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"lead": "острая зоонозная инфекционная болезнь с фекально-оральным механизмом передачи возбудителя.",
"description": "<p>Сальмонеллёз — острая зоонозная инфекционная болезнь с фекально-оральным механизмом передачи возбудителя, характеризующаяся преимущественным поражением ЖКТ, развитием интоксикации и обезвоживания.</p>",
"etiology": "<p>Сальмонеллы — грамотрицательные палочки рода Salmonella семейства Enterobacteriaceae.</p>\r\n<p>Выделяют два вида сальмонелл — S. enterica и S. bongori, не патогенный для человека.</p>\r\n<p>Сальмонеллы длительно сохраняются в окружающей среде: в воде — до 5 мес, в почве — до 18 мес, в мясе — до 6 мес, в тушках птиц — больше года, на яичной скорлупе — до 24 дней. Низкую температуру переносят хорошо, при 100 °С гибнут мгновенно.</p>",
"pathogenesis": "<p>В просвете тонкой кишки сальмонеллы прикрепляются к мембранам энтероцитов, достигают собственной пластинки слизистой оболочки. Это приводит к дегенеративным изменениям энтероцитов и развитию энтерита.</p>\r\n<p>При разрушении бактерий высвобождается липополисахаридный комплекс (эндотоксин), который играет основную роль в развитии синдрома интоксикации.</p>\r\n<p>Основную роль в развитии диареи и обезвоживания играет энтеротоксин, активирующий синтез цАМФ аденилатциклазой энтероцитов, благодаря чему усиливается секреция ионов Na+ , Cl– и воды в просвет кишки. Следствием дегидратации и интоксикации является нарушение деятельности сердечно-сосудистой системы, что выражается тахикардией и снижением АД.</p>",
"diagnostics": "<p>Клиническая</p>\r\n<p>Характерно острое начало с повышением температуры тела, тошнотой, рвотой, диареей, болью в животе.</p>\r\n<p>Эпидемиологическая</p>\r\n<p>Приём пищи, приготовленной и хранившейся с нарушением санитарных норм, употребление сырых яиц, групповые вспышки. В мегаполисах выявление групповых случаев заболевания представляет большие трудности, если контаминированный сальмонеллами продукт реализуется через торговую сеть или предприятия общественного питания. </p>\r\n<p>Специфическая и неспецифическая лабораторная диагностика</p>\r\n<p>Бактериологическое исследование кала (одно- или двукратно), рвотных масс, крови, мочи, жёлчи, промывных вод желудка, остатков подозрительных продуктов.</p>\r\n<p> </p>",
"treatment": "<p>Постельный режим назначают при выраженной интоксикации и потере жидкости. Палатный — при среднетяжёлом и лёгком течении. Диета — стол № 4. Из рациона исключают пищевые продукты, раздражающие желудок и кишечник, молочные продукты, а также тугоплавкие жиры.</p>\r\n<p>Этиотропная терапия</p>\r\n<p>Среднетяжёлая и тяжёлая локализованная форма заболевания — энтерикс.<br />Генерализованная форма — ципрофлоксацин; цефтриаксон. </p>\r\n<p>Патогенетические средства</p>\r\n<p>Регидратационная терапия, дезинтоксикационная терапия, эубиотики и биопрепараты, сорбенты, ферментотерапия, антидиарейные препараты, спазмолитики.</p>\r\n<p>Дополнительные методы лечения (хирургические, физиотерапевтические, санаторно-курортные)</p>",
"prevention": "<p>Специфическая профилактика отсутствует.</p>\r\n<p>Неспецифические меры профилактики</p>\r\n<p>Ветеринарно-санитарный надзор за убоем скота и птицы, технологией обработки туш, приготовлением и хранением мясных блюд. Соблюдение санитарно-гигиенических и противоэпидемических норм на предприятиях торговли и общественного питания.</p>",
"clinical_picture": "<p>Инкубационный период от 6 ч до 3 сут (чаще 12–24 ч); при внутрибольничных вспышках удлиняется до 3–8 дней.</p>\r\n<p>Классификация сальмонеллеза</p>\r\n<p>• Гастроинтестинальная (локализованная) форма:<br />- гастритический вариант;<br />- гастроэнтеритический вариант;<br />- гастроэнтероколитический вариант.<br />• Генерализованная форма:<br />- тифоподобный вариант;<br />- септический вариант.<br />• Бактериовыделение:<br />- острое;<br />- хроническое;<br />- транзиторное.</p>\r\n<p>Для гастритического варианта характерны острое начало, повторная <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a> и боль в эпигастрии. Синдром интоксикации выражен слабо. Небольшая продолжительность заболевания.</p>\r\n<p>Гастроэнтеритический вариант наиболее распространён. Болезнь начинается остро, с симптомов интоксикации: повышения температуры тела, головной боли, озноба, чувства ломоты в мышцах, схваткообразной .</p>\r\n<p>Присоединяются <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a>. Испражнения вначале носят каловый характер, но быстро становятся водянистыми, пенистыми зловонными, иногда с зеленоватым оттенком и имеют вид «болотной тины». Отмечают бледность кожного покрова, в более тяжёлых случаях — . Язык сухой, обложен налётом.</p>\r\n<p>Живот вздут, при пальпации болезнен во всех отделах, больше в эпигастрии и в правой подвздошной области, урчит под рукой. Тоны сердца приглушены, АД снижено. Уменьшено выделение мочи. Возможны судороги.</p>\r\n<p>При гастроэнтероколитическом варианте клиническая картина та же, но уже на 2–3-й день болезни уменьшается объём испражнений. В них появляется примесь слизи, иногда крови.</p>\r\n<p>Генерализованной форме болезни, как правило, предшествуют гастроинтестинальные расстройства. При тифоподобном варианте температурная кривая приобретает постоянный или волнообразный характер. Кожа бледная, к 6–7-му дню болезни на коже живота появляется розеолёзная. Наблюдают небольшую брадикардию. Над лёгкими выслушивают сухие рассеянные. Живот вздут. К концу первой недели болезни отмечают и селезёнки. Длительность лихорадки составляет 1–3 нед. Рецидивы возникают редко.</p>\r\n<p> </p>",
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