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"code": "A26",
"name": "Эризипелоид",
"icd_name": "Эризипелоид",
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"lead": "Нарушение здоровья, относящееся к группе некоторые бактериальные зоонозы",
"description": "Эризипелоид – инфекционное заболевание, которое передается человеку от животных и сопровождается воспалительным поражением кожи и суставов. Обычно процесс локализуется в коже и суставах пальцев кисти с тыльной стороны. Редко развивается генерализованная форма.",
"etiology": "<p>Возбудителем эризипелоида является коринебактерия Erysipelothrix rhusiopathiae, которая имеет 2 вида — мышиный и свиной. Первый распространен среди диких животных, второй — среди домашних. Заражение человека происходит контактным путем через почву, сено, воду, шкуру или мясо, инфицированные больным животным, выделяющим патогенные бактерии с мочой и испражнениями. Больной эризипелоидом человек не может стать причиной заражения окружающих.</p>\r\n<p>Проникновение возбудителя эризипелоида в кожу становиться возможным при нарушении ее целостности: царапины, расчесы при укусах насекомых или зудящих дерматозах, опрелости и потертости при травматическом дерматите.</p>",
"pathogenesis": "<p>Возбудитель проникает в организм человека через микротравмы кожи, чаще всего пальцев. В дерме формируется очаг инфекции, развивается местный воспалительный процесс с захватом межфаланговых суставов.</p>\r\n<p>Генерализованные формы наблюдают редко, при этом происходит распространение бактерий по лимфатическим и кровеносным сосудам, ведущее к возникновению распространённых поражений кожи и формированию вторичных очагов инфекции во внутренних органах. В области поражённых участков кожи развивается серозное воспаление с лимфоцитарной инфильтрацией вокруг сосудов, нарушениями микроциркуляции и оттока лимфы.</p>",
"diagnostics": "<p>Лабораторная диагностика. </p>\r\n<p>Возбудитель заболевания может быть выделен из крови при генерализованной инфекции или из везикул, образовавшихся при кожной форме на фоне эритемы. Применяют серологические методы (РА, РНГА), а также биологическую пробу на белых мышах. В большинстве случаев специальные методы исследования при эризипелоиде практически не применяют, а диагноз устанавливают на основе клинико-эпидемиологических данных. </p>",
"treatment": "<p>Этиотропная терапия эризипелоида проводится в течение 7-10 дней и осуществляется с учетом чувствительности возбудителя. Возможно применение антибиотиков пенициллинового, цефалоспоринового, тетрациклинового рядов. По показаниям антибиотикотерапия дополняется дезинтоксикационными мероприятиями, приемом противовоспалительных или антигистаминных препаратов, симптоматическим лечением поражений внутренних органов. Из физиотерапевтических методов при эризипелоиде эффективны УВЧ, УФО, магнитотерапия, электрофорез, магнитолазеротерапия.</p>",
"prevention": "<p>Предупреждение лёгких травм у рабочих мясо- и рыбокомбинатов, немедленная обработка повреждённой кожи дезинфицирующими средствами.</p>\r\n<p>Если кожа на руках повреждена, раны следует обработать так, чтобы возбудитель не проник в организм. Рабочие по уходу за животными должны строго соблюдать правила личной гигиены и постоянно дезинфицировать руки. Наиболее эффективным мероприятием по предотвращению заболевания животных и передаче болезни человеку является систематическая поголовная вакцинация всех свиней.</p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Инкубационный период эризипелоида длится в среднем 1-3 дня, но может занимать до недели.</p>\r\n<p>Клинические проявления заболевания чаще всего начинают появляться на коже пальца или тыльной стороны кисти.</p>\r\n<p>Выделяет четыре основные формы эризипелоида: кожную, кожно-суставную, ангинозную и генерализованную.</p>\r\n<p>Кожная форма эризипелоида является самой часто встречающейся. Протекает на фоне слабо выраженных признаков интоксикации: субфебрилитет, легкое недомогание, озноб и пр. Типично начало заболевания с ощущения жжения и зуда в месте внедрения возбудителя. Через короткий промежуток времени в этом месте отмечается покраснение (эритема) и отечность кожи. Краснота постепенно приобретает багровый оттенок и распространяется по периферии. Процесс может сопровождаться воспалением регионарных лимфатических узлов и сосудов.</p>\r\n<p>Для эризипелоида типично начало разрешения эритемы с ее центра, который становится вначале синюшного цвета, а затем бледнеет до голубоватого оттенка почти неизмененной кожи. При этом по периферии пораженного участка некоторое время еще сохраняется краснота и отечность, что придает ему своеобразный вид блюдца. В течение нескольких дней краснота краев бледнеет и сглаживается, их отечность спадает. Эритема проходит, оставляя после себя временное легкое шелушение. Весь процесс при кожной форме эризипелоида занимает обычно не более 10 дней.</p>\r\n<p>Кожно-суставная форма – к вышеописанным симптомам эритемы присоединяется артрит — чаще поражаются мелкие межфаланговые суставы. Суставы припухают, подвижность ограничена. Болезнь длится от 3 недель до 6 месяцев.</p>\r\n<p>Ангинозная форма эризипелоида развивается в отдельных случаях, при употреблении зараженных возбудителем продуктов. Характеризуется сочетанием кожных проявлений с клиническими симптомами ангины.</p>\r\n<p>Генерализованная форма эризипелоида отмечается крайне редко. Кожные проявления в виде эритематозных пятен появляются диффузно по всему телу и могут локализоваться на любом участке кожи. Они сопровождаются выраженным общим интоксикационным синдромом, увеличением печени и селезенки. Возможны артриты и поражения внутренних органов с развитием пневмонии, эндокардита, менингита, пиелонефрита. Тяжелым осложнением этой формы эризипелоида является сепсис.</p>",
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"code": "A27",
"name": "Лептоспироз",
"icd_name": "Лептоспироз",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
7
],
"periodicity": 1,
"slug": "a27_leptospiroz",
"lead": "Инфекционная болезнь с преимущественно водным путём передачи возбудителя, характеризующаяся общей интоксикацией, лихорадкой, поражением почек, печени, ЦНС, геморрагическим диатезом и высокой летальностью.",
"description": "Лептоспироз (болезнь Васильева–Вейля, инфекционная желтуха, японская 7-дневная лихорадка, нанукаями, водная лихорадка, иктерогеморрагическая лихорадка и др.) — острая зоонозная природно-очаговая инфекционная болезнь с преимущественно водным путём передачи возбудителя, характеризующаяся общей интоксикацией, лихорадкой, поражением почек, печени, ЦНС, геморрагическим диатезом и высокой летальностью.",
"etiology": "<p>Род Leptospira (лептоспира) семейства Leptospiraceae представлен двумя видами: паразитическим — L. interrogans и сапрофитным — L. biflexa. Оба вида подразделяют на многочисленные серотипы. </p>\r\n<p>Лептоспиры — тонкие, подвижные микроорганизмы спиралевидной формы длиной от нескольких до 40 нм и более и диаметром от 0,3 до 0,5 нм. Оба конца лептоспир, как правило, загнуты в виде крючьев, но встречаются и бескрючковые формы. Лептоспиры имеют три основных структурных элемента: наружную оболочку, осевую нить и цитоплазматический цилиндр, который винтообразно закручен вокруг продольной оси. Размножаются они путём поперечного деления.</p>\r\n<p> </p>",
"pathogenesis": "<p>Возбудитель проникает в организм человека благодаря своей подвижности. Входными воротами служат микроповреждения кожных покровов и слизистых оболочек полости рта, пищевода, конъюнктивы глаз и др. Известны случаи лабораторного заражения лептоспирозом через повреждённую кожу. При внутрикожном проникновении в эксперименте на лабораторных животных лептоспиры проникают в кровь уже через 5–60 мин, очевидно, минуя лимфатические узлы, которые не выполняют барьерной функции при лептоспирозе. На месте внедрения возбудителя не возникает первичного аффекта. Дальнейшее распространение лептоспир происходит гематогенным путём, при этом лимфатические сосуды и регионарные лимфатические узлы также остаются интактными. С током крови лептоспиры попадают в различные органы и ткани: печень, селезёнку, почки, лёгкие, ЦНС, где происходят их размножение и накопление. Развивается первая фаза инфекции продолжительностью от 3 до 8 дней, что соответствует инкубационному периоду.</p>\r\n<p>Вторая фаза патогенеза лептоспироза — вторичная бактериемия, когда количество лептоспир в крови достигает максимума и они ещё продолжают размножаться в печени и селезёнке, надпочечниках, обусловливая клиническое начало болезни. С током крови лептоспиры снова разносятся по всему организму, преодолевая даже гемато-энцефалический барьер. </p>\r\n<full></full>\r\n<p>Эта фаза продолжается в течение 1 недели, однако может укорачиваться до нескольких дней. Максимальную концентрацию лептоспир к концу фазы лептоспиремии наблюдают в печени.</p>\r\n<p>Третья фаза патогенеза лептоспироза — токсическая. Лептоспиры гибнут вследствие бактерицидного действия крови и накопления антител, исчезают из крови и накапливаются в извитых канальцах почек. Накопленный вследствие гибели лептоспир токсин оказывает токсическое влияние на различные органы и системы. У части больных лептоспиры размножаются в извитых канальцах и выделяются из организма с мочой. В этом случае на первый план выступает поражение почек. Тяжёлое поражение почек — одна из наиболее частых причин смерти при лептоспирозе.</p>\r\n<p>Центральная нервная система поражается вследствие преодоления гемато-энцефалического барьера лептоспирами. У части больных лептоспирозом развивается серозный или гнойный менингит, реже менингоэнцефалит. В отдельных случаях возникает специфический лептоспирозный миокардит. Патогномоничный симптом лептоспироза — развитие миозита с поражением скелетных, особенно икроножных мышц. Часто поражаются лёгкие (лептоспирозная пневмония), глаза (ириты, иридоциклиты), реже другие органы.</p>",
"diagnostics": "<p>Важную роль в диагностике лептоспироза играет эпиданамнез. Следует учитывать профессию больного (сельскохозяйственный рабочий, охотник, ветеринар, дератизатор), а также контакт с дикими и домашними животными. Следует обратить внимание на то, купался ли пациент в открытых водоёмах, поскольку обсеменение воды лептоспирами в отдельных регионах чрезвычайно велико.</p>\r\n<p>Лабораторное подтверждение диагноза получают при бактериоскопическом, бактериологическом, биологическом и серологическом исследованиях. В первые дни болезни лептоспиры обнаруживают в крови с помощью темнопольной микроскопии.</p>",
"treatment": "<p>Лечение осуществляют в условиях стационара. Госпитализацию проводят по эпидемиологическим показаниям. Режим в остром периоде постельный. Диету определяют клинические особенности болезни. При доминировании почечного синдрома — стол № 7, печёночного — стол № 5, при сочетанных поражениях — стол № 5 с ограничением соли или стол № 7 с ограничением жиров.</p>\r\n<p>Основной метод лечения — антибактериальная терапия, которую чаще проводят препаратами пенициллина в дозе 4–6 млн ЕД/сут или ампициллином в дозе 4 г/сут.</p>\r\n<p> </p>",
"prevention": "<p>Профилактику осуществляют совместно органы Роспотребнадзора и ветеринарной службы. Проводят выявление и лечение ценных животных, регулярную дератизацию населённых мест, охраняют водоёмы от загрязнения выделениями животных, запрещают купание в непроточных водоёмах, обеззараживают воду из открытых источников воды, борются с бездомными собаками.</p>\r\n<p>Проводят вакцинацию сельскохозяйственных животных и собак, плановую вакцинацию лиц, работа которых связана с риском заражения лептоспирозом: работников животноводческих хозяйств, зоопарков, зоомагазинов, собачьих питомников, звероводческих хозяйств, предприятий по переработке животноводческого сырья, сотрудников лабораторий, работающих с культурами лептоспир. Вводят вакцину для профилактики лептоспироза с 7 лет в дозе 0,5 мл подкожно однократно, ревакцинация через год.</p>",
"clinical_picture": "<p>Инкубационный период продолжается от 3 до 30 (чаще 7–10) дней.</p>\r\n<p>Общепринятой классификации лептоспироза нет.</p>\r\n<p>По клиническому течению выделяют лёгкую, среднетяжёлую и тяжёлую форму лептоспироза. Лёгкая форма может протекать с лихорадкой, но без выраженного поражения внутренних органов. Среднетяжёлую форму характеризуют выраженная и развёрнутая клиническая картина лептоспироза, а для тяжёлой формы характерны развитие желтухи, появление признаков тромбогеморрагического синдрома, менингита и острой почечной недостаточности. По клиническим проявлениям выделяют желтушные, геморрагические, ренальные, менингеальные и смешанные формы. Лептоспироз может быть осложнённым и неосложнённым.</p>\r\n<p>Болезнь начинается остро, без продромального периода, с сильного озноба, повышения температуры тела в течение 1–2 дней до высоких цифр (39–40 °С). Температура остаётся высокой в течение 6–10 дней, затем происходит её снижение или критически, или укороченным лизисом. У больных, не получавших антибиотики, можно наблюдать вторую лихорадочную волну. Возникают и другие симптомы интоксикации, такие, как сильная \">, , , , , \">, иногда \">Рвота\">\"><a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>. В этот период также может развиться конъюнктивит.</p>\r\n<p>Характерный признак лептоспироза — \">, преимущественно икроножных, но может возникать \"> бедра и поясничной области. При тяжёлых формах боль настолько сильна, что затрудняет движения больного. При пальпации отмечают резкую болезненность мышц. Интенсивность миалгий часто соответствует тяжести течения болезни. Миолиз приводит к развитию миоглобинемии, являющейся одной из причин развития острой почечной недостаточности. У части больных миалгию сопровождает кожи. Обращают на себя внимание кожи лица и шеи, инъекция сосудов склер. При осмотре выявляют «симптом капюшона» — одутловатость лица и гиперемию кожи лица, шеи и верхней половины грудной клетки, инъекцию сосудов склер.</p>\r\n<full></full>\r\n<p>При тяжёлом течении лептоспироза с 4–5-го дня болезни возникают иктеричность склер и желтушность кожных покровов. Клиническое течение можно схематично разделить на три периода:</p>\r\n<p>· начальный;<br />· разгара;<br />· выздоровления.</p>\r\n<p>У 30% больных в начальном, а иногда и в периоде разгара болезни возникает экзантема. состоит из полиморфных элементов, расположенных на коже туловища и конечностей. </p>\r\n<p>В этот период возможны небольшая , покашливание. При объективном исследовании нередко обнаруживают умеренную гиперемию дужек, миндалин, мягкого нёба, на котором можно увидеть энантему, кровоизлияния. У части больных увеличиваются поднижнечелюстные, задние шейные лимфатические узлы.</p>\r\n<p>Со стороны сердечно-сосудистой системы обращают на себя внимание относительная , снижение АД. Тоны сердца приглушены, при ЭКГ можно обнаружить признаки диффузного поражения миокарда.</p>\r\n<p>Возможно развитие специфической лептоспирозной пневмонии или бронхита. При её возникновении наблюдают притупление лёгочного звука и .</p>\r\n<p>Печень увеличена, умеренно болезненна при пальпации, почти у половины больных пальпируется селезёнка.</p>\r\n<p>Признаками поражения ЦНС при лептоспирозе служат шеи\"><a href=\"/symptom/skovannost_shei/\" title=\"Перейти на страницу симптома <a href=\"/symptom/skovannost_dvizheniya/\" title=\"Перейти на страницу симптома Скованность движения\">Скованность</a> шеи\">менингеальный синдром</a>: \">, , , \"> и положительные менингеальные симптомы. При исследовании цереброспинальной жидкости отмечают признаки серозного менингита: цитоз с преобладанием нейтрофилов.</p>\r\n<p>Со стороны мочевыделительной системы можно наблюдать признаки острой почечной недостаточности: снижение диуреза вплоть до развития олигоанурии, появление в моче белка, гиалиновых и зернистых цилиндров, почечного эпителия. В крови увеличено содержание калия, мочевины, креатинина.</p>\r\n<p>При исследовании периферической крови определяют повышение СОЭ и нейтрофильный лейкоцитоз со сдвигом формулы влево, нередко до миелоцитов, анэозинофилию.</p>\r\n<p>В разгаре болезни с 5–6-го дня в тяжёлых случаях нарастает интоксикация, усиливаются \">, мышечная , появляется отвращение к пище, учащается \">Рвота\">\"><a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>, хотя температура тела снижается. У части больных возникает , интенсивность которой соответствует тяжести течения болезни и которая длится от нескольких дней до нескольких недель.</p>\r\n<p>Состояние начинает улучшаться с конца второй недели, период выздоровления с 20–25-го дня болезни. </p>",
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"code": "A28",
"name": "Бактериальные зооноз неуточненный",
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"lead": "Псевдотуберкулёз — зоофильный сапроноз с фекально- оральным механизмом передачи возбудителя.",
"description": "Характеризуется полиморфизмом клинических проявлений, интоксикацией, лихорадкой, поражением желудочно-кишечного тракта, печени, кожи, суставов и других органов.",
"etiology": "<p>Yersinia pseudotuberculosis— грамотрицательная палочковидная бактерия с перитрихиальными жгутиками, относится к семейству Enterobacteriaceae. Капсул не содержит. Спор не образует.</p>",
"pathogenesis": "<p>Люди при контакте с грызунами заражаются крайне редко. Человек не может быть источником инфекции.</p>\r\n<p>Главный механизм передачи — фекально-оральный. Пути — пищевой и водный.</p>\r\n<p>Основные факторы передачи Y. pseudotuberculosis — овощи и зелень, употребляемые без термической обработки, соления (квашеная капуста, солёные огурцы, помидоры), реже — фрукты, молочные продукты и вода. Возможно заражение воздушно-пылевым путём через пыль, контаминированную вирулентными штаммами (сухая уборка помещений, подметание).</p>\r\n<p>Внедрение Y. pseudotuberculosis начинается сразу в ротовой полости, что клинически проявляется синдромом тонзиллита. Значительная часть возбудителя, преодолев желудочный барьер, колонизирует эпителий преимущественно лимфоидных образований подвздошной и слепой кишки (первая фаза). Затем происходит инвазия эпителия слизистых оболочек кишечника; возбудитель проникает в слизистый слой и преодолевает эпителий кровеносных сосудов — развиваются первичная бактериемия и гематогенная диссеминация (вторая фаза). Далее наблюдают генерализацию инфекции, характеризующуюся диссеминацией возбудителя в органах и тканях, размножение в них и развитие системных нарушений (третья фаза).</p>",
"diagnostics": "<p>Сложна при спорадической заболеваемости и становится сравнительно простой при вспышечной. Основывается на характерной клинической симптоматике и лабораторной диагностике.</p>\r\n<p>В гемограмме обнаруживают нейтрофильный лейкоцитоз, моноцитоз, эозинофилию, относительную лимфопению и увеличение СОЭ. В биохимическом анализе крови повышение активности ферментов, реже — гипербилирубинемия.</p>\r\n<p>Специфическая лабораторная диагностика псевдотуберкулёза такая же, как и при иерсиниозе. Перспективными методами специфической диагностики выступают иммуноферментная тест-система на основе белка порина.</p>",
"treatment": "<p>Рекомендуют повторное внутривенное или внутримышечное введение нормального человеческого иммуноглобулина с промежутком 2–3 дня, курс 5–6 введений.</p>\r\n<p>Если развиваются симптомы острого живота при абдоминальной форме проводят аппендэктомию. Выбор физиотерапевтических и санаторно-курортных методов лечебно-реабилитационных мероприятий зависит от формы псевдотуберкулёза и основного синдрома.</p>",
"prevention": "<p>Специфической профилактики у людей не разработано; неспецифическая включает контроль за продуктами питания, предусмотренный соответствующими нормативными документами, и санитарно-просветительную работу среди населения, особенно в группах риска.</p>",
"clinical_picture": "<p>Инкубационный период продолжается от 3 до 19 дней (в среднем 5–10 дней), иногда сокращается до 1–3 сут.</p>\r\n<p>Выделяют следующие периоды заболевания: инкубационный, начальный, разгара, реконвалесценции или ремиссии.</p>\r\n<p>Начальный период длится от 6–8 ч до 2–5 дней. Клинические проявления начального периода у всех форм псевдотуберкулёза сходны: выраженная интоксикация и полиморфизм симптомов. Своеобразие каждой формы выявляют только в период разгара. У большинства больных заболевание начинается остро, иногда бурно. Общее самочувствие резко ухудшается. Температура тела быстро повышается до 38–40 °С, может быть с ознобом. Беспокоят сильная <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома <a href=\"/symptom/migren/\" title=\"Перейти на страницу симптома Мигрень\">Головная боль</a>\"><a href=\"/symptom/migren/\" title=\"Перейти на страницу симптома Мигрень\">головная боль</a></a>, <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома <a href=\"/symptom/narushenie_koordinacii/\" title=\"Перейти на страницу симптома Нарушение координации\">Головокружение</a>\"><a href=\"/symptom/narushenie_koordinacii/\" title=\"Перейти на страницу симптома Нарушение координации\">головокружение</a></a>, резкая <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/bessonnica/\" title=\"Перейти на страницу симптома Бессонница\">бессонница</a>, артралгия, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">миалгия</a>, боли в пояснице, <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома Потливость\">потливость</a>\"><a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома Потливость\">потливость</a></a>, <a href=\"/symptom/apatiya/\" title=\"Перейти на страницу симптома Апатия\">апатия</a>, <a href=\"/symptom/anoreksiya/\" title=\"Перейти на страницу симптома Анорексия\">анорексия</a>, иногда обмороки. Больные раздражительны, адинамичны. Нередко появляются признаки острого катара верхних дыхательных путей, жжение на ладонях и подошвах. При осмотре обнаруживают симптомы «капюшона» , «перчаток» , «носков» и инъекцию сосудов склер. Слизистая оболочка ротоглотки гиперемирована, у некоторых больных — «пылающий» зев, энантема на мягком нёбе, катаральный тонзиллит. Язык с 3–5-х суток болезни становится «малиновым». У некоторых больных — <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боли в животе</a>, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\"><a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a></a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\">Рвота</a>\"><a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\">рвота</a></a> и жидкий стул.</p>\r\n<p>Период разгара составляет 3–10 дней (максимально — месяц) и характеризуется выраженностью симптомов конкретной клинической формы и интоксикации.</p>\r\n<p>Смешанная форма характеризуется сыпью, появляющейся у большинства больных на 2–7-й дни болезни. Чаще <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> скарлатиноподобная, но может быть полиморфной, эфемерной, петехиальной, мелко- и крупнопятнистой, уртикарной, эритематозной, везикулярной и в виде узловатой эритемы, иногда <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зудит</a>.</p>\r\n<p>О начале периода реконвалесценции свидетельствуют улучшение самочувствия больных, постепенная нормализация температуры, восстановление аппетита, исчезновение сыпи, болей в животе и суставах. Нередко сохраняется <a href=\"/symptom/povyshennaya_temperatura_37-38/\" title=\"Перейти на страницу симптома Повышенная температура 37-38°\">субфебрильная температура</a>. На 2–3-й неделе периода реконвалесценции появляются вегетативные расстройства, которые усиливаются при затяжном течении и формировании вторично-очаговых форм.</p>\r\n<p>При всех клинических формах заболевания обострения и рецидивы чаще возникают у больных, не получавших антибактериальной терапии.</p>\r\n<p>Септический вариант смешанной формы псевдотуберкулёза встречается редко. Летальность достигает 30–40%</p>\r\n<p> </p>",
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},
{
"id": 6036,
"symptoms": [
{
"id": 3014,
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{
"name": "Облысение"
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{
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{
"name": "Редеют волосы"
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{
"id": 2950,
"synonyms": [
{
"name": "локальная гипертермия "
},
{
"name": "горячая на ощупь"
},
{
"name": "отек на коже"
},
{
"name": "припухлость"
},
{
"name": "уплотнение"
},
{
"name": "Локализованный отек"
}
],
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"lead": "Отек в конкретном месте - это повод проконсультироваться у врача",
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},
{
"id": 2941,
"synonyms": [
{
"name": "астеническое состояние"
},
{
"name": "астенический синдром"
},
{
"name": "астения"
},
{
"name": "упадок сил"
},
{
"name": "бессилие"
}
],
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{
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},
"code": "A30",
"name": "Лепра ",
"icd_name": "Лепра [болезнь Гансена]",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5
],
"periodicity": 1,
"slug": "a30_lepra",
"lead": "Лепра — хроническая антропонозная инфекционная болезнь",
"description": "",
"etiology": "<p>Единственный доказанный источник инфекции при лепре — больной человек. Большинство специалистов допускают как воздушно-капельный, так и контактный (перкутанный) путь передачи лепры. Данные эпидемиологических исследований свидетельствуют о преобладающем значении воздушно-капельного пути передачи: обычно больной может служить источником инфекции при развитии у него обширных поражений слизистой оболочки носоглотки, т.е. в период массивного выделения возбудителя в окружающую среду респираторным путём. В то же время зарегистрированные случаи заражения при хирургических вмешательствах, а также при татуировке подтверждают, что возможны заражение лепрой и проникновение возбудителя через повреждённую кожу.</p>",
"pathogenesis": "<p>Развитие различных морфоклинических типов лепры, вызванной одним и тем же возбудителем, обусловлено особенностями (уровнем) Т-клеточного иммунитета.</p>\r\n<p> </p>",
"diagnostics": "<p>Диагностика лепры основывается на выявлении дерматологических и неврологических симптомов болезни и оценке результатов функциональных и лабораторных исследований. Большое значение придают анамнезу, проживанию в эндемической зоне, контакту с больными лепрой. Поскольку у больного человека длительно (годами) отсутствует субъективное ощущение болезни (отсутствие повышенной температуры, боли и зуда в области высыпаний), для своевременного её выявления обязательно осматривать пациента при хорошем освещении. Необходимо провести неврологическое обследование, чтобы обнаружить утолщённые нервные стволы и кожные нервные веточки (особенно в области высыпаний на коже).</p>\r\n<full></full>\r\n<p>Стандарт диагностики лепры включает:</p>\r\n<p>· осмотр всего кожного покрова, а также слизистых оболочек верхних дыхательных путей;<br />· пальпацию нервных стволов и кожных веточек нервов;<br />· обследование конечностей для обнаружения амиотрофии и контрактур;<br />· постановку функциональных проб в очагах кожных поражений (выявление нарушений различных видов чувствительности кожи, проба на потоотделение, проба с никотиновой кислотой и др.);<br />· бактериоскопическое исследование, позволяющее обнаружить кислотоустойчивые микобактерии в мазках из скарификатов кожи;<br />· патогистологическое исследование кожи, взятой из края очага поражения, с окраской по Цилю–Нильсену для выявления M. leprae.</p>",
"treatment": "<p>Для лечения бактериовыделителей ВОЗ рекомендует следующую помесячную схему комбинированной терапии.</p>\r\n<p>В России из группы препаратов сульфонового ряда производят димоцифон. В качестве препаратов второго ряда для лечения больных лепрой применяют этионамид и протионамид. Для купирования острых лепрозных реакций назначают глюкокортикоиды, НПВС, анальгетики, витамины, средства, улучшающие нервную проводимость и предупреждающие развитие мышечных атрофий, десенсибилизирующие препараты и иммуномодуляторы. Из дополнительных методов лечения по показаниям применяют физиотерапевтические (лечение невритов) и хирургические (остеомиелиты).</p>",
"prevention": "<p>Профилактика при лепре состоит из индивидуальных и общественных (социальных) предохранительных мероприятий. Особенности профилактики при лепре обусловливаются длительным инкубационным периодом, то есть невозможностью применения мер, подобных карантину, а также отсутствием вакцины и быстродействующих лекарств. Важнейшее значение в профилактике лепры имеет проведение оздоровительных и санитарно-гигиенических мероприятий.</p>",
"clinical_picture": "<p>Для лепры характерны крайне длительный и неопределённый инкубационный период (от нескольких месяцев до 20 лет и более; в среднем 3–7 лет), большое разнообразие клинических симптомов, отсутствие чётких признаков течения.</p>\r\n<p>В качестве продромальных при лепре иногда выступают признаки периферической вегетативной недостаточности и симптомы рефлекторно-сосудистых расстройств (мраморность кожи, <a href=\"/symptom/cianoz/\" title=\"Перейти на страницу симптома Цианоз\">цианоз</a>, отёки кистей и стоп, нарушения пото- и салоотделения), а также <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">ломота</a>, парестезии, кровотечения из носа.</p>\r\n<p>В начале развития манифестных форм заболевания, как правило, отмечают диффузные изменения окраски кожного покрова, одиночные или множественные пятнистые <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a>, варьирующие по локализации, форме, размерам и окраске (эритематозные, гипопигментные, гиперпигментные, синюшные, с буроватым оттенком), усиливающиеся парестезии. В более поздних стадиях болезни возникают ограниченные или разлитые кожные инфильтраты, <a href=\"/symptom/papuly/\" title=\"Перейти на страницу симптома Папулы\">папулы</a>, бугорки, узлы, <a href=\"/symptom/nasmork/\" title=\"Перейти на страницу симптома Насморк\">ринит</a> и <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> на слизистых оболочках верхних дыхательных путей, лепрозный пемфигус, выпадение бровей и ресниц (мадароз), амиотрофия, ломкость ногтей, ихтиозиформные признаки, язвы и другие трофические расстройства, грубые нарушения поверхностных видов чувствительности.</p>\r\n<p>Поражения периферической нервной системы раньше или позже обнаруживаются при всех формах лепры. Особенность лепрозных невритов — их восходящий характер и островковый (рамускулярный) тип расстройства чувствительности, что обусловлено разрушением нервных окончаний в очагах высыпаний, поражением кожных веточек нервов и отдельных нервных стволов. Чаще всего именно поражение периферической нервной системы приводит к инвалидности (отсутствие кожных видов чувствительности, амиотрофия, контрактуры, параличи, нейротрофические язвы, остеомиелит, мутиляции, лагофтальм).</p>",
"image": "http://api.symptomd.ru/storage/46b6f408f2f79ecea92d7911bf1a60d3_z3CibJ6.png",
"image_alt": "Лепра",
"standard_type": 1,
"danger": 72,
"published": 1,
"parent": null,
"block_rubric": 4,
"standards": [
4846
]
},
{
"id": 6037,
"symptoms": [
{
"id": 2866,
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{
"name": "гипертермия"
},
{
"name": "повышение температуры"
},
{
"name": "лихорадка"
},
{
"name": "жар"
}
],
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}
]
}
