What causes the plague. Bubonic plague. Plague development mechanisms

Bubonic plague is a form of plague disease. Plague is an infectious disease caused by the bacteria Yersinia pestis. This bacterium lives on small animals and fleas that exist 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 the infection with the bubonic plague occurs, how it proceeds incubation period and the symptoms of plague infection, antibiotic treatment and prevention of this most dangerous disease today. Let's see what the causative agent of the plague, the bacterium Yersinia Pestis, looks like under a microscope and under fluorescence microscopy. Let's start with the background of recent cases of plague infection and their consequences for many thousands of people.

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

History of recent infections with bubonic plague

In the 16th century, the bubonic form of the plague spread throughout Europe and claimed the lives of a third of the population. It was carried by rats. Until the 19th century, they did not know how to cure the disease, so the mortality rate was almost 100% - some miraculously recovered on their own.

And today, cases of infection with the bubonic plague have been recorded, most of the cases of infection are noted 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 that time, millions of people died. The most famous epidemic of the bubonic plague covered Europe in 1346-1353. Presumably, it arose from a natural hearth in the Gobi, and then spread to the territory of India, China, Europe along with caravans.

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

Over the 20 years of the bubonic plague, at least 60 million people have died. In the Middle Ages, there was no salvation from such a disease - they tried to treat it by bloodletting, which further complicated the condition of the patients, since they were losing their last strength.

Outbreaks of the bubonic plague were repeated as early as 1361 and 1369. The disease has affected all areas of people's lives. History indicates that after the bubonic plague, the demographic situation came to stability only 400 years after the end of the disease.

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

Important! Highly contagious are forms in which lung damage occurs, as they lead to the rapid spread of infection by airborne droplets. Patients with bubonic plague are practically non-infectious.

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

Spoiler with a slight shock photo example, manifestation 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, while resistance to the drugs used for the treatment of bubonic plague, the bacteria Yersinia Pestis, can be observed.

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

Important! Dangerous for the bacteria of bubonic plague, is sunlight and high temperatures. Within an hour, the plague bacterium Yersinia Pestis dies, at a temperature of 60 degrees, with an increase to 100 - it can withstand 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 target of a pathogenic microorganism is the human lymphatic system. Penetrating into the lymph flow, the infection instantly spreads throughout the body. At the same time, the lymph nodes stop working, and the accumulation of pathogenic bacteria begins in them.

There are cutaneous and bubonic forms of plague. With a cutaneous form, a rapidly ulcerating papule appears at the site of the bite. After this, a scab and a scar appears. 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 indicates 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 resemble a common cold in their manifestations. The patient has the following changes:

an extensive 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 in this place, which long time does not heal.

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

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

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

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

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After another 4-5 days, the lymph nodes become soft, 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.

Often, bubonic plague occurs in combination with meningitis. The patient has severe headaches, cramps throughout the body.

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

Primary septic form and secondary septic

The penetration of the pathogen into the blood is accompanied by the emergence of generalized forms of the disease. Allocate the primary septic form and the secondary septic form.

Primary septic form of bubonic plague develops in cases where the infection enters the bloodstream without affecting the lymph nodes. Signs of intoxication are observed almost immediately. Since the infection instantly spreads throughout the body, there are many foci of inflammation throughout the body. The syndrome of disseminated intravascular coagulation 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 pulmonary.

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

With septic plague fever, chills, abdominal pain, internal hemorrhages become signs of the disease. Massive tissue necrosis is observed, most often tissues on the fingers of the extremities die off. In this form, buboes are not formed, however, disturbances from the nervous system occur almost immediately. In the absence of treatment, a lethal outcome is practically guaranteed, however, with adequate therapy the likelihood of recovery is also high.

Treating the bubonic plague

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

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In the Middle Ages, no effective methods doctors, during the bubonic plague, could not offer treatment. Firstly, this was due to the practically non-developed medicine, since the main place was occupied by religion, and science was not supported. Secondly, most doctors were simply afraid to contact the infected, so as not to die themselves.

Nevertheless, attempts were made to cure the plague, although they did not give any results. For example, buboes were opened and burned. Since the plague was considered as a poisoning of the whole organism, 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 are the administrative measures taken in Venice. A special sanitary commission was organized there. All ships that sailed were subjected to special inspection and, if corpses or infected were found, were burned. Goods and travelers were quarantined for 40 days. The corpses of the deceased were immediately collected and buried in a separate lagoon at a depth of at least 1.5 meters.

The plague still exists today

One should not think that this disease has remained only in history books. Bubonic plague in Altai was recorded in the last (2016) year, and in general, about 3000 cases of infection are registered per year. Until the epidemic in the Altai Territory did not come, however, all measures were taken to prevent the spread of the infection, and people in contact with the infected were quarantined.

Chief and modern method treatment of bubonic plague in our time - the use of antibiotics. Medicines are injected intramuscularly, as well as into the buboes themselves. Typically, tetracycline and streptomycin are used for treatment.

Important! Patients with bubonic plague infected with the bacterium Yersinia Pestis are subject to compulsory hospitalization, while they are placed in special wards. All personal items, clothing must be disinfected. Contact with a plague-infected patient implies compliance with safety measures by medical personnel - the use of protective suits is mandatory.

Necessarily carried out 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, bacterium Yersinia Pestis is cultured, and the analysis is repeated 3 times. And even after that, the patient remains in the hospital for a month. After discharge, an infectious disease specialist should monitor him for 3 months.

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

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

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

Large pandemics

The plague has left an indelible dark mark on the history of mankind, and it is not for nothing that many peoples associate it with death. Even a summary of the misfortunes suffered can take several volumes, and the history goes back millennia.

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 the indisputable proof of its early existence is DNA analysis of people of the Bronze Age, confirming the presence of the plague bacillus in Asia and Europe between 3 thousand and 800 BC. Unfortunately, the nature of these flares 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 the historian Procopius and other sources, the outbreak began in Egypt and moved along the sea trade routes, hitting Constantinople in 542. There, in a short time, the disease claimed tens of thousands of lives, 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 the plague were raging in Constantinople at the same time. Over the next 50 years, the pandemic spread west to the port cities of the Mediterranean 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 sure that rats (constant passengers of sea vessels) and unsanitary living conditions of that era were the cause of the epidemic.

Black Death of Europe

The next pandemic covered Europe in the XIV century and was even worse than the previous one. The death toll has 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 it is not possible to determine the exact amount at this time. The plague, like last time, was brought by merchants on ships. Researchers suggest that the ailment got to the southern ports of present-day France and Italy from the Genoese colonies of the Crimea, spreading from Central Asia.

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

The number of peasants who made up the main labor force has become critically small. To maintain the previous standard of living, an increase in labor productivity and a change in the technological structure were required. This need served as an impetus for the development of capitalist relations in a feudal society.

Great Plague of London

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

in 1666-1670 - in Cologne and along the territory of 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 fade. The last outbreak was in the port city of Marseille in 1720, where 40 thousand people were killed. Since then, the disease has not been reported in Europe (with the exception of the Caucasus).

The retreat 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 outbreaks in Europe, the causes of the disease were poorly 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 origin of plague fever from "poisonous miasms" or vapors brought from eastern countries with the air.

The best treatment was considered the expulsion of the "poison", which was achieved by either natural rupture of the tumors, or, if necessary, their incision and drainage. Other recommended remedies were:

bloodletting;
vomit;
sweating;
purgation.

Throughout the XVIII and early XIX 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.

The last in modern times

After crossing the Himalayas and gaining momentum in the Chinese province of Yunnan, in 1894 the plague reached Guangzhou and Hong Kong. These port cities became the distribution centers of a new epidemic, which by 1922 was being imported by sea-going vessels around the world - more widely than in any previous era. As a result, about 10 million people died of the most different cities and countries:

Almost all European ports were affected, but of the affected regions, India found itself in the most dire situation. Only by the end of the 19th century did the microbial theory develop, and it was finally established which pathogen was responsible for so many deaths. It remains only to determine how the bacillus infects a person. It has long been noted that in many areas of epidemics, unusual deaths of rats precede outbreaks of plague. The disease in humans appeared some time later.

In 1897, the Japanese physician Ogata Masanori, examining the focus of the disease on the island of Farmoza, proved that rats carried the plague bacillus. The following year, the Frenchman Paul-Louis Simon demonstrated the results of experiments that showed that fleas of the species Xenopsylla cheopis are carriers of the plague in the rat population. Thus, the ways of human infection were finally described.

Since then, the world began to carry out activities for the destruction of rats in ports and on sea vessels and insecticides are used to bait rodents in outbreak areas. Since the 1930s, doctors have acquired sulfur-containing drugs for the treatment of 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.

Especially dangerous infection

Plague is one of the deadliest diseases in human history. The human body is extremely susceptible to disease, infection can occur both directly and indirectly. A defeated plague can emerge after decades of silence with an 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 in Group A bioterrorism threats.

Infection methods

The causative agent of the plague - Y. Pestis, immobile rod-shaped anaerobic bacteria with bipolar staining, capable of producing antiphagocytic mucosa. Closest relatives:

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

V wildlife and in rural areas, most of the spread of Y. pestis is between rodents and fleas. In cities, the main vectors are synanthropic rodents, primarily gray and brown rats.

The plague stick easily migrates from the urban environment to nature and vice versa. It is transmitted to humans, as a rule, through the bites of infected fleas. But there are also reports of more than 200 species of mammals (including dogs and cats) capable of carrying the bacillus. Half of them are rodents and lagomorphs.

That's why the main rules of conduct in areas at risk of an outbreak will be:

exclusion of contact with wild animals;
caution when feeding rodents and rabbits.

Pathogenesis and forms of the disease

The plague bacillus is characterized by a surprisingly stable and strong ability to reproduce in the tissues of the host and lead to 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 work. inflammatory reactions by blocking the fight against infection by macrophages.

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, which leads to blood poisoning. With 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 goes into septic or pulmonary. Clinical manifestations for these three types look like this:

Treatment and prognosis

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

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

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

Preparations for children and pregnant women

With correct 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 correctly prescribed aminoglycoside is the most effective and safe for both the mother and the fetus. It is recommended to use it for the treatment of children. Due to the relative safety, the possibility of intravenous and intramuscular injection gentamicin is the preferred antibiotic for the treatment of children and pregnant women.

Preventive therapy

Individuals who have personal contact with patients with pneumonia or 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 receive 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.

Pre-exposure antibiotic administration may be indicated when people must be in plague-prone areas for short periods. This also applies to conditions where infection is difficult or impossible to prevent.

Hospital precautions include a quarantine regime for all people with plague. These include:

In addition, a patient with suspected pneumonic plague infection should be kept in a separate room and treated with precautions against 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 the mandatory wearing of a mask in the presence of other persons.

Vaccination possibility

Around the world, live attenuated and formalin-killed Y. pestis vaccines are available for use in various ways. 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, vaccination of communities against epizootic effects is not possible.

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

Plague 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 the human plague, it is viral in nature.

Currently, the plague of carnivores is recorded among domestic, wild and industrial 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, costs of preventive measures, and disruption of the technological process of growing.

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

Plague is now a disease whose symptoms are well understood. Its foci remained in the wild and conserved in the permanent habitats of rodents. Modern statistics are as follows: all over the world in one year, up to 3 thousand people come into contact with this disease, and about 200 of them die. Most cases occur in Central Asia and Africa.

He who lived during the time of Emperor Trajan, referring to more ancient doctors (whose names have not reached us), described several cases of definitely 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. Then all the rulers of the Philistines gathered there - the kings of the five cities of the Philistines - 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 struck with growths, so that the cry of the city ascended to heaven" (1 Sam.). Chapter 6 depicts the council of all the rulers of the Philistines, to which the priests and soothsayers were summoned. They advised to bring God a sacrifice of duty - to put in the ark, before returning it to the Israelites, gifts. “According to the number of the lords of the Philistines, five growths of gold and five mice of gold, devastating the earth; for the penalty is one for you all, and for your rulers ”(1 Sam.). This biblical tradition is interesting in many ways: it contains a hidden message about an epidemic that most likely affected all five cities of Philistea. It could be about the bubonic plague, which affected people from small to large and was accompanied by the appearance of painful growths in the groin - buboes. The most remarkable thing is that the Philistine priests, apparently, connected this disease with the presence of rodents: hence the golden sculptures of mice "devastating the earth."

There is another passage in the Bible that is considered to be a record of another plague case. The Fourth Book of Kings (2 Kings) tells about the campaign of the Assyrian king Sinacherib, who decided to devastate Jerusalem. A huge army surrounded the city, but did not take it. And soon Sinacherib withdrew without a fight with the remnants of the army, in which the "Angel of the Lord" struck 185 thousand soldiers during the night (4 Kings).

Plague epidemics in historical time

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 claimed the lives of nearly a quarter of the city's population.

Plague as a biological weapon

The use of the plague pathogen 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 by the Huns, Turks and Mongols to contaminate water sources and water supply systems. There is historical information about cases of ejection of infected material during the siege of some cities (Siege of Kaffa).

State of the art

Annually, the number of people infected with plague is about 2.5 thousand people, and without a 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, and the mortality rate was about 7% of the number of cases. In a number of countries in Asia (Kazakhstan, China, Mongolia and Vietnam), Africa (Congo, Tanzania and Madagascar), the Western Hemisphere (USA, Peru), cases of human infection are recorded almost every year.

At the same time, over 20 thousand people are at risk of infection in Russia 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 detection of new cases in the states adjacent to Russia (Kazakhstan, Mongolia, China), the import through transport and trade flows from the countries of Southeast Asia of a specific vector of plague - fleas Xenopsylla cheopis .

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

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

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 of 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, there was another outbreak of plague 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, there were more than 2,000 cases of plague and 165 deaths.

Forecast

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

Infection

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

According to the main carrier, natural foci of plague are subdivided into ground squirrels, marmots, sandbirds, voles, and pikas. In addition to wild rodents, the so-called synanthropic rodents (in particular, rats and mouse-like), as well as some wild animals (hares, foxes), which are the object of hunting, are sometimes included in the epizootic process. Among domestic animals, camels suffer from the plague.

In a natural focus, 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 when hunting rodents and their further processing. Mass diseases people arise when a sick camel is slaughtered, skinned, cut, processed. An infected person, in turn, is a potential source of plague, the transmission of the pathogen from which to another person or animal, depending on the form of the disease, can be carried out 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: in front of the stomach, the flea's esophagus forms a thickening - goiter. When an infected animal (rat) bites, the plague bacterium settles in the goiter of a flea and begins to multiply intensively, completely blocking it (the so-called "plague block"). The 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 the feeling of hunger, it passes from the owner to the owner in the hope of getting its portion 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 flea infected with plague bacteria bites a person at the site of the bite, a papule or pustule filled with hemorrhagic contents (skin form) may appear. Then the process spreads through the lymphatic vessels without the manifestation of lymphangitis. The multiplication of bacteria in the macrophages of the lymph nodes leads to their sharp increase, fusion and the formation of a conglomerate ("bubo"). Further generalization of the infection, which is not strictly obligatory, especially in the conditions of modern 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, a sick person himself becomes a source of infection by contact or transmission. However, the most important role is played by "screenings" of infection in lung tissue with the development of the pulmonary form of the disease. Since the development of plague pneumonia from person to person, the pulmonary form of the disease is already transmitted 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 inguinal lymph nodes on one side. The incubation period is 2-6 days (less often 1-12 days). Within a few days, the size of the conglomerate increases, the skin over it may become hyperemic. At the same time, there is an increase in other groups of lymph nodes - secondary buboes. The lymph nodes of the primary focus undergo softening, when they are punctured, purulent or hemorrhagic contents are obtained, microscopic analysis which detects a large number of gram-negative rods with bipolar staining. In the absence of antibiotic therapy, festering lymph nodes are opened. Then there is a gradual healing of the fistula. The severity of the patient's condition gradually increases by the 4-5th day, the temperature can be elevated, sometimes high fever appears immediately, but at first the condition of the patients often remains generally satisfactory. This explains the fact that a person who has fallen ill with the 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 patient's condition very quickly becomes extremely difficult. Symptoms of intoxication increase by the hour. The temperature after severe chills rises to high febrile numbers. All signs of sepsis are noted: muscle pain, severe weakness, headache, dizziness, congestion of consciousness, up to its loss, sometimes agitation (the patient rushes about in bed), insomnia. With the development of pneumonia, cyanosis increases, a cough appears with the separation of foamy bloody sputum containing great amount sticks of plague. 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 proceed, like any severe sepsis, with manifestations of the syndrome of disseminated intravascular coagulation: minor hemorrhages on the skin may appear, bleeding from the gastrointestinal tract is possible (vomiting of bloody masses, melena), severe tachycardia, rapid and requiring correction ( dopamine) drop in blood pressure. Auscultatory - a picture of bilateral focal pneumonia.

Clinical picture

Clinical picture primary septic or primary pulmonary form does not fundamentally differ from secondary forms, but the 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 an epidemiological history. Arrival from zones endemic for the plague (Vietnam, Burma, Bolivia, Ecuador, Karakalpakia, etc.), or from the antiplague stations of a patient with the symptoms of a bubonic form described above or with signs of the most severe - with hemorrhages and bloody sputum - pneumonia with severe lymphadenopathy is for the doctor of first contact is a sufficiently serious argument for taking all measures to localize the alleged plague and its accurate diagnosis. It should be 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 staff not visible. Establishing an accurate diagnosis must be carried out using bacteriological studies. The material for them is punctate of a festering lymph node, sputum, patient's blood, discharge from fistulas and ulcers.

Laboratory diagnostics is carried out using a fluorescent specific antiserum, which stains smears of discharge of ulcers, punctate of lymph nodes, culture obtained on blood agar.

Treatment

In the Middle Ages, the plague was practically not treated, actions were reduced mainly to cutting out or burning plague buboes. Nobody knew the real cause of the disease, so there was no idea how to treat it. Doctors tried the most bizarre remedies. The composition of one such drug included a mixture of 10-year old molasses, finely chopped snakes, wine and 60 other components. According to another method, the patient took turns sleeping on the left side, then on the right. Since the 13th century, attempts have been made to limit the plague epidemic with the help of quarantines.

The turning point in plague therapy 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 with antibiotics, sulfonamides and medicinal anti-plague serum. Prevention of possible foci of the disease consists in carrying out special quarantine measures in port cities, deraising all ships that go on international flights, creating special anti-plague institutions in the steppe areas where rodents are found, identifying plague epizootics among rodents and combating them.

Anti-plague sanitary measures in Russia

If there is a suspicion of plague, the sanitary-epidemiological station of the district is immediately notified of this. The doctor who suspects the infection fills in the notification, and it is sent by chief physician institutions where such a patient is found.

The patient should be immediately hospitalized in the box of an infectious hospital. Doctor or paramedic medical institution upon detection of a sick person or suspected of having a plague disease, he is obliged to stop further admission of patients and prohibit entry and exit from the medical institution. Remaining in the office, the ward, the medical worker must inform the chief physician in a way available 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 must treat the mucous membranes of the eyes, mouth and nose with a streptomycin solution. In the absence of a cough, you can limit yourself to treating your hands with a disinfectant solution. After taking measures to separate the sick from the healthy in a medical institution or at home, a list of persons who had contact with the patient is drawn up, indicating the last name, first name, patronymic, age, place of work, profession, home address.

Until the arrival of a consultant from the anti-plague institution, the health worker remains in the outbreak. The issue of his isolation is decided on a case-by-case basis. The consultant picks up the material for bacteriological research then you can start specific treatment patient with antibiotics.

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

The head physician of the institution, having received a message about the identification of a patient suspected of plague, takes measures to stop communication between the departments of the hospital, the floors of the polyclinic, prohibits leaving the building where the patient is found. Simultaneously organizes the transmission of an emergency message to the superior 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 focus, position and the name of the doctor who identified the patient. Along with the information, the manager asks for 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 the plague. Treatment activities inseparable from the prevention of infection of personnel, who must immediately put on 3-layer gauze masks, shoe covers, a 2-layer gauze scarf that completely covers the hair, and safety glasses to prevent sputum splashing on the mucous membrane of the eyes. According to the established in Russian Federation according to the rules, personnel must wear an anti-plague suit or apply anti-infective protection similar in properties special means... All personnel in contact with the patient remain for further assistance. A special medical post isolates the compartment where the patient and the staff attending him are located from contact with other people. The isolated compartment should include a toilet and treatment room... All personnel receive immediate antibiotic prophylactic treatment for the duration of their days in the isolation ward.

Plague treatment is complex and includes the use of etiotropic, pathogenetic and symptomatic agents. For the treatment of plague, antibiotics of the streptomycin series are most effective: streptomycin, dihydrostreptomycin, pasomycin. At the same time, streptomycin is the most widely used. With the bubonic form of plague, the patient is injected intramuscularly with streptomycin 3-4 times a day (daily dose of 3 g), tetracycline antibiotics (vibromycin, morphocyclin) IV, 4 g / day. In case of intravenous intoxication, saline solutions, hemodesis are injected. 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, it becomes necessary to carry out resuscitation measures, the introduction of dopamine, the installation of an indwelling catheter. With pulmonary and septic forms of plague, the dose of streptomycin is increased to 4-5 g / day, and tetracycline - up to 6 g. In forms resistant to streptomycin, chloramphenicol succinate can be administered up to 6-8 g IV. When the condition improves, the doses of antibiotics are reduced: streptomycin - up to 2 g / day until the temperature returns to normal, but for at least 3 days, tetracyclines - up to 2 g / day daily by mouth, chloramphenicol - up to 3 g / day, in total 20-25 g. Used with great success in the treatment of plague and biseptol.

With a pulmonary, septic form, the development of hemorrhage, they immediately begin to stop the syndrome of disseminated intravascular coagulation: plasmapheresis is performed (intermittent plasmapheresis in plastic bags can be carried out on any centrifuge with special or air cooling with a capacity of its glasses of 0.5 liters or more) in the volume to be removed plasma 1-1.5 liters when replaced with the same amount of freshly frozen plasma. In the presence of hemorrhagic syndrome, daily injections of fresh frozen plasma should not be less than 2 liters. Before the relief of the most acute manifestations of sepsis, plasmapheresis is performed daily. The disappearance of signs of hemorrhagic syndrome, stabilization of blood pressure, usually with sepsis, are grounds for terminating 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 for a patient with pulmonary or septic form plague, there must be an intensive care specialist.

Notes (edit)

Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
, with. 142.
Plague - Medical Encyclopedia
, with. 131.
Plague
, with. 7.
, with. 106.
, with. 5.
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.
, with. 102.
, with. 117.
Europe's Plagues Came From China, Study Finds. // The New York Times, 31.10.2010
B. Bayer, W. Bierstein et al. History of Humanity 2002 ISBN 5-17-012785-5
Anisimov E.V. 1346-1354 "Black Death" in Europe and Russia// Chronology of Russian history. Russia and the world.
, with. 264.
, with. 500-545.
WHO: Plague in the Democratic Republic of the Congo (Russian)... Archived August 2, 2012.
Letter of the Ministry of Health of the Russian Federation of April 22, 2004 N 2510 / 3173-04-27 "On the Prevention of Plague"
Order of the territorial administration of Rospotrebnadzor in the Moscow region of 05/02/2006 N 100 "On the organization and conduct of measures to prevent plague in the Moscow region"
July 13, 2016 In Altai, a ten-year-old boy fell ill with bubonic plague
Second death from pneumonic plague reported in Qinghai, People's Daily (3 August 2009).
China fears pneumonic plague epidemic
Plague is raging in Madagascar (unspecified) ... Retrieved 13 December 2013.
WHO reported the threat of a rapid spread of plague in Madagascar
The number of plague infections in Madagascar has exceeded 2 thousand, Rosbalt... Date of treatment November 12, 2017.
Plague
, with. 623.

Literature

Anisimov P.I. and others. 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 / Per. 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", took more than 50 million human lives, which was equal to a quarter of the population of medieval Europe. The mortality rate was about 99%.

Disease facts:

Plague affects lymph nodes, lungs, and others internal organs... As a result of infection, sepsis develops. The general condition of the body is extremely difficult. The body is exposed to constant bouts of fever.
The period of development of plague after infection is on average about three days, depending on the general condition of the organism.
At the moment, mortality from this ailment makes up no more than 10% of all identified 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 are mainly affected by African countries and a number of countries in South America. The endemic countries are DR Congo, the island of Madagascar and Peru.

In the Russian Federation, the last famous case plague disease is documented in 1979. Every year more than 20 thousand people fall into the risk group, 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 disease is flea bites. This factor due to the specific structure of the digestive system of these insects. After being bitten by an infected rodent by a flea, the plague bacterium settles in its goiter 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 drunk blood together with plague bacteria into the bite.

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

Reasons for infection:

small rodent bites;
contact with infected pets, stray dogs;
direct contact with an infected person;
butchering of carcasses of affected animals;
skin treatment of killed animals - carriers of the disease;
the ingress of bacteria on the mucous membrane of a person during the autopsy of the corpses of those who died from the plague;
eating meat from infected animals;
the ingestion 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

Plague varieties are divided into two main types.

Localized type- the disease develops after the plague microbes get under the skin:
- Skin plague. There is no primary protective reaction, only in 3% of cases redness of the affected skin areas with seals occurs. No visible external signs the disease progresses, eventually forming a carbuncle, then an ulcer, which heals as it heals.
- Bubonic plague . The most common form of the disease. It affects the lymph nodes, forming "buboes". It is characterized by painful inflammatory processes in them. It affects the groin area, armpits. It is accompanied by severe fever and general intoxication of the body.
- Bubonic plague... Plague bacteria travel with lymph, end up in lymph nodes, cause inflammatory process affecting adjacent tissues. The "buboes" ripen, while the rate of development of 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:
- Septic plague... The pathogen enters through the mucous membranes. The high virulence of the microbe and the weakened body are the reasons for easy entry into the patient's blood, bypassing all of it defense mechanisms... The fatal outcome in this form of the disease can occur within less than 24 hours, the so-called. "Lightning plague".
- Pneumonic plague. Ingestion occurs through airborne droplets, infection with dirty hands and objects, and also through the conjunctiva of the eyes. This form is a primary pneumonia, and also has a high epidemic threshold due to the abundant secretion of sputum containing pathogenic bacteria during coughing.

SYMPTOMS

The incubation period for plague is 72 to 150 hours. Most often it appears on the third day. The disease is peculiar sudden onset without primary symptoms.

Clinical history of plague:

a sharp jump in body temperature up to 40 degrees;
acute headaches;
nausea;
reddish tint of the face and eyeballs;
muscle discomfort;
plaque of a white tint on the tongue;
enlarged nostrils;
dry skin of the lips;
manifestations on the body of a rash;
feeling thirsty;
insomnia;
unreasonable excitement;
difficulties in coordinating movements;
delirium (often of an erotic nature);
disturbed digestion;
Difficulty urinating
severe fever;
coughing up phlegm containing blood clots;
bleeding from the gastrointestinal tract;
tachycardia;
low blood pressure.

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

DIAGNOSTICS

Returning from travel in areas endemic for the spread of plague, with the slightest signs of the disease - an urgent reason for the isolation of the patient. On the basis of the anamnesis, all persons who, to some extent, have been in contact with a 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 a 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 almost impossible. However, all laboratory tests are carried out in specialized premises for working with especially dangerous infectious diseases.

TREATMENT

Since 1947 the plague treated with antibiotics a group of aminoglycosides of a wide spectrum of action.

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

Therapy course:

The use of antibacterial drugs based on sulfamethoxazole and trimethoprim.
Intravenous administration of chloramphenicol at the same time as streptomycin.
Detoxification procedures.
Improving microcirculation and repair. Achieved by input.
Reception of cardiac glycosides.
The use of respiratory analeptics.
The use of antipyretic drugs.

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

COMPLICATIONS

Because the disease is included in the group of fatal, the main complications with an incorrect diagnosis or lack of full treatment can be the transformation of plague from light form into heavier ones. So, skin plague can develop to septic, and bubonic to pulmonary.

Also, complications of plague affect:

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

A patient who has had a plague, although he receives immunity, however, is not fully insured against new cases of infection, especially with a negligent attitude towards preventive measures.

PREVENTION

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

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

"Instructive and methodological guidelines for the diagnosis, treatment and prevention of plague", approved by the Ministry of Health of the USSR on 09/14/1976.
Sanitary and Epidemiological Rules SP 3.1.7.1380-03 of 06.06.2003, approved by the Decree of the Chief State Sanitary Doctor in the part "Plague Prevention".

A set of measures:

surveillance of natural foci of the disease;
disinsection, reducing the number of potential carriers of the disease;
a set of quarantine measures;
education and preparation of the population to act in case of outbreaks of plague;
careful handling of animal corpses;
vaccination of medical staff;
use of anti-plague suits.

RECOVERY OUTLOOK

Deaths from plague on the present stage the use of therapy is about 10%. If treatment is started at later stages or was absent altogether, the risks increase to 30-40%.

With the right choice of treatment methods restoration of the body takes place in short time , the working capacity is fully returned.

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Plague is one of the most dangerous infectious diseases with heavy course, in which the lymph nodes are affected, internal organs with development severe sepsis... The disease is highly contagious and has a high mortality rate. World history describes three pandemics of the plague or "black death", during which more than 100 million people died. The causative agent of the plague was also used as a biological weapon during the wars. Plague is a serious disease that spreads quickly and affects everyone on the way. Today, the level of plague has dropped significantly, but the disease continues to afflict people on a daily basis.

Etiology and pathogenesis of the disease

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

Fleas Xenopsylla cheopis are the main source of the plague bacillus. When a flea is bitten by an animal sick with plague, the pathogen enters its body and remains there. A flea bites a healthy animal or person, infecting it with the plague. Rodents are carriers of these fleas. They reproduce 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. Also, the pathogen is transmitted by airborne droplets, alimentary and contact routes.

In humans, the entrance gate for plague infection is damaged skin, mucous membranes, and the digestive tract. A person is very susceptible to the plague, therefore, it becomes infected immediately. After the plague bacillus enters the body, a small papule with blood contents is formed at the site of the flea bite, which quickly passes. The pathogen from the site of the bite enters the bloodstream, and then settles in the lymph nodes. In the lymph nodes, Yersinia multiplies, inflammation develops. Without treatment, the pathogen from the lymph nodes goes back into the bloodstream with the development of bacteremia and settles on other organs, which further leads to severe sepsis.

The reasons for the development of plague

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

contact with animals with plague;
flea, tick bites;
excavations of old burials, historical excavations;
contact with people 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 infection with plague. It:

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

Such persons often come into contact with animals that carry the plague or infected fleas, as well as with people who are sick with the plague.

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

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 is often fatal.

The 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 onset of severe fever, chills, intoxication and general weakness... Symptoms progress rapidly, and muscle and joint pain is added. Such patients are often agitated, hallucinating, or delusional. With the progression of the disease, coordination is impaired in people, and excessive excitement is replaced by apathy. Such patients most often cannot even get out of bed.

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

The clinic of the disease can vary depending on the form. For example, for bubonic, a lesion of the lymph nodes is characteristic. The affected lymph nodes significantly increase in volume, protrude above the skin. They are painful and hot to the touch, welded to the surrounding tissue.

Skin plague is characterized by the appearance of bloody pustules. Over time, the pustules break up on their own and ulcers appear in their place with uneven black edges and a yellow bottom. In the future, the bottom is covered with a scab and also acquires a black color. Such ulcers appear all over the body and take a long time to heal with the formation of scars.

With intestinal plague, sharp pains in the stomach, which cannot be removed. There is vomiting and diarrhea with blood, frequent urge to defecate.

With the pulmonary form, patients have a severe cough, sputum with blood. The cough is not stopped by anything, difficulty in breathing is added to it.

All forms of plague are characterized by severe fever, intoxication, and rapid onset of 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... With sepsis, all organs are affected, primarily the brain, heart and kidneys.

Which doctors to contact and the prognosis of the disease

Patients can turn to local therapists, pulmonologists or dermatovenerologists. Or such patients cause ambulance at grave condition... If there is a suspicion of plague, all patients will be referred to an infectious disease specialist. Plague is treated in a hospital in separate closed blocks, entry to which is prohibited to outsiders.

Forecast for life with the right and timely treatment favorable. Perhaps complete recovery at early diagnosis plague. But there is a high risk of death with late initiation of therapy.

Important! When the first symptoms of the disease appear, consult a doctor as early as possible. Plague is a fleeting disease that cannot be cured on its own, therefore, life will depend on the time of admission to the hospital.

Plague diagnosis

For accurate diagnosis a detailed medical history is collected from the patient and a complete examination is performed. Most often, such events are enough to suspect the 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 the patient's biological materials, such reactions as ELISA, PCR, and the reaction of indirect hemagglutination are used. The purpose of such studies is to detect the presence of Yersinia antigens in the human body using antibodies. The presence of antibodies to the plague bacillus in the patient's blood is also determined.

Disease treatment methods

Patients are isolated from others. If there is a suspicion of plague, the doctor stops admitting other patients, and the hospital is closed for the duration of the diagnosis. 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 the plague. The rooms are also subject to disinfection. People with plague enter the box in special clothes, which they put on immediately before entering.

Also, disinfection of the room where the patient lives is carried out, a detailed examination of the contact persons.

Etiotropic treatment of plague - antibiotics. The most commonly used are Streptomycin or Tetracycline and their derivatives. Also use 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 pain relievers, anti-inflammatory drugs and stop bleeding.

Plague prevention

Today, most countries do not have the plague pathogen. Therefore, the main measure of protection is to prevent the import of the pathogen from countries that are dangerous for this disease. These measures include:

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

Also, important preventive measures include:

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

The listed activities 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.