4–8 дней (от появления сыпи до окончания лихорадочного состояния);<br />· период выздоровления — со дня нормализации температуры до исчезновения всех клинических симптомов.</p>\r\n<p>Продромальные явления обычно отсутствуют, иногда в конце инкубационного периода возникают слабая <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">ломота</a> в теле, познабливание. Болезнь начинается остро — с прогрессивно нарастающих симптомов интоксикации (<a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, мышечные боли, <a href=\"/symptom/suhoy_rot/\" title=\"Перейти на страницу симптома Сухой рот \">сухость во рту</a>, <a href=\"/symptom/zhazhda/\" title=\"Перейти на страницу симптома Жажда\">жажда</a>, <a href=\"/symptom/snizhenie_appetita/\" title=\"Перейти на страницу симптома Снижение аппетита\">потеря аппетита</a>, <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>). Через 2–4 дня постоянная диффузная <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a> становится нестерпимой, усиливаясь при перемене положения тела, разговоре, малейшем движении. Возможна повторная <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>.</p>\r\n<p>Температура тела достигает максимума (38,5–40,5 °С и выше) ко 2–3-му дню болезни. <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">Повышение температуры</a> имеет постоянный, реже ремиттирующий характер (с кратковременными «врезами» на 4-й, 8-й и 12-й день болезни).</p>\r\n<p>Больные страдают от своеобразной бессонницы: сначала засыпают, но часто просыпаются от устрашающих, неприятных сновидений. В этот период регистрируют мышечные и суставные боли, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">беспокойство</a>, эйфорию, возбуждение или <a href=\"/symptom/zatormozhennost/\" title=\"Перейти на страницу симптома Заторможенность\">заторможенность</a>.</p>\r\n<p>Характерен внешний вид больных: лицо гиперемированное, одутловатое, глаза красные («кроличьи») вследствие инъекции сосудов склер. Отмечают умеренный <a href=\"/symptom/cianoz/\" title=\"Перейти на страницу симптома Цианоз\">цианоз</a> губ, гиперемию кожи шеи и верхней части грудной клетки. Кожа сухая на ощупь, горячая.</p>\r\n<p>Язык суховат, не утолщён, обложен белым налётом. С 3-го дня болезни можно наблюдать появление пятен, симптом Киари–Авцына — точечные кровоизлияния в переходные складки конъюнктивы, энантему на мягком нёбе (симптом Розенберга), положительные симптомы щипка и жгута, которые предшествуют появлению экзантемы.</p>\r\n<p>Характерны умеренная <a href=\"/symptom/tahikardiya/\" title=\"Перейти на страницу симптома Тахикардия\">тахикардия</a> и приглушённость тонов сердца, <a href=\"/symptom/nizkoe_davlenie/\" title=\"Перейти на страницу симптома Низкое давление\">гипотония</a>, умеренная <a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">одышка</a>. С 3–4-го дня отмечают <a href=\"/symptom/uvelichenie_pecheni/\" title=\"Перейти на страницу симптома Увеличение печени\">увеличение печени</a> и селезёнки. За сутки до появления сыпи возможен «врез» температурной кривой.</p>\r\n<p>На 4–6-й день заболевания наблюдают появление обильной полиморфной розеолёзно-петехиальной сыпи. Первые элементы определяют за ушами, на боковых поверхностях шеи с последующим распространением на кожу боковых поверхностей туловища, груди, живота, сгибательных поверхностей рук и внутренних поверхностей бёдер. На лице, ладонях и подошвах <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> бывает очень редко. Размеры элементов обычно не превышают 3–5 мм. Для болезни характерен полиморфизм сыпи. Различают розеолы, розеолы со вторичными петехиями, реже первичные петехии. Подсыпаний, как правило, не бывает. Появление новых петехий — плохой прогностический признак. Розеолы исчезают бесследно через 2–4 дня, а петехии — через 7–8 дней, оставляя бурую пигментацию («нечистота кожи»).</p>\r\n<p>У подавляющего большинства больных регистрируют относительную и абсолютную тахикардию, пульс слабого наполнения и напряжения. Границы сердца расширены, тоны глухие. Часто выслушивают систолический шум на верхушке.</p>\r\n<p>АД, особенно диастолическое, падает, что связано с сосудорасширяющим действием токсина риккетсий, угнетением деятельности вазомоторного центра, симпатического отдела нервной системы и надпочечников.</p>\r\n<p>Часто возникает <a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">одышка</a>. На высоте болезни выявляют трахеобронхит и очаговую пневмонию. Язык сухой, обложен густым серо-грязным налётом, может принимать бурую окраску, нередко возникают глубокие трещины. У большинства больных отмечают значительное ухудшение аппетита, жажду, задержку стула и <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">метеоризм</a>. Диурез уменьшен, но одновременно с «температурными кризами» возможно его увеличение. У некоторых больных отмечают парадоксальную ишурию, когда при переполненном мочевом пузыре происходит мочеиспускание каплями.</p>\r\n<p>Поражение нервной системы проявляется кроме головной боли и бессонницы изменением поведения больного. Характерны двигательное <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">беспокойство</a>, сменяемое адинамией, быстрая истощаемость, эйфория, суетливость, говорливость, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, иногда плаксивость. Возможен <a href=\"/symptom/bred/\" title=\"Перейти на страницу симптома Бред\">бред</a>, сопровождающийся галлюцинациями устрашающего характера. Психические расстройства бывают при тяжёлом течении болезни с проявлением энцефалита.</p>\r\n<p>С поражением ЦНС связаны и другие типичные для сыпного тифа симптомы: амимия или гипомимия, одно- или двусторонняя сглаженность носогубной складки, мышечный <a href=\"/symptom/drozhanie/\" title=\"Перейти на страницу симптома Дрожание \">тремор</a>, симптом Говорова–Годелье, дизартрия, <a href=\"/symptom/zatrudnenie_glotaniya/\" title=\"Перейти на страницу симптома Затруднение глотания\">дисфагия</a>, <a href=\"/symptom/nistagm/\" title=\"Перейти на страницу симптома Нистагм\">нистагм</a>, <a href=\"/symptom/snizhenie_sluha/\" title=\"Перейти на страницу симптома Снижение слуха\">снижение слуха</a>, <a href=\"/symptom/povyshennaya_chuvstvitelnost/\" title=\"Перейти на страницу симптома Повышенная чувствительность\">гиперестезия</a> кожи, менингеальные симптомы. В тяжёлых случаях на фоне высокой температуры тела у некоторых больных нарушается сознание, речь становится бессвязной, поведение немотивированным (status typhosus).</p>\r\n<p>Исследование цереброспинальной жидкости в ряде случаев свидетельствует о серозном менингите (незначительное повышение содержания белка, умеренный лимфоцитарный плеоцитоз) или менингизме (отклонения от нормы в СМЖ не обнаруживают).</p>\r\n<p>Характерных изменений гемограммы нет. Имеют место тромбоцитопения, умеренный лейкоцитоз, нейтрофильная реакция, чаще с палочкоядерным сдвигом, эозинопения, лимфопения, умеренное увеличение СОЭ.</p>\r\n<p>Первый признак выздоровления — нормализация температуры, обусловленная уменьшением интоксикации. При этом уменьшается выраженность тифозного статуса (просветление сознания) и признаков делирия. На 3–5-й день после снижения температуры восстанавливается частота пульса и дыхания, нормализуются АД, размеры печени и селезёнки. Постепенно угасает вся клиническая симптоматика. На 12-й день апирексии при отсутствии осложнений пациента можно выписывать. Полное выздоровление наступает примерно через месяц после нормализации температуры. Типичная <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a> сохраняется 2–3 мес.</p>\r\n<p> </p>",
"image": "http://api.symptomd.ru/storage/5f07ed34f441334ae1934dd4107deb5f_uSzzA2D.png",
"image_alt": "Сыпной тиф",
"standard_type": 1,
"danger": 31,
"published": 1,
"parent": null,
"block_rubric": 8,
"standards": []
}
]
}
