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},
"code": "A24.4",
"name": "Мелиоидоз неуточненный",
"icd_name": "Мелиоидоз неуточненный",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"4",
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"periodicity": 1,
"slug": "a24.4_melioidoz_neutochnennyy",
"lead": "бактериальная инфекция, вызываемая бациллой Уитмора и протекающая с образованием множественных септико-некротических очагов во внутренних органах и тканях",
"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;\">Возбудителем мелиоидоза является бактерия Burkholderia pseudomallei. Заболевание чаще всего встречается в тропических странах. Бактерия, вызывающая мелиоидоз, обычно попадает в организм через порезы и раны на коже, при вдыхании, и очень редко при попадании в организм загрязненной воды. </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;\">Во время сухого сезона бактерия находится в глубоких слоях почвы, но в сезон дождей она часто обнаруживается в поверхностных слоях и водах. Вот почему большинство случаев мелиоидоза происходит во влажный сезон после проливных дождей и паводков.Источником инфекции для людей являются животные: ослы, лошади, свиньи, козы, овцы, кошки, собаки, грызуны. Случаев передачи заболевания от человека к человеку не выявлено. </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;\">Существуют также факторы, повышающие риск развития мелиоидоза. К ним относятся:</span></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: 6.5pt; font-family: Verdana; color: #666666; 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;\">сахарный диабет</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #666666; 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 легких или почек </span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #666666; 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;\">злоупотребление алкоголем</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #666666; 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;\">онкологические заболевания, ВИЧ</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #666666; 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;\">прием некоторых медикаментов</span></p>\r\n</li>\r\n</ul>\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;\">У здоровых взрослых мелиоидоз встречается редко.</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;\">Главными природными резервуарами палочки мелиоидоза служат вода и почва, загрязненные выделениями инфицированных животных. В естественных условиях носителями бациллы являются домашние и дикие животные (кошки, собаки, свиньи, коровы, лошади, козы, овцы, крысы, кенгуру, кролики), среди которых также отмечаются спорадические случаи мелиоидозной инфекции. Человек может заразиться мелиоидозом алиментарным путем при употреблении инфицированной воды и пищи; аэрогенным (воздушно-пылевым) путем при вдыхании бацилл с частицами пыли; контактным путем в случае попадания контаминированного материала на поврежденную кожу. Известны отдельные случаи передачи возбудителя половым путем от больного мелиоидозным простатитом, а также внутрибольничного инфицирования медперсонала при уходе за больными мелиоидозом. Максимальный подъем заболеваемости регистрируется в сельскохозяйственных районах в сезон дождей, а также в периоды войн и стихийных бедствий. Мелиоидоз обычно протекает в виде групповых вспышек и спорадических случаев. 98 % заболевших составляют мужчины.</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;\">Преодолев входные ворота, возбудитель мелиоидоза размножается в регионарных лимфатических узлах. Септическая форма инфекции сопровождается выходом бактерий в кровь и гематогенным распространением по организму с образованием множественных гранулем с казеозным некрозом и абсцессов. В большинстве случаев гнойные очаги возникают в легких; в тяжелых случаях – практически во всех органах и тканях (коже, подкожной клетчатке, лимфоузлах, костях, печени, почках, селезенке, головном мозге и мозговых оболочках). Септический вариант мелиоидоза развивается у ослабленных пациентов, больных хроническим гепатитом, сахарным диабетом, туберкулезом, алкоголизмом, наркозависимых (устаревшее название заболевания – «септицемия морфинистов»). У лиц с хорошей иммунной реактивностью обычно возникает легочная форма мелиоидоза, для которой свойственны только абсцессы легких. Описаны случаи латентно протекающей инфекции. Постинфекционный иммунитет длительный, возможно пожизненный.</span></p>",
"diagnostics": "<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;\">Вне эпидемических очагов диагностика мелиоидоза затруднена. Это объясняется полиморфизмом клинических проявлений, низкой настороженностью специалистов (инфекционистов, пульмонологов, хирургов и др.) в отношении возможных завозных случаев мелиоидоза. Поэтому у больных с неясной лихорадкой и септикопиемией всегда следует выяснять информацию о пребывании в эндемичных по мелиоидозу районах. Лабораторное подтверждение диагноза осуществляется с помощью бактериологического посева крови, мочи, мокроты, экссудатов, содержимого абсцессов и др. на питательные среды. </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;\">Для экспресс-диагностики и быстрой идентификации возбудителя используется люминесцентная микроскопия. Из серологических методов наибольшей ценностью обладают РСК и РНГА. Возможно проведение биологической пробы – в этом случае у зараженных лабораторных животных возбудители мелиоидоза обнаруживаются в перитонеальном экссудате.</span></p>",
"treatment": "<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;\">Комплексное лечение мелиоидоза складывается из этиотропной антибактериальной терапии, патогенетического и симптоматического лечения и хирургического дренирования абсцессов. Антибиотикотерапия при мелиоидозе проводится длительно (1-2 месяца и дольше). Наибольшую специфическую противомикробную активность показали хлорамфеникол, тетрациклины, цефалоспорины, сульфаниламиды пролонгированного действия и др. При септической форме мелиоидоза одновременно назначается сразу несколько антибактериальных препаратов; антибиотики вводятся парентерально, большими дозами (3-4 г в сутки). При необходимости проводится дренирование плевральной полости, вскрытие абсцессов мягких тканей, чрескожное или открытое дренирование абсцессов внутренних органов.</span></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;\">Профилактика мелиоидоза заключается в обеспечении защиты источников водоснабжения и продуктов питания от грызунов, проведении дератизационных мероприятий, лечении или забое инфицированных домашних животных, повышении общегигиенической культуры населения в неблагополучных по мелиоидозу местностях. При выявлении мелиоидоза больные изолируются, все их выделения подлежат дезинфекции; за реконвалесцентами устанавливается длительное наблюдение. Специфическая профилактика мелиоидоза на настоящий момент не разработана.</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 заболевания продолжается от 1 до 5 суток. Мелиоидоз характеризуется следующими симптомами:</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: 6.5pt; font-family: Verdana; color: #666666; 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;\">инфекции легких — от легкого бронхита до тяжелой пневмонии. В результате у пациентов возникают такие симптомы, как повышение температуры тела, головная боль, отсутствие аппетита, кашель, одышка, боль в груди и миалгия</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #666666; 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;\">септическая пневмония (инфекция в кровотоке и легких) может вызывать сильное повышение температуры, головную боль, затруднение дыхания, боль в животе и суставах</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #666666; 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;\">мелиоидоз может распространяться по организму, приобретая хроническую форму и поражая сердце, мозг, печень, почки, суставы и глаза. Симптомы хронической формы заболевания: повышение температуры тела, необъяснимое снижение массы тела, боль в животе, груди, в мышцах или суставах, головная боль, судороги</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #666666; 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;\">локализованная инфекция может сопровождаться болью, отеками, кожными инфекциями, язвами и абсцессами</span></p>\r\n</li>\r\n</ul>",
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