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"code": "L55",
"name": "Солнечный ожог",
"icd_name": "Солнечный ожог",
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"lead": "острое воспаление кожи, вызванное воздействием естественного (солнечного) или искусственного ультрафиолетового излучения.",
"description": "Избыточное облучение солнечными лучами может привести к повреждению кожи: вызвать покраснение, раздражение, сухость, зуд, и другие симптомы солнечного ожога.",
"etiology": "<p>Наиболее сильными биологическими свойствами в солнечном спектре обладают ультрафиолетовые лучи. Ультрафиолетовое излучение, достигающее поверхности земли, делят на два основных диапазона: УФ-В, вызывающее солнечный ожог (коротковолновая область, длина волны 290-320 нм), и УФ-А (длинноволновая область, длина волны 320- 400 нм). Солнечные ожоги вызывает именно «жесткое» коротковолновое излучение УФ-В (UVB). Оно поражает верхние слои кожи. Однако следует помнить, что \"длинноволновое\" излучение, глубоко проникающее в кожу, также может вызвать неблагоприятные последствия - они разрушают коллаген (эластичные волокна, которые придают коже упругость), приводят к изменениям толщины и текстуры кожи. Поэтому действие прямых солнечных лучей, особенно в южных широтах, - это фактор риска, и может привести не толко к солнечным ожогам, но и к другим повреждениям кожи.</p>",
"pathogenesis": "",
"diagnostics": "<p>Диагноз можно поставить врач при осмотре и сборе анамнеза.</p>",
"treatment": "<p>При подозрении на солнечный удар следует незамедлительно обращаться за медицинской помощью. В ожидании врача пострадавшему нельзя давать пить холодную воду (от этого усиливается <a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>), компрессы также должны быть пропитаны не холодной, а прохладной водой.</p>\r\n<p>При симптомах средней тяжести пострадавший должен пить как можно больше, чтобы предотвратить обезвоживание. Кроме того, необходимо:</p>\r\n<full></full>\r\n<ul>\r\n<li>Сделать прохладные компрессы (можно смочить одежду), чтобы снизить температуру тела и уменьшить болевые ощущения</li>\r\n<li>Принять прохладную ванну без мыла (оно еще сильнее раздражает обожженную кожу). Кожу после ванны ни в коем случае нельзя вытирать, достаточно просто слегка промокнуть ее</li>\r\n<li>Нанести увлажняющий или смягчающий лосьон или крем. В данном случае необходимо предварительно посоветоваться с врачом, поскольку некоторые косметические средства содержат бензокаин, который может вызвать аллергическую реакцию, а ряд мазей замедляет заживление кожи, перекрывая доступ к ней кислорода</li>\r\n<li>При наличии волдырей следует сделать повязку на пораженный участок, чтобы предотвратить проникновение инфекции</li>\r\n<li>При сильном дискомфорте можно принять обезболивающие препараты.</li>\r\n</ul>\r\n<p>Лечение солнечного ожога</p>\r\n<p>В настоящее время лечение солнечных ожогов направлено, главным образом, на уменьшение симптомов. В основном это пероральное или местное применение нестероидных противовоспалительных препаратов, которые способствуют уменьшению не только воспалительного процесса, но и болевых ощущений.</p>\r\n<p>Использование в данном случае стероидных препаратов, таких как, например, преднизон, нецелесообразно, поскольку препарат не способствует скорейшему заживлению и, к тому же, имеет ряд побочных эффектов.<br />Крем с алоэ вера хотя и не заживляет непосредственно сам ожог, облегчает некоторые симптомы. <br />Что касается местных анестетиков (бензокаин), то они способствуют облегчению симптомов, но их эффективность при лечении солнечных ожогов недостаточно подтверждена результатами клинических испытаний.</p>",
"prevention": "<ul>\r\n<li>Ограничьте время пребывания на солнце и избегайте солнечных ванн с 10.00 до 15.00 часов.</li>\r\n<li>Носите защитную одежду: широкополые шляпы, брюки, рубашки с длинным рукавом (темные плотные ткани защищают кожу лучше, чем легкие и светлые).</li>\r\n<li>Помните, что обгореть можно даже в облачную погоду (облака не задерживают ультрафиолетовые лучи) или находясь в воде.</li>\r\n<li>Помните, что песок, вода и снег отражают солнечные лучи и увеличивают вероятность солнечного ожога</li>\r\n<li>Используйте солнцезащитные кремы с солнцезащитным фильтром не менее 15 SPF, а при светлой коже защитный фактор должен быть еще выше. Крем необходимо наносить за несколько минут до выхода на улицу и чаще обновлять его.</li>\r\n</ul>",
"clinical_picture": "<p>Симптомы солнечного ожога зависят от тяжести поражения кожи. При ожоге легкой степени кожа в месте ожога воспаляется, краснеет, даже легкое прикосновение к ней причиняет боль. Ощущается сухость и жжение, <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a>, обожженная кожа <a href=\"/symptom/otek_tkaney/\" title=\"Перейти на страницу симптома Отек тканей\">горячая на ощупь</a>.</p>\r\n<p>При более тяжелом солнечном ожоге кожа может припухнуть, покрыться волдырями или корочкой. Иногда повышается общая температура тела. При тяжелом солнечном ожоге нередки <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, <a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>, <a href=\"/symptom/lihoradka_s_oznobom/\" title=\"Перейти на страницу симптома <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">Лихорадка</a> с ознобом\">жар</a>, общая <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>.</p>\r\n<p>Коварство солнечного ожога - в отличие от некоторых других видов ожогов - состоит в том, что симптомы солнечного ожога становятся заметны не мгновенно, а лишь через несколько часов. Максимально симптомы проявляются через 12 - 24 ч, <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">отшелушивание</a> обгоревшего слоя кожи начинается на 4 - 7 день после солнечного ожога.</p>",
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"description": "Для заболевания характерно наличие врождённых первичных свищевых втяжений в межягодичной складке. Нередко из таких втяжений выстоят волосы. ",
"etiology": "<p>Считают, что эпителиальный копчиковый ход является врожденным дефектом развития кожи, обусловленным неполной редукцией мышц и связок хвоста.</p>",
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"diagnostics": "<p>Местные изменения настолько типичны, что спутать копчиковый ход с другими поражениями этой области почти невозможно. При введении в один из свищей метиленового синего краска выходит из всех остальных ходов и вторичных свищей и не проходит в прямую кишку.</p>",
"treatment": "<p>Радикальное лечение пилонидальной кисты проводится только хирургическим путем, в условиях стационара хирургического или колопроктологического отделения. Существуют две тактики хирургического лечения:</p>\r\n<ol>\r\n<li>В острый период вскрывается и дренируется гнойник. После чего через 1–2 недели проводится радикальная операция – иссечение кисты в пределах здоровых тканей.</li>\r\n<li>В острый период сразу проводится радикальная операция – иссечение кисты единым блоком в пределах здоровых тканей (при этом необходимо сохранить целостность кисты, во избежание инфицирования операционной раны).</li>\r\n</ol>\r\n<p>Операция завершается ушиванием краев раны. Хотя, на усмотрение хирурга, рана может оставаться открытой и долго заживать вторичным натяжением; иногда до 6 месяцев (Прим. автора). При иссечении кисты копчика всегда имеется дефицит тканей, что приводит к чрезмерному натяжению краев раны и негативно сказывается на ее заживлении. Практически всегда послеоперационные раны заживают долго, причиняя значительные неудобства пациенту. При этом частота рецидива достигает 10–40%.</p>\r\n<p>Радикальная операция всегда проводится в условиях наркоза. В послеоперационном периоде пациенты в обязательном порядке получают антибактериальные препараты широкого спектра действия, а также противовоспалительные средства.</p>",
"prevention": "<p>Всем, кто перенес радикальное оперативное вмешательство по поводу эпителиального копчикового хода, желательно соблюдать следующие рекомендации: <br />- в течение трех недель после операции не разрешается сидеть, поднимать тяжести; после снятия швов целесообразно ежедневно принимать гигиенический душ с промыванием межъягодичной складки; <br />- в течение 6 месяцев после операции 2 раза в месяц необходимо производить эпиляцию в зоне операции.</p>",
"clinical_picture": "<p>Эпителиальный копчиковый ход расположен по средней линии в межъягодичной складке, слепо оканчивается в подкожной клетчатке крестцово-копчиковой области, открывается на коже одним или несколькими точечными отверстиями (первичный эпителиальный ход), и представляет собой узкую эпителиальную трубку. Продукты жизнедеятельности эпителия, выстилающего ход, периодически выделяются через точечные отверстия наружу. Закупорка или инфицирование выводных протоков, механическая травма приводят к задержке содержимого в просвете хода и способствуют возникновению воспаления. В результате эпителиальный копчиковый ход расширяется, стенка его разрушается и в воспалительный процесс вовлекается окружающая клетчатка. Развившиеся при этом абсцесс или флегмона крестцово-копчиковой области иногда достигают значительной величины и могут вскрыться наружу в виде гнойного свища, который принято называть вторичным отверстием. <br /><br />В 25-50% случаев внутри эпителиального копчикового хода или возникшей на его месте кисты содержатся волосы, которые могут внедряться в боковые стенки и образовывать дополнительные ходы. Гнойник иногда достигает значительной величины и, как правило, прорывается через кожу, образуя наружное отверстие гнойного свища. <br />Различают неосложненный и осложненный гнойным процессом эпителиальный копчиковый ход.</p>",
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"name": "Пилонидальная киста",
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"lead": "врождённая аномалия развития кожи крестцово-копчиковой области, связанная с неполной редукцией рудиментарной каудальной связки. ",
"description": "Для заболевания характерно наличие врождённых первичных свищевых втяжений в межягодичной складке. Нередко из таких втяжений выстоят волосы. ",
"etiology": "<p>Считают, что эпителиальный копчиковый ход является врожденным дефектом развития кожи, обусловленным неполной редукцией мышц и связок хвоста.</p>",
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"diagnostics": "<p>Местные изменения настолько типичны, что спутать копчиковый ход с другими поражениями этой области почти невозможно. При введении в один из свищей метиленового синего краска выходит из всех остальных ходов и вторичных свищей и не проходит в прямую кишку.</p>",
"treatment": "<p>Радикальное лечение пилонидальной кисты проводится только хирургическим путем, в условиях стационара хирургического или колопроктологического отделения. Существуют две тактики хирургического лечения:</p>\r\n<ol>\r\n<li>В острый период вскрывается и дренируется гнойник. После чего через 1–2 недели проводится радикальная операция – иссечение кисты в пределах здоровых тканей.</li>\r\n<li>В острый период сразу проводится радикальная операция – иссечение кисты единым блоком в пределах здоровых тканей (при этом необходимо сохранить целостность кисты, во избежание инфицирования операционной раны).</li>\r\n</ol>\r\n<p>Операция завершается ушиванием краев раны. Хотя, на усмотрение хирурга, рана может оставаться открытой и долго заживать вторичным натяжением; иногда до 6 месяцев (Прим. автора). При иссечении кисты копчика всегда имеется дефицит тканей, что приводит к чрезмерному натяжению краев раны и негативно сказывается на ее заживлении. Практически всегда послеоперационные раны заживают долго, причиняя значительные неудобства пациенту. При этом частота рецидива достигает 10–40%.</p>\r\n<p>Радикальная операция всегда проводится в условиях наркоза. В послеоперационном периоде пациенты в обязательном порядке получают антибактериальные препараты широкого спектра действия, а также противовоспалительные средства.</p>",
"prevention": "<p>Всем, кто перенес радикальное оперативное вмешательство по поводу эпителиального копчикового хода, желательно соблюдать следующие рекомендации: <br />- в течение трех недель после операции не разрешается сидеть, поднимать тяжести; после снятия швов целесообразно ежедневно принимать гигиенический душ с промыванием межъягодичной складки; <br />- в течение 6 месяцев после операции 2 раза в месяц необходимо производить эпиляцию в зоне операции.</p>",
"clinical_picture": "<p>Эпителиальный копчиковый ход расположен по средней линии в межъягодичной складке, слепо оканчивается в подкожной клетчатке крестцово-копчиковой области, открывается на коже одним или несколькими точечными отверстиями (первичный эпителиальный ход), и представляет собой узкую эпителиальную трубку. Продукты жизнедеятельности эпителия, выстилающего ход, периодически выделяются через точечные отверстия наружу. Закупорка или инфицирование выводных протоков, механическая травма приводят к задержке содержимого в просвете хода и способствуют возникновению воспаления. В результате эпителиальный копчиковый ход расширяется, стенка его разрушается и в воспалительный процесс вовлекается окружающая клетчатка. Развившиеся при этом абсцесс или флегмона крестцово-копчиковой области иногда достигают значительной величины и могут вскрыться наружу в виде гнойного свища, который принято называть вторичным отверстием. <br /><br />В 25-50% случаев внутри эпителиального копчикового хода или возникшей на его месте кисты содержатся волосы, которые могут внедряться в боковые стенки и образовывать дополнительные ходы. Гнойник иногда достигает значительной величины и, как правило, прорывается через кожу, образуя наружное отверстие гнойного свища. <br />Различают неосложненный и осложненный гнойным процессом эпителиальный копчиковый ход.</p>",
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"code": "A58",
"name": "Паховая гранулема",
"icd_name": "Паховая гранулема",
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"lead": "инфекционное заболевание, вызываемое бактериями вида Klebsiella granulomatis",
"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>",
"pathogenesis": "",
"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>",
"clinical_picture": "<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;\">Симптомы заболевания появляются приблизительно через 1-12 недель после инфицирования. Первый симптом – появление безболезненного красного узелка, который медленно превращается в круглое приподнятое образование. Инфекция поражает половой член, мошонку, пах и бедра у мужчин, и вульву, влагалище и окружающую кожу – у женщин. Как у мужчин, так и у женщин могут быть инфицированы задний проход, ягодицы и лицо. Приподнимающиеся над кожей узелки постепенно покрывают половые органы. Заживление медленное, с формированием рубцовой ткани. Обычно узелки инфицируются другими микроорганизмами.</span></p>",
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"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>",
"pathogenesis": "",
"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>",
"clinical_picture": "<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;\">Симптомы заболевания появляются приблизительно через 1-12 недель после инфицирования. Первый симптом – появление безболезненного красного узелка, который медленно превращается в круглое приподнятое образование. Инфекция поражает половой член, мошонку, пах и бедра у мужчин, и вульву, влагалище и окружающую кожу – у женщин. Как у мужчин, так и у женщин могут быть инфицированы задний проход, ягодицы и лицо. Приподнимающиеся над кожей узелки постепенно покрывают половые органы. Заживление медленное, с формированием рубцовой ткани. Обычно узелки инфицируются другими микроорганизмами.</span></p>",
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},
"code": "A43",
"name": "Нокардиоз",
"icd_name": "Нокардиоз",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"4"
],
"periodicity": 1,
"slug": "a43_nokardioz",
"lead": "глубокий псевдомикоз, возбудитель которого вызывает гнойно-гранулематозное поражение легких, кожи и внутренних органов",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заражение у людей вызывают несколько видов Nocardia. Nocardia asteroides обычно вызывает инфекции легких и всего организма. Другие виды обычно вызывают кожные инфекции, особенно у людей, живущих в тропическом климате.</span></p>\r\n<p><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;\">Люди заражаются, когда:</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;\">они вдыхают пыль, содержащую бактерии Nocardia, что приводит к инфекции легких;</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;\">почва или вода, содержащая бактерии, попадает в кожу через порез или царапину, что приводит к инфекции кожи.</span></li>\r\n</ul>\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;\">Нокардиоз редко передается от человека к человеку.</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;\">Бактерии Nocardia могут распространиться на соседние ткани или через кровоток, заражая любой орган. Они чаще всего заражают мозг, кожу, почки, кости или мышцы. Абсцессы (скопления гноя) могут образовываться в инфицированных органах.</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;\">Нокардиоз встречается во всем мире у людей всех возрастов. Но чаще всего он встречается среди пожилых людей, особенно мужчин, и у людей с ослабленной иммунной системой. Любое из следующих нарушений, ослабляющих иммунную систему, увеличивает риск заражения нокардиозом:</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;\">наличие определенных онкологических заболеваний (таких как ходжкинская лимфома);</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;\">наличие пересаженного органа;</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 высоких доз кортикостероидов и/или других препаратов, подавляющих иммунную систему;</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;\">болезнь легких;</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;\">поздняя стадия ВИЧ /СПИД.</span></li>\r\n</ul>\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;\">Нокардиоз считается оппортунистической инфекцией, потому что происходит у людей с ослабленной иммунной системой. Однако около 20–30% людей с нокардиозом не имеют нарушения или заболевания, повышающего риск заражения.</span></p>\r\n<p><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;\"> </span></p>",
"pathogenesis": "<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;\">Входные ворота инфекции – слизистая оболочка дыхательных путей, кишечника, конъюнктивы глаза, раны. Нокардиоз обычно развивается на фоне сниженной резистентности макроорганизма: при хронических заболеваниях крови, онкологических процессах, длительном лечении кортикостероидами, иммунодепрессантами, противоопухолевыми антибиотиками. Обычно нокардиоз начинается как легочная инфекция, для которой характерно образование мелких бугорков, напоминающих туберкулезные. Далее процесс может развиваться местно (образуются каверны, абсцессы, свищи) или происходит диссеминация возбудителя лимфогенным или гематогенным путем. В этом случае могут наблюдаться абсцессы мозга, почек, других органов и тканей.</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;\">Подтверждение диагноза возможно при сопоставлении клинической картины нокардиоза с лабораторно-инструментальными данными. При легочной форме рентгенография легких обнаруживает картину сливной бронхопневмонии с полостями распада. При диссеминированной форме с помощью КТ и МРТ выявляются внутримозговые абсцессы и вторичные гнойные очаги во внутренних органах.</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;\">Выделение возбудителя нокардиоза из клинического материала (мокроты, бронхиальных смывов, экссудата, крови, мочи, гноя, цереброспинальной жидкости, биоптатов) производится с помощью микроскопии, бактериологического посева, ПЦР. Дополнительно могут применяться серологические исследования (реакция агглютинации, преципитации, связывания комплемента), кожные аллергические пробы.</span></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;\">Лечение нокардиоза должно включать пролонгированную химиотерапию и хирургическое дренирование гнойных очагов. Для этиотропной химиотерапии нокардиоза применяются сульфани­ламидные препараты (сульфадимидин, сульфадиазин – в течение нескольких месяцев), сульфаметоксазол+триметоприм, антибиотики (имипенем, амикацин, цефотаксим, цефтриаксон, тетрациклины – курс 4-6 недель). При нокардиозе может встать вопрос о дренировании плевральной полости, оперативном лечении абсцессов головного мозга, вскрытии абсцессов мягких тканей и т. д.</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 легочном нокардиозе летальность составляет около 10%, при септической форме инфекции – 50%. Изолированная кожная форма нокардиоза протекает доброкачественно. Иммунопрофилактика нокардиоза не разработана. Избежать заражения патогенными микроорганизмами позволяет предупреждение травм кожи, ношение защитной одежды и обуви при контакте с землей, повышение иммунной реактивности.</span></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;\">Принципы профилактики прежде всего сводятся к избеганию попадания земли в раны, а также к повышению уровня иммунной защиты. Кроме этого, по возможности следует защищать себя от вдыхания запыленного воздуха.</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;\">Большинство случаев нокардиоза начинаются с легочных инфекций, которые развиваются в абсцессы легких. Симптомы нокардиоза могут включать:</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;\">боль в груди;</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;\">кашель;</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;\">кровянистую мокроту;</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;\">потливость;</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;\">озноб;</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;\">слабость;</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;\">отсутствие аппетита;</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;\">потерю веса;</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;\">затрудненное дыхание (одышка).</span></li>\r\n</ul>\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;\">Симптомы нокардиоза схожи с симптомами пневмонии и туберкулеза легких.</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;\">Инфекция может распространяться через кровоток, приводя к абсцессам в головном мозге, где они действительно очень серьезны, или реже, в почках, кишечнике или других органах. Приблизительно у одной трети зарегистрированных случаев развиваются абсцессы головного мозга, если их не лечить или если лечение задерживается. Симптомы, связанные с абсцессами головного мозга, могут включать сильную головную боль и очаговые, сенсорные и моторные нарушения.</span></p>\r\n<p><strong style=\"font-weight: normal;\"> </strong></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;\">Кожные абсцессы встречаются примерно в одной трети всех случаев нокардиоза и обычно обнаруживаются разбросанными по всей руке, грудной стенке и ягодицам. У пациентов, иммунная система которых угнетена из-за ВИЧ-инфекции или кортикостероидов или цитотоксических препаратов, язвенного колита, злокачественной опухоли лимфатической системы или ряда других заболеваний, прогрессирование заболевания может быть очень быстрым.</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;\">Нокардиоз может длиться от нескольких месяцев до лет. Важно, чтобы инфекция была диагностирована и дифференцирована от туберкулеза и пневмонии.</span></p>",
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