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"code": "A58",
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"description": "<p><span id=\"docs-internal-guid-b60682b0-7fff-cdbd-f559-1ede3db56f0d\"><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;\">Паховая гранулема – медленно прогрессирующее инфекционное венерическое заболевание, характеризующееся обширными изъязвлениями кожи и поражением лимфатических узлов генитальной и перианальной области.</span></span></p>",
"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 венерической гранулемы – Calymmatobacterium granulomatis, также его называют тельцами Донована.</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;\">Заразиться этим заболеванием можно не только половым путем, но и бытовым. Инфекция может проникнуть через микродефекты на коже и слизистых. Микроорганизмы, которые приводят к развитию донованоза, обладают повышенной устойчивостью к воздействию окружающей среды и могут выживать вне человеческого организма. Распространению инфекции благоприятствуют влажный климат и жара.</span></p>",
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"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;\">Диагноз устанавливается после проведения комплекса лабораторных исследований:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">исследование полученной из язвы серозной жидкости на бледную трепонему в темном поле микроскопа;</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;\">исследование мазков отделяемого из язв (окрашенных по Граму препаратов) на стрептобациллы Дюкрея;</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;\">исследование возбудителя в окрашенных по Лейшману или Романовскому-Гимзе мазках, приготовленных путем раздавливания кусочков ткани краев язв между двумя предметными стеклами.</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;\">Назначают один из следующих антибиотиков: стрептомицин, тетрациклин, эритромицин, хлорамфеникол или ко-тримоксазол. В течение 6 месяцев после лечения пациент должен наблюдаться у врача, чтобы удостовериться, что заболевание вылечено.</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;\">Если паховая гранулема оставлена без лечения, инфекция может распространяться на кости, суставы или печень; вызывать значительное снижение веса, повышение температуры тела и анемию.</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;\">Защитить себя от заболеваний, передающихся половым путем, можно при соблюдении простых правил безопасности:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Старайтесь избегать многочисленных и случайных сексуальных связей.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обязательно пользуйтесь презервативом при сексуальных отношениях с малознакомым человеком или с тем, кто имеет нескольких половых партнеров.</span></p>\r\n</li>\r\n</ul>",
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"description": "\r\nТуберкулез нервной системы обычно наблюдается в форме туберкулезного менингита (воспаление мягких мозговых оболочек) и солитарных (одиночных) туберкулем мозга. Туберкулезное воспаление мозговых оболочек является одной из самых тяжелых форм туберкулеза\r\n\r\nВ последние годы туберкулезный менингит встречается в 7—9% случаев. Он может быть единственной локализацией туберкулезного процесса, но чаще (70—80% случаев) развивается при самых различных формах легочного и внелегочного туберкулеза.",
"etiology": "<p>Возбудителями туберкулёза являются микобактерии — кислотоустойчивые бактерии рода Mycobacterium. Всего известно 74 вида микобактерий. Они широко распространены в почве, воде, среди людей и животных. Однако туберкулёз у человека вызывает условно выделенный комплекс, включающий в себя Mycobacterium tuberculosis(человеческий вид), и другими близкородственными видами) или иначе палочками Коха</p>\r\n<p>Микобактерии туберкулеза передаётся воздушно-капельным путём при разговоре, кашле и чихании больного.</p>\r\n<p>Палочкой туберкулезную микобактерию назвали не случайно: она тонкая, 1-10 мкм в длину и 0,2-0,6 мкм в ширину, прямая или слегка искривленная, концы скругленные, поверхность тела может быть слегка зернистой. МБТ уникальна тем, что под воздействием различных факторов среды она может дробиться на мелкие частички, или наоборот, слепляться, а затем снова возвращаться в обычную форму и становится возбудителем заболевания.</p>\r\n<p>Туберкулезные микобактерии могут долго жить во внешней среде. На пыльном тротуаре они остаются жизнеспособными 10 дней, между книжных страниц – 3 месяца, в воде – 5 месяцев. МБТ не любят солнечного света, но выдерживают нагревание до 80 градусов Цельсия пять минут. В засушенном виде бактерии сохраняются в течение 6 мес, а в замороженном – 30 лет.</p>\r\n<p>МБТ не имеют органоидов движения – ни жгутиков, ни ресничек – поэтому остаются там, где их «высадил» носитель. Для роста и размножения им нужна температура от 29 до 42 градусов Цельсия, оптимальные условия – 37-38 градусов, так что организм человека создает для этого просто идеальные условия.</p>",
"pathogenesis": "<p>Туберкулезный менингит развивается у лиц, инфицированных МБТ, больных туберкулезом легких или других органов. У детей он возникает как осложнение первичного туберкулезного комплекса или туберкулеза внутригрудных лимфатических узлов, у взрослых — как осложнение диссеминированного (гематогенного) туберкулеза. Туберкулезный менингит может быть единственным клиническим проявлением активного туберкулезного процесса, когда источник метастазирования МБТ клиническими методами не обнаруживается. Туберкулема мозга является вторичным заболеванием, т. е. возникает при наличии туберкулеза легких, внутригрудных лимфатических узлов или других органов, наиболее часто в фазе диссеминации.</p>\r\n<p>Туберкулез нервной системы и мозговых оболочек возникает гематогенным (через кровь), лимфогенным (по лимфатическим сосудам) или периневральным (по току спиномозговой жидкости) путями при распространении МБТ из очагов в легких, пораженных внутригрудных лимфатических узлов или других внелегочных очагов.</p>\r\n<p>Первый этап развития туберкулезного менингита — гематогенный, который завершается прорывом гематоэнцефалического барьера и инфицированием сосудистых сплетений головного мозга.</p>\r\n<p> Второй этап — ликворогенный. Микобактерии туберкулеза из сосудистых сплетений попадают в спинномозговую жидкость, оседают на основании мозга, что приводит к поражению мягкой мозговой оболочки.</p>",
"diagnostics": "<p>Туберкулез нервной системы диагностируется фтизиатром совместно со специалистами в области неврологии. Проводится пункция спиномозговой жидкости, где оценивается ее цвет, прозрачность, давление, клеточный состав. «Золотым стандартом» диагностики туберкулезного менингита является выделение микобактерий из спиномозговой жидкости методом посева. Вместе с тем бактериологическое подтверждение диагноза регистрируется менее чем в 20% случаев. Более высокая чувствительность достигается при выявлении генетического материала микобактерии методом ПЦР — 26,0%, а определение антигенов микобактерий и противотуберкулезных антител — 36%.</p>\r\n<p>Проводится рентгенография органов грудной клетки для выявления первичного очага туберкулезной инфекции.</p>\r\n<p>Компьютерная/магнитно-резонансная томография головного мозга на ранних этапах не позволяет обнаружить изменения, но позднее появляются признаки увеличения желудочков мозга, а также отек мозга и очаговую ишемию. Также данные методы применяются для дифференциальной диагностики с другими церебральными поражениями.</p>\r\n<p>Рентгенограмма черепа позволяет выявить туберкулему при отложении в нем солей кальция. Основными методами визуализации туберкулемы мозга являются КТ и МРТ.</p>\r\n<p>Офтальмоскопия позволяет выявить застойные диски зрительных нервов.</p>",
"treatment": "<p>Больным показан строгий постельный режим. Вставать можно только после купирования менингеальных симптомов, выходить на улицу — только после нормализации показателей спиномозговой жидкости. Для лечения туберкулеза нервной системы применяются противотуберкулезные препараты, разрушающие или препятствующие размножению микробной клетки.</p>\r\n<p>Ориентиром длительности химиотерапии является санация спиномозговой жидкости, лечение после которой продолжают еще 6 мес. В лечении туберкулезного менингита очень важна дегидратационная терапия. Для этого делают «разгрузочные» спинномозговые пункции, а также применяют диуретические препараты под контролем водно-электролитного баланса.</p>\r\n<p>В целях повышения эффективности этиотропной химиотерапии и профилактики осложнений необходимо в острый период заболевания назначать глюкокортикостероидные гормоны. Длительность лечения гормонами — от 4 нед до 2 мес. Всем больным назначают препараты, влияющие на мозговое кровообращение.</p>\r\n<p>В комплексном лечении менингита большое внимание уделяют витаминотерапии. Во время лечения туберкулезного менингита необходимо систематически проводить спинномозговые пункции для контроля за эффективностью лечения. Лечение туберкулем головного мозга — оперативное удаление, техника которого такая же, как и при удалении опухолей мозга. Туберкулему удаляют полностью, вылущивая ее в пределах здоровой ткани. Операционное поле тщательно изолируют во избежание попадания частиц туберкулемы в окружающее субарахноидальное пространство. Хирургическое лечение туберкулем проводят в сочетании спротивотуберкулезной терапией, дегидратационной терапией, общеукрепляющим и последующим санаторным лечением. Длительность лечения определяется течением послеоперационного периода, характером неврологических расстройств и туберкулезного процесса во внутренних органах.</p>",
"prevention": "<p>Основной профилактикой туберкулёза на сегодняшний день является вакцина БЦЖ (BCG). Она защищает от самой опасной формы туберкулёза — туберкулёзного поражения нервной системы. В соответствии с «Национальным календарём профилактических прививок» прививку делают в роддоме при отсутствии противопоказаний в первые 3—7 дней жизни ребёнка. В 7 при отрицательной реакции Манту и отсутствии противопоказаний проводят ревакцинацию.</p>\r\n<p>С целью выявления туберкулёза на ранних стадиях всем взрослым необходимо проходить флюорографическое обследование в поликлинике не реже 1 раза в год (в зависимости от профессии, состояния здоровья и принадлежности к различным «группам риска»).</p>\r\n<p>Необходимо вести здоровый образ жизни:</p>\r\n<ul>\r\n<li>не курить, не употреблять алкогольные напитки и наркотики, т.к. они значительно снижают защитные силы организма;</li>\r\n<li>заниматься физической культурой, спортом и закаливанием, это значительно повысит устойчивость организма к туберкулезу и другим болезням;</li>\r\n<li>полноценно питаться;</li>\r\n<li>стараться избегать нервных стрессов;</li>\r\n<li>соблюдать правила гигиены дома, на улице, в школе, на работе;</li>\r\n<li>по возможности не находиться вблизи кашляющего человека;</li>\r\n<li>соблюдать правила личной гигиены.</li>\r\n</ul>\r\n<p> </p>\r\n<p>Профилактика заболевания лиц, бывших в контакте с больным:</p>\r\n<ul>\r\n<li>специальное лечение (превентивная терапия и химиопрофилактика) тех людей, у которых имеется высокий риск развития туберкулеза;</li>\r\n<li>людям, недавно бывшим в контакте с больными и инфицированными туберкулезом, необходимо пройти флюорографию и реакцию Манту;</li>\r\n<li>изоляция и лечение заразных больных в противотуберкулезных учреждениях;</li>\r\n<li>дезинфекция;</li>\r\n<li>отстранение больных туберкулезом от определенных видов работ (пищевые производства, животноводческие хозяйства, учреждения коммунального хозяйства, детские учреждения, лечебно-профилактические учреждения, а также профессии, связанные с широким кругом общения);</li>\r\n<li>не допускать больных туберкулезом к прохождению службы в армии и на флоте.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Туберкулезный менингит обычно развивается постепенно. Больные ощущают недомогание, вялость, раздражительность, светобоязнь, нарушение сна, задержку стула. В этот период может незначительно повышаться температура тела. Затем начинает наростать головная боль, к которой присоединяется рвота, постепенно развиваются менингеальные симптомы, температура тела повышается до 38—39 °С. При отсутствии лечения у больных появляются амышечная слабость, безразличие к окружающему, спутанность сознания, далее развиваются сопорозное состояние, кома, и, как правило к концу третьей недели наступает смерть.</p>\r\n<p>Возможно и «нетипичное» острое начало с высокой лихорадкой и менингеальными симптомами, которое наблюдается в основном у детей младшего возраста. Характерными для туберкулезного менингита являются менингеальный синдром, параличи и парезы черепных нервов и спинномозговых нервных корешков, симптомы поражения вещества мозга. Менингеальный синдром проявляется головной болью, обусловленной воспалением мягкой мозговой оболочки, контрактурами мышц вследствие раздражения нервных корешков. О контрактурах судят по наличию следующих признаков: ригидность затылочных мышц (из-за болезненности невозможно запрокинутую голову нагнуть вперед); симптомы Кернига (невозможно у лежащего на спине больного разогнуть в коленном суставе ногу, согнутую в тазобедренном суставе) и Брудзинского (сгибание головы вызывает сгибание ног); втяжение мышц живота; «поза легавой собаки» - положение больного на боку с запрокинутой головой и подтянутыми к животу ногами.</p>\r\n<p>Характерно поражение черепных нервов с соответствующей неврологической симптоматикой опущение верхнего века, расширение зрачков, нарушение движения глазных яблок, мышц лица, языка, глотательных мышц). При корешковых поражениях у больных обнаруживаются опоясывающие боли вокруг груди, живота, периферические парезы и параличи, нарушения функции тазовых органов (характерны запоры). При появлении очаговых поражений вещества головного мозга появляются гемипарез (ослабление мышц одной стороны тела), гемиплегия (паралич одной стороны тела). Заболевание может сопровождаться вегетососудистыми нарушениями в виде сосудистых реакций, красного стойкого дермографизма, спонтанно возникающих красных пятен на коже, брадикардии (урежение ритма сердца), нарушения сна, аппетита.</p>\r\n<p>Клинические проявления туберкулемы сходны с таковыми при опухолях центральной нервной системы. Иногда течение туберкулем бессимптомное и их обнаруживают лишь на вскрытии (при супратенториальной локализации). Продолжительность заболевания от нескольких месяцев до 2—3 лет.</p>\r\n<p>Встречаются два типа развития болезни. Первый тип — заболевание начинается остро с подъема температуры и напоминает инфекционное заболевание с быстрым развитием симптомов поражения мозга, последующим волнообразным течением и длительно сохраняющейся субфебрильной температурой. При таком течении часто диагностируют менингит и менингоэнцефалит. Второй тип — постепенное начало и медленное развитие болезни с ремиссиями. Течение болезни при этом сходно с таковым при опухолях головного мозга. Для клинической картины туберкулем свойственны мозговые и очаговые симптомы, характер которых зависит от локализации туберкулемы.</p>",
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"description": "<p> Первоначальные симптомы могут напоминать пневмонию, но люди обычно не реагируют на терапию антибиотиками. Пациенты обычно обращаются за помощью в течение нескольких дней или недель после появления симптомов</p>",
"etiology": "",
"pathogenesis": "<p> </p>\r\n<table class=\"ui celled striped structured red table unstackable\" width=\"642\">\r\n<tbody>\r\n<tr>\r\n<td width=\"642\">\r\n<p><strong>На основании данных, собранных </strong><strong>CDC</strong><strong>, у пациентов с </strong><strong>EVALI</strong><strong>:</strong></p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• <strong>особенности анамнеза:</strong></p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• 95% пациентов с EVALI первоначально испытывают респираторные симптомы (кашель, боль в груди, одышка)</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• 77% имеют симптомы поражения ЖКТ (боль в животе, тошнота, рвота, диарея)</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• поражение ЖКТ предшествовало развитию респираторных симптомов у части пациентов</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• лихорадка, озноб, потеря веса у 85%</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• <strong>особенности физикального обследования:</strong></p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• 55% пациентов – тахикардия</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• 45% пациентов – тахипноэ</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• насыщение кислородом меньше 95% выявлено у 57%</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• аускультативное исследование легких – без особенностей, даже у пациентов с тяжелым повреждением легких</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• <strong>особенности лабораторного исследования:</strong></p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• повышенное количество лейкоцитов (WBC)</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• маркеры воспаления: С-реактивный белок, СОЭ</p>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td width=\"642\">\r\n<p>• повышение трансаминаз печени</p>\r\n</td>\r\n</tr>\r\n</tbody>\r\n</table>",
"diagnostics": "<ul>\r\n<li>EVALI считается диагнозом исключения. Пока не существует специального теста или маркера для диагностики.</li>\r\n<li>При подозрении на EVALI следует уточнять о статусе курения электронных сигарет или вейпинге.</li>\r\n<li>Необходима дифференциальная диагностика с сердечно-сосудистыми, желудочно-кишечными, ревматологическими, опухолевыми заболеваниями; необходимо исключить воздействие окружающей среды, профессиональные заболевания, причины острого респираторного дистресс-синдрома.</li>\r\n<li>При подозрение на EVALI необходима рентгенограмма грудной клетки.</li>\r\n</ul>",
"treatment": "<p>Рекомендуется пациентам при насыщении крови кислородом ниже 95% или респираторных расстройствах. </p>\r\n<p><strong>Амбулаторное лечение</strong></p>\r\n<ul>\r\n<li>Можно рассматривать у клинически стабильных пациентов, наблюдение за которыми возможно в течение 24–48 часов после первоначальной оценки.</li>\r\n<li>Насыщение крови кислородом должно быть 95% и выше.</li>\r\n<li>Необходимо эмпирическое назначение противомикробных средств, в том числе противовирусных.</li>\r\n<li>Следует учитывать: у некоторых пациентом изначально легкие симптомы могут ухудшаться в течение 48 часов.</li>\r\n</ul>",
"prevention": "<p>Не курить</p>",
"clinical_picture": "",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 1,
"published": 1,
"parent": null,
"block_rubric": 269,
"standards": []
}
]
}
