#1
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Êîëüöåâèäíûå ýðèòåìû ó ðåáåíêà 1.4ãîäà
Äîáðûé âå÷åð, ìàëü÷èê 1.4ã. äîíîøåí, êåñàðåâî ïî ïðè÷èíå âåñ 4êã âîçðàñò ìàòåðè, óçêèé òàç. Ñ ðîæäåíèÿ äèàãíîç êèñòà óðàõóñà, äð. çàáîëåâàíèé èëè àëåðãèé íå áûëî.
 âîçðàñòå 6ì áûëà ïîâûøåíà òåìïåðàòóðà äî 37.5-38 îêîëî 2õ ìåñÿöåâ, àíàëèçû â íîðìå, ñèìïòîìîâ íåò, ïðè÷èíó íå îïðåäåëèëè, òåðàïåâòû ñïèñàëè íà çóáû..  1ã2 áûëà äëèòåëüíàÿ òåìïåðàòóðà 7 äíåé äî 40.5 . Àíàëèçû íå ïîêàçûâàëè âîîáùå íè÷åãî, íèêàêèõ âîñïàëåíèé. Ïðîøëà ñàìîñòîÿòåëüíî.  òî âðåìÿ áîëåë ñòàðøèé ðåáåíîê ïîýòîìó ïîñ÷èòàëè, ÷òî âèðóñ. Ñåé÷àñ ïðèìåðíî íåäåëþ ðåáåíîê èñòåðèò, ïëîõî åñò, áûëà òåìïåðàòóðà äî 37.5 âûëåçëî äâà êëûêà. Äâà äíÿ íàçàä ïîñëå âàííîé çàìåòèëà äâà íåáîëüøèõ êðàñíûõ ïÿòíà â âèäå êîëüöà, ÿ ïîäóìàëà ÷òî ïðèäàâèëà ïàëüöåì èëè ÷òî-òî óêóñèëî. Íà ñëåä.äåíü áûëî óæå 6 ïÿòåí áîëüøîãî ðàçìåðà îò 2 äî 4 ñì. Ïÿòíà êàê áû "íàðèñîâàíû" íà êîæå, íåò âûñûïàíèé, ïðûùèêîâ, øåëóøåíèé, ñëåäîâ óêóñîâ, åñëè ïðîâåñòè ïàëüöåì ïÿòíî ÷óòü ïëîòíåå êîæè è ÷óòü âûøå. Àáñîëþòíî íîðìàëüíàÿ ãëàäêàÿ êîæà. Ñ óòðà ïÿòíà áûëè ÿðêèìè, íî íî÷üþ ñòàëè ÷óòü çàìåòíûìè è ñåãîäíÿ íà óòðî òîæå. Òåðàïåâò ãîâîðèò, ÷òî çà 20 ëåò ðàáîòû âïåðâûå òàêîå âèäèò, äëÿ Ëàéìà èëè ëèøàÿ ñëèøêîì áûñòðîå ðàçâèòèå, äëÿ ðåâìàòèçìà ìàëî ñèìïòîìîâ. Äåðìàòîëîã ïðåäïîëîæèë àëëåðãèþ. Îòïóñòèëè íàáëþäàòü, òàê êàê óòðîì ïÿòíà áûëè ñëàáûå è ïîíàäåÿëèñü ÷òî ñîéäóò. Ê âå÷åðó îíè îïÿòü ñòàëè êîíòðàñòíûìè è ïîÿâèëèñü íîâûå ìàëåíüêèå ïÿòíà äî 2ñì. Òåïåðü èõ îêîëî 15. Åñòü íåñêîëüêî ïÿòåí ïðÿìî íà ñòîïàõ ñíèçó. Ïîäñêàæèòå ïîæàëóéñòà, ÷òî ýòî ìîæåò áûòü? Êóäà êîïàòü? Ó íàñ ðàéîí íåáëàãîïîëó÷íûé ïî Ëàéìó, ìíîãî çàáîëåâøèõ ñðåäè ñåìüè è ñîñåäåé, íà ó÷àñòêå âèäåëè êëåùåé (÷àñòíûé äîì). Ñ ðåáåíêà êëåùåé íå ñíèìàëè è óêóñîâ äàæå êîìàðèíûõ íå âèäåëè. |
#2
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÷èòàåì âîçì. ïðè÷èíû êîëüöåâûõ ýðèòåì ó äåòåé:
In children, annular erythema, also known as erythema annulare centrifugum, is often caused by: Fungal, bacterial, or viral infections: Candida albicans, dermatophytes, VEB, and poxvirus infections Drugs: Drugs or chemicals Other causes: Recurrent or chronic appendicitis, cholestatic liver disease, or Graves disease èç äð. èñòî÷íèêà Often no specific cause for the annular erythema is found. However, it has been noted that annular erythema is sometimes linked to underlying diseases and conditions. Drugs including chloroquine and hydroxychloroquine, oestrogen, penicillin and amitriptyline Food, most often blue cheese or tomatoes These include: Bacterial, fungal and viral infections such as tuberculosis, secondary syphilis, sinusitis, candidiasis or tinea. íåïîíÿòíî, íî íè ïðî ëàéì, íè ïðî ðåâìàòèçì çäåñü íåò, òàê ÷òî âàø âðà÷ ÿâíî ïóòàåò, èëè æå ïðè÷èíà äåòñêèõ îòëè÷àåòñÿ îò âçðîñëûõ...
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Ýðèòåìû áûâàþò ò
ðóäíîîòëè÷èìû îäíà îò äðóãîé .Eryhema myltiphorme minor ÷åðåç ïàðó íåäåëü ïðîõîäèò íåðåäêî ñàìà |
#4
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×òî ëó÷øå ñäàòü, ïîäîçðåíèå íà Ëàéì ó ðåáåíêà
Äîáðûé âå÷åð, ïîäñêàæèòå ïîæàëóéñòà êàê ëó÷øå ïîñòóïèòü? Ðåáåíîê 1.4ã, ÷åòûðå äíÿ íàçàä ðåçêî ïîÿâèëèñü ìíîæåñòâåííûå êîëüöåâûå ýðèòåìû ïî íîãàì, êëåùà íå âèäåëè. Äèàãíîçû íàøèõ ìåñòíûõ äîêòîðîâ:
Ïåäèàòð- Äåðìàòîëîã-àëëåðãèÿ, íà ÷òî íå çíàþ ïîïåéòå çèðòåê Èíôåêöèîíèñò äåòñêèé: "çàïóùåííûé Ëàéì, ñäàéòå Èìóíîáëîò, òàê êàê "Àíòèòåëà" ñäàâàòü ïîçäíî, íî âïðî÷åì åñëè íå õîòèòå áëîò, îí æå äîðîãîé, ìîæåòå àíòèòåëà ñäàòü, êàê õîòèòå🤦" .. ×èòàëà, ÷òî âðîäå êàê ðåêîìåíäóåòñÿ ñïåðâà àíòèòåëà, è ïîòîì áëîò ïðè ñîìíèòåëüíîì ðåçóëüòàòå. Äâà ðàçà êîëîòü ðåáåíêà ïî âîçìîæíîñòè íå õîòåëîñü áû. Íå ìîãó ïîíÿòü, ÷òî ñäàâàòü, òî ÷òî ðåêîìåíäóåò äîêòîð (áëîò) èëè ïî "ïðîòîêîëó"(àíòèòåëà)? Èëè ëó÷øå è òî è äðóãîå îäíîâðåìåííî, ÷òîá äâà ðàçà íå õîäèòü? È åùå âîïðîñ, åñëè íåèçâåñòíî âðåìÿ óêóñà, òàì æå ïîñëå óêóñà íàäî âûæäàòü ïîêà ïîÿâÿòñÿ àíòèòåëà..Åñòü ëè ñìûñë ñäàâàòü ñåé÷àñ, èëè ïîäîæäàòü ñêàæåì íåäåëþ. Èëè ïðè ýðèòåìàõ æäàòü íåàêòóàëüíî? Íóæíî íà÷àòü ëè ÷òî-òî ïðèíèìàòü äëÿ ïðîôèëàêòèêè â îæèäàíèè ðåçóëüòàòà, ÿ òàê ïîíèìàþ ýòî íå îäèí äåíü? Ïîäñêàæèòå ïîæàëóéñòà |
#5
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êëåùåôîáèÿ êàê è ïàðàçèòîôîáèÿ î÷åíü çàðàçíû è èäóò èç ãîëîâû áåñïîêîéíûõ ðîäèòåëåé, ïðîäîëæèòå ìóññèðîâàòü-òèðàæèðîâàòü - áóäåò áàíÿ
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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Óâàæàåìûå äîêòîðà, ÿ âñåãî ëèøü âûïîëíÿþ íàçíà÷åíèå âðà÷à. Ò.ê.ÿ íå êîìïåòåíòíà â äàííîì âîïðîñå. Ôîáèè ó ìåíÿ íåò.
Íå çíàþ âîçìîæíî ëè èìåÿ âûñûïàíèÿ ïî âñåìó ðåáåíêó ñèäåòü äîìà è æäàòü ïîêà âñå ðàññîñåòñÿ ñàìî. Âîò ìû ñõîäèëè ê òåì âðà÷àì êîòîðûõ íàçíà÷èë ïåäèàòð è èìååì òàêîé ðåçóëüòàò. Ìîæåò áûòü ôîáèÿ ó èíôåêöèîíèñòà êîòîðûé ïðåäïîëîæèë áîðåëèîç. ß íà ïðèåìå ìîë÷àëà è ñâîè âàðèàíòû íå îçâó÷èëà. Òåì áîëåå ÿ íå çàèíòåðåñîâàíà â òàêîì ðåçóëüòàòå è ëåæàíèè ìåñÿö â ñòàöèîíàðå, áîëüøå íàäåþñü íà àëëåðãèþ) Çà òåìû ïîíÿëà, íå ïîäóìàëà, ÷òî ýòî äóáëü, ò.ê.âîïðîñ óæå äðóãîé, èçâèíèòå Ïîäñêàæèòå ïîæàëóéñòà, åñëè ðåçóëüòàò èìóíîáëîòà ïðèéäåò ïîëîæèòåëüíûì, ÿ ìîãó âûëîæèòü åãî òóò, èëè ýòî òîæå áóäåò ìóñèðîâàíèåì? Ñïàñèáî |
#7
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Ïèøèòå çäåñü, íî øàíñû äèàãíîñòèðîâàòü áîðåëëèîç â äàííîì ñëó÷àå ñòðåìèòüñÿ ê íóëþ: ïðè èçó÷åíèè áîëåå 100+ äåòåé ñ áîðåëëèîçîì, èõ âîçðàñò áûë ñòàðøå 2 ëåò è íîëü ñëó÷àåâ ìíîæåñòâåííîé åðèòåìû
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#8
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Öèòàòà:
Ðåçóëüòàò ïðèøåë, ÎÀÊ ïðåêðàñíûé íåò ñìûñëà ïîêàçûâàòü, à áëîò âûñòàâëÿþ Èçâèíèòå çà øðèôò, ïåðåâîäèëà íà ðóññêèé ãóãë îáüåêòèâîì, îí òàê ïèøåò Òàì ãäå Ñòð è öèôðû, äîëæíî áûòü P è öèôðû, ïðîñòî îí áóêâó P ïåðåâåë êàê page |
#9
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Íå çíàþ, âîò äóìàþ, ìîæåò åãî ïåðåäåëàòü åùå ãäå-íèáóäü, èëè íà òàêóþ îøèáêó ëàáîðàòîðèè
íå ñòîèò ðàññ÷èòûâàòü? Ê èíôåêöèîíèñòó ïîïðîáóþ çàâòðà ïîïàñòü |
#10
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â òàáëèöå 2 êàêèå èç ìàðêåðîâ áîððåëèè ìîãóò áûòü íåñïåöèôè÷íû è äàâàòü ëîæíî-ïîëîæ. ðåçóëüòàòû
Antibody Cross-Reactivity in Serodiagnosis of Lyme Disease [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ïîëüñêèå âðà÷è ñ÷èòàþò òàêèå/ïîäîáíûå âûñûïàíèÿ ïàòîãíîìè÷íûìè äëÿ ëàéìà - ñì ôîòî 6 ïî ññûëêå: 3.4. Multiple Erythema Migrans (MEM) The presence of MEM is evidence of spirochaetemia in the body. It can also be the result of multiple bites on a child. The appearance of MEM may be accompanied by general flu-like symptoms, headaches, joint pain, and neurological symptoms. MEM is a rare manifestation of infection in children [10], and is still often unrecognized as one of the clinical forms of Lyme disease [22]. The location of multiple erythema is not related to the tick bite site. Characteristic erythema appears around the injection site, as in distant areas of the skin [7,23]. If the primary lesion is the erythema around the tick bite, the remaining lesions (usually smaller than the original lesion) are satellite lesions (Figure 6) The diagnosis of MEM, like EM, is a clinical diagnosis; there are no indications that serological tests should be performed in the presence of lesions of such morphology. Patients presenting with EM and MEM should receive adequate treatment, without delays associated with serological testing. In doubtful cases, the lesions should be observed for the next 24–28 h, and evaluated for peripheral enlargement. Serological tests should be performed at least 2 weeks after the onset of MEM [24]. Patients with early disseminated disease who present with multiple erythema migrans lesions are treated the same way as those with a single erythema migrans lesion [11,12,13]. Cutaneous Manifestations of Lyme Borreliosis in Children—A Case Series and Review [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#11
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Ñïàñèáî áîëüøîå çà ñòàòüè, î÷.ìíîãî èíòåðåñíîãî
Äà, ôîòî 6 ïðÿìî 1â 1 Îò÷èòàþñü Î÷íî ïðîøëà êîíñóëüòàöèè ñ äâóìÿ èíôåêöèîíèñòàìè.  îñíîâíîì ãîâîðèëè, ÷òî ýòî ýòàï äèññåìèíàöèè è ïðîøëî íå ìåíüøå ìåñÿöà ïîñëå óêóñà. Òàê êàê â ëàáîðàòîðèè îñòàëàñü êðîâü ñ ïðåäûäóùåãî àíàëèçà, äîäåëàëè ïî íåé îáû÷íûé lg m g êîëè÷åñòâåííûé. Äîêòîðà ãîâîðèëè, ÷òî íåò ñìûñëà, íî òóò íàñòîÿëè áàáóøêè "÷òîáû âèäåòü ïðîãðåññ". Ïîêàçàëî LG M >200 LG G>200 ñòðàííî, ÷òî è òåõ è òåõ àò îäèíàêîâî ìíîãî. Ïðîïèñàí àìîêñèöèëèí 250ìãõ2ð â äåíü íà 21 äåíü. Ýðèòåìû ïðîïàëè â ïåðâûé-âòîðîé äåíü ïðèåìà |
#12
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â øtàòàõ òàêèå ðåêîìåíäàöèè, íå çíàþ ïî÷åìó òàê: òðèæäû ÷åðåç 8 ÷, à íå äâàæäû ÷åðåç 12 ÷
Amoxicillin 50 mg/kg per day in 3 equal doses (maximum 500 mg/dose)
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |