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"code": "A03",
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"lead": "инфекционное кишечное заболевание. Встречается по всему миру у людей всех возрастов, но особенное распространение получает в жаркий сезон",
"description": "<p>Шигеллез - <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">инфекционное заболевание человека, которое вызывается бактериями, относящимися к роду шигелл и протекающее с преимущественным вовлечением в воспалительный процесс нижнего отдела толстого кишечника и признаками общей интоксикации.</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\"> </span></p>",
"etiology": "<p>Шигелла – неподвижная бактерия, напоминающая по форме палочку размером 2-3 мкм. Она не образует спор, поэтому не очень устойчива в окружающей среде, хотя некоторые виды бактерий могут длительно сохранять свою жизнеспособность в воде и молочных продуктах.<br /> <br /> Шигеллы разделены на группы (Григорьева—Шига, Штуцера— Шмитца, Ларджа — Сакса, Флекснера и Зонне), а те в свою очередь на серовары, которых насчитывается около 50. Их отличают по территории обитания, свойствам токсинов и, выделяемых ими, ферментов.</p>\r\n<p>Шигеллы живут только в организме человека. Попав из кишечника больного или носителя в окружающую среду они остаются жизнеспособными на протяжении 5-14 дней. Прямой солнечный свет убивает бактерии на протяжении 30-40 минут, на фруктах и молочных продуктах они могут сохраняться до 2-х недель.<br /> <br /> Мухи могут быть переносчиком болезни. На лапках насекомых бактерии остаются жизнеспособны до 3-х дней. Сев на пищевые продукты, мухи инфицируют их. Даже небольшого количества шигелл достаточно, чтобы вызвать болезнь.</p>",
"pathogenesis": "<p>Первая фаза. Попав в организм с пищей или водой, шигеллы преодолевают ротовую полость и желудок. Бактерии спускаются в тонкий кишечник и прикрепляются к его клеткам – энтероцитам. Здесь они размножаются и выделяют токсины, вызывающие интоксикацию организма.<br /> <br /> Вторая фаза включает несколько этапов.</p>\r\n<ul>\r\n<li>Количество шигелл увеличивается, и они заселяют нижние отделы толстого кишечника. На поверхности бактерий есть особые белки, которые обеспечивают прикрепление к клеткам эпителия. Они воздействуют на рецепторы и побуждают клетку захватить бактерию. Таким образом, возбудитель проникает внутрь эпителия.</li>\r\n<li>Шигеллы выделяют фермент муцин. С его помощью они растворяют клеточные мембраны и заселяют глубокие слои кишечной стенки. Начинается <a title=\"Перейти на страницу симптома воспаление\" href=\"/symptom/vospalenie/\">воспаление</a> подслизистого слоя.</li>\r\n<li>Бактерии нарушают связи между клетками кишечника, что способствует их распространению по здоровым участкам. Кишечная стенка разрыхляется, процесс всасывания нарушается, в просвет кишечника выделяется большое количество жидкости.</li>\r\n<li>Развивается язвенный колит. На слизистой кишечника образуются кровоточащие <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\">эрозии</a> и язвы. На этом этапе бактерии активно выделяют токсины.</li>\r\n</ul>",
"diagnostics": "<p>Диагноз дизентерии ставится врачом-инфекционистом по совокупности симптомов. Дополнительно назначают исследования, позволяющие уточнить возбудителя и применить антибиотики направленного действия, — посевы кала.</p>",
"treatment": "<p>Лечение шигеллеза можно проводить на дому, если состояние больного удовлетворительное. Для госпитализации существует перечень показаний:</p>\r\n<ul>\r\n<li>среднетяжелое и тяжелое течение болезни</li>\r\n<li>тяжелые сопутствующие заболевания</li>\r\n<li>лица декретированных групп, работающие с детьми или на предприятиях питания</li>\r\n<li>дети до года</li>\r\n</ul>\r\n<p><br /> Режим. При легком течении болезни нет необходимости соблюдать строгий постельный режим. Больной может вставать и ходить по палате (квартире). Однако стоит избегать физических нагрузок и соблюдать правила гигиены.<br /> <br /> Диета при шигеллезе помогает нормализовать стул и избежать истощения. В остром периоде болезни необходимо придерживаться диеты №4, а после прекращения поноса диета №4А.<br /> <br /> В дни, когда в кале присутствуют кровь и слизь, блюда должны быть максимально щадящими, чтобы не раздражать пищеварительный тракт. Это: рисовый отвар, протертый манный суп, кисели, нежирные бульоны, сухари.<br /> <br /> По мере улучшения состояния рацион можно расширить. В меню включают: протертый творог, супы на бульонах, вареное перетертое мясо, рисовую кашу, черствый белый хлеб.<br /> <br /> Через 3 дня после прекращения поноса можно постепенно возвращаться к нормальному питанию.</p>",
"prevention": "<ul>\r\n<li>использовать для питья только кипяченую воду или бутилированную</li>\r\n<li>не пить воду из водопровода, непроверенных колодцев или родников</li>\r\n<li>тщательно мыть овощи и фрукты перед едой</li>\r\n<li>не потреблять подпорченные фрукты, в которых бактерии размножаются в мякоти</li>\r\n<li>не покупать разрезанные арбузы и дыни</li>\r\n<li>тщательно мыть руки после посещения туалета</li>\r\n<li>не допускать мух к пищевым продуктам</li>\r\n<li>не потреблять продукты с истекшим сроком хранения</li>\r\n<li>в странах с повышенным риском заражения шигеллами не покупать блюда, не подвергшиеся термической обработке</li>\r\n<li>вакцинация дизентерийным бактериофагом троекратно с интервалом в 3 дня</li>\r\n</ul>",
"clinical_picture": "<p>Инкубационный период. С момента заражения до появления первых симптомов шигеллеза (бактериальной дизентерии) может пройти 1-7 дней. Чаще 2-3 дня.</p>\r\n<ul>\r\n<ul>\r\n<li><a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">Повышение температуры</a>. Начало заболевания острое. Резкое <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">повышение температуры</a> до 38-39 градусов – реакция иммунитета на появление в крови токсинов шигелл. Больные жалуются на <a title=\"Перейти на страницу симптома Озноб\" href=\"/symptom/oznob/\">озноб</a> и чувство жара.<br /> </li>\r\n<li>Интоксикация. Признаки отравления головного и спинного мозга токсинами: <a title=\"Перейти на страницу симптома Снижение аппетита\" href=\"/symptom/snizhenie_appetita/\">потеря аппетита</a>, <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Боль в мышцах\" href=\"/symptom/bol_v_myshcah/\">ломота</a> в теле, <a title=\"Перейти на страницу симптома Головная боль\" href=\"/symptom/golovnaya_bol/\">головная боль</a>, <a title=\"Перейти на страницу симптома Апатия\" href=\"/symptom/apatiya/\">апатия</a>. Развивается в первые часы болезни.<br /> </li>\r\n<li>Учащение стула (<a title=\"Перейти на страницу симптома Диарея\" href=\"/symptom/diareya/\">понос</a>). <a title=\"Перейти на страницу симптома Диарея\" href=\"/symptom/diareya/\">Диарея</a> развивается на 2-3 день болезни. Сначала выделения имеют каловый характер. Со временем становятся более скудными, жидкими, с большим количеством слизи. При развитии эрозий в кишечнике, в кале появляются прожилки крови и гноя. Больной опорожняется 10-30 раз в сутки. Дефекация сопровождается мучительной болью при напряжении воспаленной прямой кишки.<br /> </li>\r\n<li><a title=\"Перейти на страницу симптома Боль в животе\" href=\"/symptom/bol_v_zhivote/\">Боли в животе</a> появляются при внедрении шигелл в слизистую оболочку кишечника и развитии воспаления. Это происходит через 2 дня после начала заболевания. Первые часы боль носит разлитый характер. Когда повреждается нижний отдел кишечника, боль становится резкой, режущей схваткообразной. Преимущественно ощущается в левой половине живота. Неприятные ощущения усиливаются непосредственно перед дефекацией и ослабевают после опорожнения кишечника.<br /> </li>\r\n<li><a title=\"Перейти на страницу симптома Тошнота\" href=\"/symptom/toshnota/\">Тошнота</a>, иногда повторная <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a> – результат воздействия токсина на рвотный центр в головном мозге.<br /> </li>\r\n<li>Ложные болезненные позывы к дефекации – тенезмы. Признак раздражения нервных окончаний кишечника.</li>\r\n</ul>\r\n</ul>\r\n<p> </p>\r\n<ul>\r\n<li><a title=\"Перейти на страницу симптома Тахикардия\" href=\"/symptom/tahikardiya/\">Тахикардия</a> и снижение давления – количество сердечных сокращений более 100 в минуту. Артериальное давление снижено из-за интоксикации и потери жидкости.</li>\r\n</ul>",
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{
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{
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"code": "A02",
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"lead": "острая зоонозная инфекционная болезнь с фекально-оральным механизмом передачи возбудителя.",
"description": "<p>Сальмонеллёз — острая зоонозная инфекционная болезнь с фекально-оральным механизмом передачи возбудителя, характеризующаяся преимущественным поражением ЖКТ, развитием интоксикации и обезвоживания.</p>",
"etiology": "<p>Сальмонеллы — грамотрицательные палочки рода Salmonella семейства Enterobacteriaceae.</p>\r\n<p>Выделяют два вида сальмонелл — S. enterica и S. bongori, не патогенный для человека.</p>\r\n<p>Сальмонеллы длительно сохраняются в окружающей среде: в воде — до 5 мес, в почве — до 18 мес, в мясе — до 6 мес, в тушках птиц — больше года, на яичной скорлупе — до 24 дней. Низкую температуру переносят хорошо, при 100 °С гибнут мгновенно.</p>",
"pathogenesis": "<p>В просвете тонкой кишки сальмонеллы прикрепляются к мембранам энтероцитов, достигают собственной пластинки слизистой оболочки. Это приводит к дегенеративным изменениям энтероцитов и развитию энтерита.</p>\r\n<p>При разрушении бактерий высвобождается липополисахаридный комплекс (эндотоксин), который играет основную роль в развитии синдрома интоксикации.</p>\r\n<p>Основную роль в развитии диареи и обезвоживания играет энтеротоксин, активирующий синтез цАМФ аденилатциклазой энтероцитов, благодаря чему усиливается секреция ионов Na+ , Cl– и воды в просвет кишки. Следствием дегидратации и интоксикации является нарушение деятельности сердечно-сосудистой системы, что выражается тахикардией и снижением АД.</p>",
"diagnostics": "<p>Клиническая</p>\r\n<p>Характерно острое начало с повышением температуры тела, тошнотой, рвотой, диареей, болью в животе.</p>\r\n<p>Эпидемиологическая</p>\r\n<p>Приём пищи, приготовленной и хранившейся с нарушением санитарных норм, употребление сырых яиц, групповые вспышки. В мегаполисах выявление групповых случаев заболевания представляет большие трудности, если контаминированный сальмонеллами продукт реализуется через торговую сеть или предприятия общественного питания. </p>\r\n<p>Специфическая и неспецифическая лабораторная диагностика</p>\r\n<p>Бактериологическое исследование кала (одно- или двукратно), рвотных масс, крови, мочи, жёлчи, промывных вод желудка, остатков подозрительных продуктов.</p>\r\n<p> </p>",
"treatment": "<p>Постельный режим назначают при выраженной интоксикации и потере жидкости. Палатный — при среднетяжёлом и лёгком течении. Диета — стол № 4. Из рациона исключают пищевые продукты, раздражающие желудок и кишечник, молочные продукты, а также тугоплавкие жиры.</p>\r\n<p>Этиотропная терапия</p>\r\n<p>Среднетяжёлая и тяжёлая локализованная форма заболевания — энтерикс.<br />Генерализованная форма — ципрофлоксацин; цефтриаксон. </p>\r\n<p>Патогенетические средства</p>\r\n<p>Регидратационная терапия, дезинтоксикационная терапия, эубиотики и биопрепараты, сорбенты, ферментотерапия, антидиарейные препараты, спазмолитики.</p>\r\n<p>Дополнительные методы лечения (хирургические, физиотерапевтические, санаторно-курортные)</p>",
"prevention": "<p>Специфическая профилактика отсутствует.</p>\r\n<p>Неспецифические меры профилактики</p>\r\n<p>Ветеринарно-санитарный надзор за убоем скота и птицы, технологией обработки туш, приготовлением и хранением мясных блюд. Соблюдение санитарно-гигиенических и противоэпидемических норм на предприятиях торговли и общественного питания.</p>",
"clinical_picture": "<p>Инкубационный период от 6 ч до 3 сут (чаще 12–24 ч); при внутрибольничных вспышках удлиняется до 3–8 дней.</p>\r\n<p>Классификация сальмонеллеза</p>\r\n<p>• Гастроинтестинальная (локализованная) форма:<br />- гастритический вариант;<br />- гастроэнтеритический вариант;<br />- гастроэнтероколитический вариант.<br />• Генерализованная форма:<br />- тифоподобный вариант;<br />- септический вариант.<br />• Бактериовыделение:<br />- острое;<br />- хроническое;<br />- транзиторное.</p>\r\n<p>Для гастритического варианта характерны острое начало, повторная <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a> и боль в эпигастрии. Синдром интоксикации выражен слабо. Небольшая продолжительность заболевания.</p>\r\n<p>Гастроэнтеритический вариант наиболее распространён. Болезнь начинается остро, с симптомов интоксикации: повышения температуры тела, головной боли, озноба, чувства ломоты в мышцах, схваткообразной .</p>\r\n<p>Присоединяются <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a>. Испражнения вначале носят каловый характер, но быстро становятся водянистыми, пенистыми зловонными, иногда с зеленоватым оттенком и имеют вид «болотной тины». Отмечают бледность кожного покрова, в более тяжёлых случаях — . Язык сухой, обложен налётом.</p>\r\n<p>Живот вздут, при пальпации болезнен во всех отделах, больше в эпигастрии и в правой подвздошной области, урчит под рукой. Тоны сердца приглушены, АД снижено. Уменьшено выделение мочи. Возможны судороги.</p>\r\n<p>При гастроэнтероколитическом варианте клиническая картина та же, но уже на 2–3-й день болезни уменьшается объём испражнений. В них появляется примесь слизи, иногда крови.</p>\r\n<p>Генерализованной форме болезни, как правило, предшествуют гастроинтестинальные расстройства. При тифоподобном варианте температурная кривая приобретает постоянный или волнообразный характер. Кожа бледная, к 6–7-му дню болезни на коже живота появляется розеолёзная. Наблюдают небольшую брадикардию. Над лёгкими выслушивают сухие рассеянные. Живот вздут. К концу первой недели болезни отмечают и селезёнки. Длительность лихорадки составляет 1–3 нед. Рецидивы возникают редко.</p>\r\n<p> </p>",
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