Инфекционные болезни


Инфекционные болезни
(позднелат. infectio заражение)
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                        |                                                  |
|-------------------------------------------------------------------------------------------------------------------------------------------|
| 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/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 Аи Аиз   |                                    | 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 —        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | энантема. На 4—5-й  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | день на фоне            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | усиления                   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | интоксикации,            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | катаральных              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | явлений и лихорадки |                                           |                                          |
|                                 |                                |                                    |                               |                                 | появляется                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | пятнисто-папулезная |                                           |                                          |
|                                 |                                |                                    |                               |                                 | сыпь на лице, затем  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | на туловище и           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конечностях              |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Краснуха                 | Вирус из                 | Человек — больной,    | Путь передачи —    | От 15 до 24 дней,     | Начало острое.          | Исследования крови           | Корь, энтеровирусная        |
|                                 | семейства               | вирусоноситель          | воздушно-               | чаще 16—18 дней    | Температура тела     | (лейкопения, лимфоцитоз,  | инфекция, лекарственные  |
|                                 | Togavindae              |                                    | капельный, а также |                                 | субфебрильная,        | моноцитоз). Определение   | сыпи                                  |
|                                 |                                |                                    | трансплацентарный |                                 | интоксикация слабо   | титра вирус-                       |                                          |
|                                 |                                |                                    |                               |                                 | выражена. На 1—2-й  | нейтрализующих антител в |                                          |
|                                 |                                |                                    |                               |                                 | день болезни             | парных сыворотках,           |                                          |
|                                 |                                |                                    |                               |                                 | появляется розовая,  | взятых с интервалом 7—    |                                          |
|                                 |                                |                                    |                               |                                 | пятнистая, пятнисто- | 10 дней при нарастании      |                                          |
|                                 |                                |                                    |                               |                                 | папулезная сыпь       | титра в 4 и более раз          |                                          |
|                                 |                                |                                    |                               |                                 | одновременно на       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | всем теле или на       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лице и туловище. На  |                                          |                                          |
|                                 |                                |                                    |                               |                                 | следующий день       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | сыпь появляется на   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конечностях.             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Преимущественная   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | локализация сыпи на |                                           |                                          |
|                                 |                                |                                    |                               |                                 | разгибательной         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | поверхности              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конечностей, вокруг  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | суставов, на спине,   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | ягодицах.                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Одновременно с        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | сыпью или за 1—2     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | дня до нее                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | отмечаются               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | катаральные              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | явления,                    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | обнаруживается        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | энантема на небе.     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Лимфатические         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | узлы, особенно          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | затылочные и            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | латеральные             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | шейные, увеличены   |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Крымская                 | Вирус — CHF-vinia  | Коровы, козы, дикие    | Путь передачи —    | 2—14 дней, чаще     | Начало острое.          | Исследование крови           | Лептоспироз, сыпной тиф, |
| геморрагическая      | из семейства          | млекопитающие          | трансмиссивный.    | 3—5 дней                 | Появляется озноб.     | (вначале — лейкопения,     | сепсис, другие                  |
| лихорадка                | Bunyaviridae            |                                    | Переносчики           |                                 | Температура тела     | эритроцитоз, уменьшение   | геморрагические                |
|                                 |                                |                                    | возбудителей —     |                                 | повышается до 39—  | СОЭ, позже — анемия,       | лихорадки,                        |
|                                 |                                |                                    | клещи Hyalomma    |                                 | 40°, длительность     | нарастание лейкопении,     | геморрагический                |
|                                 |                                |                                    | margioatum.            |                                 | лихорадки 12 дней.   | тромбоцитопения).              | васкулит,                           |
|                                 |                                |                                    | Возможна               |                                 | Появляются резкая   | Выделение вируса.            | тромбоцитопеническая      |
|                                 |                                |                                    | передача вируса     |                                 | головная боль,          | Реакции связывания           | пурпура, острый лейкоз     |
|                                 |                                |                                    | при попадают         |                                 | сонливость, боли в    | комплемента и пассивной   |                                          |
|                                 |                                |                                    | крови больных на    |                                 | мышцах и суставах,  | гемагглютинации, реакции  |                                          |
|                                 |                                |                                    | слизистые               |                                 | тошнота, рвота, боли | диффузной преципитации  |                                          |
|                                 |                                |                                    | оболочки глаз,        |                                 | в животе, пояснице.  | в агаре и                            |                                          |
|                                 |                                |                                    | носоглотки и           |                                 | Лицо, верхняя часть  | иммунофлюоресценции      |                                          |
|                                 |                                |                                    | поврежденную        |                                 | туловища,                 |                                           |                                          |
|                                 |                                |                                    | кожу                       |                                 | конъюнктивы,            |                                           |                                          |
|                                 |                                |                                    | соприкасавшихся с |                                 | склеры                      |                                           |                                          |
|                                 |                                |                                    | больными людей     |                                 | гиперемированы.       |                                           |                                          |
|                                 |                                |                                    | (чаще                     |                                 | Печень увеличена.    |                                           |                                          |
|                                 |                                |                                    | медперсонала)        |                                 | На туловище и          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конечностях имеется |                                           |                                          |
|                                 |                                |                                    |                               |                                 | геморрагическая       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | сыпь. Наблюдаются  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кровоизлияния в        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | слизистые оболочки  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | и их кровоточивость, |                                           |                                          |
|                                 |                                |                                    |                               |                                 | носовые, маточные,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | желудочные и           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | другие кровотечения |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Ку-лихорадка           | Риккетсия —           | Крупный и мелкий       | Пути передачи —    | От 3 до 32 дней,      | Начало острое.          | Исследование крови (чаще | Грипп, сыпной тиф,           |
|                                 | Coxiella burnetil        | рогатый скот, лошади, | пищевой (через       | чаще — 12—19        | Появляются озноб,    | лейко- и нейтропения,         | брюшной тиф, бруцеллез,  |
|                                 |                                | свиньи, собаки,           | загрязненные          | дней                        | головная боль, боли  | относительный                   | орнитоз, лептоспироз,        |
|                                 |                                | птицы, грызуны.          | молоко и молочные |                                 | в мышцах и               | лимфоцитоз, увеличение    | туляремия, сепсис             |
|                                 |                                | Исключительно редко  | продукты);              |                                 | суставах,                  | СОЭ). Рентгенологически   |                                          |
|                                 |                                | человек                       | воздушно-пылевой  |                                 | температура тела      | — пневмония. Реакция       |                                          |
|                                 |                                |                                    | (вдыхание               |                                 | повышается до 39—  | связывания комплемента,  |                                          |
|                                 |                                |                                    | зараженной пыли    |                                 | 40°. Лихорадка          | реакция нейтрализации,      |                                          |
|                                 |                                |                                    | при работе с           |                                 | постоянного и            | реакция непрямой              |                                          |
|                                 |                                |                                    | шерстью, мехом),   |                                 | ремиттирующего       | иммунофлюоресценции,     |                                          |
|                                 |                                |                                    | а также при уходе   |                                 | типа от 3 дней до 2   | кожная аллергическая        |                                          |
|                                 |                                |                                    | за больными           |                                 | недель в                   | проба                                 |                                          |
|                                 |                                |                                    | животными, при их  |                                 | зависимости от         |                                           |                                          |
|                                 |                                |                                    | убое и разделке      |                                 | тяжести болезни.       |                                           |                                          |
|                                 |                                |                                    | туш;                        |                                 | Сухой кашель,           |                                           |                                          |
|                                 |                                |                                    | трансмиссивный — |                                 | потливость. Лицо      |                                           |                                          |
|                                 |                                |                                    | иксодовыми,           |                                 | гиперемировано,       |                                           |                                          |
|                                 |                                |                                    | аргасовыми и          |                                 | отмечаются               |                                           |                                          |
|                                 |                                |                                    | гамазовыми            |                                 | инъекция склер,        |                                           |                                          |
|                                 |                                |                                    | клещами. От           |                                 | гиперемия зева,        |                                           |                                          |
|                                 |                                |                                    | человека с              |                                 | гепатолиенальный     |                                           |                                          |
|                                 |                                |                                    | мокротой и              |                                 | синдром. Часто         |                                           |                                          |
|                                 |                                |                                    | молоком кормящей |                                 | пневмония и              |                                           |                                          |
|                                 |                                |                                    | женщины                |                                 | трахеобронхит           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможно затяжное   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | и хроническое           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | течение болезни        |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Лайма болезнь         | Спирохета —          | Мышевидные грызуны | Путь передачи —    | От 2 до 31 дня         | Начало острое.          | Исследование                    | Рожа, дерматит,                |
|                                 | Borrelia Burdorferi     | (мыши, полевки,          | трансмиссивный.    |                                 | Отмечаются              | цереброспинальной            | вирусные менингиты,         |
|                                 |                                | хомяки и др.), олени,   | Переносчики           |                                 | лихорадка, миалгия,  | жидкости (при поражении   | клещевой и другие            |
|                                 |                                | лоси, крупный             | возбудителей —     |                                 | артралгия. В месте    | ц.н.с. лимфоцитарный        | энцефалиты,                     |
|                                 |                                | рогатый скот, собаки   | иксодовые клещи    |                                 | укуса клеща              | плеоцитоз, повышение        | ревматоидный и другие     |
|                                 |                                |                                    | (lxodes ricinus, I.      |                                 | появляется эритема  | содержания белка,             | артриты                             |
|                                 |                                |                                    | persulcatus)             |                                 | кольцевидной            | выделение культуры          |                                          |
|                                 |                                |                                    |                               |                                 | формы,                     | возбудителя). Реакция       |                                          |
|                                 |                                |                                    |                               |                                 | увеличивающаяся     | непрямой                           |                                          |
|                                 |                                |                                    |                               |                                 | до 20 см и более в    | иммунофлюоресценции.     |                                          |
|                                 |                                |                                    |                               |                                 | диаметре, бледная в | Иммуноферментный           |                                          |
|                                 |                                |                                    |                               |                                 | центре. Возможны     | анализ в парных                 |                                          |
|                                 |                                |                                    |                               |                                 | вторичные эритемы   | сыворотках, взятых с         |                                          |
|                                 |                                |                                    |                               |                                 | на других участках    | интервалом 2 недели          |                                          |
|                                 |                                |                                    |                               |                                 | кожи, регионарный    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лимфаденит,             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | парестезии. Через     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 4—5 недель —          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | серозный менингит,   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | энцефаломиелит,      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | энцефалит,               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | полирадикулоневрит, |                                           |                                          |
|                                 |                                |                                    |                               |                                 | миокардит. Через      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | несколько месяцев    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | — полиартрит,           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | хронический              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | энцефалит,               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | энцефаломиелит,      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | деменция,                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | хронический              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | атрофический           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | акродермит,              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | доброкачественный   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лимфоденоз кожи      |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Ласса                      | Вирус из                 | Больной человек, а     | Путь передачи —    | От 3 до 20 дней,      | Начало постепенное. | Исследование крови           | Желтая лихорадка,            |
| геморрагическая      | семейства               | также крысы               | воздушно-               | чаще 7—8 дней        | Температура тела к   | (лейкопения, повышение     | геморрагические                |
| лихорадка — см.      | Arenaviridae             |                                    | капельный.             |                                 | концу недели             | гематокрита, увеличение    | лихорадки,                        |
| Геморрагические      |                                |                                    | Возможна               |                                 | повышается до 39—  | СОЭ). Исследование мочи  | менингококковая                |
| лихорадки                |                                |                                    | передача вируса     |                                 | 40°,                           | (микрогематурия,               | инфекция                          |
|                                 |                                |                                    | через                      |                                 | продолжительность   | протеинурия).                     |                                          |
|                                 |                                |                                    | загрязненный          |                                 | лихорадки 3—5         | Биохимические                  |                                          |
|                                 |                                |                                    | кровью больного     |                                 | недель.                     | исследования (повышение  |                                          |
|                                 |                                |                                    | медицинский           |                                 | Наблюдаются            | активности                         |                                          |
|                                 |                                |                                    | инструментарий      |                                 | тошнота, рвота,         | аминотрансфераз,              |                                          |
|                                 |                                |                                    |                               |                                 | диарея,                     | щелочной фосфатазы,       |                                          |
|                                 |                                |                                    |                               |                                 | обезвоживание,         | декомпенсированный         |                                          |
|                                 |                                |                                    |                               |                                 | петехиальная сыпь    | ацидоз). Вирусологические |                                          |
|                                 |                                |                                    |                               |                                 | на коже,                    | исследования (выделение  |                                          |
|                                 |                                |                                    |                               |                                 | кровоизлияния, отек  | вируса из крови, смывов    |                                          |
|                                 |                                |                                    |                               |                                 | лица, шеи.                 | из зева, слюны, мочи).       |                                          |
|                                 |                                |                                    |                               |                                 | Слизистая оболочка  | Реакция непрямой              |                                          |
|                                 |                                |                                    |                               |                                 | зева, кожа лица и      | иммунофлюоресценции (с  |                                          |
|                                 |                                |                                    |                               |                                 | груди                        | 7—10-го дня) и реакция      |                                          |
|                                 |                                |                                    |                               |                                 | гиперемированы.       | связывания комплемента   |                                          |
|                                 |                                |                                    |                               |                                 | Развивается              | (с 3-й недели болезни)        |                                          |
|                                 |                                |                                    |                               |                                 | язвенный фарингит.  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Характерны миалгия, |                                           |                                          |
|                                 |                                |                                    |                               |                                 | боли в животе.          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Больной                    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | заторможен,              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | появляются               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | судороги, слух          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | снижен. В тяжелых    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | случаях —                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гиповолемический и  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | инфекционно-            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | токсический шок        |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Легионеров болезнь | Бактерия —             | Возможно, почва,        | Путь передачи —    | При                          | Начало острое.          | Исследование крови           | Другие пневмонии,            |
|                                 | Legionella                | вода — места             | воздушно-               | пневмонической       | Температура тела     | (умеренный                        | микоплазменная                |
|                                 | pneumophila            | естественного             | капельный              | форме от 2 до 10     | повышается до          | нейтрофильный                  | инфекция. орнитоз, Ку-      |
|                                 |                                | обитания легионелл     |                               | дней; при                 | 38,5—40°.                  | лейкоцитоз со сдвигом       | лихорадка, грипп, острые  |
|                                 |                                |                                    |                               | лихорадке Понтиак   | Появляются сухой     | влево, лимфопения,           | респираторные вирусные   |
|                                 |                                |                                    |                               | — 6—48 часов         | кашель, насморк,      | высокая СОЭ,                    | инфекции, грипп                |
|                                 |                                |                                    |                               |                                 | боли в грудной          | тромбоцитопения).              |                                          |
|                                 |                                |                                    |                               |                                 | клетке при дыхании,  | Биохимические                  |                                          |
|                                 |                                |                                    |                               |                                 | затем кашель с         | исследования                     |                                          |
|                                 |                                |                                    |                               |                                 | мокротой. В легких    | (гипонатриемия,                 |                                          |
|                                 |                                |                                    |                               |                                 | — ослабленное         | гипоальбуминемия,            |                                          |
|                                 |                                |                                    |                               |                                 | дыхание, влажные     | повышение уровня             |                                          |
|                                 |                                |                                    |                               |                                 | хрипы. Отмечаются   | билирубина, креатинина,    |                                          |
|                                 |                                |                                    |                               |                                 | диарея, бессонница,  | мочевины, активности        |                                          |
|                                 |                                |                                    |                               |                                 | головная боль,          | аминотрансфераз и других |                                          |
|                                 |                                |                                    |                               |                                 | головокружение.        | сывороточных                    |                                          |
|                                 |                                |                                    |                               |                                 | Развиваются             | ферментов).                       |                                          |
|                                 |                                |                                    |                               |                                 | сердечно-                  | Рентгенологически в          |                                          |
|                                 |                                |                                    |                               |                                 | сосудистая,              | легких очаговая, затем       |                                          |
|                                 |                                |                                    |                               |                                 | дыхательная,            | сливная пневмония.           |                                          |
|                                 |                                |                                    |                               |                                 | почечная                   | Бактериологические           |                                          |
|                                 |                                |                                    |                               |                                 | недостаточность,      | исследования (выделение  |                                          |
|                                 |                                |                                    |                               |                                 | повышенная              | культуры возбудителя из    |                                          |
|                                 |                                |                                    |                               |                                 | кровоточивость,        | крови и мокроты,                |                                          |
|                                 |                                |                                    |                               |                                 | токсическая              | обнаружение его экспресс- |                                          |
|                                 |                                |                                    |                               |                                 | энцефалопатия         | методами). Реакция           |                                          |
|                                 |                                |                                    |                               |                                 | (бред,                        | непрямой                           |                                          |
|                                 |                                |                                    |                               |                                 | галлюцинации,           | иммунофлюоресценции,     |                                          |
|                                 |                                |                                    |                               |                                 | спутанность              | реакция пассивной             |                                          |
|                                 |                                |                                    |                               |                                 | сознания, дизартрия, | гемагглютинации,               |                                          |
|                                 |                                |                                    |                               |                                 | атаксия)                    | иммуноферментный           |                                          |
|                                 |                                |                                    |                               |                                 |                                  | анализ                                |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Лейшманиоз             | Leishmania              | При индийском            | Путь передачи —    | При индийском         | Начало постепенное. | Исследование крови           | Малярия, бруцеллез,         |
| висцеральный (см.   | Donovani, L. d.         | лейшманиозе —          | трансмиссивный.    | лейшманиозе — 6— | На месте внедрения  | (анемия, лейкопения,          | лейкоз, сепсис,                  |
| Лейшманиозы)         | infantum, L. d.          | больной человек; при  | Переносчики           | 8 мес..; при              | возбудителя              | тромбоцитопения,               | лимфогранулематоз          |
|                                 | archibaldii                | средиземноморском    | возбудителей —     | средиземноморском | появляется                | увеличение СОЭ).              |                                          |
|                                 |                                | — собаки, а также       | москиты                  | и восточно-              | первичный аффект.   | Обнаружение возбудителя  |                                          |
|                                 |                                | шакалы, лисы; при      |                               | африканском — от   | Отмечаются              | в мазке и толстой капле     |                                          |
|                                 |                                | восточноафриканском |                               | 20 дней до 1 года     | слабость, снижение   | крови, пунктатах костного  |                                          |
|                                 |                                | — больной человек и  |                                |                                 | аппетита, сплено- и   | мозга, биоптатах                |                                          |
|                                 |                                | грызуны, хищники       |                               |                                 | гепатомегалия,          | лимфатических узлов,        |                                          |
|                                 |                                |                                    |                               |                                 | длительная               | печени, селезенки,             |                                          |
|                                 |                                |                                    |                               |                                 | волнообразная          | выделение культуры          |                                          |
|                                 |                                |                                    |                               |                                 | лихорадка,                | возбудителя из биоптатов  |                                          |
|                                 |                                |                                    |                               |                                 | полиаденит,              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | пигментация кожи,     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кахексия, атрофия    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | мышц,                       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | геморрагические       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | проявления и             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | высыпания на коже.  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Течение                    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | хроническое              |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Лейшманиоз             | Leishmania tropica   | При сельском —         | Путь передачи —    | От 1 недели до 11/  | Начало постепенное. | Бактериоскопия мазков,     | Сифилис, лепра,                |
| кожный                    | major (кожного         | грызуны (песчанки,     | трансмиссивный.    | месяцев при             | На месте внедрения  | взятых с краев язв.            | трофические язвы             |
|                                 | лейшманиоза          | суслик и др.); при        | Переносчики           | сельском кожном     | возбудителя (лицо,    | Биопробы на                      |                                          |
|                                 | сельского типа), L.  | городском — больной  | возбудителей —     | лейшманиозе; от 2   | конечности, реже      | лабораторных животных     |                                          |
|                                 | tropica minor            | человек                       | москиты                  | месяцев до 11/лет  | туловище)                 | (выделение культуры         |                                          |
|                                 | (кожного                  |                                    |                               | — при городском     | появляется папула,   | возбудителя)                      |                                          |
|                                 | лейшманиоза          |                                    |                               | кожном                    | увеличивающаяся в  |                                           |                                          |
|                                 | городского типа)     |                                    |                               | лейшманиозе           | размерах. Через        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | несколько месяцев    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | папула покрывается  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | коркой, после            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | отторжения которой   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | образуется                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | поверхностная язва   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | до 4—6 см в              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | диаметре.                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Рубцевание ее          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | зависит от формы     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | болезни и занимает   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | от 6—7 месяцев        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | (рано                         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | изъязвляющийся       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кожный лейшманиоз) |                                           |                                          |
|                                 |                                |                                    |                               |                                 | до 1 года (поздно      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | изъязвляющийся       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кожный                      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лейшманиоз).            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Количество язв от     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 1—2 до 10 и более.   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Лихорадка,                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | интоксикация             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | отсутствует               |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Лептоспироз            | Leptospira                | В природных очагах    | Основной путь        | От 3 до 30 дней,      | Начало острое,          | Исследование крови           | Грипп, сыпной тиф,           |
|                                 | interrogans               | — грызуны,                 | передачи —            | чаще 7—10 дней      | бурное. Появляется   | (нейтрофильный                 | вирусные гепатиты,           |
|                                 |                                | насекомоядные,          | водный. Заражение |                                 | озноб, температура   | лейкоцитоз со сдвигом       | геморрагические                |
|                                 |                                | парнокопытные,          | происходит при       |                                 | тела повышается до  | влево, увеличение СОЭ,     | лихорадки                         |
|                                 |                                | хищные животные;      | купании,                 |                                 | 39—40° и выше.        | анемия, тромбоцитопения). |                                          |
|                                 |                                | антропоургических      | употреблении для   |                                 | Длительность            | Исследование мочи            |                                          |
|                                 |                                | очагах — крупный и    | питья и                   |                                 | лихорадки 5—10        | (протеинурия, лейкоциты,   |                                          |
|                                 |                                | мелкий рогатый скот,  | хозяйственных        |                                 | дней и более,            | эритроциты, цилиндры).      |                                          |
|                                 |                                | свиньи, лошади,          | нужд загрязненной  |                                 | возможны повторные | Биохимические                  |                                          |
|                                 |                                | собаки, а также           | воды (из открытых  |                                 | волны лихорадки. С   | исследования (азотемия,    |                                          |
|                                 |                                | домовые мыши и         | водоемов), а также |                                 | первых часов            | повышение уровня             |                                          |
|                                 |                                | крысы                         | пищи, например      |                                 | отмечаются               | билирубина).                      |                                          |
|                                 |                                |                                    | сырого молока от    |                                 | головная боль, боли  | Бактериоскопия крови,       |                                          |
|                                 |                                |                                    | больных животных, |                                 | и болезненность        | мочи, цереброспинальной   |                                          |
|                                 |                                |                                    | при разделке их      |                                 | мышц, боли в            | жидкости.                           |                                          |
|                                 |                                |                                    | туш, обработке       |                                 | животе, тошнота,       | Бактериологическое           |                                          |
|                                 |                                |                                    | животного сырья     |                                 | рвота, адинамия.       | исследование крови.          |                                          |
|                                 |                                |                                    |                               |                                 | Лицо одутловатое и   | Биопроба на морских         |                                          |
|                                 |                                |                                    |                               |                                 | гиперемированное.    | свинках. Реакции               |                                          |
|                                 |                                |                                    |                               |                                 | Отмечаются              | микроагглютинации и          |                                          |
|                                 |                                |                                    |                               |                                 | гиперемия                 | лизиса для обнаружения    |                                          |
|                                 |                                |                                    |                               |                                 | конъюнктивы склер,  | антител                              |                                          |
|                                 |                                |                                    |                               |                                 | герпес. На 3—5-й      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | день появляется       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | полиморфная сыпь.   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Печень и селезенка   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличены.                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Наблюдаются            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | менингеальные          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | симптомы,                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | геморрагические       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | проявления, боли в    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | пояснице, олигурия.  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможно развитие   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | острой почечной        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | недостаточности. В   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | части случаев           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | появляется желтуха  |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Лимфоретикулез      | Бактерии Rothia      | Кошки                         | Передача                | От 3 до 60 дней       | Начало острое.          | Исследование крови           | Неспецифический              |
| доброкачественный  | dentocariosa            |                                    | возбудителя в         | чаще 2—3 недели    | Температура тела     | (умеренный лейкоцитоз,     | лимфаденит, туляремия,   |
| (Лимфоретикулёз     |                                |                                    | результате              |                                 | повышается до 38—  | эозинофилия, увеличение  | бруцеллез, туберкулез       |
| доброкачественный) |                                |                                    | царапанья, укуса    |                                 | 39°, длительность     | СОЭ)                                  | лимфатических узлов,       |
|                                 |                                |                                    | кошек                     |                                 | лихорадки до 2 нед.  |                                           | лимфогранулематоз,         |
|                                 |                                |                                    |                               |                                 | Отмечаются              |                                           | инфекционный                   |
|                                 |                                |                                    |                               |                                 | головная боль, боли  |                                           | мононуклеоз                      |
|                                 |                                |                                    |                               |                                 | в мышцах,                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | высыпания на коже.  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | В месте внедрения    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | возбудителя —          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | безболезненная         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | красноватая папула,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | которая часто            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | нагнаивается.            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Наиболее                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | постоянный симптом |                                           |                                          |
|                                 |                                |                                    |                               |                                 | — регионарный         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лимфаденит, чаще    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | локтевой,                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | аксиллярный,            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | паховый, реже           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | полиаденит.              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможны нагноение |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лимфатического        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | узла, образование     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | свища, заживление   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | которого происходит  |                                          |                                          |
|                                 |                                |                                    |                               |                                 | в течение 2—3 мес.   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможны серозный  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | менингит, энцефалит |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Лямблиоз                 | Простейшие —        | Человек (больной,       | Путь передачи —    | От 10 до 15 дней      | Чаще протекает        | Исследование мазков         | Холецистит, энтерит,         |
|                                 | Lamblia intestinalis   | лямблионоситель),      | водный, пищевой,   |                                 | бессимптомно. В       | дуоденального                   | глистные инвазии              |
|                                 |                                | возможно, собака        | бытовой, а также    |                                 | ряде случаев            | содержимого                      |                                          |
|                                 |                                |                                    | через грязные руки |                                 | наблюдаются            | (обнаружение                     |                                          |
|                                 |                                |                                    |                               |                                 | приступообразные     | возбудителя)                      |                                          |
|                                 |                                |                                    |                               |                                 | боли в животе,          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | тошнота,                   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | неустойчивый стул,   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | метеоризм                 |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Малярия                  | Plasmodium vivax,   | Человек — больной и  | Путь передачи —    | При трехдневной      | Начало острое или    | Исследование крови           | Грипп, острые                    |
|                                 | P. ovale                   | паразитоноситель       | трансмиссивный.    | малярии — от 1 до   | после                        | (анемия, лейкопения).         | респираторные вирусные   |
|                                 | (трехдневная          |                                    | Переносчики           | 21 дня при за           | продромального        | Повторная бактериоскопия | инфекции. Острые             |
|                                 | малярия), P.            |                                    | возбудителей —     | ражении кожным      | периода,                   | мазков и толстой капли      | кишечные инфекции,         |
|                                 | malariae                  |                                    | комары рода           | штаммом PI. vivax    | проявляющегося       | крови                                 | лептоспироз, желтая          |
|                                 | (четырехдневная     |                                    | Anopheles               | 6—14 месяцев при   | лихорадкой,              |                                           | лихорадка, тяжелые          |
|                                 | малярия), P.            |                                    |                               | заражении                | головной болью,        |                                           | формы вирусных               |
|                                 | falcipanim                |                                    |                               | северным штаммом  | ломотой в теле.        |                                           | гепатитов, брюшной тиф,   |
|                                 |                                |                                    |                               | PI. vivax при             | Через 3—4 дня —     |                                           | бруцеллез, сепсис,            |
|                                 |                                |                                    |                               | четырехдневной —  | приступ,                    |                                           | геморрагические                |
|                                 |                                |                                    |                               | 14—42 дня при         | сопровождающийся  |                                           | лихорадки                         |
|                                 |                                |                                    |                               | тропической — 8—   | ознобом,                   |                                           |                                          |
|                                 |                                |                                    |                               | 31 день, чаще 9    | повышением              |                                           |                                          |
|                                 |                                |                                    |                               | 16 дней                    | температуры тела до |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 40—41°, гиперемией  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лица, одышкой,         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | возбуждением,          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | бредом, головной      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | болью, артериальной |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гипотензией,              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | поносом. Приступ      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | заканчивается           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | критическим              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | падением                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | температуры,            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | обильным                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | потоотделением.       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Длительность            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | приступа 6—10 ч.      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Приступы могут         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | возникать через 1, 2  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | дня или быть             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | ежедневными. Кожа  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | бледная, склеры        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | субиктеричны.           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Селезенка и печень   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличены.                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможны ранние      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | (через несколько       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | недель) и поздние     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | (через 8—10 мес.)     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | рецидивы. В ряде      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | случаев                     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | развиваются             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | желтуха, почечная    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | недостаточность,      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | делирий, кома,          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | инфекционно-            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | токсический шок        |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Марбург лихорадка  | Вирус из                 | Обезьяны —               | Заражение              | От 2 до 16 дней       | Начало острое.          | Исследование крови           | Другие геморрагические    |
| (см.                          | семейства               | Cercopithecus aethiops | происходит через   |                                 | Отмечаются              | (лейкопения, сдвиг             | лихорадки                         |
| Геморрагические      | Arenaviridae             | и больные люди          | кровь отделяемое   |                                 | высокая                    | формулы влево,                 |                                          |
| лихорадки)               |                                |                                    | носоглотки, мочу    |                                 | температура тела,     | атипичные лимфоциты,      |                                          |
|                                 |                                |                                    | при попадании их    |                                 | головная боль, боли  | тромбоцитопения).              |                                          |
|                                 |                                |                                    | на поврежденную   |                                 | в спине и пояснице,   | Исследование мочи            |                                          |
|                                 |                                |                                    | кожу и слизистые    |                                 | конъюнктивит,           | (протеинурия).                    |                                          |
|                                 |                                |                                    | оболочки                 |                                 | энантема, гиперемия | Биохимические                  |                                          |
|                                 |                                |                                    |                               |                                 | зева. На 3—4-й день  | исследования (повышение |                                          |
|                                 |                                |                                    |                               |                                 | — тошнота, рвота,     | активности                         |                                          |
|                                 |                                |                                    |                               |                                 | часто кровавая,         | аминотрансфераз).             |                                          |
|                                 |                                |                                    |                               |                                 | понос. На 5—6-й        | Вирусологические              |                                          |
|                                 |                                |                                    |                               |                                 | день — пятнисто-      | исследования. Реакция      |                                          |
|                                 |                                |                                    |                               |                                 | папулезная сыпь. С   | непрямой                           |                                          |
|                                 |                                |                                    |                               |                                 | 6—7-го дня                | иммунофлюоресценции      |                                          |
|                                 |                                |                                    |                               |                                 | геморрагический       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | синдром, петехии,     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кровоподтеки,           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гематурия, носовые   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кровотечения,           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | мелена. С 6-го дня    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | шелушение кожи       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | ладоней и подошв.    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможны                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | менинтеальные         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | симптомы, судороги, |                                           |                                          |
|                                 |                                |                                    |                               |                                 | расстройства            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | сознания                   |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Марсельская            | Риккетсии               | Предположительно     | Путь передачи —    | От 3 до 18 дней,      | Начало острое.          | Исследование крови           | Сыпной и брюшной тиф,    |
| лихорадка                | Rickettsia conorii      | собаки                        | трансмиссивный.    | чаще 3—7 дней        | Температура тела     | (лейкопения с                     | паратифы, сифилис           |
|                                 |                                |                                    | Переносчик             |                                 | повышается с            | относительным                   |                                          |
|                                 |                                |                                    | собачий клещ         |                                 | ознобом до 38—40°;  | лимфоцитозом, СОЭ          |                                          |
|                                 |                                |                                    | Rhipicephalus          |                                 | лихорадка                 | несколько увеличена).        |                                          |
|                                 |                                |                                    | sanguineus              |                                 | постоянная или         | Реакции связывания           |                                          |
|                                 |                                |                                    |                               |                                 | ремиттирующая,       | комплемента и непрямой    |                                          |
|                                 |                                |                                    |                               |                                 | длительность ее 3—  | гемагглютинации                |                                          |
|                                 |                                |                                    |                               |                                 | 14 дней. Лицо,           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конъюнктивы и кожа  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | шеи умеренно           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гиперемированы. На  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | месте укуса клеща    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | появляется                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | первичный аффект    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | — плотный                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | безболезненный        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | инфильтрат с            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | некрозом, а затем и   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | струпом в центре,     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | который отпадает на  |                                          |                                          |
|                                 |                                |                                    |                               |                                 | 4—5-й день               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | нормальной               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | температуры. При     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | этом образуется        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | язвочка,                    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | эпителизирующаяся  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | через 8—12 дней. На |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 2—4-й день болезни  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | обнаруживается        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | обильная пятнисто-   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | папулезная сыпь,      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | которая сохраняется |                                           |                                          |
|                                 |                                |                                    |                               |                                 | в течение                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лихорадочного          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | периода. Часто         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличены печень и  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | селезенка                  |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Менингококковая      | Менингококк            | Человек — больной и  | Путь передачи —    | От 1 до 20 дней,      | Начало острое.          | Исследование крови           | Грипп, геморрагические     |
| инфекция                 | Neisseria                 | бактерионоситель       | воздушно-               | чаще 3—7 дней        | Появляются озноб,    | (нейтрофильный                 | лихорадки, сепсис,            |
|                                 | meningitidis             |                                    | капельный              |                                 | боли в мышцах,         | гиперлейкоцитоз со            | лептоспироз,                     |
|                                 |                                |                                    |                               |                                 | температура тела      | сдвигом влево,                   | тромбоцитопеническая      |
|                                 |                                |                                    |                               |                                 | повышается до          | увеличение СОЭ,               | пурпура, гнойные               |
|                                 |                                |                                    |                               |                                 | 38,5—41°.                  | тромбоцитопения).              | вторичные менингиты,       |
|                                 |                                |                                    |                               |                                 | Наблюдаются            | Исследование                    | вирусные менингиты,         |
|                                 |                                |                                    |                               |                                 | головная боль,          | цереброспинальной            | менингоэнцефалиты          |
|                                 |                                |                                    |                               |                                 | рвота, миалгия,         | жидкости (высокий             |                                          |
|                                 |                                |                                    |                               |                                 | геморрагическая       | нейтрофильный плеоцитоз, |                                          |
|                                 |                                |                                    |                               |                                 | сыпь (на 1—2-й день | повышение содержания      |                                          |
|                                 |                                |                                    |                               |                                 | болезни),                   | белка, внутриклеточно —   |                                          |
|                                 |                                |                                    |                               |                                 | кровоизлияния в        | диплококки).                       |                                          |
|                                 |                                |                                    |                               |                                 | конъюнктивы,            | Бактериологическое           |                                          |
|                                 |                                |                                    |                               |                                 | менингеальный          | исследование крови и        |                                          |
|                                 |                                |                                    |                               |                                 | синдром, артрит. В    | цереброспинальной            |                                          |
|                                 |                                |                                    |                               |                                 | тяжелых случаях —  | жидкости. Реакция             |                                          |
|                                 |                                |                                    |                               |                                 | инфекционно-            | непрямой                           |                                          |
|                                 |                                |                                    |                               |                                 | токсический шок,       | гемагглютинации.               |                                          |
|                                 |                                |                                    |                               |                                 | острая почечная        | Встречный                         |                                          |
|                                 |                                |                                    |                               |                                 | недостаточность,      | иммуноэлектрофорез (для  |                                          |
|                                 |                                |                                    |                               |                                 | кома, судорога          | обнаружения антигена)       |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Микоплазменные      | Микоплазма —        | Человек — больной и  | Путь передачи —    | От 7 до 14 дней       | Начало острое или    | Рентгенологическое           | Грипп, острые                    |
| инфекции                 | Mycoplasma            | носитель микоплазм    | воздушно-               |                                 | постепенное.             | исследование грудной        | респираторные вирусные   |
|                                 | pneumoniae, М.       |                                    | капельный              |                                 | Клиническая картина | клетки. Реакция                  | инфекции, Ку-лихорадка,   |
|                                 | hominis, Т-              |                                    |                               |                                 | полиморфна.             | связывания комплемента и | орнитоз, туберкулез           |
|                                 | микоплазмы            |                                    |                               |                                 | Температура тела     | непрямой гемагглютинации |                                          |
|                                 |                                |                                    |                               |                                 | 37—39°.                    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Развиваются ринит,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | фарингит, ларингит,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | пневмония, плеврит.  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Интоксикация            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | выражена слабо или  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | умеренно.                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Длительность            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | болезни от 2—3 дней |                                           |                                          |
|                                 |                                |                                    |                               |                                 | до 1 мес.                   |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Мононуклеоз            | Вирус —                 | Человек — больной и  | Путь передачи —    | От 4 до 60 дней,      | Начало чаще             | Исследование крови           | Дифтерия, ангина другой   |
| инфекционный         | Эпстайна— Барр,   | вирусоноситель           | воздушно-               | чаще 7—10 дней      | постепенное.             | (лейкоцитоз,                       | этиологии, аденовирусная |
|                                 | из семейства          |                                    | капельный, а также |                                 | Появляются              | лимфомоноцитоз,               | инфекция, вирусные          |
|                                 | Herpesviridae           |                                    | при                         |                                 | недомогание и боли   | атипичные                          | гепатиты, брюшной тиф и  |
|                                 |                                |                                    | непосредственном  |                                 | в горле. Выявляются | Широкоплазменные            | паратифы,                         |
|                                 |                                |                                    | контакте (поцелуи), |                                 | фарингит,                  | лимфоциты,                       | доброкачественный           |
|                                 |                                |                                    | через                      |                                 | катаральная,             | тромбоцитопения).              | лимфоретикулез,               |
|                                 |                                |                                    | загрязненные          |                                 | фолликулярная,        | Биохимические                  | лимфогранулематоз,         |
|                                 |                                |                                    | слюной предметы   |                                 | лакунарная или         | исследования (повышение  | острый лейкоз                   |
|                                 |                                |                                    | обихода                  |                                 | некротическая           | активности                         |                                          |
|                                 |                                |                                    |                               |                                 | ангина. Лихорадка     | аминотрансфераз               |                                          |
|                                 |                                |                                    |                               |                                 | от нескольких дней   | сыворотки, реже уровня     |                                          |
|                                 |                                |                                    |                               |                                 | до 3—4 недель.         | билирубина). Реакция         |                                          |
|                                 |                                |                                    |                               |                                 | Увеличение               | Пауля — Буннелля             |                                          |
|                                 |                                |                                    |                               |                                 | лимфатических         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | узлов, особенно        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | латеральных             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | шейных, увеличение  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | селезенки и печени,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | иногда желтуха и      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | диспептические         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | расстройства,           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | высыпания на коже   |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Омская                    | Вирус —                 | Грызуны                      | Путь передачи —    | 2—4 дня                  | Начало острое.          | Исследование крови           | Лептоспироз, сыпной тиф, |
| геморрагическая      | Haemorrhagogenes   | (преимущественно      | трансмиссивный.    |                                 | Температура тела     | (лейкопения,                       | менингококковая                |
| лихорадка                | sibiricus, из             | мышевидные)              | Переносчики           |                                 | высокая, лихорадка   | нейтрофильный сдвиг        | инфекция, сепсис, другие  |
|                                 | семейства               |                                    | возбудителей —     |                                 | длится от 4 до 12      | влево, тромбоцитопения).   | геморрагические                |
|                                 | Bunyaviridae            |                                    | клещи Dennacentor  |                                 | дней, часто               | Вирусологические              | лихорадки,                        |
|                                 |                                |                                    | pictus, D.                |                                 | двугорбая                 | исследования (выделение  | геморрагический                |
|                                 |                                |                                    | marginatus              |                                 | температурная          | вируса из крови). Реакции  | васкулит,                           |
|                                 |                                |                                    |                               |                                 | кривая. Отмечаются  | связывания комплемента и | тромбоцитопеническая      |
|                                 |                                |                                    |                               |                                 | озноб, головная         | непрямой гемагглютинации | пурпура, вирусные            |
|                                 |                                |                                    |                               |                                 | боль, миалгии. Лицо  |                                           | менингоэнцефалиты          |
|                                 |                                |                                    |                               |                                 | гиперемировано.       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Склеры и                   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конъюнктивы             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | инъецированы.          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможны патехии,   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | другие проявления    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кровоточивости,        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | пневмония,                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | менингоэнцефалит    |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Орнитоз                   | Хламидии —           | Птицы — домашние и  | Пути передачи —    | От 6 до 25 дней,      | Начало острое.          | Исследование крови           | Грипп, острые                    |
|                                 | Chlamydia psittaci    | дикие птицы                | воздушно-               | чаще 8—12 дней      | Появляются озноб,    | (лейкопения, нормоцитоз,   | респираторные вирусные   |
|                                 |                                |                                    | капельный и            |                                 | головная боль,          | лейкоцитоз, раннее             | инфекции, легиоиеллез,     |
|                                 |                                |                                    | воэдушно-пылевой, |                                 | миалгии,                    | увеличение СОЭ).              | Ку-лихорадки, пневмония,  |
|                                 |                                |                                    | возможно                |                                 | температура тела до | Рентгенологически —         | микоплазменная                |
|                                 |                                |                                    | заражение и при     |                                 | 38—39,5°, Сухой       | пневмония. Реакция           | инфекция брюшной и         |
|                                 |                                |                                    | непосредственном  |                                 | кашель, ларингит,      | связывания комплемента   | сыпной тиф, лептоспироз  |
|                                 |                                |                                    | соприкосновении с  |                                 | трахеобронхит. С      | (в титре 1: 16и выше после |                                          |
|                                 |                                |                                    | птицами                  |                                 | 5—7-го дня — боли в | 10-го дня болезни).             |                                          |
|                                 |                                |                                    |                               |                                 | грудной клетке,         | Внутрикожная проба с        |                                          |
|                                 |                                |                                    |                               |                                 | одышка,                    | орнитином                          |                                          |
|                                 |                                |                                    |                               |                                 | продуктивный            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кашель,                     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | физикальные             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | признаки пневмонии. |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Бессонница,              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | адинамия,                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | головокружения,        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | менингизм.                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | (Селезенка и печень  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличены                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможно острое,     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | затяжное и                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | хроническое течение |                                           |                                          |
|                                 |                                |                                    |                               |                                 | болезни                     |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Оспа натуральная    | Вирус —                 | Больной человек         | Пути передачи —    | От 7 до 15 дней,      | Начало острое.          | Исследование крови (в       | Ветряная оспа                   |
|                                 | Strongyloplasma      |                                    | воздушно-               | чаще 10—12 дней    | Появляются озноб,    | период нагноения сыпи      |                                          |
|                                 | variolae, из              |                                    | капельный и            |                                 | боли в крестце,         | нейтрофильный                  |                                          |
|                                 | семейства               |                                    | бытовой через        |                                 | рвота, температура   | лейкоцитоз). Реакция          |                                          |
|                                 | Poxviridae               |                                    | предметы обихода  |                                 | тела повышается до  | непрямой                           |                                          |
|                                 |                                |                                    |                               |                                 | 40° и выше. Лицо,      | гемагглютинации.               |                                          |
|                                 |                                |                                    |                               |                                 | конъюнктивы,            | Микропреципитация в         |                                          |
|                                 |                                |                                    |                               |                                 | слизистая оболочка   | агаре. Электронная            |                                          |
|                                 |                                |                                    |                               |                                 | ротоглотки                 | микроскопия и метод          |                                          |
|                                 |                                |                                    |                               |                                 | гиперемированы. На  | флюоресцирующих            |                                          |
|                                 |                                |                                    |                               |                                 | 2—3-й день               | антител.                             |                                          |
|                                 |                                |                                    |                               |                                 | появляется                | Вирусологические              |                                          |
|                                 |                                |                                    |                               |                                 | продромальная         | исследования (выделение  |                                          |
|                                 |                                |                                    |                               |                                 | пятнистая или           | вируса из крови,                 |                                          |
|                                 |                                |                                    |                               |                                 | мелкоточечная сыпь, | элементов сыпи)                |                                          |
|                                 |                                |                                    |                               |                                 | исчезающая в           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | течение 1—2 дней,    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | На 4—5 день             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | температура тела      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | снижается,                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | состояние                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | улучшается.              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Одновременно          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | появляется истинная |                                           |                                          |
|                                 |                                |                                    |                               |                                 | сыпь вначале на        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лице, затем на           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | туловище и               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конечностях.             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Элементы сыпи         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | имеют вид пятен,      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | затем папул, через    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 2—3 дня — везикул   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | с вдавлением в         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | центре, окруженных  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | венчиком гиперемии. |                                           |                                          |
|                                 |                                |                                    |                               |                                 | С 7—8-го дня            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | болезни элементы     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | сыпи нагнаиваются,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | вновь повышается     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | температура тела,     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | появляются               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | интоксикация, отек    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кожи, тахикардия.     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | одышка, бред.           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Элементы сыпи         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | также имеются на     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | слизистых оболочках |                                           |                                          |
|                                 |                                |                                    |                               |                                 | глаз, носа,                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | ротоглотки,                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | дыхательных путей,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | уретры. На 15—17-й  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | день пустулы            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | подсыхают,               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | температура тела      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | снижается. Корки      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | отпадают на 4—5-й   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | неделе болезни         |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Паратифы А и В       | Бактерии —            | Человек — больной,    | Пути передачи —    | От 2 до 21 дня,        | Начало подострое     | Бактериологические           | Брюшной тиф,                   |
|                                 | Saimonella               | бактерионоситель       | пищевой, водный,   | чаще 8—10 дней      | или острое.               | исследования                     | сальмонеллез,                   |
|                                 | paratyphi A u S.       |                                    | бытовой.                 |                                 | Температура тела     | (гемокультура,                   | инфекционный                   |
|                                 | schottmuelleri          |                                    | Заражение              |                                 | повышается до 38—  | копрокультура,                   | мононуклеоз, сыпной тиф, |
|                                 |                                |                                    | происходит через   |                                 | 39°. Лихорадка          | уринокультура). Реакция    | сепсис, малярия, грипп,     |
|                                 |                                |                                    | загрязненные          |                                 | продолжается от       | непрямой гемагглютинации | бруцеллез                          |
|                                 |                                |                                    | пищевые                 |                                 | нескольких дней до   |                                           |                                          |
|                                 |                                |                                    | продукты, воду,      |                                 | 3—4 недель. Кожа     |                                           |                                          |
|                                 |                                |                                    | предметы обихода; |                                 | бледная с                  |                                           |                                          |
|                                 |                                |                                    | фактором               |                                 | розеолезной,             |                                           |                                          |
|                                 |                                |                                    | передачи                |                                 | розеолезно-               |                                           |                                          |
|                                 |                                |                                    | инфекции могут      |                                 | папулезной сыпью,    |                                           |                                          |
|                                 |                                |                                    | быть грязные руки,  |                                | которая появляется   |                                           |                                          |
|                                 |                                |                                    | мухи                       |                                 | на 4—7-й день           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | болезни. Язык           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | обложен, селезенка   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | и печень увеличены.  |                                          |                                          |
|                                 |                                |                                    |                               |                                 | Возможны                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | катаральные и           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | диспептические         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | явления                     |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Паротит                   | Вирус —                 | Больной человек         | Пути передачи —    | От 11 до 23 дней,     | Начало острое.          | Исследование крови           | Гнойный паротит,               |
| эпидемический        | Pneumophilus          |                                    | воздушно-               | чаще 5—20 дней,     | Температура тела     | (лейкопения, лимфоцитоз). | подчелюстной                    |
|                                 | parotitidis, из           |                                    | капельный и            | но иногда                 | повышается до 37—  | Биохимические                  | лимфаденит                      |
|                                 | семейства               |                                    | бытовой, возможен | удлиняется до 26—  | 39°. Появляются        | исследования (повышение  | слюннокаменная болезнь,  |
|                                 | Paramyxoviridae      |                                    | через предметы      | 35 дней                    | боли в области уха,   | уровня амилазы крови и     | панкреатит, менингит         |
|                                 |                                |                                    | обихода                  |                                 | отечность и               | диастазы мочи), Реакции    | орхит другой этиологии     |
|                                 |                                |                                    |                               |                                 | болезненность в        | связывания комплемента и |                                          |
|                                 |                                |                                    |                               |                                 | области                     | непрямой гемагглютинации |                                          |
|                                 |                                |                                    |                               |                                 | околоушных, реже     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | подчелюстных           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | слюнных желез,        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | максимальная на 3— |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 5 день, к 7—10-му     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | дню уменьшается.    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Лихорадка в течение |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 4—7 дней.                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможны орхит,       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | эпидидимит,              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | панкреатит,               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | серозный менингит    |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Полиомиелит            | Вирус —                 | Человек — больной,    | Пути передачи —    | От 2 до 35 дней,      | Начало острое.          | Исследование крови           | Коксаки, ЕСНО-инфекций, |
|                                 | Myelophilus hominis | вирусоноситель           | пищевой, водный,   | чаще 5—14 дней      | Температура тела     | (лейкопения, лимфоцитоз). | острый миелит,                  |
|                                 | из семейства          |                                    | бытовой, через       |                                 | повышается до 38—  | Исследование                    | полирадикулоневрит,         |
|                                 | Picornaviridae          |                                    | загрязненные          |                                 | 40°. Отмечаются       | цереброспинальной            | клещевой энцефалит,        |
|                                 |                                |                                    | пищевые                 |                                 | головная боль,          | жидкости (лимфоцитарный | ботулизм.                          |
|                                 |                                |                                    | продукты, воду,      |                                 | першение и боли в     | плеоцитоз, увеличение       |                                          |
|                                 |                                |                                    | предметы обихода, |                                 | горле, тошнота,         | содержания белка).            |                                          |
|                                 |                                |                                    | а также грязные      |                                 | рвота, боли в             | Выделение вируса из         |                                          |
|                                 |                                |                                    | руки; возможен и    |                                 | животе, запор.           | фекалий,                            |                                          |
|                                 |                                |                                    | воздушно-               |                                 | Выявляются              | цереброспинальной            |                                          |
|                                 |                                |                                    | капельный путь       |                                 | ригидность                | жидкости, смывов из          |                                          |
|                                 |                                |                                    | передачи                |                                 | затылочных мышц,    | носоглотки, крови.              |                                          |
|                                 |                                |                                    |                               |                                 | симптомы Кернига и  | Реакция связывания           |                                          |
|                                 |                                |                                    |                               |                                 | Брудзинского,           | комплемента, реакция        |                                          |
|                                 |                                |                                    |                               |                                 | угнетение                  | нейтрализации вируса        |                                          |
|                                 |                                |                                    |                               |                                 | сухожильных             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | рефлексов, вялые     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | параличи мышц         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | спины, шеи,               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | брюшной стенки,       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конечностей,             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | диафрагмы,              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | бульбарные               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | параличи,                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | дыхательная             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | недостаточность       |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Псевдотуберкулез    | Бактерии —            | Многие                        | Пути передачи —    | От 2 до 18 дней       | Начало острое или    | Исследование крови           | Скарлатина, краснуха,       |
|                                 | Yersinia                   | млекопитающие и       | пищевой, водный.   | (чаще 5—7 дней)      | подострое.                | (умеренный лейкоцитоз,     | ревматизм, ревматоидный |
|                                 | pseudotuberculosis   | птицы — в природных | Заражение              |                                 | Температура тела     | увеличение СОЭ). Посев    | артрит, вирусные               |
|                                 |                                | очагах, в основном     | происходит чаще    |                                 | повышается до          | крови, кала,                        | гепатиты, сепсис,              |
|                                 |                                | грызуны; в                  | через                      |                                 | 38,5—39,5°.               | цереброспинальной            | сальмонеллез, пищевые    |
|                                 |                                | антропоургических      | загрязненные          |                                 | Лихорадка                 | жидкости. Реакции             | токсикоинфекции,              |
|                                 |                                | очагах — домовые      | грызунами воду и   |                                 | постоянного,             | агглютинации и непрямой   | иерсиниоз, ди-дизентерия, |
|                                 |                                | мыши, крысы, кошки,  | пищевые                 |                                 | неправильного,          | гемагглютинации                | брюшной тиф, паратифы   |
|                                 |                                | мелкий и крупный        | продукты, в т. ч.     |                                 | ремиттирующего       |                                           | А и В, инфекционный         |
|                                 |                                | рогатый скот, птицы    | через овощи,          |                                 | типа, продолжается   |                                           | мононуклеоз, острый         |
|                                 |                                |                                    | загрязненные при    |                                 | от нескольких дней   |                                           | аппендицит                        |
|                                 |                                |                                    | хранении в              |                                 | до 2—3 недель и       |                                           |                                          |
|                                 |                                |                                    | овощехранилищах  |                                 | более. Ознобы,          |                                           |                                          |
|                                 |                                |                                    | и не подвергшиеся  |                                 | катаральные              |                                           |                                          |
|                                 |                                |                                    | термической           |                                 | явления, миалгия,     |                                           |                                          |
|                                 |                                |                                    | обработке               |                                 | артралгия. Тошнота,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | рвота, понос, боли в  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | правой подвздошной |                                           |                                          |
|                                 |                                |                                    |                               |                                 | области. Сыпь           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | розеолезная,             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | эритематозная,         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | папулезная,               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | уртикарная,               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | узловатая эритема.   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Наиболее частая       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | локализация сыпи:     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | боковая поверхность |                                           |                                          |
|                                 |                                |                                    |                               |                                 | груди, низ живота,     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | медиальная               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | поверхность              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | конечностей, вблизи  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | суставов. Лицо,         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | ладони, стопы           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гиперемированы,       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | жжение кожи.            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Лимфаденит,            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | полиаденит. Артриты |                                           |                                          |
|                                 |                                |                                    |                               |                                 | и полиартриты.          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Селезенка и печень   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличены. Иногда    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | отмечаются               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | желтуха, миокардит.  |                                          |                                          |
|                                 |                                |                                    |                               |                                 | Возможно                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | волнообразное и        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | рецидивирующее      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | течение                     |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Рожа                        | Гемолитический      | Человек больной и      | Заражение              | От нескольких          | Начало острое.          | Исследование крови           | Флегмона, тромбофлебит,  |
|                                 | стрептококк группы | бактерионоситель        | происходит через   | часов до 3—5 дней  | Появляются озноб,    | (выраженный                      | узловатая эритема,           |
|                                 | А                            | стрептококка               | загрязненное          |                                 | головная боль,          | нейтрофильный                  | экзема, дерматит, кожная  |
|                                 |                                |                                    | белье, одежду,       |                                 | миалгия, рвота,         | лейкоцитоз со сдвигом       | форма сибирской язвы      |
|                                 |                                |                                    | полотенца, руки.     |                                 | температура тела      | влево, увеличение СОЭ).    |                                          |
|                                 |                                |                                    | Возможен и            |                                 | повышается до 38—  | Выделение возбудителя из |                                          |
|                                 |                                |                                    | воздушно-               |                                 | 40°. Одновременно    | крови, из очага поражения. |                                          |
|                                 |                                |                                    | капельный путь       |                                 | или вскоре                | Иммунологические             |                                          |
|                                 |                                |                                    | передачи                |                                 | возникает чувство     | исследования (повышение  |                                          |
|                                 |                                |                                    | (особенно при роже |                                 | жжения кожи в очаге | титров                                |                                          |
|                                 |                                |                                    | лица)                      |                                 | поражения, который  | противострептококковых     |                                          |
|                                 |                                |                                    |                               |                                 | имеет вид розового   | антител)                             |                                          |
|                                 |                                |                                    |                               |                                 | пятна, быстро            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличивается в        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | размерах,                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | становится                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | интенсивно-красным. |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Кожа в зоне               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | поражения горячая,   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | блестящая, мягкие    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | ткани отечны. Очаг    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | резко отграничен от   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | окружающей кожи.    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Отмечается               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | регионарный              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лимфаденит.             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Наиболее частая       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | локализация —          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | голень, лицо.             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Длительность 7—12  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | дней. Возможны        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | рецидивы                  |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Ротавирусный          | Вирус из                 | Человек — больной,    | Пути передачи —    | От 1 до 5 дней         | Начало острое.          | Исследование крови           | Холера, сальмонеллез,      |
| гастроэнтерит          | семейства               | вирусоноситель          | пищевой, водный,   |                                 | Температура тела до | (лейкопения),                      | пищевые                           |
|                                 | Reoviridae               |                                    | бытовой.                 |                                 | 38—38,5°. Обильный  | Иммунофлюоресцентный   | токсикоинфекции,              |
|                                 |                                |                                    | Заражение              |                                 | жидкий стул с           | метод и электронная          | энтеровирусная инфекция |
|                                 |                                |                                    | происходит через   |                                 | резким запахом без   | микроскопия (обнаружение |                                          |
|                                 |                                |                                    | загрязненные          |                                 | патологических         | возбудителя в                    |                                          |
|                                 |                                |                                    | пищевые                 |                                 | примесей до 10—15  | испражнениях). Реакция     |                                          |
|                                 |                                |                                    | продукты, воду,      |                                 | раз в сутки, рвота,    | связывания комплемента.  |                                          |
|                                 |                                |                                    | предметы обихода, |                                 | метеоризм, урчание  | Иммуноферментный           |                                          |
|                                 |                                |                                    | а также грязные      |                                 | в животе. Возможно  | анализ                                |                                          |
|                                 |                                |                                    | руки                        |                                 | обезвоживание          |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Сальмонеллез (        | Бактерии — из        | Крупный и мелкий       | Путь передачи —    | От 6 ч до 3 сут.,       | Начало острое.          | Исследование крови           | Пищевая                           |
| Сальмонеллёз)         | рода Salmonella (S. | рогатый скот, свиньи,  | пищевой.                | чаще 12—24 ч          | Появляются озноб,    | (умеренный                        | токсикоинфекция,              |
|                                 | typhimurium, S.        | куры, утки, гуси,         | Заражение              |                                 | головная боль и         | нейтрофильный                  | ботулизм, холера,              |
|                                 | heidelberg, S.           | голуби и т. п., а также | происходит чаще    |                                 | головокружение,        | лейкоцитоз со сдвигом       | дизентерия, ротавирусный |
|                                 | enteritidis, S.           | человек — больной и  | при употреблении    |                                 | температура тела      | формулы влево).                | гастроэнтерит,                   |
|                                 | london, S. anatum,   | бактерионоситель       | неправильно           |                                 | повышается до 38—  | Исследование рвотных       | энтеровирусная                 |
|                                 | S. newport, S. derby |                                    | кулинарно               |                                 | 39° и более.               | масс, промывных вод         | инфекция, отравление       |
|                                 | и др.)                      |                                    | обработанных или   |                                 | Отмечаются боли в   | желудка, фекалий с целью | грибами, ботулизм,            |
|                                 |                                |                                    | загрязненных          |                                 | мышцах,                    | выделения возбудителя.    | отравления химическими   |
|                                 |                                |                                    | мясных, яичных      |                                 | тахикардия.               | Реакции агглютинации и     | веществами, острые          |
|                                 |                                |                                    | блюд                      |                                 | Одновременно          | непрямой гемагглютинации | хирургические                   |
|                                 |                                |                                    |                               |                                 | возникают боли в      |                                           | заболевания органов         |
|                                 |                                |                                    |                               |                                 | эпи- и мезогастрии,   |                                           | брюшной полости,             |
|                                 |                                |                                    |                               |                                 | тошнота,                   |                                           | внематочная                      |
|                                 |                                |                                    |                               |                                 | многократная рвота,  |                                           | беременность, инфаркт     |
|                                 |                                |                                    |                               |                                 | частый водянистый   |                                           | миокарда                           |
|                                 |                                |                                    |                               |                                 | зловонный стул с      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | зеленью.                   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Обезвоживание,        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | судороги,                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | артериальная            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гипотензия. При         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | генерализованной      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | форме —                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличение               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | селезенки и печени,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | брадикардия, иногда |                                           |                                          |
|                                 |                                |                                    |                               |                                 | розеолезная сыпь,     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лихорадка длится до |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 2—3 недель              |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Сап                          | Бактерии —            | Домашние животные   | Заражение              | Чаще 1—5 дней       | Начало острое.          | Реакции связывания           | Сепсис, мелиоидоз            |
|                                 | Pseudomonas          | (лошади, ослы, мулы,  | происходит при       | иногда до 3 недель  | Отмечаются озноб,   | комплемента и                   |                                          |
|                                 | mallei                      | верблюды)                  | уходе за больным   |                                 | головная боль,          | агглютинации. Выделение  |                                          |
|                                 |                                |                                    | животным и            |                                 | артралгия, миалгия.   | культуры возбудителя из    |                                          |
|                                 |                                |                                    | соприкосновении с  |                                 | На месте внедрения  | гнойного отделяемого язв,  |                                          |
|                                 |                                |                                    | загрязненными        |                                 | возбудителя              | абсцессов, крови. Кожная  |                                          |
|                                 |                                |                                    | объектами (фураж, |                                 | образуется папула,   | аллергическая проба с       |                                          |
|                                 |                                |                                    | солома и т. п.).       |                                 | которая быстро         | маллеином                         |                                          |
|                                 |                                |                                    | Возбудители           |                                 | превращается в        |                                           |                                          |
|                                 |                                |                                    | проникают через     |                                 | пустулу и язву.         |                                           |                                          |
|                                 |                                |                                    | слизистые               |                                 | Затем появляются     |                                           |                                          |
|                                 |                                |                                    | оболочки                 |                                 | абсцессы в легких,    |                                           |                                          |
|                                 |                                |                                    | дыхательных путей |                                 | мышцах, мягких        |                                           |                                          |
|                                 |                                |                                    | и желудочно-          |                                 | тканях. Гектическая  |                                           |                                          |
|                                 |                                |                                    | кишечного тракта,   |                                 | лихорадка, падение   |                                           |                                          |
|                                 |                                |                                    | через конъюнктиву  |                                | АД. Возможно           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | хроническое течение |                                           |                                          |
|                                 |                                |                                    |                               |                                 | с лихорадкой             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | неправильного типа,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | множественными       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | пустулами и              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гнойными                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | процессами во          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | внутренних органах   |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Североазиатский      | Риккетсии —           | Грызуны — полевки,   | Путь передачи —    | От 2 до 7 дней         | Начало острое.          | Реакция связывания           | Грипп, пневмония,             |
| клещевой                 | Rickettsia sibirica     | полевые и лесные       | трансмиссивный.    |                                 | Отмечаются озноб,   | комплемента и реакция      | клещевой энцефалит,        |
| риккетсиоз               |                                | мыши, домовые          | Переносчики           |                                 | жар, головная боль,   | непрямой гемагглютинации | геморрагическая                |
|                                 |                                | мыши, суслики,           | возбудителей —     |                                 | миалгия,                    | со специфическим             | лихорадка с почечным       |
|                                 |                                | хомяки, бурундуки      | иксодовые клещи    |                                 | температура тела      | антигеном с 5—7-го дней    | синдромом, лихорадка      |
|                                 |                                |                                    | Dermacentor            |                                 | повышается до 39—  | болезни                              | цуцугамуши                       |
|                                 |                                |                                    | nuttalli, D. pictus, D. |                                 | 40°. Характерна         |                                           |                                          |
|                                 |                                |                                    | silvarum и др.          |                                 | ремиттирующая        |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лихорадка                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | длительностью 7—    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 10 дней. Лицо            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гиперемировано,       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | одутловатое              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гиперемия слизистой |                                           |                                          |
|                                 |                                |                                    |                               |                                 | оболочки ротоглотки. |                                           |                                          |
|                                 |                                |                                    |                               |                                 | В месте укуса клеща |                                           |                                          |
|                                 |                                |                                    |                               |                                 | первичный аффект с |                                           |                                          |
|                                 |                                |                                    |                               |                                 | регионарным             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | лимфаденитом,         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | розеолезно-               |                                           |                                          |
|                                 |                                |                                    |                               |                                 | папулезная сыпь.      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Наблюдаются            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | относительная           |                                           |                                          |
|                                 |                                |                                    |                               |                                 | брадикардия,            |                                           |                                          |
|                                 |                                |                                    |                               |                                 | адинамия,                 |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличение печени,   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | реже селезенки         |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Сибирская язва        | Бактерии —            | Домашние и дикие      | Заражение              | От несколькио          | Начало острое. При   | Бактериоскопия мазка        | Карбункул, фурункул,        |
|                                 | Bacillus anthracis     | копытные животные    | происходит при       | часов до 12 дней     | кожной форме:          | отделяемого язвы,             | пневмония, сепсис, рожа,  |
|                                 |                                |                                    | соприкосновении с  | чаще 2—3 дня         | красное пятно,          | мокроты. Выделение          | чума, туляремия, сап,       |
|                                 |                                |                                    | больными               |                                 | которое                     | культуры возбудителя из    | дизентерия, перитонит,      |
|                                 |                                |                                    | животными,            |                                 | превращается в        | крови, мокроты,                  | менингоэнцефалит            |
|                                 |                                |                                    | сырьем (кожа,         |                                 | папулу, затем            | отделяемого язвы.             |                                          |
|                                 |                                |                                    | шерсть, овчина и    |                                 | везикулу, пустулу и   | Заражение лабораторных   |                                          |
|                                 |                                |                                    | др.); пищевым        |                                 | язву, покрытую         | животных. Внутрикожная    |                                          |
|                                 |                                |                                    | путем — при           |                                 | темной коркой,          | аллергическая проба с       |                                          |
|                                 |                                |                                    | употреблении          |                                 | окруженную зоной     | антраксином                       |                                          |
|                                 |                                |                                    | недостаточно          |                                 | гиперемии; резкий     |                                           |                                          |
|                                 |                                |                                    | термически             |                                 | отек мягких тканей.   |                                           |                                          |
|                                 |                                |                                    | обработанного        |                                 | По периферии в        |                                           |                                          |
|                                 |                                |                                    | мяса; воздушно-     |                                 | виде венчика             |                                           |                                          |
|                                 |                                |                                    | пылевым — при      |                                 | располагаются          |                                           |                                          |
|                                 |                                |                                    | вдыхании пыли,      |                                 | вторичные пустулы.  |                                           |                                          |
|                                 |                                |                                    | содержащей споры |                                 | Характерно               |                                           |                                          |
|                                 |                                |                                    | возбудителей;         |                                 | отсутствие болевой   |                                           |                                          |
|                                 |                                |                                    | трансмиссивным     |                                 | чувствительности в   |                                           |                                          |
|                                 |                                |                                    | — переносчиками   |                                 | области язвы и в       |                                           |                                          |
|                                 |                                |                                    | возбудителей          |                                 | зоне отека.                |                                           |                                          |
|                                 |                                |                                    | являются мухи       |                                 | Регионарный             |                                           |                                          |
|                                 |                                |                                    | (жигалки, слепни)    |                                 | лимфаденит.             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Температура тела     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | повышена до 38—     |                                           |                                          |
|                                 |                                |                                    |                               |                                 | 40° и более со 2—3   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | дня болезни. При       |                                           |                                          |
|                                 |                                |                                    |                               |                                 | генерализованной      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | форме —                  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | гипертермия,             |                                           |                                          |
|                                 |                                |                                    |                               |                                 | катаральные              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | явления, боли в         |                                           |                                          |
|                                 |                                |                                    |                               |                                 | груди, одышка,          |                                           |                                          |
|                                 |                                |                                    |                               |                                 | цианоз, тахикардия,  |                                           |                                          |
|                                 |                                |                                    |                               |                                 | коллапс,                    |                                           |                                          |
|                                 |                                |                                    |                               |                                 | кровянистая              |                                           |                                          |
|                                 |                                |                                    |                               |                                 | мокрота, пневмония.  |                                          |                                          |
|                                 |                                |                                    |                               |                                 | Селезенка и печень   |                                           |                                          |
|                                 |                                |                                    |                               |                                 | увеличены.                |                                           |                                          |
|                                 |                                |                                    |                               |                                 | Возможны понос,      |                                           |                                          |
|                                 |                                |                                    |                               |                                 | рвота, метеоризм      |                                           |                                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Скарлатина              | Токсигенные           | Больной человек         | Пути передачи —    | 1—12 дней, чаще     | Начало острое.          | Исследование крови           | Иерсиниоз, токсико-           |
|                                 | гемолитические       |                                    | воздушно-               | 2—7 дней                 | Появляется озноб,     | (нейтрофильный                 | аллергический дерматит    |
|                                 | стрептококки           |                                    | капельный, а также |                                 | температура тела в   | лейкоцитоз со сдвигом       |                                          |
|                                 | группы А                 |                                    | через                      |                                 | течение нескольких   | влево, увеличение СОЭ).    |                                          |
|                                 |                                |                                    | загрязненные          |                                 | часов повышается     | В качестве                         |                                          |
|                                 |                                |                                    | предметы и             |                                 | до 38—40°, рвота,     | вспомогательных методов  |                                          |
|                                 |                                |                                    | пищевые продукты  |                                | головная боль.          | используют определение    |                                          |
|                                 |                                |                                    | (например, молоко) |                                 | Яркая гиперемия       | титров антистрептолизина- |                                          |
|                                 |                                |                                    |                               |                                 | зева, отечность         | О и                                     |                                          |
|                                 |                                |                                    |                               |                                 | небных миндалин и   | антистрептогиалуронидазы |                                          |
|                                 |                                |                                    |                               |                                 | налеты на них. К       |                                           |                                          |
|                                 |                                |                                    |