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"lead": "злокачественное новообразование молочной железы",
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"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;\">Рак молочной железы – это сложное заболевание, обусловленное целым комплексом причин и факторов риска:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Генетическая предрасположенность – один из основных факторов риска. Около 10% случаев рака молочной железы имеют связь с передачей по наследству мутаций генов BRCA1 и BRCA2. У женщин с наличием этих мутаций вероятность заболеть раком молочных желез в течение жизни составляет от 50 до 85%.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">С возрастом вероятность заболеть раком молочных желез увеличивается. В основной группе риска женщины старше 45–50 лет.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Избыточный вес является фактором риска в постменопаузе. Однако повышенный коэффициент индекса массы тела имеет связь со сниженным риском в предклимактерическом периоде.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Высокий уровень женских гормонов эстрогенов.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Высокая плотность молочной железы, которая выявляется при маммографии.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Заместительная гормональная терапия в менопаузе.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Начало менструации до 12 лет и прекращение после 55 лет, поздние роды и их отсутствие, отсутствие кормления грудью.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Травмы молочных желез, мастит.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Курение.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Злоупотребление алкоголем.</span></li>\r\n</ul>",
"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;\">Часто рак груди относится к категории аденокарцином. Так называют опухоли из железистого эпителия. В данном случае это клетки, которые выстилают протоки молочных желез. Внутри них и развивается опухоль, постепенно разрастаясь и захватывая все большее количество тканей. Сначала кожа груди становится морщинистой или втянутой, но если поражение более серьезно, внутренние слои кожи разрушаются, появляется синдром «апельсиновой корки», а затем происходит изъязвление кожного покрова.</span></p>\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;\">Метастазы рака груди распространяются по организму через лимфатическую и кровеносную систему. Прежде всего страдают лимфатические узлы, которые находятся вблизи от пораженных участков (подмышечные, подключичные, надключичиные). Опухоли часто метастазируют в легкие, печень, головной мозг и кости. Врачами неоднократно зафиксированы и случаи отдаленных метастазов, например, в брюшную полость. Именно отдаленные метастазы, а не основное заболевание, нередко становятся причиной гибели пациентов, поскольку они поражают различные системы организма и нарушают их нормальное функционирование.</span></p>",
"diagnostics": "<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;\">Одним из важнейших методов раннего выявления рака молочных желез является регулярное и тщательное самообследование женщин. Самообследование женщинам, входящим в группу риска по раку молочной железы, а также всем женщинам старше 35-40 лет, желательно производить каждый месяц. Первый этап – осмотр груди перед зеркалом. Выявляют деформации, заметное увеличение одной груди по сравнению с другой. Определение симптома «лимонной корки» (втяжения кожи) является показанием к немедленному обращению к маммологу.</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;\">После осмотра производят тщательное ощупывание, отмечая консистенцию железы, дискомфорт и болезненность. Надавливают на соски для выявления патологических выделений. В диагностике рака молочной железы осмотр и пальпация позволяют обнаружить в ткани железы новообразование. Инструментальные методы диагностики позволяют детально исследовать опухоль и сделать выводы о её размере, форме, степени поражения железы и окружающих тканей. при подозрении на РМЖ проводится:</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;\">Рентгеновское обследование: маммография, дуктография, при необходимости - цифровой томосинтез.</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;\">УЗИ молочных желез. Ультразвуковое исследование дополняется исследованием региональных лимфоузлов и доплерографией.</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;\">Термография.</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;\">МРТ молочной железы.</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;\">Биопсия молочной железы. Последующее цитологическое исследование тканей опухоли показывает наличие злокачественного роста.</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;\">Дополнительная диагностика. Среди новейших методик обследования молочных желез также можно отметить сцинтиомаммографию, СВЧ-РТС.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><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;\"> </span></p>",
"treatment": "<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;\">Рак молочной железы – одно из наиболее поддающихся лечению плотных злокачественных новообразований. Небольшие опухоли, локализованные в тканях железы, удаляют, и, зачастую, случаев рецидивирования неметастазировавшего удаленного рака не отмечают.</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;\">Лечение рака молочной железы – хирургическое. Выбор операции зависит от размера опухоли, степени пораженности окружающих тканей и лимфоузлов.</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;\">Мастэктомия. Долгое время практически всем женщинам с выявленной злокачественной опухолью молочной железы производилась радикальная мастэктомия (полное удаление железы, расположенных рядом лимфатических узлов и мышц грудной клетки, располагающихся под ней). Сейчас все чаще производят модифицированный аналог операции, когда грудные мышцы сохраняют (если они не затронуты злокачественным процессом).</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;\">Резекция молочной железы. В случаях ранних стадия заболевания и небольших размеров опухоли в настоящее время производят частичную мастэктомию: удалению подвергается только участок железы, пораженный опухолью с небольшим количеством окружающих тканей. Частичная мастэктомия обычно сочетается с радиолучевой терапией и показывает вполне сопоставимые с радикальной операцией результаты излечения.</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;\">Удаление лимфатических узлов способствует снижению вероятности рецидивирования заболевания. После удаления их исследуют на присутствие раковых клеток. Если в удаленных во время операции лимфатических узлах обнаружены метастазы, женщины проходят курс лучевой терапии. Помимо прочего пациенткам с высоким риском попадания злокачественных клеток в кровоток назначается химиотерапевтическое лечение.</span></li>\r\n</ul>\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;\">В настоящее время существует способ выявления рецепторов к эстрогену в клетках рака молочных желез. Они выявляются примерно у двух третей больных. В таких случаях есть возможность остановить развитие опухоли, применив гормонотерапию РМЖ.</span></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;\">Основной профилактической мерой является скрининг молочных желез, начиная с 40–45 лет один раз в два года и ежегодно с 50 лет. Скрининг включает консультацию маммолога и выполнение маммографии.</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;\">Посещение гинеколога не реже одного раза в год с 18 лет с обязательным осмотром и пальпацией молочных желез.</span></p>\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;\">Самообследование молочных желез следует выполнять ежемесячно.</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;\">К ранним признакам рака молочной железы относят изменения кожи груди (отек, покраснение или другие видимые различия одной или двух молочных желез), увеличение размера или изменение формы груди, изменения внешнего вида одного или обоих сосков, выделения из сосков, болезненные ощущения в области груди, уплотнения, узелки в одной или обеих молочных железах.</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;\">Симптомы, более специфичные для инвазивного рака молочной железы:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">зуд или раздражение кожи груди;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">изменение цвета кожи молочных желез;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">увеличение размера или формы груди (в течение короткого периода времени);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">шелушение кожи соска;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">при пальпации груди ощущается комок, узел;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">покраснение, отек (по типу апельсиновой корки) или изъязвление кожи молочной железы;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">боль в груди или соске;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">втягивание соска и/или ареолы;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">кожа соска или груди выглядит красной, чешуйчатой или утолщенной;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">кровянистые выделения из соска/сосков;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">опухолевое образование в подмышечных лимфатических узлах.</span></li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 50,
"published": 1,
"parent": 7950,
"block_rubric": 27,
"standards": [
4931,
4901,
5034,
4975,
4976,
4943,
5017,
4991
]
},
{
"id": 6140,
"symptoms": [
{
"id": 2878,
"synonyms": [
{
"name": "Дрожь"
},
{
"name": "Холод"
},
{
"name": "Знобит"
}
],
"body_points": [
{
"x": 74,
"y": 3727,
"r": 0
}
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"code": "B51",
"name": "Малярия, вызванная Plasmodium vivax",
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"lead": "Нарушение здоровья, относящееся к группе протозойные болезни",
"description": "Малярия - группа трансмиссивных инфекционных заболеваний, передаваемых человеку при укусах самками комаров рода Anopheles («малярийных комаров») и сопровождающихся лихорадкой, ознобами, спленомегалией (увеличением размеров селезёнки), гепатомегалией (увеличением размеров печени), анемией. Характеризуется хроническим рецидивирующим течением. Вызывается паразитическими протистами рода Plasmodium ",
"etiology": "<p>Возбудители малярии — простейшие рода Plasmodium vivax. Источником болезни являются люди, в крови которых циркулируют зрелые гаметоциты. При кровососании вместе с кровью в желудок комара проникают гаметоциты, и комар становится резервуаром инфекции. Ведущий механизм заражения человека — трансмиссивный, реализующийся самками комаров рода Anopheles при кровососании. </p>\r\n<p>Возможен парентеральный путь заражения при гемотрансфузиях, использовании плохо обработанного или не подлежащего повторном у использованию инструментария, а также передача плазмодиев от матери к плоду (при тропической малярии) — так называемая шизонтная малярия. </p>",
"pathogenesis": "<p>Человек заражается ими в момент инокуляции (впрыскивания) самкой малярийного комара одной из стадий жизненного цикла возбудителя (так называемых спорозоитов) в кровь или лимфатическую систему, которое происходит при кровососании. </p>\r\n<p>После кратковременного пребывания в крови спорозоиты малярийного плазмодия проникают в гепатоциты печени, давая тем самым начало доклинической печёночной (экзоэритроцитарной) стадии заболевания. В процессе бесполого размножения, называемого шизогонией, из одного бывшего спорозоита, который в клетке печени превращается в шизонта, в итоге образуется от 2000 до 40 000 печёночных мерозоитов. В большинстве случаев эти дочерние мерозоиты через 1—6 недель снова попадают в кровь. </p>\r\n<p> </p>",
"diagnostics": "<p>Диагноз устанавливается на основе выявления паразитов в мазках крови. Традиционно используют два типа мазков — тонкий и толстый (или так называемую «толстую каплю»). Тонкий мазок позволяет с большей надёжностью определить разновидность малярийного плазмодия, поскольку внешний вид паразита (форма его клеток) при данном типе исследования лучше сохраняется. Толстый мазок позволяет микроскописту просмотреть больший объём крови, поэтому этот метод чувствительнее, но внешний вид плазмодия при этом изменяется, что не позволяет легко различать разновидности плазмодия. Поставить диагноз на основе микроскопического исследования зачастую бывает затруднительно, так как незрелые трофозоиты разных видов малярийного плазмодия плохо различимы, и обычно необходимо несколько плазмодиев, находящихся на разных стадиях созревания, для надёжной дифференциальной диагностики. </p>\r\n<p>В настоящее время используются также быстрые диагностические тесты с использованием иммунохимических наборов и ПЦР диагностика (определения генома паразита в крови). </p>\r\n<p> </p>",
"treatment": "<p>Режим: </p>\r\n<ul>\r\n<li>полупостельный (малярия без осложнений);</li>\r\n<li>постельный (при развитии осложнений).</li>\r\n</ul>\r\n<p> Диета (легкоусвояемая); </p>\r\n<ul>\r\n<li>диета №5</li>\r\n<li>диета №7 (при развитии нефротического синдрома).</li>\r\n</ul>\r\n<p> Обильное питье до 2,5-3,0 л жидкости. </p>\r\n<p>Медикаментозное лечение </p>\r\n<p>Лечение проводится препаратом хлорохином. Лечение хлорохином не гарантирует полного, радикального излечения трехдневной малярии, так как гематошизотропные препараты не действуют на гипнозоиты в печени, поэтому курс купирующего лечения должен дополняться назначением радикального лечения гистошизотропным препаратом Примахин. </p>\r\n<p>Лечение неосложненной малярии, устойчивой к хлорохину проводится хинином. При устойчивости к хинину применяют артемизинин (экстракт полыни) и его производные. </p>\r\n<p> </p>",
"prevention": "<p>Методы, которые используются для предотвращения распространения болезни или для защиты в областях, эндемичных для малярии, включают профилактические лекарственные средства, уничтожение комаров и средства для предотвращения укусов комаров. </p>\r\n<p>Современные лекарственные средства для профилактики включают мефлохин (Лариам), доксициклин и атовакуон-прогуанил гидрохлорид. </p>",
"clinical_picture": "<p>Длительность инкубационного периода: минимальная - 10 - 20 дней, при заражении брадиспоро-зоитами - 6 - 12 и более месяцев. </p>\r\n<p>Характерны продромальные явления в конце инкубации. За несколько дней до начала приступов появляется познабливание, головная боль, боли в пояснице, разбитость, тошнота. </p>\r\n<p>Заболевание начинается остро. Первые 5-7 дней лихорадка может носить неправильный характер (инициальная), затем устанавливается интермиттирующего типа лихорадка с типичным чередованием приступов через день. Для приступа свойственна четкая смена стадий озноба, жара и пота. Период жара длится 2 - 6 ч, реже 12 ч и сменяется периодом потения. Приступы возникают, как правило, в первой половине дня. </p>\r\n<p>Селезенка и печень после 2-3 температурных пароксизмов увеличиваются, при пальпации чувствительны. </p>\r\n<p>На 2 - 3-й неделе развивается умеренная анемия. Для этой видовой формы характерны ближние и отдаленные рецидивы. Общая продолжительность болезни составляет 2-3 года. </p>",
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"description": "Малярия - группа трансмиссивных инфекционных заболеваний, передаваемых человеку при укусах самками комаров рода Anopheles («малярийных комаров») и сопровождающихся лихорадкой, ознобами, спленомегалией (увеличением размеров селезёнки), гепатомегалией (увеличением размеров печени), анемией. Характеризуется хроническим рецидивирующим течением. Вызывается паразитическими протистами рода Plasmodium ",
"etiology": "<p>Возбудители малярии — простейшие рода Plasmodium vivax. Источником болезни являются люди, в крови которых циркулируют зрелые гаметоциты. При кровососании вместе с кровью в желудок комара проникают гаметоциты, и комар становится резервуаром инфекции. Ведущий механизм заражения человека — трансмиссивный, реализующийся самками комаров рода Anopheles при кровососании. </p>\r\n<p>Возможен парентеральный путь заражения при гемотрансфузиях, использовании плохо обработанного или не подлежащего повторном у использованию инструментария, а также передача плазмодиев от матери к плоду (при тропической малярии) — так называемая шизонтная малярия. </p>",
"pathogenesis": "<p>Человек заражается ими в момент инокуляции (впрыскивания) самкой малярийного комара одной из стадий жизненного цикла возбудителя (так называемых спорозоитов) в кровь или лимфатическую систему, которое происходит при кровососании. </p>\r\n<p>После кратковременного пребывания в крови спорозоиты малярийного плазмодия проникают в гепатоциты печени, давая тем самым начало доклинической печёночной (экзоэритроцитарной) стадии заболевания. В процессе бесполого размножения, называемого шизогонией, из одного бывшего спорозоита, который в клетке печени превращается в шизонта, в итоге образуется от 2000 до 40 000 печёночных мерозоитов. В большинстве случаев эти дочерние мерозоиты через 1—6 недель снова попадают в кровь. </p>\r\n<p> </p>",
"diagnostics": "<p>Диагноз устанавливается на основе выявления паразитов в мазках крови. Традиционно используют два типа мазков — тонкий и толстый (или так называемую «толстую каплю»). Тонкий мазок позволяет с большей надёжностью определить разновидность малярийного плазмодия, поскольку внешний вид паразита (форма его клеток) при данном типе исследования лучше сохраняется. Толстый мазок позволяет микроскописту просмотреть больший объём крови, поэтому этот метод чувствительнее, но внешний вид плазмодия при этом изменяется, что не позволяет легко различать разновидности плазмодия. Поставить диагноз на основе микроскопического исследования зачастую бывает затруднительно, так как незрелые трофозоиты разных видов малярийного плазмодия плохо различимы, и обычно необходимо несколько плазмодиев, находящихся на разных стадиях созревания, для надёжной дифференциальной диагностики. </p>\r\n<p>В настоящее время используются также быстрые диагностические тесты с использованием иммунохимических наборов и ПЦР диагностика (определения генома паразита в крови). </p>\r\n<p> </p>",
"treatment": "<p>Режим: </p>\r\n<ul>\r\n<li>полупостельный (малярия без осложнений);</li>\r\n<li>постельный (при развитии осложнений).</li>\r\n</ul>\r\n<p> Диета (легкоусвояемая); </p>\r\n<ul>\r\n<li>диета №5</li>\r\n<li>диета №7 (при развитии нефротического синдрома).</li>\r\n</ul>\r\n<p> Обильное питье до 2,5-3,0 л жидкости. </p>\r\n<p>Медикаментозное лечение </p>\r\n<p>Лечение проводится препаратом хлорохином. Лечение хлорохином не гарантирует полного, радикального излечения трехдневной малярии, так как гематошизотропные препараты не действуют на гипнозоиты в печени, поэтому курс купирующего лечения должен дополняться назначением радикального лечения гистошизотропным препаратом Примахин. </p>\r\n<p>Лечение неосложненной малярии, устойчивой к хлорохину проводится хинином. При устойчивости к хинину применяют артемизинин (экстракт полыни) и его производные. </p>\r\n<p> </p>",
"prevention": "<p>Методы, которые используются для предотвращения распространения болезни или для защиты в областях, эндемичных для малярии, включают профилактические лекарственные средства, уничтожение комаров и средства для предотвращения укусов комаров. </p>\r\n<p>Современные лекарственные средства для профилактики включают мефлохин (Лариам), доксициклин и атовакуон-прогуанил гидрохлорид. </p>",
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"lead": "Нарушение здоровья, относящееся к группе протозойные болезни",
"description": "Малярия - группа трансмиссивных инфекционных заболеваний, передаваемых человеку при укусах самками комаров рода Anopheles («малярийных комаров») и сопровождающихся лихорадкой, ознобами, спленомегалией (увеличением размеров селезёнки), гепатомегалией (увеличением размеров печени), анемией. Характеризуется хроническим рецидивирующим течением. Вызывается паразитическими протистами рода Plasmodium . ",
"etiology": "<p>Возбудители малярии — простейшие рода Plasmodium falciparum . Передаётся самками комаров из рода Anopheles. Малярия, которая вызывается этим видом, иногда называется молниеносной или тропической и является самой опасной формой болезнис самым высоким уровнем смертности. </p>",
"pathogenesis": "<p>Человек заражается ими в момент инокуляции (впрыскивания) самкой малярийного комара одной из стадий жизненного цикла возбудителя (так называемых спорозоитов) в кровь или лимфатическую систему, которое происходит при кровососании. </p>\r\n<p>После кратковременного пребывания в крови спорозоиты малярийного плазмодия проникают в гепатоциты печени, давая тем самым начало доклинической печёночной (экзоэритроцитарной) стадии заболевания. В процессе бесполого размножения, называемого шизогонией, из одного бывшего спорозоита, который в клетке печени превращается в шизонта, в итоге образуется от 2000 до 40 000 печёночных мерозоитов. В большинстве случаев эти дочерние мерозоиты через 1—6 недель снова попадают в кровь. </p>\r\n<p>При инфекциях, вызываемых P.falciparum печёночная стадия развития паразитов на этом и заканчивается. </p>",
"diagnostics": "<p>Диагноз устанавливается на основе выявления паразитов в мазках крови. Традиционно используют два типа мазков — тонкий и толстый (или так называемую «толстую каплю»). Тонкий мазок позволяет с большей надёжностью определить разновидность малярийного плазмодия, поскольку внешний вид паразита (форма его клеток) при данном типе исследования лучше сохраняется. Толстый мазок позволяет микроскописту просмотреть больший объём крови, поэтому этот метод чувствительнее, но внешний вид плазмодия при этом изменяется, что не позволяет легко различать разновидности плазмодия. Поставить диагноз на основе микроскопического исследования зачастую бывает затруднительно, так как незрелые трофозоиты разных видов малярийного плазмодия плохо различимы, и обычно необходимо несколько плазмодиев, находящихся на разных стадиях созревания, для надёжной дифференциальной диагностики. </p>\r\n<p>В настоящее время используются также быстрые диагностические тесты с использованием иммунохимических наборов и ПЦР диагностика (определения генома паразита в крови). </p>",
"treatment": "<p>Режим: </p>\r\n<ul>\r\n<li>полупостельный (малярия без осложнений);</li>\r\n<li>постельный (при развитии осложнений).</li>\r\n</ul>\r\n<p> Диета (легкоусвояемая); </p>\r\n<ul>\r\n<li>диета №5</li>\r\n<li>диета №7 (при развитии нефротического синдрома).</li>\r\n</ul>\r\n<p>Обильное питье до 2,5-3,0 л жидкости. </p>\r\n<p>Медикаментозное лечение </p>\r\n<p>Лечение проводится препаратом хлорохином. Лечение хлорохином не гарантирует полного, радикального излечения трехдневной малярии, так как гематошизотропные препараты не действуют на гипнозоиты в печени, поэтому курс купирующего лечения должен дополняться назначением радикального лечения гистошизотропным препаратом Примахин. </p>\r\n<p>Лечение неосложненной тропической малярии, устойчивой к хлорохину проводится хинином. При устойчивости к хинину применяют артемизинин (экстракт полыни) и его производные. </p>\r\n<p>Лечение осложненной тропической малярии (церебральная малярия, малярийный алгид) проводят в отделении интенсивной терапии. </p>",
"prevention": "<p>Методы, которые используются для предотвращения распространения болезни или для защиты в областях, эндемичных для малярии, включают профилактические лекарственные средства, уничтожение комаров и средства для предотвращения укусов комаров. </p>\r\n<p>Современные лекарственные средства для профилактики включают мефлохин (Лариам), доксициклин и атовакуон-прогуанил гидрохлорид. </p>",
"clinical_picture": "<p>Инкубационный период около 10 дней с колебаниями от 8 до 16 дней. Тропическая малярия у неиммунных лиц характеризуется наибольшей тяжестью и нередко приобретает злокачественное течение. Без дачи противомалярийных препаратов летальный исход может наступить в первые дни болезни. </p>\r\n<p>У части лиц, впервые заболевших малярией, отмечаются продромальные явления - общее недомогание, повышенная потливость, снижение аппетита, подташнивание, послабление стула, двух-трехдневное повышение температуры тела до 38°С.</p>\r\n<p>У большинства неиммунных лиц начало болезни внезапное и характеризуется умеренно выраженным ознобом, высокой лихорадкой, возбуждением больных, выраженной головной болью, ломотой в мышцах, суставах. В первые 3-8 дней лихорадка постоянного типа, затем принимает устойчивый перемежающийся характер. В разгаре заболевания приступы лихорадки имеют некоторые особенности. Строгой периодичности начала приступов лихорадки нет. Они могут начинаться в любое время суток, но чаще возникают в первой половине дня. Снижение температуры тела не сопровождается резким потоотделением. Лихорадочные приступы длятся более суток (около 30 ч), периоды отсутствия лихорадки короткие (менее суток). </p>\r\n<p>В периоды озноба и жара кожа сухая. Характерны тахикардия и значительное снижение артериального давления. Частота дыханий нарастает, появляются сухой кашель, сухие и влажные хрипы, указывающие на развитие бронхита или бронхопневмонии. Часто развиваются диспепсические явления: анорексия, тошнота, рвота, разлитые боли в эпигастрии, энтерит, энтероколит. </p>\r\n<p>Селезенка увеличивается с первых дней заболевания, что проявляется болезненностью в левом подреберье, усиливающейся при глубоком вдохе. К 8-10-му дню болезни она легко прощупывается, край ее плотный, гладкий, болезненный. </p>\r\n<p>Часто развивается токсический гепатит, однако функции печени нарушаются незначительно, у 1/4 больных наблюдается поражение почек. </p>\r\n<p>С первых дней болезни выявляется гемолитическая анемия (повышенное разрушение эритроцитов). </p>\r\n<full></full>\r\n<p>Малярийная кома. Различают три периода малярийной комы. </p>\r\n<p>Первый период — сомноленции—характеризуется состоянием оглушенности, сонливостью. Контакт с больным затруднен, однако он может отвечать на вопросы. Сухожильные рефлексы нормальны или повышены. </p>\r\n<p>Второй период — сопора, спячки. Сознание возвращается к больному только временами. Сухожильные рефлексы повышены, выражены патологические рефлексы, нередко судорожные подергивания, спастическое состояние нижних конечностей. </p>\r\n<p>В третьем периоде— при полной коме —сознание отсутствует, сухожильные рефлексы высокие, патологические — резко выражены. Зрачки расширены, корнеальный рефлекс отсутствует. При глубокой коме рефлексы отсутствуют. </p>\r\n<p>Коматозное состояние чаще возникает при свежей малярия. В коматозном состоянии больной может находиться несколько часов. Иногда вместе со снижением температуры состояние больного может улучшиться, сознание вернуться. Однако обратное развитие наступает очень редко и только после неполной комы. </p>\r\n<p>Малярийный алгид. </p>\r\n<p>Алгидное состояние развивается также только при тропической малярии. В отличие от коматозной малярии сознание у больного сохранено. Больной находится в состоянии тяжелого коллапса, безучастен, черты лица заострены. Кожа бледна, холодна на ощупь, покрыта липким потом. Вместе с тем температура в подмышечной впадине и ректальная может быть повышена. Сухожильные рефлексы понижены, иногда отсутствуют. В крови обнаруживают все формы P. falciparum в большом количестве. Прогноз при алгидной форме тропической малярии очень тяжел. Нередко даже активное противомалярийное лечение и применение сердечно-сосудистых средств не могут вывести больного из состояния коллапса. </p>\r\n<p>Церебральная форма обычно развивается на фоне интенсивной паразитемии с инвазией значительной доли эритроцитов. Часто находят эритроциты, одновременно пораженные 2—3 паразитами и более. Характерна высокая лихорадка. Поражение центральной нервной системы проявляется сначала возбуждением, затем состоянием оглушенности, после чего больной может впасть в коматозное состояние. Могут возникать также менингиты, менингоэнцефалиты, эпилептиформные припадки, малярийные психозы и др. </p>",
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"lead": "Нарушение здоровья, относящееся к группе протозойные болезни",
"description": "Малярия - группа трансмиссивных инфекционных заболеваний, передаваемых человеку при укусах самками комаров рода Anopheles («малярийных комаров») и сопровождающихся лихорадкой, ознобами, спленомегалией (увеличением размеров селезёнки), гепатомегалией (увеличением размеров печени), анемией. Характеризуется хроническим рецидивирующим течением. Вызывается паразитическими протистами рода Plasmodium . ",
"etiology": "<p>Возбудители малярии — простейшие рода Plasmodium falciparum . Передаётся самками комаров из рода Anopheles. Малярия, которая вызывается этим видом, иногда называется молниеносной или тропической и является самой опасной формой болезнис самым высоким уровнем смертности. </p>",
"pathogenesis": "<p>Человек заражается ими в момент инокуляции (впрыскивания) самкой малярийного комара одной из стадий жизненного цикла возбудителя (так называемых спорозоитов) в кровь или лимфатическую систему, которое происходит при кровососании. </p>\r\n<p>После кратковременного пребывания в крови спорозоиты малярийного плазмодия проникают в гепатоциты печени, давая тем самым начало доклинической печёночной (экзоэритроцитарной) стадии заболевания. В процессе бесполого размножения, называемого шизогонией, из одного бывшего спорозоита, который в клетке печени превращается в шизонта, в итоге образуется от 2000 до 40 000 печёночных мерозоитов. В большинстве случаев эти дочерние мерозоиты через 1—6 недель снова попадают в кровь. </p>\r\n<p>При инфекциях, вызываемых P.falciparum печёночная стадия развития паразитов на этом и заканчивается. </p>",
"diagnostics": "<p>Диагноз устанавливается на основе выявления паразитов в мазках крови. Традиционно используют два типа мазков — тонкий и толстый (или так называемую «толстую каплю»). Тонкий мазок позволяет с большей надёжностью определить разновидность малярийного плазмодия, поскольку внешний вид паразита (форма его клеток) при данном типе исследования лучше сохраняется. Толстый мазок позволяет микроскописту просмотреть больший объём крови, поэтому этот метод чувствительнее, но внешний вид плазмодия при этом изменяется, что не позволяет легко различать разновидности плазмодия. Поставить диагноз на основе микроскопического исследования зачастую бывает затруднительно, так как незрелые трофозоиты разных видов малярийного плазмодия плохо различимы, и обычно необходимо несколько плазмодиев, находящихся на разных стадиях созревания, для надёжной дифференциальной диагностики. </p>\r\n<p>В настоящее время используются также быстрые диагностические тесты с использованием иммунохимических наборов и ПЦР диагностика (определения генома паразита в крови). </p>",
"treatment": "<p>Режим: </p>\r\n<ul>\r\n<li>полупостельный (малярия без осложнений);</li>\r\n<li>постельный (при развитии осложнений).</li>\r\n</ul>\r\n<p> Диета (легкоусвояемая); </p>\r\n<ul>\r\n<li>диета №5</li>\r\n<li>диета №7 (при развитии нефротического синдрома).</li>\r\n</ul>\r\n<p>Обильное питье до 2,5-3,0 л жидкости. </p>\r\n<p>Медикаментозное лечение </p>\r\n<p>Лечение проводится препаратом хлорохином. Лечение хлорохином не гарантирует полного, радикального излечения трехдневной малярии, так как гематошизотропные препараты не действуют на гипнозоиты в печени, поэтому курс купирующего лечения должен дополняться назначением радикального лечения гистошизотропным препаратом Примахин. </p>\r\n<p>Лечение неосложненной тропической малярии, устойчивой к хлорохину проводится хинином. При устойчивости к хинину применяют артемизинин (экстракт полыни) и его производные. </p>\r\n<p>Лечение осложненной тропической малярии (церебральная малярия, малярийный алгид) проводят в отделении интенсивной терапии. </p>",
"prevention": "<p>Методы, которые используются для предотвращения распространения болезни или для защиты в областях, эндемичных для малярии, включают профилактические лекарственные средства, уничтожение комаров и средства для предотвращения укусов комаров. </p>\r\n<p>Современные лекарственные средства для профилактики включают мефлохин (Лариам), доксициклин и атовакуон-прогуанил гидрохлорид. </p>",
"clinical_picture": "<p>Инкубационный период около 10 дней с колебаниями от 8 до 16 дней. Тропическая малярия у неиммунных лиц характеризуется наибольшей тяжестью и нередко приобретает злокачественное течение. Без дачи противомалярийных препаратов летальный исход может наступить в первые дни болезни. </p>\r\n<p>У части лиц, впервые заболевших малярией, отмечаются продромальные явления - общее недомогание, повышенная потливость, снижение аппетита, подташнивание, послабление стула, двух-трехдневное повышение температуры тела до 38°С.</p>\r\n<p>У большинства неиммунных лиц начало болезни внезапное и характеризуется умеренно выраженным ознобом, высокой лихорадкой, возбуждением больных, выраженной головной болью, ломотой в мышцах, суставах. В первые 3-8 дней лихорадка постоянного типа, затем принимает устойчивый перемежающийся характер. В разгаре заболевания приступы лихорадки имеют некоторые особенности. Строгой периодичности начала приступов лихорадки нет. Они могут начинаться в любое время суток, но чаще возникают в первой половине дня. Снижение температуры тела не сопровождается резким потоотделением. Лихорадочные приступы длятся более суток (около 30 ч), периоды отсутствия лихорадки короткие (менее суток). </p>\r\n<p>В периоды озноба и жара кожа сухая. Характерны тахикардия и значительное снижение артериального давления. Частота дыханий нарастает, появляются сухой кашель, сухие и влажные хрипы, указывающие на развитие бронхита или бронхопневмонии. Часто развиваются диспепсические явления: анорексия, тошнота, рвота, разлитые боли в эпигастрии, энтерит, энтероколит. </p>\r\n<p>Селезенка увеличивается с первых дней заболевания, что проявляется болезненностью в левом подреберье, усиливающейся при глубоком вдохе. К 8-10-му дню болезни она легко прощупывается, край ее плотный, гладкий, болезненный. </p>\r\n<p>Часто развивается токсический гепатит, однако функции печени нарушаются незначительно, у 1/4 больных наблюдается поражение почек. </p>\r\n<p>С первых дней болезни выявляется гемолитическая анемия (повышенное разрушение эритроцитов). </p>\r\n<full></full>\r\n<p>Малярийная кома. Различают три периода малярийной комы. </p>\r\n<p>Первый период — сомноленции—характеризуется состоянием оглушенности, сонливостью. Контакт с больным затруднен, однако он может отвечать на вопросы. Сухожильные рефлексы нормальны или повышены. </p>\r\n<p>Второй период — сопора, спячки. Сознание возвращается к больному только временами. Сухожильные рефлексы повышены, выражены патологические рефлексы, нередко судорожные подергивания, спастическое состояние нижних конечностей. </p>\r\n<p>В третьем периоде— при полной коме —сознание отсутствует, сухожильные рефлексы высокие, патологические — резко выражены. Зрачки расширены, корнеальный рефлекс отсутствует. При глубокой коме рефлексы отсутствуют. </p>\r\n<p>Коматозное состояние чаще возникает при свежей малярия. В коматозном состоянии больной может находиться несколько часов. Иногда вместе со снижением температуры состояние больного может улучшиться, сознание вернуться. Однако обратное развитие наступает очень редко и только после неполной комы. </p>\r\n<p>Малярийный алгид. </p>\r\n<p>Алгидное состояние развивается также только при тропической малярии. В отличие от коматозной малярии сознание у больного сохранено. Больной находится в состоянии тяжелого коллапса, безучастен, черты лица заострены. Кожа бледна, холодна на ощупь, покрыта липким потом. Вместе с тем температура в подмышечной впадине и ректальная может быть повышена. Сухожильные рефлексы понижены, иногда отсутствуют. В крови обнаруживают все формы P. falciparum в большом количестве. Прогноз при алгидной форме тропической малярии очень тяжел. Нередко даже активное противомалярийное лечение и применение сердечно-сосудистых средств не могут вывести больного из состояния коллапса. </p>\r\n<p>Церебральная форма обычно развивается на фоне интенсивной паразитемии с инвазией значительной доли эритроцитов. Часто находят эритроциты, одновременно пораженные 2—3 паразитами и более. Характерна высокая лихорадка. Поражение центральной нервной системы проявляется сначала возбуждением, затем состоянием оглушенности, после чего больной может впасть в коматозное состояние. Могут возникать также менингиты, менингоэнцефалиты, эпилептиформные припадки, малярийные психозы и др. </p>",
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}
]
}
