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},
"code": "B02",
"name": "Опоясывающий лишай",
"icd_name": "Опоясывающий лишай [herpes zoster]",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
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"periodicity": 1,
"slug": "b02_opoyasyvayuschiy_lishay",
"lead": "Опоясывающий лишай (герпес зостер) - это заболевание вирусного происхождения из семейства герпесвируса, поражающее центральную и периферическую нервные системы, а также кожу и слизистые оболочки. Герпес зостер характеризуется односторонним",
"description": "<p>Опоясывающий лишай – это инфекционное заболевание вирусной природы, для которого характерны сгруппированные везикулярные кожные высыпания на эритематозном отечном фоне. Как правило, они носят ограниченный характер, располагаются на одной стороне тела по ходу веточек кожного нерва и в некоторых случаях могут сопровождаться длительными невралгиями. Возбудитель данного заболевания — вирус из семейства Herpes viridae. Он способен вызывать две абсолютно различные по клинической картине патологии: ветряную оспу (ветрянку) и опоясывающий герпес (лишай). Этот вирус представляет собой нуклеотид с овальной мембраной, достигающий в диаметре 30-50 нм. Наиболее оптимальной температурой для его развития и размножения является температура 37 градусов Цельсия. Герпес зостер поражает эпителиальные и соединительнотканные клетки кожи, а также клетки центральной и периферической нервной системы. Он очень чувствителен и быстро гибнет под воздействием высоких температур и УФ-излучения, нестоек к дезсредствам и не способен существовать во внешней среде. Вместе с тем возбудитель опоясывающего лишая отлично переносит низкие температуры и даже после замораживания способен сохранять свою жизнеспособность.</p>",
"etiology": "<div>Возбудитель вирус ветряной оспы (вирус герпеса 3 типа). Вне обострения локализация вируса задние корешки спинного мозга и межпозвонковые нервные узлы.</div>\r\n<div>Опоясывающий лишай часто возникает у лиц, которые подвергаются различным воздействиям, ослабляющим иммунитет (больные лейкозами, лимфогранулематозом, новообразованиями, получающие химиотерапию, длительно получающие кортикостероиды и иммунодепрессанты, особенно часто инфекция развивается у больных с синдромом приобретенного иммунодефицита). Заболевают лица старческого возраста в связи с возрастным снижением иммунной защиты. В результате активизируется латентная инфекция вируса ветряной оспы, который в течение нескольких десятилетий сохранялся в организме, не вызывая каких-либо клинических проявлений.</div>",
"pathogenesis": "<p style=\"margin-bottom: 20px; border: 0px; vertical-align: baseline;\">Опоясывающий <a title=\"Перейти на страницу симптома Обметывание губ\" href=\"/symptom/obmetyvanie_gub/\">герпес</a> всегда локализуется по ходу расположения нервных стволов, очень часто в межрёберных, и в ветвях тройничного нерва; характерные симптомы — односторонность поражения и болевой синдром. В большинстве случаев <a title=\"Перейти на страницу симптома Сыпь\" href=\"/symptom/syp/\">высыпания</a> появляются на туловище, но могут появляться на лице и даже на голове. Кожным высыпаниям при опоясывающем лишае практически всегда предшествуют общее <a title=\"Перейти на страницу симптома Утомляемость\" href=\"/symptom/utomlyaemost/\">недомогание</a>, <a title=\"Перейти на страницу симптома Зуд\" href=\"/symptom/zud/\">зуд</a>, <a title=\"Перейти на страницу симптома Повышенная температура 37-38°\" href=\"/symptom/povyshennaya_temperatura_37-38/\">субфебрильная температура</a> тела, невралгические боли и покалывания на местах будущих высыпаний.</p>\r\n<p style=\"margin-bottom: 20px; border: 0px; vertical-align: baseline;\">Следующая стадия характеризуется появлением отечных розовых пятен, которые в течение 3—4 суток группируются в эритематозные <a title=\"Перейти на страницу симптома Папулы\" href=\"/symptom/papuly/\">папулы</a>, которые быстро превращаются в пузырьки. Примерно на 6—8 сутки пузырьки начинают подсыхать, ни их месте появляются жёлто-коричневые <a title=\"Перейти на страницу симптома Корочки\" href=\"/symptom/korochki/\">корочки</a>, которые потом самостоятельно отпадают, на их месте может сохранятся незначительная пигментация. После исчезновения высыпаний у некоторых больных может сохранятся постгерпетическая невралгия, которая очень тяжело поддается лечению.</p>\r\n<p style=\"margin-bottom: 20px; border: 0px; vertical-align: baseline;\">Длительность течения неосложнённой формы опоясывающего лишая составляет примерно 3—4 недели. Болевой синдром может не утихать в течение нескольких месяцев. В очень редких, ничем не осложненных случаях течение опоясывающего герпеса может быть не просто легким, но и практически безболезненным.</p>\r\n<p style=\"margin-bottom: 14px; padding-top: 5px; padding-bottom: 5px;\">Рассмотренная выше типичная форма протекания опоясывающего лишая наблюдается у более чем 90% пациентов. Однако в отдельных случаях инфекция может проявлять себя и по другому, протекая в следующих формах:</p>\r\n<ul style=\"margin-bottom: 25px; margin-left: 18px;\">\r\n<li style=\"margin: 2px 2px 2px 30px;\">пузырная, при которой на теле появляются не мелкие, а достаточно большие пузыри, наполненные жидкостью.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Абортивная, при которой нет ни высыпаний, ни болей.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Геморрагическая, характеризующаяся присутствием крови в пузырьках.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Глазная форма, при которой поражаются участки кожи возле глаз и возможно развитие кератита, ирита и глаукомы; при этой форме часто возникают поражения лицевого нерва, параличи и потеря зрения.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Ушная форма, приводящая к сильным болям в слуховом проходе и нередко – к потере слуха.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Менингоэнцефалическая форма, при которой поражаются нервные ткани, оболочка и сам головной мозг. При этой форме возникают галлюцинации, атаксия, <a title=\"Перейти на страницу симптома Гемиплегия\" href=\"/symptom/gemiplegiya/\">гемиплегия</a>, и она же характеризуется высокой летальностью — свыше 60%.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Гангренозная, приводящая к некрозу тканей в области высыпаний и последующему образованию многочисленных рубцов на коже.</li>\r\n</ul>\r\n<p style=\"margin-bottom: 14px; padding-top: 5px; padding-bottom: 5px;\">Последняя форма наиболее характерна для пациентов с иммунодефицитом.</p>\r\n<p style=\"margin-bottom: 14px; padding-top: 5px; padding-bottom: 5px;\">Характерной особенностью опоясывающего лишая является то, что от рецидива к рецидиву в одном организме острота симптомов постепенно снижается. Но при этом с каждой новой реактивацией вируса возрастает риск появления осложнений.</p>",
"diagnostics": "<p style=\"margin-bottom: 14px; padding-top: 5px; padding-bottom: 5px;\">В медицинской практике опоясывающий лишай диагностируют, как правило, при внешнем осмотре пациента при уже выраженных внешних симптомах.</p>\r\n<p style=\"margin-bottom: 14px; padding-top: 5px; padding-bottom: 5px;\">При этом в продромальной фазе опоясывающий лишай легко можно принять за многие заболевания со схожими симптомами — простудные, диспепсические, вирусные. Нередко при первых симптомах опоясывающего лишая ошибочно диагностируют почечные колики, острый аппендицит, инфаркт лёгкого, стенокардию или плеврит. А в дальнейшем генерализованную форму болезни можно спутать с экземой, простым герпесом или рожистым воспалением. Поэтому при подобных признаках необходимо проводить более подробную диагностику болезни. Для этого используют следующие методы:</p>\r\n<ul style=\"margin-bottom: 25px; margin-left: 18px;\">\r\n<li style=\"margin: 2px 2px 2px 30px;\">микроскопию — вирус ветряной оспы имеет достаточно большие размеры и хорошо различим даже в обычный световой микроскоп.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Серологические методы, основанные на определении титра иммуноглобулинов, специфичных к вирусу Varicella zoster.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Иммунофлюоресцентный метод.</li>\r\n<li style=\"margin: 2px 2px 2px 30px;\">Культуральный метод выращивания вируса на питательных средах.</li>\r\n</ul>\r\n<p style=\"margin-bottom: 14px; padding-top: 5px; padding-bottom: 5px;\">Тем не менее, несмотря на обилие способов диагностики, применяют их достаточно редко — тогда, когда симптомы проявляются особенно сильно, но есть сомнения относительно диагноза.</p>",
"treatment": "<p><span style=\"text-align: justify;\">Пациенты, у которых диагностируется тяжелая форма опоясывающего герпеса, в обязательном порядке госпитализируются в инфекционный стационар. Это объясняется тем, что для людей, у которых отсутствует иммунитет к вирусу <a title=\"Перейти на страницу симптома Обметывание губ\" href=\"/symptom/obmetyvanie_gub/\">герпес</a> зостер, они являются источниками инфекции. В том случае, когда больному лечение проводится в амбулаторных условиях, ему назначается симптоматическая терапия, направленная на купирование болевого синдрома, а также показан прием противовирусных препаратов, предупреждающих вторичное инфицирование через серозное содержимое везикул. Примечание: этиотропное лечение предусматривает применение препаратов местного и системного действия на протяжении всего периода активной инфекции (пока не прекратятся <a title=\"Перейти на страницу симптома Сыпь\" href=\"/symptom/syp/\">высыпания</a> и не начнут формироваться <a title=\"Перейти на страницу симптома Корочки\" href=\"/symptom/korochki/\">корочки</a>). Параллельно с противовирусными препаратами больным в обязательном порядке назначают иммуномодулирующие средства, стимулирующие продукцию интерферона практически во всех клетках, которые принимают участие в противовирусном ответе организма. Для облегчения болей пациентам назначаются анальгетики, ганглиоблокаторы и нестероидные противовоспалительные средства. Также неплохо себя зарекомендовали некоторые методы физиотерапевтического лечения (новокаиновая блокада, ультразвук и диадинамик по ходу нервных волокон), а также рефлексотерапия, плазмафорез и иглоукалывание. Дважды в день образовавшиеся пузырьки рекомендуется смазывать специальными анилиновыми красителями (метиленовым синим или бриллиантовым зеленым), а по мере их подсыхания использовать повязки, пропитанные димексидом или специальные противовирусные мази. Предупреждение! Лечение опоясывающего лишая кортикостероидными препаратами категорически противопоказано!</span></p>",
"prevention": "<p>Профилактикой этого заболевания могут быть любые формы закаливания и повышения сопротивляемости организма. В пожилом возрасте, когда опоясывающий лишай чаще всего поражает людей, лучшей профилактикой являются активный двигательный режим и максимальное пребывание на свежем воздухе.</p>",
"clinical_picture": "<p>Процесс локализуется по ходу нервных стволов, чаще межрёберных, и ветвей тройничного нерва; характерный признак — односторонность поражения. У большинства больных <a title=\"Перейти на страницу симптома Сыпь\" href=\"/symptom/syp/\">высыпания</a> располагаются на туловище. Кожным проявлениям обычно предшествуют общее <a title=\"Перейти на страницу симптома Утомляемость\" href=\"/symptom/utomlyaemost/\">недомогание</a>, <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">повышение температуры</a>, небольшой <a title=\"Перейти на страницу симптома Зуд\" href=\"/symptom/zud/\">зуд</a>, чувство покалывания, невралгические боли на месте будущих высыпаний. Затем появляются розовые отёчные пятна, на фоне которых в течение 3—4 суток образуются группы эритематозных папул, быстро превращающихся в пузырьки с прозрачным содержимым; наблюдается увеличение местных лимфатических узлов и усиление болевых ощущений. Через 6—8 суток пузырьки подсыхают, образуя жёлто-коричневые <a title=\"Перейти на страницу симптома Корочки\" href=\"/symptom/korochki/\">корочки</a>, которые затем отпадают, оставляя незначительную пигментацию. После исчезновения сыпи может оставаться плохо поддающаяся лечению боль (постгерпетическая невралгия).</p>",
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"code": "B38",
"name": "Кокцидиоидомикоз",
"icd_name": "Кокцидиоидомикоз",
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"lead": "Неконтагиозный системный микоз, проявляющийся в виде первичной лёгочной инфекции или прогрессирующих гранулематозных поражений кожи, костей, суставов, внутренних органов и мозговых оболочек",
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"etiology": "<p> Возбудитель — Coccidioides immitis встречается в двух формах: тканевой и культуральной. Тканевые формы — сферулы — считаются незаразными, хотя и могут перевиваться от человека к лабораторным животным в условиях эксперимента. Культуральная форма — патогенная, с ней связано заражение и распространение кокцидиоидного микоза в эндемических очагах. Во внешней среде гриб образует колонии, состоящие из длинных сегментированных нитей мицелия, который в молодых культурах распадается на прямоугольные и бочкообразные артроспоры (диаметром 2,5—4 мкм). Старая культура состоит из обрывков мицелия, артроспор и хламидоспор. Споры С. immitis при высушивании могут сохраняться в течение ряда лет. Культуры хорошо растут на среде Сабуро, мартеновском бульоне и др. Работа с культурами гриба проводится при строгом соблюдении правил, предусмотренных для работы с возбудителями особо опасных инфекций. Тканевая форма является весьма характерной, широко используется в диагностике микоза. Морфологически она довольно разнообразна, особенно на разных этапах созревания гриба в тканях. Здесь встречаются преимущественно сферулы диаметром 15—75 мкм. Сферулы, содержащие внутри эндоспоры, имеют плотную оболочку, при разрыве которой споры попадают в окружающие ткани, где из каждой эндоспоры развивается новая сферула.</p><p>Эпидемиология. Хранителем инфекции является почва, в которой происходит развитие гриба с образованием спор. В засушливое время года споры с пылью разносятся воздухом. Заражение происходит при вдыхании инфицированной спорами пыли. Нельзя исключить возможность внедрения спор через поврежденную кожу, а также через слизистые оболочки пищеварительного тракта. Заражения человека от больных людей и животных не наблюдалось. Кокцидиоидомикоз относится к эндемическим заболеваниям, распространенным в полупустынных и степных местностях. В отдельных эндемических районах США до 60% населения заражены кокцидиоидомикозом, у многих из них были те или иные проявления инфекции. По данным внутрикожной аллергической пробы и результатам серологических реакций, в США инфицировано кокцидиоидомикозом около 10 млн человек. Вероятно, многие из них перенесли инфекцию в прошлом и сохранилась лишь аллергическая перестройка организма к антигенам гриба. Единичные случаи кокцидиоидомикоза описаны в Европе. В нашей стране наблюдалось около 50 случаев заболевания (Ленинград, Москва, Владимирская область, Амурская область).</p>",
"pathogenesis": "<p>Воротами инфекции чаще являются органы дыхания. В большинстве случаев заражение не ведет к выраженным клиническим формам кокцидиоидомикоза. Первичная инфекция может протекать бессимптомно в виде аллергической перестройки организма и появления в сыворотке крови специфических антител. В эндемичных очагах аллергические пробы с кокцидиоидином дают положительный результат у 70% населения. У части инфицированных развивается своеобразная пневмония с образованием специфических гранулем, сходных по клеточному составу с туберкулезными. Гранулемы проявляются в многочисленных мелких воспалительных очагах, которые, сливаясь, могут образовать крупные очаги или же захватить целую долю легкого. Участки воспаления часто некротизируются, образуя каверны и абсцессы. При долевых поражениях могут наблюдаться участки казеозной пневмонии с обширными полостями. Гранулемы в результате развития иногда приводят к фиброзу и кальцинации. Сформировавшиеся абсцессы могут соединяться длинными свищевыми ходами с поверхностью кожи, поражая по пути плевру, кости, подкожную клетчатку. В тяжелых случаях может наступить гематогенная диссеминация, при которой эндоспоры из разрушившихся сферул проникают в кровь и разносятся по всему организму, обусловливая появление вторичных очагов в различных тканях и органах. Гематогенное диссеминирование гриба может происходить в любой орган, формируются инфекционные гранулемы, сходные по морфологии с первичными очагами воспаления. Наиболее частый исход гранулем - некроз и гнойное расплавление. Наиболее тяжело проявляются вторичные очаги в центральной нервной системе. Абсцессы чаще всего образуются на основании головного мозга и сопровождаются развитием гнойного менингита. Часто поражаются кости (ребра, позвонки, мелкие кости конечностей, эпифизы трубчатых костей и др.). Почти всегда в процесс вовлекается кожа. Образуются узелково-язвенные изменения, инфильтраты, абсцессы. Чаще они локализуются на голове, шее, конечностях. <br><br>Иммунитет при кокцидиоидомикозе гуморальный и клеточный, однако после первичного перенесенного заболевания гриб длительно сохраняется в виде латентной инфекции и при ослаблении защитных сил организма может возникнуть рецидив болезни.<br></p>",
"diagnostics": "<p style=\"padding-bottom: 19px;\" data-mce-style=\"padding-bottom: 19px;\" align=\"justify\">Возбудитель кокцидиомикоза может быть выявлен при микроскопии специально окрашенных мазков, полученных из мокроты, отделяемого кожных элементов, пунктата плевральной или суставной жидкости. Для подтверждения кокцидиомикоза и определения чувствительности возбудителя к противогрибковым препаратам проводят посев отделяемого или мокроты.</p><p style=\"padding-bottom: 19px;\" data-mce-style=\"padding-bottom: 19px;\" align=\"justify\">Для серологической диагностики кокцидиомикоза используют реакцию связывания комплимента со специфическим антигеном (РСК). Проводят пробы с нанесением на кожу кокцидиоидина. Однако следует учитывать, что кожные пробы положительны в течение нескольких лет после перенесенного кокцидиомикоза.</p><p style=\"padding-bottom: 19px;\" data-mce-style=\"padding-bottom: 19px;\" align=\"justify\">Если кокцидиомикоз протекает с поражением органов дыхания, то на рентгенограммах легких определяются очаги пневмонии или абсцессы. При появлении симптомов менингита производят люмбальную пункцию с последующим исследованием спинномозговой жидкости. По показаниям проводят пункцию сустава или плевральную пункцию.</p>",
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]
}
