Harrison's

PRINCIPLES
OF INTERNAL
MEDICINE
Eleventh Edition
Editors
EUGENE BRAUNWALD, A.B., M.D, MA
(Hon.), M.D. (Hon.) Hersey Professor of the Theory
and Practice of Physic and Herrman Ludwig Blumgart
Professor of Medicine, Harvard Medical School;
Chairman, Department of Medicine, Brigham and
Women's and Beth Israel Hospitals, Boston

KURT J. ISSELBACHER, , M.D

Mallinckrodt Professor of Medicine, Harvard Medical

School; Physician and Chief, Gastrointestinal Unit,
Massachusetts General Hospital, Boston
R O B E R T Q. P E T E R S D O R F , A.B., M.D, MA
(Hon.), D.Sc. (Hon.), M.D. (Hon.), L.H.D. (Hon.)
Professor of Medicine, Dean and Vice Chancellor,
Health Sciences, University of California School of
Medicine, San Diego, La Jolla

JEAN D. WILSON, M.D.

Professor of Internal Medicine, The University of Texas
Southwestern Medical School, Dallas
J O S E P H B. M A R T I N , M.D.. Ph.D., F.E.C.P.(C),
M.A. (Hon.) Julieanne Dorrt Professor of Neurology,
Harvard Medical School; Chief, Neurology Service,
Massachusetts General Hospital, Boston

ANTHONY 9. FAUCI, M.D.

Chief, Laboratory of Immunoregulation and Director,
National Institute of Allergy and Infectious Diseases,
, National Institutes of Health, Bethesda
MCGRAW-HILL BOOK COMPANY
New York St. Louis San Francisco Auckland Bogota
Hamburg Johannesburg London Madrid Mexico
Milan Montreal New Delhi Panama Paris Sao Paulo
Singapore Sydney Tokyo Toronto

..
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., ., ,
. , .

10

3


. . . . ,
. . . .

" " 1993

 54.1
60
616.1/4(035)

. .
. , . . ,
. . , . . , . . , . ..

60

. 10 . 3: .
./ . . , . . ,
. . .-.: . 1993.
480 : .
ISBN 5-225-00602-7
ISBN 0-07-100134-4

, - , .
,
.
.

4108040000032
039(01)93

072-92

I S B N 5-225-00602-7
I<sRM 7 114 A
1& U-U/'-lUUld4-4

54.1
1 9 8 7 McGraw-Nill Company
. . , . . ,
, 1993

,

I .

. . / . . .

82. . .
, . (Robert G. Petersdorf, Richard .
Root)
83. . .
(James J. Plorde)
84. . , . (Henry Masur, Anthony S. Fauci)
1' 85. . ,
. (Pierce Gardner, Paul M. Arnow)
86. . . , .
(David . Dale, Robert G. Petersdorf)
87. . . (Jan V. Hirschmann)
88. .
. (Harold . Neu)
89. , , . - .
(Charles . J. Carpenter)
90. . - , X. (King . Holmes, H. Hunter Handsfield)
91. . . (King
. Holmes)
92. :
. , .
(Lawrence Corey, Robert G. Petersdorf)
2. ,
93. . (Robert
Austrian)
94. . . (Richard M. Locksley)
95. . . ' (Alan
. Bisno)
96. . . (James P. Harnisch) . .
97. . . (Paul
D . Hoeprich)
98. . , .
(Donald Kaye, Robert G. Petersdorf)
99. . . (Harry N. Beaty)
100. . . (Harry N. Beaty)

7
17
33
42
52
61
78
116
127
150
161
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(Dennis L. Kasper)
102. . . (Dennis
L. Kasper)
3. .
103. . . (Harry
N. Beaty)
104. . . (King . Holmes)
105. ,
. . , (Dennis R. Schaberg.
Marvin Turck)
106. . . (Jay P. Sanford) .
107.
. . (Richard L.
Guerrant)
108. . . , .
(Richard D. Pearson, Richard L. Guerrant)
109. , . .
. , . (Ralph D. Feigin, Frederich
. Murphy)
110. . . , .
(Allan R. Ronald, Francis A. Plummer)
111. ( ). .
(King . Holmes)
112. . , .
(Donald Kaye, Robert G. Petersdorf)
113. . (Donald Kaye)
114. , .
. (Darwin L. Palmer)
115. . . . (Charles . J. Carpenter)
.
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117. , . . ,
. (Harry N. Beaty, A. William Pasculle) . . .
118. . (Lawrence Corey)

4.

119. . . (Thomas M. Daniel) .

120. ( ). . (Richard A. Miller)
121. . . (Stenley D. Freedman)
5. .
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. Holmes, Sheila A. Lukehart)
123. * : , ,
. . (Peter L Perine) . . . .
124. . . (Jay P. Sanford) . . .
125. . . (Jan
V. Hirschmann)
126. . .
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127. . . (Allen . Steere) . . .
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Staphylococcus
aureus

Streptococcus
- pneumoniae
Haemophilus
ibfluenzae

' S . pyogenes
H. influenzae
S. pneumoniae.
H. influenzae
()
S. pneumoniae.
Mycoplasma
pneumoniae
Mycobacterium
tuberculosis

S. aureus,

Bacteroides,
Fusobacterium
Streptococcus
viridans
S. aureus
Enterococcus

,
,

14

Salmonella,
Shigella,

Campylobacter
jejuni,
Escherichia coli
()
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,
Bacteroides,

,
Fusobacterium

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oyogenes
Candida

S. pyogenes,
H. influenzae,
S. aureus

(.
)

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Gonococcus

Corynebacterium
diphtheriae

S. pyogenes
S. aureus

Pseudomonas,
Proteus

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Klebsiella
Enterobacter

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, ,

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. influenzae
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multocida

Legionella
pneumophila
Klebsiella
()
.
S. pneumoniae

'

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Giardia

Klebsiella
Enterobacter,
Proteus spp.

Pseudompnas,
Candida,
Staphylococcus
epidermidis,
Listeria
monocytogenes
Yersinia enterocolitica
Entamoeba
histolytica.
Vibrio cholerae,
V. parahemolyticus

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- . coli

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(, - Enterobacter
)

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,

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trachomatis

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,
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trachomatis

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()

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,
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S. pneumoniae,

H. influenzae,
N. meningitidis

Pseudomonas

S. aureus
S. saprophyticus

Treponema
pallidum.
Mycoplasma
Klebsiella
Enterobacter,

Fusobacterium

,
S. aureus

Salmonella

S. pyogenes

S. pyogenes
Neisseria
meningitidis
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Enterobacter,
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Pseudomonas

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.

Gallin . /., Fauci A. S. (Eds.) Advances in Defence Host Mechanisms, vol. 5
Acquired Immunodeficiency Syndrome (AIDS). New York: Raven, 1985.
International Conference on Acquired Immunodeficiency Syndrome. Ann. Intern.
Med., 1985, 103, 653.
Mandell G. L. et al. (Eds.) Principles and Practice of Infectious Diseases, 2d ed.
New York: Wiley, 1985.
Root R. K- Infectious diseases: Pathogenetic mechanisms and host responses.
In: Pathophysiology The Biological Principles of Diseases, 2d ed./Eds.
L. H. Smith Jr., S. O. Thier. Philadelphia: Saunders, 1985.
83

. (James J. Ptorde)

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.

Eisenberg H. D. et al. Collection, handling and processing of specimens. In:
Manual of linica Microbiology, 4th ed./Eds. E. H. Lennette et al. Washington: DC, American Society for Microbiology, 1985.
Engteberg N. C, Eisenstein B. I. The impact of new cloning techniques on the diagnosis and treatment of infectious diseases. New Engl. J. Med., 1984, 311,
892.
Plorde J. J. Newer methods in microbial diagnosis. In: Contemporary Issues in
Infectious Diseases, vol. 4: Septic Shock/Eds. R. K. Root, M. A. Sande. New
York: Churchill Livingstone, 1985.
Todd J. K. Nonculture techniques using blood specimens for the diagnosis of infectious disease. In: Proceedings of Symposium: Body Fluids and Infectious
Diseases. Amer. J. Med., July 28, 1983, vol. 75, 3743.
Washington J. A. II Bacteria, fungi and parasites, the clinician and microbiology
laboratory. In: Principles and Practice of Infectious Diseases, 2d ed./Eds.
G. L. Mandell et al. New York: Wiley, 1985.

84

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(Henry Masur, Anthony S. Fauci)
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 84-2. ,

Staphylococcus aureus

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Staphylococcus aureus
Haemophilus inftuenzae

Streptococcus pneumoniae
Haemophilus influenzae
:
,
Escherichia coli.
,
Pseudomonas aeruginosa,
Candida,
Aspergillus,
NocarA ja

Staphylococcus aureus,
Streptococcus pyogenes

Staphylococcus aureus
Streptococcus pneumoniae
,
Pseudomonas species,

6, --7
-8

Neisseria meningitidis
Neisseria gonorrhoeae
Stpertococcus pneumoniae

im/VrAu

liJJUI

Listeria monocytogenes

Candida
Aspergillus
Cryptococcus neoformans
Herpes simplex
37

/
El

-
-
/

Herpes zoster
Pneumocystis carinii,

Herpes simplex
Mycobacterium
avium-intracellulare
Cryptococcus neoformans
Candida species
Candida
,

Streptococcus pneumoniae

Haemophilus influenzae
Neisseria meningitidis
Staphylococcus aureus
Streptococcus pneumoniae
Staphylococcus aureus,
Klebsiella pneumoniae,"
Escherichia coli
Giardia lamblia

Pneumocystis carinii,

Streptococcus pneumoniae
IgM
Haemophilus influenzae
Escherichia coli
Giardia lamblia,

Streptococcus pneumoniae
Haemphilus influenzae
- Pneumocystis carinii,

.
Streptococcus
pneumoniae,
Haemophilus influenzae,


Streptococcus
pneumoniae,
Haemophilus influenzae,
Staphylococcus aureus,
Rubella,
Giardia lamblia

Candida albicans

Pneumocystis carinii,
V dl ICtlld,

38

Rubella,

- -

 .

.
.
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(. 62). IgG
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tuberculosis) .
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Pneumocystis carinii.

Brovn A. ., Armstrong D. A. Symposium on infectious complications of neoplastic disease. Amer. J. Med., 1984, 76, 413, 631.
Eraklis A. I. et al. Hazard of overwhelming infection after splenectomy in childhood. New Engl. J. Med., 1967, 276, 1255.
Gallin 1. I., Fauci A. S. Advances in Host Defense Mechanisms, vol 1: Phagocytic
Cells. New York: Raven, 1982.
Gallin J. ]. Advances in Host Defense Mechanisms, vol. 2: Lymphoid Cells.
New York: Raven, 1983.
Gallin J. J. Advances in Host Defense Mechanisms, vol. 3: Chronic Granulomatous
Disease. - New York: Raven, 1983.
Kapadia S. B. Multiple myeloma: A clinicopathologic study of 62 corresponding
autopsy cases. Medicine, 1980, 5, 380.
Lau W. K. et al. Comparative efficacy and toxicity of amikacin/carbenicillin
versus gentamycin/carbenicillin in leukopenic patients. Amer. J. Med., 1977,
62, 959.
Notter D. T. et al. Infections in patients with Hodgkin's disease: A clinical study
of 300 consecutive adult patients. Rev. Infect. Dis., 1980, 2, 761.
Pizzo P. A. et al. Empiric antibiotic and antifungal therapy for cancer patients
with prolonged fever and granulocytopenia. Amer. J. Med., 1982, 72, 101.
Pizzo P. A. et al. Fever in the pediatric and young adult patient with cancer:
A prospective study of 1001 episodes. Medicine, 1982, 61, 153.
Pizzo P. A., Schimpff S. .C. Strategies for the prevention of infection in the myelosuppressed or immunosuppressed cancer patient. Cancer Treat. Rep., 1983,
67, 223.
Ross S. C, Densen P. Complement deficiency states and infection. Epidemiology,
pathogenesis and consequences of neisserial and other infections in an immune
deficiency. Medicine, 1984, 63, 243.
Rubin R. H., Young L. S. The Clinical Approach to Infection in the Immunocompromised Host. New York: Plenum, 1981.
Tratnont E. General or non-specific host defense mechanisms. In: Principles
and Practice of Infectious Diseases. 2d ed./Eds. G. L. Mandel et al. New
York: Wiley, 1985, 2531.

41

 85

, .
(Pierce Gardner, Paul M. Arnow)
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, , , , 42

 85-1.

( 1983 .)

. coli
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f\ \/ f\ 1 1 \

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: Centers for Disease Control. National Nosocomial Infections Study, 1983.

Morb. Mort. Week Rep. (suppl.), 1984, 33, 2 SS.

.
( Enterobacter, Pseudomonas
Serratia) , . .
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46

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,
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Bennett J. V., Brachman P. S. (Eds.) Nosocomial Infections. Boston: Little,
Brown, 1979.
Committee on Immunizations: Guide for Adult Immunization. Philadelphia:
American College of Physicians, 1985.
Conte J. E. Jr et al. Infection control guidelines for patients with the acquired
immunodeficiency syndrome (AIDS). New Engl. J. Med., 1983, 309, 740.
Cooper G. L., Hopkins . Rapid diagnosis of intravascular catheter-associated
infection by direct gram staining ofcatheter segments. New Engl. J. Med.,
1985, 312, 1142.
Dixon R. E. (Ed.) Symposium on nosocomia! infections. Amer. J. Med., 1981,
70, 379, 478, 631, 744, 899, 986.
Garner J. S., Simmons B. P. CDC guidelines for isolation precautions in hospitals. Infect. Contr., 1983, 4, 249.
Haley R. W. et al. The efficacy of infection surveillance and control programs in
preventing nosocomial infections in US hospitals. Amer. J. Epidemiol.,
1985, 121, 182.
Kim K-H. et al. Isolation of Clostridium difficile from the environment and
contacts of patients with antibiotic-associated colitis.--J. Infect. Dis., 1981,
143, 42.
Meyer R. D. Legionella infections: A review of five years of research. Rev.
Infect. Dis., 1983, 5, 258.

51

 86

. , .
(David . Dale, Robert G. Petersdorf)
.
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Bernton E. W. et al. Opioids and neuropeptides: Mechanisms in circulatory
shock. Fed. Proc, 1985, 44, 290.
Bryan S. et al. Analysis of 1186 episodes of gram-negative bacteremia in
non-university hospitals. The effects of antimicrobial therapy. Rev. Infect.
Dis., 1983, 5, 629.
60

Houston M. . et al. Shock diagnosis and management. Arch. Intern. Med.,

1984, 144, 1433.
Houtchens B. A., Westenskow D. R. Oxygen consumption in septic shock: Collective review. Circ. Shock, 1984, 13, 361.
Kreger B. E. et al. Gram-negative bacteremia: III. Reassessment of etiology,
epidemiology and ecology in 612 patients. Am. J. Med., 1980, 68, 322.
Kreger . . Gram-negative bacteremia: IV. Re-evaluation of clinical features
and treatment in 612 patients. Am. J. Med., 1980, 68, 344.
McCabe W. R. et al. Pathophysiology of bacteremia. Am. J. Med., 1983, 75, 225.
Mizock B. Septic shocka metabolic perspective. Arch. Intern. Med., 1984,
144, 579.
Parker M. M., Parrillo J. E. Septic shock: Hemodynamics and pathogenesis.
JAMA, 1983, 250, 3324.
Root R. K., Sande M. M. Septic shock. New York: Churchill Livingstone, 1985.
Schumer W. Steroids in the treatment of clinical septic shock.. Ann. Surg.,
1976, 184, 333.
Sprung L. et. al. The effects of high-dose corticosteroids in patients with
septic shock. N. Engl. J. Med., 1984, 311, 1137.
87

. (Jan V. Hirschmann)
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Bartlett I. G. et. al. Anaerobic infections of the head and neck. Otolaryng. Clin.
North. Amer., 1976, 9, 655.
Chow A. W. et al. Orofacial odontogenic infections. Ann. Intern. Med., 1978,
88, 392.
Federle M. P. et al. Computed tomography of pancreatic abscesses. Amer. J. Roehtgenol., 1981, 136, 879.
Goligher J. C. Surgery of the Anus, Rectum, and Colon. 5th ed. New York:
Macmillan, 1984.
Hau T. et. al. Pathophysiology, diagnosis, and treatment of abdominal abscesses.
Curr. Probl. Surg., 1984, 21, 8.
77

Hoverman IV et. al. Intrarenal abscess: Report of 14 cases. Arch. Intern.

Med., 1980, 140, 914.
Linscheid R. L. et al. Common and uncommon infections of the hand. Orthop.
Clin. N. Amer., 1975, 6, 1063.
McDonald M. I. et al. Single and multiple pyogenic liver abscesses. Medicine,
1984, 63, 291.
Sart M. G., Zuidema G. D. Splenic abscess Presentation, diagnosis and treatment. Surgery, 1982, 92, 480.
Simons G. W. et al. Retroperltbneal and retrofascial abscesses. J. Bone Jt Surg.,
1983, 65-A, 1041.
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.

Barza M. Imipenem: First of a new class of beta-lactam antibiotics. Ann.
Intern. Med., 1985, 103, 552.
GerdingD.N. (Ed.) Role of aminoglycosides as first-line therapy in multiple
clinickal settings.- Am. J. Med., 1985, 79 (1A), 1. .
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Neu H. C. (Ed.) Lactamase inhibition: Therapeutic advances. Am. J. Med.,
1985, 79 (5B), 1.
Remington J. S. (Ed.) Carbapenems: A new class of antibiotics.
Am. J. Med.,
1985, 78 (6A), 1.
Soully . ., NeuH.C. Use of aztreonam in the treatment of serious infections
due to multiresistant gram-negative organisms, including Pseudomonas
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SnavelyS.R., Hodges G. R. The neurotoxicity of antibacterial agents. Ann.
Intern. Med., 1984, 101, 92.
Winston D. J. et. al. Moxalactan plus piperacillin versus moxalactam plus amikacin in febrile granulocytopenic patients. Am. J. Med., 1984, "4, 442.
89

,
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.
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, ,
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(
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, .
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.
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122

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. .
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,
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),
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. ,
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.
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123

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.
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.
.
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124

 50 %
.
,
, , . . () 100
57 , 250 7 .

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.
.
, .
, .
,
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,
.
,
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, , . (, ) (, )
10 % .
. , , ,
.
.
,
, .
, 3 5 .
. , .
.
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. ,
,
. ,
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3
4 | ' / 2 - ,
.
.
,

125

. , ,
: -
().
50-86 %. ,
,
. ,

, .

Barker W. H., Jr. Vibrio parahemolyticus outbreak in Covington, Looisiana,
in August, 1972. Am. J. Epidemiol., 1974, 100, 316.
Btacklow N. R., Cukor G. Viral gastroenteritis. N. Engl. J. Med., 1981, 304, 397.
Blaser M. J. et al. Campillobacter enteritis in the United States. A multicenter
study. Ann. Intern. Med., 1983, 98, 360.
Blaser M. L, Reller B. /,. Campilobacter enteritis. N. Engl. J. Med., 1981, 305,
1444.
Carpenter . J., Sack R. B. Infectious diarrheal syndromes. In: Update
Harrison's Principles of Internal Medicine/Eds. K. J. Iselbacter et al.
New York: McGraw Hill, 1981, p. 209229.
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Dupont H. L. et al. Pathogencsis of Escherichia coli diarrhea. - N. Engl. J. Med.,
1971, 285, 1.
Dupont H. 1. et al. Symptomatic treatment of diarrhea with bismuth subsalicylate
among students attending a Mexican university. Gastroenterology, 1977,
73, 715.
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of childhood. N. Engl. J. Med., 1974, 293, 576.
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Norwalk virus in acute nonbacterial gastroenteritis. Ann. Intern. Med.,
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126

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90

. , X.
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.


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, (, HLA-B27)
, . ,

146

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,

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148

 (-). .
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. 90-7 , ,
, ,
.

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Bowie W. R. et a!. Etiology of nongonococcal uretritis: Evidence for Chlamydia
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Berger R. E. et al. Etiology, manifestations, and therapy of acute epididymitis:

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Stamm W. E. et al. Causes of acute urethra[ syndrome in women. N. Engl.

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Holmes K- K. Lower genital tract infections in women. In: Sexually Transmitted

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'

Brunham R. C. et al. Mucopurulent ce/vicitis the ignored counterpart in women

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Chapel . A. et al. The microbiological flora of penile ulceration. J. Infect. Dis.,

1978, 137, 50.
149

Kraus S. J. Genital ulcer adenopathy syndrome. In: Sexually Transmitted Diseases/Eds. K. K. Holmes et al. New York: McGraw-Hill, 1984, p, 706714.
Nsanze H. et al. Genital ulcers in Kenya: Clinical and laboratory study. Br.
J. Vener. Dis., 1981, 57(6), 378.
, ,
Qunn . . et al. The polymicrobial etiology of intestinal infections in homosexual
men. N. Engl. J. Med., 1983, 309, 576.

Holmes - . et al. Disseminated gonococcal infection. Ann. Intern. Med., 1971,

74, 979.
Pollock P. S., Handsfield H. H. Arthritis. In: Sexually Transmitted Diseases/Eds. . . Holmes et al. New York: McGraw-Hill, 1984, p. 745760.
91

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Acute Pelvic Inflamatory Disease (PID) 1985 STD Treatment Guidelines. - Morb.
Mort. Week. Pep., 1985, 34 (4S), 925.
Eschenbach D. A. et al. Polymicrobial etiology of acute pelvic inflammatory disease. N. Engl. J. Med., 1975, 293, 166.
Falk V. Treatment of acute nontuberculous salpigitis with antibiotics alone and
in combination with glucocorticoids. Acta Obstet. Gynecol. Scand., 1965,
44(Suppl.), 1.
Falk V. et al. Genital tuberculosis in women. Am. J. Obstet. Gynecol., 1980,
138, 974.
Gj^naess H. et al. Pelvic inflammatory disease: Etiologic studies with emphasis on
chlamidial infection. Obstet. Gynecol., 1982, 59, 550.
Henry-Suchet !. et al. Chlamydia trachomatis associated with chronic inflammation in abdominal specimens from women selected for tuboplasty. Am. J. Obstet. Gynecol., 1980, 138, 1022.
Jacobsen L., Westrom L. Objectivized diagnosis of acute pelvic inflammatory
disease. Am. J. Obstet. Gynecol., 1969, 105, 1088.
Mardh P. A. et al. Chlamydia trachomatis infection in patients with acute salpingitis. N. Engl. J. Med., 1977, 296, 1377.
. R. et al. Pelvic infection after elective abortion associated Chlamydia
trachomatis. Obstet. Gynecol., 1982, 59, 210.
Osser S., Persson K. Epidemiologic and serodiagnostic aspects of chlamydial salpingitis. - Obstet. Gynecol., 1982, 59, 206.
Paavonen J. et al. Comparison of endomelrial biopsy and peritoneal fluid cytologic
testing with iaparoscopy in the diagnosis of acute pelvic inflammatory disease. Am. J. Obstet. Gynecol., 1985, 151, 645.
Stjonh R. K., Brown S. T. (eds.) International symposium on pelvic inflammatory
disease. Am. J. Obstet. Gynecol., 1980, 138, 845.
Svennsson L. et al. Differences in some clinical and laboratory parameters in
acute salpingitis related to culture and serologic findings. Am. J. Obstet.
Gynecol., 1980, 138, 1017.
Suensson L. et al. Infertility after acute salpingitis with special reference to
Chlamydia trachomatis-associated infections. Fertil. Steril., 1983, 40, 322.
Thompson S. E. et al. High failure rates in outpatient treatment of salpingitis with
either tetracycline alone or penicillin/ampicillin combination. Am. J. Obstet.
Gynecol., 1985, 152, 635.
Wasserheit.J. N. et al. Microbial causes of proven pelvic inflammatory disease and
efficacy of clindamycin with tobramycin. Ann. Intern. Med. (in press).
Wflner-Hanssen P. et al. Endometrial infection in women with chlamydial salpingitis. Sex. Transm. Dis., 1982, 9, 84.
92

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Adult immunization: Recommendations of the immunization practices adviso

. committee. Morb. Mort. Week. Rep., 1984, 33, 15.
Broome V. Pneumococcal disease after pneumococcal vaccination. N. Eng
J. Med., 1980, 303, 549.
Centers for Disease Control: 1985 STD treatment guidelines. - - Morb. Mort. Wei
Rep., 1985, 34, (4S).
Committee on Immunization, Council of Medical Societies: Guide to adult immur
zation. Am. Col. Phis., 1985.
Dupont H. L. Chemotherapy and Chemoprophylaxis of traveler's diarrhea. An
Intern. Med., 1985, 102, 258.
Goldman P.. G., Petersdorf R. G. Prophylactic antibiotics: Controversies give wi
to guidelines. Drug. Ther. June 1979, pp. 5777.
Hirschmann J. V., Inui T. S. Antimicrobial prophylaxis: A critique of recent ti
als. Rev. Infect. Dis., 1980, 2, 1.
Immunization Practices Advisory Committee, CDC: Poliomyelitis prevention.
Ann. Intern. Med., 1982, 96, 630.
Krugman S. Effect of human immune serum globulin on infectivity of hepatii
A virus. J. Infect. Dis., 1975, 34, 70.
Levin S. Selected overview of nongynecologic surgical intraabdominal infection
Prophylaxis and Therapy. Am. J. Med., 1985, 79 (syppl. 5B), 146.
Ruben F. L. Antitoxin responses in the elderly to tetanus-diphtheria (Td) immur
zation. Am. J. Epidemiol., 1978, 108, 145.
Schimpff S. E. Infection prevention during profound granulocytopenia. An
Intern. Med., 1980, 93, 358.
Shapiro E. D. Controlled evaluation of the protective efficacy of pneumococc
vaccine for patients at high risk or serious pneumococcal infection. An
Intern. Med., 1984, 301, 325.
Weiss B. P. Tetanus and diphtheria immunity in an elderly population in Los Ang
les Country. Am. J. Public. Health, 1982, 73, 802.

93

(Robert Austrian)
. (Streptococcus pneumoniae)
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Austrian /?., Gold J. Pneumococcal bacteremia with especial reference to bacteremic
pneumococcal pneumonia. - Ann. Intern. Med., 1964, 60, 759.
Austrian R., Gold et al. Prevention of pneumococcal pneumonia by vaccination. -Trans. Assoc. Am. Phys., 1976, 89, 184.
Fruchtman S. M. et al. Adult respiratory distress syndrome as a cause of death in
pneumococcal pneumonia. Chest., 1983, 83, 598.
Gopal V., Bisno A. L. Fulminant pneumococcal infections in "normal" asplenic
hosts. - A r c h . Intern. Med., 1977, 137, 1526.
Hejjron R. Pneumonia with Special Reference to Pneumococcus Lobar Pneumonia. Cambridge: Harvard, 1979.
Kaplan S. L. Antigen detection in cerebrospinal fluid-pros and cons. Am. J. Med.,
1983, 79, 109.
Light R. W. et al. Parapneumonic effusions. Am. J. Med., 1980, 69, 507.
Marino P. L. et al. Bacteremic pneumococcal pneumonia and myoglobinuric renal
failure.
Am. J. Med., 1986, 80, 521.
Robbins J. B. et al. Considerations for formulating the second-generation pneumococcal polysaccharide vaccine with emphasis on the cross-reactive tipes within
groups. - J. Infect. Dis., 1983, 148, 1136.
Shapiro E. D., Clemens J. D. A controlled evaluation of the protective efficacy of
pneumococcal vaccine for patients as high risk of serious pneumococcal infections. Ann. Intern. Med., 1984, 101, 325.
Stephen J. J. et al. The radiographic resolution of Streptococcus pneumoniae pneumonia. N. Engl. J. Med., 1975, 293, 798.
Tuomanen E. et al. The induction of meningeal inflammation by components of
the pneumococcal cell wall. - J. Infect. Dis., 1985, 151, 859.
Ward J.. Antibiotic-resistant Streptococcus pneumoniae: Clinical and epidemiologic
aspects.--Rev. Infect. Dis., 1981, 3, 254.
192

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Archer G. L. Staphylococcus epidermidis and other cpagulase-negative staphylococci. In: Principles and Practice of Infectious Diseases/Eds. G. Mandell
et al. New York: Wiley Medical, 1985, pp. 11171123.
Chambers H. F. et al. Staphylococcus aureus endocarditis: Clinical manifestations
in addicts and nonaddicts. Medicine, 1983, 62, 170.
Garse P. L. et a I. Staphylococcus aureus isolates from patients with nonmenstrual
toxic shock syndrome. Evidence for additional toxins. JAMA, 1985, 253, 2538.
Hovelius .. Mardh P. A. Staphylococcus saprophyticus as a common cause of
urinary tracs infections. Rev. Infect. Dis., 1984, 6, 328.
Lowy F. D., Hammer S. M. Staphylococcus epidermidis infections. Ann. Intern.
Med., 1983, 99, 834.
Sheagren J. N. Staphylococcus aureus. The persistent pathogen. New Engl. J.
Med., 1984, 310, 1368.
Walvogel F. A. Staphylococcus aureus (including toxic shock syndrome). In:
Principles and Practice of Infectious Diseases/Eds. G. C. Mandell et al."
New York: Wiley Medical, 1985, pp. 10971117.
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American Heart Association, Committee on rheumatic fever and bacterial endocarditis: Prevention of rheumatic fever. Circulation, 1984, 70, 1118A.
Auckentaller R. et al. Group G streptococcal bacteremia: Clinical study and review
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with superficial fungal infection in saphenous venectomy limbs. JAMA,
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96

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Belsey M. A., LeBlanc D. R. Skin infections and the epidemiology of diphtheria,
acquisition and persistence of C. diphtheriae infections. Am. J. Epidemiol.,
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1974, 129, 172.
.
'
Good I. Myocardial changes in fatal diphtheria. A summary of observations in
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of diphtheria in modern American. Ann. Intern. Med. (in press).
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Kurdi A., Abdul-Kader M. Clinical and Electrophtysiological studies of diphtheritic
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229

McCloskey R. V. et al. The 1970 epidemic of diphtheria in San Antonio. N. Ann.

Intern. Med., 1971, 75, 495.
Naiditsh M. L, Bower A. G. Diphtheria: A study of 1,433 cases observed during a
tenyaer period at the Los Angeles Country Hospital. Am. J. Mel., 1954, 17,
229.
Pappenheimer A. M., Jr. Diphtheria toxin. Ann. Rev. Biochem., 1977, 46, 69.
Pappenheimer A. M., Jr., Murphy J. R. Studies on the molecular epidemiology of
diphtheria. Lancet, 1983, 2, 923.
Scheid W. Diphtherial paralysis: An analysis of 2292 cases of diphtheria in adults
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Schiller J. et al. Plasmids in Gorynebacterium diphtheriae and diphtheroids mediating erytromycin resistance.
Antimicrob. Agents Chemother., 1980, 18, 814.
Tompson N. L., Ellner P. D. Rapid determination of Corynebacterium diphtheriae
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493.
Wittels ., Bressler R. Biochemical lesion of diphtheria toxin on the heart.
J.
Clin. Invest., 1964, 43, 630.

97

. (Paul D. Hoeprich)

. (Listeria monocytogenes)
. , ,
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.
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230

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232

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234


Rojsen-Moller J. Human listeriosis. Diagnostic, epiderhiological and clinical slu' dies. - Acta Pathol. Microbiol. Scand., 1972, 229, 13.
Fleming D. W. et al. Pasteurized milk as a vehicle of infection in an outbreak of
listeriosis. N. P.ngl. J. Med., 1985, 312, 404.
Holiday H. L.. Hirata T. Perinatal listeriosis a review of twelwe patients.
Am. J. Obstet. Gynecol., 1975, 133, 405.
Hoeprich P. D. Listeriosis. In: Infectious Diseases/Ed. P. D. Hoeprich. -- 3d
ed. Philadelphia: Lippincott-Harper, 1982, chap. 51.
Hoeprich P. D. Erysipeloid. In: Infectious Diseases/Ed. P. D. Hoeprich. - 3d
ed. Philadelphia: Lippincott-Harper, 1982, chap. 103.
Listeriosis outbreak associated with Mexican-style cheese. California Morb. Mort.
Week. Rep., 1985, 34, 357.
Nelson E. Fife hundred cases of erysipeloid. Rocky Mount. Med. J., 1955, 52, 40.
Rocourt J., Grimont P.A.D. I.isteria welshimeri sp. nov. and Listeria seeligeri sp.
nov. Int. J. Syst. Bacteriol., 1983, 33, 866.
Schlech W. F. Ill et al. Epidemic listeriosis evidence for transmission by food.
N. Engl. J. Med., 1983, 308, 203.
Seeliger H.P.R. Listeriosis. Base: Karger, 1961.
98

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,
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Brachman P. S. Inhalation antrax. - Ann. NY Acad. Sci., 1980, 353, 83.
Brachman P. S. Antrax. In: Bacterial Infections of Human: Epidemiology and
Control/Eds. A. Evans, H. Feldman. New York: Ms Hilary Evans Publishing, 1982, pp. 6364.
Feeley J. C, Patton . . Bacillus. - In: Manual of Clinical Microbiology/Eds.
E. H. Lennette et al. 3 Ed. Washington: DC, American Sociaty of Microbiology, 1980, p. 145.
Laforce F. M. Woolsorters' disease in England. Bull. NY Acad. Med., 1978, 54,
956.
Nalin D. R. et al. Survival of a patient with intestinal antrax. Am'. J. Med.,
1977, 62, 130.
Sirisanthana T. et al. Outbreak of orai-oropharyngeal antrax: An unusual manifestation of human infection with Bacillus anthracis. Am. J Trop. Med.
Hyg., 1984, 33, 144.

99

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Brand D. A. et al. Adequacy of antitetanus prophylaxis in six hospital emergency
rooms. N. Engl. J. Med., 1983, 309, 636.
Centers for disease control: Diphtheria, tetanus, and pertussis. Guidelines for vaccine prophylaxis and preventive measures. Morb. Mort. Week. Rep., 1981, 30,
392.
Newton-John H. F. Tetanus in Victoria, 19571980. Med. J. Aust., 1984, 140,
194.
O'Keefe S. J. D. et al. The metabolic response and problems with nutritional support in acute tetanus. Metabolism, 1984, 33, 482.
Scher K. S. et al. Inadequate tetanus protection among rural elderly. South.
Med. J., 1985, 78, 153.
Simonsen O. et al. Immunity against tetanus and effect of revaccination 25
30 years after primary vaccination. Lancet, 1984, 2, 1240.
Tidyman M. et al. Adjunctive use of dantrolene in severe tetanus. Anesth.
Analg., 1985, 64, 538.
245

100

. _

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Arnon S. S. Infant botulism. Annu. Rev. Med., 1980, 31, 541.
Dowell V. R. et al. Botulism and tetanus: Selected epidemiologic and microbiologic aspects. Rev. Infect. Dis., 1985, 6 (suppl. 1), 5202.
Hughes 1. M. et al. Clinical features of types A and food-borne botulism. Ann.
Intern. Med., 1981, 95, 442.
Long S. S. et al. Clinical, laboratory, and environmental features of infant botulism
in southeastern Pennsylvania. Pediatrics, 1985, 75, 935.
250

McDonalds . L. et al. Botulism and botulism-like illness in chronic drug abusers. - Ann. Intern. Med., 1985, 102, 616.
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Jacket C. 0. Equine antitoxin use and other factors that predict outcome in type
A foodborne botulism. Am. J. Med., 1984, 76, 794.

101

. (Dennis L. Kasper)
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257

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.
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.
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*

259


Barth'tt J. G. et al. Antibiolic-associated pseudomembranous colitis due to toxin
producing clostridia. New E. J. Med., 1978, 298, 531.
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p. 1 48.
Bornstein D. L. Clostridial myonecrosis.
In: Medical Microbiology and Infections
Diseases/Ed. A. Braude.
Philadelphia: Saunders, 1981, Chap. 239.
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human infections. - Scand. J. Infect. Dis., 1975, 7, 127.
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York: Wiley, 1985.
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1978, 65, 542.
Koransky J. R. et al. Clostridium septicum bacteremia. Am. J. Med., 1979, 66, 63.
Lawrence G. el al. Predention of necrotizing enteritis in Papua, New Guinea by
active immunization. Lancet, 1979, 1, 227.
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infection. Am. J. Gynecol., 1971, 111, 484.
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1979, 1, 254.
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agents. Antimicrob. Agents Chemother., 1976, 10, 736.
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1043.
Thadepalli H. et al. Abdominal trauma, anaerobes, and antibiotics. - Surg. Gynecol. Obstet., 1973, 137, 270.

102

. (Dennis L. Rasper)
. , 10 % .
10%, .
, .
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, , . 72 ,
.
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.
.
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.
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260

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. .
, , . thetaiotaomicron, . distasonis, . vulgaris
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, .
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. . 52 % ,
.
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, .
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.
.
.
264

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, , .
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. . fragilis in vitro , . , .
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.

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266

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, .
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,
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, , , ,
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, . . 90 %
, 50 % ,
.
267

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, ,
. - .
. ,
.
: ,
.
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, . , . fragilis, . melaninogenicus, .
- , , , ,
.
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)
, .
,
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.
, .
. ,
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. ,

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. , . ,
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.

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, D. . ,
, .
.
, , . .
, ,
. . .
. .
. , , , .
. , , , .
. (. . 147)
268

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. ,
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,
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, .
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,
.
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,
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, . , , .
269

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.
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. ,
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270

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.

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, .
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.
, ,
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, ,
.
,
, . fragilis , G.
. , 612 / 4 (. . 205).
, , , . , ,
, .i (.-) . 271

 . melaninogenicus .
, , ,
. fragilis .
. fragilis , , .

, , ,
,
. ,
.
, . fragilis, ,
,
. , 80 %
, . Fragilis, .
,
. fragilis. , .
, , ()
, ,
, . fragilis. , ,
, , .
. , (600 8 ), . (7,5 / 8 ).
(, ) . , ,
, . fragilis. , , . ,
, , , Serratia.
() 30 -60 /
. , . G

,
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.
, , , , G,
. fragilis .
,
.
. () 40 000-100 000 . , ,
, .
.
.
272

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.

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, , , .
.
,
. , ().
.
, , ,
,

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.

Balows A. et al. Anaerobic Bacteria: Role in Disease. Springfield: Thomas, 1974.
Barlletl J. G., Finegold S. M. Anaerobic Infections of the Lung and Pleural Space. Am. Rev. Resp. Dis., 1974, 110, 56.
Finegold S. M. Anaerobic Bacteria in Human Disease. New York: Academic,
1977.
Gorbach S. C. Anaerobic bacteria.
In: Principles and Practices of Infectious
Diseases/Eds. G. L. Mandell et al. New York: Wiley, 1985.
Gorbach S. C. Bartlett J. G. Anaerobic' infections. New Engl. J. Med., 1974,
290, 1177.
Harding G. K. M. et al. Prospective randomized comparative study of elindamycin,
chloramphenicol and ticarcillin, each in combination with gentarnycin in therapy for intraabdominal and female tract sepsis. J: Infect. Dis., 1980, 142,
384.
Kasper D. L. et al. Virulence factors of anaerobic bacteria. Rev. Infect. Dis.,
1979, 1, 246.
Kasper D. L. et al. Capsular polysaccharides and lipopolysaccharides from two
strains of Bacteroids fragilis.
Rev. Infect. Dis., 1984, 6, 525.
Ledger W. J. Infection in the Female. Philadelphia: Lea and Febiger, 1977.
Mansheim B. J., Kasper D. L. Infections produced by non-sporulating anaerobic
bacteria. -- In: Seminars in Infectious Diseases VII/Eds. L. Weinstein, B. J.
Fields. - New York: Grune and Stratton, 1979.
Mathisen G. E. at al. Brain abscess and cerebritis. - Rev. Infect. Dis., 1984, 6,,
5101.
-Nakata M. N., Lewis R. P. Anaerobic bacteria in bone and joint infections.
Rev. Infect. Dis., 1984, 6, 5165.
Newman M. G. Anaerobic oral and dental infections. Rev. Infect Dis., 1984,
6, 5107.
Onderden K. et al. Use of a model of tntraabdomina! sepsis for studies of the pathogenicity of Bacteroides fragilis. Rev. Infect. Dis., 1984, 6, 5191.
Perera M. R. et al. Presentation, diagnosis and management of liver abscess.
Lancet, 1980. 2, 629.
Sutler V. L. et al. Wadsworth Anaerobic Bacteriology Manual. 3d ed. St Louis: Mosby, 1980.
273

103

. (Harry N.Beaty)
. ( Neisseria) , .
.
. , , , 3537 5 - 1 0 % . , ( ) 1824
, .
, , ; ,
. , , ,
, .

.
Z. V W 135.
,
. , , .
.
- .
-
. -, - . , ,
812 4- 6 .
1965 . ( 100 000 ).
:
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, . 274


1000 . 15 000 . ,
, .
,

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.
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5055 % .
, , W 135 V,
2025, 15 10% . 12% , - 3060 % .
, , ,

. , , .
, , , . 60- , 1982 . 90 %
. ,
, , . ,
, 30 % .

, .
.
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.
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100%.
, , !i 75 % . , , . ,
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,
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.
275

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, .
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276

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.

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.


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.
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278

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.
. .
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.
, ,
279

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2448 ,

.

Band J. D. et al. Trends in meningococcal disease in the United States, 19751980. J. Infect. Dis., 1983, 148, 754.
Black J. R. et al. Neisserial antigen H. 8 is immunogenic in patients with disseminated gonococcal and meningococcal infections.J. Infect. Dis., 1985, 151, 650.
Buchan H. et al. An outbreak of meningococcal disease: implications for community
medicine. - NZ. Med. J., 1984, 97, 860.
Centers for Disease Control Meningococcal vaccines. Mortr. Mort. Weekl Report,
1985, 34, 255.
Ross S. C. et al. Complement deficiency states and infection: Epidemiology, pathogenesis and consequences of neisserial and other infections in an immune deficiency. Medicine, 1984, 63, 243.

104

. (King .Holmes)
. , ,
. . , , ,
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. ,
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.

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.
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, ,
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.
,
20 000.
.
in vitro in vivo. .

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280

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,
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, ( ) -
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. ,
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,
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282

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.
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286

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10114

289


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.
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.
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290

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291

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.
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,
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,
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.
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4,8
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, . 280 .
, , .
. ,
, ,
292

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. . ,
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,
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.
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,
( 5%) .
.
, .

Britigan . ., Sparling P. F. Gonococcal infection: A model of molecular pathogenesis. N. Engl. J. Med., 1985, 312, 1683.
Centers for Disease Control: 1985 STD treatment guidelines. Morb. Mort. Week
Rep., 1985, 34 (4S), 75S.
Curran J. W. et al. Female gonorrhea: Its relations to abnormal uterine bleeding,
urinary tract symptoms and cervicitis.Obstet. Gynecol., 1975, 45, 195.
Easmon S. F. et al. Emergence of resistance after spectinomycin treatment of
gonorrhoea due to beta-lactamase-producing strain of Neisseria gonorrhoeae. Br. Med. J., 1982, 284, 1604.
Handsfield H. H. et al. Asymptomatic gonorrhea in men. Diagnosis, natural course,
prevalence and significance. N. Engl. J. Med., 1974, 290, 117.
Handsfield H. H. et al. Treatment of the gonococcal arthritis-dermatitis syndrome.Ann. Intern. Med., 1976, 84, 661.
Handsfield H. H. et al. Epidemiology of penicillinase-producing Neisseria gonorrhoeae infections: Analysis by auxotyping and serogrouping. N. Engl. J. Med.,
1982, 306, 950.
Holmes - - et al. Disseminated gonococcal infection. Ann. Intern. Med., 1971,
74, 979.
Hook E. H., Ill, Holmes - . Gonococcal infections. Ann. Intern. Med., 1985,
102, 229.
Knapp J. S. et al. Serologic classification of Neisseria gonorrhoeae using monoclonal antibodies directed against outer membrane protein I. J. Infect. Dis.,
1985, 150, 44.
Panikabutra K- et al. Randomized comparative study of ceftriaxone and spectinomycin in gonorrhea. Genitourin Med., 1985, 61, 106.
Petersen B. H. et al. Neisseria meningitidis and Neisseria gonorrhoeae bacteremia
associated with C6, C7 or C8 deficiency. Ann. Intern. Med., 1979, 90, 917.
Roberts M. et al. Molecular characterization of two beta-lactamase specifying plasmids isolated from Neisseria gonorrhoeae. J. Bacteriol., 1977, 131, 557.
Roberts R. B. The Gonococcus. New York: Wiley, 1977.
Schoolnik G. K- et al. (eds.) The Pathogenic Neisseria. Washington; Dc, American Society for Microbiology, 1985.
293

105

,

. ,
(Dennis R. Schaberg, Marvin Turck)
. ,
, , , , - .

, . , Escherichia,
Salmonella, Shigella, Klebsiella, Serratia, Enterobacter, Proteus, Morganella,
Yersinia, Providencia ,
. , .
,
.
Pseudomonas, Acinetobacter Eikenella.

, Escherichia coli
. . coli Enterobacteriaceae
- , , , , , , . ,
, .
. , , , (. . 86). 50 % ,
,
; , , . . coli
;
.
, ,
, -
, , . , , , ,
.
, ,
, , . Bacteroides
spp., .
. . coli (), () () . . .
,
, ,
, .
294

 . coli, , , - (
), . ,
.
,
. coli O4, 075 ,
, ' . ,
, .
. coli 1 ,
. - .
. . 75 % , , , (. . 225).
, , , coli,

Pseudomonas.
.
, ,
, , , , .
:
, , Bacteroides. -
. -
, ,
. ,
. -
(),
.
. - . , , .

; .
,
.
. ,
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. , , .
,
, ,
, .
, . ,
, .
295

 . , ,
,
. , .
de novo,
.
. ,
, . coli ,
.
- (IgM) ,
-.
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, (LT) , Vibrio cholerae, (ST) (. . 89 115).
, , .
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,
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,
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.
.
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.
, , , , ,
. .
. .
.
. coli.
. , , , . . coli, , - . .
, ,
, , , . , ,
296

, ,
.
in vitro.
,
, . . colt,
, ,
2 4 , . 12
.
. coli; ,
. , , .
, . coli (. . 346).
,
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. 15 / ,
812 .
, , , .
, , . ,
. coli, (400 ) (24 );
,
.
().
.
.
, , .
, ,
, .

, - KlebsiellaEnterobacterSerratia
. coli , , Klebsiella, Enterobacter Serratra,
. ,
, , ,

.
(. pneumoniae) , . Serratia Enterobacter
. Klebsiella,
Enterobacter Serratia ,
Klebsiella
,
. , Klebsiella
.
75 . ,
297

 , , .
Klebsiella rhinoscleromatis, ,
, . ozenae , ,
. Klebsiella oxytoca . pneumoniae.
. Klebsiella, Enterobacter Serratia .
,

. . pneumoniae ,
.
, ,
. , , , , , . Klebsiella ,
Enterobacter Serratia, , , . , Serratia,
.
Escherichia
, .
. , , ,
, ,
. , , , .
. Serratia Enterobacter
.
, .
.
, , , 1 %
, .
40 . , ,
. , , , . ',
(. . 93),
, , , .
,
. . ,
- , , . ,
, , .
.
, , ,
,
.
, ,
298

. .

, , ;
, ,
.
Klebsiella, Serratia Enterobacter . ,
. , Serratia, ,
, . , Serratia, ,
. , - Serratia
, .
, , (
), , . , , , , .
. , , .
,
. , , ,
. , , ,
. , ,
.
.
, , . .
( ) , .
. Klebsiella, Enterobacter Serratia -.

in vitro. ,
.
Klebsiella . ,
, (Mezlocillin).
Serratia , ; . , Klebsiella, Enterobacter Serratia,

, . ,
( 3 5 / )
(15 / ), , ( 4 12
). / [ ,
299

' (Cefoxitin)],
Klebsiella, Enterobacter Serratia.
, ,

in vitro. -
, ,
^ I ,
, in vitro.
, 1014 , . . .
. .
.
50 80 % 48
. , . ,
, -
.

, Proteus, Morganella Providencia

. Proteus Enterobacteriaceae ,

. ,
Proteus,
. ; morganii Morganella morganii, . rettgeri Providencia stuartii Providencia rettgeri. P. mirabilis P. vulgaris
. . mirabilis 7590 %
, . . P. vulgaris ,
( ) , ()
. , Providencia, ,
.
.
, .
, .
,
, , .
, .
.
. , : , , , ,
, , , , , ,
.
.
, , ,
, .
300

 , , ,
.
.
, P. mirabilis,
. , ,
. .
, , , .
. ,
, .
. ' ,
.
. ,
, , .
,
. ,

-- .
. , Proteus, Morganella Providencia. 75 % ;
, - , , , . , , ,
.- , , , , , , , .
. , Proteus, Morganella videncia, , . P. mirabilis, - , - , P. mirabilis
. . ,
P. mirabilis P. vulgaris,
, . .
. P. mirabilis
(10 I ), , , , ,
. , P. mirabilis,
.
0,5
46 . :
6 12 20 000 000 G 5 / ,
. , ,
301

P. mirabilis, G.
, P. mirabilis, . P. mirabilis . , P. mirabilis,
. ,
,
.
in vitro, . , , ,
.

, Pseudomonas
. P. aeruginosa
, .
, , , - ,
,
. (
) , .
.
, . P. maltophilia, P. cepacia, P. fluorescens,
P. testosteroni P. putida .
. , , , .
. Pseudomonas ,
. , ,
.

, .
- , ,
. , , , -,
, , , ,
.

.
,
.
, P. aeruginosa, , , . , , ,
, (
,
), " , . ,
, , .
, , , , ,
,
.
302

 , , , . , . P.aeruginosa - 5 % ,
.
.
.
, - ;
, , .
. , , , , , . ,
, , .
. , .
P. aeruginosa ,

.

. . , ,
, P. aeruginosa. , P. aeruginosa,
.
. , ,
, , , ,
.
,
, , P. aeruginosa.
.
Pseudomonas
, , , .
. ,
. . ,
, ; ,
(
). , ,
. , .
.
. . , , , , . ,
, * 34 , , .
, . , 303

, .
. -
. . .
- , .
,
.
.
, .

. .
\
.
. Pseudomonas
.
, ,
.

, .
- . Pseudomonas , . , , ,
, ,
. "" ,
. , 13- Shanghai, . .
. . , ,
.
, .
, , .
. , ,
. . , ", , ,
, . . , ,
. , .
. , Pseudomonas,
,
, ,
. ,
, ,
.
304


,
, ,
, , .
, , . Pseudomonas , . ,
: , ,

- 1 ; , , .
.
. , ,
.
, .
.
.
, , , .
.
1 %
.

. , ,
, .
, Pseudomonas.

5 /
.
. 15 / .
(Ticarcillin) (Mezlocillin)
Pseudomonas 16 20 . (Piperacillin)
(Azlocillin) in vitro
, . ,
, , .
, , , , , .
,
, ,.
, . , P. aeruginosa, ,
. , (Cefoperasone) (Ceftazidime), in vitro .
. , ,
, (. . 85).
305

 ,
,
. ,
-,
.
. , Pseudomonas,
75 %
III , ,
. , . ,
, , - .

, Acinetobacter

. Acinetobacter , Neisseria. , , , , , , .
. A. calcoaceticus Iwoffi DeBord Mima
polymorpha 1939 . Acinetobacter.
A. calcoaceticus anitratus, Herella
vaginicola. , Bacterium anitratum B5W,
Acinetobacter. ,
, , .
, , , .
, , ;

. , Neisseria,
, , .
. Acinetobacter . 25 % . Acinetobacter ,
, .
Acinetobacter , ,
, -,
.
, ,
,
, . ,
, Acinetobacter, , . ,
, .
Acinetobacter .
, .
. , Acinetobacter,
, , , .
, . Acinetobacter
, ,
, ,
306

. , ,
, , . .
. , .
. , Acinetobacter,
,
, . , , . Acinetobacter , ,
, , - . Acineto-
bacter Neisseria, , .
. Acinetobacter
, , ,
, . ,
, , , .
, , . ,
,
.

, Eikenella
. . corrodens
.

. 48 72 .
. . corrodens ,
- .
.
Eikenella- , ,
- , ,
.
. , Eikenella,
. , ,
. Eikenella- ,
, Bacteroides fragilis Peptostreplococcus.
,
; ; .
. . corrodens , , . . .
Eikenella .
, Eikenella, .

307


:
Kreger . . et al. Gram-negative bacteremia. Amer. J. Med., 1980, 68, 332.
Maki D. G. Nosocomial bacteremia: An epidemiologic overview. Amer. J. Med.,
1981, 70, 719.
Moore R. D. et al. Association of aminoglycoside plasma levels with therapeutic
outcome in gram-negative pneumonia. Amer. J. Med., 1984, 77, 657.
Schaberg D. R. et al. Epidemics of nosocomial urinary tract infection caused by
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Tancrede C. H., Andremont A. O. Bacterial translocation and gram-negative
bacteremia in patients with hematological malignancies. J. infect. Dis.,
1985, 152, 99.
, Escherichia coli
Berk S. L., McCabe W. R. Meningitis caused by gram-negative bacilli. Ann.
Int. Med., 1980, 93, 253.
Conn H. O., Fessel J. M. Spontaneous bacterial peritonitis in cirrhosis. Medicine, 1971, 50, 161.
Geraci J. E. et al. Endocarditis due to gram-negative bacteria. -- Mayo Clin.
Proc, 1982, 57, 145.
, Klebsiella Enterobacter Serratia
Cooper R., Mills I. Serratia endocarditis. Arch, intern. Med., 1980, 140, 199.
Meltz D. J., Grieco M. H. Characteristics of Serratia marcescens pneumonia.
Arch, intern. Med., 1973, 132, 359.
Rennie R. P., Duncan I. B. R. Emergence of gentamicin resistant Klebsiella
in a general hospital. Antimicrob. Agents Chemother., 1978, 11, 179.
, Proteus
lannini P. B. et al. Multidrug resistant P. rettgeri. Ann. intern. Med., 1976,
55, 161.
Lewis J., Fekety F. R. Proteus bacteremia. Johns Hopkins Med. J., 1969, 124, 151.
Muscher D. M. et al. Role of urease in pyelonephritis resulting from urinary
tract infections with Proteus. J. infect. Dis., 1975, 131, 177.
, Pseudomonas
Bagel J., Grossman M. E. Subcutaneous nodules in Pseudomonas sepsis.
Amer. J. Med., 1986, 80, 528.
Bodey G. P. et al. Infections caused by Pseudomonas aeruginosa. Rev. infect.
Dis., 1983, 5, 279.
Collini F. J. et al. Ecthyma gangrenosum in a kidney. transplant recipient with
Pseudomonas septicemia. Amer. J. Med., 1986, 80, 729.
Doggett R. G. (Ed.) Pseudomonas aeruginosa: Clinical manifestations of infection
and current therapy. New Fork: Academic, 1979.
Flick M. R., Cluff L. E. Pseudomonas bacteremia. Review of 108 cases. -Amer. J. Med., 1976, 60, 501.
Pollack M The role of exotoxin A in Pseudomonas disease and immunity. Rev.
infect. Dis., 1983, 5 (Suppl), 979.
, Acinetobacter
Buxton A. E. et al. Nosocomial respiratory tract infection and colonization with
Acinetobacter calcoaceticus. Amer. J. Med., 1978, 65, 507.
Glew R. H. et al. Infections with Acinetobacter calcoaceticus: Clinical and laboratory studies. Medicine, 1977, 56, 79.
Retailliau F. H. et al. Acinetobacter calcoaceticus: A nosocomial pathogen with
unusual seasonal pattern. J. infect. Dis., 1979, 139, 371.
308

, Eikenella

Brooks G. F. et at. Eikenella corrodens, a recently recognized pathogen. Medicine, 1974, 53, 325.
Goldstein F. J. C. et al. Isolation of Eikenella corrodens from pulmonary infections. Amer. Rev. resp. Dis., 1979, 119, 55.
106

. (Jay P. Sanford)

.
. ,
, , , .
. Pseudomonas pseudomallei,
P. mallei . P. pseudomallei
( ) , . , Wayson Wright
.
, 4872 . : I (),
, , II (), .
.
. - , .
, , , , , ,
, ( , ). ,
, , (, ),
. 1976 . P. pseudomallei
. ,
. (, )
,
. , ,
, . 1973 .,
, , , 343
36 .
P. pseudomallei , ,
, , , .
. P. pseudomallei
, , . .
, , , ,
. , , -,
. P. pseudomallei . .
. 309

 ,
.
, . P. pseudomallei (
), , ,
" . . P. pseudomallei , ,
1:10 240 . 2-
,
, ,
.
. , . ,
: , ,
, , , , , , , ,
, .
, , - ,
,
,
.
( ).
,
. .
; 10 109/, - 50 % -. . - - .
. . , .
. ,
, - , 2 .
3 .
,
. ,
26 . , ,
. , ,
, ,
, .
. ,
6 8 %
P. pseudomallei.
, ,
20 %.
1 %. . , 2 % , , 19 %
, .
. (1:40 )
10,6% ( 5,7%) .
310

 10 % ,
.
.
"
() . ,
.
.
. ,
.

.
, ,
, .
, 38,9
.
. .
.
. ,
.
. ,
-20 109/.
, . ,
.
2 7 . .
. ,
1 .

.
, ' .
. , , ,
, . .
, ,
, , , ,
, , . , ,
; .

. . .

, , .
.
4- 10 . , .
.
, .
. , .
311

 , , , , , ,
, , , .
.
. ,
, . 26
. , , , , ,
, . P. pseudomallei , -, ,
, ,
HTLV-III , ,
P. pseudomallei .
.
, , . ,
,
, ,
.
, , ,

. P. pseudomallei
2448 ,
() .
P. mallei P. aeruginosa
,
.
72 . j-e, ,
.
-
.
1 :8 ,
P. mallei. . . .
1:40 . 30 %
,
,
.
.
.
.

, 30 .
P. pseudomallei in vitro , ,
, , , ,
(), ( )
G, , , ,
, , ,
, , .
23 (40 /) , 3 (40 /) 312

 ( 4 / 20 /
) 60 150 .
6 (100 /).
30

30120 .
6 .
'6 , . 6
I .
.. , .
46 (80 /) ; 4--6 (80 /) : (9 / , 45 /
), (30 /) (60 /). , in vitro, : , ,
. ,
.
. .
( 100 /
6 ) . (150
) . (
.) ,
.
. 95 %. ,
, . .
50 %.
;
20 %.
. .
.

.
, Pseudornonasrnallei. .
. P. mallei , ,
. .
,
, .
. ,

, , ,
. ;
. 1938 . .

, , ,
, , .
,
313

 . .
()

( ).
,
. , , , >
.
.
. , - ,
. '
-, .
.
. , . .
.
. , , : ; ;
; . 60%
2040 . , , .

. ,
, 1 5 . , ,
.
, ,
,
. , .
, , .
7 10 .

10 14 .
, , , , .
, .
, ,
( ) . 6080 % , .

, .
. , .
, , .
, , , , , .
.
,
314

; . P. mallei
P. pseudomallei . - .
, ,
, . , , ; G (100
1 ).
. , , .
, 2 1:64'0. 1:320. ,
3- .
1:20 .
.
.
.
100 / . , 3 ,
1 . . ,
, , , .
in vitro ,
.
,
.
. .
.
.
.
.
, .

Ashdown L. R., Guard R. W. Prevalence of human melioidosis in northen Queensland. Amer. J. trop. Med. Hyg., 1984, 33, 474.
Dodin A., Ferry R. Recherche epidemiologique dubacille de Whitmore en Afrique.
Bull. Soc. pathol. Exot., 1974, 67, 121.
Dodin A., Galimand M. Whitmore's bacillus. Rec. Med. Vet., 1976, 152, 323.
Eickhoff . et al. Pseudomonas pseudomallei: Susceptibility to chemotherapeutic agents. J. infect. Dis., 1970, 121, 95.
Everett E. D., Nelson R. Pulmonary melioidosis, observations in 39 cases. Amer.
Rev. resp. Dis., 1975, 112, 331.
Guard L. R. et al. Melioidosis in far north Queesland. Amer. J. trop. Med. Hyg.,
1984, 33, 467.
Howe G., Miller W. R. Human glanders: Report of six cases. Ann. intern. Med.,
1947, 26, 93.
Jackson A. E. et al. Recrudescent melioidosis associated with diabetic ketoacidosis. Arch, intern. Med., 1972, 130, 268.
McCormick J. B. et al. Human-to-human transmission of Pseudomonas pseudomallei. Ann. intern. Med., 1975, 83, 512.
Mays E. F., Rickets E. A. Melioidosis: Recrudescence associated with bronchogenie carcinoma twenty-six years following initial geographic exposure.
Chest, 1975, 68, 261.
315

Sanford ]. P. Melioidosis: Another great imitator. In: Infectious Diseases:

Current Topics in Diagnosis and Treatment/Eds. D.N.Gilbert, J. P. Sanford.
New .York: Grune and Stratton, 1978.
Schlech W. F. Ill et al. Laboratory-acquired infection with Pseudomonas pseudomallei (melioidosis). New Eng. J. Med., 1981, 305, 1133.
Tanphaichitra D., Srimuang S. Cellular immunity in tuberculosis, melioidosis,
pasteurellosis, penicilliosis and role of levamisole and isoprinosine. Dev.
Biol. Stand., 1984, 57, 117.
Wall R. A. et al. A case of melioidosis in West Africa. J. infect. Dis., 1985,
152, 424.
Wilkinson L. Clanders: Medicine and veterinary medicine in common pursuit
of a contagious disease. Med. Hist., 1981, 25, 363.
Zajtchuk R. et al. Surgical treatment of melioidosis. J. thorac. cardiovasc.
Surg., 1973, 66, 838.
107

. (Richard G. Guerrant)
Salmonella , 2000 .
., .
, S. typhi, .
, :
( ), , . ,
, ."' .

, .
. , .
S. typhi S. cholerae-suis
. S. typhi , ' . S. choleraesuis
.
() () .
- -. , , . , -.
, .
S. typhi S. cholerae-suis
( D ).
,
.
S. typhi
500 ( - ),
() , -, ,
,
.
,
316

, 20 000
1968 . '40 000 1983 .
,

, , . , ,
2 .
1983 . , ,
: S. typhimurium, S. heidelberg, S. entertitidis, S. newport, S. agona,
S. infantis, S. saint-paul, S. montevideo, S. oranienburg, S. typhi. 70 % . 20-35 % S. typhimurium.
, S. agona, ,
, , , . 1971 . . , S. dublin, .
, ,
, ,

.

.
, S. typhi. . , , - , , , . . ,
. ,
, .
.
, . , ,
.
, . . ,
.
,
.
, , ,
.
.
, ,
, 600 . - , , , .
317

 . 60 % , 65 %
. , , ,
. 4 % .
,
, ,
. ,
. ,
, , , ,
.

. 75 %
30 . , , (
3: 1), (88 %
50 ).
. , , .
.
.
.
, , ,
, . , -, 2472 , - .
.
, -,
. , $ .
.

, . , --'
, .

, Vi- .
,

.
, 50 % -,
107
.
, , ,
.
,
.

.
,
, . , , , , 318

 .
. ,
.
. , ,
.
3- 4- ,
.
, , .
, , ,
. , .
, ,
. ,
,
. ,
, . , ( ) , ,
. ,
, .
.
. , ,
, ( ).
,
. |31
1 35-
. , , ,
.
. , ,
3- .
. , ,
.
12 , 3 % .
.
10 , 3 10 .

. ,
, 1 ,
8 .
, , 319

 4 , , ,
. ^ . . ,
. ,
- . 60 %
, ,
.
.
57 ,

39 40 23 . 3040 % .
, , .
, .
. .
- () 2- .
, 2 -4 , ,

. ;
23 . , , 90 % ,
10 % . , ,
. .
1-
.
75 % . ,
.
, .
.
3- , .

. ;
.

, .
.
, .
, , 12-32 % . | 2 %.
.

. , 20 %
, .
10 % ,
. ,
2- 3- .
.
.

.
320

 3 % . 1 %.

60 , 3- .
.
,
.
. , .
,
, , , .
, , , , , . .
, . ,
-6-.
. , 2
,
. , , .
, .
510%. ; ,
, ,
, , . 2 , -, .

, , Vi- .
.

, 3 %
,
,
. , , , , 1 .

, . , , . ,
, . , ,
,
. ,
; 3
, . ,
,
, , ,
.
,
. ,
.

11

114

321

 ,
.

.
,
, .
.
3,04,0 109/.
10-109/
,
,
.
,
. 2-
. ,
.
. 1-
70 90 % .
.
3- 3040 % ,
.
.
, , .
1- 1015%
. , 3- 4- 75 %.
,
8-
10 % .
,
3 %
.
.
.
,
.
, , , 4- , - .
Vi-, D- d-
.
4
,
. D ,
, ,
, ,
-, . -, , -. - ; -, .
2- , 5- 6- .
322

 .
. -
.
. ,
. ; , , ,
, , , , , , , .
, .
.
.

, . , . , .

. 48
, 25
. ,
2 4 - 4 8 .
50 /, 34 , 6 8 .

30 /. 2 .
, .
80 / 6 ,
4 6 , ,
.

, ().

4- 5- , .
1 % 510 %
.
, , 1972 .
, , - ,
. ' R-,
, . , , ,
.
, , .
.
,
.
, ,
.
300 (
*

323

60 ), (3 -/),
,
. 2448 .
.
.
.
(), ,
.
,
.
.
.
.
,
.
"
. . .
. , , .
. , .
.
. ,
, . 6 , 4 ,
. , .
, 8 5 % . .
23 . ,
.
. , , ,
.
, , . ,
, , .
0,5 1-2 . 3 .
- -. ,
.

, 324

 . , , .
.

, . .
.
12 %. , ,
, .
2 %; ,
,
.

. ,
( ), ,
, .
, ,
, .
, .

, , .
.
.
0,2 %
( , , 2 ), , 1 20 % . , , , , ,
, , , , , , *
. ,
, , ,
.
,
.

.

.

,
.
, , - ,
,
. , , 50 % ,
, , .
,
,
, .
, ,
325

 .
, , , ,
, ,
.
.
, ,
.
, S. dublin,
.

, , , . , , , , ,
.
.
,
,
, , . ,
;
, , , , , .
, , , , 1020 % .
.
, ,
,
.


, . ,
,
.
, ,
, ,
.
- . ,
, .
, ,
. , , ,
, .
, . , , 10 100 000
.
,

, .
, , 2 ,
1 %. ,
326


, ,
.
, , , . ,
.
. - , , ,
. "
. , S. anatum, , . , S. cholerae-suis, ,
. ,
. , ,
, .
, , , .
. ,
-
. ,

.
S. typhimurium ,
.
, .
,
.
,
, .
10 100 ,
. .
, .
, ,
. ,
.
. ,
.

. 10 000-
S. enteritidis.
, 327

, . ,

. ,
, ,
. ,

, .

,
.

. 30 %
, , , ,
. ,
()
.
, , . -
. - ,
, . ^ (. . 116).

. ,
.
. .
,
,
. , 8 -48 , .
, .
, , . 3839 , , . ,
.
.
, . , .
25 , .
, 10-14 .
1 %, .
,
. 14 ,
. 328


, .
. .
. ,
, , , , , , .
S. cholerae-suis S. enteritidis,
. .
,
.
, ,
.
. , . ,
, .

, , , ,
.
, ,
. .
,
. 25 % .
,
, , , , , ,
. ,
20-25-10 9 /.
, ,
, ,

.

,

, ,
. , , ,
,
.

.

,

.
- ,

. , . , , , ,
, .
,
.
.
.
329

 , , . ,
, . - (), , , .
, .
, Clostridium perfringens. ,
,
.
.
.
.
. .
.
, 812 .
,
.

, ,
.
50 , , ,
, ,
,
. ,
, .
.

.
3
, ,
. ,
, 34- .
2 , , ,
.
, , .
, , .
in vitro.
, - ,
. ,
330

 , .
, , , , ,
.

. 13 .

, 1 ,
, , .
. .
.
,
, . , .
.
, , . .
.
(
)

.

, - , , ,
. , , .

Alvarez-Elcoro S. et al. Salmonella bacteremia in patients with prostetic heart
valves. Amer. J. Med., 1984, 77, 61.
Baine W. B. et al. Institutional salmonellosis. J. infect. Dis., 1973, 128, 357.
Blaser M. J. et al. Salmonella typhi: The laboratory as a reservoir of infection.
J. infect. Dis., 1980, 142, 934.
Butler T. et al. Typhoid fever: Studies of blood coagulation, bactererhia and endotoxemia. Arch, intern. Med., 1978, 138, 407.
Cohen P. S. et al. The risk of endothelial infection in adults with Salmonella
bacteremia.- Ann. intern. Med., 1978, 89, 931.
Freerksen E. et al. Treatment of chronic salmonella carriers. Chemotherapy,
1977, 23, 192.
Hoffman S. L. et al. Reduction of mortality in chloramphenicol-treated severe
typhoid fever by high-dose dexamethasone. New Engl. J. Med., 1981,
310, 82.
Holmberg S. D. et al. Drug-resistant Salmonella from animals fed antimicrobials. New Engl. J. Med., 1984, 311, 617.
Hook E. W. Typhoid fever today. New Engl. J. Med., 1981, 310, 82.
Hornick R. ., Griesman S. On the patogenesis of typhoid fever. Arch, intern.
Med., 1978, 138, 357.
Human Salmonella isolates United States, 1980, Morb. Mort. Week. Rep., 1981,
30, 377.
331

Jacobs I. L. et al. Salmonella intections in patients'with the acquired immunodeficiency syndrome. Ann. intern. Med., 1985, 102, 186.
Kaye D. et al. Treatment of chronic enteric carriers of Salmonella typhosa with
ampicillin. Ann. N. Y. Acad. Sci., 1967, 145, 429.
Levy S. B. Playing antibiotic pool: Time totally the score. New Engl. J. Med.,
1984, 311. 617.
Manual . . Typhoid and paratyphoid fever. Clin. Gastroent., 1979, 8, 715.
Potter M. E. et al. Unpasteurized milk. The hazard of a health fetish. J. A. M. A.,
1984, 252, 2048.
Que J. U., Hentges D. J. Effect of streptomycin administration on colonization
resistance to Salmonella typhimurium in mice. Infect. Immun., 1985, 48,
169.
Ryder R. W. et al. Increase in antibiotic resistance among isolates of Salmonella
in the U. S. J. infect. Dis., 1980, 142, 485.
Tauxe R. V. et al. Turtle-associated salmonellosis in Purto rico. J. A. M. A., 1985,
254, 237.
Taylor D. N. et al. Typhoid in the United States and the risk to the international
traveler. J. infect. Dis., 1983, 148, 599.
Turnbull P. . . Food poisoning with special reference to Salmonella Its
epidemiology, pathogenesis and control. Clin. Gastroent., 1979, 8, 663.
108

. , .
(Richard D. Pearson, Richard L. Guerrant)
. , .
, , ,
, , .
. Shigella Enterobacteriaceae
, , , .
; 37 ".
.
, , . 40 . ()
: S. dysenteriae ( A), S. flexneri ( ), S. boydii
( ) S. sonnei ( D). S. dysenteriae I S. flexneri.
1940 .,
S. sonnei.
,
Enterobacteriaceae.
, S. dysenteriae I ( ) .
, , , . , ,
, . ,
, S. flexneri S. sonnei.
.
. 1983 .
15 000 ; 6 6 % S. sonnei.
332

 10 .
, ,
.
S. flexneri S. dysenteriae
I.

. - . - ;
,
100 .

.
, ,
. , , , , ,
, .

.
- .
, .
.
, ,
. ,
, .
, -,
,
.
, , '
. , , 14 ,
. , -, .
. ,
,
, .
.
,
, .
.
,
.
. ,
, .
, ,
60S. ,
- , ,
, . 120140 Meal, , ,
, .
, 333

, , ( )
, , .

. , -,
.
, , . . ,
,
(IgA).
1--2 . . , -,
. , .
,
in vitro , ,
Fc-,
.
.

, , . 17 .
, ( 41 ),
, . , , .
-, , , - . ,
.
1- .
,
S. dysenteriae I, . , ,
, , .
,
.
, . .
,
.
,
, , ,

. 34 ,,
I2 .
0,1 %,

. , S. dysenteriae I, , ,
,
.
. .
5 .
. , S. dysenteriae I, , ,
S. boydii, . , , , , . , 334

 , , .
. ,
, ,
.
, , , 14
, HLA
27 (. . 268). ,
27.
.
, . , .
- , , ,
.
, ,
.
. , .

, .
. - 50-10?/
. . . .
.
.
, . ; . ( -
-, ), (-, ) ( ). .
. , . ,
.
, , ,
, , , , , , Vibrio parahemolyticus, Clostridium difficile,
(. . 89). , ,
. , ,
. .
. ,
, .
, .
335

. ,
-
, ,
, . .
,
.
,
.
,
. 48
, .
.
R-. 90 % ,
.
,
/,
[ (
160 800 )] 12
5 - 6 .
50 /, 4 ,
5- -6 . , . 2,5
. 10 ,
. ,
in vitro, in vivo.
, , . . , , ,
, Bicozamycin ,
(Cyprofloxacin). ,
(Paregoric), (Loperamidi). ( (Lomotil)],
.
.
, . , . , . . ,
, , . .
.
, ,
.
.

, .
336


Barrett-Connor ., Connor J. D. Extraintestinal manifestations of shigellosis.
Amer. J. Gastroent., 1970, 53, 234.
Dritz S. K. et al. Patterns of sexually transmitted enteric diseases in a city.
Lancet, 1977, 2, 3.
Dupont H. C. Shigella species (bacillary dysentery). ~- In: Principles and Practice of Infectious Diseases 2/Eds. G. L. Mandell et al. New York: Wiley, 1985,
1269-1273.
Keusch G. T. The epidemiology and pathophysiology of invasive bacterial diarrheas
with note on biological considerations in control strategies. In: Diarrhea
and Malnutrition: Interactions, Mechanisms and Interventions/Eds. L. C. Chen,
N. S. Scrimshaw. New York: Plenum, 1983, 4572.
Pickering L. K. et al. Diarrhea caused by Shigella, rotavirus, agd Giardia in daycare centers: Prospective study. J. Pediatr., 1981, 99, 51.
Sansonetti P. J. et al. Genetics of virulence in enteroinvasive Escherichia coli.
In: Microbiology 1985/Eds. L. Leive et al. Am, Soc. Microbiol., 1985,
7477.
Shigellosis United States, 1983. Morb. Mort. Week. Rep., 1984, 33, 616.
Struelens M. J. et al. Shigella septicemia: Prevalence, presentation, risk factors,
and outcome. J. infect. Dis., 1985, 152, 784.
Tackett C. O., Cohen M. L. Shigellosis in day care centers: Use of plasmid analysis
to assess control measures. Pediatr. infect. Dis., 1983, 2, 172.
109

, .
. , .
(Ralph D. Feigin, Frederick M. Murphy)
(Haemophilus influenzae)
1892 . , .
, in vitro , , . Haemophilus : , , , , , , , .
16 . . influenzae. , ,
. aegypticus, H. ducreyi, H. parainfluenzae, H. aphrophilus . paraphrophilus.
.. vaginalis . pertussis.

X V; .
. vaginalis Gardnerella vaginalis, . 143. . pertussis,
Bordetella pertussis.
Haemophilus influenzae. .
V
X, . V I (), II (), , X
X. , .
X
.
337

. X . ,
.
(IVII)
.
,
, ,
.
, .
, 5 -10 % ;

,
.
,
.
. 0,51,5
; 34 , .
, (1 -0,3 ); .
,
.
,
, , (), , .
.
.
. , F. . a, b . ,
, (),

.
.
( )--S ( ) - R ().
, . .
R--S-*M. R
. ,
,
. . aegypticus . influenzae . influenzae . parainfluenzae .
b () in vitro
, , ,
.
, , . 338

 , ,
, , .
25 % . influenzae b , . , , ( ,
/ ).
. '
.
90 %,
.
b 5 %.
,
, , , .
, , ,
. ,
, :
648 ; , .
b 6000
, , , , , - , , ,
. , , , , . , .
, .
3045 ,
, 4 ,
. , , , ,
. ,
/
.
.
,
, ,
, .
, , .
, , 95 % .

. ,
. ,
-
. .
.
.
339

 b
in vitro,
b . influenzae ,
.
,
,
, . coli 100,
. , . influenzae , . , .
,
, , , ,
.
,
, .
( )

. ,
.
, . influenzae
, . ,
/ , ,
, , .
.
. , b 50 %
, 17 % 10 % - , 1 % - .
, , ,
; , , .
, ,
, ;
.
. 9 4 .

.
: , ,
, , ; . .
,
, , , .
.
, ,
, , , .
-
( )
.
340

 . ,
() . 75 % ,
. 5 %
.
. ,
, ,
.
, .
. . , 624 , .
39 . , - ,
. ,
. , , .
.
. ,
624 .
, , , - . ,
,
.
. , ,
. ,
. 10 %
.
.
. 4 ,
.
. 90 % ,
. , , , , ,
. , , , ,
.

. ,
, .
, . , , .

, .
, ,
.
. b
2
.
341

 , , 22 % .
, . .
. b
.
, , , .
.
. .
, ,
, .
, , , , , ,
, . ,
, ,
.
, , . .
. ,
. , .

.
.
, ,
. .
, , . 70 %

. 15 %
, 15 % . ,
, .
.
95 % ,
()
(), -
, (ELISA).
. , Elisa
, .
, . , , , , ,
.
.
,
,
, , .
342

 .

,
,
.
, ,
. , ,
80 %.
,
. , '
, 30 % ,
. .
. ,
, , ,
.
( )
. ,
, . , ,
100 / 4 ,
' 6 , ,
. ,
,
.
, 200400 /
6 , ' 4 .
, ; ,
.

,

.
, (Moxalactam) , .
, , , (Ceftriaxone),
(Ceftazidime), (Cefotaxime) (Cefuroxime).
(Amoxicillin) , .
(Cefaclor),
(), , , . ,
, , ,
.
, , ,
.
343

 ,
, . , , 35
. , , 1014 .
()
, .
, , ;
. ' .

36 ; . , ; 50 /
( 2 ), '/*
34 ; , 710 . 3 ; .

, .
,
,
,
, .

, .

, .
.
, , ,
, . ,
, : 6 0,5%,
4 2,1 % 1 6 % . ,
4 , , 0 1 %.
1978-1984 .
, . 20 / ( 600 ) 1
4 .
, , , ,
.

, ( )
, ( -)
4 , ' 4
20 / ( 600 ). ,
,
-. ,
-, ,
60
344

 .
, , , .
20 ,

( 510%) ( 70%) , .
b
, ,
. ,
. 1,5 4 ;
1,5 .

2 5 ; , ,
, , - ,
, 1,5 . , , , .
( - ), .
, , .

, , ,
.
, ,
, ,
.
Haemophilis aegypticus. ,
, . . ,
. aegypticus .
, . aegypticus,
, , .
, ,
, , , .
, (, , ) 56
, .
Haemophilus aphrophllus. , , , X ( V) ( 5 % ) . ,

, , , .
, . aphrophilus, , , , , , , , , , ,
, .
. aphrophilus
345

,
, , , , , .
, , , ,
.
Haemophilus ducreyi. H. ducreyi , (. . 110). , , , .
X, V. ,
,
, , .
, , . ;
.
5070 % . , ,

.
Haemophilus parainfluenzae.
V, X. , X,
,
.
,
. parainfluenzae, , .
, . parainfluenzae , , , , , . 1 % ,
( 6- -8 )
. . parainfluenzae . aphrophilus, . ,
. parainfluenzae ,
- .
. (Bordetella pertussis) ,
, . pertussis , whooping cough,
.
.
. pertussis;
. parapertussis, . bronchiseptica .
- , , , , .
.
, . .
- , ,
.
X Y, .
346

 . parapertussis,
, , . bronchiseptica
. ,

.
. pertussis S- ( I),
, , , . ( II, III IV).
, I.
.
, .
, - . ( .)
90 % ( ,
100 % ) . .
, . . , ,
.
50 % , -, , ,
. , , ,
; , .
5 % 15 . ,
,
.
3000 , , . , 1525 % . 40-
, , . 1 .
1944 . 85 , 1974 . .
,
.
30 % , . , , ,
, ,
.
. , I
, , .
:
. .
; , , , , . - ; , , ; .
347

 ( ), (, ), (, ), - ,
. , , ,
. ,
, (), (), , () , .
. .
IgA
. , . .
. 620 ( 7 ) ,
, , ( ),
12 , . , , , . ,
(
), 24 ( ).
. ; , ,
, .
, ,
. , ,
,
.. .

, . , 1
6 ; ,
, .
,
,
90 % 3 , . ;
. ,
( ), , , , , .
.
,
. .
.
4 -6- ,
, ,
.
,
. 90 % ,
50 % .
,
40 % , 10
348

20 % .
. , ; , , . ,
.
(ELISA) igM, IgA IgG, . IgA , 23-
3 .
, . , , , ,
, .
.
; , ; ; ; , ,

. , .
. :
, , , , - .
' .
in vitro. . , . ,
.
, , . , -, . .
,
.
. , . ,
, (. )
.
, .
, .
, . , 7
12 . ,
349

 .
6 5 ; 2 , .
7080 %
, , .
, ,
, . , 10

. ,
.
, . , .

50%; , , , .

. , , , 3 , , ,
40,5 ,
. , , .
. - ,
, . , ,
, .
, ; .
,
.
. , 6 .
, , -,
( 0,10,25 ).

Haemophilus aphrophilus
Bieger R. . et al. Haemophilus aphrophilus: a microbiologic and clinical review
and report of 42 cases. Medicine, 1978, 57, 345.
Elster S. K. et al. Haemophilus aphrophilus endocarditis: A review of 23 cases.
Amer. J. Cardiol., 1975, 35, 72.
Haemophilus influenzae
Band J. D. et al. Prevention of Haemophilus influenzae type b disease. -- J.A.M.A.,
1984, 251, 2381.
Fleming D. W- et al. Secondary Haemophilus influenzae type b in day-care facilities. Risk factors and prevention. J. A. M. A., 1985, 254, 509.
Kaplan S. L. et al. Prospective comparative trial of moxalactam versus ampicillin
350

or choramphenicol for treatment of Haemophilus influenzae type b meningitis

in children. J. Pediatr., 1984, 104, 447.
Levin D. et al. Bacteremic Haemophilus influenzae pneumonia in adults: Report
of 244 cases and review of the literature. Amer. J. Med., 1977, 62, 219.
Mustoe ., Strome M. Adult epiglottitis. Am. J. Otolaryngol., 1983, 4, 393.
Peltda H. et al. Haemophilus influenzae type b capsular polysaccharide vaccine in
children: A double-blind field study of 100 000 vaccines 3 months to 5 years of
age in Finland. Pediatrics, 1977, 60, 730.
Rotbart H. A., Golde M. P. Haemophilus influenzae type b septic arthritis in children: Report of 23 cases. Pediatrics, 1985, 75, 254.
Smith A. L. Antibiotic resistance in Haemophilus influenzae. Pediatr. infect. Dis.,
1983, 2, 352.
Smith D. H. et al. Responses of children immunized with the capsular polysaccharide of Haemophilus influenzae type b. Pediatrics, 1973, 52, 637.
Todd J. K-, Bruhn F. W. Severe Haemophilus influenzae infections. Amer. J. Dis.
Child., 1975, 129, 607.
Update: Haemophilus influenzae b polysaccharide vaccine. Morb. Mort. Week.
Rep., 1986, 35, 144.
Ward J. I. et al. Haemophilus influenzae meningitis: A national study of secondary
spread in household contacts. New Engl. J. Med., 1979, 301, 122.
Haemophilus

parainfluenzae

Chunn C. J. et al. Haemophilus parainfluenzae infective endocarditis. Medicine,

1977, 56, 99.
Frazier J. P. Meningitis due to Haemophilus parainfluenzae: Report of three cases
and review of the literature. Pediatr. infect. Dis., 1983, 1, 119.
Haemophilus aegipticus
Albritton W. L. Infection due to Haemophilus species other than H. influenzae.
Ann. Rev. Microbiol., 1982, 36, 199.
Haemophilus

ducreyi

Plummer F. A. et al. Antimicrobial therapy of chancroid: Effectiveness of erythromycin. J. infect. Dis., 1983, 148, 726.
Bordetella pertussis
American Academy of Pediatrics Committee on Infectious Diseases: Pertussis
vaccine. Pediatrics, 1984, 74, 303.
Bass J. W. et al. Antimicrobial treatment of pertussis. J. Pediatr., 1969, 75, 768.
Buchanan R. D., Gibbons N. E. (Eds.) Bergey's Manual of Determinative Bacte riology, 9th ed. Baltimore: Williams and Wilkins, 1984.
Cherry J. D. The epidemiology of pertussis and pertussis inmmunization in the
United Kingdom and the United States: A comparative study. Curr. Probl.
Pediatr., 1984, 14(2), 1.
Donaldson P., Whitacker J. Diagnoses of pertussis by fluorescent antibody staining
of nasopharyngeal smears. Amer. J. Dis. Child., 1960, 99, 423.
Kaplan J. P. et al. Pertussis vaccine An analysis of benefits, risks and costs.
New Engl. J. Med., 1979, 301, 906.
Nelson J. D. The changing epidemiology of pertussis in young infants: The role of
adults as reservoirs of infection. Amer. J. Dis. Child., 1978, 132, 371.

 110

. , .
(Allan R. Ronald, Francis A. Plummer)
. ( )
, , . .
Haemophilus
ducreyi
,
.
. . ducreyi . . , ; . ducreyi.
, , . ducreyi
90 % , .
, ( X),
( Y);
. - ,
. ducreyi : -
. ;.
.
. , . -
. 1000 . : , 1981
1982 . , . 5:1. , ,
. , ,
, , . . ducreyi
. ,
, , . .
. 3 10 , 23. . (. 110-1), , ,

. , .
, ,
, .
.

; ,
352

. 110-1.
.

. , ; .
50 % ,
, , . , , .
, , .
. , , , , ,
, . 100 "
22 , 17 , 8
.
12, 2 .
2 . ducreyi.
. 97 60
. ducreyi, 11
4 .
,

,
. , , .
353
12114

 , , , . , ,
( ) , (
) .
(LGV)
. ,

.
. ducreyi
.
, 1 % Isovitalex 5 %
3 / . 48 , 5 % 100 % ,
45 .
.
.
. 24 .
,-
. . ducreyi , , , , .
(320
1600 )
2 .

Treponema pallidum ( ) . , , 9 .
, , 640 3200 , 2 250 (Ceftriaxone)
. , ,
5 , . ,
.
, ,
. . , , (,
), ' ,
.

Blackmore . A. et al. An outbreak of chancroid in Orange County, California:
Descriptive epidemiology and disease-control measures. J. infect. Dis., 1985,
151, 840.
Chapel T. et al. How reliable is the morphologic diagnosis of penile ulcers? Sex
trans. Dis., 1977, 4, 150.
Fast M. et al. Treatment of chancroid by clavulanic acid with amoxicillin in patients
with beta-lactamase-positive Haemophilus ducreyi infection. Lancet, 1982,
2, 509.
354

Hammond G. W. et al. Comparison of specimen collection and laboratory techniques for isolation of Haemophilus ducreyi. J. clin. Microbiol., 1978, 7, 39.
Hammond G. W. et al. Epidemiologic, clinical, laboratory and therapeutic features
of an urban outbreak of chancroid in North America. Rev. infect. Dis., 1980,
2, 867.
Handsfield H. H. et al. Molecular epidemiology of Haemophilus ducreyi infection.
Ann. intern. Med., 1981, 95, 315.
Kraus S. 1. et al. Pseudogranuloma inguinale caused by Haemophilus ducreyi.
Arch. Dermatol., 1982, 118, 494.
McNico.1 P. J. et al. The plasmids of Haemophilus ducreyi. J. antimicrob. Chemother., 1984, 14, 561.
Nsanze H. et al. Genital ulcers in Kenya: A clinical and laboratory study of 97
patients. Brit. J. vener. Dis., 1981, 57, 378.
Plummer F. A. et al. Short course of single-dose antimicrobial therapy of chancroid in Kenya: Reports of studies with rifampin-trimethoprim and rifampin
alone. Rev. infect. Dis., 1983, 5, 565.
Plummer F. A. et al. Single-dose therapy of chancroid with trimeihoprim-sulfametrole. New Engl. J. Med., 1983, 309, 67.
Plummer F. A. et al. Epidemiology of chancroid and Haemophilus ducreyi in Nairobi. Lancet, 1983,2, 1293.
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Med., 1985, 102, 705.

111

( )
. (King . Holmes)
. ( ) - ,
, ,
.
,
. .
. McLeod 1882 ., 1905 . - , .
, ,
. , Calymmatobacterium granulomatis,
1,5 0,7 , ,

. , . -
.
. ,
, ,
. . - .
10:1. . '
1 64 %.
i : ,
;
; 355

 .
. 8 12 ,
30
.
,
- .
; per continuitatem,

.
.
, , , , ,
.
(. 111-1) , ,
.
() . , , ,
. , , . , , ,
,
..
.
, ,
( ) .
.
. . ( )
. , , . .
, ,
. , ,
Haemophilus ducreyi.
.
,
. , ,
. , -, , . ,
, . 1 X 2 ,
(. 111-2). , , .
2590
.
356

. 111-1. , -
, , ,

;
( A. Brathwaite).

. , . ,
. ,
, . , .
. 2 10 . , . 3 ,
, (. . 111-16). . -
, 357

. 111-2.
.

,
. .

I 12 1015 . 500 8 1 /
. - ( 160 ,
800 ) 10 . 500 6 .
, Hart (1984).

Davis . . Granuloma inguinale. A clinical, histological, and ultrastructural
study. - J. A. M. A., 1970, 211, 632.
Dodson R. F. et al. Donovanosis: A morphologic study. J. invest. Dermatol.,
1974, 62, 611.
Garg B. R. et al. Efficacy of cotrimoxazole in donovanosis. Brit. J. vener. Dis.,
1978, 54, 348.
Hart G. Chancroid, donovanosis, lymphogranuloma venerum. US Department of
Health, Education, and Welfare Publication (CDC), 1975, 75, 8302.
Hart G. Donovanosis. In: Sexually Transmitted Diseases/Eds. . . Holmes et
al. New York: McGraw-Hill, 1984, 393397.
Jofre M. E. et al. Granuloma inguinale simulating advanced pelvic cancer. "Med.
J. Aust., 1976, 2, 869.
Kraus S. J. et al. Pseudogranuloma inguinale caused by Haemophilus ducreyi.
Arch. Dermatol., 1982, 118, 494.
Kuberski T. Granuloma inguinale (donovanosis). Sex. trans. Dis., 1980, 7, 29.
Kuberski T. et al. Ultrastructure of Calymmatobacterium granulomatis in lesions
of granuloma inguinale. J. infect. Dis., 1980, 42, 744.
Lai S., Nicholas C. Epidemiological and clinical features in 165 cases of granuloma
inguinale. Brit. J. vener. Dis., 1970, 46,'461:
Sowmini N. Donovanosis. In: International Perspectives on Neglected Sexually Transmitted Diseases: Impact on Venerology, Infertility and Infant Health/
Eds. - . Holmes, P. A. Mardh. Washington: DC, Hemisphere Publishing,
1982, 205217.
358

112

, .
(Donald Kaye, Robert G. Petersdorf)
. ( , ,
) , Brucella, . , , ,
, .
. : . melitensis ( ), . suis (
), . abortus ( ) . canis
( ). ,
. canis, , , ,
.
, . abortus . suis, ,
.
. , , , ,
37 6,6 6,8 .
.
, , . . , .
.
. ,

.
200 ,
4 % . . , , . , .
, ,
(), , , , ,
, - . , ,
( .) , . , . ,
(). ,
,

^
.
.
. abortus, . suis,
. melitensis . canis. 23 %
359

 , ,
( ,
) . ,
, .
. , . ()
. ,
, , , .
, , , , , .
, ,
.

.
,
,
, .
,
, , .
. abortus
.
. suis
, . , ,
. melitensis. . canis, . abortus, .
.
,
, ., , .
. , . ,
.
. 7 21 , . , , . melitensis. .
, , , , , , , , ;
.
.
( 1020% ), ( 1 5 % )
( 10 % ) .
.
,
, ,
, , . ,
, , - ,
. ,
,
>. , .
, 360

 .
.
, ,
.
* .

. , , .
, .
. , .
,
,
,
(, ) ( , ).
, , , ,
.
, , , , , , '
.
. , , : , , , , , , , , , .
, , , .
: , .
,

,

III . , , .
. 50 % , - , 5 10 %
1-3 . 10- . - 4 .
, . , '
, . 1520% .
.

.
361

 . 1- , 3- ,
.
. IgG
23- ,
8 ,
.
IgG . IgM IgG .
()
, ,
.
4 ,
1 4 , . . ,
1 2- , 3-
.
,
, , , Francisella
tularensis Yersinia enterocolitica.
.
.
1 : 160
. , 1:1280,
1 :640 .
^1:160.
.
'

IgG 2- (2-). IgM

,
IgG. (Js 1:160) 2- .
IgM. 2-, IgG, .
- .
, . ,
, . .

. abortus. . melitensis . suis ' . abortus,
. cam's. . canis , ,
.
. . ,
.
. ,
, 500
4 36 1 2
2 .
,
362

( 2 % ), .
8 -
. ,
, ,
.
, , .
(480 2400 ) 4 .
(900 /) ,
. .
.
, , , .

,
.
60 ;
57 . , .
, . , ,
.
.
, 85 % 3 . , . 12 , , , .
2 %.
, 2- 1:160 .
1:40, ,
.
, ,
. , -, , .
.
. .

. , , - , , , , .
,
.
''''

363


Buchanan . . et al. Brucellosis in the United States, 19601972: An abattoirassociated disease: 1. Clinical features and therapy; II. Diagnostic aspects; II.
Epidemiologic evidence for acquired immunity. Medicine, 1974, 53, 403, 415,
427.
Buchanan T. M., Faber L. C. 2-Mercaptoethanol Brucella agglutination test: Usefulness for predicting recovery from brucellosis. J. clin. Microbiol., 1980, 11,
691.
Cervantes F. et al. Liver disease in brucellosis: A clinical and patological study of
40 cases. Postgrad, med. J., 1982, 58, 346.
Cohen P. S. et al. Infective endocarditis caused by gram-negative bacteria. Prog,
cardiovasc. Dis., 1980, 22, 205.
Heibig J. et al. Brucella aortic endocarditis corrected by prosthetic valve repllacement. - Amer. Heart J., 1983, 106, 594.
Hewitt W.G., Payne D. J. Estimation of IgG and IgM Brucella antibodies in infected and non-infected persons by a radioimmune technique. J. clin. Pathol.,
1984, 37, 692.
Larbrisseau A. et al. The neurological complications of brucellosis. Canad. J.
Neurol. Sci., 1978, 5, 369.
Llorens-Terol J., Busquets R. M. Brucellosis treated with rifampicin. Arch. Dis.
Child., 1980, 55(6), 486.
Poll S. S. et al. Human brucellosis caused by Brucella canis: Clinical features and
immune response. - Ann. intern. Med., 1982, 99, 717.
Spink W. W. The nature of Brucellosis. Minneapolis: University of Minnesota
Press, 1956.
Young E. J. Human brucellosis. Rev. infect. Dis., 1983, 5, 821.

113

(Donate Kaye)
. ( ,
) , FranciseHa tularensis. .
, .
. F. tularensis , , , . (-
, , ). .
. A Jellison ;
; .
, ;
;
.
F. tularensis Brucella spp. Yersinia pestis.
, .
. F. tularensis ,
, , , , , ,
, .
; . , .
F. tularensis .
: Dermacentor andersoni (
), Dermacentor variabilis ( ), Derma364

centor occidentalis ( ) Amblyomma americanum ( Lone Star). .

(
) .

. .
. ,
.
,
, , .
300 . ,
, ,

.
. . .
.

50 , 8 10 .
25
( 1 10 )
.
.
, ;
. ( )
.
(, , ) , - .
,
, , . .
, . .
. .
.
- , , .
,
. .

-
- . ; ,
- . - .
.
2 5 , (. ); .
, .
365

 , . 20 % - , .
- . (7585 %)
. . , , , .

. ,
. .
(
).
. 510%

. .
- . (
1 %) .
,
, , . .
.
( 1 % ) , .
.
- .
-
, .
, ,
, - .

.

,
.
.
1015 % -
. , , . , , . , . , .
. 10 % .
.
. , , , , . .
. .
- . 366

 , , . 40 %
.
- , ,
.
, , ,
, Spirillum minor,
, ,
A, Mycobacterium marinum.
,
.

(. 114), (. 150)
(. 118). , .
, , , ( ), , -, , , . , , , , .
. . ( 4 ) , 23- .
12 . 50 %
2- , . 4 8- .
. ,
1 :160 , , 2 , , . F. tularensis
Brucella, Brucella , F. tularensis.
,
F. tularensis . , , , .
.

, 10 ,
- . ,
F. tularensis,
(Cycloheximide), .
F. tularensis . 1-
, . , .
.
. , .
.
7,510 / 12 .
4872 15 /
367

12 . 7--10 .
1,7 / 8 .
. , I2 . ,
. .

30 /, 4 . 14 . , 20 %.
,

.
. ,
, ,
. , ,
. .
, .

( )
, , ,
. .
F. tularensis . , , , .
, , , .
,
, .
, F. tularensis, .
. , 1 4 , . ( ) 30 %. 8,%.

. .

Buchanan . . et al. The tularemia skin test. 325 skin tests in 210 persons: Serologic correlation and review of the literature. Ann. intern. Med., 1971, 74,
336.
Koskela P., Herva E. Cell-mediated and humoral immunity induced by a live Francisella tularensis vaccine. Infect. Immunol., 1982, 36, 983.
Mason W. L. et al. Treatment of tularemia, including pulmonary tularemia, with
gentamicin. Amer. Rev. resp. Dis., 1980, 121, 39.
Sandstrom G. et al. Antigen from Francisella tularensis: Nonidentity between determinants participating in cell-mediated and humoral reactions. Infect.
Immunol., 1984, 45, 101.
Sanford J. P. Landmark perspective: Tularemia. J. A. M. A., 1983, 250, 3225.
368

Schmid G. P. Clinically mind tularemia associated with tick-borne Francisella

tularensis. 3. infect. Dis., 1983, 148, 63.
Tularemia. Morb. Mort. Week. Rep., 1982, 31, 39.
Young L. S. et al. Tularemia epidemic: Vermont 1968. Forty-seven cases linked to
contact with muskrats: New Engl. J. Med., 1969, 280, 1253.

114

. (Darwin L. Palmer)
. , ,
Yersinia pestis. - ,
.
. .
. . () , , . - .
.
. 200 - , , ,
.
, , , , ,
. -
, , ,
. , ,
.
, , , . , , .
, , Y. pestis .
, ,
.
,

. ,
, .
85 %
. , . . Xenopsylla cheopsis, ,
.
, . .
369

 .
, 15 %. , , ,
.
, ,
20 , .
, : , 1983 ., -
. -
.
. 1919 ., 13 12 ( ) , .
.
,
.
. Yersinia pestis .
, , , 28 . ,
,
72 . , Y. pestis
,
, . , V-
W-, .
I ( ) - . , , . V- W- ,
Y. pestis . , antigua,
orientalis mediaevalis ,
.
,
.
. - .
. , , ( ) .
, 1 ;
. 26 . - , 1 ( :
), - . ,
, '
.

, ,
370

 . 1020 % .
, .
, , ,
. ,
.
- . - ,
.
515 % ( ),
, .
,
. , (-) .
. 2 7 .
, .
, , , . , , , . 1 10 70 % . ,

.
, , .
, 13 .
- , ,
, ,
, .
550 % , ' .
86 % . 5- 10 % , , .
( ) , , 2 10 .
. ,
,
. , , , ,
, , , ;
48 .
,
.

; 1020 % . 23-
, , .
, , , . . Y. pestis
- .
37!

 ; 2 6 . - (ARDS), , . ,
ARDS . , Y. pestis, -, 75 %.
, ,
.
, .
, , .

; ;
.
. ,
. 1520-. 109/,
. 100 109/ . , . ,
. , ,
.
, , .
- . - ,
, .
, .

. ,
,
.
80 % . , ,
.
. Y. pestis . , 2- 4- .
.
,
, . , , ,
, , - .

372

 .
,
, , , . -
,
.
.

,
.
, 4872 .

5- 14- . , ,

.
. , , ,
. 40100%,
5 -10 %.
, . 7,5-15 / 12 ; , 510 / 6 ,
,
. ,
, , . 3 -4 . 510 / 6 .

12,5 25 / 6 , . -
, ,
, .
5 . ,
. .
-
.
. , Y. pestis, .
6 . ,
, . .
.
, ,
250 4
.

.
373

 . , ,
. ,
,
- ,
.
, , .
. ,
, ,
.

,
. Y. enterocolitica Y. pseudoluberculosis
, Y. pestis,
. , . 2025 .
. -.
Y. pestis , . , " W V- , , Y. pseudotuberculosis
. , a Y. enterocolitica
, .
,
, .
. , Y, enterocolitica, , I 3 %
. , ,
. .
. , 3 14 . 5 % . , .
, 40 , I2
. , - (,
) .
. 65 % , ,
HZA-B27. Y. enterocolitica , ,
- , ,
, .
, ,
, .
374

, , Y. enterocolitica .
,
, - .
; ; , .
.
,
, ,
. , . ,

. , , Y. enterocolitica,
, .
. Y. enterocolitica Y. pseudotuberculosis , .
, . , Y. enterocolitica , ,
. .
, ,
. ,
. 810-
18 .
, .
Y. pseudotuberculosis .
. Y. enterocolitica in vitro , , , , , ,
. ,
.
,

. Y. pseudotuberculosis ,
, . , , , .
, .
, , ,
.

,
Pasteurella multocida , , , ,
. (P. haemolytica, P. pneumotropica . ureae) .
(
Mac Conley), , 375

. , , . P. multocida -
. 50
90 %.

.

,
, . ,
( 1 2 ), , , , . , , . , P. multocida, ,
. , , , . , , .
-
. ,
, ,
, , ,
. Pasteurella spp.
,
.

Barnes A. M., Poland J. D. Plague in the United States, 1983 Centers for Disease
Control Surveillance Summaries, Publication 33 (no 1SS), 1984.
Butler . A clinical study of bubonic plague: Observations on the 1970 Vietnam
epidemic with emphasis on coagulation studies, skin histology, and electrocardiograms. Amer. J. Med.,' 1972, 53, 268.
Kaufman A. F. et al. Public health implications of plague in domestic cats. Amer.
J. Vet. Assoc, 1981, 179, 875.
Reed W. P. et al. Bubonic plague in the Southwestern United States A review of
recent experience. Medicine, 1970, 49, 465.
Tomich P. Q. et al. Evidence for the extinction of plague in Hawaii. Amer. J. Epidem., 1984, 119, 261.
P. multocida
Weber D. J. et al. Pasteirella multocida infections: Report of 34 cases and review of
the literature. -- Medicine, 1984, 63, 133.
Yersinia
Boyce J. M. Yersinia species. In: Principles and Practice of Infectious Diseases.
2d ed./Eds. G. L. Mandell et al. New York: Wiley, 1985, 1296- 1301.
Brubaker R. R. The Vwa 1 virulences factor of yersiniae: The molecular basis of the
4
attendant nutritional requirement for Ca "* Rev. infect. Dis., 1983, 5(Suppl
4), S748.
Tacket . . et al. Yersinia enterocolitica pharyngitis. Ann. intern. Med., 1983,
99, 40.
Tertti R. et al. An outbreak of Yersinia pseudotuberculosis infection. J. infect.
Dis., 1984, 149, 245.

376

115

. . (Charles . I. Carpenter)
. ,
.

.
. .
-, -.
-.
150
. , , 1961 1981 .,

.
18661867 . 1978 . 40 , . '
, . ,
(44 ) . 1900 .
.
,

.
, , ,
. ;
15 10 , 14 . ,
,
.
, ,

.
, ,
.
. , . , 84 000,
,
-3',5'-, .
. -
'
lamina propria. ,
, 2 , 35 .

, ,
, .
, ,
- , , .
.
377

12 48 . , , ,
.
1000 , , . , ; , - . .

, , ,
.
, , , , , . ,
, . , - ,
, , 10:1.
2 7 , .
,
. ,
.
.

. ,
() - (). 24
, , .
.

6
, , . "

- , .
. . ,
1 5 NaCl, 4 1 .1. '
.

50100 /. ,
.
,
,
. .
,
I - 1
.
. ,
( )
.
378

, , 1013 /.
, .
500 6
48 . , , , -,
.
, , . ,
, , , . (),
20 ( 40 ), 2,5 2, 3,5 NaCl
1,5 KCI 1 , . 1981
1982 . 87 41
. ,
,
, , ,
.
, , ,

.
, , ,
.
.
.
, .
, ,
60 %,
,

.
. , 10 1 ,
(4060%) (46 )
.
. .

Carpenter . . I. et al. Clinical studies in Asiatic cholera IVI. Bull. Johns
Hopkins Hosp., 1966, 118, 165.
Fishman P. H. Mechanism of action of cholera toxin: Events on the cell surface.
In: Secretory Diarrhea/Eds. M. Field et al. Bethesda: American Physiological
Society, 1980, 85106.
379

Gangarosa E. P. et al. The nature of gastrointestinal lesion and its relation to

pathogenesis: a biopsy study. Amer. J. Trop. Med. Hyg., 1960, 9, 125.
Hirshhorn N. et al. The treatment of cholera. In: Cholera/Eds. D. Barua,
W. Burrows. Philadelphia: Saunders, 1974, 235.
Johnson J. M. et al. Cholera on a Gulf Coast oil rig. New Engl. J. Med., 1983,
309, 523.
Mahalanobis D. et al. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med. J., 1973, 132, 197.
Morris J. G. Jr. et al. Non-O group 1 Vibrio cholerae gastroenteritis in the United
States: Clinical, epidemiologic, and laboratory characteristics of sporadic
cases. Ann. intern. Med., 1981, 94, 656.
116

. (fames J. Plorde)
. ( ) ,
Bartonella bacilliformis. : , , , , , .
. .
. Bartonella bacilliformis , , , , , - . .
In vitro ;
.
. () , .
, 2400
8000 , Lutzomyia . L. verrucarum, .

. ,
. bacilliformis 5
10 % . .
. ,
. . , ,
, . . ,
. ,
. .
, .
. ,
, , .
380


.
, , ,

. , , .
.
3 , .
, . , . .
.
, , . 45
1 000 000 I 3.
,
, , , . .
; 90 % . ,
, , ;
.
, ; ,
. 5 0 % ; , , 10 4 . ,
, .
6 .
. ;
- .
, , ; 2
10 34 ; .
,
,
. , , . ,
. . 1 2 . .
. . .

. .
. , .
2 7
, . 48 , . . .
,
381

.
, .

Caudra . . Salmonellosis complication in human bartonellosis. Tex. Rep.
Biol. Med., 1956, 14, 97.
Dooley J. R. Haemotropic bacteria in man. Lancet, 1980, 2, 1237.
Kaye D. et al. Factors influencing host resistance to Salmonella infections: The
effects of hemolysis and erythrophagocytosis. Amer. J. med. Sci., 1967,
254, 205.
Ricketts W. E. Clinical manifestations of Carrion's disease. AMA Arch, intern.
Med., 1949, 84, 751.
Schultz M. G. Daniel Carrion's experiment. New Engl. J. Med., 1968, 278, 1323.

117

,
. , .
(Harry N. Beat , A. William Pasculle)
. , ,
Legionella. '
L. pneumophila. , ,
, . . Legionella
,
, L. pneumophile.
, , ,
, .
. 1976 . , . - ,
.
, 220 , 34
, ,

, . ,
, Legionella pneumophila.
,
( ) . , 1974 . . ,
L. pneumophila , 1965 .
. 80 ,
14 .
, , 1957 .
. . 78 , .
, L. pneumophila, , , , 382

 , 1968 .
(),
.
,
L. pneumophila, ,
. 1978
1979 .
() ()
,
. . ,
L. pneumophila, . Legionella micdadei Joseph McDade, L. pneumophila.

, ,
Legionella. L. pneumophila , .
.
, Legionella. 22
, 35 (. 117-1).
. . 0,5 ,
,
. , - .

117-1. Legionella

L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.
L.

pneumophila
micdadei
bozemanii
dumoffii
gormanii
feeleii
longbeacheae
jordanis
oakridgensis
wadsworthii
hackeliae
maceachernii
sainthelensi
spiritensis
jamestownensis
santicrucis
anisa
cherni
steigerwattii
paresiensis
rubrilucens
erythra

10
1
2
1
1
2
2
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1

383

 .
,
- (BCYE-). BCYE-arap , , , .
,
Coccidioides immitis. BCYE- , ,

, , .
. , ,
. . , ,
,
Legionella.

. 22
. Legionella
.
. . , , ,
.
.
, , -
( , ) ,
.
,
, . ,
,
, ().

.
. ,
, ,
. , ,
, .

.
, L. micdadei
. .

, -
. , , . .
, -, . 2 10 .
,
. 384

 ,
,
. ,
; .
, ' . , ,
, , . , , , 15 %;
50 %.
,
5 % L. pneumophila 1:128 . ,
, , 15 25 %
L. pneumophila .
,
.
. , , .
, ,
, , . .
.
- .
.
;
50 % .
, , ,
. ,
, ,
.
,
Dieterle .
, L. micdadei
. , , .
. ,
, , ,

. , , .
.
, .
. .
,
, .
()
, ,
. 13-114

385

 ,
, L. feeleii, ,
L. pneumophila.
' , , .
, ,
.
,
, 2448 40 50 % ; .
; , , - . 20 % . , , , . 25 % - , , , . .
.
,
.
.
, ;
, . ? ,
.

, .
46 . 45 ,
.
, , 13 . , . .
.
. 20
30 % , ,
. . . ,

.
. , ( 20%)
( 20 10 /), , .
,
.
65 %
. .
- . 30 % .
, , . ,
386


, , ,
.
.

. , . ,
. , . ,
, . 90 %,
.
. -,

. ,
, .
, L. micdadei
,
, ,
.
, .

,
: L. pneumophila, L. micdadei, L. bozemanii,
L. dumoffii, L. gormanii L. longbeacheae. ,
L. pneumophila,
(DFA)
,
, .
, .
() 3 .

-.
, , , : ,
22 35 , .
- , , , , .
. , in vitro,
, ,
0,5 1,0 6
15 / 6 . . ,
. , . ,
, , . 13*

3 8 7

 , ,
.
, , ,
. 14 ,
.
.

,
.
, . , ,
.
.

. ,
.
, , , .
:
, , , .
, , ,
.
. .
, , 15 %.

2 3 . , , . , , .

Bernardini D. L. et al. Neurogenic bladder. New clinical finding in Legionnaires'
disease. Amer. J. Med., 1985, 78, 1045.
Brenner D. J. et al. Ten new species of Legionella. Int. J. system. Bact., 1985,
35, 50.
Garbe P. L. et al. Nosocomial Legionnaires' disease. Epidemiologic demonstration of
coling towers as a source. J. A. M. A., 1985, 254, 521.
Herwaldt L. A. et al. A new Legionella species, Legionella feeleii species nova, causes
Pontiac fever in an automobile plant. Ann. intern. Med., 1984, 100, 333.
Meyer R. D. Legionella infections: A review of five years of research.
Rev. infect.
Dis., 1983, 5, 258.
Rudin J. E., Wing E. J. A comparative study of Legionella micdadei and other nosocomial acquired pneumonia. Chest, 1984, 86, 675.
Thornsberry C. et al. (Eds.) Legionella: Proceeding of the 2d International Symposium. Washington: American Society for Microbiology, 1984.
Winn W. C. Jr. et al. The pathology of the Legionella pneumonias. -- Hum. Pathol.,
1981, 12, 401.

118

(Lawrence Corey)
. ,
, , .
, 90 %
.
. .
, ,
, . , , ,
Warthin Starry 25
34
.
, ,
. .
. ,
Rothia.
. in vitro , , (Cotrimoxazole),
(Clindamycin). .
. .
, 75 %
. 3
20 % .
, , ( , ), , , ,
. , .
, ,
. , ,
, . , , ,
.
.
. : ; ; . , ,
, , , , .
. 3 10 .
, ,
, , , 23 .
. . 40 % ,
.

389

6 . ,
- ,
. ,
, , , , ,
.
, ,
. , ,
. , , .
,
, .

.40 , .
.
, 48 .

.
, , , , ( ); - , ; ; ; .
.
.
, :
; ; ;
; , , (
, );

.
.
.
,
,
. 2448
5
10 . ,
, ,
. . 30 .
.
.
5 % .
(15 109/), .
- .
, ,
. , , , , ,
390

 . , ,
. , .
, ,-
, , , , ,
, , ,
. ; .
.
. ,
I2 .
. .

Carithers H. A. et al. Cat-scratch disease: its natural history. An overview based on a
study of 1200 patients. Amer. J. Dis. Child., 1985, 135, 1124.
Carithers H. A. Cat-scratch skin test antigen: Purification by heating. Pediatrics,
1977, 60, 928.
Elliot D. L. et al. Pet-associated illness. Wew Engl. J. Med., 1985, 313, 985.
Gerber M. A. et al. The aetiological agent of cat-scratch disease. Lancet, 1985,
1, 1236.
Lyon L. W. Neurologic manifestations of cat-scratch disease. Arch. Neurol.,
1971, 25, 23.
Margileth A. M. Cat-scratch disease: Bacteria in skin at the primary inoculation
site. J. A. M. A., 1984, 252, 928.
Margileth A. M., Marcy S. M. Cat-scratch disease: Safety of cat-scratch skin test
material. Pediatr. infect. Dis., 1984, 3, 281.
Wear D. J. et al. Cat-scratch disease: A bacterial infection. Science, 1983, 221,
1403.

119

. (Thomas M. Daniel)
. , Mycobacterium tuberculosis
- . , , , .
, .
. Mycobacterium tuberculosis, , Mycobacterium, 30 . . tuberculosis
. bovis . . leprae (. 120)
(. 121).
, .
, . ,
. .
, , . tuberculosis .

,
. ,
, - . , , , , - . .
- ,
.
. ,
. XVIII XIX . ,
25 30 % . ,
.
1984 . 22 255 , 9,4 100 000 .
5 - 6 %. 1982 . 1807 . , 392

 10 000 000 ,
1 %. , . 2 , . , -
,
,
.
, .
. .
,
, . , . , , . ( )
, .
, . ,
- .
, , ,
.
, . 400 100 000 .
.

.
.
, . 30
, 10 ,
3 . 6 %
.
.
.
, .
, , . , , ,
.

. , ,
; , .
, ,

.
, , .
,
. , , .
. 2 .
, . bovis, 393

 . .
.

, .
, .
.
,
.
, , .
,
.
28 ,
, - .
. , . ,
, ,
.
, , . , , ( )
,
.

() .
95 % . , ,
,

.
.
, , , . .
,

. , , . ,
,
, . 12 , , ,

. , ,
3 . ,
.
. .
, . , , ,
394

 ,
.
HLA
. , .
, . , , ,
() .
. , ,
.
,
. , , .
,
, (BCG), , .
BCG . , BCG
,
.
.
-
. . , ,
.
..

.
. - ,
.
. , ,
. (PPD)
,

.
PPD .
. - , D -.
, , . , ,
,
.
. in vitro , .

, 1-,
395

 . -. -
-1.
-. () -,
.
, .
4 -
, 8 .
,
.
. ,
,
,
, ,
. , -. / , .

( 15 % ).
,
, ,
.
,
. -- ,
, ,
.
(. ),
, -, ,
, .
,
, , ,
, .
- .
, - , .
. . . . ,
, .

. .
, .
. , .
. 396

 ,
.
.

. ,
. (,
) ( ). .
,
.
, ,
, . , . . 30 %
, , .
60 %,
2,5 .
, ,

,
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,
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. intracellulare. , 5 . ,
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.
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.
399

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, .

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. ,
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.
.
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.
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. , ,

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.
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.
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.
.
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.
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.

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(PPD). . 5 , ()
- PPD-S. PPD RT-23, . . , 2 5 PPD-S. , PPD,
-80,
.
, . .
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. 4872 , .
17 . ,
. , PPD .
,
, .
, PPD
, .
, , , ,
10
. , . tuberculosis.

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,
. , PPD
. . ,

. ,
, 710
404

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.
PPD , 50
PPD, . PPD , , . PPD. '/ 5 , ,
.

, . 15 %
.
.
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. , ,
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, ,
,
. .
. . , , .
- , , .


. .
. 119-1 , . . 119-2
. 9- -12 , 99 %
. -
.
, - . , . 18 90-95 % , ,
. , ,
, , 1218 80-90 % .
,
, .
, ,
, , ,
, ,
405

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300

600

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15 /

12

150

(Capreomycin)

1
1

, ,
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,
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,
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)
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,
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.
406

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( )

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;


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. .
.
8
(0,751 ),

. ,

(300 )
(15 /) 12
18
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18

(300 ),
(600 ), (2 ) (1 )
(15 /) 2

:
. (300 ) (600 ) 4
. (300 ) (150 ) 6 .
. (300 ), (600 )
(I ) 2
6
(300 )
(600 ) 1 ,
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,
. 2 , ,
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4 , , 6 . 300 600 1 900 600 2
8 .
1 %.
, . .
407

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,
, 23 . , ,
24- .
4- -. .
, 6
, . 2 . ,
- ,
, ,
.

, .
. 119-1. .
35 % , , 1,5 %,
. ,
.
30 % 2 5 %
.
, , ,
. , , ,
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,
- .
, , . ,
-450, , . , .

, , , ,
. 50 /.
, . _
, ,
.
. ,
.
, .

.
,
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,
.
, . ,
.
408

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. , ,
. , , . ,
, .

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. , .

.
.

.
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,
- . ,
,
60 % .

- , .
, , ,
.
,
. , , ,
,
. ,
, , .

.: , , ; , ; ,
.
, - . ,
. . , . , .
. .
- ,
1 , . tuberculosis.
,
, .
, , , .
. 0,5 %
409

 3 % .
, .
. , . ,
12 .

, , ,

. ,
2 % . ,
, , 45 1:1.
,
35
300 1 .
,
, .
0,5 %,
70 % . ,
2 %,
, 1 : 1, 5,7 . 300 1 ,
10 .
, ,
, () , - ; , ; , ; ; , . ,
, 1 , . ,
,
, , .
. () , . bovis,
. . ,
, ,
80 %. , -,
. , ,
. ,
- ,
, , . , ,
, ,
. , , .
.
PPD , , , ,
410

. PPD,
,
.
.
. (, ) , .
, .
, , , , .
. , . ,
.
, . .

.
,
.
, ,
,
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.
. ,
.
15 20 .
, .
.
.

American Thoracic Society: Diagnostic standards and classification of tuberculosis
and other mycobacterial diseases (14th ed).Amer. Rev. resp. Dis., 1981,
123, 343.
American Thoracic Society. Treatment of tuberculosis and other mycobacterial
diseases. Amer. Rev. resp. Dis., 1983, 128, 336.
Comstock G. W., Edwards P. Q. The competing risks of tuberculosis and hepatitis
for adult tuberculin reactors. Amer. Rev. resp. Dis., 1975, 111, 573.
Comstock G. W. et al. The tuberculin skin test. Amer. Rev. resp. Dis., 1981, 124,
356.
Comstock G. W. Epidemiology of tuberculosis. Amer. Rev. resp. dis., 1982, 125
(suppl), 8.
Dutt A. K. et. al. Short-course chemotherapy for extrapulmonary tuberculosis.
Ann. intern. Med., 1986, 104, 7.
Edwards L. B. et al. An atlas of sensitivity to tuberculin PPD-B, and histoplasmosis
in the United States.- Amer. Rev. resp. Dis., 1969, 99 (suppl), 1.
411

Fox W. The chemotherapy of pulmonary tuberculosis: A review. Chest, 1979,

76 (suppl), 785.
Gtassroth J. et al. Tuberculosis in 1980s. New Engl. J. Med., 1980, 302, 1441.
Goren M. B. Immunoreactive substances of mycobacteria. Amer. Rev. resp. Dis.,
1982, 125 (suppl), 50.
Grosset J. Bacteriologic basis of short-course chemotherapy for tuberculosis.
Clin. Chest. Med., 1980, 1, 231.
Grzybowski S., Enarson D. A. The fate of cases of pulmonary tuberculosis under
various treatment programmes. Bull. Int. Union. Tuberc, 1978, 53, 70.
Snider D. E., Jr. The tuberculin skin test. Amer. Rev. resp. Dis., 1982, 125
(suppl), 108.
Stead W. W. et al. Tuberculosis as an endemic and nosocomial infection among the
elderly in nursing homes. New Engl. J. Med., 1985, 312, 1483.
TenDam H. G. et al. Present knowledge of immunization against tuberculosis.
Bull WHO, 1976, 54, 255.

120

( )
. (Richard A. Milled)
. ( )
, ,
. ,
, .
.
: - ,
- . ,
, .
. Mycobacterium lepreae, ,
. , , Mycobacteriaceae.
, .
, ,
. :
11
13 . , ,
, .
- ' , .
( )
48 34 ( ). ,
. ,
,
, .
.
1

Charles . Shepard ,
.

412

. 10 20 ,
. .
, 12 % .
,
,
.
, 20 % .
: , , . 270
90 % .
, ,
.
,
1 .
10 .
20 % .
- , . 1:1,
2 : 1 .
, ,
.
, , , ,
.
. ( , )
8 ,
10 %.

,
, . , ,
,
. , .

, .
3 5 ,
6 .
.
. ,
, . ,
, . ,
(, 1020 %) , , ,
50 % .
. leprae .
,
. , HLA
. HLA-DR3 413

 ,
HLA-MT1 . HLA- .
HLA .
, , bacterium lepraemurium Leishmania donovani.
he-H-2 ( -2 HLA- ),
-2- , .
. ,
, , , .
, , .
,
8 (),
. leprae, , , 8. 4- () -
. . leprae
. in vitro , , .
,
-.
,
,
.
,
, , , , . , , ,
, (
37 ).
,
; , ,
, .
, . - , ,
.
- . ,
, , . .
.
, .
. , ,
, , . ,
, .
.
- .
414

 , , . ( ). , - ^ ; .
" . ,
, . :
.
.
-
. ,
. -, . . .
.

,
. , .
. .
.
, , ,
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, ,
. ,
.
.
. , . .
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.
, , ,
. ( , )
, , ,
.
. ,
. .
.
.
,
, .
.
, , . . , , , , ,
. . 415

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,
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), .

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, .
. .
.
.
.
,
, ,
, .
.
,
. , ,
.
,
. . ,
. -

. ,
.
. , , , .
. ,
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, . 12 ,
. , , . - , IgG ,
.
. , 1- , .
. , .
. .

,
. , , I I I .
.
. , ,
.
. .
416

 Lucio , , ;
. , , .
.
,
.
. , -, , . , ,
,
. , .
.
. , . 10 40 %
.

.
. . leprae, 1,
, . ,
95 % 50 % .
^ , . ,
.
,
,
, , , ,
. ,
, ,
. . , , ,
, . .
.
, , , , .
. [ (Dapsone) 4,4-, DDS, ], . 50 100 ,
, , ( 24 ), . ,
, , . 10
12 , .

510 . , (
) , .
. 14114

417


, .
.
2 30 % . , 30 %,
,
.
, .
, . 5 1500
, ,
. 600 .
, 600
900 1 . ,
. , ,
2 . .
.

(Clofazimine) .
, - ,
, 50 200 ; 70 .
- .
, , , .
. , .
, , .
, , , (Th'ambutosine) . . .
, , . , ,
- , .
, . , , . , 2 .
.
, , , .
6- ,
, .
6 --12 (
418

) ,
24- .
"
23- . ,
,
.
.
.
. (60--120 ).
, , . ,

. (Thalidomide) . 200
. 50100 . , .
, , .
,
,
34 ,
. , , , ;
-.

. .
, , , .
.
. , , , .
,
; . . () . , ,
.
. , ,
.
.
.
. .

. . ,
, .
,
. 14*

419

 , ,
, - . BCQ ,

. , . BCG . leprae,
.

Bloom . R., Godal T. Selective primary health care: Strategies for control of
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Bullock W. E. Rifampin in the treatment of leprosy. Rev. infect. Dis., 1983, 5,
S606.
Bullock W. E. Mycobacterium leprae (leprosy). - In: Principles and Practice of
Infectious Diseases, 2nd. ed/Eds. G. 1.. Mandell et al. New York: Wiley, 1985,
14061413.
Duncan M. E. et al. Pregnancy and leprosy: The consequences of alterations of
cell-mediated and humoral immunity during pregnancy and lactation.
Int. J. Lepr., 1982, 50, 425.
Neill M. A. et al.-Leprosy in the United States, 1971 1981.
J. infect. Dis., 1985,
152, 1064.
Ridley D. S., loping W. H. Classification of leprosy according of immunity:
A five-group system. Int. J. Lepr., 1966, 34, 255.
Sansonetti P., Lagrange P. H. The immunology of leprosy: Speculations on the
leprosy spectrum. Rev. infect. Dis., 1981, 3, 422.
van Eden W. et al. HLA-linked control of predisposition to lepromatous leprosy.
J. infect. Dis., 1985, 151, 9.
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307, 1593.
WHO Study Group Chemotherapy of leprosy for control programs. WHO Tech.
Rep. Ser., 1982, 675, 7.
Young D. ., Buchanan . . A serological test for leprosy with a glycolipid specific for Mycobacterium leprae. Science, 1983, 221, 1057.

121

. (Stanley D. Freedman )
. 50- ,
' ,
Mycobacterium. , , . .
,
. . . ,
, , .
. , 1

Dr. Charles
. Shepard

420

 , .
, , (. 121-1).

,
, .
Mycobacterium ulcerans. M. ulcerans
Bairnsdale. 30- 33 .
7 ; . , . , . ulcerans, , ,
.
. . .
Mycobacterium marinum. , ( . balnei). -
, , . ; ,
, (). 121-1. ,
. tuberculosis . leprae

. marinum

. ulcerans

. avium-intracellulare
. kansasii
. xenopi
. szulgai
. scrofulaceum

-
, (,

,
?
?
, ?

. fortuitum

. chelonei

(),

(),

, .

, ,

. (- ); ; (- ); * - 37 ", 25 .
421

 , .
, . tuberculosis. , ,
3032 .
,
. , , . ulcerans, . . in vitro
, . , (Minocyclini) .
Mycobacterium kansasii. M. kansasii ,
,
, 37 .
, , . , , ,
- . .
.
-- ,
. , .

.
. .
. kansasii
. , , ,
. , , .
.
, . marium,
, , ,
.
, . kansasii, . , ,

. .
95 %. in
vitro. , .
Mycobacterium scrofulaceum.
. , .
.
, .
, , . scrofulaceum.
.
,
.
Mycobacterium szulgai. 37 , .
;
, , . 422

 , , .
Mycobacterium xenopi. M. xenopi
, , .
,
(. ). .
Mycobacterium avium-intracellulare. M. avium . intracellulare ,
, ,
( M A I ) . - , ,
. tuberculosis.
, M A I ;
. ; .
, . .
,
.
, ,
, .
, . , , , .
, .
,
.
. ,
.
-
. , , , M A I .
'.
. ..
,
, , ,
,
in vitro.
, . , , : ,
, , , , , ,
. ,
. . (Clofazimine) (Rifabutine) MAI-, (. . 257).
Mycobacterium fortuitum chelonei.
; 1 5 ,
5 .
. ,
. . fortuitum
423

 . . chelonei
. .
, ,
,
.

.
.
, , .
, - , ,
, . , , ,
.
.

.
,
.
, ,
, , , , , .
. fortuitum, . chelonei. - .
. . haemophilum .
,
. , ,
.
,
, , ,
. . ; . paratuberculosis, Joune, .

, , .

Collins . ., Grange 1. . Mycobacterium marinum infections in man. J. Hyg.
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424

Wallace R. J., Swenson J. M. Spectrum of disease due to rapidly growing mycobacteria. Rev. infect. Dis., 1983, 5, 657.
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Amer. J. Med., 1985, 78, 35.

122

. , .
(King . Holmes, Sheila A. Lukehart)
. ,
Treponema pallidum paliidum. , 3
, .
.
. 30 % ,
-, - ;
.
. . pallidum
1905 . Treponema pallidum ,
. ,
; Leptospira, ; Borrelia, . recurrentis . vincentii,
- ( ),
. burgdorferi, ; Treponema, , . Treponema
. pallidum pallidum ( . pallidum), ; . pallidum pertenue, T. pallidum endemicum
. carateum, , ,
(. . 123); . paraluiscuniculi
. ,
, ,

( ).
. pallidum. .
. pallidum , 6 14
. 615 ,
0,2 . , . , N- N-
, .
. pallidum , .. ,
, ,
, ,
426

 .
in vitro , , ,
.
.

. pallidum.
.
. pallidum, ,
. . pallidum .
. XV , , ()
(), .
,
, , .

. . XVIII XIX
- . .
1903 .
. , , 1905 . 1910 . , , [(Arsphenqmine), 606, (Salvarsan)],
.
.
(,
, ).
,
.
1940 . 99 %.
1943 . . 1983 . 7,4 100 000 ,
1943 . 98 %. 1983 .
239 , 1941 .
98 %. 1984 . 321 34 %
.
1947 ., 6000 1957 .,
70- . 1984 . 285 599 23 117
.
.
15
34 . ( 1 )
0,8:1 1950 . 3,2:1 1980 .
2,6: 1 1983 .
-. , , 1980 .,
- . , 1983 . ' , , ,
.
, . ,

427

 1983 1984 . 12,7 %,

12,2 %. , , .
, ,
, , , ,
, , . - , . . .
1983 . 52 %
, 24 % ,
, 23 %
.
1,98 . , , .

, 30 %, , , , 30
, , ,
. , , . ,
, , . 45 , 1980 ., 1,5
,
. 1983 . 1
47 % , . ,
. 3,8 , 1978 ., 1 8461 . , , , , ,
.
; ,
, ,
, .
.
,

. , ,
. . pallidum
30 33 ,
.

I07 1 .
.
,

. I06 72 . , , 8
. ,
428

 103 ,
102 10 63 38 % .
20
42 . (ID50) 57 . pallidum. 21 , 500 1000 . pallidum.
9 - 9 0 , , 6 . , ,
.
, 26 .
,
, , .
- , , , , ,
. ,
, .
, - 69
, 15 %
.
, -
. - , - ,
-- ,
. ,
.
40 % . , ' . 85 %
;

; .
( ) . pallidum .
2 6 , ,
. 25 %
24 .
90 %
,
, 1 .

() : ( 1 ) (
1 ). , 2
429

 ,
2 , ,
2 . 30 %
. , . ,
. ,
, .
, vasa vasorum
, , . , , .

2000 (, 1891 1951 .), 431 ()
3 [Tuskegee, 1932
1972 .]; 198 ,
.
, , , 24 % 4 , 28 %
. - , ,
10 % , , 15 ,
- . 7 % , 16 % ( ,
). 15 %
8 % . , , , ,
, , , -, .
- 35 % 22 % .
, ,
.
, Tuskegee, ,

2550 17 % , , ,
30 % -
. , ,
, 70- .
.
- .
4060 % ( 15 % ),
4 %. . , Tuskegee, - ,
, . , 30 % ;
25 % , ,
,
. , , , .
430

. .
, , ( ), , (. 122-1):
. -
. pallidum
, , , .
.

, .
. . . , 1974 . 42 % ,
2 3 % , -- 1 1 % .
, 15 %
, , , ,
, ,
. ,
. , , .
,
, , .
46 ( 2 12 ), .
. , ,
. , , -
, , .

. , ,
.
,
, ,
(. . 136)
(. . 110). ;
,
, . , , , .
,
, , . - , .
. ,
-
.
431

.
122-1.
. (

Sexually
Transmitted
Diseases.
Prof. Dr. E. Stolz, Rotterdam,
Boehringer
Ingelheim International, 1977.)

15 % . , ,
, , .
, 25 %
.
, , - , ,
, 510 ,
(. 122-2). 12
3 10 .
, ,
.
(. 122-3),
. ,
,
(alopecia a r e a t a ) , .
, , (telogen effuvium).
( ) ,

(
).
, , , , , , ,
, , , . , , . 10 % .
,
, 30 % ,
(. 122-4), , ,
,
. .
- ,
.
. , ,
, , .
, , (15%), ( 5
432

. 122-2. . (
Sexually Transmitted Diseases. Prof. Dr. E. Stolz.
Rotterdam; Boehringer Ingelheim
International,
1977.)

. 122-3.

. ( Ronald Roddy;
Gynec. and Obstet.
Ed. J. W. Sciarra, New
York; Harper and Row,
1985.)

8 % ) , (220 % ) , (25 % ) , ,
(10%) ( 5 % ) .
I2 % , 30 %
. 40 % ^
. pallidum . 433

. 122-4.
. ( Ronald Roddy
Sexually
Transmitted Diseases/Eds.
. . Holmes et al.,
New York; McGraw-Hill,
1984.)

,
.
- ,
, linitis plastica ,
, .
, , , .
, , . ,
,
( ) .
, .
, - , .
, , , . ' - , - .
, ,
. 510%
; .
.
,

,
.
, ,
1 , .

.
, ,
. ,
434

: ;

. ,
. 50- 70 % ,
.
.
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,

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, ;
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.
.
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.
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. , , ,
.
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. pallidum .

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.
.
. . pallidum
,
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,
,
. pallidum.
7595%. ,
2 , 35 %,
. 16 .

1 , 2
100 .
19781983 . 5331 9082
107 158 , '
48 %. 1984 . 240 ( 120% 1978 .).
50 , 1982 ., , 56 %
437

 ,
, 14 % , 14 %
, ,
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( , ,
),
,
. .
2 21 % , 13 %
2 , 43 % , ,
23 %
. , , III .
;
.

.
:
, 2 ,
2- 10- ;
; ,
2 ; ;
. 1984 . 75 %

.
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, ,
.

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, . ,
438

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,

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.
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.
5
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.

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.

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IgM-, , . pallidum , , ,
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IgE,
, .

, ,
(RPR), (ART),
VDRL- ( Venereal
Disease Research Laboratory,
. . ) .

(USR) (RST).
(VDRL, USR) (RPR, RST) (. . 122-1)
RPR , VDRL,
.
. VDRL , .
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.
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. :

440

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( )
- .

: (FTA-ABS),
. pallidum (MHA-TP)
(HATTS).
, .
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, () , ,
.
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,
, - .
. pallidum (MHA-TP, HATT, )
' .
. pallidum .
,
. pallidum . , - .
FTA-ABS

.
I 2 %
.
VDRL, FTA-ABS MHA-TP
. 122-2.
30 %
.
, FTAABS, VRDL 12 , . ,
FTA-ABS-.
, , , FTA-ABS.
,
( ,
1 - 2 %
VDRL ;

).

. , , ,
, , 1:8. , , , 20 40 % , 441

122-1.

()
: -
(VDRL)
: (RPR)

:
(FTA-ABS)
: . pallidum (MHA-TP,
HATTS, )
: . pallidum (TPI)
122-2.

, . , %"

VDRL
FTA-ABS
MHA-TP

5987
86100
64 87

100
99-100
96-100

73-91
96 99
96100

3794
96--100
94- 100

,
.
: . Jaffe, Management of the reactive serology. In: Sexually Transmitted
Diseases [Eds. . . Holmes et al. New York: McGraw-Hill, 1984 ( ).]
.
,
, , .
, 6 .
, , , .
, 6 ,
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. 1545 % ,
, , . , , , , . ,
, ,
. 70 10 % . , 442

, , .

. FTA-ABS- ,
. ()
,
, , ,
. ,
.
FTA-ABS, , . FTA-ABS- 15 % ,
,
. , .
- FTA-ABS
TPI
.

:
(, RPR VDRL);

(, VDRL RPR);
(, FTA-ABS,
-, MATT).
.

( ) .
,
40 % .
, ,
40 % , .
,
. .
, 1 . ,
,
. - , ,
,
, .
, VDRL. -VDRL ,
.
. FTA-, , ,
VDRL,
443

.
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.

, - , , , , .

IgM IgG. , 80 %
40 % (, , , ), - . ,
(, . patlidum ). per se . IgG IgM ,
.
. G .
. , .
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.
.

.


, ,
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.
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3 ( 7 200 000 ).
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:
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,
:

:
,

445

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)

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2 400 000 + 500 4
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, 10

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-1 . CDC

,
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).
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, . , . ,
,
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. (, , )
,
.
: Sexually transmitted diseases treatment guidelines, 1985. Morb. Mort.
Week. Rep., 1985, Suppl 34 (4S).
446

 - ,
. - , ,
.
, - G . .
1086 , , ,
38 %
81 % . ,
6 000 000 ,

.
.

.
, , ,
.
, 600 000 900 000 10 90 %. , 1985 .
, . 122-3. -1 2 400 000 50 000 1 ,
.
, , 25 % , -1, 2 400 000 , . ,
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10 , . , - , G,
(, , ) .
.
, , , , III . ,
, ,
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,
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.
,

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447


, , 020 %
.

. .
100 2 15 , (,
),
, , .
. , ,
, .
.
, VDRL
FTA-ABS , , , , , IgG. IgM FTA-ABS IgM. ,
IgM
IgG ( ), . IgM-FTA-ABS IgM
IgG,
, .
IgM-FTA-ABS
.
, , .
.
, ( ),
,
. . .

, ,
, , I
, ,
.

.

,

( 1,5 ), , , , ,
, ( 12,5 109/),
. 50 % , 90 % 25 % . 2 , 7 ,
1224 . ( 12-14 ) . . .
448

 - . . ,
. - , , .

- .

VDRL 1, 3, 6 12 . FTA-ABS ,
, . VDRL
312 75 %
40 % . 2
VDRL,
25 % , ,
, ,
. VDRL
1 2 ,
,
. , 12 VDRL, 1:8 ,
4 , 4
, .
.
,
, , . , , . , ,
VDRL, ;
56 %
.
,
.
,
. , , . 3- 6 3 .

9
0,01 10 / 3-12 95 %
2 - 4 .
.
. ,

, , ,
, . ,
, ,
,
, .
15-114

449

, .
. ,
.
.
50 % , .
, , .
, ,
, . ,
,
- .
. - ,
.

. , ,
, ,
,
. ,
,
.
. . , , , ; . ,

- .
, .
in vitro
, ,
.
, -,

105 . .

Bryceson A. D. M. Clinical pathology of the JarisehHerxheimer reaction.
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Campisi D., Whitcomb C. Liver disease in early syphilis. Arch, intern. Med.,
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Chapel T. The signs and symptoms of secondary syphilis. Sex. Trans. Dis.,
1980, 7, 161.
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Fischer A. et al. Tertiary syphilis in Denmark 1961 1970, a description of
105 cases not previously diagnosed or specifically treated. Acta derm,
venereol., 1976, 56, 485.
450

Fiumara N. J. Treatment of primary and secondary syphilis: Serologic response.

J. A. M. A., 1980, 243, 2500.
Greene B. M. et al. Failure of penicillin G benzathine in the treatment of neurosyphilis. Arch, intern, med., 1980, 140, 1117.
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Hotson J. R. Modern neurosyphilis: A partially treated chronic meningitis.
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. J. A. M. A., 1976, 236, 2208.
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98, 496.
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123

: ,
,
. (Peter L. Ferine)
. . ,
. , ( Treponema
pertenue,
. carateum), 15*

451

 . pertenue,
. carateum . pallidum.
. pallidum . pallidum endemicum.
,
, , .
, , ,
, .
-
,
. , , ,

. . 123-1.
123-1. ,

. pallidum

. pallidum en-

. pertenue

. carateum

(),

- ;

/{am

4/4

11

UClIHLlilll

,
- 1

:
,

()

-
;

, -

-
(
, ,
);

-
-

'
,
.
452

. -.
, , . ,
, . , ,
.
. , . , , .
, , .
, ,
, .
, .
,
.
, ;
, .
, ,
, ,
. 10
20 . , .
,
1948 1969 .,
. 46 160 50 ,
. . , , 20 % 1 %. ()
.
, .
- . , , , 90 % , 1982 . ,
, , 10 15 %.
,
. .
1980 .

.
(, , )
, ,
.
( ,
),
.
453

 ,
, -, , , , , .
, .
, , 1 % ,
20 .
. . pallidum
, , , .
:
(FTA-ABS), . pallidum (TPHA), . pallidum (TPI)
.
,
. , . carateum
, ,
. ,
. pallidum . pertenue. , , .

, . pallidum.
, ,
, . pertenue .
. . ,
, , ..pertenue
(), ,
.
, .

3 4 .
, ;
,

.
, .
, .
(), . ,
, . pertenue.
, . 6 . , , ,

.
-,
(. 123-1).
,
(crab yaws). ; ,
, ,
. , (. 123-2), ;
454

. 123-1.

!
( ).

, , . .,
, .
5 . 10 % 5 , .
, , , ,
, .

. , ,
, , , ,
. , .
,
, (RPR), .
. pertenue 455

. 123-2. -

( ).

, , .
1 , FTA-ABS
.
. :' ,
, , , . ,
,
, , -
, . ; ,
. ,
P. pallidum.
,
. - , .
, , , , . ( )
- ,
. ,
. , . . 456

. .
. ,
, ,
. , . ,
. .
. , , ,
, , . carateum.
,
;
; , .

, 730,
,
, . _ . . , , 1 1
. , , .
,
- . , . .

. . 3
1 ,
. , , . , . ,
. caraleum.
, 4 ,
.
. . 1 200 000 -1 6 000 000 ,
.

2 % (). , ,
, (. . 122).
, 5 % ,
, , , .
.
, , ,
,
. , , , , ,
.

457-


Burke J. P. et al. (Eds.) International symposium on yaws and ether endemic
treponematoses. Rev. infect. Dis., 1985, 7, S217.
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548.
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Treponematoses Research: Report of a WHO Scientific Group. WHO Technical
Report Series, 455, 1970.
World Health Organization: Endemic treponematoses.--Week Epidem.. Rec,
1981, 56, 241.

124

. (Jay P. Sanford)
. , Leptospira .
, ; , , , . ,
, .
. Leptospira , L. interrogans,
- Interrogans
Biflexa. (Interrogans) , (Biflexa) .
, ,
, (). ().
, : Pomona L. interrogans L. interrogans var. pomona,
L. pomona. 170 , 18 (, ,
): Icterohemorrhagiae (18), Hendomadis (30), Autumnalis (17), Canicola (12), Australis (12), Tarassovi (17), Pyrogenes (12), Bataviae (10), Javanica (8), Pomona (8), Ballum (3), Cynopteri (3),
Celledoni (3), Grippotyphosa (5), Panama (92), Shermani (1), Ranarum (2)
Bufonis (1). 27 .
. , .
, , . ,
, . 1974 1983 .
61 110 . . ,
. , , , . 10 50. 458

^ , Pomona, , .
. (
10' 1 ).
,
.
.
, , ,
, . ,
( ),
648 .
;
, 22 ,
.
,
,
. ,
, , ,

, . ,
,
. ,
, .

.
( 50 % 10 39 ).
(80 %)
: 50 % , . ,
,
, . ,
,
, , .
; ,
. 20 %
; ,
. ;
60 % , .
, , , 20 % , - . 20 %
, .
. , ( ), . , ,
, , , , ,
.
. ,
, .
459

 .
. , .
, .
,
, , . ,
, ,
.

.
, , . ,
, . .
, .
, .
. .
2 26 , , 7
13 ; 10 .
.
, ,
.
, , ,
, , . ; ,
. ( ).
,
. , , 4 9 .
, (
38,9 ), . 50 % , . .
, ,
, 25-86 % . . (-).
,
.
25 % . , ,
(), .

, " 3-
4- , .
, .
, ,
.
, .
, ,
: 49 , ,
.
460

 IgM. .
, ,
, .
1 3 , .
38,9 1 3 . . 7- 5090 % .
, , , .
, ,
2- 4- , ,
. .
.
. . , . ,
Icterohemorragiae, , ,
, .
, .
.

. 36- ,
.
, 7- ,
. ,
. , ;
. () 5 , (). ,
40 /, 170 ME.
, ,
.
, , . .
,
.
57- .
, , ,
.
. , .
. 5 1 3 %
.

9
. 1 10 / . , (),
100 /
.
. ,
461

 , .
Canicola, Icterohemorragiae Pomona.
( ).
1942 . , .
4-

, 2 - 5 . 95 % . , Autumnalis. , ,
Pomona, ,
,
.
. ,
, , , ,
, .
. , , , .
Icterohetnorrhagiae, Pomona Grippotyphosa.
. , , .
, (
), ,
, . , , ,
(. .'49).
.
,
.
70 109/. ,
, 70 %.
. ' , in vivo, , -, . .
.
.
, ,

9
( 30 10 /). 50 /, 50 % .

, .
, , .
.
,
.
25 % . 75 %
100 /. , ,
.
65 /, 00 % 20 /.
50 % , 5 .
462

 ,

. ,
.
.
. , , ,
, , ,
, .

.
11 , .
, , EMJH.
, , , ( ),
11 .
( , );
, .
,
, .
, 612- .
: ,
, ', ,
, , , . 4 .
,
.
. ,
. 1974 1981 . 2,5 16,4 % ,
7,1 %. , , .

10 % 50 56 % .
. , , ,
15 48 %.
. .
2 , ,
.
. , ,
, , , in vitro . .
,
4 . 46
G ,
. , 200
1 . , (100 2 7 ) 4
463


,
. , . , . ,
,
.
, , 5- ,
. ,
(
) . . ,

. , .

Alston J. ., Broom J. . Leptospirosis in Man and Animals. - Edinburgh:
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outcome in six cases. Quart. J. Med., 1984, 53, 487.
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125

. (Jan V. Hirschmann)
. ,
Streptobacillus rnoniliformis Spirillum minus. , S. minus, .
. S. moniliformis , , . 2--7-
, .
L- .
S. moniliformis,
. , ,
,
464

 .
. () 1926 .,
86 ,
. , .
Spirillum minus , ,
2 5 2 5 , 610 .

.
,
.
.

25 % .
. , S. minus, .
. ,
S. moniliformis, , 10 , 13 , 22 . ,
, ,
. ,
, . 75 %
, 1 3
, .'
, .
50 %
, .
. S. moniliformis
.
, S. minus, 1 4 , 1 36 .
, ,
, . .

2 4 ,
.
, , .
. 50 % - - .
. .
. , S. moniliformis,
, . ,
. 2- .
, S. minus,
.
. .
515 .
50 %
.
465

 .
, , , S. moniliformis, , S. minus,
,
,
.
. . , ; , S. moniliformis,
10 %; , Spirillum minus, 6 %. ,
, 710
600 000 2 V 0,6 4 .
0,5 4 . G
12 000 000 16 000 000 4 .

Cole . S. et al. Rat-bite fever. Ann. intern. Med., 1969, 71, 979.
McCormack R. et al. Endocarditis due to Streptobacillus. moniliformis.
J. A. M. A., 1967, 200, 77.
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1984, June 8.
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intern. Med., 1965, 116, 39.
126

. (Peter L. Ferine)
. , ,
. Borrelia
- , , ,
.
. Borellia , , 7 20 , 0,7 .
. , ,
, Kelly. ,
, .
. recurrentis. , . . hermsi, . parked . turicate.
.
, , . recurrentis.
. ,
. .

, ,
, .
, . 466

 , 50 5 . , . '' .

Ornithodorus.
, , , , .
.
. , , , , .
, ,
. ,
. ,
, , .
, -. , , .
. ,
.
, . , -, 3 12 .
,
100 102/.
. 35 () , , . ,
, , , ,
/ . , .

3
5
10 I0 ,
, , .

, ] ,
, .
, , , ,
,
.
,
, , , .
.
.
,
. 3 18 , (39
40 ), .
.
, , .
, , , 467

 .
. . 40 % .
, . ,
, 1080 % ;
.
. 1060 %
.
25 % . , , .
.
. ,
, .
36 , , , ,
,
.
,
, .
,
24 ,
, . ,
-
. , ,

.
5 7 , . , ,
.
, .
. . . . 150 109/ . , . , , . ,
. QTc.
30 %
Proteus OXK.

, . .
- .

" .
468

 . : ,
, , . ,
.
. , ,
.
,
, 12
.
, ~ ;
. ,
. 24 .
. , 24
4 .
;
, .
, 500
. 12
'/ . 100 ,
.
500 , . 100 2
. 12 '/2 .
500 6 10 .
.
30 70 %.
1 % .
, , QTc.
, , , , , .

Horton J. M., Blaser M. J. The spectrum of relapsing fever in the Rocky Mountains. Arch, intern. Med., 1985, 145, 871.
Judge D. M. et al. Louse-borne relapsing fever in man. Arch. Path., 1974, 97,
136.
Perine P. L., Teklu B. Antibiotic treatment of relapsing fever in Ethiopia: A report
of 377 cases. Amer. J. trop. Med. Hyg.,-1983, 32, 1096.
Southern P. M., Sanford J. P. Relapsing fever: A clinical and microbiological
review. Medicine, 1969, 48, 129.
Teklu B. et al. Meptazinol diminishes the Jarisch-Herxheimer reaction of relapsing
fever. Lancet, 1983, 1, 835.
Warrell D. M. et al. Pathophysiology and immunology of the Jarisch Herxheimer like reaction in louse borne relapsing fever: Comparison of tetracycline and solw release penicillin. J . infect. Dis., 1983, 147, 898.

469

127

. (Allen . Steere)
. .

, ( ). , ,
- ( ),
, , ( ).
.
(),
Bannwarth'a, , .
-
. , .
.
, lxodes dammini,
I. ricinus. , , ,
, Borrelia
burgdorferi. 25 , 7 11 . : 27,3 30,5.
Borrelia,
Kelly.
. ,

I. dammini, I. pacificus 1. ricinus. , Amblyomma americanum, , , ,
, .
I. dammini -

. I. dammini
20 % . burgdorferi,
.
I. pacificus , , ,
. ,
1 % . , , , ,
- , , , ,
, , , .
,
1. ricinus. . . I. dammini
, .
. , , , . . 1962 .,
1000 .
. , , , ,
. ,
470

 ,
.
. , , , .
.
, .
. , 3 32 , .
,
- . -
. , , .
,
, , .
, , . ,
.

.
;
. .

, .
, , , .
, , , , - , .

, , , , ,
.

,
.
.
, -
.
. , ,
,
, , ,

. 15 %
, ,
( ), , , ,
. .
(
0,1 109/),
.
,
.
8 %
.
471

 (
, Wenckebach, ). , ,
( )
'.
- ,
, , , " .
.
, 60 %
2 .
, , , ;
.
, .
, ,
. ,
.
. , ,
, , ,
, .

0,5- 10!'/ ( 25 '/'), - .
, , .
, , ,
.
( ).
.
, ,
. . biirgdorferi , ()
.
, , . ,

,
.
, .
,
, -
, .
, -. -,
IgM, . IgM . burgdorferi
3- 6-> ;
IgG
, . , , .
- . ,
, , - DR2.
. ,
.
, . , 472

 . 50 %
IgM IgG . burgdorferi.
IgG .
. burgdorferi ,
Trcponema pallidum, VDRL-. , IgM, .
.
250 4 ,
500 4 250 4 . 10 , , , 20 . ( 50 /, 2 )
,
30 / .
15 --20 . 15 % 24
, - .
. .
G 20 000 000
10 . PR 0,3
10 000 000 - 20 000 000
10 .

, 24
. ,
5 0 % -i 2 400 000 3 ( 7 200 000 ) G
20 000 000 1020 .

.
. 50 % , - , . .

Pachner A. R., Steere . . The trial of neurologic manifestations of I.ymo disease:
Meningitis, cranial neuritis, and radiculoneuritis. Neurology, 1985, 35, 47.
Steere A. C, Malawista S. E. Lyme disease.
In: Principles and Practice of
Infectious Diseases, 2nd ed./Eds. G. L. Mandell et al. New York: Wiley, 1985,
p. 13431349.
Steere A. C. et al. Lyme carditis: Cardiac abnormalities of Lyme disease. -- Ann.
intern. Med., 1980, 93, 8.
Steere A. C. et al. The spirochetal etiology of Lyme disease. New Engl. J. Med.,
1983, 308, 733.
Steere A. C. et al. The early clinical manifestations of Lyme disease. -- Ann.
intern. Med., 1983, 99, 70.
Steere A. C. et al. Treatment of the early manifestations of Lyme disease.
Ann. intern. Med., 1983, 99, 22.
Steere A. C. et al. Neurologic abnormalities of Lyme disease: Successful treatment
with high-dose intravenous penicillin.
Ann. intern. Med., 1983, 99, 767.
Steere A. C. et al. Successful parenteral penicillin therapy of established Lyme
arthritis.
New Engl. J. Med., 1985. 312, 809.
473

() 52, 61, 88, 151, 193, 200,

82
212, 232, 261, 270, 271, 311, 312,
54, 56
365
63
69
322
69
179
314
82, 98
82, 191, 297, 305
261
58, 65, 74, 8991,
. 69
69
96, 104, 191, 228, 305, 346
66
106
73
106
94
186, 187, 254, 314
80, 95, 104, 159, 291,
- 266
186
323, 336, 343
- 72
80, 82, 94, 159, 180, 219,
63
. 232, 297, 302, 307, 323, 330, 336, 343
66
229
73
244
88, 90, 188, 265, 345
226
.
335, 426

37
72
37
400
- 37, 74, 171,
63
328, 345
345
402
261
56
283
436
. 73, 88, 267
12, 188, 193
65
148

285, 340
63, 71
22, 292
74
335
314
121
74
146
74
191
76, 77
- 345
76
269
74
22
. . 234

26
- 72, 254
24
- - 268
192
- 203
55, 187
120
88
104
38, 192
54
10
54, 56
11
179
68
82, 97
474

 10, 46, 52, 62, 122, 185,

187, 201, 204, 213, 218, 226, 232,
233, 236, 261, 269, 295, 301, 305, 319,
323, 325, 329, 340
269
~- 269
26
47
.
148
128, 130
369
22, 391, 459
32

25
150, 158
148
432

37
44, 48, 382--388
381
237
226
--- 346
38
45
128, 130, 135, 141
135, 153
153
128, 130
135
- 163
- 173
173, 192, 324
173, 410
- 170, 171
165
172, 279
174, 175
171
23- 191
,
172
- 345
-- - 34-5
- 175
175

175
164
175
175
174, 379
174, 373
170
174

84, 104, 179, 202,. 203,

259, 312
'
45'
10
300
372
28, 210
-- 263
263
139
.

220
206
75
5355
57
58, 89, 179, 191, 203, 219,
232, 299, 301, 305, 368
72
198, 268
249
263
319
9
30, 31
30, 31
395, 404
267
185
128
- 95
250
417
59
107
170
37
9, 13, 29, 116, 126, 200, 294,
331, 334, 379
124
123, 252
-
123
._ _. 123

117
Vibrio parahemolyticus 122
-- mimicus 123
195'
124
- 119
- 118, 125
117
24
61
- 71
26, 72
475

 80, 96, 202

38, 185, 192

55, 59, 192, 200, 263,

320, 371
118, 120
- 21
80, 108, 158, 159
356, 357
141, 142, 351
357
58
72
87, 90, 114, 181, 406
59
83, 103
162
163
11
162
175
165
176
176
178
- 175
175
176
- 176
i
176
176
176
178
178
223
11, 231, 310, 328
: 10
8
8, 11
() 40
10, 124
229
IgA 11, 13, 33, 334, 362
348
IgG 33, 35, 39, 195, 232, 362
lgE 98
IgM 232, 362
- 38,
124
10
39
7, 16
97
85
-1 13, 195
179
62
45
() 11
476

128
61
- 10
- 11
146
61
39
7, 8, 33, 39
12, 198
90
44, 45
68, 205, 261
9
- 10
'72, 76
72, 76
10, 62
120

83, 313
29
38
8, 128, 130
58, 80, 84, 96
96
35
128
141
113, 297
113
" 104
58, 70, 74, 83, , 158,
180, 203, 228, 234, 271, 272, 307,
312, 406
80, 96
112
49, 253, 335
259
27, 335
() 21
141
33, 37
53
39
129
432
128, 130
130
- 232
71, 72, 145
318
190

171, 224, 226
226
207
150
58, 65, 70, 74, 80, 86, 87,
88, 108, 191,. 234, 271, 278, 297, 330,
343? 346, 349, 368, 373, 463 .

.195
36, 198
31, 412
37, 414, 415
416
415
414, 415
118
89, 90, 92
8
16, 108, 470472
62
62
7
12
145
23
8
141
10

13
13, 108, 200, 300
462
118, 120
261
' 124, 129
212
84, 97, 299
268
8, 88, 92, 101,. 226, 231, 232,
235, 291, 304, 306, 307, 334, 335, 343
12
276
277
53
107
59
79, 84, 95, 197, 202
138
70, 81, 84, , 125, 259
12, 171, 200
37

38, 185
79
79
79, 85, 86
81, 108
225, 426
84, 101, 102
130
128
89
84, 91, 95, 202
225
435, 444, 449
52

256 >
52
'
52
180, 18.1
188
320
199
179
87, 180, 297
184
81, 113
10
62
- 36
10
84, 91, 95, 202
107
36, 55, 58
120
138
380, 381
12, 15, 303, 325, 345
203
81, 1 13, 114
301
317, 325, 330
66
68
31, 169, 170
209
() 65, 87, 95, 159, 187,
203, 219, 234, 272, 291, 299, 307, 346
G 84, 94, 98, 181, 190, 202, 212, 232,
238, 243, 289, 301, 302, 344
V 81, 94, 180, 212
95
207
128
188, 342, 344
398
14, 151, 345
321
321
190
113, 114
14
84, 97
115
i
179
72
46
112
.
399, 400
55
- 10
404
159

 128, 130, 144, 145, 157

145
145
128, .130, 144
462
465, 468
397
() 34
207
31, 121
- ELISA 20, 288, 349, 403

189, 338, 340
189, 338,
340
- FTA-ABC 441, 442, 449

- 441, 442

RPR 440

VRDL 31, 440, 441, 449

13
98
206, 212
146, 148
96
-, 58
58
378
209
81, 86, 90, , 206, 232,
387, 406, 418
213
R- 8, 42, 90, 323
15
128, 151, 157
154, 155
153
154
154
154, 155, 160
37
- 57
271
-- 269
291
145
146
328
- 123
-- 141
119
195
199
128
7,
8, 17, 33, 38, 48, 423
10, 195, 199. 200
133
133
478

14
- 13
34
37, 361
432
432
432
141146
209
12
39, 74
9, 12, 176
28
87, 105, 232, 359, 362,
367, 373, 406, 463
- 207
- ^- 207, 211
- 207
81
179
179
179
436
242
.
.- 287
38
98
66
227, 391
227
138
(), 65, 81, 96, 107, 108,
118, 138, 159, 180, 191, 232, 234, 238,
270, 288, 297, 305, 312, 346, 349,
357, 362, 368, 373, 384, 387, 463
84, 96, 272
37
37
138
317, 361
58, 84, 89, 191, 232, 299,
301, 305
319
() 9, 12, 200, 296
- 246, 247
- 236
239
- 117
- 119
117
-1 196, 198
319
68
243, 249
206
41,
81, 112, 113, 118, 179, 180, 297, 313,
323, 336, 343, 354

 62, 64,
65, 269
10, 11, 13, 46, 48, 392414
364
- 366
- 366
366
365, 366
- 366
309
38

192
14, 128, 129, 132, 141, 148, 157
128
- 128, 129
287
()
348
55
55, 56
348
12, 14, 128
184
23, 68, 208, 209,
218
212, 213
209, 265
97
.
243
59
156

284
12
297
87
268
12
.
125
113
. '
206
7- .
179
243
107
37, 339, 340
14, 73
259
462
320, 322, 345
321
128, 130

128, 130, 140

140
150
- 140
141, 153
98, 99
79, 84, 99, 182
98, 99
79, 80, 98, 99
79, 83, 98, 99, 228
98, 99
86, 87, 90, 95, 103, 181,
190, 197, 202, 228, 234, 270, 297, 299,
346, 363
99
99
101, 279, 300
82, 99, 228
79, 82, 83, 98, 99
83, 100, 159, 271, 293
100
82
83, 92, 101, 191
83, 102
159
79, 80, 98, 99
'
100
82, 101
101
83, 92, 101, 191
83, 92, 100
80, 83, 113, 114
14, 133
37
141, 142, 143, 352, 431
431
436
165
55
128
128
- 141
223, 229
52, 60, 269
-- 371
221
45
- 378
24
- 24
10, 48, 64, 74, 99, 193, 226,
233, 234, 286, 291, 305, 306, 307, 344
270
13, 24
- - 188
232
- 189, 191

479

 201, 202. 204

202
219
95
234
128, 130, 150
- 153
56, 319
() 53, 195, 319
332
113, 114
148
144, 145
121

252

330
144, 145, 325

119
- 124
340, 343
128, 130
-- 131
-- 11, 16, 130
80, 83, 108, 121, 180, 232,
234, 238, 387, 463
114
352
286
235
67
220
- 448,
469

3
. . .
. . ,
. .
. .
.
. .
. . , . .
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6480
010215 11.03.92.
15.02.93. 09.06.93. 60X90'/ie.
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