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},
"code": "B25",
"name": "Цитомегаловирусная болезнь",
"icd_name": "Цитомегаловирусная болезнь",
"gender": 0,
"age_min": 0,
"age_max": 89,
"cause": [
2,
4,
5,
8,
9,
10
],
"periodicity": 4,
"slug": "b25_citomegalovirusnaya_bolezn",
"lead": "Нарушение здоровья, относящееся к группе другие вирусные болезни",
"description": "Цитомегаловирусная инфекция – инфекционное заболевание, вызываемое герпесвирусом человека 5 типа, характеризующееся многообразием клинических форм (от бессимптомных до генерализованных), морфологически проявляющееся образованием в слюнных железах, внутренних органах и ЦНС цитомегалов – гигантских клеток с типичными внутриядерными и цитоплазматическими включениями.",
"etiology": "<p>Возбудитель относится к бетагерпесвирусам – медленно размножающимся вирусам, вызывающим цитомегалию клеток и латентную инфекцию в слюнных железах и почках. Вирион содержит ДНК. Размножающиеся вирусы оказывают цитопатическое действие с образованием гигантских клеток (цитомегалов) вследствие увеличения ядра и цитоплазмы. Возбудитель высоко видоспецифичен, т.е. вызывает заболевание только у человека. Особенно чувствительны к вирусу клетки плода и новорожденных.</p>\r\n<p>Вирус малоустойчив во внешней среде, инактивируется при температуре +56°C? , быстро теряет патогенные свойства при -20°C, уменьшении pH среды.</p>\r\n<p>Цитомегаловирус передается воздушно-капельным (при чихании, кашле, разговоре, нахождении в закрытом пространстве), половым (вирус содержится во влагалищном секрете и сперме), контактно-бытовым, вертикальным (во время беременности или грудного вскармливания от матери ребенку) и парентеральными путями (например, во время переливания зараженной крови).</p>",
"pathogenesis": "<p>Вирус попадает в организм человека через слизистые оболочки верхних дыхательных путей, пищеварительного тракта и мочеполовой системы. Воспалительных изменений в месте внедрения не отмечается. Течение ЦМВИ определяется путем проникновения вируса в организм: при гематогенном – заболевание чаще протекает остро, с генерализаций процесса; при других путях инфицирования отмечаются, преимущественно, бессимптомные формы. Характер клинических проявлений зависит от состояния иммунной системы человека. Так, при нормальном иммунитете, как правило, отмечаются латентные формы, а на фоне иммунодефицитного состояния – манифестные, в том числе генерализованные.</p>\r\n<p>Вирус обладает политропностью, но основными мишенями вируса являются лейкоциты (клетки иммунной системы) и эпителиальные клетки слюнных желез, легких, почек. Пораженные вирусом клетки увеличиваются в 3-4 раза, в ядре формируются внутриядерные включения, представляющие собой незрелые вирусные частицы. Клетка при этом имеет вид «совиного глаза».</p>\r\n<p>Пораженные клетки не погибают, а сохраняют функциональную активность, способность к слизисто-белковой секреции. Клеточный секрет обволакивает вирусную частицу, обеспечивая его «маскировку», при этом ферменты клетки препятствуют размножению вирусов и даже частично инактивируют их. Данные механизмы способствуют пожизненной персистенции вируса в эпителии слюнных желез и лимфоидной ткани.</p>\r\n<p>В организме человека вирус может длительное время сохраняться в состоянии слабой репликации без клинических проявлений. При возникновении иммунодефицита вирус проникает в кровь и разносится в различные органы.</p>",
"diagnostics": "<p>В общем анализе крови на фоне нормального, пониженного или повышенного количества лейкоцитов наблюдается лимфоцитоз с наличием атипичных мононуклеаров в количестве более 10%.</p>\r\n<p>Используют вирусологический метод — обнаружение вируса и его антигенов в моче, слюне, вагинальном секрете и других биологических жидкостях. Метод ИФА используют для выявления специфических иммуноглобулинов класса М к цитомегаловирусу. Серологические методы диагностики (РИМ, РСК, РИФ) – повышение титра антител в 4 и более раза.</p>\r\n<p>Цитоскопия осадков мочи и слюны, цервикального и влагалищного секретов позволяет выявить характерные цитомегалы с крупным ядром и узкой каймой цитоплазмы («совиный глаз»). </p>\r\n<p>С целью пренатальной диагностики инфекции проводят УЗИ плода: обнаружение внутричерепных кальцификатов может свидетельствовать о врожденной инфекции.</p>",
"treatment": "<p>Характер режима и диеты зависит от возраста ребенка, тяжести и локализации патологического процесса. </p>\r\n<p>Этиотропная терапия включает применение противовирусных препаратов, специфического иммуноглобулина (цитотект). Этиотропные средства назначают больным тяжелыми формами ЦМВИ, а также детям с сопутствующими заболеваниями. </p>\r\n<p>Патогенетигеская и симптоматигеская терапия определяется локализацией патологического процесса. Для лечения больных генерализованными формами используют глюкокортикоиды.</p>\r\n<p>Антибиотики назначают при наслоении вторичной бактериальной флоры. В связи с иммуносупрессивным действием вируса показано назначение иммуномодуляторов (под контролем иммунограммы).</p>",
"prevention": "<p>Неспецифическая профилактика заключается в выполнении гигиенических навыков беременными; санэпидрежима — медработниками при уходе за инфицированными детьми и контакте с экскрементами больных. </p>\r\n<p>Рекомендуется обследование беременных и доноров на наличие антител к ЦМВ; использование замороженной крови от серонегативных доноров, а также масок и перчаток при работе с больными острыми формами ЦМВИ.</p>",
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},
"code": "B25.9",
"name": "Цитомегаловирусная болезнь неуточненная",
"icd_name": "Цитомегаловирусная болезнь неуточненная",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
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],
"periodicity": 1,
"slug": "b25.9_citomegalovirusnaya_bolezn_neutochnennaya",
"lead": "хроническое инфекционное заболевание вирусной этиологии, характеризующееся многообразием клинических форм и проявлений - от бессимптомного течения до тяжелого поражения внутренних органов и центральной нервной системы",
"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;\">Возбудитель цитомегаловирусной инфекции – цитомегаловирус - относится к семейству герпесвирусов человека. Клетки, пораженные цитомегаловирусом, многократно увеличиваются в размерах. Цитомегалия не является высоко заразной инфекцией. Обычно заражение происходит при тесных, длительных контактах с носителями цитомегаловируса. Цитомегаловирус передается следующими путями:</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;\">воздушно-капельным: при чихании, кашле, разговоре, поцелуях и т.д.;</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;\">половым путем: при сексуальных контактах через сперму, влагалищную и шеечную слизь;</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;\">гемотрансфузионным: при переливании крови, лейкоцитарной массы, иногда - при пересадке органов и тканей;</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;\">трансплацентарным: во время беременности от матери плоду.</span></li>\r\n</ul>\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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Нередко цитомегаловирус находится в организме многие годы и может ни разу не проявить себя и не нанести вреда человеку. Проявление скрытой инфекции происходит, как правило, при ослаблении иммунитета. Угрожающую по своим последствиям опасность цитомегаловирус представляет у лиц со сниженным иммунитетом (ВИЧ-инфицированных, перенесших трансплантацию костного мозга или внутренних органов, принимающих иммунодепрессанты), при врожденной форме цитомегалии, у беременных.</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;\">Входными воротами для Cytomegalovirus является слизистая оболочка, преимущественно верхних дыхательных путей и ротоглотки. Инфицирование также может произойти через мочеполовую систему, желудочно-кишечный тракт и другие органы.</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;\">В месте внедрения не наблюдается структурных изменений. После того, как вирус проникает в организм, он начинает атаковать моно- и лимфоциты, а также эпителий слюнных желез, почек, легких и других внутренних органов. При этом наблюдается цитомегалия (увеличение пораженных клеток в размерах в 3-4 раза). В ядрах клеток происходит формирование незрелых вирионов. </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;\">В ответ на проникновение ЦМВ наблюдается развитие защитной реакции – образуются специфические антитела, и наблюдается гиперчувствительность замедленного типа. Данный процесс сопровождается появлением узелковых образований лимфоцитарных инфильтратов. Клетки, которые были инфицированы, продолжают функционировать, выделяя специальный секрет, обеспечивающий маскировку вируса от защитных функций организма человека.</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;\">В случае цитомегаловирусной инфекции вирус может быть выделен и детально описан после ряда исследований представленных для анализа жидкостей: крови, спермы, слюны, мочи. Чаще всего проводится анализ мочи.</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;\">Методами исследования являются:</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;\">посев на культуре или гибридизация (устанавливается тип вируса, его форма и степень агрессивности);</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;\">полимеразная цепная реакция (ПЦР) (определяется ДНК ЦМВ и подтверждающая их наличие в представленной жидкости);</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;\">серодиагностика (поиск не только самого вируса, но и вырабатываемых организмом антител);</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;\">микроскопия (обнаруживается, что пораженные клетки приобрели характерный вид «совиного глаза»). В них обнаруживаются инклюзии (включения), которые являются скоплениями вирусов)</span></li>\r\n</ul>\r\n<p> </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;\">Неосложненные формы мононуклеазоподобного синдрома не требует специфической терапии. Обычно проводятся мероприятия, идентичные лечению обычного простудного заболевания. Для снятия симптомов интоксикации, вызываемой цитомегаловирусом, рекомендуется пить достаточное количество жидкости.</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 цитомегаловирусной инфекции у лиц, входящих в группу риска, проводится противовирусным препаратом ганцикловиром. В случаях тяжелого течения цитомегалии ганцикловир вводится внутривенно, т. к. таблетированные формы препарата обладают лишь профилактическим эффектом в отношении цитомегаловируса. Поскольку ганцикловир обладает выраженными побочными эффектами (вызывает угнетение кроветворения - анемию, нейтропению, тромбоцитопению, кожные реакции, желудочно-кишечные расстройства, повышение температуры и ознобы и др.), его применение ограничено у беременных, детей и у людей, страдающих почечной недостаточностью (только по жизненным показаниям), он не используется у пациентов без нарушения иммунитета.</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;\">Для лечения цитомегаловируса у ВИЧ-инфицированных наиболее эффективен препарат фоскарнет, также обладающий рядом побочных эффектов. Фоскарнет может вызывать нарушение электролитного обмена (снижение в плазме крови магния и калия), изъязвление половых органов, нарушение мочеиспускания, тошноту, поражение почек. Данные побочные реакции требуют осторожного применения и своевременной корректировки дозы препарата.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-2f24c18b-7fff-4229-c73a-b1bf720fab1c\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Неспецифические методы профилактики (например, соблюдение личной гигиены) неэффективны в отношении цитомегаловируса, так как заражение им возможно даже воздушно-капельным путем. Специфическая профилактика цитомегаловирусной инфекции проводится ганцикловиром, ацикловиром, фоскарнетом среди пациентов, входящих в группы риска.</span></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 цитомегаловирусной болезни составляет от 15 дней до трех месяцев (при манифестной, выраженной форме заболевания). Однако чаще первичное инфицирование протекает или бессимптомно, или по типу легкой формы ОРЗ – у пациента наблюдаются незначительная слабость, лихорадка (температура 37,1-38,0°С), дискомфорт в мышцах, першение в горле, иногда насморк, увеличение шейных лимфатических узлов, болезненность слюнных желез, головная боль, отсутствие аппетита.</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;\">У беременных острая первичная инфекция протекает, как правило, бессимптомно (25–50%) или с неспецифическими проявлениями (с лихорадкой, астенией и головной болью).</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;\">В редких случаях развиваются гепато- и спленомегалия, гепатит с минимальной степенью активности цитолитического синдрома, дерматиты, васкулиты, интерстициальный пневмонический процесс, тромбоцитоз или тромбоцитопения, лимфоцитоз.</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;\">У больных с иммунодефицитом цитомегаловирусная инфекция протекает тяжело - вирус быстро распространяется по организму и вызывает серьезные осложнения.</span></p>",
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{
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{
"name": "Боль головная у детей"
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{
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{
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{
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{
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{
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{
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{
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{
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{
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},
{
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},
{
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},
"code": "B25",
"name": "Цитомегаловирусная болезнь",
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"lead": "Нарушение здоровья, относящееся к группе другие вирусные болезни",
"description": "Цитомегаловирусная инфекция – инфекционное заболевание, вызываемое герпесвирусом человека 5 типа, характеризующееся многообразием клинических форм (от бессимптомных до генерализованных), морфологически проявляющееся образованием в слюнных железах, внутренних органах и ЦНС цитомегалов – гигантских клеток с типичными внутриядерными и цитоплазматическими включениями.",
"etiology": "<p>Возбудитель относится к бетагерпесвирусам – медленно размножающимся вирусам, вызывающим цитомегалию клеток и латентную инфекцию в слюнных железах и почках. Вирион содержит ДНК. Размножающиеся вирусы оказывают цитопатическое действие с образованием гигантских клеток (цитомегалов) вследствие увеличения ядра и цитоплазмы. Возбудитель высоко видоспецифичен, т.е. вызывает заболевание только у человека. Особенно чувствительны к вирусу клетки плода и новорожденных.</p>\r\n<p>Вирус малоустойчив во внешней среде, инактивируется при температуре +56°C? , быстро теряет патогенные свойства при -20°C, уменьшении pH среды.</p>\r\n<p>Цитомегаловирус передается воздушно-капельным (при чихании, кашле, разговоре, нахождении в закрытом пространстве), половым (вирус содержится во влагалищном секрете и сперме), контактно-бытовым, вертикальным (во время беременности или грудного вскармливания от матери ребенку) и парентеральными путями (например, во время переливания зараженной крови).</p>",
"pathogenesis": "<p>Вирус попадает в организм человека через слизистые оболочки верхних дыхательных путей, пищеварительного тракта и мочеполовой системы. Воспалительных изменений в месте внедрения не отмечается. Течение ЦМВИ определяется путем проникновения вируса в организм: при гематогенном – заболевание чаще протекает остро, с генерализаций процесса; при других путях инфицирования отмечаются, преимущественно, бессимптомные формы. Характер клинических проявлений зависит от состояния иммунной системы человека. Так, при нормальном иммунитете, как правило, отмечаются латентные формы, а на фоне иммунодефицитного состояния – манифестные, в том числе генерализованные.</p>\r\n<p>Вирус обладает политропностью, но основными мишенями вируса являются лейкоциты (клетки иммунной системы) и эпителиальные клетки слюнных желез, легких, почек. Пораженные вирусом клетки увеличиваются в 3-4 раза, в ядре формируются внутриядерные включения, представляющие собой незрелые вирусные частицы. Клетка при этом имеет вид «совиного глаза».</p>\r\n<p>Пораженные клетки не погибают, а сохраняют функциональную активность, способность к слизисто-белковой секреции. Клеточный секрет обволакивает вирусную частицу, обеспечивая его «маскировку», при этом ферменты клетки препятствуют размножению вирусов и даже частично инактивируют их. Данные механизмы способствуют пожизненной персистенции вируса в эпителии слюнных желез и лимфоидной ткани.</p>\r\n<p>В организме человека вирус может длительное время сохраняться в состоянии слабой репликации без клинических проявлений. При возникновении иммунодефицита вирус проникает в кровь и разносится в различные органы.</p>",
"diagnostics": "<p>В общем анализе крови на фоне нормального, пониженного или повышенного количества лейкоцитов наблюдается лимфоцитоз с наличием атипичных мононуклеаров в количестве более 10%.</p>\r\n<p>Используют вирусологический метод — обнаружение вируса и его антигенов в моче, слюне, вагинальном секрете и других биологических жидкостях. Метод ИФА используют для выявления специфических иммуноглобулинов класса М к цитомегаловирусу. Серологические методы диагностики (РИМ, РСК, РИФ) – повышение титра антител в 4 и более раза.</p>\r\n<p>Цитоскопия осадков мочи и слюны, цервикального и влагалищного секретов позволяет выявить характерные цитомегалы с крупным ядром и узкой каймой цитоплазмы («совиный глаз»). </p>\r\n<p>С целью пренатальной диагностики инфекции проводят УЗИ плода: обнаружение внутричерепных кальцификатов может свидетельствовать о врожденной инфекции.</p>",
"treatment": "<p>Характер режима и диеты зависит от возраста ребенка, тяжести и локализации патологического процесса. </p>\r\n<p>Этиотропная терапия включает применение противовирусных препаратов, специфического иммуноглобулина (цитотект). Этиотропные средства назначают больным тяжелыми формами ЦМВИ, а также детям с сопутствующими заболеваниями. </p>\r\n<p>Патогенетигеская и симптоматигеская терапия определяется локализацией патологического процесса. Для лечения больных генерализованными формами используют глюкокортикоиды.</p>\r\n<p>Антибиотики назначают при наслоении вторичной бактериальной флоры. В связи с иммуносупрессивным действием вируса показано назначение иммуномодуляторов (под контролем иммунограммы).</p>",
"prevention": "<p>Неспецифическая профилактика заключается в выполнении гигиенических навыков беременными; санэпидрежима — медработниками при уходе за инфицированными детьми и контакте с экскрементами больных. </p>\r\n<p>Рекомендуется обследование беременных и доноров на наличие антител к ЦМВ; использование замороженной крови от серонегативных доноров, а также масок и перчаток при работе с больными острыми формами ЦМВИ.</p>",
"clinical_picture": "<p>Приобретенная цитомегаловирусная инфекция.</p>\r\n<p>Инкубационный период колеблется от 15 дней до 3 мес. </p>\r\n<p>Латентная форма является самой распространенной. Протекает без клинических проявлений. У детей на фоне снижения иммунитета может отмечаться активация латентной инфекции с развитием манифестной формы болезни. </p>\r\n<p>Манифестные формы. Локализованная форма (сиалоаденит) характеризуется изолированным увеличением слюнных желез (чаще околоушных, реже подчелюстных и подъязычных) и умеренно выраженным синдромом интоксикации. </p>\r\n<p>Генерализованные формы. </p>\r\n<p>Мононуклеозоподобная форма. Начинается остро, протекает с лихорадкой, выраженным синдромом интоксикации (слабость, головная боль, боли в мышцах), иногда с ознобами. Отмечается увеличение лимфатических узлов, увеличение печени и селезенки. В ряде случаев выявляется реактивный гепатит.</p>\r\n<p>Легочная форма проявляется развитием интерстициальной пневмонии, характеризующейся затяжным течением. Отмечается приступообразный кашель с малым количеством мокроты, одышка, цианоз (синюшность), вздутие грудной клетки.</p>\r\n<p>Церебральная форма может проявляться в виде менингоэнцефалита (воспаление вещества и оболочек мозга). Отмечаются нарушения сознания, психические расстройства, судороги, параралич, парапарезы, приступы эпилепсии. </p>\r\n<p>Почечная форма встречается довольно часто, но из-за слабо выраженных проявлений диагностируется редко. Обычно единственными признаками болезни является наличие белка и увеличение количества эпителиальных клеток в моче, а также обнаружение в ней цитомегалических клеток. </p>\r\n<p>Печеночная форма проявляется клиническими симптомами подостро протекающего холестатического гепатита. У ребенка длительное время сохраняется увеличение печени и селезенки, желтушность кожи и слизистых оболочек полости рта (за счет увеличения в сыворотке крови связанного билирубина).</p>\r\n<p>Желудочно-кишечная форма характеризуется вздутием живота, упорной рвотой, учащенным (до 10 – 15 раз в сутки) жидким стулом без патологических примесей, отставанием в физическом развитии. В кале может отмечаться большое количество нейтрального жира в связи с поражением поджелудочной железы по типу поликистозного перерождения. </p>\r\n<p>Комбинированная форма приобретенной цитомегалии характеризуется вовлечением в патологический процесс ряда органов и систем (легкие, почки, ЦНС, печень, желудочно-кишечный тракт). Встречается у детей с иммунодефицитными состояниями; клинически проявляется выраженным синдромом интоксикации, высокой длительной лихорадкой с дневными колебаниями температуры тела до 2—4°С, генерализованным увеличением лимфатических узлов, воспалением слюнных желез, увеличением печени и селезенки, геморрагическим синдромом, сыпью. </p>\r\n<p>Внутриутробное инфицирование плода на сроке до 12 недель, как правило, заканчивается выкидышем, при заражении после 12 недель у ребенка может развиться тяжелое заболевание - врожденная цитомегалия. По статистике врожденной цитомегалией страдают примерно 5% зараженных внутриутробно новорожденных. К ее симптомам можно отнести недоношенность, увеличение печени, почек, селезенки, хориоретинит, пневмонию. У детей, перенесших внутриутробно ЦМВ- инфекцию и избежавших генерализации процесса, может выявляется задержка психомоторного развития, тугоухость, нарушения зрения, аномалии развития зубов.</p>\r\n<p> </p>",
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},
"code": "B25.9",
"name": "Цитомегаловирусная болезнь неуточненная",
"icd_name": "Цитомегаловирусная болезнь неуточненная",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
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],
"periodicity": 1,
"slug": "b25.9_citomegalovirusnaya_bolezn_neutochnennaya",
"lead": "хроническое инфекционное заболевание вирусной этиологии, характеризующееся многообразием клинических форм и проявлений - от бессимптомного течения до тяжелого поражения внутренних органов и центральной нервной системы",
"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;\">Возбудитель цитомегаловирусной инфекции – цитомегаловирус - относится к семейству герпесвирусов человека. Клетки, пораженные цитомегаловирусом, многократно увеличиваются в размерах. Цитомегалия не является высоко заразной инфекцией. Обычно заражение происходит при тесных, длительных контактах с носителями цитомегаловируса. Цитомегаловирус передается следующими путями:</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;\">воздушно-капельным: при чихании, кашле, разговоре, поцелуях и т.д.;</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;\">половым путем: при сексуальных контактах через сперму, влагалищную и шеечную слизь;</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;\">гемотрансфузионным: при переливании крови, лейкоцитарной массы, иногда - при пересадке органов и тканей;</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;\">трансплацентарным: во время беременности от матери плоду.</span></li>\r\n</ul>\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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Нередко цитомегаловирус находится в организме многие годы и может ни разу не проявить себя и не нанести вреда человеку. Проявление скрытой инфекции происходит, как правило, при ослаблении иммунитета. Угрожающую по своим последствиям опасность цитомегаловирус представляет у лиц со сниженным иммунитетом (ВИЧ-инфицированных, перенесших трансплантацию костного мозга или внутренних органов, принимающих иммунодепрессанты), при врожденной форме цитомегалии, у беременных.</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;\">Входными воротами для Cytomegalovirus является слизистая оболочка, преимущественно верхних дыхательных путей и ротоглотки. Инфицирование также может произойти через мочеполовую систему, желудочно-кишечный тракт и другие органы.</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;\">В месте внедрения не наблюдается структурных изменений. После того, как вирус проникает в организм, он начинает атаковать моно- и лимфоциты, а также эпителий слюнных желез, почек, легких и других внутренних органов. При этом наблюдается цитомегалия (увеличение пораженных клеток в размерах в 3-4 раза). В ядрах клеток происходит формирование незрелых вирионов. </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;\">В ответ на проникновение ЦМВ наблюдается развитие защитной реакции – образуются специфические антитела, и наблюдается гиперчувствительность замедленного типа. Данный процесс сопровождается появлением узелковых образований лимфоцитарных инфильтратов. Клетки, которые были инфицированы, продолжают функционировать, выделяя специальный секрет, обеспечивающий маскировку вируса от защитных функций организма человека.</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;\">В случае цитомегаловирусной инфекции вирус может быть выделен и детально описан после ряда исследований представленных для анализа жидкостей: крови, спермы, слюны, мочи. Чаще всего проводится анализ мочи.</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;\">Методами исследования являются:</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;\">посев на культуре или гибридизация (устанавливается тип вируса, его форма и степень агрессивности);</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;\">полимеразная цепная реакция (ПЦР) (определяется ДНК ЦМВ и подтверждающая их наличие в представленной жидкости);</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;\">серодиагностика (поиск не только самого вируса, но и вырабатываемых организмом антител);</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;\">микроскопия (обнаруживается, что пораженные клетки приобрели характерный вид «совиного глаза»). В них обнаруживаются инклюзии (включения), которые являются скоплениями вирусов)</span></li>\r\n</ul>\r\n<p> </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;\">Неосложненные формы мононуклеазоподобного синдрома не требует специфической терапии. Обычно проводятся мероприятия, идентичные лечению обычного простудного заболевания. Для снятия симптомов интоксикации, вызываемой цитомегаловирусом, рекомендуется пить достаточное количество жидкости.</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 цитомегаловирусной инфекции у лиц, входящих в группу риска, проводится противовирусным препаратом ганцикловиром. В случаях тяжелого течения цитомегалии ганцикловир вводится внутривенно, т. к. таблетированные формы препарата обладают лишь профилактическим эффектом в отношении цитомегаловируса. Поскольку ганцикловир обладает выраженными побочными эффектами (вызывает угнетение кроветворения - анемию, нейтропению, тромбоцитопению, кожные реакции, желудочно-кишечные расстройства, повышение температуры и ознобы и др.), его применение ограничено у беременных, детей и у людей, страдающих почечной недостаточностью (только по жизненным показаниям), он не используется у пациентов без нарушения иммунитета.</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;\">Для лечения цитомегаловируса у ВИЧ-инфицированных наиболее эффективен препарат фоскарнет, также обладающий рядом побочных эффектов. Фоскарнет может вызывать нарушение электролитного обмена (снижение в плазме крови магния и калия), изъязвление половых органов, нарушение мочеиспускания, тошноту, поражение почек. Данные побочные реакции требуют осторожного применения и своевременной корректировки дозы препарата.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-2f24c18b-7fff-4229-c73a-b1bf720fab1c\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Неспецифические методы профилактики (например, соблюдение личной гигиены) неэффективны в отношении цитомегаловируса, так как заражение им возможно даже воздушно-капельным путем. Специфическая профилактика цитомегаловирусной инфекции проводится ганцикловиром, ацикловиром, фоскарнетом среди пациентов, входящих в группы риска.</span></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 цитомегаловирусной болезни составляет от 15 дней до трех месяцев (при манифестной, выраженной форме заболевания). Однако чаще первичное инфицирование протекает или бессимптомно, или по типу легкой формы ОРЗ – у пациента наблюдаются незначительная слабость, лихорадка (температура 37,1-38,0°С), дискомфорт в мышцах, першение в горле, иногда насморк, увеличение шейных лимфатических узлов, болезненность слюнных желез, головная боль, отсутствие аппетита.</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;\">У беременных острая первичная инфекция протекает, как правило, бессимптомно (25–50%) или с неспецифическими проявлениями (с лихорадкой, астенией и головной болью).</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;\">В редких случаях развиваются гепато- и спленомегалия, гепатит с минимальной степенью активности цитолитического синдрома, дерматиты, васкулиты, интерстициальный пневмонический процесс, тромбоцитоз или тромбоцитопения, лимфоцитоз.</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;\">У больных с иммунодефицитом цитомегаловирусная инфекция протекает тяжело - вирус быстро распространяется по организму и вызывает серьезные осложнения.</span></p>",
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},
"code": "B19",
"name": "Вирусный гепатит неуточненный",
"icd_name": "Вирусный гепатит неуточненный",
"gender": 0,
"age_min": 0,
"age_max": 84,
"cause": [
2,
7,
9,
10
],
"periodicity": 4,
"slug": "b19_virusnyy_gepatit_neutochnennyy",
"lead": "Нарушение здоровья, относящееся к группе вирусный гепатит",
"description": "Вирусные гепатиты – группа инфекционных заболеваний, вызываемых первично-гепатотропными вирусами, характеризующихся преимущественным поражением печени.",
"etiology": "<p>Гепатит может быть вызван многими причинами, но наиболее часто гепатит вызывается вирусами. На данный момент известно большое количество вирусов, способных вызвать вирусный гепатит: вирус гепатита A, вирус гепатита B, вирус гепатита C, вирус гепатита D, вирус гепатита E, вирус гепатита F и вирус гепатита G, вирусы гепатитов TTV и SEN, цитомегаловирус, вирус Эпштейна — Барр, ВИЧ и другие. Некоторые вирусы, вызывающие вирусный гепатит, недостаточно изучены.</p>\r\n<p>Известны также вирусы гепатитов животных:</p>\r\n<ul>\r\n<li>собак (аденовирус),</li>\r\n<li>мышей (коронавирус),</li>\r\n<li>уток (энтеровирус) и, вероятно,</li>\r\n<li>обезьян (пегивирус).</li>\r\n</ul>\r\n<p>Кроме того, гепатит может вызываться такими вирусами, как вирус желтой лихорадки, герпесвирусы, вирус краснухи, вирусы Коксаки, вирус лихорадки Ласса, вирусы лихорадок Марбург-Эбола и другими.</p>",
"pathogenesis": "<p>Вирусы гепатита попадают в организм разными путями: гепатит А и Е — через загрязненные пищевые продукты и воду; гепатит В — через небезопасную кровь и другие жидкости организма; гепатит С — в основном, через зараженную кровь и гепатит D — в качестве дополнительной инфекции при наличии гепатита В.</p>\r\n<p>Вирусы обладают тропностью к ткани печени, при этом они вызывают острое ее воспаление, повреждение и разрушение печеночных клеток (гепатоцитов), воспалительный отек и снижение функциональной деятельности органа. Недостаточность желчеобразующая функции печени является первопричиной повышенного накопления билирубина в крови (билирубинемии) и, как следствие, желтухи. Поскольку в тканях печени нет болевых рецепторных зон, болевой синдром редко выражен и связан с увеличением печени, растяжении ее хорошо иннервированной капсулы и воспалительными процессами в желчном пузыре.</p>\r\n<p>Хроническое воспаление, как правило, развивается вследствие нелеченного или недостаточно леченного острого гепатита. Нередко хронический гепатит постепенно переходит в цирроз печени.</p>",
"diagnostics": "<p><strong></strong></p>\r\n<p>Диагностика гепатитов осуществляется на основании анамнеза, клинических данных, данных физикального осмотра, функциональных и лабораторных исследований.</p>\r\n<p> </p>\r\n<p>Лабораторные исследования включают: </p>\r\n<ul>\r\n<li>Биохимический анализ крови (повышение уровня печеночно-клеточных ферментов – АЛТ, АСТ; повышение общего билирубина, изменение соотношения прямой и непрямой фракций билирубина);</li>\r\n<li>Общий анализ мочи – появление в моче билирубина, накопление уробилина;</li>\r\n<li>Коагулограмма – оценка свертывающей системы крови;</li>\r\n<li>Тимоловая и сулемовая пробы;</li>\r\n<li>ПЦР-диагностика крови – выявление генома (РНК или ДНК) вируса;</li>\r\n<li>ИФА – выявление в сыворотке крови специфических антител (иммуноглобулинов класса М)</li>\r\n</ul>\r\n<p> </p>\r\n<p>Инструментальные методы диагностики включают:</p>\r\n<ul>\r\n<li>УЗИ органов брюшной полости – отмечают увеличение печени и изменение ее звуковой проницаемости и, кроме этого, отмечают увеличение селезенки и, возможно, расширение полой вены;</li>\r\n<li>Реогепатография(исследование печеночного кровотока), </li>\r\n<li>Гепатохолецистосцинтиография(радиоизотопное исследование желчевыводящих путей), </li>\r\n<li>Пункционная биопсия печени.</li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>Лечение острого гепатита обязательно проводится в стационаре.</p>\r\n<p>Назначается:</p>\r\n<p>прописывается диета №5, полупостельный режим (при тяжелом течении – постельный);</p>\r\n<p> </p>\r\n<p>Этиотропная терапия</p>\r\n<ul>\r\n<li>Интерферон-а</li>\r\n<li>Индукторы интерферона</li>\r\n<li>Ламивудин</li>\r\n</ul>\r\n<p>Патогенетическая и посиндромная терапия:</p>\r\n<ul>\r\n<li>Интенсивная дезинтоксикационная инфузионная терапия, при необходимости экстракорпоральная детоксикация;</li>\r\n<li>Желчегонные препараты или тюбажи по Демьянову;</li>\r\n<li>Ферментные препараты;</li>\r\n<li>Гепатопротективные препараты;</li>\r\n<li>Глюкокортикоиды;</li>\r\n<li>Ингибиторы протеолиза;</li>\r\n<li>Поливитамины, витамино-минеральные комплексы, фитотерапия.</li>\r\n</ul>\r\n<p>Хорошие результаты по улучшению общего состояния при выраженной гипоксии дает кислородотерапия, оксигенобаротерапия. Если присутствуют признаки геморрагического диатеза, назначают витамин К внутривенно.</p>",
"prevention": "<p>Первичная профилактика вирусных гепатитов – соблюдение гигиенических предписаний, осуществление санитарно-эпидемических мер, санитарный надзор над предприятиями, могущими стать очагом распространения инфекции, вакцинация. Профилактикой других форм гепатитов является избегание действия гепатотравмирующих факторов – алкоголя, лекарственных средств, токсических веществ.</p>\r\n<p>Вторичная профилактика хронического гепатита заключается в соблюдении диеты, режима, врачебных рекомендаций, регулярном прохождении обследования, контроле клинических показателей крови. Больным рекомендовано регулярное санаторно-курортное лечение, водолечение.</p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Выделяют две основные формы клинического течения гепатитов: острую и хроническую.</p>\r\n<p>Острая форма течения наиболее характерна для гепатитов вирусной природы. Иногда начало гепатита напоминает грипп: с повышением температуры тела, головной болью, общим недомоганием, ломотой в теле. Как правило, это — так называемая «маска» начинающегося вирусного гепатита, характеризующаяся слабостью.</p>\r\n<p>При острой форме развития гепатита наблюдается заметное ухудшение общего состояния больного, развития признаков общей интоксикации организма и нарушения функции печени (повышение температуры тела, в ряде случаев развитие желтухи и др.), а также повышение уровня печеночных ферментов (трансаминаз) и общего билирубина крови. Моча темнеет, при выраженных нарушениях синтеза желчных кислот кал теряет цвет, становится беловато-глинистым.</p>\r\n<p>Больные могут отмечать такие симптомы, как кожный зуд, возникновение на коже красных точек – петехий, брадикардию, невротические симптомы.</p>\r\n<p>Острый гепатит, как правило, заканчивается полным выздоровлением больного, однако в некоторых случаях наблюдается переход острого течения болезни в хроническое.</p>\r\n<p>Клиническая картина при хроническом гепатите бедная, заболевание долгое время протекает бессимптомно. Хронический гепатит характеризуется постепенным развитием следующих клинических синдромов:</p>\r\n<ul>\r\n<li>астеновегетативный (слабость, повышенная утомляемость, расстройства сна, психическая лабильность, головные боли – обусловлен интоксикацией организма в связи с нарастающей печеночной недостаточностью;</li>\r\n<li>диспепсический (тошнота, иногда - рвота, понижение аппетита, метеоризм, поносы, чередующиеся с запорами, отрыжка горечью, неприятный привкус во рту) связан с нарушениями пищеварения в связи с недостаточностью выработки печенью необходимых для пищеварения ферментов и желчных кислот);</li>\r\n<li>болевой синдром (боль постоянного, ноющего характера локализуется в правом подреберье, усиливается при физических нагрузках и после резких нарушений диеты) – может отсутствовать или выражаться в умеренном ощущении тяжести в эпигастрии;</li>\r\n<li>субфебрилитет (умеренное повышение температуры до 37,3 – 37,5 градусов может держаться по нескольку недель);</li>\r\n<li>телеангиэктазии (сосудистые звездочки на коже) на шее, лице, плечах;</li>\r\n<li>геморрагический (петехии, склонность к образованию синяков и кровоподтеков, носовые, геморроидальные, маточные кровотечения) связан с понижением свертываемости крови вследствие недостаточного синтеза факторов свертываемости в клетках печени;</li>\r\n<li>желтуха – наиболее известный симптом, возникает, когда билирубин, не переработанный в печени, попадает в кровь и придаёт коже характерный желтоватый оттенок. Однако часто бывают и безжелтушные формы гепатита;</li>\r\n<li>увеличение печени, может сочетаться с увеличением селезенки.</li>\r\n</ul>\r\n<p> </p>",
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},
"code": "B19",
"name": "Вирусный гепатит неуточненный",
"icd_name": "Вирусный гепатит неуточненный",
"gender": 0,
"age_min": 0,
"age_max": 84,
"cause": [
2,
7,
9,
10
],
"periodicity": 4,
"slug": "b19_virusnyy_gepatit_neutochnennyy",
"lead": "Нарушение здоровья, относящееся к группе вирусный гепатит",
"description": "Вирусные гепатиты – группа инфекционных заболеваний, вызываемых первично-гепатотропными вирусами, характеризующихся преимущественным поражением печени.",
"etiology": "<p>Гепатит может быть вызван многими причинами, но наиболее часто гепатит вызывается вирусами. На данный момент известно большое количество вирусов, способных вызвать вирусный гепатит: вирус гепатита A, вирус гепатита B, вирус гепатита C, вирус гепатита D, вирус гепатита E, вирус гепатита F и вирус гепатита G, вирусы гепатитов TTV и SEN, цитомегаловирус, вирус Эпштейна — Барр, ВИЧ и другие. Некоторые вирусы, вызывающие вирусный гепатит, недостаточно изучены.</p>\r\n<p>Известны также вирусы гепатитов животных:</p>\r\n<ul>\r\n<li>собак (аденовирус),</li>\r\n<li>мышей (коронавирус),</li>\r\n<li>уток (энтеровирус) и, вероятно,</li>\r\n<li>обезьян (пегивирус).</li>\r\n</ul>\r\n<p>Кроме того, гепатит может вызываться такими вирусами, как вирус желтой лихорадки, герпесвирусы, вирус краснухи, вирусы Коксаки, вирус лихорадки Ласса, вирусы лихорадок Марбург-Эбола и другими.</p>",
"pathogenesis": "<p>Вирусы гепатита попадают в организм разными путями: гепатит А и Е — через загрязненные пищевые продукты и воду; гепатит В — через небезопасную кровь и другие жидкости организма; гепатит С — в основном, через зараженную кровь и гепатит D — в качестве дополнительной инфекции при наличии гепатита В.</p>\r\n<p>Вирусы обладают тропностью к ткани печени, при этом они вызывают острое ее воспаление, повреждение и разрушение печеночных клеток (гепатоцитов), воспалительный отек и снижение функциональной деятельности органа. Недостаточность желчеобразующая функции печени является первопричиной повышенного накопления билирубина в крови (билирубинемии) и, как следствие, желтухи. Поскольку в тканях печени нет болевых рецепторных зон, болевой синдром редко выражен и связан с увеличением печени, растяжении ее хорошо иннервированной капсулы и воспалительными процессами в желчном пузыре.</p>\r\n<p>Хроническое воспаление, как правило, развивается вследствие нелеченного или недостаточно леченного острого гепатита. Нередко хронический гепатит постепенно переходит в цирроз печени.</p>",
"diagnostics": "<p><strong></strong></p>\r\n<p>Диагностика гепатитов осуществляется на основании анамнеза, клинических данных, данных физикального осмотра, функциональных и лабораторных исследований.</p>\r\n<p> </p>\r\n<p>Лабораторные исследования включают: </p>\r\n<ul>\r\n<li>Биохимический анализ крови (повышение уровня печеночно-клеточных ферментов – АЛТ, АСТ; повышение общего билирубина, изменение соотношения прямой и непрямой фракций билирубина);</li>\r\n<li>Общий анализ мочи – появление в моче билирубина, накопление уробилина;</li>\r\n<li>Коагулограмма – оценка свертывающей системы крови;</li>\r\n<li>Тимоловая и сулемовая пробы;</li>\r\n<li>ПЦР-диагностика крови – выявление генома (РНК или ДНК) вируса;</li>\r\n<li>ИФА – выявление в сыворотке крови специфических антител (иммуноглобулинов класса М)</li>\r\n</ul>\r\n<p> </p>\r\n<p>Инструментальные методы диагностики включают:</p>\r\n<ul>\r\n<li>УЗИ органов брюшной полости – отмечают увеличение печени и изменение ее звуковой проницаемости и, кроме этого, отмечают увеличение селезенки и, возможно, расширение полой вены;</li>\r\n<li>Реогепатография(исследование печеночного кровотока), </li>\r\n<li>Гепатохолецистосцинтиография(радиоизотопное исследование желчевыводящих путей), </li>\r\n<li>Пункционная биопсия печени.</li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>Лечение острого гепатита обязательно проводится в стационаре.</p>\r\n<p>Назначается:</p>\r\n<p>прописывается диета №5, полупостельный режим (при тяжелом течении – постельный);</p>\r\n<p> </p>\r\n<p>Этиотропная терапия</p>\r\n<ul>\r\n<li>Интерферон-а</li>\r\n<li>Индукторы интерферона</li>\r\n<li>Ламивудин</li>\r\n</ul>\r\n<p>Патогенетическая и посиндромная терапия:</p>\r\n<ul>\r\n<li>Интенсивная дезинтоксикационная инфузионная терапия, при необходимости экстракорпоральная детоксикация;</li>\r\n<li>Желчегонные препараты или тюбажи по Демьянову;</li>\r\n<li>Ферментные препараты;</li>\r\n<li>Гепатопротективные препараты;</li>\r\n<li>Глюкокортикоиды;</li>\r\n<li>Ингибиторы протеолиза;</li>\r\n<li>Поливитамины, витамино-минеральные комплексы, фитотерапия.</li>\r\n</ul>\r\n<p>Хорошие результаты по улучшению общего состояния при выраженной гипоксии дает кислородотерапия, оксигенобаротерапия. Если присутствуют признаки геморрагического диатеза, назначают витамин К внутривенно.</p>",
"prevention": "<p>Первичная профилактика вирусных гепатитов – соблюдение гигиенических предписаний, осуществление санитарно-эпидемических мер, санитарный надзор над предприятиями, могущими стать очагом распространения инфекции, вакцинация. Профилактикой других форм гепатитов является избегание действия гепатотравмирующих факторов – алкоголя, лекарственных средств, токсических веществ.</p>\r\n<p>Вторичная профилактика хронического гепатита заключается в соблюдении диеты, режима, врачебных рекомендаций, регулярном прохождении обследования, контроле клинических показателей крови. Больным рекомендовано регулярное санаторно-курортное лечение, водолечение.</p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Выделяют две основные формы клинического течения гепатитов: острую и хроническую.</p>\r\n<p>Острая форма течения наиболее характерна для гепатитов вирусной природы. Иногда начало гепатита напоминает грипп: с повышением температуры тела, головной болью, общим недомоганием, ломотой в теле. Как правило, это — так называемая «маска» начинающегося вирусного гепатита, характеризующаяся слабостью.</p>\r\n<p>При острой форме развития гепатита наблюдается заметное ухудшение общего состояния больного, развития признаков общей интоксикации организма и нарушения функции печени (повышение температуры тела, в ряде случаев развитие желтухи и др.), а также повышение уровня печеночных ферментов (трансаминаз) и общего билирубина крови. Моча темнеет, при выраженных нарушениях синтеза желчных кислот кал теряет цвет, становится беловато-глинистым.</p>\r\n<p>Больные могут отмечать такие симптомы, как кожный зуд, возникновение на коже красных точек – петехий, брадикардию, невротические симптомы.</p>\r\n<p>Острый гепатит, как правило, заканчивается полным выздоровлением больного, однако в некоторых случаях наблюдается переход острого течения болезни в хроническое.</p>\r\n<p>Клиническая картина при хроническом гепатите бедная, заболевание долгое время протекает бессимптомно. Хронический гепатит характеризуется постепенным развитием следующих клинических синдромов:</p>\r\n<ul>\r\n<li>астеновегетативный (слабость, повышенная утомляемость, расстройства сна, психическая лабильность, головные боли – обусловлен интоксикацией организма в связи с нарастающей печеночной недостаточностью;</li>\r\n<li>диспепсический (тошнота, иногда - рвота, понижение аппетита, метеоризм, поносы, чередующиеся с запорами, отрыжка горечью, неприятный привкус во рту) связан с нарушениями пищеварения в связи с недостаточностью выработки печенью необходимых для пищеварения ферментов и желчных кислот);</li>\r\n<li>болевой синдром (боль постоянного, ноющего характера локализуется в правом подреберье, усиливается при физических нагрузках и после резких нарушений диеты) – может отсутствовать или выражаться в умеренном ощущении тяжести в эпигастрии;</li>\r\n<li>субфебрилитет (умеренное повышение температуры до 37,3 – 37,5 градусов может держаться по нескольку недель);</li>\r\n<li>телеангиэктазии (сосудистые звездочки на коже) на шее, лице, плечах;</li>\r\n<li>геморрагический (петехии, склонность к образованию синяков и кровоподтеков, носовые, геморроидальные, маточные кровотечения) связан с понижением свертываемости крови вследствие недостаточного синтеза факторов свертываемости в клетках печени;</li>\r\n<li>желтуха – наиболее известный симптом, возникает, когда билирубин, не переработанный в печени, попадает в кровь и придаёт коже характерный желтоватый оттенок. Однако часто бывают и безжелтушные формы гепатита;</li>\r\n<li>увеличение печени, может сочетаться с увеличением селезенки.</li>\r\n</ul>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 91,
"published": 2,
"parent": null,
"block_rubric": 12,
"standards": [
4662,
5105
]
}
]
}
