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"lead": "заболевание легких, связанное с употреблением электронных сигарет, которое может быть тяжелым и опасным для жизни.",
"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>",
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"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>",
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"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>",
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},
"code": "A17+",
"name": "Туберкулез нервной системы",
"icd_name": "Туберкулез нервной системы",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2
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"periodicity": 1,
"slug": "a17+_tuberkulez_nervnoy_sistemy",
"lead": "Нарушение здоровья, относящееся к группе туберкулез",
"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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},
"code": "B42",
"name": "Споротрихоз",
"icd_name": "Споротрихоз",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"3",
"5"
],
"periodicity": 1,
"slug": "b42_sporotrihoz",
"lead": "инфекция кожи, вызываемая сапрофитной плесенью Sporothrix schenckii",
"description": "<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;\">Споротрихоз – это инфекционное заболевание кожных покровов, подкожного жирового слоя и неглубоко расположенных лимфатических узлов. </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 инфекции – гриб споротрихумов Sporothrix schenkii. Его споры можно обнаружить в почве, соломе, сене, культурных растениях, особенно цветах (чаще всего шипах роз и барбарисов). При контакте поврежденного участка кожи со спорами гриба происходит заражение. Развитие инфекции может происходить локально, только в месте контакта, или же распространяться по лимфатической системе.</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;\">Данное заболевание не передается от зараженного другим людям.</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;\">Выделяют несколько факторов развития споротрихоза:</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: 6pt; font-family: Verdana; color: #333536; 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;\">снижение иммунитета (особенно ВИЧ, СПИД);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; 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;\">алкогольная зависимость;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; 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;\">хронические заболевания эндокринной системы (диабет, гипотериоз);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; 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;\">онкозаболевания;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; 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;\">нарушение гормонального фона;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333536; 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;\">люди, которым был пересажен орган.</span></p>\r\n</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;\">Возбудитель проникает в слои кожных покровов или слизистых при травматическом контакте (царапина, прокол). Компоненты клеточной стенки грибков имеют рецепторы для иммунокомпетентных клеток Т-хелперов первого порядка, однако белковые составляющие рецепторов увеличивают сцепление споротрихий с эпителием, усугубляя инвазию. Воспалительные процессы протекают не только в коже, но и в лимфатических узлах, с током лимфы споротрихии распространяются по организму и попадают в систему кровообращения, следствием чего является контаминация внутренних органов.</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;\">Гранулемы могут образовываться в любых органах и тканях, чаще всего страдают суставы, кости, головной мозг и легкие. Патогистологически выявляются признаки диффузного хронического гранулематозного дерматита с множественными центральными абсцессами, очагами акантоза и гиперкератоза, интраэпидермальными микроабсцессами. В центре гранулемы преобладают нейтрофилы и эозинофилы, далее обнаруживается слой мононуклеаров, наружная область состоит из плазмоцитов и лимфоцитов.</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;\">Диагноз споротрихоза верифицируется врачом-инфекционистом. Чаще всего врачу требуется консультативная помощь дерматовенеролога, в зависимости от имеющихся симптомов (поражения костно-суставного аппарата, легких и пр.) могут назначаться осмотры пульмонолога, хирурга и других специалистов. Диагностический поиск проводится с использованием следующих клинических, лабораторных и инструментальных методов:</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;\">Физикальное исследование. В ходе осмотра оценивается тяжесть состояния больного. Поражение при кожной форме споротрихоза выглядит как папулонодулярный очаг с тенденцией к изъязвлению, нередко со свищевым ходом и отделяемым. Регионарные лимфатические узлы увеличены, чувствительны, болезненны при пальпации. Суставная форма обычно проявляется моноартритом. Другие органные поражения носят неспецифический характер.</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;\">Лабораторные исследования. Общеклинические анализы крови и мочи при споротрихозе не имеют патогномоничных признаков. Биохимические параметры изменяется соразмерно органной недостаточности. При гистологическом исследовании пораженных тканей могут определяться астероидные тельца или феномен Сплендора-Хоппли. В анализе синовиальной жидкости выявляется высокое содержание полиморфноядерных лейкоцитов и белка, низкий уровень глюкозы.</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;\">Выявление инфекционных агентов. Основным методом обнаружения грибка в организме является ПЦР биологических жидкостей и тканей организма. Обязательна микроскопия биоптатов, мокроты и отделяемого свищей, посев на питательные среды. Кожная аллергопроба со споротрихином применяется ограниченно. Серологические исследования (ИФА) преимущественно служат для диагностики генерализованной инфекции и рецидивов.</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;\">Лучевая диагностика. Рентгенография органов грудной клетки при легочной форме свидетельствует о поражении верхних долей легких в виде инфильтрации, фиброза, иногда – полостей распада. На рентгенограммах суставов при костно-суставной форме визуализируются свищевые ходы и признаки остеопороза. УЗИ мягких тканей и лимфатических узлов назначается для выявления воспалительных изменений.</span></p>\r\n</li>\r\n</ul>",
"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;\">Характер лечения, его длительность и подбор медикаментов зависят от формы споротрихоза, тяжести течения болезни, и определяются для каждого больного отдельно.</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;\">назначение противогрибковых препаратов в виде таблеток или инъекций</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;\">перевязки и местная обработка кожных очагов заболевания</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;\">прием обезболивающих, дезинтоксикационных и других симптоматических препаратов</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 пораженных тканей методами криохирургии, электрохирургии, классического оперативного вмешательства</span></li>\r\n</ul>\r\n<p> </p>",
"prevention": "<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;\">Специфическая профилактика (вакцина) не разработана, проводятся испытания новых препаратов. Важность поиска профилактических средств обусловлена появлением устойчивых видов грибка. </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;\">К неспецифическим мерам борьбы со споротрихозом относят использование перчаток и защитной одежды, предупреждение травм во время работ с почвой и растениями, ухода за домашними животными. Трупы больных животных рекомендуется подвергать кремации.</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 болезни составляет около 12 недель, а первая клиническая симптоматика может проявляться уже на 3 – 4 недели, после инфицирования.</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;\">Далее болезнь проявляется в зависимости от формы протекания.</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;\">При поверхностном заражении на коже возникают акне, папулы, бляшки, микроабсцессы, папилломатозная или веррукозная сыпь на коже. Сюда также можно отнести и поражение слизистых: эритематозные, язвенные поражения полости рта, глотки, гортани, носа и носоглотки.</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;\">Локализованный подкожный: в начале заболевания под кожей определяется небольшой, не спаянный с кожей инфильтрат, размером от 0,5 до 1 см. Далее он спаивается с кожей, увеличивается в размерах, а кожа над ним имеет синюшный оттенок. Далее этот узел некротизируется, на его месте образуется язва – споротрихозный шанкр, от которого, по ходу лимфатического сосуда, тянется, подобный нити, тяж с множеством этих инфильтратов.</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;\">При диссеминированном кожном виде будут образовываться абсцессы, язвы и другие образования.</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;\">Висцеральный вид характеризуется поражением легких, желудочно-кишечного тракта, печени, селезенки, суставов. При поражении легких симптомы похожи на легочный туберкулез, при поражении суставов – например, остеомиелит, периостит. Эта форма данного микоза протекает с высокой температурой, гемодинамическими изменениями, нарушением общего состояния больного.</span></p>",
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"slug": "infekcionnye_bolezni",
"lead": "Область медицины, включающая в себя лечение 518 заболеваний. В 499 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"lead": "Область медицины, включающая в себя лечение 145 заболеваний. В 181 клинике России оказывается помощь по этому направлению медицины.",
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{
"id": 16,
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"name": "клиническая лабораторная диагностика",
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"lead": "Область медицины, включающая в себя лечение 2214 заболеваний. В 886 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"lead": "Область медицины, включающая в себя лечение 1066 заболеваний. В 376 клиниках России оказывается помощь по этому направлению медицины.",
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]
}
