Тянет низ живота при беременности - причины в 1, 2, 3 триместре

Размещено:  Варикоз
группа болезней, которые вызываются специфическими возбудителями, характеризуются заразительностью, циклическим течением и формированием постинфекционного иммунитета. Термин «инфекционные болезни» был введен Гуфеландом (Ch. W. Hufeland) и получил международное распространение. Он используется также для обозначения области клинической медицины, которая изучает патогенез, клинику инфекционных болезней и разрабатывает методы их диагностики и лечения.
Классификация. В связи с многообразием биологических свойств возбудителей инфекций, механизмов их передачи, патогенетических особенностей и клинических проявлений И. б. классификация последних по единому признаку представляет большие трудности. Наибольшее распространение получила классификация, теоретически обоснованная Л.В. Громашевским, в основу которой положен механизм передачи возбудителя инфекции и локализация его в организме (табл. 1). В естественных условиях существуют четыре типа механизмов передачи: фекально-оральный (при кишечных инфекциях), аспирационный (при инфекциях дыхательных путей), трансмиссивный (при кровяных инфекциях) и контактный (при инфекциях наружных покровов). Механизм передачи в большинстве случаев определяет преимущественную локализацию возбудители в организме. При кишечных инфекциях возбудитель в течение всей болезни или в определенные ее периоды в основном локализуется в кишечнике; при инфекциях дыхательных путей — в слизистых оболочках глотки, трахеи, бронхов и в альвеолах, где развивается воспалительный процесс; при кровяных инфекциях — циркулирует в крови и лимфатической системе; при инфекциях наружных покровов (к ним относятся также раневые инфекции) в первую очередь поражаются кожа и слизистые оболочки. В зависимости от основного источника возбудителя И. б. подразделяются на антропонозы (источник возбудителей человек) и зоонозы (источник возбудителей животные).

Таблица 1.

Классификация основных инфекционных болезней человека (по основному механизму передачи и источнику возбудителя инфекции)

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| Группа              | Антропонозы                                        | Зоонозы                                    |

| болезней           |                                                             |                                                  |

|-------------------------------------------------------------------------------------------------------------------------------------------|

| Кишечные         | Брюшной тиф, вирусный гепатит А,     | Ботулизм, бруцеллез,                |

| инфекции          | вирусный гепатит ни А ни В с               | иерсиниоз, кампилобактериоз,   |

|                          | фекально-оральным механизмом         | лептоспироз,                             |

|                          | передачи, дизентерия, полиомиелит,    | псевдотуберкулез,                     |

|                          | паратифы А и Б, ротавирусный            | сальмонеллез                            |

|                          | гастроэнтерит, холера                          |                                                  |

|-------------------------------------------------------------------------------------------------------------------------------------------|

| Инфекции         | Аденовирусные болезни, болезнь         | Геморрагическая лихорадка с    |

| дыхательных    | легионеров, ветряная оспа,                  | почечным синдромом,               |

| путей                | герпетическая инфекция, грипп,           | геморрагическая лихорадка       |

|                          | дифтерия, инфекционный                    | Ласса, лимфоцитарный             |

|                          | мононуклеоз, коклюш, корь, краснуха,  | хориоменингит, орнитоз, оспа   |

|                          | менингококковая инфекция,                 | обезьян                                     |

|                          | микоплазменная инфекция,                  |                                                  |

|                          | натуральная оспа, респираторно-         |                                                  |

|                          | синцитиальная инфекция, парагрипп,   |                                                  |

|                          | риновирусная инфекция, скарлатина,   |                                                  |

|                          | цитомегаловирусная инфекция,            |                                                  |

|                          | эпидемический паротит                        |                                                  |

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| Кровяные          | Возвратный тиф эпидемический          | Блошиный тиф эндемический,   |

| инфекции          | (вшиный), окопная лихорадка, сыпной  | болезнь Лайма, везикулезный    |

|                          | тиф эпидемический                             | риккетсиоз, возвратный тиф      |

|                          |                                                             | (клещевой), крымская                |

|                          |                                                             | геморрагическая лихорадка,      |

|                          |                                                             | желтая лихорадка, клещевой     |

|                          |                                                             | энцефалит, комариный              |

|                          |                                                             | энцефалит, Ку-лихорадка,         |

|                          |                                                             | денге, цуцугамуши,                   |

|                          |                                                             | марсельская лихорадка,            |

|                          |                                                             | омская геморрагическая            |

|                          |                                                             | лихорадка, североазиатский      |

|                          |                                                             | клещевой риккетсиоз,                |

|                          |                                                             | туляремия, флеботомная           |

|                          |                                                             | лихорадка, чума                        |

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| Инфекции         | Вирусный гепатит В, вирусный             | Бешенство, вакцина,                 |

| наружных          | гепатит ни А ни В с парентеральным    | геморрагические лихорадки       |

| покровов           | механизмом передачи, ВИЧ-                | Марбург и Эболы,                      |

|                          | инфекция, гонорея, лепра,                   | доброкачественный                   |

|                          | мочеполовой хламидиоз, рожа,            | лимфоретикулез, листериоз,      |

|                          | сифилис, трахома                                | мелиоидоз, паравакцина,           |

|                          |                                                             | пастереллез, сап, сибирская      |

|                          |                                                             | язва, содоку, столбняк,             |

|                          |                                                             | стрептобациллез, эризипелоид,  |

|                          |                                                             | ящур                                         |

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Некоторые И. б., кроме основного механизма передачи, обусловливающего их групповую принадлежность, имеют и другой механизм передачи возбудителя. Это приводит к тому, что болезнь может проявляться в разных клинических формах, соответствующих механизму передачи. Так, туляремия у человека чаще протекает в бубонной форме, но при воздушно-пылевом пути передачи возбудителя развивается легочная форма болезни.
Не все И. б. можно с достаточной уверенностью отнести к той или иной группе (например, полиомиелит, лепру, туляремию) Однако ценность классификации Л.В. Громашевского состоит в том, что по мере углубления знаний о природе недостаточно изученных болезней, они находят в ней соответствующее место.
В СССР принята также Международная классификация болезней, которая используется для регистрации и учета заболеваемости. В первый ее класс включены инфекционные и паразитарные болезни, подразделяемые на группы по смешанному принципу; 1) кишечные инфекции; 2) туберкулез; 3) бактериальные зоонозы; 4) другие бактериальные болезни; 5) полиомиелит и другие вирусные болезни ц.н.с., непередаваемые членистоногими; 6) вирусные болезни, сопровождающиеся высыпаниями; 7) вирусные болезни, передаваемые членистоногими; 8) другие болезни, вызываемые вирусами и хламидиями; 9) риккетсиозы и другие болезни, передаваемые членистоногими; 10) сифилис и другие венерические болезни; 11) другие болезни, вызываемые спирохетами; 12) микозы; 13) гельминтозы; 14) другие инфекционные и паразитарные болезни.
Однако допускаются некоторые отступления от Международной классификации болезней. Так, грипп и другие острые респираторные вирусные инфекции отнесены к инфекционным болезням (группа первого класса), а в Международной классификации болезней они входят в число болезней органов дыхания.

Характеристика важнейших инфекционных и некоторых протозойных болезней приведена в таблице 2.

Таблица 2.

Характеристика важнейших инфекционных и протозойных заболеваний

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| Название болезни    | Возбудитель           | Источник возбудителя | Пути и факторы      | Инкубационный        | Клиническая              | Методы исследования        | Дифференциально-           |

|                                 | инфекции (инвазии) | инфекции (инвазии)     | передачи                | период                     | характеристика         |                                           | диагностический ряд         |

|                                 |                                |                                    | возбудителя           |                                 | болезни                     |                                           |                                          |

|                                 |                                |                                    | инфекции (инвазии) |                                 |                                  |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 1                              | 2                             | 3                                 | 4                             | 5                              | 6                               | 7                                        | 8                                       |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Аденовирусные        | Вирусы из               | Человек — больной,    | Основной —           | 3—14 дней, в           | Начало острое.          | Люминесцентная                | Грипп, парагрипп,              |

| болезни                    | семейства               | реконвалесцент,          | воздушно-               | среднем 5—7 дней   | Интоксикация            | риноцитоскопия, реакция    | брюшной тиф и паратифы  |

|                                 | Adenoviridae,           | вирусоноситель          | капельный путь       |                                 | выражена слабо.       | связывания комплемента,  | А и В, инфекционный         |

|                                 | наибольшее            |                                    | передачи,               |                                 | Характерны               | реакции торможения           | мононуклеоз, ангина,         |

|                                 | значение имеют      |                                    | возможен также      |                                 | конъюнктивит,           | гемагглютинации и             | энтеровирусная инфекция |

|                                 | типы 3, 4, 7, 8, 14,   |                                    | пищевой, бытовой   |                                 | гиперемия слизистой | нейтрализации с парными   |                                          |

|                                 | 21                           |                                    | путь передачи        |                                 | оболочки ротоглотки, | сыворотками (нарастание   |                                          |

|                                 |                                |                                    | вируса через          |                                 | тонзиллит,                 | титра антител в 4 и более   |                                          |

|                                 |                                |                                    | загрязненные          |                                 | увеличение шейных   | раз)                                    |                                          |

|                                 |                                |                                    | пищевые                 |                                 | и других групп           |                                           |                                          |

|                                 |                                |                                    | продукты,               |                                 | лимфатических         |                                           |                                          |

|                                 |                                |                                    | предметы               |                                 | узлов, часто              |                                           |                                          |

|                                 |                                |                                    | домашнего              |                                 | гепатолиенальный     |                                           |                                          |

|                                 |                                |                                    | обихода                  |                                 | синдром, диарея.      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Продолжительность  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | лихорадочного          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | периода от 5—7        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | дней до 2—3 недель  |                                          |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Амебиаз                   | Амеба —                 | Человек — больной,    | Основной путь        | От 1 нед. до             | Начало постепенное, | Ректороманоскопия и         | Дизентерия, балантидиаз,  |

|                                 | Entamoeba              | реконвалесцент           | передачи —            | нескольких месяцев | реже острое. Стул     | колоноскопия (глубокие      | колиты, в т. ч.                    |

|                                 | histolytica                |                                    | пищевой, водный    |                                 | жидкий, каловый 3—  | язвы на мало измененном  | неспецифический              |

|                                 |                                |                                    | бытовой,                 |                                 | 4 раза в сутки, затем | фоне слизистой оболочки). | язвенный колит, рак и        |

|                                 |                                |                                    | заражение              |                                 | до 10—15 раз и         | Копроскопия (эритроциты,  | полипоз толстой кишки,     |

|                                 |                                |                                    | происходит через   |                                 | чаще, с примесью     | эозинофилы, кристаллы     | кишечные гельминтозы      |

|                                 |                                |                                    | загрязненные          |                                 | слизи и крови.           | Шарко — Лейдена; в          |                                          |

|                                 |                                |                                    | пищевые продукты  |                                | Схваткообразные      | свежих испражнениях        |                                          |

|                                 |                                |                                    | и воду, предметы   |                                 | боли в низу живота    | обнаруживают тканевую и  |                                          |

|                                 |                                |                                    | домашнего              |                                 | перед дефекацией,   | большую вегетативную      |                                          |

|                                 |                                |                                    | обихода; фактором |                                 | возможны тенезмы.   | форму возбудителя).          |                                          |

|                                 |                                |                                    | передачи                |                                 | Сигмовидная и          | Реакция непрямой              |                                          |

|                                 |                                |                                    | возбудителей          |                                 | слепая кишка            | гемагглютинации                |                                          |

|                                 |                                |                                    | могут быть также    |                                 | болезненны при         |                                           |                                          |

|                                 |                                |                                    | грязные руки, мухи |                                 | пальпации,                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | уплотнены.                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Возможны                 |                                           |                                          |

|                                 |                                |                                    |                               |                                 | лихорадка,                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | интоксикация,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | анемия. Течение       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | затяжное, иногда       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | хроническое              |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Балантидиаз            | Паразитическая      | Свиньи, реже человек | Пути передачи —    | Не определен           | Начало чаще острое. | Исследование крови           | Амебиаз, дизентерия,        |

|                                 | инфузория —          | — больной, носитель  | пищевой, водный,   |                                 | Лихорадка, ознобы,   | (нейтрофильный                 | сальмонеллез,                   |

|                                 | Balantidium coli        | балантидий                 | бытовой, через       |                                 | резкие боли в            | лейкоцитоз, эозинофилия,  | неспецифический              |

|                                 |                                |                                    | загрязненные          |                                 | животе, стул до 15— | увеличение СОЭ),              | язвенный колит, рак           |

|                                 |                                |                                    | пищевые                 |                                 | 20 раз в сутки и         | Ректороманоскопия и         | толстой кишки                   |

|                                 |                                |                                    | продукты, воду,      |                                 | более, обильный со   | колоноскопия (очаговый     |                                          |

|                                 |                                |                                    | предметы               |                                 | слизью и кровью.      | инфильтративно-язвенный  |                                          |

|                                 |                                |                                    | домашнего              |                                 | Возможно                  | процесс). Микроскопия       |                                          |

|                                 |                                |                                    | обихода. Фактором |                                 | обезвоживание.         | свежих фекалий                 |                                          |

|                                 |                                |                                    | передачи                |                                 | Течение острое и      | (вегетативные формы         |                                          |

|                                 |                                |                                    | инфекции могут      |                                 | хроническое              | балантидий)                       |                                          |

|                                 |                                |                                    | также служить        |                                 |                                  |                                           |                                          |

|                                 |                                |                                    | грязные руки, мухи |                                 |                                  |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Бешенство               | Вирус из                 | Волки, лисы, шакалы,  | Заражение              | От 10 дней до 1       | В начале                   | Выделение вируса из         | Столбняк, истерия,            |

|                                 | семейства               | собаки, кошки,            | происходит при       | года, чаще 1—3       | заболевания              | ткани головного мозга,       | энцефалиты, отравление   |

|                                 | Rhabdoviridae —      | летучие мыши, реже   | укусе или                | мес.                         | появляются               | обнаружение телец             | атропином                         |

|                                 | Neurorrhycetes         | грызуны и                   | ослюнении              |                                 | неприятные               | Бабеша — Негри, антигена |                                          |

|                                 | rabiei                       | травоядные животные | поврежденной         |                                 | ощущения в области | вируса в ткани головного    |                                          |

|                                 |                                |                                    | кожи или слизистой |                                 | укуса, чувство          | мозга и слюнных железах.  |                                          |

|                                 |                                |                                    | оболочки больным  |                                 | тревоги, депрессия.  | Реакция пассивной             |                                          |

|                                 |                                |                                    | бешенством            |                                 | Через 1—3 дня          | гемагглютинации, реакция  |                                          |

|                                 |                                |                                    | животным               |                                 | отмечаются               | связывания комплемента   |                                          |

|                                 |                                |                                    |                               |                                 | гидрофобия,              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | судороги мышц         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | глотки и гортани,       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | слюнотечение,          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | лихорадка,                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | потливость,               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | двигательное            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | возбуждение,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | галлюцинации.           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Затем развивается    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | паралич мышц           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | конечностей, языка,  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | лица, дыхательной    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | мускулатуры             |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Блошиный тиф         | Риккетсии —           | Крысы и домовые       | Путь передачи —    | От 5 до 15 дней       | Начало острое.          | Реакция связывания           | Сыпной тиф и другие         |

| эндемический          | Rickettsia typhi        | мыши                          | трансмиссивный     |                                 | Появляются озноб,    | комплемента                      | риккетсиозы                      |

| (крысиный                |                                |                                    | (при втирании в       |                                 | головная боль, боли  |                                           |                                          |

| эндемический          |                                |                                    | кожу фекалий         |                                 | в мышцах, суставах. |                                           |                                          |

| сыпной тиф)             |                                |                                    | зараженных блох);  |                                 | Температура тела     |                                           |                                          |

|                                 |                                |                                    | воздушно-пылевой  |                                 | повышена до 39—     |                                           |                                          |

|                                 |                                |                                    | (при попадании       |                                 | 40°, длительность     |                                           |                                          |

|                                 |                                |                                    | возбудителей на     |                                 | лихорадки 7—15        |                                           |                                          |

|                                 |                                |                                    | слизистые               |                                 | дней. Лицо,               |                                           |                                          |

|                                 |                                |                                    | оболочки глаз и       |                                 | конъюнктивы             |                                           |                                          |

|                                 |                                |                                    | верхних                  |                                 | гиперемированы. На  |                                           |                                          |

|                                 |                                |                                    | дыхательных путей |                                 | 2—7-й дни болезни    |                                           |                                          |

|                                 |                                |                                    | с пылью; а также    |                                 | на всем теле,            |                                           |                                          |

|                                 |                                |                                    | пищевой при           |                                 | включая лицо,           |                                           |                                          |

|                                 |                                |                                    | загрязнении            |                                 | ладони и подошвы,    |                                           |                                          |

|                                 |                                |                                    | пищевых                 |                                 | появляется обильная |                                           |                                          |

|                                 |                                |                                    | продуктов               |                                 | розеолезно-               |                                           |                                          |

|                                 |                                |                                    | содержащими         |                                 | папулезная сыпь.      |                                           |                                          |

|                                 |                                |                                    | риккетсии               |                                 | Селезенка и печень   |                                           |                                          |

|                                 |                                |                                    | испражнениями       |                                 | увеличены                 |                                           |                                          |

|                                 |                                |                                    | грызунов                 |                                 |                                  |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Ботулизм                 | Бациллы —             | Теплокровные             | Заражение              | От 2 до 10 дней,      | Начало острое.          | Исследование крови           | Энцефалиты,                     |

|                                 | Clostridiuro              | животные, реже          | происходит             | чаще 12—24 ч          | Отмечаются              | (умеренный лейкоцитоз,     | полиомиелит, пищевые      |

|                                 | botulinum (главным  | рыбы, ракообразные,   | пищевым путем      |                                 | слабость, головная    | нейтрофилез).                    | токсикоинфекции,              |

|                                 | образом серовары   | а также человек          | через пищевые       |                                 | боль,                         | Исследование промывных  | сальменеллез, отравления |

|                                 | А, В, E)                   |                                    | продукты                |                                 | головокружение, в     | вод желудка и рвотных      | беленой, метиловым          |

|                                 |                                |                                    | (маринованные       |                                 | первый день              | масс (обнаружение             | спиртом, грибами              |

|                                 |                                |                                    | грибы, колбасные и |                                 | возможны боли в       | возбудителя). Биопроба на |                                          |

|                                 |                                |                                    | рыбные изделия, в  |                                 | животе, рвота,           | белых мышах                     |                                          |

|                                 |                                |                                    | т.ч. рыбные             |                                 | диарея, затем           | (обнаружение                     |                                          |

|                                 |                                |                                    | консервы),              |                                 | метеоризм, запор.     | ботулянического токсина)   |                                          |

|                                 |                                |                                    | обсемененные        |                                 | Характерны               |                                           |                                          |

|                                 |                                |                                    | спорами                  |                                 | нечеткость зрения,    |                                           |                                          |

|                                 |                                |                                    | возбудителя и не    |                                 | диплопия, птоз,         |                                           |                                          |

|                                 |                                |                                    | подвергшиеся         |                                 | анизокория,               |                                           |                                          |

|                                 |                                |                                    | достаточной           |                                 | мидриаз, нарушения  |                                           |                                          |

|                                 |                                |                                    | термической           |                                 | глотания и речи,        |                                           |                                          |

|                                 |                                |                                    | обработке               |                                 | афония, парез           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | мягкого неба,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | одышка,                    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | брадикардия             |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Температура тела     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | нормальная или         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | субфебрильная,        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | сознание ясное         |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Бруцеллез (              | Бактерии —            | Мелкий и крупный       | Пути передачи —    | 1—3 недели, иногда | Начало обычно          | Исследование крови           | Брюшной тиф, паратифы   |

| Бруцеллёз)               | Brucella melitensis,  | рогатый скот,              | пищевой, бытовой,  | несколько месяцев   | подострое. Высокая  | (умеренная лейкопения,     | А и В, малярия, сепсис,     |

|                                 | Br. abortus, bovis     | значительно реже       | возможен —           |                                 | или субфебрильная   | относительный                   | ревматизм, ревматоидный |

|                                 | Br. suis                   | свиньи, верблюды,      | воздушно-пылевой. |                                 | температура тела,     | лейкоцитоз).                       | артрит, иерсиниоз,             |

|                                 |                                | собаки, кошки             | Заражение              |                                 | ознобы, обильная      | Бактериологическое           | псеадотуберкулез,             |

|                                 |                                |                                    | происходит через   |                                 | потливость,               | исследование крови,          | лихорадка Ку, орнитоз,      |

|                                 |                                |                                    | загрязненные          |                                 | полиаденит, боли в    | серологические методы      | инфекционный                   |

|                                 |                                |                                    | пищевые                 |                                 | суставах,                  | исследования: реакция       | мононуклеоз,                     |

|                                 |                                |                                    | продукты: сырое     |                                 | фиброзиты, артриты, | Райта, Хаддлсона,             | лептоспироз,                     |

|                                 |                                |                                    | молоко от больных  |                                 | бурситы, орхит,         | реакция пассивной             | лимфогранулематоз          |

|                                 |                                |                                    | бруцеллезом           |                                 | увеличение печени и | гемагглютинации, реакция  |                                          |

|                                 |                                |                                    | животных и             |                                 | селезенки.                 | Кумбса, внутрикожная        |                                          |

|                                 |                                |                                    | изготовленные из    |                                 | Интоксикация            | аллергическая проба          |                                          |

|                                 |                                |                                    | него молочные        |                                 | выражена слабо.       | Бюрне, реакция                  |                                          |

|                                 |                                |                                    | продукты (брынза),  |                                | Позже появляются    | связывания комплемента   |                                          |

|                                 |                                |                                    | недостаточно          |                                 | поражения                 |                                           |                                          |

|                                 |                                |                                    | термически             |                                 | периферической и     |                                           |                                          |

|                                 |                                |                                    | обработанное мясо |                                 | нейтральной нервной |                                           |                                          |

|                                 |                                |                                    | больных животных, |                                 | системы. Течение     |                                           |                                          |

|                                 |                                |                                    | овощи,                    |                                 | острое,                      |                                           |                                          |

|                                 |                                |                                    | загрязненные          |                                 | рецидивирующее и    |                                           |                                          |

|                                 |                                |                                    | выделениями          |                                 | хроническое              |                                           |                                          |

|                                 |                                |                                    | животных, а также  |                                 |                                  |                                           |                                          |

|                                 |                                |                                    | при уходе за           |                                 |                                  |                                           |                                          |

|                                 |                                |                                    | больными               |                                 |                                  |                                           |                                          |

|                                 |                                |                                    | животными, при      |                                 |                                  |                                           |                                          |

|                                 |                                |                                    | разделке их туш,    |                                 |                                  |                                           |                                          |

|                                 |                                |                                    | обработке кожи,      |                                 |                                  |                                           |                                          |

|                                 |                                |                                    | шерсти и др.           |                                 |                                  |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Брюшной тиф          | Бактерия —            | Человек — больной,    | Пути передачи —    | 3—21 день, в           | Начало чаще             | Исследование крови           | паратифы А и В,                |

|                                 | Salmonella typhi       | бактерионоситель       | пищевой, водный,   | среднем 10—14       | подострое.                | (лейкопения, нейтропения   | сальмонеллез, сыпной       |

|                                 |                                |                                    | бытовой.                 | дней                        | Отмечается высокая | со сдвигом влево,              | тиф и другие                     |

|                                 |                                |                                    | Заражение              |                                 | температура тела в   | относительный                   | риккетсиозы, сепсис,         |

|                                 |                                |                                    | происходит через   |                                 | течение 2—3             | лимфоцитоз,                      | бруцеллез, малярия,          |

|                                 |                                |                                    | загрязненные          |                                 | недель, лихорадка    | анэозинофилия). Посев      | трихинеллез, милиарный    |

|                                 |                                |                                    | пищевые                 |                                 | постоянного типа       | крови, мочи, кала. Реакция | туберкулез,                       |

|                                 |                                |                                    | продукты, воду,      |                                 | или ремиттирующая, | пассивной                          | лимфогранулематоз,         |

|                                 |                                |                                    | предметы обихода, |                                 | наблюдаются            | гемагглютинации                | грипп                                 |

|                                 |                                |                                    | грязные руки.          |                                 | головная боль,          | (положительна со 2-й          |                                          |

|                                 |                                |                                    | Фактором                |                                 | бессоница, потеря     | недели болезни)                 |                                          |

|                                 |                                |                                    | передачи                |                                 | аппетита, запор,        |                                           |                                          |

|                                 |                                |                                    | инфекции                |                                 | заторможенность,     |                                           |                                          |

|                                 |                                |                                    | являются также      |                                 | бред. Кожа бледная,  |                                          |                                          |

|                                 |                                |                                    | мухи                       |                                 | на 8—10-й день         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | болезни появляется   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | розеолезная сыпь.     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Язык обложен.           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Характерны               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | метеоризм,                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гепатолиенальный     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | синдром,                   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | относительная           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | брадикардия,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | артериальная            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гипотензия                |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Ветряная оспа         | Вирус —                 | Больной человек         | Путь передачи        | 11—21 день, чаще   | Начало острое.          | Вирусологические              | Стрептодермия,                 |

|                                 | Strongyloplasma      |                                    | воздушно-               | 13—17 дней             | Температура тела     | исследования (возможно    | строфулез, натуральная    |

|                                 | varicellae, из            |                                    | капельный,             |                                 | повышается от 37 до | выделение вируса из          | оспа                                  |

|                                 | семейства               |                                    | возможен                |                                 | 39°. Интоксикация не | элементов сыпи и крови)    |                                          |

|                                 | Herpesviridae           |                                    | трансплацентарный |                                 | характерна.               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Основной симптом    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | — сыпь на 1-й день   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | болезни. Новые ее     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | элементы                  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | появляются в            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | течение 3—4 дней.    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Локализация сыпи — |                                           |                                          |

|                                 |                                |                                    |                               |                                 | туловище, лицо,        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | волосистая часть      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | головы. Вначале        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | образуется пятно, в   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | течение нескольких   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | часов — папула,       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | затем везикула,         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | после вскрытия         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | которой — корки,       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | отпадающие на 2—   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | 3-й неделе.                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Характерен зуд.        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Возможны                 |                                           |                                          |

|                                 |                                |                                    |                               |                                 | высыпания на            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | слизистых оболочках |                                           |                                          |

|                                 |                                |                                    |                               |                                 | рта, половых             |                                           |                                          |

|                                 |                                |                                    |                               |                                 | органов,                    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | конъюнктивах            |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| ВИЧ-инфекция         | Вирус                     | Больной человек         | Передача вируса    | От 3 дней до            | Начало острое с        | Исследование крови           | Врожденные                      |

|                                 | иммунодефицита    |                                    | происходит при       | нескольких месяцев | повышения                | (лимфопения, анемия,        | иммунодефициты,             |

|                                 | человека (ВИЧ) из   |                                    | половых                  |                                 | температуры тела,    | тромбоцитопения,               | приобретенные                  |

|                                 | семейства               |                                    | сношениях, при       |                                 | полиаденита,             | гипергаммаглобулинемия).  | иммунодефициты в           |

|                                 | Retroviridae             |                                    | переливании крови, |                                 | увеличения               | Вирусологическое              | результате хронических    |

|                                 |                                |                                    | при грудном            |                                 | селезенки и печени,  | исследование (выделение  | интоксикаций (алкоголизм  |

|                                 |                                |                                    | вскармливании от   |                                 | диареи. В                  | вируса из крови).                | и др.), сахарного диабета, |

|                                 |                                |                                    | женщины ребенку   |                                 | дальнейшем              | Иммуноферментные           | применения                       |

|                                 |                                |                                    | и от ребенка           |                                 | периодически            | методы (обнаружение         | кортикостероидов,             |

|                                 |                                |                                    | женщине, во время |                                 | отмечается               | антител в крови). Метод     | цитостатиков,                    |

|                                 |                                |                                    | беременности и      |                                 | лихорадка, стойкая   | иммунного блоттинга.         | воздействия                      |

|                                 |                                |                                    | родов — от матери |                                 | полиаденопатия,       | Исследование показателей | ионизирующего излучения |

|                                 |                                |                                    | плоду,                    |                                 | развиваются             | клеточного иммунитета      |                                          |

|                                 |                                |                                    | медицинским          |                                 | подострый                 |                                           |                                          |

|                                 |                                |                                    | инструментом,        |                                 | энцефалит с              |                                           |                                          |

|                                 |                                |                                    | загрязненным         |                                 | деменцией,               |                                           |                                          |

|                                 |                                |                                    | инфицированной     |                                 | кандидоз слизистых  |                                           |                                          |

|                                 |                                |                                    | кровью                   |                                 | оболочек, простой и  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | опоясывающий          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | герпес, пиодермия.   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Характерны потеря    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | веса тела,                 |                                           |                                          |

|                                 |                                |                                    |                               |                                 | рецидивирующая      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | пневмония, саркома  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Калоши, другие         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | новообразования,      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | сепсис, другие          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гнойно-                      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | воспалительные        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | заболевания.             |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Течение                    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | прогрессирующее,    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | продолжительность   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | жизни от 1—11/2 лет у |                                           |                                          |

|                                 |                                |                                    |                               |                                 | детей до 5—8 лет у   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | взрослых                   |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Возвратный тиф       | Спирохета —          | Больной человек         | Путь передачи        | От 3 до 14 дней, в    | Начало внезапное.    | Исследование крови           | Малярия, лептоспироз,      |

| эпидемический        | Borrelia recurrentis   |                                    | трансмиссивный.    | среднем 7—8 дней   | Появляется озноб,     | (нейтрофильный                 | сыпной тиф, грипп,            |

| (вшиный)                  |                                |                                    | Переносчик             |                                 | температура тела      | лейкоцитоз, увеличение      | клещевой возвратный        |

|                                 |                                |                                    | возбудителя           |                                 | повышается до 39—  | СОЭ, анэозинофилия,        | тиф, геморрагические        |

|                                 |                                |                                    | платяная вошь        |                                 | 40°, наблюдаются     | тромбоцитопения). В          | лихорадки                         |

|                                 |                                |                                    | (заражение             |                                 | жар, головная боль,   | окрашенных мазках,           |                                          |

|                                 |                                |                                    | происходит при       |                                 | бессонница, рвота,    | толстой и висячей капле     |                                          |

|                                 |                                |                                    | втирании в кожу      |                                 | боли в мышцах, по    | крови, взятой во время       |                                          |

|                                 |                                |                                    | гемолимфы             |                                 | ходу нервов, в          | приступа, обнаруживают    |                                          |

|                                 |                                |                                    | раздавленных         |                                 | левом подреберье.    | возбудителя. Реакция        |                                          |

|                                 |                                |                                    | вшей)                      |                                 | Лицо                         | связывания комплемента   |                                          |

|                                 |                                |                                    |                               |                                 | гиперемировано,       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | склеры                      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | инъецированы,          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | субиктеричны.           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Характерны               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | тахикардия,               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | артериальная            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гипотензия. Язык       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | сухой, обложен.        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Печень и селезенка   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | увеличены                 |                                           |                                          |

|                                 |                                |                                    |                               |                                 | (селезенка плотная    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | болезненная).            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Сознание сохранено. |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Возможен                  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | менингеальный          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | синдром. Лихорадка  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | постоянного типа       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | длится 5—8 дней,     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | затем температура    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | критически падает.    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Безлихорадочный      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | период длится 7—14 |                                           |                                          |

|                                 |                                |                                    |                               |                                 | дней, затем               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | возникает повторный |                                           |                                          |

|                                 |                                |                                    |                               |                                 | менее                        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | продолжительный      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | приступ. Число          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | приступов от 1 до 5-  |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Возвратный тиф       | Borrelia sogdianum,  | Грызуны (крысы,         | Путь передачи —    | 5—20 дней               | На месте укуса         | Исследование крови           | См. Возвратный тиф          |

| эндемический          | В. duttonii, В.           | домовая мышь).          | трансмиссивный.    |                                 | клеща — первичный  | (гипохромная анемия,         | эпидемический                  |

| (клещевой)               | persica                    | Хищники,                    | Переносчики и        |                                 | аффект в виде          | лейкоцитоз, лимфоцитоз).   |                                          |

|                                 |                                | населяющие пустыни, | резервуары             |                                 | папулы с                   | В окрашенных мазках,        |                                          |

|                                 |                                | степи                          | возбудителя           |                                 | геморрагическим       | толстой и висящей капле    |                                          |

|                                 |                                |                                    | инфекции —           |                                 | венчиком. Начало      | крови, взятой во время       |                                          |

|                                 |                                |                                    | аргасовые клещи    |                                 | внезапное. Озноб,     | приступа и между              |                                          |

|                                 |                                |                                    | рода Alectorobius    |                                 | боли в мышцах,         | приступами,                       |                                          |

|                                 |                                |                                    |                               |                                 | головная боль,          | обнаруживают                    |                                          |

|                                 |                                |                                    |                               |                                 | рвота, понос, боли в  | возбудителя. Биопроба на  |                                          |

|                                 |                                |                                    |                               |                                 | животе, бессонница.  | мышах                               |                                          |

|                                 |                                |                                    |                               |                                 | Лицо                         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гиперемировано.       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Печень и селезенка   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | увеличены.                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Температура тела во |                                           |                                          |

|                                 |                                |                                    |                               |                                 | время приступа 39— |                                           |                                          |

|                                 |                                |                                    |                               |                                 | 40°,                           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | продолжительность   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | приступа 1—4 дня.    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Приступ                    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | заканчивается           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | критическим              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | падением                  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | температуры. Число  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | приступов 8—10 и     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | более, промежутки    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | между приступами    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | от 1 до 30 дней         |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Геморрагическая      | Вирус —                 | Грызуны (рыжая          | Путь передачи —    | 8—35 дней, чаще     | Начало острое, реже | Исследование крови           | Другие геморрагические    |

| лихорадка с             | Haemorrhagogenes   | полевка, большая        | воздушно-пылевой, | 21 день                    | наблюдается             | (лейкопения, затем             | лихорадки, лептоспироз,    |

| почечным                 | nephritidis из            | полевка, полевая и      | а также пищевой и  |                                 | продромальный         | лейкоцитоз, увеличение      | острый гломерулонефрит  |

| синдромом               | семейства               | лесная мышь и др.)     | при                         |                                 | период, температура | СОЭ, повышение уровня    |                                          |

|                                 | Bunyaviridae            |                                    | соприкосновении с  |                                 | тела повышается до  | мочевины и креатинина).    |                                          |

|                                 |                                |                                    | грызунами и их       |                                 | 38—40°. Озноб,         | Исследование мочи            |                                          |

|                                 |                                |                                    | испражнениями       |                                 | головная боль,          | (протеинурия, гиалиновые  |                                          |

|                                 |                                |                                    | (через                     |                                 | жажда, сухость во    | и зернистые цилиндры,       |                                          |

|                                 |                                |                                    | поврежденную        |                                 | рту. Гиперемия лица, | эритроциты). Реакция         |                                          |

|                                 |                                |                                    | кожу)                      |                                 | верхней части груди. | иммунофлюоресценции      |                                          |

|                                 |                                |                                    |                               |                                 | Гиперемия                 |                                           |                                          |

|                                 |                                |                                    |                               |                                 | слизистой оболочки   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | глотки. Склерит,        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | конъюнктивит. С 3—  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | 4-го дня на фоне       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | снижения                  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | температуры             |                                           |                                          |

|                                 |                                |                                    |                               |                                 | появляются боли в    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | пояснице, в животе,  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | жажда, икота,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | бледность, олигурия, |                                           |                                          |

|                                 |                                |                                    |                               |                                 | петехиальная сыпь    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | на туловище,             |                                           |                                          |

|                                 |                                |                                    |                               |                                 | кровоизлияния в        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | склеры, носовые       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | кровотечения,           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гематурия,                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | брадикардия,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | повышение АД. Язык |                                           |                                          |

|                                 |                                |                                    |                               |                                 | сухой, обложен.        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Печень увеличена.    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Заторможенность,     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | бессонница,              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | снижение зрения. С   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | 9—12-го дня —          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | полиурия,                  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | постепенное              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | улучшение                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | состояния                 |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Гепатит вирусный А | Вирусы из               | Человек — больной,    | Пути передачи —    | От 7 до 45 дней, в    | Начало острое.          | Исследование крови           | Острые респираторные      |

| (см. Гепатиты           | различных               | реконвалесцент и        | пищевой, водный,   | среднем 20—30       | Отмечаются              | (лейкопения, лимфоцитоз). | вирусные инфекции,          |

| вирусные)                | семейств                | вирусоноситель.         | бытовой.                 | дней                        | повышение                | Исследование мочи            | пищевые                           |

|                                 |                                | Вирус выделяется из  | Заражение              |                                 | температуры тела,    | (обнаружение уробилина,   | токсикоинфекции, другие   |

|                                 |                                | зараженного                | происходит через   |                                 | головная боль, боли  | желчных пигментов).          | вирусные гепатиты,           |

|                                 |                                | организма с                | загрязненные          |                                 | в мышцах, снижение  | Биохимические                  | лептоспироз, иерсиниоз,    |

|                                 |                                | фекалиями                  | пищевые                 |                                 | аппетита, тошнота,    | исследования (увеличение | псевдотуберкулез,             |

|                                 |                                |                                    | продукты, воду,      |                                 | рвота, отрыжка          | уровня связанного              | инфекционный                   |

|                                 |                                |                                    | предметы обихода, |                                 | горечью, тупые боли  | билирубина, активности     | мононуклеоз, желтая         |

|                                 |                                |                                    | грязные руки           |                                 | в правом                   | трансфераз, показателя     | лихорадка, сепсис,            |

|                                 |                                |                                    |                               |                                 | подреберье,              | тимоловой пробы).              | токсоплазмоз, синдром      |

|                                 |                                |                                    |                               |                                 | потемнение мочи,      | Иммунологические             | Жильбера,                         |

|                                 |                                |                                    |                               |                                 | гипохоличный кал,     | исследования                     | гемолитическая анемия,    |

|                                 |                                |                                    |                               |                                 | желтушность кожи и  | (обнаружение в крови         | токсические гепатиты,       |

|                                 |                                |                                    |                               |                                 | слизистых оболочек  | специфических антител      | желчнокаменная болезнь,  |

|                                 |                                |                                    |                               |                                 | на 5—7-й дни            | класса lgM, 4-кратное         | опухоли                             |

|                                 |                                |                                    |                               |                                 | болезни, увеличение  | нарастание в парных         | холедохопанкреатической  |

|                                 |                                |                                    |                               |                                 | печени, реже             | сыворотках антител            | области, альвеококкоз,      |

|                                 |                                |                                    |                               |                                 | селезенки.                 | класса lgG)                         | первичный рак печени,      |

|                                 |                                |                                    |                               |                                 | Брадикардия,            |                                           | хронический гепатит,         |

|                                 |                                |                                    |                               |                                 | артериальная            |                                           | цирроз печени                   |

|                                 |                                |                                    |                               |                                 | гипотензия                |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Гепатит вирусный В | То же                      | Человек — больной и  | Передача вируса    | От 30 до 180 дней,   | Начало постепенное. | Исследования крови,          | См. Вирусный гепатит А    |

|                                 |                                | вирусоноситель, у       | происходит             | в среднем 60—90     | Наблюдаются            | мочи, биохимические         |                                          |

|                                 |                                | которых вирус             | парентерально при  | дней                        | снижение аппетита,   | исследования (см.              |                                          |

|                                 |                                | находится в крови       | переливании крови  |                                 | тошнота, рвота,         | Вирусный гепатит А).         |                                          |

|                                 |                                |                                    | или ее препаратов,  |                                | непереносимость      | Специфические методы:    |                                          |

|                                 |                                |                                    | при использовании  |                                 | жирной пищи,            | обнаружение в крови          |                                          |

|                                 |                                |                                    | недостаточно          |                                 | изжога, отрыжка,       | вирусных антигенов —       |                                          |

|                                 |                                |                                    | стерилизованного   |                                 | тяжесть и тупые        | HBsAg и HBeAg и антител  |                                          |

|                                 |                                |                                    | инфицированного    |                                 | боли в эпигастрии и   | анти-HBs, анти-НВе, анти-  |                                          |

|                                 |                                |                                    | вирусом                  |                                 | в правом                   | НВс                                    |                                          |

|                                 |                                |                                    | медицинского         |                                 | подреберье, боли в   |                                           |                                          |

|                                 |                                |                                    | инструментария      |                                 | суставах. Через 2—  |                                           |                                          |

|                                 |                                |                                    | (шприцев, игл,         |                                 | 3 нед. темнеет моча, |                                           |                                          |

|                                 |                                |                                    | хирургических и      |                                 | обесцвечивается       |                                           |                                          |

|                                 |                                |                                    | стоматологических  |                                | кал, появляется         |                                           |                                          |

|                                 |                                |                                    | инструментов);       |                                 | желтуха на фоне       |                                           |                                          |

|                                 |                                |                                    | половым путем, в   |                                 | нарастания                |                                           |                                          |

|                                 |                                |                                    | процессе родов,     |                                 | диспептических         |                                           |                                          |

|                                 |                                |                                    | возможно                |                                 | расстройств,             |                                           |                                          |

|                                 |                                |                                    | заражение плода в  |                                 | слабости, головной    |                                           |                                          |

|                                 |                                |                                    | III триместре           |                                 | боли, нарушение       |                                           |                                          |

|                                 |                                |                                    | беременности (так  |                                 | сна. Затем желтуха   |                                           |                                          |

|                                 |                                |                                    | называемая            |                                 | становится                |                                           |                                          |

|                                 |                                |                                    | вертикальная          |                                 | интенсивной. Печень |                                           |                                          |

|                                 |                                |                                    | передача)               |                                 | увеличена. В             |                                           |                                          |

|                                 |                                |                                    |                               |                                 | тяжелых случаях       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | печень уменьшается |                                           |                                          |

|                                 |                                |                                    |                               |                                 | в размерах,               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | развиваются             |                                           |                                          |

|                                 |                                |                                    |                               |                                 | бессонница,              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | анорексия,                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | тахикардия,               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | кровоточивость,        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | тремор, больной        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | возбужден, сознание |                                           |                                          |

|                                 |                                |                                    |                               |                                 | спутанное, кома        |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Гепатит вирусный    | То же                      | Человек — больной и  | Парентерально       | 50—75 дней             | Клинически сходен с | Исследования крови,          | См. Вирусный гепатит А    |

| ни А ни В с              |                                | вирусоноситель          | (см. Гепатит            |                                 | вирусным гепатитом  | мочи, биохимические         |                                          |

| парентеральным      |                                |                                    | вирусный В)            |                                 | В                               | исследования (см.              |                                          |

| механизмом             |                                |                                    |                               |                                 |                                  | Вирусный гепатит А).         |                                          |

| передачи                 |                                |                                    |                               |                                 |                                  | Специфические методы     |                                          |

| возбудителя             |                                |                                    |                               |                                 |                                  | диагностики не                   |                                          |

|                                 |                                |                                    |                               |                                 |                                  | разработаны                       |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Гепатит вирусный    | То же                      | Человек — больной и  | Путь передачи —    | 30—40 дней             | Клинически сходен с | Исследования крови,          | См. Вирусный гепатит А    |

| ни А ни В с              |                                | вирусоноситель          | пищевой, водный,   |                                 | вирусным гепатитом  | мочи, биохимические         |                                          |

| фекально-оральным |                                |                                    | бытовой (см.           |                                 | А, но протекает         | исследования (см.              |                                          |

| механизмом             |                                |                                    | Гепатит вирусный   |                                 | более тяжело            | Вирусный гепатит А).         |                                          |

| передачи                 |                                |                                    | А)                           |                                 |                                  | Специфические методы     |                                          |

| возбудителя             |                                |                                    |                               |                                 |                                  | диагностики не                   |                                          |

|                                 |                                |                                    |                               |                                 |                                  | разработаны                       |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Грипп                       | Вирусы гриппа,       | Больной человек         | Путь передачи —    | От 12 часов до 3      | Начало острое.          | Исследование крови           | Острые респираторные      |

|                                 | подразделяющиеся |                                    | преимущественно   | дней, чаще 1—2       | Появляются              | (лейкопения и                     | вирусные инфекции,          |

|                                 | на серологические  |                                    | воздушно-               | дня                          | головная боль, боли  | лимфоцитоз). Реакция        | сыпной тиф и другие         |

|                                 | типы А, В, С и         |                                    | капельный, а также |                                 | в мышцах, суставах, | прямой                               | риккетсиозы, брюшной       |

|                                 | подтипы А1 и А2 из   |                                    | бытовой через        |                                 | познабливание.         | иммунофлюоресценции      | тиф, бруцеллез, орнитоз,   |

|                                 | семейства               |                                    | предметы обихода  |                                 | Температура тела     | (обнаружение антигена в    | легионеллез,                      |

|                                 | Orthomyxoviridae     |                                    | (полотенца,             |                                 | повышается до 38—  | слизи из носа и зева).         | инфекционный                   |

|                                 |                                |                                    | носовые платки,      |                                 | 40°, длительность     | Реакция непрямой              | мононуклеоз,                     |

|                                 |                                |                                    | посуду и др.),         |                                 | лихорадки 3—6         | иммунофлюоресценции      | геморрагические                |

|                                 |                                |                                    | загрязненные          |                                 | дней. Отмечаются     | (обнаружение антител в      | лихорадки лептоспироз,     |

|                                 |                                |                                    | выделениями          |                                 | сухой кашель,           | слизи из носа и зева).         | вирусный гепатит А           |

|                                 |                                |                                    | больного                 |                                 | першение в горле,     | Реакция торможения          | (преджелтушный период),  |

|                                 |                                |                                    |                               |                                 | саднение за              | гемагглютинации и             | менингит, энцефалит,        |

|                                 |                                |                                    |                               |                                 | грудиной,                  | реакция связывания           | пневмония, туберкулез      |

|                                 |                                |                                    |                               |                                 | заложенность носа,   | комплемента в парных       |                                          |

|                                 |                                |                                    |                               |                                 | затем слизисто-         | сыворотках используются  |                                          |

|                                 |                                |                                    |                               |                                 | гнойные выделения   | для ретроспективной          |                                          |

|                                 |                                |                                    |                               |                                 | из носа. Гиперемия   | диагностики                       |                                          |

|                                 |                                |                                    |                               |                                 | лица, инъекция          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | конъюнктив,              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гиперемия слизистой |                                           |                                          |

|                                 |                                |                                    |                               |                                 | оболочки носоглотки, |                                           |                                          |

|                                 |                                |                                    |                               |                                 | зернистость мягкого  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | и твердого неба,        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | относительная           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | брадикардия,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | артериальная            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гипотензия                |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Денге                       | Вирусы из               | Больной человек         | Путь передачи —    | При классической    | Начало внезапное.    | Исследование крови           | Малярия, корь,                  |

|                                 | семейства               |                                    | трансмиссивный.    | лихорадке денге      | Появляется сильный  | (лейкоцитоз, затем             | скарлатина,                       |

|                                 | Togaviridae              |                                    | Переносчики           | 3—15 дней. При       | озноб, температура   | лейкопения,                        | менингококковая                |

|                                 |                                |                                    | возбудителей —     | геморрагической      | тела быстро              | относительный                   | инфекция, желтая              |

|                                 |                                |                                    | комары рода Aedes | лихорадке денге —  | повышается до 40—  | лимфоцитоз,                      | лихорадка,                        |

|                                 |                                |                                    | (Aedes aegypti)        | 4—10 дней               | 41°, форма                | тромбоцитопения).              | геморрагические                |

|                                 |                                |                                    |                               |                                 | температурной          | Выделение вируса из         | лихорадки, флеботомная   |

|                                 |                                |                                    |                               |                                 | кривой двугорбая.     | крови. Реакция                   | лихорадка                         |

|                                 |                                |                                    |                               |                                 | Отмечаются              | связывания комплемента,  |                                          |

|                                 |                                |                                    |                               |                                 | головная боль, боли  | реакция торможения           |                                          |

|                                 |                                |                                    |                               |                                 | в глазных яблоках,    | гемагглютинации, реакция  |                                          |

|                                 |                                |                                    |                               |                                 | мышцах, суставах,    | нейтрализации в парных     |                                          |

|                                 |                                |                                    |                               |                                 | рвота,                       | сыворотках                        |                                          |

|                                 |                                |                                    |                               |                                 | головокружение,        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | бред, боли в животе. |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Лицо «пылающее»,    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | сосуды склер и         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | конъюнктив               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | инъецированы,          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | наблюдаются            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | светобоязнь,             |                                           |                                          |

|                                 |                                |                                    |                               |                                 | пятнисто-папулезная |                                           |                                          |

|                                 |                                |                                    |                               |                                 | или мелкоточечная    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | сыпь, повышенная     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | кровоточивость.        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Периферические       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | лимфатические узлы |                                           |                                          |

|                                 |                                |                                    |                               |                                 | увеличены и              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | болезненны               |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Дизентерия              | Бактерии рода        | Человек — больной,    | Пути передачи —    | От нескольких          | Начало острое.          | Выделение возбудителя из | Амебиаз, пищевые            |

|                                 | Shigella — S.           | бактерионоситель       | пищевой, водный,   | часов до 7 суток,     | Появляются              | фекалий. Копрологическое | токсикоинфекции,              |

|                                 | dysenteriae, S.         | (выделитель)               | бытовой,                 | чаще 2—3 дня         | схваткообразные       | исследование (лейкоциты   | сальмонеллез, холера,      |

|                                 | flexneri, S. boydii,    |                                    | заражение              |                                 | боли в левой             | и эритроциты).                    | неспецифический              |

|                                 | S. sonnei                 |                                    | происходит через   |                                 | подвздошной             | Ректороманоскопия            | язвенный колит, рак           |

|                                 |                                |                                    | загрязненные          |                                 | области, тенезмы,     | (катаральный, катарально-  | дистального отдела           |

|                                 |                                |                                    | пищевые                 |                                 | ложные позывы.        | геморрагический,               | толстой кишки                   |

|                                 |                                |                                    | продукты, воду,      |                                 | Стул скудный,           | эрозивный, язвенный          |                                          |

|                                 |                                |                                    | предметы обихода, |                                 | слизисто-                  | проктосигмоидит,               |                                          |

|                                 |                                |                                    | а также грязные      |                                 | кровянистый.             | сфинктерит).                      |                                          |

|                                 |                                |                                    | руки, возможна       |                                 | Температура тела     | Дополнительные методы:   |                                          |

|                                 |                                |                                    | передача                |                                 | повышена.                 | реакция непрямой              |                                          |

|                                 |                                |                                    | возбудителя           |                                 | Отмечаются              | гемагглютинации,               |                                          |

|                                 |                                |                                    | мухами                   |                                 | головная боль,          | внутрикожная                     |                                          |

|                                 |                                |                                    |                               |                                 | головокружение,        | аллергическая проба с       |                                          |

|                                 |                                |                                    |                               |                                 | слабость. Язык          | дизентерином                     |                                          |

|                                 |                                |                                    |                               |                                 | обложен.                   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Сигмовидная кишка   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | спазмирована,           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | болезненна при         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | пальпации                 |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Дифтерия                | Бактерия —            | Человек— больной,     | Путь передачи —    | От нескольких          | При дифтерии           | Исследование крови           | Стрептококковая,               |

|                                 | Corynebacterium      | реконвалесцент,          | воздушно-               | часов до 12 дней,    | ротоглотки начало в  | (умеренный                        | стафилококковая ангины,  |

|                                 | diphtheriae               | здоровый носитель     | капельный              | чаще 2—7 дней        | легких случаях          | нейтрофильный                  | ангина Симановского —     |

|                                 |                                |                                    | Заражение может   |                                 | постепенное, в          | лейкоцитоз). Выделение     | Плаута — Венсана,           |

|                                 |                                |                                    | произойти также     |                                 | тяжелых — острое.   | культуры возбудителя из    | инфекционный                   |

|                                 |                                |                                    | через предметы      |                                 | Температура тела     | слизи зева и носа с            | мононуклеоз,                     |

|                                 |                                |                                    | обихода (белье,      |                                 | 38—40°, отмечаются | обязательным                     | ларинготрахеобронхиты     |

|                                 |                                |                                    | полотенца,              |                                 | умеренные боли при  | определением                    | при острых                        |

|                                 |                                |                                    | носовые платки,      |                                 | глотании. Небные      | токсигенности                    | респираторных вирусных   |

|                                 |                                |                                    | игрушки, посуду)    |                                 | миндалины отечны,   |                                           | инфекциях                         |

|                                 |                                |                                    |                               |                                 | слабо                        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гиперемированы, с    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | серовато-белыми       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | островчатыми или     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | распространенными  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | налетами, которые    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | могут переходить на  |                                          |                                          |

|                                 |                                |                                    |                               |                                 | мягкое и твердое       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | небо; снимаются с    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | трудом, при этом      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | ткань миндалин         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | кровоточит. В            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | тяжелых случаях —  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | отек клетчатки шеи,   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | тахикардия или         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | брадикардия,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | аритмия, парез          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | мягкого неба,            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | полиневрит,               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | токсический нефроз. |                                           |                                          |

|                                 |                                |                                    |                               |                                 | При дифтерии           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гортани —                 |                                           |                                          |

|                                 |                                |                                    |                               |                                 | интоксикация слабо   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | выражена. Сухой       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | «лающий» кашель,    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | затрудненное            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | шумною дыхание,     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | афония. При              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | дифтерии носа —      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | сукровичное              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | отделяемое из носа.  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | на носовой                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | перегородке —          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | серые пленчатые       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | налеты,                     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | интоксикация не        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | выражена                  |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Желтая лихорадка (  | Вирус — Flavivinis  | При эндемическом      | Путь передачи —    | 3—6 дней, иногда    | Начало внезапное.    | Исследование крови           | Геморрагические               |

| Жёлтая лихорадка)  | febris из семейства  | типе желтой                | трансмиссивный.    | до 10 дней               | Появляются озноб,    | (лейкопения, затем             | лихорадки, вирусные         |

|                                 | Togaviridae              | лихорадки —               | Переносчики           |                                 | интенсивная              | лейкоцитоз).                       | гепатиты, лептоспироз,      |

|                                 |                                | обезьяны, возможно,   | возбудителей при   |                                 | головная боль, боли  | Исследование мочи            | малярия, денге                  |

|                                 |                                | грызуны; при               | эндемическом типе |                                 | в мышцах, тошнота,  | (эритроциты, белок).           |                                          |

|                                 |                                | эпидемическом типе   | лихорадки —          |                                 | рвота, боли в             | Биохимические                  |                                          |

|                                 |                                | — человек                  | комары рода Aides  |                                 | пояснице;                  | исследования (повышение  |                                          |

|                                 |                                |                                    | и Haemagogus; при  |                                | температура тела      | уровня билирубина и          |                                          |

|                                 |                                |                                    | эпидемическом       |                                 | повышается до 39—  | активности трансфераз).    |                                          |

|                                 |                                |                                    | типе — комары       |                                 | 41°. Лицо                   | Выделение вируса из         |                                          |

|                                 |                                |                                    | рода Aedes             |                                 | одутловатое,             | крови. Реакция                   |                                          |

|                                 |                                |                                    |                               |                                 | гиперемировано.       | связывания комплемента,  |                                          |

|                                 |                                |                                    |                               |                                 | Кроме того,               | реакция непрямой              |                                          |

|                                 |                                |                                    |                               |                                 | наблюдаются            | иммунофлюоресценции,     |                                          |

|                                 |                                |                                    |                               |                                 | гиперемия шеи,         | реакция торможения           |                                          |

|                                 |                                |                                    |                               |                                 | грудной клетки,         | гемагглютинации                |                                          |

|                                 |                                |                                    |                               |                                 | инъекция сосудов     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | склер и конъюнктив,  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | слезотечение, бред,  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | тахи- и брадикардия, |                                           |                                          |

|                                 |                                |                                    |                               |                                 | артериальная            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гипотензия, печень    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | увеличена. После      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | ремиссии возможны  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | желтуха, геморрагии  |                                          |                                          |

|                                 |                                |                                    |                               |                                 | на коже,                    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | кровотечения,           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | олигурия, азотемия,  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | печеночно-почечная  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | недостаточность       |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Иерсиниоз                | Бактерия —            | Свинья, корова,          | Пути передачи —    | От 15 часов до 15    | Начало острое,          | Исследование крови           | Дизентерия,                       |

|                                 | Versinia                   | собака, кошка,            | пищевой, водный,   | суток                       | температура тела      | (нейрофильный                  | сальмонеллез, пищевые    |

|                                 | enterocolitica           | грызуны (мыши,          | бытовой;                 |                                 | повышается до          | лейкоцитоз, эозинофилия,  | токсикоинфекции,              |

|                                 |                                | крысы) и др., а также  | заражение              |                                 | 37,5—40°.                  | увеличение СОЭ).              | аппендицит, сепсис,          |

|                                 |                                | человек — больной и  | происходит через    |                                 | Отмечаются боли в   | Выделение возбудителя из | вирусные гепатиты,           |

|                                 |                                | бактерионоситель       | пищевые                 |                                 | животе различной      | крови, лимфатических        | ревматизм, полиартриты,   |

|                                 |                                |                                    | продукты, воду,      |                                 | локализации, жидкий | узлов, мочи, кала. Реакция | брюшной тиф, паратифы   |

|                                 |                                |                                    | предметы обихода; |                                 | стул с примесью       | агглютинации, реакция       | А и В, бруцеллез               |

|                                 |                                |                                    | факторами              |                                 | слизи, рвота. Сыпь    | пассивной                          |                                          |

|                                 |                                |                                    | передачи могут       |                                 | появляется чаще на  | гемагглютинации в парных  |                                          |

|                                 |                                |                                    | быть также             |                                 | дистальных отделах  | сыворотках                        |                                          |

|                                 |                                |                                    | грязные руки           |                                 | конечностей.             | (диагностический титр не   |                                          |

|                                 |                                |                                    |                               |                                 | Наблюдаются            | менее 1: 400)                      |                                          |

|                                 |                                |                                    |                               |                                 | полиартрит,               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | полиаденит, гепатит. |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Возможно                  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | волнообразное          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | затяжное и                |                                           |                                          |

|                                 |                                |                                    |                               |                                 | хроническое течение |                                           |                                          |

|                                 |                                |                                    |                               |                                 | болезни                     |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Кампилобактериоз    | Бактерии —            | Домашние и дикие      | Пути передачи —    | От 1 до 6 дней,        | Начало острое.          | Исследование крови           | Дизентерия,                       |

|                                 | Campylobacter         | животные, крупный и   | пищевой, водный,   | чаще 1—2 дня         | Появляются              | (возможен нейтрофильный | сальмонеллез, пищевые    |

|                                 | jejuni, C. coli            | мелкий рогатый скот,  | бытовой                  |                                 | коликообразные боли | лейкоцитоз). Выделение     | токсикоинфекции, сепсис  |

|                                 |                                | свиньи, домашние       |                               |                                 | в животе, стул           | культуры возбудителя из    |                                          |

|                                 |                                | птицы, кролики,           |                               |                                 | частый калового        | фекалий, реакция               |                                          |

|                                 |                                | собаки, кошки,            |                               |                                 | характера со слизью | микрогемагглютинации,      |                                          |

|                                 |                                | грызуны, зайцы,          |                               |                                 | и кровью. Возможно  | реакция связывания           |                                          |

|                                 |                                | кабаны, некоторые      |                               |                                 | обезвоживание. В      | комплемента, реакция        |                                          |

|                                 |                                | птицы, реже —            |                               |                                 | тяжелых случаях —  | пассивной                          |                                          |

|                                 |                                | человек — больной,    |                               |                                 | лихорадка, озноб,      | гемагглютинации                |                                          |

|                                 |                                | носитель                     |                               |                                 | головная боль, боли  |                                           |                                          |

|                                 |                                | возбуяителей              |                               |                                 | в пояснице,               |                                           |                                          |

|                                 |                                |                                    |                               |                                 | менингизм, почечная |                                           |                                          |

|                                 |                                |                                    |                               |                                 | недостаточность,      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | сепсис                      |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Коклюш                    | Бактерия —            | Больной человек         | Путь передачи —    | От 3 до 15 дней,      | Начало постепенное  | Исследование крови           | Грипп, острые                    |

|                                 | Bordetella pertussis  |                                    | воздушно-               | чаще 5—8 дней        | с легких                    | (высокий лимфоцитарный   | респираторные вирусные   |

|                                 |                                |                                    | капельный              |                                 | катаральных              | лейкоцитоз). Выделение     | инфекции, бронхит,           |

|                                 |                                |                                    |                               |                                 | явлений, затем          | возбудителя из                   | бронхаденит, паракоклюш  |

|                                 |                                |                                    |                               |                                 | появляется                | носоглоточной слизи.         |                                          |

|                                 |                                |                                    |                               |                                 | приступообразный     | Реакции агглютинации,       |                                          |

|                                 |                                |                                    |                               |                                 | кашель, особенно      | связывания комплемента,  |                                          |

|                                 |                                |                                    |                               |                                 | ночью. Приступы       | пассивной                          |                                          |

|                                 |                                |                                    |                               |                                 | сопровождаются       | гемагглютинации                |                                          |

|                                 |                                |                                    |                               |                                 | гиперемией и             | используются для              |                                          |

|                                 |                                |                                    |                               |                                 | цианозом лица,          | ретроспективной                |                                          |

|                                 |                                |                                    |                               |                                 | рвотой, дыхание        | диагностики                       |                                          |

|                                 |                                |                                    |                               |                                 | свистящее. Приступ  |                                           |                                          |

|                                 |                                |                                    |                               |                                 | заканчивается после |                                           |                                          |

|                                 |                                |                                    |                               |                                 | отхождения вязкой    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | слизистой мокроты.   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Температура тела     |                                           |                                          |

|                                 |                                |                                    |                               |                                 | нормальная и            |                                           |                                          |

|                                 |                                |                                    |                               |                                 | субфебрильная.        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Общая                      |                                           |                                          |

|                                 |                                |                                    |                               |                                 | продолжительность   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | болезни обычно         |                                           |                                          |

|                                 |                                |                                    |                               |                                 | 1,5—2 мес.                |                                           |                                          |

|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Корь                        | Вирус из                 | Больной человек в      | Путь передачи —    | От 8 до 17, чаще 10 | Начало острое.          | Исследование крови           | Острая респираторная       |

|                                 | семейства               | последние 1—2 дня    | воздушно-               | дней (до 21 дня у     | Появляются кашель,  | (умеренный лейкоцитоз,     | вирусная инфекция,          |

|                                 | Puunyxoviridae        | инкубационного           | капельный, а также | лиц, получавших      | насморк,                   | который сменяется             | краснуха, энтеровирусная |

|                                 |                                | периода и 3—5 дней   | трансплацентарный | гамма-глобулин)       | конъюнктивит,           | лейкопенией). Реакция       | инфекция, токсико-            |

|                                 |                                | после появления сыпи |                               |                                 | недомогание,            | пассивной                          | аллергический дерматит    |

|                                 |                                |                                    |                               |                                 | головная боль,          | гемагглютинации и             |                                          |

|                                 |                                |                                    |                               |                                 | температура тела      | торможения                        |                                          |

|                                 |                                |                                    |                               |                                 | повышается до 38—  | гемагглютинации                |                                          |

|                                 |                                |                                    |                               |                                 | 39°. Лицо                   | (определение                     |                                          |

|                                 |                                |                                    |                               |                                 | одутловатое, склеры | специфических антител)     |                                          |

|                                 |                                |                                    |                               |                                 | и конъюнктива           |                                           |                                          |

|                                 |                                |                                    |                               |                                 | гиперемированы,       |                                           |                                          |

|                                 |                                |                                    |                               |                                 | светобоязнь. На        |                                           |                                          |

|                                 |                                |                                    |                               |                                 | слизистой оболочке   |                                           |                                          |

|                                 |                                |                                    |                               |                                 | щек и десен —          |                                           |                                          |

|                                 |                                |                                    |                               |                                 | пятна Вольского —    |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Филатова —              |                                           |                                          |

|                                 |                                |                                    |                               |                                 | Коплика, на мягком и |                                           |                                          |

|                                 |                                |                                    |                               |                                 | твердом небе —        |                            &n