Частная микробиология. Учебное пособие

ɬɢɩɢɱɧɨɟ ɞɥɹ ɪɢɤɤɟɬɫɢɣ ɫɬɪɨɟɧɢɟ Ɉɛɥɚɞɚɸɬ ɫɩɨɫɨɛɧɨɫɬɶɸ ɤ ɚɤɬɢɜɧɨɦɭ ɞɜɢɠɟ ɧɢɸ ɡɚ ɫɱɟɬ ɨɫɟɜɵɯ ɮɢɛɪɢɥɥ ɇɟ ɨɛɪɚɡɭɸɬ ɫɩɨɪ ɢ ɤɚɩɫɭɥ

ɄɍɅɖɌɍɊȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ ȼɵɪɚɳɢɜɚɸɬ ɜ ɚɧɚɷɪɨɛɧɵɯ ɭɫɥɨɜɢɹɯ ɧɚ ɩɢɬɚɬɟɥɶɧɨɣ ɫɪɟɞɟ ɫ pH ɪɚɜɧɵɦ –7,4. əɜɥɹɸɬɫɹ ɦɢɤɪɨɚɷɪɨɮɢɥɚɦɢ ɉɥɨɯɨ ɤɭɥɶɬɢɜɢɪɭɸɬɫɹ ɧɚ ɢɫɤɭɫɫɬɜɟɧɧɵɯ ɩɢɬɚɬɟɥɶɧɵɯ ɫɪɟɞɚɯ ȼɨɡɦɨɠɟɧ ɪɨɫɬ ɜ ɠɢɞ ɤɢɯ ɫɪɟɞɚɯ ɫ ɫɵɜɨɪɨɬɤɨɣ ɤɪɨɜɢ ɫɪɟɞɚ Ʉɟɥɥɢ

ȺɇɌɂȽȿɇɇȺə ɋɌɊɍɄɌɍɊȺ Ⱥɧɬɢɝɟɧɧɵɟ ɫɜɨɣɫɬɜɚ ɛɨɪɪɟɥɢɣ ɜɚɪɢɚ ɛɟɥɶɧɵ

ɎȺɄɌɈɊɕ ɉȺɌɈȽȿɇɇɈɋɌɂ ɗɧɞɨɬɨɤɫɢɧ – Ʌɉɋ ɤɥɟɬɨɱɧɨɣ ɫɬɟɧɤɢɜɵɡɵɜɚɟɬ ɨɛɳɭɸ ɢɧɬɨɤɫɢɤɚɰɢɸ ɨɪɝɚɧɢɡɦɚ ɝɢɩɟɪɦɢɸ ɩɨɜɵɲɚɟɬ ɩɪɨɧɢɰɚɟ ɦɨɫɬɶ ɤɪɨɜɟɧɨɫɧɵɯ ɫɨɫɭɞɨɜ ɱɬɨ ɜɟɞɟɬ ɤ ɧɚɪɭɲɟɧɢɸ ɮɭɧɤɰɢɢ ɠɢɡɧɟɧɧɨ ɜɚɠɧɵɯ ɨɪɝɚɧɨɜ ɢ ɫɢɫɬɟɦ

ɊȿɁɂɋɌȿɇɌɇɈɋɌɖ ɑɭɜɫɬɜɢɬɟɥɶɧɵ ɤ ɜɵɫɭɲɢɜɚɧɢɸ ɞɟɡɢɧɮɢɰɢɪɭɸ ɳɢɦ ɫɪɟɞɫɬɜɚɦ ɜɵɫɨɤɨɣ ɬɟɦɩɟɪɚɬɭɪɟ ɍɫɬɨɣɱɢɜɨɫɬɶ ɜɨ ɜɧɟɲɧɟɣ ɫɪɟɞɟ ɧɢɡɤɚɹ ɧɨ ɜ ɨɪɝɚɧɢɡɦɟ ɩɟɪɟɧɨɫɱɢɤɚ ɜɲɢ ɤɥɟɳɢ ɦɨɝɭɬ ɜɵɠɢɜɚɬɶ ɞɥɢɬɟɥɶɧɨɟ ɜɪɟɦɹ

ɗɉɂȾȿɆɂɈɅɈȽɂə Ɋɟɡɟɪɜɭɚɪɨɦɢɢɫɬɨɱɧɢɤɨɦɢɧɮɟɤɰɢɢɫɥɭɠɢɬɛɨɥɶ ɧɨɣ ɱɟɥɨɜɟɤ ɇɚɢɛɨɥɶɲɟɟ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɟ ɡɚɛɨɥɟɜɚɧɢɹ ɨɬɦɟɱɚɟɬɫɹ ɜɨ ɜɪɟɦɹ ɜɨɣɧ ɫɨɰɢɚɥɶɧɵɯ ɢ ɩɪɢɪɨɞɧɵɯ ɩɨɬɪɹɫɟɧɢɣ ɩɪɢ ɫɤɭɱɟɧɧɨɦ ɩɪɨɠɢɜɚɧɢɢ ɛɨɥɶ ɲɢɯ ɝɪɭɩɩ ɥɸɞɟɣ ɢ ɜɵɫɨɤɨɣ ɡɚɜɲɢɜɥɟɧɧɨɫɬɢ ɧɚɫɟɥɟɧɢɹ ɉɟɪɟɧɨɫɱɢɤɨɦ ɹɜɥɹɟɬɫɹ ɩɥɚɬɹɧɚɹɜɨɲɶ 3HGLFXOXVKXPDQXVFRUSRULV ɧɚɬɟɥɶɧɚɹ ɛɟɥɶɟɜɚɹ ɪɟɠɟ– ɝɨɥɨɜɧɚɹ3HGLFXOXV KXPDQXV FDSLWLV ɜɨɲɶ

ɉȺɌɈȽȿɇȿɁ ȼɨɡɛɭɞɢɬɟɥɶ ɩɪɨɧɢɤɚɟɬ ɜ ɤɪɨɜɶ ɱɟɪɟɡ ɩɨɜɪɟɠɞɟɧɧɭɸ ɤɨɠɭ Ɋɚɡɦɧɨɠɚɟɬɫɹɜɤɪɨɜɢɢɜɵɡɵɜɚɟɬɩɟɪɜɵɣɩɪɢɫɬɭɩɥɢɯɨɪɚɞɤɢ ɂɦɦɭɧ ɧɚɹ ɫɢɫɬɟɦɚ ɪɟɚɝɢɪɭɟɬ ɧɨ ɛɚɤɬɟɪɢɢ ɢɡɦɟɧɹɸɬ ɚɧɬɢɝɟɧɵ ɜɵɡɵɜɚɹ ɩɨɜɬɨɪɧɵɟ ɩɪɢɫɬɭɩɵ ɉɨɜɪɟɠɞɟɧɢɟ ɫɨɫɭɞɨɜ ɢɧɬɨɤɫɢɤɚɰɢɹ ɝɢɩɨɤɫɢɹ ɬɤɚɧɟɣ

ɄɅɂɇɂɑȿɋɄȺə ɄȺɊɌɂɇȺ ɂɧɤɭɛɚɰɢɨɧɧɨɝɨ ɩɟɪɢɨɞɚ ɜ ɫɪɟɞɧɟɦ 3– ɞɧɟɣ ɉɟɪɜɵɣɥɢɯɨɪɚɞɨɱɧɵɣɩɟɪɢɨɞɩɪɢɜɨɡɜɪɚɬɧɨɦɬɢɮɟɞɥɢɬɫɹ – ɞɧɟɣ ɩɨɫɥɟ ɱɟɝɨ ɧɚɫɬɭɩɚɟɬ ɩɟɪɢɨɞ ɚɩɢɪɟɤɫɢɢ ɩɟɪɢɨɞ ɦɟɠɞɭ ɞɜɭɦɹ ɩɪɢɫɬɭɩɚɦɢ ɥɢɯɨ ɪɚɞɤɢ ɩɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶɸ – ɧɟɞɟɥɢ Ɇɟɠɞɭ ɩɪɢɫɬɭɩɚɦɢ ɫɨɫɬɨɹɧɢɟ ɛɨɥɶɧɵɯ ɭɥɭɱɲɚɟɬɫɹ ɨɞɧɚɤɨ ɫɨɯɪɚɧɹɸɬɫɹ ɫɥɚɛɨɫɬɶ ɧɟɞɨɦɨɝɚɧɢɟ ɫɧɢɠɟɧɢɟ ɚɩɩɟɬɢɬɚ ɉɨɫɥɟɩɟɪɢɨɞɚɚɩɢɪɟɤɫɢɢ ɤɚɤɩɪɚɜɢɥɨ ɧɚɫɬɭɩɚɟɬɜɬɨɪɚɹɜɨɥɧɚɜɨɡɜɪɚɬɧɨɝɨɬɢɮɚ ɫ ɬɟɦɢ ɠɟ ɤɥɢɧɢɱɟɫɤɢɦɢ ɫɢɦɩɬɨɦɚɦɢ Ɉɞɧɚɤɨ ɞɥɢɬɟɥɶɧɨɫɬɶ ɩɨɜɬɨɪɧɨɝɨ ɩɪɢ ɫɬɭɩɚ ɫɨɤɪɚɳɚɟɬɫɹ ɞɨ – ɞɧɟɣ ɚ ɛɟɡɥɢɯɨɪɚɞɨɱɧɵɣ ɢɧɬɟɪɜɚɥ ɧɚɩɪɨɬɢɜ ɭɞɥɢɧɹ ɟɬɫɹ Ɉɛɵɱɧɨ ɩɪɢɫɬɭɩɵ ɜɲɢɜɨɣ ɜɨɡɜɪɚɬɧɨɣ ɥɢɯɨɪɚɞɤɢ ɩɨɜɬɨɪɹɸɬɫɹ – ɪɚɡ ɫ ɤɚɠɞɵɦ ɪɚɡɨɦ ɫɬɚɧɨɜɹɫɶ ɤɨɪɨɱɟ ɢ ɥɟɝɱɟ ɩɪɟɞɵɞɭɳɟɝɨ

ɆȿɌɈȾɕ ȾɂȺȽɇɈɋɌɂɄɂ Ȼɚɤɬɟɪɢɨɥɨɝɢɱɟɫɤɢɣ ȼɵɪɚɳɢɜɚɧɢɟ ɧɚ ɠɢɞɤɢɯ ɫɪɟɞɚɯ ɪɟɞɤɨ ɢɫɩɨɥɶɡɭɟɬɫɹ ɢɡ-ɡɚ ɫɥɨɠɧɨɫɬɢ Ȼɚɤɬɟɪɢɨɫɤɨɩɢɱɟɫɤɢɣ

51

Ɇɢɤɪɨɫɤɨɩɢɹ ɦɚɡɤɨɜ ɤɪɨɜɢ ɨɤɪɚɲɟɧɧɵɯ ɩɨ Ɋɨɦɚɧɨɜɫɤɨɦɭ – Ƚɢɦɡɟ ɋɟɪɨɥɨɝɢ ɱɟɫɤɢɣ Ɋɟɚɤɰɢɹ ɚɝɝɥɸɬɢɧɚɰɢɢ ɂɎȺ ɧɚ ɚɧɬɢɬɟɥɚ Ɇɨɥɟɤɭɥɹɪɧɨ-ɛɢɨɥɨɝɢɱɟ ɫɤɢɣ ɉɐɊ ɞɥɹ ɜɵɹɜɥɟɧɢɹ ȾɇɄ %RUUHOLD

Ʌȿɑȿɇɂȿ Ʌɟɱɟɧɢɟ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɚɧɬɢɛɢɨɬɢɤɚɦɢ ɬɟɬɪɚɰɢɤɥɢɧɨɜɨɝɨ ɪɹɞɚ ȼɨɡɛɭɞɢɬɟɥɶ ɱɭɜɫɬɜɢɬɟɥɟɧ ɬɚɤɠɟ ɤ ɥɟɜɨɦɢɰɟɬɢɧɭ ɪɢɮɚɦɩɢɰɢɧɭ ɢ ɮɬɨɪɯɢ ɧɨɥɨɧɨɜɵɦ ɩɪɟɩɚɪɚɬɚɦ ȼ ɩɚɬɨɝɟɧɟɬɢɱɟɫɤɭɸ ɬɟɪɚɩɢɸ ɜɤɥɸɱɚɸɬ ɞɟɡɢɧɬɨɤɫɢɤɚ ɰɢɨɧɧɵɟ ɢ ɫɟɞɚɬɢɜɧɵɟ ɫɪɟɞɫɬɜɚ ɫɟɪɞɟɱɧɵɟ ɝɥɢɤɨɡɢɞɵ ɞɢɭɪɟɬɢɤɢ Ⱦɥɹ ɩɪɟɞɨɬ ɜɪɚɳɟɧɢɹ ɨɛɪɚɡɨɜɚɧɢɹ ɬɪɨɦɛɨɜ ɩɪɢɦɟɧɹɸɬ ɚɧɬɢɤɨɚɝɭɥɹɧɬɵ

ɉɊɈɎɂɅȺɄɌɂɄȺ. ɋɩɟɰɢɮɢɱɟɫɤɚɹ ȼɚɤɰɢɧɵ ɨɬɫɭɬɫɬɜɭɸɬ. ɇɟɫɩɟɰɢ ɮɢɱɟɫɤɚɹ Ȼɨɪɶɛɚ ɫ ɩɟɞɢɤɭɥɟɡɨɦ ɢ ɤɥɟɳɚɦɢ ɋɚɧɢɬɚɪɧɨ-ɝɢɝɢɟɧɢɱɟɫɤɢɟ ɦɟɪɵ Ɂɚɳɢɬɚ ɨɬ ɭɤɭɫɨɜ ɤɥɟɳɟɣ

ɂɆɆɍɇɂɌȿɌ ɇɟɫɬɨɣɤɢɣ ɜɨɡɦɨɠɧɵ ɩɨɜɬɨɪɧɵɟ ɡɚɪɚɠɟɧɢɹ ɜɲɢɜɵɦ ɜɨɡɜɪɚɬɧɵɦ ɬɢɮɨɦ

4.3. ȻɈɅȿɁɇɖ ɅȺɃɆȺ ɄɅȿɓȿȼɈɃ ȻɈɊɊȿɅɂɈɁ

ɄɅȺɋɋɂɎɂɄȺɐɂə ɩɨɪɹɞɨɤ 6SLURFKDHWDOHV ɫɟɦɟɣɫɬɜɨ 6SLURFKDHWDFHDH ɪɨɞ %RUUHOLD ɜɢɞ %RUUHOLD EXUJGRUIHUL ɨɫɧɨɜɧɨɣ ɜɨɡɛɭɞɢɬɟɥɶ

Borrelia afzelii, Borrelia garinii.

ɆɈɊɎɈɅɈȽɂə ɂ ɌɂɇɄɌɈɊɂȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ ɉɨ ɦɨɪɮɨɥɨ ɝɢɢ ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ ɫɥɟɝɤɚ ɭɩɥɨɳɟɧɧɭɸ ɭɧɞɭɥɢɪɭɸɳɭɸ ɫɩɢɪɚɥɶ ɫɨɫɬɨɹ ɳɭɸ ɢɡ ɨɫɟɜɨɣ ɧɢɬɢ ɜɨɤɪɭɝ ɤɨɬɨɪɨɣ ɧɚɤɪɭɱɟɧɚ ɰɢɬɨɩɥɚɡɦɚ Ⱦɥɢɧɚ ɛɨɪɪɟɥɢɣ ɨɬɞɨ ɦɤɦ ɬɨɥɳɢɧɚ – ɨɬ ɞɨ ɦɤɦ Ɂɚɜɢɬɤɢ ɤɪɭɩɧɵɟ ɱɢɫɥɨɦ ɨɬ ɞɨ ɪɟɞɤɨ ɛɨɥɶɲɟ ɫ ɝɥɭɛɢɧɨɣ ɡɚɜɢɬɤɚ ɞɨ ɦɤɦ Ɋɚɡɦɧɨɠɚɸɬɫɹ ɛɨɪɪɟɥɢɣ ɩɨɩɟɪɟɱ ɧɵɦ ɞɟɥɟɧɢɟɦ Ƚɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɟ ɨɤɪɚɲɢɜɚɸɬɫɹ ɫɥɚɛɨ ɏɨɪɨɲɨ ɜɵɹɜɥɹɸɬɫɹ ɩɨ Ɋɨɦɚɧɨɜɫɤɨɦɭ – Ƚɢɦɡɟ ɮɢɨɥɟɬɨɜɨ-ɪɨɡɨɜɚɹ ɨɤɪɚɫɤɚ ȼɢɡɭɚɥɢɡɢɪɭɸɬɫɹ ɜ ɬɟɦ ɧɨɩɨɥɶɧɨɣ ɦɢɤɪɨɫɤɨɩɢɢ

ɄɍɅɖɌɍɊȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ ɋɬɪɨɝɢɟ ɚɧɚɷɪɨɛɵ ɉɪɢɯɨɬɥɢɜɵ ɤ ɩɢ ɬɚɬɟɥɶɧɵɦ ɫɪɟɞɚɦ ɢ ɭɫɥɨɜɢɹɦ ɤɭɥɶɬɢɜɢɪɨɜɚɧɢɹ Ɉɩɬɢɦɚɥɶɧɚɹ ɬɟɦɩɟɪɚɬɭɪɚɋ Ɋɚɫɬɭɬ ɧɚ ɫɪɟɞɚɯ ɫ ɫɵɜɨɪɨɬɤɨɣ ɤɪɨɜɢ ɢ ɤɭɫɨɱɤɚɦɢ ɬɤɚɧɟɣ Ɋɨɫɬ ɫɤɭɞɧɵɣ ɜɢɞɢɦɵɦ ɫɬɚɧɨɜɢɬɫɹ ɱɟɪɟɡ – ɫɭɬɨɤ

ȺɇɌɂȽȿɇɇȺə ɋɌɊɍɄɌɍɊȺ Ⱥɧɬɢɝɟɧɧɵɣ ɫɨɫɬɚɜ ɩɨɞɜɟɪɠɟɧ ɜɚɪɢɚ ɰɢɹɦ ɜ ɩɪɨɰɟɫɫɟ ɠɢɡɧɟɧɧɨɝɨ ɰɢɤɥɚ ɛɨɪɪɟɥɢɢ ɉɪɢ ɢɯ ɤɭɥɶɬɢɜɢɪɨɜɚɧɢɢ ɧɚ ɩɢɬɚ ɬɟɥɶɧɵɯ ɫɪɟɞɚɯ ɢ ɧɚɯɨɠɞɟɧɢɢ ɜ ɨɪɝɚɧɢɡɦɟ ɱɟɥɨɜɟɤɚ ɧɚ ɩɨɡɞɧɢɯ ɫɬɚɞɢɹɯ ɡɚɛɨɥɟ ɜɚɧɢɹ ɭ ɛɨɪɪɟɥɢɢ ɩɪɟɨɛɥɚɞɚɟɬ ɚɧɬɢɝɟɧ RVS$ ɬɨɝɞɚ ɤɚɤ ɩɪɢ ɩɪɟɛɵɜɚɧɢɢ ɜ ɤɥɟɳɟ ɢ ɜ ɨɪɝɚɧɢɡɦɟ ɱɟɥɨɜɟɤɚ ɧɚ ɪɚɧɧɢɯ ɷɬɚɩɚɯ ɡɚɛɨɥɟɜɚɧɢɹ ɭ ɧɢɯ ɩɪɟɨɛɥɚɞɚɟɬ ɚɧɬɢ ɝɟɧ ospC.

52

ɎȺɄɌɈɊɕ ɉȺɌɈȽȿɇɇɈɋɌɂ Ɏɚɤɬɨɪɵ ɚɞɝɟɡɢɢ Ⱥ ɤɨɥɥɚɝɟɧɫɜɹ ɡɵɜɚɸɳɢɣ ɛɟɥɨɤ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɬɪɨɦɛɨɰɢɬɚɦ. Ȼ ɛɟɥɨɤ ɫɜɹɡɵɜɚɸɳɢɣ ɭɪɨ ɤɢɧɚɡɭ ȼ ɥɢɩɢɞɦɨɞɢɮɢɰɢɪɨɜɚɧɧɵɟ ɛɟɥɤɢ ɧɚɪɭɠɧɨɣ ɦɟɦɛɪɚɧɵ ɨɛɟɫɩɟɱɢ ɜɚɸɬ ɫɩɨɫɨɛɧɨɫɬɶ ɛɨɪɪɟɥɢɢ ɩɪɢɤɪɟɩɥɹɬɶɫɹ ɢ ɩɪɨɧɢɤɚɬɶ ɜ ɤɥɟɬɤɢ ɯɨɡɹɢɧɚ

2.Ɏɚɤɬɨɪɵ ɢɧɜɚɡɢɜɧɨɫɬɢ Ⱥ ɩɨɜɟɪɯɧɨɫɬɧɵɟ ɫɬɪɭɤɬɭɪɵ Ȼ ɩɨɞɜɢɠɧɨɫɬɶ

3.Ɍɨɤɫɢɧɨɨɛɪɚɡɨɜɚɧɢɟ – ɷɧɞɨɬɨɤɫɢɧ Ɏɚɤɬɨɪɵ ɚɝɪɟɫɫɢɜɧɨɫɬɢ. Ⱥ ȼɪɟɡɭɥɶ ɬɚɬɟ ɜɡɚɢɦɨɞɟɣɫɬɜɢɹ ɛɨɪɪɟɥɢɢ ɫ ɦɚɤɪɨɮɚɝɚɦɢ ɩɪɨɢɫɯɨɞɢɬ ɜɵɞɟɥɟɧɢɟ ɂɅ-1, ɤɨ ɬɨɪɵɣɢɧɞɭɰɢɪɭɟɬɜɨɫɩɚɥɢɬɟɥɶɧɵɣɩɪɨɰɟɫɫ Ȼ Osp Ⱥ-ɩɪɨɬɟɢɧɩɪɢɧɢɦɚɟɬɭɱɚɫɬɢɟ ɜ ɪɚɡɜɢɬɢɢ ɢɦɦɭɧɨɩɚɬɨɥɨɝɢɱɟɫɤɢɯ ɪɟɚɤɰɢɣ ɩɪɢɜɨɞɹɳɢɯ ɤ ɪɚɡɜɢɬɢɸ ɚɪɬɪɢɬɨɜ

ɊȿɁɂɋɌȿɇɌɇɈɋɌɖ ȼɨ ɜɧɟɲɧɟɣ ɫɪɟɞɟ ɛɨɪɪɟɥɢɢ ɦɚɥɨ ɭɫɬɨɣɱɢɜɵ ɩɪɢ ɬɟɦɩɟɪɚɬɭɪɟ ɋ ɩɨɝɢɛɚɸɬ ɜ ɬɟɱɟɧɢɟ – ɦɢɧ ȼ ɩɢɬɚɬɟɥɶɧɵɯ ɫɪɟɞɚɯ ɜ ɡɚɜɢ ɫɢɦɨɫɬɢ ɨɬ ɬɟɦɩɟɪɚɬɭɪɵ ɦɨɝɭɬ ɫɨɯɪɚɧɹɬɶɫɹ ɨɬ ɧɟɫɤɨɥɶɤɢɯ ɞɧɟɣ ɞɨ ɧɟɫɤɨɥɶɤɢɯ ɦɟɫɹɰɟɜ ȼ ɤɪɨɜɢ ɩɪɢ ɧɢɡɤɨɣ ɬɟɦɩɟɪɚɬɭɪɟ ɋ ɦɨɝɭɬ ɬɚɤɠɟ ɫɨɯɪɚɧɹɬɶɫɹ ɧɟ ɫɤɨɥɶɤɨ ɦɟɫɹɰɟɜ

ɗɉɂȾȿɆɂɈɅɈȽɂə ɂɫɬɨɱɧɢɤ ɢɧɮɟɤɰɢɢ ɢɧɮɢɰɢɪɨɜɚɧɧɵɟ ɢɤɫɨɞɨɜɵɟ ɤɥɟɳɢ ,[RGHV ULFLQXV ,[RGHV SHUVXOFDWXV Ɇɟɯɚɧɢɡɦ ɩɟɪɟɞɚɱɢ ɬɪɚɧɫɦɢɫɫɢɜɧɵɣɱɟɪɟɡɭɤɭɫɤɥɟɳɚ ɉɪɢɪɨɞɧɵɟɨɱɚɝɢ ɥɟɫɧɵɟɢɥɟɫɨɫɬɟɩɧɵɟɡɨɧɵȿɜɪɨɩɵ Ⱥɡɢɢ ɋɟɜɟɪɧɨɣ Ⱥɦɟɪɢɤɢ ɉɢɤ ɡɚɛɨɥɟɜɚɟɦɨɫɬɢ – ɜɟɫɧɚ-ɥɟɬɨ ɩɟɪɢɨɞ ɚɤɬɢɜɧɨɫɬɢ ɤɥɟ ɳɟɣ

ɉȺɌɈȽȿɇȿɁ ɉɚɬɨɝɟɧɟɡɫɜɹɡɚɧɫɪɚɫɩɪɨɫɬɪɚɧɟɧɢɟɦɜɨɡɛɭɞɢɬɟɥɹɢɡɦɟɫɬɚ ɭɤɭɫɚ ɱɟɪɟɡ ɨɤɪɭɠɚɸɳɭɸ ɤɨɠɭ ɫ ɩɨɫɥɟɞɭɸɳɟɣ ɞɢɫɫɟɦɢɧɚɰɢɟɣ ɫ ɬɨɤɨɦ ɤɪɨɜɢ ɤ ɪɚɡɥɢɱɧɵɦ ɨɪɝɚɧɚɦ ɨɫɨɛɟɧɧɨ ɫɟɪɞɰɭ ɐɇɋ ɫɭɫɬɚɜɚɦ Ɂɚɛɨɥɟɜɚɧɢɟ ɫɨɩɪɨɜɨɠɞɚ ɟɬɫɹ ɪɚɡɜɢɬɢɟɦ ɚɭɬɨɢɦɦɭɧɧɵɯ ɢ ɢɦɦɭɧɨɩɚɬɨɥɨɝɢɱɟɫɤɢɯ ɩɪɨɰɟɫɫɨɜ

ɄɅɂɇɂɑȿɋɄȺə ɄȺɊɌɂɇȺ Ʉɥɢɧɢɤɚ ɩɨɞɪɚɡɞɟɥɹɟɬɫɹ ɧɚ ɫɬɚɞɢɢ

1.Ɇɢɝɪɢɪɭɸɳɚɹ ɷɪɢɬɟɦɚ ɤɨɬɨɪɚɹ ɫɨɩɪɨɜɨɠɞɚɟɬɫɹ ɪɚɡɜɢɬɢɟɦ ɝɪɢɩɩɨɩɨ ɞɨɛɧɨɝɨ ɫɢɦɩɬɨɦɨɤɨɦɩɥɟɤɫɚ ɥɢɦɮɚɞɟɧɢɬɚ ɢ ɩɨɹɜɥɟɧɢɟɦ ɜ ɦɟɫɬɟ ɭɤɭɫɚ ɤɥɟɳɚ ɤɨɥɶɰɟɜɢɞɧɨɣ ɷɪɢɬɟɦɵ ɤɨɬɨɪɚɹ ɛɵɫɬɪɨ ɭɜɟɥɢɱɢɜɚɟɬɫɹ ɜ ɪɚɡɦɟɪɚɯ Ɋɚɡɜɢɬɢɟ ɞɨɛɪɨɤɚɱɟɫɬɜɟɧɧɵɯ ɩɨɪɚɠɟɧɢɣ ɫɟɪɞɰɚ ɢ ɐɇɋ ɜ ɜɢɞɟ ɦɢɨɤɚɪɞɢɬɚ ɢ ɚɫɟɩɬɢɱɟɫɤɨɝɨ ɦɟɧɢɧɝɢɬɚ ɤɨɬɨɪɵɟ ɧɚɫɬɭɩɚɸɬ ɧɚ –5-ɣ ɧɟɞɟɥɟ ɡɚɛɨɥɟɜɚɧɢɹ ɢ ɩɪɨɬɟɤɚɸɬ ɜ ɬɟɱɟɧɢɟ ɨɞɧɨɝɨ ɢɥɢ ɧɟɫɤɨɥɶɤɢɯ ɦɟɫɹɰɟɜ Ɋɚɡɜɢɬɢɟ ɚɪɬɪɢɬɨɜ ɤɪɭɩɧɵɯ ɫɭɫɬɚɜɨɜ ɱɟɪɟɡ ɧɟɞɟɥɶ ɢ ɛɨɥɟɟ ɨɬ ɧɚɱɚɥɚ ɡɚɛɨɥɟɜɚɧɢɹ Ɂɚɛɨɥɟɜɚɧɢɟ ɩɪɨɬɟɤɚɟɬ ɞɨɛɪɨɤɚɱɟ ɫɬɜɟɧɧɨ ɉɪɨɝɧɨɡ ɛɥɚɝɨɩɪɢɹɬɧɵɣ

ɆȿɌɈȾɕ ȾɂȺȽɇɈɋɌɂɄɂ Ȼɚɤɬɟɪɢɨɥɨɝɢɱɟɫɤɢɣ Ʉɭɥɶɬɢɜɢɪɨɜɚɧɢɟ %RUUHOLD ɜ ɫɪɟɞɟ Ʉɟɥɥɢ ɫɥɨɠɧɨ ɢ ɪɟɞɤɨ ɢɫɩɨɥɶɡɭɟɬɫɹ Ȼɚɤɬɟɪɢɨɫɤɨɩɢɱɟɫɤɢɣ Ɍɟɦɧɨɩɨɥɶɧɚɹ ɦɢɤɪɨɫɤɨɩɢɹ ɤɪɨɜɢ ɢɥɢ ɥɢɤɜɨɪɚ ɋɟɪɨɥɨɝɢɱɟɫɤɢɣ ɂɎȺ ɢɦɦɭ ɧɨɛɥɨɬ ɩɨɢɫɤ ɚɧɬɢɬɟɥ ,J0 ,J* ɊɇɂɎ Ɇɨɥɟɤɭɥɹɪɧɨ-ɛɢɨɥɨɝɢɱɟɫɤɢɣ ɉɐɊ ɞɥɹ ɜɵɹɜɥɟɧɢɹ ȾɇɄ %RUUHOLD ɜ ɤɪɨɜɢ ɥɢɤɜɨɪɟ ɫɭɫɬɚɜɧɨɣ ɠɢɞɤɨɫɬɢ

53

Ʌȿɑȿɇɂȿ Ⱥɧɬɢɛɢɨɬɢɤɢ ɪɚɧɧɹɹ ɫɬɚɞɢɹ ɞɨɤɫɢɰɢɤɥɢɧ ɚɦɨɤɫɢɰɢɥɥɢɧ ɉɨɡɞɧɢɟ ɫɬɚɞɢɢ ɰɟɮɬɪɢɚɤɫɨɧ ɩɟɧɢɰɢɥɥɢɧ ɜ ɜ ɩɪɢ ɧɟɣɪɨɛɨɪɪɟɥɢɨɡɟ ɋɢɦɩɬɨ ɦɚɬɢɱɟɫɤɚɹ ɬɟɪɚɩɢɹ ɇɉȼɋ ɤɚɪɞɢɨɩɪɨɬɟɤɬɨɪɵ ɧɟɣɪɨɩɪɨɬɟɤɬɨɪɵ

ɉɊɈɎɂɅȺɄɌɂɄȺ ɋɩɟɰɢɮɢɱɟɫɤɚɹ ɩɪɨɮɢɥɚɤɬɢɤɚ ɧɟ ɪɚɡɪɚɛɨɬɚɧɚ ɇɟ ɫɩɟɰɢɮɢɱɟɫɤɚɹ ɩɪɨɮɢɥɚɤɬɢɤɚ ɫɜɨɞɢɬɫɹ ɤ ɢɫɩɨɥɶɡɨɜɚɧɢɸ ɡɚɳɢɬɧɨɣ ɨɞɟɠɞɵ ɢ ɛɨɪɶɛɟ ɫ ɤɥɟɳɚɦɢ

ɂɆɆɍɇɂɌȿɌ Ƚɭɦɨɪɚɥɶɧɵɣ ɜɢɞɨɫɩɟɰɢɮɢɱɟɫɤɢɣ ɤ ɚɧɬɢɝɟɧɚɦ ɤɥɟɬɨɱ ɧɨɣ ɫɬɟɧɤɢ ɛɨɪɪɟɥɢɣ

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5. ɂɇɎȿɄɐɂɂ ɉȿɊȿȾȺɘɓɂȿɋə ɉɈɅɈȼɕɆ ɉɍɌȿɆȼȿɇȿɊɂɑȿɋɄɂȿ ɁȺȻɈɅȿȼȺɇɂə Ɂɉɉɉ)

5.1. ɋɂɎɂɅɂɋ

ɄɅȺɋɋɂɎɂɄȺɐɂə ɩɨɪɹɞɨɤ – 6SLURFKDHWDOHV ɫɟɦɟɣɫɬɜɨ – 6SLURKDHWDFHD ɪɨɞ – Treponema; ɜɢɞ – Treponema pallidum

ɆɈɊɎɈɅɈȽɂə ɂ ɌɂɇɄɌɈɊɂȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ Treponema

SDOOLGXPɩɪɟɞɫɬɚɜɥɹɟɬɫɨɛɨɣɫɩɢɪɚɥɶɧɭɸɛɚɤɬɟɪɢɸ ɫɩɢɪɢɥɥɭ ɢɦɟɸɳɭɸɯɚɪɚɤ ɬɟɪɧɭɸ ɮɨɪɦɭ ɫ ɧɟɫɤɨɥɶɤɢɦɢ ɜɢɬɤɚɦɢ ɧɚɩɨɦɢɧɚɸɳɢɦɢ ɲɧɭɪ ɢɥɢ ɩɪɭɠɢɧɭ Ɋɚɡɦɟɪɵ ɛɚɤɬɟɪɢɣ ɞɥɢɧɚ ɨɛɵɱɧɨ ɨɤɨɥɨ –15 ɦɤɦ ɲɢɪɢɧɚ – ɦɤɦ Ɉɧɢ ɨɛ ɥɚɞɚɸɬ ɜɵɫɨɤɨɣ ɩɨɞɜɢɠɧɨɫɬɶɸ ɛɥɚɝɨɞɚɪɹ ɮɥɚɝɟɥɥɚɦ ɪɚɫɩɨɥɨɠɟɧɧɵɦ ɜ ɩɟ ɪɢɩɥɚɡɦɚɬɢɱɟɫɤɨɦ ɩɪɨɫɬɪɚɧɫɬɜɟ ɦɟɠɞɭ ɦɟɦɛɪɚɧɨɣ ɢ ɤɥɟɬɨɱɧɨɣ ɫɬɟɧɤɨɣ Ɉɤɪɚɲɢɜɚɧɢɟ ɢɡ-ɡɚ ɫɜɨɟɣ ɬɨɧɤɨɣ ɫɬɪɭɤɬɭɪɵ ɢ ɥɢɩɢɞɧɨɣ ɦɟɦɛɪɚɧɵ 7UHSRQHPD SDOOLGXP ɧɟ ɨɤɪɚɲɢɜɚɟɬɫɹ ɫɬɚɧɞɚɪɬɧɵɦɢ ɤɪɚɫɢɬɟɥɹɦɢ ɬɚɤɢɦɢ ɤɚɤ ɝɪɚɦɦ-ɨɤɪɚ ɲɢɜɚɧɢɟ Ɉɞɧɚɤɨ ɞɥɹ ɢɯ ɜɵɹɜɥɟɧɢɹ ɩɪɢɦɟɧɹɸɬɫɹ ɫɩɟɰɢɚɥɶɧɵɟ ɦɟɬɨɞɵ ɬɚɤɢɟ ɤɚɤ ɦɟɬɨɞ ɬɟɦɧɨɝɨ ɩɨɥɹ ɞɢɮɮɟɪɟɧɰɢɚɥɶɧɵɣ ɦɢɤɪɨɫɤɨɩ ɩɨɡɜɨɥɹɟɬ ɭɜɢɞɟɬɶ ɛɚɤɬɟɪɢɢ ɜ ɢɫɯɨɞɧɨɣ ɧɟɨɤɪɚɲɟɧɧɨɣ ɮɨɪɦɟ Ɇɟɬɨɞ ɫɟɪɟɛɪɟɧɢɹ: ɩɪɢɦɟɧɹɸɬɫɹ ɪɚɡɥɢɱɧɵɟ ɜɚɪɢɚɧɬɵ ɫɟɪɟɛɪɟɧɢɹ ɧɚɩɪɢɦɟɪ ɩɨ Ƚɢɦɡɟ ɢɥɢ ɩɨ ȼɚɪɬɟɧɲɬɟɣɧɭ ɞɥɹ ɜɵɹɜɥɟɧɢɹ ɬɪɟɩɨɧɟɦ Ɏɥɭɨɪɟɫɰɟɧɬɧɵɟ ɦɟɬɨɞɵ ɢɫɩɨɥɶɡɨɜɚɧɢɟ ɚɧɬɢɬɟɥ ɦɟɱɟɧ ɧɵɯ ɮɥɭɨɪɟɫɰɟɧɬɧɵɦɢ ɦɟɬɤɚɦɢ ɩɨɡɜɨɥɹɟɬ ɨɛɧɚɪɭɠɢɬɶ ɛɚɤɬɟɪɢɢ ɜ ɦɚɡɤɚɯ

ɄɍɅɖɌɍɊȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ ȼɨɡɛɭɞɢɬɟɥɶ ɫɢɮɢɥɢɫɚ ɹɜɥɹɟɬɫɹ ɦɢɤ ɪɨɚɷɪɨɮɢɥɨɦ Ȼɥɟɞɧɚɹ ɬɪɟɩɨɧɟɦɚ ɩɥɨɯɨ ɪɚɫɬɟɬ ɧɚ ɩɢɬɚɬɟɥɶɧɵɯ ɫɪɟɞɚɯ ɩɨɷɬɨɦɭ ɤɭɥɶɬɭɪɚɥɶɧɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɩɪɢ ɞɢɚɝɧɨɫɬɢɤɟ ɫɢɮɢɥɢɫɚ ɜ ɥɚɛɨɪɚɬɨɪɧɨɣ ɩɪɚɤ ɬɢɤɟɧɟɩɪɢɦɟɧɹɟɬɫɹ Ʉɭɥɶɬɢɜɢɪɭɟɦɵɟɧɚɩɢɬɚɬɟɥɶɧɵɯɫɪɟɞɚɯɫɩɢɪɨɯɟɬɵɬɟɪɹɸɬ ɩɚɬɨɝɟɧɧɵɟ ɫɜɨɣɫɬɜɚ Ⱦɥɹ ɩɨɥɭɱɟɧɢɹ ɤɭɥɶɬɭɪɵ ɬɪɟɩɨɧɟɦ ɜɨɡɛɭɞɢɬɟɥɶ ɫɢɮɢɥɢɫɚ ɤɭɥɶɬɢɜɢɪɭɟɬɫɹ ɩɭɬɟɦ ɡɚɪɚɠɟɧɢɹ ɤɪɨɥɢɤɨɜ Ɋɚɡɦɧɨɠɟɧɢɟ ɛɥɟɞɧɨɣ ɬɪɟɩɨɧɟɦɵ ɩɪɨɢɫɯɨɞɢɬ ɜ ɭɡɤɨɦ ɢɧɬɟɪɜɚɥɟ ɬɟɦɩɟɪɚɬɭɪ – ɨɤɨɥɨ °ɋ

ȺɇɌɂȽȿɇɇȺə ɋɌɊɍɄɌɍɊȺ ɍ ɜɨɡɛɭɞɢɬɟɥɹ ɫɢɮɢɥɢɫɚ ɨɩɪɟɞɟɥɹɸɬɫɹ ɛɟɥɤɨɜɵɟ ɩɨɥɢɫɚɯɚɪɢɞɧɵɟ ɢ ɥɢɩɢɞɧɵɟ ɚɧɬɢɝɟɧɵ ɇɚɢɛɨɥɟɟ ɢɡɜɟɫɬɧɵɦ ɹɜɥɹɟɬɫɹ ɬɚɤ ɧɚɡɵɜɚɟɦɵɣ «ɚɧɬɢɝɟɧ ȼɚɫɫɟɪɦɚɧɧɚ» ɢɥɢ «ɤɚɪɞɢɨɥɢɩɢɧɨɜɵɣ ɚɧɬɢɝɟɧ».

Ɉɧ ɫɨɞɟɪɠɢɬɫɹ ɧɟ ɬɨɥɶɤɨ ɜ ɫɨɫɬɚɜɟ ɬɪɟɩɨɧɟɦ ɧɨ ɢ ɜ ɫɟɪɞɟɱɧɨɣ ɦɵɲɰɟ ɦɥɟɤɨɩɢ ɬɚɸɳɢɯ ɩɨɷɬɨɦɭ ɷɤɫɬɪɚɤɬ ɥɢɩɨɩɪɨɬɟɢɞɨɜ ɢɡ ɫɟɪɞɰɚ ɛɵɤɚ ɢɫɩɨɥɶɡɭɟɬɫɹ ɜ ɞɢɚ ɝɧɨɫɬɢɱɟɫɤɢɯɫɟɪɨɥɨɝɢɱɟɫɤɢɯ ɪɟɚɤɰɢɹɯ ɉɨɫɜɨɟɣɯɢɦɢɱɟɫɤɨɣɫɬɪɭɤɬɭɪɟɷɬɨɬɚɧ ɬɢɝɟɧ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɞɢɮɨɫɮɚɞɢɥɝɥɢɰɟɪɢɧ Ⱥɧɬɢɬɟɥɚ ɤ ɷɬɨɦɭ ɚɧɬɢɝɟɧɭ ɨɛ ɪɚɡɭɸɬɫɹ ɬɨɥɶɤɨ ɭ ɛɨɥɶɧɵɯ ɫɢɮɢɥɢɫɨɦ ɱɬɨ ɢɫɩɨɥɶɡɭɟɬɫɹ ɩɪɢ ɞɢɚɝɧɨɫɬɢɤɟ ɡɚɛɨ ɥɟɜɚɧɢɹ ɪɟɚɤɰɢɹ ȼɚɫɫɟɪɦɚɧɧɚ – ɪɟɚɤɰɢɹ ɫɜɹɡɵɜɚɧɢɹ ɤɨɦɩɥɟɦɟɧɬɚ

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ɎȺɄɌɈɊɕ ɉȺɌɈȽȿɇɇɈɋɌɂ Ȼɟɥɤɢ ɜɧɟɲɧɟɣ ɦɟɦɛɪɚɧɵ Tromp1 ɢ

Tromp2 (Treponema pallidum rare outer membrane protein 1, 2 – ɪɟɞɤɢɟ ɛɟɥɤɢ ɧɚɪɭɠɧɨɣɦɟɦɛɪɚɧɵ ɫɩɨɫɨɛɫɬɜɭɸɳɢɟ ɚɞɝɟɡɢɢ ɜɨɡɛɭɞɢɬɟɥɹ ɧɚ ɤɥɟɬɤɚɯ ɯɨɡɹɢɧɚ ɝɢɚɥɭɪɨɧɢɞɚɡɚ ɨɛɥɟɝɱɚɸɳɚɹ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɟ ɜɨɡɛɭɞɢɬɟɥɹ ɩɨ ɬɤɚɧɹɦ ɢ ɩɟɪɢ ɜɚɫɤɭɥɹɪɧɭɸ ɢɧɮɢɥɶɬɪɚɰɢɸ ɬɤɚɧɟɣ ɭɫɤɨɥɶɡɚɧɢɟ ɨɬ ɮɚɝɨɰɢɬɨɡɚ ɡɚ ɫɱɟɬ ɨɛɪɚ ɡɨɜɚɧɢɹ ɧɚ ɫɜɨɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɫɥɨɹ ɮɢɛɪɨɧɟɤɬɢɧɚ ɩɟɪɢɩɥɚɡɦɚɬɢɱɟɫɤɢɟ ɠɝɭ ɬɢɤɢ ɮɢɦɛɪɢɢ ɨɛɟɫɩɟɱɢɜɚɸɳɢɟ ɯɟɦɨɬɚɤɫɢɫ ɢ ɫɩɨɫɨɛɧɨɫɬɶ ɜɧɟɞɪɹɬɶɫɹ ɜ ɦɟɠ ɤɥɟɬɨɱɧɨɟɩɪɨɫɬɪɚɧɫɬɜɨɷɧɞɨɬɟɥɢɹ ɮɨɪɦɢɪɨɜɚɧɢɟɩɨɥɢɦɟɦɛɪɚɧɧɵɯɮɚɝɨɫɨɦ,

ɨɛɟɫɩɟɱɟɧɢɟ ɧɟɡɚɜɟɪɲɟɧɧɨɝɨ ɮɚɝɨɰɢɬɨɡɚ ɢ ɞɥɢɬɟɥɶɧɨɟ ɫɨɯɪɚɧɟɧɢɟ ɬɪɟɩɨɧɟɦ ɜ ɨɪɝɚɧɢɡɦɟ

ɊȿɁɂɋɌȿɇɌɇɈɋɌɖ ɉɪɢɤɢɩɹɱɟɧɢɢ– ɩɨɝɢɛɚɟɬɩɪɚɤɬɢɱɟɫɤɢɦɝɧɨɜɟɧɧɨ ɑɭɜɫɬɜɢɬɟɥɶɧɵ ɤ ɤɢɫɥɨɬɚɦ ɫɨɥɹɦ ɬɹɠɟɥɵ ɦɟɬɚɥɥɨɜ ɞɟɡɢɧɮɢɰɢɪɭɸɳɢɦ ɜɟɳɟ ɫɬɜɚɦ ɜ ɨɛɵɱɧɵɯ ɤɨɧɰɟɧɬɪɚɰɢɹɯ

ɗɉɂȾȿɆɂɈɅɈȽɂə ɂɫɬɨɱɧɢɤ ɢɧɮɟɤɰɢɢ – ɛɨɥɶɧɨɣ ɫɢɮɢɥɢɫɨɦ ɱɟɥɨ ɜɟɤ ɇɚɢɛɨɥɶɲɭɸ ɨɩɚɫɧɨɫɬɶ ɩɪɟɞɫɬɚɜɥɹɸɬ ɛɨɥɶɧɵɟ ɫ ɚɤɬɢɜɧɵɦɢ ɩɪɨɹɜɥɟɧɢɹɦɢ ɫɢɮɢɥɢɫɚ ɜ ɩɟɪɜɢɱɧɨɦ ɢ ɜɬɨɪɢɱɧɨɦ ɩɟɪɢɨɞɚɯ Ȼɨɥɶɧɵɟ ɫ ɩɨɡɞɧɢɦɢ ɮɨɪɦɚɦɢ ɫɢ ɮɢɥɢɬɢɱɟɫɤɨɣ ɢɧɮɟɤɰɢɢ ɦɚɥɨ ɤɨɧɬɚɝɢɨɡɧɵ ȼ ɟɫɬɟɫɬɜɟɧɧɵɯ ɭɫɥɨɜɢɹɯ ɛɨɥɟɟɬ ɬɨɥɶɤɨ ɱɟɥɨɜɟɤ ɠɢɜɨɬɧɵɟ ɧɟ ɜɨɫɩɪɢɢɦɱɢɜɵ ɤ ɞɚɧɧɨɦɭ ɡɚɛɨɥɟɜɚɧɢɸ ȼ ɷɤɫɩɟɪɢ ɦɟɧɬɚɥɶɧɵɯ ɰɟɥɹɯ ɜɨɡɦɨɠɧɨ ɡɚɪɚɠɟɧɢɟ ɨɛɟɡɶɹɧ ɢ ɤɪɨɥɢɤɨɜ Ɂɚɛɨɥɟɜɚɧɢɟ ɭ ɱɟɥɨ ɜɟɤɚ ɪɚɫɩɪɨɫɬɪɚɧɟɧɨ ɩɨɜɫɟɦɟɫɬɧɨ Ɇɟɯɚɧɢɡɦ ɩɟɪɟɞɚɱɢ – ɤɨɧɬɚɤɬɧɵɣ Ɉɫɧɨɜ ɧɨɣ ɩɭɬɶ ɩɟɪɟɞɚɱɢ – ɩɨɥɨɜɨɣ ɪɟɠɟ – ɤɨɧɬɚɤɬɧɨ-ɛɵɬɨɜɨɣ ɢ ɬɪɚɧɫɩɥɚɰɟɧɬɚɪɧɵɣ

ɉȺɌɈȽȿɇȿɁ Ɂɚɪɚɠɟɧɢɟ ɫɢɮɢɥɢɫɨɦ ɩɪɨɢɫɯɨɞɢɬ ɱɟɪɟɡ ɦɢɤɪɨɬɪɚɜɦɵ ɤɨɠɢ ɢɥɢ ɫɥɢɡɢɫɬɵɯ ɨɛɨɥɨɱɟɤ ɩɨɥɨɜɵɯ ɩɭɬɟɣ ɪɬɚ ɩɪɹɦɨɣ ɤɢɲɤɢ ɉɨɫɥɟ ɩɪɨ ɧɢɤɧɨɜɟɧɢɹ ɜ ɨɪɝɚɧɢɡɦ 7 SDOOLGXPɜɡɚɢɦɨɞɟɣɫɬɜɭɟɬ ɫ ɮɢɛɪɨɧɟɤɬɢɧɨɦ ɢ ɞɪɭɝɢɦɢ ɤɥɟɬɨɱɧɵɦɢ ɪɟɰɟɩɬɨɪɚɦɢ ɨɪɝɚɧɢɡɦɚ ɉɨɫɥɟ ɚɞɝɟɡɢɢ ɛɥɚɝɨɞɚɪɹ ɜɢɧɬɨɨɛɪɚɡɧɵɦ ɞɜɢɠɟɧɢɹɦ ɬɪɟɩɨɧɟɦɵ ɜɯɨɞɹɬ ɜ ɤɨɧɬɚɤɬ ɫ ɷɧɞɨɬɟɥɢɟɦ ɫɨɫɭɞɨɜ ɢ ɪɚɡɪɭɲɚɸɬ ɫɨ ɟɞɢɧɢɬɟɥɶɧɭɸ ɬɤɚɧɶ ɜɨɤɪɭɝ ɫɨɫɭɞɨɜ ɜ ɪɟɡɭɥɶɬɚɬɟ ɱɟɝɨ ɫɬɟɧɤɢ ɫɨɫɭɞɨɜ ɫɩɚɞɚ ɸɬɫɹ Ɋɚɡɜɢɜɚɟɬɫɹ ɬɪɨɦɛɨɡ ɷɧɞɨɩɟɪɢɚɪɬɟɪɢɢɬɵ ɧɟɤɪɨɡ ɢ ɢɡɴɹɡɜɥɟɧɢɟ ɬɤɚɧɟɣ ȼ ɪɟɡɭɥɶɬɚɬɟ ɷɬɨɝɨ ɜɨɡɧɢɤɚɟɬ ɩɟɪɜɢɱɧɵɣ ɚɮɮɟɤɬ ɜ ɜɢɞɟ ɭɩɥɨɬɧɟɧɧɨɣ ɩɚɩɭɥɵ Ɂɚ ɬɟɦ ɩɨɜɟɪɯɧɨɫɬɶ ɟɟ ɧɟɤɪɨɬɢɡɢɪɭɟɬɫɹ ɫ ɨɛɪɚɡɨɜɚɧɢɟɦ ɷɪɨɡɢɢ ɢɥɢ ɹɡɜɵ ɫ ɱɟɬɤɢɦɢ ɝɪɚɧɢɰɚɦɢ Ȼɥɟɞɧɚɹ ɬɪɟɩɨɧɟɦɚ ɩɪɢ ɷɬɨɦ ɧɚɯɨɞɢɬɫɹ ɜ ɦɟɠɷɩɢɬɟɥɢɚɥɶɧɨɦ ɩɪɨ ɫɬɪɚɧɫɬɜɟ ɜ ɢɧɜɚɝɢɧɚɰɢɹɯ ɤɥɟɬɨɤ ɷɧɞɨɬɟɥɢɹ ɜɧɭɬɪɢ ɥɢɦɮɚɬɢɱɟɫɤɢɯ ɫɨɫɭɞɨɜ ɢ ɥɢɦɮɨɭɡɥɨɜ ȼ ɩɨɫɥɟɞɭɸɳɟɦ ɜɨɡɛɭɞɢɬɟɥɶ ɦɢɝɪɢɪɭɟɬ ɜ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ ɚ ɡɚɬɟɦ ɜ ɤɪɨɜɶ ɋ ɬɨɤɨɦ ɤɪɨɜɢ ɨɧ ɞɢɫɫɟɦɢɧɢɪɭɟɬ ɩɨ ɨɪɝɚɧɢɡɦɭ ɋɨ ɜɪɟɦɟɧɟɦ ɪɚɡ ɜɢɜɚɸɬɫɹ ɢɦɦɭɧɧɵɟ ɪɟɚɤɰɢɢ ɨɪɝɚɧɢɡɦɚ ɩɪɟɩɹɬɫɬɜɭɸɳɢɟ ɞɚɥɶɧɟɣɲɟɦɭ ɪɚɫɩɪɨ ɫɬɪɚɧɟɧɢɸ ɜɨɡɛɭɞɢɬɟɥɹ ɧɨ ɧɟ ɨɛɟɫɩɟɱɢɜɚɸɳɢɟ ɩɨɥɧɨɣ ɷɥɢɦɢɧɚɰɢɢ ɬɪɟɩɨɧɟɦ

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ɄɅɂɇɂɑȿɋɄȺə ɄȺɊɌɂɇȺ ɋɢɮɢɥɢɫ ɩɪɨɬɟɤɚɟɬ ɜ ɧɟɫɤɨɥɶɤɨ ɫɬɚɞɢɣ ɤɚɠɞɚɹ ɢɡ ɤɨɬɨɪɵɯ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɨɩɪɟɞɟɥɟɧɧɵɦɢ ɤɥɢɧɢɱɟɫɤɢɦɢ ɩɪɨɹɜɥɟɧɢ ɹɦɢ ɉɟɪɜɢɱɧɵɣ ɫɢɮɢɥɢɫ ɩɟɪɢɨɞ ɢɧɤɭɛɚɰɢɢ – ɞɧɟɣ Ɉɫɧɨɜɧɨɣ ɫɢɦɩ ɬɨɦ ɧɚ ɦɟɫɬɟ ɜɧɟɞɪɟɧɢɹ ɛɚɤɬɟɪɢɣ ɱɚɳɟ ɧɚ ɝɟɧɢɬɚɥɢɹɯ ɚɧɭɫɟ ɝɭɛɚɯ ɪɟɠɟ – ɧɚ ɞɪɭɝɢɯɱɚɫɬɹɯɬɟɥɚ ɩɨɹɜɥɹɟɬɫɹɛɟɡɛɨɥɟɡɧɟɧɧɚɹɹɡɜɚ ɲɚɧɤɪ əɡɜɚɨɛɵɱɧɨɨɤɪɭɝ ɥɚɹ ɬɜɟɪɞɚɹ ɫ ɱɟɬɤɢɦɢ ɝɪɚɧɢɰɚɦɢ ɧɟ ɜɨɫɩɚɥɟɧɧɚɹ ɧɟ ɫɨɩɪɨɜɨɠɞɚɟɬɫɹ ɜɵɪɚɠɟɧ ɧɵɦ ɛɨɥɟɜɵɦ ɫɢɧɞɪɨɦɨɦ Ʌɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɪɹɞɨɦ ɫ ɹɡɜɨɣ ɭɜɟɥɢɱɢɜɚɸɬɫɹ ɢ ɫɬɚɧɨɜɹɬɫɹ ɛɨɥɟɡɧɟɧɧɵɦɢ əɡɜɚ ɡɚɠɢɜɚɟɬ ɱɟɪɟɡ – ɧɟɞɟɥɶ ɧɨ ɢɧɮɟɤɰɢɹ ɨɫɬɚɟɬɫɹ ɜ ɨɪɝɚɧɢɡɦɟ ȼɬɨɪɢɱɧɵɣ ɫɢɮɢɥɢɫ ɩɟɪɢɨɞ – ɧɟɞɟɥɶ ɩɨ ɫɥɟɢɫɱɟɡɧɨɜɟɧɢɹɲɚɧɤɪɚ ɉɨɹɜɥɹɸɬɫɹɩɚɩɭɥɟɡɧɵɟɢɩɭɫɬɭɥɟɡɧɵɟɜɵɫɵɩɚɧɢɹɧɚ ɤɨɠɟ ɢ ɫɥɢɡɢɫɬɵɯ ɨɛɨɥɨɱɤɚɯ Ɉɧɢ ɦɨɝɭɬ ɛɵɬɶ ɧɚ ɥɚɞɨɧɹɯ ɩɨɞɨɲɜɚɯ ɜ ɩɨɥɨɫɬɢ ɪɬɚɢɝɨɪɥɟ ɏɚɪɚɤɬɟɪɟɧɫɢɮɢɥɢɞ– ɤɪɚɫɧɵɟɩɹɬɧɚ ɤɨɬɨɪɵɟɩɪɟɜɪɚɳɚɸɬɫɹɜɹɡɜɵ ɑɚɫɬɨ ɧɚɛɥɸɞɚɸɬɫɹ ɨɛɳɢɟ ɫɢɦɩɬɨɦɵ ɥɢɯɨɪɚɞɤɚ ɫɥɚɛɨɫɬɶ ɭɜɟɥɢɱɟɧɢɟ ɥɢɦɮɚ ɬɢɱɟɫɤɢɯ ɭɡɥɨɜ ɝɨɥɨɜɧɚɹ ɛɨɥɶ Ɇɨɠɟɬ ɜɨɡɧɢɤɧɭɬɶ ɩɫɨɪɢɚɡɨɩɨɞɨɛɧɚɹ ɫɵɩɶ ɜɵ ɩɚɞɟɧɢɟ ɜɨɥɨɫ ɚɥɨɩɟɰɢɹ ɇɚ ɫɥɢɡɢɫɬɵɯ ɨɛɨɥɨɱɤɚɯ ɩɨɥɨɫɬɢ ɪɬɚ ɜɥɚɝɚɥɢɳɚ ɢɥɢ ɚɧɭɫɚ ɩɨɹɜɥɹɸɬɫɹ ɩɚɩɭɥɵ ɛɨɪɨɞɚɜɱɚɬɵɟ ɨɛɪɚɡɨɜɚɧɢɹ Ʌɚɬɟɧɬɧɵɣ ɫɢɮɢɥɢɫɫɤɪɵɬɚɹ ɫɬɚɞɢɹ ɇɚ ɷɬɨɦ ɷɬɚɩɟ ɨɬɫɭɬɫɬɜɭɸɬ ɜɧɟɲɧɢɟ ɫɢɦɩɬɨɦɵ ɧɨ ɛɚɤɬɟɪɢɹ ɜɫɟ ɟɳɟ ɩɪɢɫɭɬɫɬɜɭɟɬ ɜ ɨɪɝɚɧɢɡɦɟ Ȼɚɤɬɟɪɢɢ ɦɨɠɧɨ ɨɛɧɚɪɭɠɢɬɶ ɜ ɤɪɨɜɢ ɫ ɩɨɦɨ ɳɶɸ ɫɟɪɨɥɨɝɢɱɟɫɤɢɯ ɬɟɫɬɨɜ Ʌɚɬɟɧɬɧɵɣ ɫɢɮɢɥɢɫ ɦɨɠɟɬ ɩɪɨɞɨɥɠɚɬɶɫɹ ɨɬ ɧɟ ɫɤɨɥɶɤɢɯ ɦɟɫɹɰɟɜ ɞɨ ɞɟɫɹɬɢɥɟɬɢɣ Ɍɪɟɬɢɱɧɵɣ ɫɢɮɢɥɢɫ ɱɟɪɟɡ – ɥɟɬ ɩɨɫɥɟ ɢɧɮɢɰɢɪɨɜɚɧɢɹ ɗɬɨ ɬɹɠɟɥɚɹ ɮɨɪɦɚ ɡɚɛɨɥɟɜɚɧɢɹ ɤɨɬɨɪɚɹ ɦɨɠɟɬ ɡɚɬɪɨɧɭɬɶ ɜɧɭɬɪɟɧɧɢɟ ɨɪɝɚɧɵ ɜɤɥɸɱɚɹ ɫɟɪɞɰɟ ɫɨɫɭɞɵ ɤɨɫɬɢ ɫɭɫɬɚɜɵ ɢ ɧɟɪɜɧɭɸ ɫɢɫɬɟɦɭ ɇɚ ɤɨɠɟ ɜɧɭɬɪɟɧɧɢɯ ɨɪɝɚɧɚɯ ɢɥɢ ɤɨɫɬɹɯ ɩɨɹɜɥɹɸɬɫɹ ɝɭɦɦɵ – ɨɩɭɯɨɥɟɜɢɞɧɵɟ ɨɛɪɚɡɨɜɚɧɢɹ Ɇɨɠɟɬ ɪɚɡɜɢɬɶɫɹ ɫɢɮɢɥɢɬɢɱɟɫɤɚɹ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɚɹ ɛɨɥɟɡɧɶɧɚɩɪɢɦɟɪ ɚɧɟɜɪɢɡɦɚ ɚɨɪɬɵ ɢ ɧɟɜɪɨɫɢɮɢɥɢɫ ɤɨɬɨɪɵɣ ɩɪɢɜɨɞɢɬ ɤ ɩɨɜɪɟɠɞɟ ɧɢɸ ɰɟɧɬɪɚɥɶɧɨɣ ɧɟɪɜɧɨɣ ɫɢɫɬɟɦɵ ɧɚɩɪɢɦɟɪ ɩɚɪɚɥɢɱ ɞɟɦɟɧɰɢɹ

ɆȿɌɈȾɕ ȾɂȺȽɇɈɋɌɂɄɂ Ɇɢɤɪɨɫɤɨɩɢɹ Ɇɟɬɨɞ ɬɟɦɧɨɝɨ ɩɨɥɹ ɢɫ ɩɨɥɶɡɭɟɬɫɹ ɞɥɹ ɜɵɹɜɥɟɧɢɹ 7UHSRQHPD SDOOLGXP ɜ ɜɵɞɟɥɟɧɢɹɯ ɫ ɹɡɜɵ ɧɚ ɫɬɚɞɢɢ ɩɟɪɜɢɱɧɨɝɨ ɫɢɮɢɥɢɫɚ ɋɟɪɟɛɪɟɧɢɟ ɩɪɢɦɟɧɹɟɬɫɹ ɞɥɹ ɜɵɹɜɥɟɧɢɹ ɛɚɤɬɟɪɢɣ ɜ ɦɚɬɟ ɪɢɚɥɚɯ ɢɡ ɹɡɜɵ ɢ ɜɵɫɵɩɚɧɢɣ 2. ɋɟɪɨɥɨɝɢɱɟɫɤɢɟ ɬɟɫɬɵ RPR-ɬɟɫɬ ɪɟɚɤɰɢɹ ɫ ɜɨɫɫɬɚɧɨɜɥɟɧɢɟɦɨɫɚɞɤɚ ɢ9'5/ ɪɟɚɤɰɢɹȼɚɫɫɟɪɦɚɧɚ – ɢɫɩɨɥɶɡɭɸɬɫɹɞɥɹɩɟɪ ɜɢɱɧɨɣ ɞɢɚɝɧɨɫɬɢɤɢ ɢ ɦɨɧɢɬɨɪɢɧɝɚ ɥɟɱɟɧɢɹ ɗɬɢ ɬɟɫɬɵ ɨɛɧɚɪɭɠɢɜɚɸɬ ɚɧɬɢɬɟɥɚ ɤɨɬɨɪɵɟ ɨɪɝɚɧɢɡɦ ɜɵɪɚɛɚɬɵɜɚɟɬ ɜ ɨɬɜɟɬ ɧɚ ɢɧɮɟɤɰɢɸ )7$-$%6 ɮɥɭɨɪɟɫɰɟɧɬ ɧɚɹ ɪɟɚɤɰɢɹ ɚɧɬɢɬɟɥ ɜɵɫɨɤɨɫɩɟɰɢɮɢɱɧɵɣ ɬɟɫɬ ɞɥɹ ɩɨɞɬɜɟɪɠɞɟɧɢɹ ɫɢɮɢɥɢɫɚ 73+$ ɬɪɟɩɨɧɟɦɧɵɣ ɚɝɝɥɸɬɢɧɚɰɢɨɧɧɵɣ ɬɟɫɬ ɜɵɹɜɥɹɟɬ ɚɧɬɢɬɟɥɚ ɩɪɨɬɢɜ Treponema pallidum. ɉɐɊ ɢɫɩɨɥɶɡɭɟɬɫɹ ɞɥɹ ɨɩɪɟɞɟɥɟɧɢɹ ȾɇɄ 7UHSRQHPD SDOOLGXP ɜ ɦɚɬɟɪɢɚɥɚɯ ɧɚɩɪɢɦɟɪ ɢɡ ɹɡɜɵ ɫɥɢɡɢ ɢɥɢ ɤɪɨɜɢ

57

Ʌȿɑȿɇɂȿ Ɉɫɧɨɜɧɵɦ ɦɟɬɨɞɨɦ ɥɟɱɟɧɢɹ ɫɢɮɢɥɢɫɚ ɹɜɥɹɟɬɫɹ ɚɧɬɢɛɢɨɬɢɤɨ ɬɟɪɚɩɢɹ ɉɪɢɦɟɧɹɸɬ ɚɧɬɢɛɢɨɬɢɤɢ ɩɟɧɢɰɢɥɥɢɧɨɜɨɝɨ ɪɹɞɚ Ɇɨɠɧɨ ɢɫɩɨɥɶɡɨɜɚɬɶ ɷɪɢɬɪɨɦɢɰɢɧ ɰɟɮɚɥɨɫɩɨɪɢɧɵ ɇɚɪɹɞɭ ɫ ɚɧɬɢɛɢɨɬɢɤɚɦɢ ɢɫɩɨɥɶɡɭɸɬɫɹ ɜɢɫɦɭɬ ɫɨɞɟɪɠɚɳɢɟ ɩɪɟɩɚɪɚɬɵ ɑɟɦ ɪɚɧɶɲɟ ɧɚɱɚɬɨ ɥɟɱɟɧɢɟ ɬɟɦ ɥɭɱɲɟ ɪɟɡɭɥɶɬɚɬɵ

ɉɊɈɎɂɅȺɄɌɂɄȺ ɋɩɟɰɢɮɢɱɟɫɤɚɹ – ɧɟɬ ɇɟɫɩɟɰɢɮɢɱɟɫɤɚɹ 1. ɉɪɢ ɦɟɧɟɧɢɟ ɛɚɪɶɟɪɧɵɯ ɦɟɬɨɞɨɜ ɤɨɧɬɪɚɰɟɩɰɢɢ ɩɪɟɡɟɪɜɚɬɢɜɵ – ɨɫɧɨɜɧɨɣ ɦɟɬɨɞ ɩɪɨ ɮɢɥɚɤɬɢɤɢ ɫɢɮɢɥɢɫɚ ɩɪɢ ɩɨɥɨɜɨɦ ɤɨɧɬɚɤɬɟ ȼɚɠɧɨ ɢɫɩɨɥɶɡɨɜɚɬɶ ɩɪɟɡɟɪɜɚɬɢɜɵ ɤɚɤ ɞɥɹ ɜɚɝɢɧɚɥɶɧɵɯ ɬɚɤ ɢ ɞɥɹ ɚɧɚɥɶɧɵɯ ɢ ɨɪɚɥɶɧɵɯ ɤɨɧɬɚɤɬɨɜ Ɉɛɪɚɡɨɜɚɧɢɟ ɢ ɨɫɜɟɞɨɦɥɟɧɧɨɫɬɶ ɨɛɪɚɡɨɜɚɬɟɥɶɧɵɟ ɩɪɨɝɪɚɦɦɵ ɨ ɫɟɤɫɭɚɥɶɧɨɦ ɡɞɨɪɨɜɶɟ ɢ ɦɟ ɪɚɯ ɩɪɨɮɢɥɚɤɬɢɤɢ ɡɚɛɨɥɟɜɚɧɢɣ ɩɟɪɟɞɚɸɳɢɯɫɹ ɩɨɥɨɜɵɦ ɩɭɬɟɦ Ɋɚɧɧɹɹ ɞɢɚɝɧɨ ɫɬɢɤɚ ɢ ɥɟɱɟɧɢɟ ɪɟɝɭɥɹɪɧɨɟ ɨɛɫɥɟɞɨɜɚɧɢɟ ɭ ɜɪɚɱɟɣ ɨɫɨɛɟɧɧɨ ɞɥɹ ɥɸɞɟɣ ɫ ɜɵɫɨ ɤɢɦ ɪɢɫɤɨɦ ɡɚɪɚɠɟɧɢɹ Ɍɟɫɬɢɪɨɜɚɧɢɟ ɢ ɥɟɱɟɧɢɟ ɩɚɪɬɧɟɪɚ ɩɪɢ ɜɵɹɜɥɟɧɢɢ ɫɢ ɮɢɥɢɫɚ ɜɚɠɧɨ ɩɪɨɜɟɫɬɢ ɬɟɫɬɢɪɨɜɚɧɢɟ ɢ ɥɟɱɟɧɢɟ ɜɫɟɯ ɩɨɥɨɜɵɯ ɩɚɪɬɧɟɪɨɜ ɩɚɰɢ ɟɧɬɚ ɱɬɨɛɵ ɩɪɟɞɨɬɜɪɚɬɢɬɶ ɩɨɜɬɨɪɧɨɟ ɡɚɪɚɠɟɧɢɟ Ȼɟɡɨɩɚɫɧɨɫɬɶ ɩɪɢ ɦɟɞɢɰɢɧ ɫɤɢɯ ɦɚɧɢɩɭɥɹɰɢɹɯ ɫɬɪɨɝɢɟ ɫɚɧɢɬɚɪɧɵɟ ɦɟɪɵ ɢ ɫɬɟɪɢɥɢɡɚɰɢɹ ɢɧɫɬɪɭɦɟɧɬɨɜ ɜ ɦɟɞɢɰɢɧɫɤɢɯ ɭɱɪɟɠɞɟɧɢɹɯ

ɂɆɆɍɇɂɌȿɌ. ɉɪɢɨɛɪɟɬɟɧɧɵɣ ɢɦɦɭɧɢɬɟɬ ɩɪɢ ɫɢɮɢɥɢɫɟ ɯɚɪɚɤɬɟɪɢɡɭ ɟɬɫɹ ɡɚɳɢɬɧɵɦɢ ɤɥɟɬɨɱɧɵɦɢ ɪɟɚɤɰɢɹɦɢ ɧɨ ɨɧɢ ɧɚɩɪɚɜɥɟɧɵ ɧɟ ɧɚ ɜɵɜɟɞɟɧɢɟ ɜɨɡɛɭɞɢɬɟɥɹ ɢɡ ɨɪɝɚɧɢɡɦɚ ɚ ɧɚ ɮɢɤɫɚɰɢɸ ɬɪɢɩɨɧɟɦɵ ɜ ɬɤɚɧɹɯ Ɉɛɪɚɡɭɸɳɢɟɫɹ ɚɧɬɢɦɢɤɪɨɛɧɵɟ ɚɧɬɢɬɟɥɚ ɤ ɬɪɢɩɨɧɟɦɦɟ ɜɨɨɛɳɟ ɧɟ ɨɛɥɚɞɚɸɬ ɡɚɳɢɬɧɵɦɢ ɫɜɨɣ ɫɬɜɚɦɢ ɂɦɦɭɧɢɬɟɬ ɩɪɢ ɫɢɮɢɥɢɫɟ – ɧɟɫɬɟɪɢɥɶɧɵɣ ɯɚɪɚɤɬɟɪ ɩɨɤɚ ɟɫɬɶ ɜɨɡɛɭɞɢ ɬɟɥɶ ɜ ɨɪɝɚɧɢɡɦɟ ɉɟɪɟɧɟɫɟɧɧɨɟ ɡɚɛɨɥɟɜɚɧɢɟ ɧɟ ɨɫɬɚɜɥɹɟɬ ɧɟɜɨɫɩɪɢɢɦɱɢɜɨɫɬɢ

5.2. ȽɈɇɈɊȿə

ɄɅȺɋɋɂɎɂɄȺɐɂə ɩɨɪɹɞɨɤ 1HLVVHULDOHV ɫɟɦɟɣɫɬɜɨ Neisseriaceae;

ɪɨɞ Neisseria ɜɢɞ Neisseriagonorrhoeae

ɆɈɊɎɈɅɈȽɂə ɂ ɌɂɇɄɌɈɊɂȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ Ƚɨɧɨɤɨɤɤ – ɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɣ ɞɢɩɥɨɤɨɤɤ ɛɨɛɨɜɢɞɧɨɣ ɮɨɪɦɵ ɧɟɩɨɞɜɢɠɟɧ ɫɩɨɪ ɧɟ ɢɦɟɟɬ ɤɚɩɫɭɥɵ ɧɟ ɨɛɪɚɡɭɟɬ ɏɟɦɨɨɪɝɚɧɨɬɪɨɮ Ɋɚɡɦɟɪɵ – ɢɧɨɝɞɚ – ɦɤɦ ɧɟɩɨɞɜɢɠɧɵ Ɉɧɢ ɯɨɪɨɲɨ ɨɤɪɚɲɢɜɚɸɬɫɹ ɚɧɢɥɢɧɨɜɵɦɢ ɤɪɚɫɢɬɟɥɹɦɢ ɦɟɬɢɥɟɧɨ ɜɵɦ ɫɢɧɢɦ ɛɪɢɥɥɢɚɧɬɨɜɵɦ ɡɟɥɟɧɵɦ ɢ ɞɪ ɉɨ Ƚɪɚɦɭ ɨɤɪɚɲɢɜɚɸɬɫɹ ɜ ɪɨɡɨɜɵɣ ɰɜɟɬ

ɄɍɅɖɌɍɊȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ Ƚɨɧɨɤɨɤɤɢ ɹɜɥɹɸɬɫɹ ɚɷɪɨɛɧɵɦɢ ɦɢɤ ɪɨɨɪɝɚɧɢɡɦɚɦɢ Ɉɩɬɢɦɚɥɶɧɚɹ ɬɟɦɩɟɪɚɬɭɪɚ ɤɭɥɶɬɢɜɢɪɨɜɚɧɢɹ °ɋ ɨɩɬɢɦɚɥɶɧɨɟ ɡɧɚɱɟɧɢɟ ɪɇ – 7,2– Ƚɨɧɨɤɨɤɤɢ ɬɪɟɛɨɜɚɬɟɥɶɧɵ ɤ ɩɢɬɚɬɟɥɶɧɵɦ ɫɪɟɞɚɦ Ⱦɥɹ ɢɯ

58

ɜɵɪɚɳɢɜɚɧɢɹ ɢɫɩɨɥɶɡɭɸɬ ɫɪɟɞɵ ɫɨɞɟɪɠɚɳɢɟ ɤɪɨɜɶ ɫɵɜɨɪɨɬɤɭ ɤɪɨɜɢ ɢɥɢ ɚɫɰɢ ɬɢɱɟɫɤɭɸ ɠɢɞɤɨɫɬɶ ɇɚ ɩɥɨɬɧɵɯ ɩɢɬɚɬɟɥɶɧɵɯ ɫɪɟɞɚɯ ɱɟɪɟɡ ɱɚɫɚ ɢɧɤɭɛɢɪɨɜɚ ɧɢɹ ɩɪɢ ɨɩɬɢɦɚɥɶɧɨɣ ɬɟɦɩɟɪɚɬɭɪɟ ɝɨɧɨɤɨɤɤɢ ɨɛɪɚɡɭɸɬ ɫɥɟɝɤɚ ɦɭɬɧɵɟ ɢɥɢ ɩɪɨ ɡɪɚɱɧɵɟ ɛɟɫɰɜɟɬɧɵɟ ɤɨɥɨɧɢɢ ɤɪɭɝɥɨɣ ɮɨɪɦɵ ɫ ɪɨɜɧɵɦɢ ɤɪɚɹɦɢ ɞɢɚɦɟɬɪɨɦ 1– ɦɦ ɇɚ ɫɪɟɞɚɯ ɫ ɤɪɨɜɶɸ ɝɟɦɨɥɢɡɚ ɧɟ ɜɵɡɵɜɚɸɬ

ȺɇɌɂȽȿɇɇȺə ɋɌɊɍɄɌɍɊȺ Ƚɨɧɨɤɨɤɤɢ ɫɨɞɟɪɠɚɬ ɫɥɟɞɭɸɳɢɟ ɚɧɬɢ ɝɟɧɵ - ɫɨɦɚɬɢɱɟɫɤɢɣɚɧɬɢɝɟɧ - ɤɚɩɫɭɥɶɧɵɣɚɧɬɢɝɟɧ - ɥɢɩɨɨɥɢɝɨɫɚɯɚɪɢɞ ɅɈɋ - ɚɧɬɢɝɟɧɵ ɩɢɥɟɣ - ɛɟɥɤɢ ɧɚɪɭɠɧɨɣ ɦɟɦɛɪɚɧɵ ɋɪɟɞɢ ɚɧɬɢɝɟɧɨɜ ɝɨɧɨɤɨɤɤɨɜ ɨɫ ɧɨɜɧɚɹ ɪɨɥɶ ɩɪɢɧɚɞɥɟɠɢɬ ɚɧɬɢɝɟɧɚɦ ɩɢɥɟɣ ɢ ɛɟɥɤɚɦ ɧɚɪɭɠɧɨɣ ɦɟɦɛɪɚɧɵ ɉɢɥɢ ɫɨɫɬɨɹɬ ɢɡ ɛɟɥɤɨɜɵɯ ɫɭɛɴɟɞɢɧɢɰ ɨɫɬɚɬɤɨɜ ɫɚɯɚɪɨɜ ɢ ɮɨɫɮɨɪɧɨɣ ɤɢɫɥɨɬɵ ɉɨ ɫɥɟɞɨɜɚɬɟɥɶɧɨɫɬɶɫɨɟɞɢɧɟɧɢɹɛɟɥɤɨɜɵɯɫɭɛɴɟɞɢɧɢɰɩɢɥɟɣ ɦɨɠɟɬ ɦɟɧɹɬɶɫɹ ɜ ɪɟ ɡɭɥɶɬɚɬɟ ɱɟɝɨ ɢɡɦɟɧɹɸɬɫɹ ɚɧɬɢɝɟɧɧɵɟ ɫɜɨɣɫɬɜɚ ɤɥɟɬɨɤ ɇɚɪɭɠɧɚɹ ɦɟɦɛɪɚɧɚ ɫɨ ɞɟɪɠɢɬ ɩɪɨɬɟɢɧɵ ɪɚɡɧɵɯ ɤɥɚɫɫɨɜ ɗɬɢ ɩɪɨɬɟɢɧɵ ɩɪɨɹɜɥɹɸɬ ɫɢɥɶɧɵɟ ɢɦɦɭɧɨ ɝɟɧɧɵɟ ɫɜɨɣɫɬɜɚ ɉɨ ɫɨɫɬɚɜɭ ɩɪɨɬɟɢɧɨɜ ɧɚɪɭɠɧɨɣ ɦɟɦɛɪɚɧɵ ɜɵɞɟɥɹɸɬ ɧɟ ɫɤɨɥɶɤɨ ɫɟɪɨɬɢɩɨɜ ɝɨɧɨɤɨɤɤɨɜ Ⱥɧɬɢɬɟɥɚ ɤ ɩɪɨɬɟɢɧɚɦ ɤɥɟɬɨɱɧɨɣ ɫɬɟɧɤɢ ɝɨɧɨ ɤɨɤɤɨɜ ɜ ɩɪɢɫɭɬɫɬɜɢɢ ɤɨɦɩɥɟɦɟɧɬɚ ɩɪɨɹɜɥɹɸɬ ɛɚɤɬɟɪɢɰɢɞɧɵɟ ɫɜɨɣɫɬɜɚ

ɎȺɄɌɈɊɕ ɉȺɌɈȽȿɇɇɈɋɌɂ ɉɢɥɢ ɚɞɝɟɡɢɹ ɤ ɷɩɢɬɟɥɢɚɥɶɧɵɦ ɤɥɟɬ ɤɚɦ Ȼɟɥɤɢ ɧɚɪɭɠɧɨɣ ɦɟɦɛɪɚɧɵ ɢɡɛɟɝɚɸɬ ɢɦɦɭɧɧɨɝɨ ɨɬɜɟɬɚ Ʌɢɩɨɨɥɢɝɨɫɚɯɚ ɪɢɞɵ ɬɨɤɫɢɱɟɫɤɨɟ ɜɨɡɞɟɣɫɬɜɢɟ ,J$-ɩɪɨɬɟɚɡɚ ɪɚɡɪɭɲɚɟɬ ɫɟɤɪɟɬɨɪɧɵɟ ɚɧɬɢ ɬɟɥɚ

ɊȿɁɂɋɌȿɇɌɇɈɋɌɖ Ƚɨɧɨɤɨɤɤɢ ɧɟɭɫɬɨɣɱɢɜɵ ɜɨ ɜɧɟɲɧɟɣ ɫɪɟɞɟ ɉɪɢ ɬɟɦɩɟɪɚɬɭɪɟ °ɋ ɨɧɢ ɩɨɝɢɛɚɸɬ ɜ ɬɟɱɟɧɢɟ ɦɢɧɭɬ ɩɪɢ °ɋ – ɦɝɧɨɜɟɧɧɨ Ƚɨɧɨɤɨɤɤɢ ɱɭɜɫɬɜɢɬɟɥɶɧɵ ɤ ɞɟɣɫɬɜɢɸ ɦɧɨɝɢɯ ɚɧɬɢɫɟɩɬɢɤɨɜ ɢ ɞɟɡɢɧɮɟɤɬɚɧɬɨɜ Ɉɧɢ ɨɛɥɚɞɚɸɬ ɜɵɫɨɤɨɣ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶɸ ɤɨ ɦɧɨɝɢɦ ɚɧɬɢɛɢɨɬɢɤɚɦ ɜ ɬɨɦ ɱɢɫɥɟ ɤ ɩɟɧɢɰɢɥɥɢɧɚɦ Ɉɞɧɚɤɨ ɜ ɩɨɫɥɟɞɧɟɟ ɜɪɟɦɹ ɩɨɥɭɱɢɥɢ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɟ ɲɬɚɦɦɵ ɭɫɬɨɣɱɢɜɵɟ ɤ ɚɧɬɢɛɢɨɬɢɤɚɦ ȼ ɱɚɫɬɧɨɫɬɢ ɲɬɚɦɦɵ ɭɫɬɨɣɱɢɜɵɟ ɤ ɩɟ ɧɢɰɢɥɥɢɧɭ ɩɪɨɞɭɰɢɪɭɸɬ ȕ-ɥɚɤɬɚɦɚɡɵ ɫɢɧɬɟɡ ɤɨɬɨɪɵɯ ɨɛɭɫɥɨɜɥɟɧ ɧɚɥɢɱɢɟɦ R-ɩɥɚɡɦɢɞ

ɗɉɂȾȿɆɂɈɅɈȽɂə Ƚɨɧɨɪɟɹ ɨɬɧɨɫɢɬɫɹ ɤ ɧɚɢɛɨɥɟɟ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɵɦ ɢɧɮɟɤɰɢɨɧɧɵɦ ɡɚɛɨɥɟɜɚɧɢɹɦ ɩɟɪɟɞɚɜɚɟɦɵɦ ɩɨɥɨɜɵɦ ɩɭɬɟɦ ɂɫɬɨɱɧɢɤɨɦ ɢɧ ɮɟɤɰɢɢ ɩɪɢ ɝɨɧɨɪɟɟ ɹɜɥɹɟɬɫɹ ɛɨɥɶɧɨɣ ɱɟɥɨɜɟɤ ɨɫɨɛɟɧɧɨ ɫ ɯɪɨɧɢɱɟɫɤɨɣ ɛɟɫ ɫɢɦɩɬɨɦɧɨ ɩɪɨɬɟɤɚɸɳɟɣ ɮɨɪɦɨɣ ɛɨɥɟɡɧɢ Ɇɟɯɚɧɢɡɦ ɩɟɪɟɞɚɱɢ ɜɨɡɛɭɞɢɬɟɥɹ – ɤɨɧɬɚɤɬɧɵɣ ɩɭɬɶ ɩɟɪɟɞɚɱɢ – ɩɨɥɨɜɨɣ ȼɨɫɩɪɢɢɦɱɢɜɨɫɬɶ ɤ ɝɨɧɨɤɨɤɤɨɜɨɣ ɢɧɮɟɤ ɰɢɢ ɨɱɟɧɶ ɜɵɫɨɤɚɹ

ɉȺɌɈȽȿɇȿɁ Ⱥɞɝɟɡɢɹɤɫɥɢɡɢɫɬɵɦɨɛɨɥɨɱɤɚɦɭɪɨɝɟɧɢɬɚɥɶɧɨɝɨɬɪɚɤɬɚɂɧɜɚɡɢɹ ɢ ɪɚɡɪɭɲɟɧɢɟ ɷɩɢɬɟɥɢɹ ȼɨɫɩɚɥɢɬɟɥɶɧɚɹ ɪɟɚɤɰɢɹ ɝɧɨɣɧɨɟ ɜɨɫɩɚ ɥɟɧɢɟ Ⱦɢɫɫɟɦɢɧɚɰɢɹ ɜɨɡɦɨɠɧɚ ɩɪɢɜɨɞɹ ɤ ɝɨɧɨɤɨɤɤɨɜɨɦɭ ɫɟɩɫɢɫɭ ɚɪɬɪɢɬɭ

59

ɄɅɂɇɂɑȿɋɄȺə ɄȺɊɌɂɇȺ. ɍ ɦɭɠɱɢɧ ɭɪɟɬɪɢɬ ɠɠɟɧɢɟ ɜɵɞɟɥɟɧɢɹ ɛɨɥɟɡɧɟɧɧɨɟ ɦɨɱɟɢɫɩɭɫɤɚɧɢɟ ɍ ɠɟɧɳɢɧ ɰɟɪɜɢɰɢɬ ɭɪɟɬɪɢɬ ɛɟɥɢ ɛɨɥɢ ɜɧɢɡɭ ɠɢɜɨɬɚ Ɉɫɥɨɠɧɟɧɢɹ ɷɩɢɞɢɞɢɦɢɬ ɩɪɨɫɬɚɬɢɬ ɜɨɫɩɚɥɢɬɟɥɶɧɵɟ ɡɚɛɨɥɟɜɚɧɢɹ ɨɪ ɝɚɧɨɜ ɦɚɥɨɝɨ ɬɚɡɚ ɛɟɫɩɥɨɞɢɟ

ɆȿɌɈȾɕ ȾɂȺȽɇɈɋɌɂɄɂ Ȼɚɤɬɟɪɢɨɥɨɝɢɱɟɫɤɢɣ ɉɨɫɟɜ ɨɬɞɟɥɹɟɦɨɝɨ ɧɚ ɫɩɟɰɢɚɥɶɧɵɟ ɫɪɟɞɵ ɢɞɟɧɬɢɮɢɤɚɰɢɹ ɜɨɡɛɭɞɢɬɟɥɹ Ȼɚɤɬɟɪɢɨɫɤɨɩɢɱɟɫɤɢɣ ɈɤɪɚɲɢɜɚɧɢɟɦɚɡɤɨɜɩɨȽɪɚɦɭ ɜɵɹɜɥɟɧɢɟɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɯɞɢɩɥɨɤɨɤɤɨɜ ɋɟ ɪɨɥɨɝɢɱɟɫɤɢɣ ɉɪɚɤɬɢɱɟɫɤɢ ɧɟ ɢɫɩɨɥɶɡɭɟɬɫɹ ɜɨɡɦɨɠɧɵ ɂɎȺ ɊɋɄ Ɇɨɥɟɤɭ ɥɹɪɧɨ-ɛɢɨɥɨɝɢɱɟɫɤɢɣ ɉɐɊ ɨɩɪɟɞɟɥɟɧɢɟ ȾɇɄ 1 JRQRUUKRHDH

Ʌȿɑȿɇɂȿ Ʌɟɱɟɧɢɟ ɝɨɧɨɤɨɤɤɨɜɨɣ ɢɧɮɟɤɰɢɢ ɡɚɜɢɫɢɬ ɨɬ ɮɨɪɦɵ ɡɚɛɨɥɟɜɚ ɧɢɹ ɉɪɢ ɨɫɬɪɨɣ ɢ ɩɨɞɨɫɬɪɨɣ ɝɨɧɨɪɟɟ ɩɪɢɦɟɧɹɸɬ ɚɧɬɢɛɢɨɬɢɤɢ ɝɪɭɩɩɵ ɩɟɧɢɰɢɥ ɥɢɧɚ Ɉɞɧɚɤɨ ɜ ɩɨɫɥɟɞɧɢɟ ɝɨɞɵ ɩɪɚɤɬɢɱɟɫɤɢ ɜɫɟ ɲɬɚɦɦɵ ɝɨɧɨɤɨɤɤɨɜ ɹɜɥɹɸɬɫɹ ɭɫɬɨɣɱɢɜɵɦɢ ɤ ɩɟɧɢɰɢɥɥɢɧɚɦ Ʉɪɨɦɟ ɬɨɝɨ ɜɫɟ ɱɚɳɟ ɜɫɬɪɟɱɚɸɬɫɹ ɲɬɚɦɦɵ ɨɛ ɥɚɞɚɸɳɢɟ ɭɫɬɨɣɱɢɜɨɫɬɶɸ ɤ ɮɬɨɪɯɢɧɨɥɨɧɚɦ 451* ɉɨɷɬɨɦɭ ɞɥɹ ɥɟɱɟɧɢɹ ɝɨ ɧɨɪɟɢ ɢɫɩɨɥɶɡɭɸɬ ɞɪɭɝɢɟ ɚɧɬɢɛɢɨɬɢɤɢ ɗɮɮɟɤɬɢɜɧɨɣ ɫɱɢɬɚɟɬɫɹ ɤɨɦɛɢɧɚɰɢɹ ɚɡɢɬɪɨɦɢɰɢɧɚ ɫ ɰɟɮɬɪɢɚɤɫɨɧɨɦ ɑɟɪɟɡ – ɞɧɟɣ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ ɜɨɫɩɚɥɢ ɬɟɥɶɧɵɟ ɹɜɥɟɧɢɹ ɭɦɟɧɶɲɚɸɬɫɹ ɜɵɞɟɥɟɧɢɹ ɫɬɚɧɨɜɹɬɫɹ ɫɤɭɞɧɵɦɢ ɝɨɧɨɤɨɤɤɢ ɜ ɧɢɯ ɧɟ ɨɛɧɚɪɭɠɢɜɚɸɬɫɹ ɉɨ ɢɫɬɟɱɟɧɢɢ – ɞɧɟɣ ɨɩɪɟɞɟɥɹɸɬ ɢɡɥɟɱɟɧɧɨɫɬɶ ɡɚ ɛɨɥɟɜɚɧɢɹ ɉɪɢ ɯɪɨɧɢɱɟɫɤɨɣ ɝɨɧɨɪɟɟ ɩɪɢɦɟɧɹɸɬ ɫɩɟɰɢɮɢɱɟɫɤɭɸ ɝɨɧɨɜɚɤɰɢɧɚ ɢɥɢɧɟɫɩɟɰɢɮɢɱɟɫɤɭɸ ɩɢɪɨɝɟɧɚɥ ɢɦɦɭɧɨɬɟɪɚɩɢɸɢɦɟɫɬɧɨɟɜɨɡɞɟɣɫɬɜɢɟɧɚɩɨ ɪɚɠɟɧɧɵɣ ɨɪɝɚɧ ɉɨɫɥɟ ɬɚɤɨɝɨ ɜɨɡɞɟɣɫɬɜɢɹ ɜ ɫɬɚɰɢɨɧɚɪɧɵɯ ɭɫɥɨɜɢɹɯ ɩɪɨɜɨɞɹɬ ɤɭɪɫ ɬɟɪɚɩɢɢ ɩɨɜɵɲɟɧɧɵɦɢ ɞɨɡɚɦɢ ɚɧɬɢɛɢɨɬɢɤɨɜ

ɉɊɈɎɂɅȺɄɌɂɄȺ ɉɪɨɮɢɥɚɤɬɢɤɚ ɝɨɧɨɤɨɤɤɨɜɨɣ ɢɧɮɟɤɰɢɢ ɜɤɥɸɱɚɟɬ ɫɥɟɞɭɸɳɢɟ ɦɟɪɨɩɪɢɹɬɢɹ - ɚɤɬɢɜɧɨɟɜɵɹɜɥɟɧɢɟɢ ɥɟɱɟɧɢɟ ɛɨɥɶɧɵɯ ɢ ɢɯ ɩɨɥɨɜɵɯ ɩɚɪɬɧɟɪɨɜ ɫ ɩɨɫɥɟɞɭɸɳɢɦ ɤɨɧɬɪɨɥɟɦ ɧɚ ɢɡɥɟɱɟɧɧɨɫɬɶ - ɨɛɹɡɚɬɟɥɶɧɨɟ ɨɛɫɥɟɞɨ ɜɚɧɢɟ ɞɟɤɪɟɬɢɪɨɜɚɧɧɵɯ ɝɪɭɩɩ ɧɚɫɟɥɟɧɢɹ ɪɚɛɨɬɧɢɤɢ ɞɟɬɫɤɢɯ ɞɨɲɤɨɥɶɧɵɯ ɭɱɪɟ ɠɞɟɧɢɣ ɢ ɨɛɳɟɩɢɬɚ ɩɟɪɟɞ ɩɨɫɬɭɩɥɟɧɢɟɦ ɧɚ ɪɚɛɨɬɭ ɢ ɜ ɩɨɫɥɟɞɭɸɳɟɦ ɱɟɪɟɡ ɤɚɠ ɞɵɟ ɬɪɢ ɦɟɫɹɰɚ - ɨɛɹɡɚɬɟɥɶɧɚɹ ɩɟɪɜɢɱɧɚɹ ɨɛɪɚɛɨɬɤɚ ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ ɫ ɜɧɟɫɟ ɧɢɟɦ ɡɚ ɜɟɤɢ ɬɟɬɪɚɰɢɤɥɢɧɨɜɨɣ ɢɥɢ ɷɪɢɬɪɨɦɢɰɢɧɨɜɨɣ ɦɚɡɢ ɞɥɹ ɩɪɨɮɢɥɚɤɬɢɤɢ ɛɥɟɧɧɨɪɟɢ Ɉɫɧɨɜɧɨɟ ɜɧɢɦɚɧɢɟ ɜ ɩɪɨɮɢɥɚɤɬɢɤɟ ɝɨɧɨɤɨɤɤɨɜɨɣ ɢɧɮɟɤɰɢɢ ɩɪɢɧɚɞ ɥɟɠɢɬ ɫɚɧɢɬɚɪɧɨ-ɩɪɨɫɜɟɬɢɬɟɥɶɧɨɣ ɪɚɛɨɬɟ ɧɚɩɪɚɜɥɟɧɧɨɣ ɧɚ ɩɪɨɩɚɝɚɧɞɭ ɡɞɨɪɨ ɜɨɝɨ ɨɛɪɚɡɚ ɠɢɡɧɢ ɢ ɢɫɤɥɸɱɟɧɢɟ ɫɥɭɱɚɣɧɵɯ ɩɨɥɨɜɵɯ ɫɜɹɡɟɣ ɋɪɟɞɫɬɜɚ ɫɩɟɰɢ ɮɢɱɟɫɤɨɣ ɩɪɨɮɢɥɚɤɬɢɤɢ ɝɨɧɨɪɟɢ ɨɬɫɭɬɫɬɜɭɸɬ

ɂɆɆɍɇɂɌȿɌ ɂɦɦɭɧɢɬɟɬ ɩɨɫɥɟ ɩɟɪɟɧɟɫɟɧɧɨɣ ɝɨɧɨɪɟɢ ɩɪɚɤɬɢɱɟɫɤɢ ɨɬ ɫɭɬɫɬɜɭɟɬ ɩɨɷɬɨɦɭ ɦɨɝɭɬ ɪɟɝɢɫɬɪɢɪɨɜɚɬɶɫɹ ɩɨɜɬɨɪɧɵɟ ɡɚɛɨɥɟɜɚɧɢɹ

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