What causes the plague? Bubonic plague. Mechanisms of plague development

Bubonic plague is a form of plague disease. Plague is an infectious disease caused by the bacterium Yersinia Pestis. This bacterium lives on small animals and the fleas that live on them. Infection occurs by transmission, i.e. through a flea bite, as well as through direct contact and airborne droplets. Let's figure out how infection with bubonic plague occurs, how it proceeds incubation period and symptoms of plague infection, treatment with antibiotics and prevention of this most dangerous disease today. Let's see what the plague causative agent, the bacterium Yersinia Pestis, looks like under a microscope and with fluorescent microscopy. Let's start with the background of the latest cases of plague infection and their consequences for many thousands of people.

Important! Bubonic plague is characterized by painful lymph nodes, affected by the inflammatory process, and is the most common form of the disease.

History of recent bubonic plague infections

In the 16th century, the bubonic plague spread throughout Europe and killed a third of the population. Rats became its carriers. Until the 19th century, they did not know how to treat the disease, so the mortality rate was almost 100% - some miraculously recovered on their own.

And to date, cases of infection with bubonic plague have been recorded, most cases of infection are observed in Central Asia, as well as in northern China.

The causative agent, the bacterium Yersinia Pestis, was discovered only in 1894, therefore, at the same time, scientists were able to study the course of the disease and develop a vaccine. But before this time, millions of people died. The most famous epidemic of bubonic plague covered Europe in 1346-1353. Presumably, it originated from a natural center in the Gobi, and then spread to the territory of India, China, and Europe along with caravans.

On video the film Dark Ages of the Middle Ages: Black Death

Over the course of 20 years, the bubonic plague killed at least 60 million people. In the Middle Ages there was no salvation from such a disease - they tried to treat it with bloodletting, which further complicated the condition of the patients, as they lost their last strength.

There were repeated outbreaks of the bubonic plague in 1361 and 1369. The disease has affected all areas of people's lives. History indicates that after the bubonic plague, the demographic situation reached stability only 400 years after the end of the disease.

There are several forms of the disease, depending on which it acquires a specific course.

Important! Forms in which the lungs are affected are highly contagious, as they lead to rapid spread of infection through airborne droplets. With bubonic plague, patients are practically not infectious.

The causative agent of the bubonic plague is the bacterium Yersinia Pestis

Spoiler with a mild shock photo example, manifestations of bubonic plague on the right leg.

Manifestation of bubonic plague on the right leg.

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Once in the body, the infection begins to develop rapidly, and resistance to the drugs used to treat bubonic plague, the bacterium Yersinia Pestis, may be observed.

The lifespan of the bacterium in sputum is about 10 days. It can persist even longer (several weeks) on clothing, in plague secretions, and in the corpses of people who died from the disease - up to several months. Freezing processes and low temperatures do not destroy the plague pathogen.

Important! Dangerous for the bubonic plague bacterium sunlight and high temperatures. Within an hour, the plague bacterium Yersinia Pestis dies; at a temperature of 60 degrees, when it rises to 100, it survives for only a few minutes.

The incubation period after infection with bubonic plague is quite short - 1-3 days, while in some people it can be only a few hours due to weakened immunity. The pathogen's target is the human lymphatic system. Having penetrated the lymph flow, the infection instantly spreads throughout the body. At the same time, the lymph nodes stop working, and pathogenic bacteria begin to accumulate in them.

There are cutaneous and bubonic forms of plague. In the cutaneous form, a quickly ulcerating papule appears at the site of the bite. After this, a scab and scar appear. Then usually more serious signs diseases.

The bubonic form begins with an increase in the lymph nodes closest to the site of the bite.

Wikipedia states that lymph nodes in any area can be affected. In this case, the lymph nodes are most often affected groin area, less often - axillary.

Symptoms of bubonic plague infection

Symptoms at the initial stage of infection with the plague bacterium Yersinia Pestis are not specific and in their manifestations resemble a cold. The patient experiences the following changes:

A large red swelling appears at the site of the bite, resembling an allergic reaction in appearance;
the resulting spot gradually transforms into a papule filled with blood and purulent contents;
opening the papule leads to the appearance of an ulcer at this site, which for a long time doesn't heal.

At the same time, the bubonic plague also has other symptoms, such as:

temperature increase;
characteristic signs of intoxication: nausea, vomiting, diarrhea, etc.;
an increase in the size of the lymph nodes (at first a few, then the disease affects the rest);
headaches similar to meningitis.

After a couple of days, the lymph nodes greatly increase in size, stop functioning, lose mobility, and pain occurs when you touch them.

Spoiler with a shock photo of the bubonic plague, 10 days after infection.

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After another 4-5 days, the lymph nodes become soft and filled with fluid. When touched, you can feel its vibrations. On the 10th day, the nodes are opened and non-healing fistulas are formed.

In the photo on the right, all these manifestations are visible, click on the photo to enlarge.

Bubonic plague often occurs in combination with meningitis. The patient experiences severe headaches and cramps throughout the body.

The bubonic form is not accompanied by the development of a local reaction to the bite, unlike cutaneous bubonic plague. In the second case, the microbe penetrates the skin and then enters the lymph nodes through the lymph flow.

Primary septic form and secondary septic form

Penetration of the pathogen into the blood is accompanied by the occurrence of generalized forms of the disease. There are primary septic forms and secondary septic forms.

Primary septic form of bubonic plague develops in cases where the infection enters the blood without affecting the lymph nodes. Signs of intoxication are observed almost immediately. Since the infection instantly spreads throughout the body, many foci of inflammation arise throughout the body. Disseminated intravascular coagulation syndrome develops, accompanied by damage to all organs. A patient with bubonic plague dies due to infectious-toxic shock.

Secondary septic form of plague accompanied by the development of infectious sepsis.

Complications. Bubonic plague can be complicated by pneumonia. In such cases, it becomes a pulmonary form.

Pulmonary form of bubonic plague manifests itself as fever, severe headaches, pneumonia, chest pain, cough and expectoration of blood. Infection occurs by airborne droplets, but can develop as a secondary form from bubonic or septic. The disease quickly spreads throughout the body, but modern antibacterial drugs can cope with it quite successfully. Unfortunately, even intensive treatment cannot guarantee the exclusion of death.

With septic form of plague signs of the disease include fever, chills, abdominal pain, and internal hemorrhages. Massive tissue necrosis is observed, most often the tissues on the fingers of the extremities die. Buboes do not form in this form, but disorders of the nervous system occur almost immediately. In the absence of treatment, death is almost guaranteed, but with adequate therapy the likelihood of recovery is also high.

Treatment of bubonic plague

Spoiler with a shock photo of the process of necrotization of the hand during bubonic plague.

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In the Middle Ages, none effective methods During the bubonic plague, doctors could not offer treatment. Firstly, this was due to the practically non-developing medicine, since religion occupied the main place, and science was not supported. Secondly, most doctors were simply afraid to contact the infected, so as not to die themselves.

Nevertheless, attempts to treat the plague were made, although they did not produce any results. For example, buboes were opened and cauterized. Since the plague was considered as a poisoning of the entire body, there were attempts to use antidotes. Frogs and lizards were applied to the affected areas. Of course, such methods could not help.

The cities were enslaved by panic. An interesting example of how the disease was somewhat contained is the administrative measures taken in Venice. A special sanitary commission was organized there. All ships that arrived were subjected to special inspection and, if corpses or infected people were found, they were burned. Goods and travelers were quarantined for 40 days. The corpses of the dead were immediately collected and buried in a separate lagoon at a depth of at least 1.5 meters.

The plague still exists today

Don't think that this disease is only left in the history books. Bubonic plague in Altai was recorded last year (2016), and in general about 3,000 cases of infection are recorded per year. There was no epidemic in the Altai Territory, but all measures were taken to prevent the spread of infection, and people who had contact with the infected person were quarantined.

Chief and modern method Treatment of bubonic plague in our time is the use of antibiotics. Medicines are administered intramuscularly, as well as into the buboes themselves. As a rule, tetracycline and streptomycin are used for treatment.

Important! Patients with bubonic plague infected with the bacterium Yersinia Pestis are subject to mandatory hospitalization, and they are placed in special departments. All personal items and clothing are subject to disinfection. Contact with a plague-infected patient requires compliance with safety measures by medical personnel - the use of protective suits is mandatory.

Mandatory symptomatic treatment manifestations of plague, manifestations of buboes on the human body, the purpose of which is to alleviate the patient’s condition and eliminate complications.

To confirm recovery, a bacterial culture is carried out for the bacterium Yersinia Pestis, and the analysis is repeated 3 times. And even after this, the patient remains in the hospital for another month. After discharge, he must be monitored by an infectious disease specialist for 3 months.

On video: 10 interesting facts about the plague, from Dameoz

In the video, the Live Healthy program will talk about the bubonic plague, infection with the plague bacterium Yersinia Pestis and treatment:

Plague is a potentially serious infectious disease caused by the plague bacillus, pathogenic for humans and animals. Before the invention of antibiotics, disease was very high level mortality in Medieval Europe irrevocably changed the social and economic structure of society.

Great pandemics

The plague has left an indelible dark mark on the history of mankind, and it is not without reason that many peoples associate it with death. Even a brief summary of the misfortunes suffered can take several volumes, but the history goes back thousands of years.

Ancient sources indicate that the disease was known in North Africa and the Middle East. It is assumed that this is what is described in the biblical book of Kings as a pestilence. But indisputable proof of its early existence is the DNA analysis of Bronze Age people, confirming the presence of the plague bacillus in Asia and Europe between 3 thousand and 800 BC. Unfortunately, the nature of these outbreaks cannot be verified.

During the time of Justinian

The first reliably confirmed pandemic occurred during the reign of the Byzantine Emperor Justinian in the 6th century AD.

According to historian Procopius and other sources, the outbreak began in Egypt and moved along maritime trade routes, striking Constantinople in 542. There, the disease claimed tens of thousands of lives in a short period of time, and the death rate grew so quickly that the authorities had problems getting rid of the corpses.

Judging by the descriptions of the symptoms and modes of transmission of the disease, it is likely that all forms of plague were raging in Constantinople at the same time. Over the next 50 years, the pandemic spread west to Mediterranean port cities and east to Persia. Christian authors, for example, John of Ephesus, considered the cause of the epidemic to be the wrath of God, and modern researchers are confident that it was caused by rats (constant passengers on sea ships) and the unsanitary living conditions of that era.

Black Death of Europe

The next pandemic hit Europe in the 14th century and was even more terrible than the previous one. The death toll reached, according to various sources, from 2/3 to ¾ of the population in the affected countries. There is evidence that During the rampant Black Death, about 25 million people died, although determining the exact amount is currently impossible. The plague, like last time, was brought by merchants on ships. Researchers suggest that the disease came to the southern ports of what is now France and Italy from the Genoese colonies of Crimea, spreading from Central Asia.

The consequences of this catastrophe not only left an imprint on the religious and mystical characteristics of the Europeans’ worldview, but also led to a change in the socio-economic formation.

The peasants who made up the main workforce became critically small. To maintain the same standard of living, it was necessary to increase labor productivity and change the technological structure. This need gave impetus to the development of capitalist relations in feudal society.

Great Plague of London

Over the next three centuries, small outbreaks of the disease were observed across the continent from the British Isles to Russia. Another epidemic broke out in London in 1664-1666. The number of deaths is expected to be between 75 and 100 thousand people. The plague spread rapidly:

in 1666-1670 - in Cologne and throughout the Rhine Valley;
in 1667-1669 - in the Netherlands;
in 1675−1684 - in Poland, Hungary, Austria, Germany, Turkey and North Africa;

Briefly about the losses: in Malta - 11 thousand people died, in Vienna - 76 thousand, in Prague - 83 thousand. By the end of the 17th century, the epidemic began to gradually subside. The last outbreak was in the port city of Marseille in 1720, where it killed 40,000 people. After this, the disease was not recorded in Europe (with the exception of the Caucasus).

The decline of the pandemic can be explained by progress in sanitation and the use of quarantine measures, the fight against rats as carriers of the plague, and the abandonment of old trade routes. During the outbreaks in Europe, the causes of the disease were not well understood from a medical point of view. In 1768, the first edition of the Encyclopedia Britannica published the scientific opinion widespread among contemporaries about the emergence of plague fever from “poisonous miasma” or vapors brought from eastern countries with the air.

The best treatment was considered to be expulsion of the "poison", which was achieved either by natural rupture of the tumors or, if necessary, by incising and draining them. Other recommended remedies were:

bloodletting;
vomit;
sweating;
purgation.

During the 18th and early 19th centuries. the plague was recorded in the countries of the Middle East and North Africa, and in 1815−1836. appears in India. But these were only the first sparks of a new pandemic.

Latest in modern times

Having crossed the Himalayas and gained momentum in the Chinese province of Yunnan, in 1894 the plague reached Guangzhou and Hong Kong. These port cities became distribution centers for the new epidemic, which by 1922 was being imported by shipping throughout the world, more widely than in any previous era. As a result, about 10 million people died, from the most different cities and countries:

Almost all European ports were hit, but of the affected regions, India found itself in the worst situation. Only towards the end of the 19th century did the germ theory develop, and it was finally established which pathogen was responsible for so many deaths. All that remains is to determine how the bacillus infects humans. It has long been observed that in many epidemic areas unusual deaths of rats precede outbreaks of plague. The disease appeared in people some time later.

In 1897, the Japanese doctor Ogata Masanori, examining the outbreak of the disease on the island of Farmosa, proved that the plague bacillus was carried by rats. The following year, the Frenchman Paul-Louis Simon demonstrated the results of experiments that showed that fleas of the species Xenopsylla cheopis were carriers of plague in the rat population. This is how the routes of human infection were finally described.

Since then, measures have been taken around the world to exterminate rats in ports and on sea vessels, and insecticides are used to bait rodents in areas of outbreaks. Since the 1930s, doctors have used sulfur-containing drugs to treat the population, and later antibiotics. The effectiveness of the measures taken is evidenced by the reduction in the number of deaths over the next decades.

Particularly dangerous infection

Plague is one of the deadliest diseases in human history. The human body is extremely susceptible to the disease, infection can occur both directly and indirectly. A defeated plague may emerge after decades of silence with even greater epidemic potential and significantly affect the population of entire regions. Due to its easy spread, it, along with botulism, smallpox, tularemia and viral hemorrhagic fevers(Ebola and Marburg) are included in group A of bioterrorism threats.

Methods of infection

The causative agent of plague is Y. Pestis, nonmotile rod-shaped anaerobic bacterium with bipolar staining, capable of producing antiphagocytic mucosa. Closest relatives:

The resistance of the plague pathogen to the external environment is low. Drying, sunlight, competition with putrefactive microbes kill it. Boiling a stick in water for a minute leads to its death. But it is able to survive on wet linen, clothes with sputum, pus and blood, and is stored for a long time in water and food.

IN wildlife and rural areas, most of the spread of Y. pestis is due to transmission between rodents and fleas. In cities, the main carriers are synanthropic rodents, primarily gray and brown rats.

The plague bacterium easily migrates from the urban environment to nature and back. It is usually transmitted to humans through the bites of infected fleas. But there is also information about more than 200 species of mammals (including dogs and cats) that can be carriers of the stick. Half of them are rodents and lagomorphs.

That's why The main rules of conduct in areas at risk of a disease outbreak will be:

avoiding contact with wild animals;
Be careful when feeding rodents and rabbits.

Pathogenesis and forms of the disease

The plague bacillus is characterized by a surprisingly stable and strong ability to multiply in the tissues of the host and lead to his death. After entering the human body, Y. pestis migrates along lymphatic system to the lymph nodes. There the bacillus begins to produce proteins that disrupt the functioning of inflammatory reactions, blocking the fight of macrophages against infection.

Thus, the host's immune response is weakened, bacteria quickly colonize the lymph nodes, causing painful swelling, and eventually destroying the affected tissue. Sometimes they enter the bloodstream, leading to blood poisoning. During pathological and anatomical studies, their accumulations are found in the following organs:

in the lymph nodes;
spleen;
in the bone marrow;
liver.

The disease in humans has three clinical forms: bubonic, pulmonary and septic. Pandemics are most often caused by the first two. Bubonic without treatment turns into septic or pulmonary. Clinical manifestations for these three types look like this:

Treatment and prognosis

Whenever a diagnosis of plague is suspected on clinical and epidemiological grounds, appropriate specimens for diagnosis should be obtained immediately. Antibacterial therapy is prescribed without waiting for a response from the laboratory. Suspicious patients with signs of pneumonia are isolated and treated with airborne precautions. The most applicable schemes:

Other classes of antibiotics (penicillins, cephalosporins, macrolides) have had varying success in treating this disease. Their use is ineffective and questionable. During therapy, it is necessary to provide for the possibility of complications such as sepsis. With absence medical care The forecasts are not encouraging:

pulmonary form - mortality 100%;
bubonic - from 50 to 60%;
septic - 100%.

Medicines for children and pregnant women

With proper and early treatment, complications of plague during pregnancy can be prevented. In this case the choice of antibiotics is based on analysis side effects the most effective drugs:

Experience has shown that a properly prescribed aminoglycoside is the most effective and safe for both the mother and the fetus. It is also recommended for use in the treatment of children. Due to the relative safety, the possibility of intravenous and intramuscular injection Gentamicin is the antibiotic of choice for treating children and pregnant women.

Preventive therapy

Persons who are in personal contact with persons with pneumonia, or persons who are likely to have been exposed to fleas infected with Y. pestis, have had direct contact with body fluids or tissues of an infected mammal, or have been exposed during laboratory testing of infectious materials, should undergo antibacterial preventive therapy in case the contact took place in the previous 6 days. Preferred antimicrobial agents for this purpose are tetracycline, chloramphenicol or one of the effective sulfonamides.

Administration of an antibiotic before infection may be indicated in cases where people must remain in plague-prone areas for short periods. This also applies to being in an environment where infection is difficult or impossible to prevent.

Precautionary measures for hospitals include a quarantine regime for all cases of plague. These include:

In addition, a patient with suspected pneumonic plague infection should be kept in a separate room and treated with precautions regarding the possibility of airborne infection of personnel. In addition to those listed, they include restricting the patient’s movement outside the room, as well as mandatory wearing of a mask in the presence of other persons.

Possibility of vaccination

Live attenuated and formalin-killed Y. pestis vaccines are available for use in different ways around the world. They are distinguished by their immunogenic and moderately high reactivity. It is important to know that they do not protect against primary pneumonia. In general, it is not possible to vaccinate communities against epizootic impacts.

Additionally, this measure is little used during human plague outbreaks because it takes a month or more for a protective immune response to develop. The vaccine is indicated for people in direct contact with the bacterium. These may be employees of research laboratories or people studying infected animal colonies.

Distemper of carnivores

This disease (Pestis carnivorum) is known among domestic dogs as distemper and is not related to Y. pestis. It is manifested by damage to the central nervous system, inflammation of the mucous membranes of the eyes and respiratory tract. Unlike human plague, it is viral in nature.

Currently, canine plague is recorded among domestic, wild and industrially bred animals in all countries of the world. Economic damage is expressed in losses from culling and slaughter, a decrease in the volume and quality of fur, the cost of carrying out preventive measures, and disruption of the technological process of growing.

The disease is caused by an RNA virus 115−160 nm in size from the Paramyxoviridae family. Dogs, foxes, arctic foxes, Ussuri raccoons, otters, jackals, hyenas and wolves are susceptible to it. For different types In animals, the pathogenicity of the virus varies - from a latent asymptomatic course of the disease to an acute one with 100% mortality. Ferrets are the most sensitive to it. The canine distemper virus is very virulent, but does not pose a danger to humans.

Currently, the plague is a disease whose symptoms are well studied. Its foci remain in the wild and are preserved in permanent habitats of rodents. Modern statistics are as follows: throughout the world in one year, approximately 3 thousand people come into contact with this disease and about 200 of them die. Most cases occur in Central Asia and Africa.

Who lived during the time of Emperor Trajan, referring to more ancient doctors (whose names have not reached us), described several cases of the disease definitely with bubonic plague in Libya, Syria and Egypt.

The Philistines did not calm down and for the third time transported the trophy of war, and with it the plague, to the city of Askralon. All the Philistine rulers later gathered there - the kings of the five cities of Philistia - and they decided to return the ark to the Israelites, because they realized that this was the only way to prevent the spread of the disease. And chapter 5 ends with a description of the atmosphere that reigned in the doomed city. “And those who did not die were smitten with growths, so that the cry of the city went up to heaven” (1 Sam.). Chapter 6 depicts the council of all the rulers of the Philistines, to which priests and soothsayers were called. They advised to bring a trespass offering to God - to put gifts in the ark before returning it to the Israelites. “According to the number of the rulers of the Philistines, there are five golden growths and five golden mice that devastate the land; for the execution is one for all of you and for those who rule you” (1 Sam.). This biblical legend is interesting in many respects: it contains a hidden message about an epidemic that most likely swept through all five cities of Philistia. We could be talking about the bubonic plague, which affected people young and old and was accompanied by the appearance of painful growths in the groin - buboes. The most remarkable thing is that the Philistine priests apparently associated this disease with the presence of rodents: hence the golden sculptures of mice “ravaging the earth.”

There is another passage in the Bible that is considered to be a record of another instance of the plague. The Fourth Book of Kings (2 Kings) tells the story of the campaign of the Assyrian king Sennacherib, who decided to devastate Jerusalem. A huge army surrounded the city, but did not take control of it. And soon Sennacherib withdrew without a fight with the remnants of the army, in which the “Angel of the Lord” struck 185 thousand soldiers overnight (2 Kings).

Plague epidemics in historical times

The middle of the 17th century was marked by several major epidemics. In Russia, about 700 thousand people became victims of the epidemic of 1654-1655. The Great London Epidemic of 1664-1665 killed almost a quarter of the city's population.

Plague as a biological weapon

The use of the plague agent as a biological weapon has deep historical roots. In particular, events in ancient China and medieval Europe showed the use of corpses of infected animals (horses and cows), human bodies Huns, Turks and Mongols to contaminate water sources and water supply systems. There are historical reports of cases of ejection of infected material during the siege of some cities (Siege of Kaffa).

Current state

Every year the number of people sick with the plague is about 2.5 thousand people, with no downward trend [ ] .

According to available data, according to the World Health Organization, from 1989 to 2004, about forty thousand cases were recorded in 24 countries, with a mortality rate of about 7% of the number of cases. In a number of countries in Asia (Kazakhstan, China, Mongolia and Vietnam), Africa (Congo, Tanzania and Madagascar), and the Western Hemisphere (USA, Peru), cases of human infection are recorded almost every year.

At the same time, in Russia, over 20 thousand people are at risk of infection every year on the territory of natural foci (with a total area of more than 253 thousand km²). For Russia, the situation is complicated by the annual identification of new cases in states neighboring Russia (Kazakhstan, Mongolia, China), and the importation of a specific carrier of the plague - fleas - through transport and trade flows from the countries of Southeast Asia. Xenopsylla cheopis .

From 2001 to 2006, 752 strains of the plague pathogen were recorded in Russia. IN this moment the most active natural foci are located in the territories Astrakhan region, Kabardino-Balkarian and Karachay-Cherkess republics, republics of Altai, Dagestan, Kalmykia, Tyva. Of particular concern is the lack of systematic monitoring of the activity of outbreaks located in the Ingush and Chechen Republics.

In July 2016, in Russia, a ten-year-old boy with bubonic plague was taken to the hospital in the Kosh-Agach district of the Altai Republic.

In 2001-2003, 7 cases of plague were registered in the Republic of Kazakhstan (with one death), in Mongolia - 23 (3 deaths), in China in 2001-2002, 109 people fell ill (9 deaths). The forecast for the epizootic and epidemic situation in the natural foci of the Republic of Kazakhstan, China and Mongolia adjacent to the Russian Federation remains unfavorable.

At the end of August 2014, an outbreak of plague occurred again in Madagascar, which by the end of November 2014 had claimed 40 lives out of 119 cases.

A new outbreak of plague occurred in Madagascar in the fall of 2017: as of early November, more than 2 thousand cases of plague and 165 deaths were reported.

Forecast

Under modern therapy, mortality in the bubonic form does not exceed 5-10%, but in other forms the recovery rate is quite high if treatment is started early. In some cases, a transient septic form of the disease is possible, which is poorly amenable to intravital diagnosis and treatment (“fulminant form of plague”).

Infection

The causative agent of plague is resistant to low temperatures, preserves well in sputum, but at a temperature of +55 °C it dies within 10-15 minutes, and when boiled, almost instantly. The gateway of infection is damaged skin (with a flea bite, as a rule, Xenopsylla cheopis), mucous membranes of the respiratory tract, digestive tract, conjunctiva.

Based on the main carrier, natural plague foci are divided into ground squirrels, marmots, gerbils, voles and pikas. In addition to wild rodents, the epizootic process sometimes includes so-called synanthropic rodents (in particular, rats and mice), as well as some wild animals (hares, foxes) that are the object of hunting. Among domestic animals, camels suffer from the plague.

In a natural outbreak, infection usually occurs through the bite of a flea that previously fed on a sick rodent. The likelihood of infection increases significantly when synanthropic rodents are included in the epizootic. Infection also occurs during hunting of rodents and their further processing. Mass diseases people arise when a sick camel is slaughtered, skinned, butchered, or processed. An infected person, in turn, is a potential source of plague, from which the pathogen can be transmitted to another person or animal, depending on the form of the disease, by airborne droplets, contact or transmission.

Fleas are a specific carrier of the plague pathogen. This is due to the characteristics of the device digestive system fleas: just before the stomach, the flea's esophagus forms a thickening - a goiter. When an infected animal (rat) is bitten, the plague bacterium settles in the flea’s crop and begins to multiply intensively, completely clogging it (the so-called “plague block”). Blood cannot enter the stomach, so the flea regurgitates the blood along with the pathogen back into the wound. And since such a flea is constantly tormented by a feeling of hunger, it moves from owner to owner in the hope of getting its share of blood and manages to infect a large number of people before dying (such fleas live no more than ten days, but experiments on rodents have shown that one flea can infect up to 11 hosts).

When a person is bitten by fleas infected with plague bacteria, a papule or pustule filled with hemorrhagic contents (skin form) may appear at the site of the bite. The process then spreads through the lymphatic vessels without the appearance of lymphangitis. The proliferation of bacteria in macrophages of the lymph nodes leads to their sharp increase, fusion and formation of a conglomerate (“bubo”). Further generalization of the infection, which is not strictly necessary, especially in modern conditions antibacterial therapy, can lead to the development of a septic form, accompanied by damage to almost all internal organs. From an epidemiological point of view, it is important that plague bacteremia develops, as a result of which a sick person himself becomes a source of infection through contact or transmission. However, the most important role is played by the “screening out” of infection in lung tissue with the development of the pulmonary form of the disease. From the moment plague pneumonia develops, the pulmonary form of the disease is already transmitted from person to person by airborne droplets - extremely dangerous, with a very rapid course.

Symptoms

The bubonic form of plague is characterized by the appearance of sharply painful conglomerates, most often in the inguinal lymph nodes on one side. The incubation period is 2-6 days (less often 1-12 days). Over the course of several days, the size of the conglomerate increases, and the skin over it may become hyperemic. At the same time, an increase in other groups of lymph nodes appears - secondary buboes. The lymph nodes of the primary lesion undergo softening, and when punctured, purulent or hemorrhagic contents are obtained, microscopic analysis which reveals a large number of gram-negative rods with bipolar staining. In the absence of antibacterial therapy, festering lymph nodes are opened. Then gradual healing of the fistula occurs. The severity of the patients' condition gradually increases by the 4-5th day, the temperature may be elevated, sometimes a high fever immediately appears, but at first the condition of the patients often remains generally satisfactory. This explains the fact that a person sick with bubonic plague can fly from one part of the world to another, considering himself healthy.

However, at any time, the bubonic form of plague can cause generalization of the process and turn into a secondary septic or secondary pulmonary form. In these cases, the condition of the patients very quickly becomes extremely serious. Symptoms of intoxication increase by the hour. The temperature after severe chills rises to high febrile levels. All signs of sepsis are noted: muscle pain, severe weakness, headache, dizziness, congestion of consciousness, up to its loss, sometimes agitation (the patient tosses around in bed), insomnia. With the development of pneumonia, cyanosis increases, a cough appears with the release of foamy, bloody sputum containing great amount plague sticks. It is this sputum that becomes the source of infection from person to person with the development of the now primary pneumonic plague.

Septic and pneumonic forms of plague occur, like any severe sepsis, with manifestations of disseminated intravascular coagulation syndrome: minor hemorrhages may appear on the skin, bleeding from the gastrointestinal tract is possible (vomiting of bloody masses, melena), severe tachycardia, rapid and requiring correction ( dopamine) drop in blood pressure. Auscultation reveals a picture of bilateral focal pneumonia.

Clinical picture

Clinical picture primary septic or primary pulmonary form is not fundamentally different from secondary forms, but primary forms often have a shorter incubation period - up to several hours.

Diagnosis

The most important role in diagnosis in modern conditions is played by epidemiological anamnesis. Arrival from zones endemic for plague (Vietnam, Burma, Bolivia, Ecuador, Karakalpakstan, etc.), or from anti-plague stations of a patient with the signs of the bubonic form described above or with signs of the most severe - with hemorrhages and bloody sputum - pneumonia with severe lymphadenopathy is for doctor of first contact is a sufficiently serious argument for taking all measures to localize the suspected plague and accurately diagnose it. It should be especially emphasized that in the conditions of modern drug prevention the likelihood of illness among personnel who have been in contact with a coughing plague patient for some time is very low. Currently, cases of primary pneumonic plague (that is, cases of infection from person to person) among medical personnel not visible. An accurate diagnosis must be made using bacteriological studies. The material for them is the punctate of a suppurating lymph node, sputum, the patient’s blood, discharge from fistulas and ulcers.

Laboratory diagnosis is carried out using a fluorescent specific antiserum, which is used to stain smears of discharge from ulcers, punctate lymph nodes, and cultures obtained on blood agar.

Treatment

In the Middle Ages, the plague was practically not treated; actions were reduced mainly to cutting out or cauterizing the plague buboes. No one knew the real cause of the disease, so there was no idea how to treat it. Doctors tried to use the most bizarre means. One such drug included a mixture of 10-year-old molasses, finely chopped snakes, wine and 60 other ingredients. According to another method, the patient had to take turns sleeping on his left side, then on his right. Since the 13th century, attempts have been made to limit the plague epidemic through quarantines.

A turning point in plague treatment was reached in 1947, when Soviet doctors were the first in the world to use streptomycin to treat plague in Manchuria. As a result, all patients who were treated with streptomycin recovered, including a patient with pneumonic plague, who was already considered hopeless.

Treatment of plague patients is currently carried out using antibiotics, sulfonamides and medicinal anti-plague serum. Prevention of possible outbreaks of the disease consists of carrying out special quarantine measures in port cities, deratization of all ships that sail on international flights, creating special anti-plague institutions in steppe areas where rodents are found, identifying plague epizootics among rodents and combating them.

Anti-plague sanitary measures in Russia

If plague is suspected, the sanitary and epidemiological station of the area is immediately notified. The doctor who suspects an infection fills out the notification and ensures its forwarding chief physician institutions where such a patient was found.

The patient should be immediately hospitalized in the infectious diseases hospital. Doctor or paramedical worker medical institution If a patient is detected or suspected of having the plague, he is obliged to stop further admission of patients and prohibit entry and exit from the medical institution. While remaining in the office or ward, the medical worker must inform the chief physician in a way accessible to him about the identification of the patient and demand anti-plague suits and disinfectants.

In cases of receiving a patient with lung damage, before putting on a full anti-plague suit, the medical worker is obliged to treat the mucous membranes of the eyes, mouth and nose with streptomycin solution. If there is no cough, you can limit yourself to treating your hands with a disinfectant solution. After taking measures to separate the sick person from the healthy, a list of persons who had contact with the patient is compiled in a medical institution or at home, indicating the last name, first name, patronymic, age, place of work, profession, home address.

Until the consultant from the anti-plague institution arrives, the health worker remains in the outbreak. The issue of its isolation is decided in each specific case individually. The consultant takes the material for bacteriological research, after which you can start specific treatment patient on antibiotics.

When identifying a patient on a train, plane, ship, airport, or railway station, the actions of medical workers remain the same, although the organizational measures will be different. It is important to emphasize that isolation of a suspicious patient from others should begin immediately after identification.

The head doctor of the institution, having received a message about the identification of a patient suspected of plague, takes measures to stop communication between the hospital departments and clinic floors, and prohibits leaving the building where the patient was found. At the same time, organizes the transmission of emergency messages to a higher organization and the anti-plague institution. The form of information can be arbitrary with the obligatory presentation of the following data: last name, first name, patronymic, age of the patient, place of residence, profession and place of work, date of detection, time of onset of the disease, objective data, preliminary diagnosis, primary measures taken to localize the outbreak, position and the name of the doctor who diagnosed the patient. Along with the information, the manager requests consultants and the necessary assistance.

However, in some situations it may be more appropriate to carry out hospitalization (before establishing accurate diagnosis) in the institution where the patient is at the time of the assumption that he has plague. Therapeutic measures are inseparable from the prevention of infection of personnel, who must immediately put on 3-layer gauze masks, shoe covers, a scarf made of 2 layers of gauze that completely covers the hair, and protective glasses to prevent splashes of sputum from entering the mucous membrane of the eyes. According to the Russian Federation rules, personnel must wear an anti-plague suit or use anti-infective protection with similar properties special means. All personnel who had contact with the patient remain to provide further assistance to him. A special medical post isolates the compartment where the patient and the personnel treating him are located from contact with other people. The isolated compartment must include a toilet and treatment room. All personnel immediately receive prophylactic antibiotic treatment, continuing throughout the days they spend in isolation.

Treatment of plague is complex and includes the use of etiotropic, pathogenetic and symptomatic agents. Antibiotics of the streptomycin series are most effective for treating plague: streptomycin, dihydrostreptomycin, pasomycin. In this case, streptomycin is most widely used. For the bubonic form of plague, the patient is administered streptomycin intramuscularly 3-4 times a day (daily dose 3 g), tetracycline antibiotics (vibromycin, morphocycline) intramuscularly at 4 g/day. In case of intoxication, saline solutions and hemodez are administered intravenously. A drop in blood pressure in the bubonic form should in itself be regarded as a sign of generalization of the process, a sign of sepsis; in this case there is a need to carry out resuscitation measures, administration of dopamine, installation of a permanent catheter. For pneumonic and septic forms of plague, the dose of streptomycin is increased to 4-5 g/day, and tetracycline - to 6 g. For forms resistant to streptomycin, chloramphenicol succinate can be administered up to 6-8 g intravenously. When the condition improves, the dose of antibiotics is reduced: streptomycin - up to 2 g / day until the temperature normalizes, but for at least 3 days, tetracyclines - up to 2 g / day daily orally, chloramphenicol - up to 3 g / day, for a total of 20-25 g. Biseptol is also used with great success in the treatment of plague.

In case of pulmonary, septic form, development of hemorrhage, they immediately begin to relieve disseminated intravascular coagulation syndrome: plasmapheresis is performed (intermittent plasmapheresis in plastic bags can be carried out in any centrifuge with special or air cooling with a capacity of 0.5 l or more) in the volume removed plasma 1-1.5 liters when replaced with the same amount of fresh frozen plasma. In the presence of hemorrhagic syndrome, daily administration of fresh frozen plasma should not be less than 2 liters. Until the acute manifestations of sepsis are relieved, plasmapheresis is performed daily. The disappearance of signs of hemorrhagic syndrome and stabilization of blood pressure, usually in sepsis, are grounds for stopping plasmapheresis sessions. At the same time, the effect of plasmapheresis in the acute period of the disease is observed almost immediately, signs of intoxication decrease, the need for dopamine to stabilize blood pressure decreases, muscle pain subsides, and shortness of breath decreases.

In a team of medical personnel providing treatment to a patient with pulmonary or septic form plague, there must be an intensive care specialist.

Notes

Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
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Plague - Medical encyclopedia
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Plague — For doctors, students, patients medical portal, abstracts, cheat sheets for doctors, disease treatment, diagnosis, prevention
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Drancourt M. et al. Detection of 400-year-old Yersinia pestis DNA in human dental pulp: An approach to the diagnosis of ancient septicemia // PNAS. - 1998. - Vol. 95, No. 21. - P. 12637-12640.
Papagrigorakis, Manolis J.; Yapijakis, Christos; Synodinos, Philippos N.; Baziotopoulou-Valavani, Effie (2006). “DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens” . International Journal of Infectious Diseases. 10 (3): 206-214. DOI:10.1016/j.ijid.2005.09.001. PMID.
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Europe's Plagues Came From China, Study Finds (English) . // The New York Times, 10/31/2010
B. Bayer, W. Birstein and others. History of mankind 2002 ISBN 5-17-012785-5
Anisimov E.V. 1346–1354 “Black Death” in Europe and Rus'// Chronology of Russian history. Russia and the world.
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WHO: Plague in the Democratic Republic of the Congo (Russian). Archived from the original on August 2, 2012.
Letter of the Ministry of Health of the Russian Federation dated April 22, 2004 N 2510/3173-04-27 “On the Prevention of Plague”
Order of the territorial administration of Rospotrebnadzor for the Moscow Region dated 02.05.2006 N 100 “On the organization and implementation of measures for the prevention of plague in the Moscow region”
On July 13, 2016, in Altai, a ten-year-old boy fell ill with bubonic plague
A second case of death from pneumonic plague was recorded in Qinghai, People's Daily (August 3, 2009).
China fears an epidemic of pneumonic plague
Plague is raging in Madagascar (undefined) . Retrieved December 13, 2013.
WHO reported the threat of rapid spread of plague in Madagascar
The number of plague infections in Madagascar exceeded 2 thousand, Rosbalt. Retrieved November 12, 2017.
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Literature

Anisimov P.I. et al. Plague: bibliography of Russian literature. 1740-1964 / P. I. Anisimov, T. I. Anisimova, Z. A. Koneva; ed. T. I. Anisimova. - Saratov: Publishing house Sarat. University, 1968. - 420 p.
Diamond D. M.“Guns, Germs, and Steel: The Fates of Human Societies” = Guns, Germs, and Steel: The Fates of Human Societies / Trans. from English M. V. Kolopotin. - M.: AST Moscow: Corpus, 2010. - 720 p. - 3000 copies. -

The plague has deep historical roots. Humanity first encountered the disease in the 14th century. The epidemic, which was dubbed the “Black Death,” claimed more than 50 million human lives, which was equal to a quarter of the population of medieval Europe. The mortality rate was about 99%.

Facts about the disease:

Plague affects lymph nodes, lungs, etc. internal organs. As a result of infection, sepsis develops. The general condition of the body is extremely difficult. The body is subjected to constant attacks of fever.
The period of development of plague after infection is on average about three days, depending on the general condition of the body.
Currently, mortality from of this disease constitutes no more than 10% of all detected cases.
There are about 2 thousand cases of the disease per year. According to WHO, in 2013, 783 cases of infection were officially registered, of which 126 cases resulted in death.
Outbreaks of the disease mainly affect African countries and a number of countries in South America. Endemic countries are the Democratic Republic of Congo, the island of Madagascar and Peru.

In the Russian Federation the last famous case plague cases were documented in 1979. Every year, more than 20 thousand people are at risk, being in the zone of natural foci of infection with a total area of more than 250 thousand km2.

CAUSES

The main cause of plague is flea bites. This factor due to the specific structure of the digestive system of these insects. After a flea bites an infected rodent, the plague bacterium settles in its crop and blocks the passage of blood to the stomach. As a result, the insect experiences a constant feeling of hunger and, before its death, manages to bite, thereby infecting up to 10 hosts, regurgitating the blood it drinks along with plague bacteria into the bite.

After a bite, the bacteria enters the nearest lymph node, where it actively multiplies and, without antibacterial treatment, affects the entire body.

Causes of infection:

bites of small rodents;
contact with infected domestic animals, stray dogs;
direct contact with an infected person;
cutting up carcasses of animals affected by disease;
treatment of the skin of killed animals that carry the disease;
contact of bacteria with the human mucosa during autopsy of corpses of those who died from the plague;
eating meat from infected animals;
entry of particles of saliva of an infected person into the oral cavity of a healthy person by airborne droplets;
military conflicts and terrorist attacks using bacteriological weapons.

The plague bacterium is highly resistant to low temperatures, multiplies vigorously in a humid environment, but does not tolerate high temperatures (above 60 degrees), and dies almost instantly in boiling water.

CLASSIFICATION

Varieties of plague are divided into two main types.

Localized type- the disease develops after plague microbes get under the skin:
- Skin plague. There is no primary protective reaction, only in 3% of cases redness of the affected areas of the skin with induration occurs. No visible external signs the disease progresses, eventually forming a carbuncle, then an ulcer, which scars as it heals.
- Bubonic plague . The most common form of the disease. It affects the lymph nodes, forming “buboes”. Characterized by painful inflammatory processes in them. Affects the groin area and armpits. Accompanied by severe fever and general intoxication of the body.
- Bubonic skin plague. Plague bacteria travel with the lymph, end up in the lymph nodes, causing inflammatory process affecting adjacent tissues. The “buboes” mature, and the rate of development of the pathology decreases.
Generalized type- the pathogen enters the body by airborne droplets, as well as through the membranes of the mucous surfaces of the body:
- Septicemic plague. The pathogen penetrates through the mucous membranes. The high virulence of the microbe and a weakened body are the reasons for its easy entry into the patient’s blood, bypassing all of it. defense mechanisms. A fatal outcome with this form of the disease can occur in less than 24 hours, the so-called. "lightning plague"
- Pneumonic plague. Entry into the body occurs through airborne droplets, infection through dirty hands and objects, as well as through the conjunctiva of the eyes. This form is a primary pneumonia, and also has a high epidemic threshold due to copious discharge of sputum containing pathogenic bacteria during coughing.

SYMPTOMS

The incubation period of the plague ranges from 72 to 150 hours. Most often it appears on the third day. The disease is characterized sudden manifestation without primary symptoms.

Clinical history of plague:

a sharp jump in body temperature up to 40 degrees;
acute headaches;
nausea;
reddish tint to the face and eyeballs;
muscle discomfort;
white coating on the tongue;
enlarged nostrils;
dry skin of lips;
manifestations of a rash on the body;
feeling of thirst;
insomnia;
causeless excitement;
difficulties in coordinating movements;
delusions (often of an erotic nature);
impaired digestion;
difficulty urinating;
high fever;
cough with sputum containing blood clots;
bleeding from the gastrointestinal tract;
tachycardia;
low blood pressure.

Hidden primary symptoms lead to outbreaks of disease epidemics. Thus, a potential carrier of plague can travel long distances, feeling absolutely healthy, while infecting everyone who comes into contact with the plague bacteria.

DIAGNOSTICS

Returning from travel to areas endemic for the spread of plague, with the slightest signs of the disease - urgent reason to isolate the patient. Based on the medical history, all persons who have had any contact with the potentially affected person are identified.

Diagnostics is carried out in the following ways:

bacterial culture from blood, sputum and lymph node tissue samples;
immunological diagnostics;
polymerase chain reaction;
passage on laboratory animals;
serological technique;
isolation of pure culture with subsequent identification;
laboratory diagnostics based on fluorescent antiserum.

In modern medical conditions direct transmission from the patient to the attending physician and hospital staff is practically impossible. However, everything laboratory tests are carried out in specialized premises for working with particularly dangerous infectious diseases.

TREATMENT

Since 1947 plague treatable with antibiotics group of aminoglycosides with a broad spectrum of action.

Inpatient treatment is used in isolated wards of infectious diseases departments in compliance with all safety rules when working with plague patients.

Course of therapy:

The use of antibacterial drugs based on sulfamethoxazole and trimethoprim.
Intravenous administration of chloramphenicol simultaneously with streptomycin.
Detoxification procedures.
Improving microcirculation and repair. Achieved by entering .
Taking cardiac glycosides.
Use of respiratory analeptics.
Use of antipyretics.

Treatment is most effective and does not cause any consequences in the initial stages of plague.

COMPLICATIONS

Because the disease is included in the group of fatal, the main complications in case of an incorrect diagnosis or lack of proper treatment may be the transformation of plague from light form to heavier ones. Thus, cutaneous plague can develop into septicemic plague, and bubonic plague into pneumonic plague.

Complications from plague also affect:

Cardiovascular system (pericarditis develops).
Central nervous system(purulent meningoencephalitis).

Although a patient who has recovered from the plague receives immunity, he is not completely immune from new cases of infection, especially if preventive measures are taken carelessly.

PREVENTION

At the state level, a whole range of directive preventive measures for the plague has been developed.

The following decrees and rules are in effect on the territory of the Russian Federation:

“Instructional and methodological guidelines for the diagnosis, treatment and prevention of plague”, approved by the USSR Ministry of Health on September 14, 1976.
Sanitary and epidemiological rules SP 3.1.7.1380-03 dated 06.06.2003, approved by the Resolution of the Chief State Sanitary Doctor in the part “Prevention of plague”.

Set of measures:

epidemiological surveillance of natural foci of disease;
disinsection, reducing the number of potential disease carriers;
a set of quarantine measures;
training and preparing the population to respond to outbreaks of plague;
careful handling of animal corpses;
vaccination of medical staff;
use of anti-plague suits.

PROGNOSIS FOR RECOVERY

Death rate from plague modern stage therapy use is about 10%. If treatment is started at a later stage or is absent altogether, the risks increase to 30-40%.

With the right choice of treatment methods restoration of the body occurs in short time , performance is fully restored.

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Plague is one of the most dangerous infectious diseases With severe course, in which the lymph nodes and internal organs are affected with the development severe sepsis. The disease is highly contagious and has a high fatality rate. In world history, three plague or “Black Death” pandemics have been described, during which more than 100 million people died. The plague causative agent was also used as a biological weapon during wars. Plague is a serious disease that spreads quickly and affects everyone it meets along the way. Today, the level of plague has decreased significantly, but the disease continues to affect people every day.

Etiology and pathogenesis of the disease

The causative agent of plague is the plague bacillus or Yersinia pestis. The bacterium is stable in the external environment and remains viable for many years in infected corpses and sputum. But it quickly dies at a temperature of 55-60° C.

The flea Xenopsylla cheopis is the main source of the plague bacillus. When a flea bites an animal suffering from plague, the pathogen enters its body and remains there. A flea bites a healthy animal or person, infecting it with plague. Rodents are carriers of these fleas. They breed and move quickly, spreading large numbers of infected fleas and infecting large numbers of people and animals.

The main mechanism of transmission of the disease is transmissible. The pathogen is also transmitted by airborne droplets, nutritional and contact routes.

In humans, the entry points for plague infection are damaged skin, mucous membranes, and the digestive tract. A person is very susceptible to the plague, so he becomes infected immediately. After the plague bacillus enters the body, a small papule with bloody contents forms at the site of the flea bite, which quickly passes. The pathogen from the bite site enters the bloodstream and then settles in the lymph nodes. In the lymph nodes, Yersinia multiplies and inflammation develops. Without treatment, the pathogen leaves the lymph nodes again in the bloodstream with the development of bacteremia and settles on other organs, which subsequently leads to severe sepsis.

Reasons for the development of plague

Reservoirs of Yersinia pestis, for example burials of plague patients, are the main reason for its development. The pathogen retains pathogenic properties for decades. Therefore, the opening of such burials is the main reason for the development of plague outbreaks today. Other causes of the disease include:

contact with animals suffering from plague;
flea and tick bites;
excavations of old burials, historical excavations;
contact with people sick with plague.

These factors significantly contribute to the rapid spread of the plague pathogen, increasing the number of cases. Therefore, it is possible to identify risk groups that are more prone to contracting the plague. This:

veterinarians;
archaeologists;
health workers;
farmers, foresters, zoo workers, field workers;
employees of scientific laboratories who work with rodents.

Such individuals often come into contact with animals that carry plague or infected fleas, as well as with people who have plague.

Doctor's advice. The main carriers of plague are rats. Try to avoid any contact with them. It is also necessary to control the presence of rats and mice in basements in residential buildings, and immediately eliminate their holes

Classification of the disease

Plague is divided into the following types depending on the extent of the pathological process:

local;
generalized;
externally disseminated.

The following forms of plague are distinguished depending on the organs affected:

bubonic;
pulmonary:
cutaneous;
intestinal;
mixed.

Sepsis is a severe complication of any form of plague. It leads to the circulation of a large number of pathogens in the blood and damage to all organs in the body. It is difficult to cure such sepsis. It often leads to death.

Clinical picture of plague and complications

The incubation period lasts 1-7 days, after which symptoms begin to appear. The disease begins abruptly, with the appearance of severe fever, chills, intoxication and general weakness. Symptoms progress quickly, adding pain in muscles and joints. Such patients are often agitated, hallucinating or delirious. As the disease progresses, people lose coordination, and excessive agitation gives way to apathy. Such patients most often cannot even get out of bed.

An important symptom of the plague is “chalk tongue.” It becomes dry, thick with a large layer white plaque. The pressure in such patients is usually low, and a decrease in the amount of urine up to its absence is also characteristic.

The clinical picture of the disease may vary depending on the form. For example, bubonic is characterized by damage to the lymph nodes. The affected lymph nodes increase significantly in volume and protrude above the skin. They are painful and hot to the touch, fused with the surrounding tissues.

Cutaneous plague is characterized by the appearance of pustules with bloody contents. Over time, the pustules open on their own and in their place appear ulcers with uneven black edges and a yellow bottom. Subsequently, the bottom becomes covered with a scab and also acquires a black color. Such ulcers appear throughout the body and take a long time to heal with the formation of scars.

With intestinal plague appear sharp pains in the stomach, which cannot be removed by anything. Vomiting and diarrhea with blood and frequent urge to defecate appear.

In the pulmonary form, patients develop a severe cough and bloody sputum. The cough is not relieved by anything, and difficulty breathing is added to it.

All forms of plague are characterized by severe fever, intoxication and a rapid increase in symptoms.

The most severe complication of plague is sepsis. It is typical for him sharp deterioration conditions, fever, chills, hemorrhagic rash all over the body. Often pulmonary or intestinal bleeding. Sepsis affects all organs, primarily the brain, heart and kidneys.

Which doctors to contact and prognosis of the disease

Patients can turn to local therapists, pulmonologists or dermatovenerologists. Or such patients cause ambulance at in serious condition. If plague is suspected, all patients will be referred to an infectious disease specialist. Plague is treated in a hospital setting in separate closed units, into which outsiders are prohibited.

Prognosis for life with correct and timely treatment favorable. Maybe full recovery at early diagnosis plague But there is a high risk of death if therapy is started late.

Important! If the first symptoms of the disease appear, consult a doctor as soon as possible. Plague is a fleeting disease that cannot be cured on your own, so your life will depend on the time you go to the hospital

Diagnosis of plague

For accurate diagnosis A detailed history of the disease is collected from the patient and a full examination is performed. Most often, such events are enough to suspect plague and isolate the patient.

To confirm the diagnosis, it is necessary to isolate the pathogen from the victim’s body. To do this, use the patient's sputum, pus from ulcers, the contents of the affected lymph nodes and blood.

To determine the pathogen in biological materials of the patient, reactions such as ELISA, PCR, and indirect hemagglutination reaction are used. The purpose of such studies is to use antibodies to detect the presence of Yersinia antigens in the human body. The presence of antibodies to the plague bacillus in the patient’s blood is also determined.

Methods of treating the disease

Patients are isolated from others. If plague is suspected, the doctor stops seeing other patients, and the hospital is closed until the diagnosis is made. The doctor, who suspects the plague, sends an emergency message to the epidemiological station. A patient with plague is transported by ambulance to an infectious diseases hospital. In the hospital they are placed in separate boxes with a separate entrance from the street, as well as a separate bathroom.

A doctor who has been in contact with a plague patient treats himself with a streptomycin solution to prevent plague. Offices are also subject to disinfection. People entering a plague patient's box wear special clothing, which they put on immediately before entering.

Disinfection of the premises where the patient lives and a detailed examination of contact injuries is also carried out.

Etiotropic treatment of plague is antibiotics. The most commonly used are Streptomycin or Tetracycline and their derivatives. Also used symptomatic therapy. Antipyretics are administered to reduce fever. To reduce the symptoms of intoxication, the patient is given droppers with saline solutions, rheosorbilact, hemodez, albumin solutions, etc. Plasmapheresis is also performed. Apply surgical treatment ulcers on the skin, apply sterile dressings. If necessary, patients are given painkillers, anti-inflammatory drugs and stop bleeding.

Prevention of plague

Today, in most countries, the plague pathogen is absent. Therefore, the main protective measure is to prevent the import of the pathogen from countries dangerous for this disease. Such measures include:

training of people who travel to epidemiological foci of plague;
specific vaccination against plague of persons who live in unfavorable areas, persons who travel to these areas;
examination of persons coming from unfavorable plague epidemic zones.

Important preventive measures also include:

isolation of plague patients;
disinfection of premises and examination of contact persons;
elimination of rat and mouse nests.

The listed measures do not provide one hundred percent protection against the plague. Therefore, it is important to protect your health by observing simple rules personal hygiene. Remember, your health is only in your hands.