Plague bacterial disease. What is plague. Historical facts about cholera

plague doctor in the Middle Ages

No first hundred years in the people of the plague are associated with a special disease, carrying the lives of millions of people. Everyone knows the striking ability of the causative agent of this disease and its lightning spread. Everyone knows about this disease, it has been so rooted in the consciousness of man that all negative in life is associated with this word.

What is a plague and where does an infection come from? Why still does it exist in nature? What is the case of the causative agent and the path of his transfer? What are the forms of the disease and symptoms? What is the diagnosis and how is the treatment? Thanks to which prevention, in our time, you can save billions of human lives?

What is Chuma

Specialists argue that the epidemics of the plague was mentioned not only in historical reference books, but also in the Bible. Cases of the disease were regularly registered on all continents. But more interest is not an epidemic, but pandemics or outbreaks of infection, commonly distributed throughout the country and covering neighboring. In the entire history of the existence of people, they counted three.

1. The first outbreak of the plague or pandemic originated in the VI century in Europe and the Middle East. During its existence, the infection challenged more than 100 million people.
2. The second case when the disease covered a significant territory was noted in Europe, from where it got from Asia in 1348. At this time, more than 50 million people died, and the pandemic itself is known in history called "Plague - Black Death". She did not bypass the side and territory of Russia.
3. The third pandemic was rampant at the end of the XIX century in the east, mainly in India. A flash began in 1894 in Canton and Hong Kong. A large number of deaths were recorded. Despite all precautions from the local authorities, the number of deaths exceeded 87 million.

But it was during the third pandemic that he managed to carefully explore the dead people and reveal not only the source of infection, but also the carrier of the disease. The French scientist Alexander Yersen found that a person is infected with sick rodents. After a few decades, they created an effective vaccine against the plague, although it did not help humanity to completely get rid of the disease.

Even in our time, single cases of plague are registered in Russia, Asia, USA, Peru, Africa. Every year, doctors discover several dozen cases of disease in various regions, and the number of deaths ranges from one to 10 people and this can be considered a victory.

Where is the plague now

Foci of infection in our time are not marked in red on a regular tourist map. Therefore, before traveling to other countries, it is better to consult with an infectious person, where the plague is still found.

According to experts, this disease is not yet eradicated completely. In which countries can be infected with plague?

1. Single cases of the disease are found in the USA and Peru.
2. The plague in Europe was practically not registered for several years, but here Asia the disease did not bypassed the party. Before visiting China, Mongolia, Vietnam and even Kazakhstan is better to make vaccinations.
3. In the territory of Russia, it is also better to be more nevertheless, because several cases of the plague annually register here (in Altai, Tyva, Dagestan) and it borders with dangerous countries in relation to infection.
4. Africa is considered dangerous, from the point of view of epidemiology, the continent, most modern heavy infections can be sick here. The plague is no exception, single cases of the disease have been registered here for the past few years.
5. There is an infection and on individual islands. For example, only two years ago the plague struck several dozen people in Madagascar.

The last hundred years of pandemic plague was observed, but the infection could not be eradicated completely.

It has not been a secret for a long time that many particularly dangerous infections to which the plague relates, the military is trying to use as biological weapons. During World War II in Japan, scientists brought a special kind of causative agent of the disease. By the ability to infect people, he was ten times more than a natural pathogens. And no one knows what war could have ended, if Japan had used this weapon.

Although the plague pandemic is not registered the last hundred years - completely dealt with bacteria that caused the disease, failed. There are natural sources of plague and anthropurgic, that is, natural and artificially created in the process of vital activity.

Why is the infection considered particularly dangerous? Plague is a disease with a high level of mortality. Until the creation of the vaccine, and it happened in 1926, mortality from various types of plague was at least 95%, that is, they survived units. Now the mortality does not exceed 10%.

Causative agent of plague

The causative agent of infection - Yersinia Pestis (a plague) Bacterry of the genus of Iranin, which is included in the large family of enterobacteria. To survive in natural conditions of this bacterium, it was necessary to adapt a long time, which led to the peculiarities of its development and livelihoods.

1. Growing on simple available nutrient media.
2. It can be of different shapes - from the filamentous to the spherical.
3. The plague in its structure contains more than 30 types of antigens, helping to survive in the body of the carrier and man.
4. Resistant to environmental factors, but instantly dies when boiling.
5. The bacteria has several pathogenic factors - this is an exo and endotoxins. It is they who lead to the defeat of organs of organs in the human body.
6. It is possible to deal with bacteria in an external environment using conventional disinfectants. Antibiotics are destructive on them.

Ways to transfer plague

Not only a person amazes this disease, in nature there are many other sources of infection. Large danger represent the sluggish options for the plague, when the affected animal can be overwhelmed, and after infecting others.

Plague - a disease with natural foci, striking, except for man and other beings, for example, pets - camels and cats. They are infected from other animals. Today, more than 300 types of bacteria carriers have been revealed.

In natural conditions, the natural carrier of the pathogen of the plague are:

• susliki;
• surki;
• gerbil;
• stores and rats;
• guinea pigs.

In urban conditions, the reservoir of bacteria are special types of rats and mice:

• pumpkin;
• gray and black rat;
• alexandrovskaya and Egyptian species of rats.

The carrier of the plague in all cases are flea. The contamination of a person occurs in the bite of this artistic, when infected flea, not finding a suitable animal, biting a person. Only one flea for the life cycle can infect about 10 people or animals. The susceptibility to the disease in people is high.

How is the plague?

1. Transmissive by or through the bites of an infected animal mainly fleas. This is the most common path.
2. Contact, which are infected during the cutting of carcasses of patients with pets, as a rule, is camels.
3. Despite the fact that the championship is given to the transmissive way to transfer the plague bacteria, an alimentary also plays a latter role. A person is infected during eating food, an infection causative.
4. To the methods of penetration of bacteria in the human body with a plamber there are an aerogenic path. During cough or chihanye, a sick person with ease infects everyone around, so they need to be kept in a separate box.

Pathogenesis of the plague and its classification

How does the pathogen of the plague in the human body behave? The first clinical manifestations of the disease depend on the method of penetration of bacteria into the body. Therefore, there are different clinical forms of the disease.

Penetrating into the body, the causative agent with blood flow penetrates the nearest lymph nodes, where it remains and safely multiplies. It is here that the first local inflammation of lymph nodes with the formation of a bubon, due to the fact that blood cells cannot fully destroy bacteria. The lesion of lymph nodes leads to a decrease in the protective functions of the body, which contributes to the spread of the causative agent in all systems.

In the future, Iracini is affected by lungs. In addition to infection with bacteria of the plague of lymph nodes and internal organs, blood or sepsis is infected. This leads to numerous complications and changes in the heart, lungs, kidneys.

What are the views of the plague? Doctors distinguish two main types of illness:

• easy;
• bubonic.

They are considered the most common variants of the disease, although conditionally, because bacteria are not affected by some particular organ, and gradually the entire human body is involved in the inflammatory process. According to the severity, the disease is divided into a slight subclinical flow, medium-sized and heavy.

Symptoms of the plague

Plague is an acute natural-focal infection caused by Irani. It is characterized by such clinical signs as pronounced fever, leshes of lymph nodes and sepsis.

Any form of the disease begins with common symptoms. The incubation period of the plague lasts at least 6 days. For the disease, a sharp start is characterized.

The first signs of the plague in humans are as follows:

• chills and practically a lightning increase in body temperature up to 39-40 ºC;
• pronounced symptoms of intoxication - head and muscle pain, weakness;
• dizziness;
• defeat the nervous system of varying degrees of severity - from stunning and inhibition to nonsense and hallucinations;
• the patient disrupts the coordination of movements.

It is characterized by a typical view of a sick person - a reddened face and conjunctiva, dry lips and a language that is increased and covered with white dense raids.

Due to the increase in the language, the speech of the patient of the plague becomes illegible. If the infection proceeds in a heavy form - a person's face with a blue tint or a shiny, on the face of an expression of suffering and horror.

Symptoms of bubonic plague

The name of the disease itself comes from the Arabic word "JUMBA", which means Bob or Bubon in translating. That is, it can be assumed that the first clinical sign of "black death", which described our distant ancestors was to increase the lymph nodes that resembled the type of beans.

What is the difference between the bubonic plague from other disease options?

1. A typical clinical symptom of this type of plague is a bubo. What does he represent? - This is a pronounced and painful increase in lymph nodes. As a rule, these are single formations, but in very rare cases their number increases to two or more. The plague Bubon is often localized in the axillary, gentle and cervical area.
2. Even before the appearance of a bubon, a sick person appears a painfulness so pronounced that it is necessary to accept the forced position of the body to facilitate the state.
3. Another clinical symptom of the bubonic plague is the smaller the size of these formations, the more pain they cause when tonging.

How are the bubons form? This is a long process. It all begins with the occurrence of pain in the place of education. Then the lymph nodes are also increasing here, they become painful to the touch and launched with a fiber, a bubo is gradually formed. The skin above it is tense, painful and becomes intensive red staining. Approximately for 20 days there is a resolution of a bubon or its reverse development.

There are three options for further disappearance of the bubon:

• long-term complete absorption;
• opening;
• sclerosis.

In modern conditions, with the right approach to the treatment of the disease, and most importantly, with a timely manner initiated therapy, the number of deaths from the bubonic plague does not exceed 7-10%.

Symptoms of Light Chima

The second most common option of the plague is its easy form. This is the most difficult version of the development of the disease. There are 3 main periods of development of light plague:

• elementary;
• rapid period;
• comporny or terminal.

In recent times, this species of the plague is taken from the life of millions of people, because the mortality of it is 99%.

Symptoms of light plague, the following.

More than 100 years ago, the light shape of the plague almost 100% of cases ended with death! Now the situation has changed, which is undoubtedly connected with the correct treatment tactics.

How other forms of plague occur

In addition to the two classical options for the flow of plague, there are other forms of the disease. As a rule, this is a complication of the main infection, but sometimes they proceed as primary independent.

1. Primary septic shape. The symptoms of this type of plague are slightly different from the two options described above. The infection is developing and flows rapidly. The incubation period is shortened and lasts no more than two days. High temperatures, weakness, nonsense and excitement are not all signs of a state of violation. Inflammation of the brain and infectious-toxic shock develops, then coma and death. In general, the disease lasts no more than three days. In relation to this type of disease, the prognosis is unfavorable, recovery is almost never found.
2. Stretched or light course of the disease is observed with the skin of the plague. The causative agent penetrates the human body through damaged skin. At the site of the introduction of the pathogen of the plague, changes are observed - the formation of necrotic ulcers or the formation of a furuncle or carbuncule (this is inflammation of the skin and the surrounding fiber around the hair with the donation sites and the selection of pus). Ulcers heal long and gradually form a scar. The same changes may manifest themselves as secondary during the bubonic or light form of the plague.

Diagnosis of plague

The first stage in determining the presence of infection - epidemic. But so to make the diagnosis easily when several cases of the disease arose with the presence of typical clinical symptoms in patients. If the plague in this area has not yet met, and the number of cases is calculated by units - the diagnosis causes difficulties.

In the event of the development of infection, one of the first steps in the definition of the disease is a bacteriological method. If the plague of working with biological material is suspected for detecting the pathogen, it is carried out in special conditions, because the infection is easily and quickly distributed in the environment.

For research take almost any biological material:

• wet;
• blood;
• punctrate bubones;
• investigate the contents of peptic skin lesions;
• urine;
• vomit masses.

Almost everything that distinguishes the patient can be used for research. Since the illness of the plague in people proceeds hard and the person is very susceptible to infection, the taking of material is made in special clothes, and sowing on the nutrient media in equipped laboratories. Infected bacteria animals die in 3-5 days. In addition, when using the method of fluorescent antibodies, bacteria are glow.

Additionally, serological methods of research of the plague: ELISA, RNNGA.

Treatment

Any patient with suspected plague is subject to immediate hospitalization. Even in the case of the development of lung forms of human infection, completely isolate from others.

In the distant past, the only method of treating the plague was migration and processing of bubes, their removal. In an attempt to get rid of infections, people used only symptomatic methods, but unsuccessfully. After identifying the pathogen and the creation of antibacterial drugs, not only the number of patients, but also complications, decreased.

What do this disease treat?

1. The basis of treatment is antibacterial therapy, using tetracycline antibiotics in the appropriate dose. At the very beginning of treatment, maximum daily doses of drugs are used, with gradually reduced to minimal in case of temperature normalization. Before starting treatment, the sensitivity of the pathogen towards antibiotics is determined.
2. An important step of treating the plague in people is to carry out disinfect. Salt solutions are injected with patients.
3. Symptomatic treatment is used: diuretics are used in the event of a fluid delay, hormonal substances are used.
4. Use therapeutic anticipated serum.
5. Together with the main treatment, supporting therapy is applied - cardiac drugs, vitamins.
6. In addition to antibacterial drugs, local medicines are prescribed from the plague. Antibiotics handle plague bubons.
7. In the case of the development of septic form of the disease, plasmapheresis is used daily - this is a complex procedure for cleaning the blood of a patient person.

After the end of treatment, approximately 6 days later, a control study of biological materials is carried out.

Prevention of plague

The invention of antibacterial drugs would not solve the problem of the appearance and distribution of pandemic. This is just an effective way to cope with the already emerged of the disease and the prevention of its very terrible complication - death.

So how did they ever beat the plague? - After all, single cases per year without declared pandemics and the minimum amount of deaths after the suffered infection can be considered a victory. A large role belongs to the proper prevention of the disease. And she began the moment of the emergence of the second pandemic, in Europe.

In Venice, after the second wave of the spread of the plague in the XIV century, while the city remained a quarter of the population, the first quarantine measures were introduced for arrivals. Ships were kept in the port for 40 days and watched the team in order to prevent the spread of infection so that it does not penetrate other countries. And it worked, new cases of infection were no longer noted, although the second pandemic of the plague had already carried out most of the population of Europe.

How is the prevention of infection been carried out today?

1. Even with the occurrence of single cases of plague in any countries, all those who arrived from there are isolated and are observed for six days. If a person has revealed some signs of the disease, then preventive doses of antibacterial drugs are prescribed.
2. The prevention of plague includes complete insulation of patients with suspicion of an infection. People not only put in separate closed boxes, but in most cases try to isolate and that part of the hospital, where the patient is located.
3. A large role in preventing the emergence of infection belongs to the state-poid service. They annually control the foci of the emergence of plague, take water samples in a given locality, examine animals that may be a natural tank.
4. In the foci of the development of the disease, the destruction of plague carriers is carried out.
5. The measures for the prevention of the disease of the plague in the foci of the appearance of the disease include sanitary and educational work with the population. Explain the rules for the behavior of people at the next outbreak of infection and where to contact first.

But even all of the above was not enough for victory over the disease, if there was no vaccine against the plague. It is from the moment of its creation that the number of cases of the disease decreased dramatically, and there were no pandemics for more than 100 years.

Vaccination

Today, more efficient methods that helped forget for the "black death" are used to fight the plague, except for general preventive measures.

In 1926, the Russian biologist V. A. Havkin invented invented in the world of vaccine from the plague. Since its inception and onset of universal vaccination in the foci of the appearance of infection of the epidemic, the plague remained far in the past. Who and how is vaccination? What are its pros and cons?

Nowadays, the lyophilisate or vaccine is used lively dry against the plague, this is a suspension of live bacteria, but a vaccine strain. The drug is bred immediately before use. It is used against the causative agent of the bubonic plague, as well as a light and septic form. This is a universal vaccine. The drug divided into solvent in various ways is introduced, which depends on the degree of dilution:

• apply it subcutaneously needle or impulse method;
• cOVER;
• intraodelly;
• use a vaccine against the plague even inhalation method.

The prevention of the disease is carried out by adults and children since the two-year-old age.

Indications and Contraindications for Vaccination

The vaccination from the plague makes one once and protects it for only 6 months. But certain groups of the population are subject to prevention, not vaccinating.

For today, this vaccination is not made as mandatory, in the national vaccination calendar, it is done only on strict indications and only to certain citizens.

Grafting make the following categories of citizens:

• everyone who lives on dangerous areas in epidemic relations, where the plague is found in our time;
• health workers whose professional activities are directly related to work in the "hot spots", that is, in the occurrence of illness;
• developers of vaccine and laboratories in contact with bacteria strains;
• preventive vaccination makes people with high risk of infection working in the foci of the emergence of infection - these are geologists, workers of anticipate institutions, shepherds.

It is impossible to prevent these drugs to two years old, pregnant and lactating women, if the first symptoms of the plague have already appeared and everyone who has a reaction to the previous introduction of the vaccine. Reactions and complications for this vaccination practically does not occur. Of the cons of such prevention, it is possible to note its short effect and the possible development of the disease after vaccination, which is extremely rare.

Can there be a plague at the grafts? Yes, this also happens if an already sick person or the vaccination turned out to be poor quality. This type of disease is characterized by a slow course with sluggish symptoms. The incubation period exceeds 10 days. The patients in patients are satisfactory, so it is almost impossible to suspect the development of the disease. The diagnosis is facilitated with the appearance of a painful bubon, although inflammation of tissues and lymph nodes is observed around. In case of late treatment or its complete absence, the further development of the disease is fully consistent with its usual classical flow.

The plague is currently not a sentence, and another dangerous infection with which you can cope. And although in the recent past, all people and health workers were afraid of this disease, today, the basis of its treatment is prevention, timely diagnosis and complete insulation of the patient.

The illness of the plague, with which humanity came across about one and a half thousand years ago, previously caused large outbreaks of morbidity, carrying tens and hundreds of millions of lives. A more merciless and devastating history does not know, and so far, despite the development of medicine, it has not been completely failed to cope with it.

What is plague?

Plague is a disease in people who are natural and focal infectious nature, in many cases ending with fatal outcome. This is a very infectious pathology, and the susceptibility to her is universal. After transferred and cured plague, steady immunity is not formed, that is, the risk of re-infection remains (however, the second time the disease proceeds more easier).

The exact origin of the name of the disease is not established, while the word "plague" translated from Turkish means "round, bump", from the Greek - "Shaft", from Latin - "Blow, Rana". In long and modern scientific sources, you can find such a definition as a disease of the bubonic plague. This is due to the fact that Bubon is one of the distinguctive signs of the disease - rounded swelling in the field of inflamed. In this case, there are other forms of infection, without the formation of bubo.

Plague - pathogen

For a long time it was incomprehensible than the bubonic plague was caused, the pathogen was discovered and tied with the disease only at the end of the XIX century. They were a gram-negative bacterium from the Enterobacteria family - a plague stick (Yersinia Pestis). The pathogen was well studied, it was revealed by several subspecies and the following features were established:

• may have a different shape - from filamentous to spherical;
• long-term preservation of viability in the discharge of patients;
• good tolerance of low temperatures, freezing;
• high sensitivity to disinfectants, sunlight, sour reaction medium, high temperatures;
• contains about thirty antigenic structures, allocates endo and exotoxins.

Plague - methods of penetration of bacteria in the human body

It is important to know how the plague of man is passed to man, as well as from other living beings. The plague wand circulates in natural infectious foci in the organisms of animal carriers, which include wild rodents (gopters, crops, voles), gray and black rats, houses, cats, bay, camels. The pathogens are flears (distributors) of pathogens are fleas of different types and several types of bloodsowing ticks that are infected with the causative agent of the disease when feeding in patients with animals containing a plaque chum.

They distinguish the transfer of the pathogen through fleas from the animal carriers to a person and from a person to man. Let us list the possible ways of penetrating the plague in the human body:

1. Transmissible - getting into the bloodstream after the bite of an infected insect.
2. Contact - When contacting a person having a microtraum on the skin or mucous membranes, with bodies of infected animals (for example, when cutting a carcass, skin processing).
3. Alimentary - through the gastrointestinal tract when eating meat of sick animals that have not passed sufficient heat treatment, or other saming products.
4. Contact-household - with the touch of a patient person, contacting with its biological fluids, the use of dishes, personal hygiene objects, and the like.
5. Aerosol - From man to man through mucous respiratory tract with coughing, sneezing, close conversation.

Plague - human symptoms

The path of the pathogen depends on what form of the disease will develop, with the defeat of which organs with what manifestations. The following main forms of human plague are distinguished:

• bubonic;
• pulmonary;
• septic;
• intestinal.

In addition, there are such rare forms of pathology, like skin, pharyngal, meningeal, asymptomatic, abortive. Plague's disease has an incubation period from 3 to 6 days, sometimes 1-2 days (with a primary pulmonary or septic form) or 7-9 days (in the graft or already suffered patients). For all forms, a sudden start with pronounced symptoms and intoxication syndrome, manifested in the following:

• high body temperature;
• chills;
• headache;
• muscular and articular pain;
• nausea;
• vomiting;
• strong weakness.

As the disease develops, the appearance of the patient changes: the face becomes puffed, hyperemic, the eye proteins are blushing, lips and tongue are dry, dark circles appear under the eyes, the face expresses fear, horror ("Mask of Plague"). In the future, the patient disrupts consciousness, becomes illegible, the coordination of movements is disturbed, delirium and hallucinations appear. In addition, specific lesions are developing, depending on the form of the plague.

Bubon Plague - Symptoms

Statistics show that the bubonic plague is the most common variety of the disease, which develops in 80% infected when penetrating the pathogenic bacterium through mucous and skin. In this case, the infection spreads through the lymphatic system, causing the defeat of the inguinal lymph nodes, in rare cases - axillary or cervical. The resulting bubos are solid and multiple, they can vary from 3 to 10 cm, and in their development they often pass several stages:

Pneumonic plague

Such a form is diagnosed in 5-10% of patients, while the disease of the plague is developing after the aerogenic infection (primary) or as a complication of the bubonic form (secondary). This is the most dangerous variety, and specific signs of the plague in humans in this case are noted by about 2-3 days, after the start of acute intoxication symptoms. The pathogen affects the walls of the pulmonary alveoli, causing necrotic phenomena. Distinctive manifestations are:

• rapid breathing, shortness of breath;
• cough;
• wet selection - at first foamy, transparent, then - with strengths of blood;
• pain in the chest;
• tachycardia;
• flow of blood pressure.

Septic form of plague

The primary septic form of plague, developing when penetrating a massive dose of microbes in the bloodstream, is rare, but it takes very hard. Inxication signs occur lightning, as the pathogen applies to all organs. There are numerous hemorrhages in leather and mucous tissues, conjunctiva, intestinal and renal bleeding, early development. Sometimes this form proceeds as a secondary complication of other varieties of plague, which is manifested by the formation of secondary bubons.

Intestinal form of plague

Not all experts identify the intestinal variety of plague separately, considering it as one of the manifestations of the septic form. When intestinal plague is developing signs of disease in people against the background of general intoxication and fever are recorded as follows:

• sharp abdominal pains;
• multiple bloody vomiting;
• diarrhea with mucous-bloody stool;
• tenses - painful urge for intestinal emptying.

Plague - Diagnosis

The meaningful role is played when the diagnosis of "Plague" laboratory diagnostics, carried out by the following methods:

• serological;
• bacteriological;
• microscopic.

For the study, blood is taken, punctures from tapes, separated by ulcers, sputum separated by the rotogling, vomit masses. To check the presence of the causative agent, the selected material can be grown on special nutrient media. In addition, X-ray of lymph nodes, lungs. It is important to establish the fact of bite insects, contact with patients with animals or people, visiting zones endemic by plague.

Plague - Treatment

In suspected or diagnosing pathology, the patient is urgently hospitalized into an infectious hospital in an isolated boxing, from which direct air outflow is excluded. Treatment of plague in humans is based on such events:

• reception of antibiotics, depending on the form of the disease (, tetracycline, streptomycin);
• disintellation therapy (albumin, refooliglyukin, hemodez);
• the use of drugs to improve microcirculation and repair (trental, peyonal);
• antipyretic and symptomatic therapy;
• supporting therapy (vitamins, heartbreaks);
• - with septic lesion.

During the fever, the patient must comply with bed regime. Antibiotic therapy is carried out for 7-14 days, after which the control studies of biomaterials are appointed. The patient is discharged after complete recovery, as evidenced by the receipt of a three-time negative result. The success of treatment is largely depends on the timeliness of the detection of plague.

Preventive measures in the human body

To prevent the spread of infection, nonspecific preventive measures are carried out, including:

• analysis of information about the incidence of plague in different countries;
• identification, insulation and treatment of people with suspected pathology;
• disinfection of transport arriving from disadvantaged in relation to the plague of the regions.

In addition, work is constantly carried out in the natural foci of the disease: the accounting of the number of wild rodents, the study of them on the identification of plague bacteria, the destruction of infected individuals, the fight against fleas. When identifying even one patient in the settlement, such anti-epidemic measures are held:

• overlay quarantine with a prohibition of entry and leaving people for several days;
• insulation of people in contact with the patients of the Chuma;
• disinfection in the foci of the disease.

People who were in contact with the fallen plane, with a prophylactic goal, is introduced by antibiotic serum in combination with antibiotics. Vaccination from the plague to a person of a living plague vaccine is placed in such cases:

• when in the natural foci of infection or the upcoming departure to the unfavorable area;
• when working associated with possible contact with sources of infection;
• with the wide distribution of infection among animals in the vicinity of settlements.

Plague - incidence statistics

Thanks to the development of medicine and maintain interstate prevention measures, the disease of the plague rarely proceeds largely. In ancient times, when drugs were not invented from this infection, mortality was almost 100%. Now these numbers do not exceed 5-10%. At the same time, how many people died from the plague in the world lately, can not fail.

Plague in the history of mankind

Plague in the history of mankind left destructive traces. The largest epidemics are considered:

• "Justinian Plaby" (551-580), which began in Egypt, from which more than 100 million people died;
• epidemic "Black Death" (XIV century) in Europe, brought from East China, which carried about 40 million lives;
• plague in Russia (1654-1655) - about 700 thousand deaths;
• plague in Marseille (1720-1722) - 100 thousand people died;
• pandemic of plague (the end of the XIX century) in Asia - more than 5 million people died.

Plague today

The bubonic plague is found in all continents, except Australia and Antarctica. In the period from 2010 to 2015, more than 3 thousand cases of the disease were diagnosed, while the fatal outcome was observed in 584 infected. Most cases are registered in Madagascar (more than 2 thousand). Foci of plague is noted in countries such as Bolivia, USA, Peru, Kyrgyzstan, Kazakhstan, Russia and others. Endemic in chum by the regions of Russia are: Altai, East-Ural region, Stavropol, Transbaikalia, Caspian lowland.

What is a plague and why is it called black death?

Plague is a severe infectious disease that leads to large-scale epidemics and often ends with the death of a fallen person. Iersinia Pestis is caused by bacterium, which was discovered at the end of the 19th century by the French scientist A. Yersen and the Japanese researcher S. Kitazato. At the moment, the pathogens of the plague have been studied quite well. In developed countries, outbreaks of the disease of the plague happen extremely rarely, but it was not always. The first epidemic of the plague described in the sources happened in the VI century in the Roman Empire. Then the disease fell about 100 million people. After 8 centuries, the History of the plague was repeated in Western Europe and the Mediterranean, where more than 60 million people died. The third large-scale epidemic began in Hong Kong at the end of the XIX century and quickly spread in more than 100 port cities of the Asian region. In only India, the plague led 12 million people to death. For the hardest consequences and characteristic symptoms of the plague are often called "black death." She really does not spare neither adults or children and in the absence of treatment "kills" more than 70% of infected people.

Currently, the plague is rare. Nevertheless, on the globe still remain natural foci, where the causative agents of infection are regularly detected from rodent living there. The latter, by the way, are the main carriers of the disease. In the human body, the deadly bacteria of the plague fall through fleas who are looking for new owners after the mass death of infected rats and mice. In addition, the air-drip path of transmitting an infection, which, in fact, is determined by the rapid spread of the plague and the development of epidemics.

In our country, the endemic in the plague of the regions includes Stavropol, Transbaikalia, Altai, Caspian lowland and the East-Ural region.

Etiology and pathogenesis

The plague pathogens are resistant to low temperatures. They are well preserved in sputum and easily transmitted from man to man with air-droplet. When the bite of fleas on the affected skin, a small papule appears, filled with hemorrhagic content (skin plague). After that, the process quickly applies to lymphatic vessels. They created ideal conditions for breeding bacteria, which leads to the explosive growth of the pathogens of the plague, their merger and education of conglomerates (bubonic plague). It is possible to penetrate bacteria into the respiratory system with the further development of the pulmonary form. The latter is extremely dangerous, as it is characterized by a very rapid flow and covers huge areas due to the intensive distribution between the members of the population. If the plant's treatment begins too late, the disease passes into a septic shape, which affects absolutely all organs and systems of the body, and in most cases ends with the death of man.

Plague - Symptoms of Disease

The symptoms of the disease of the plague appear in 2 - 5 days. The disease begins acutely from chills, a sharp increase in body temperature to critical marks, drop in blood pressure. In the future, neurological symptoms are joined in these features: nonsense, coordination breach, confusion. Other characteristic manifestations of "black death" depend on the specific form of infection.

• bubonic plague - the lymph nodes, liver, spleen increase. Lymph nodes become solid and extremely painful, fill in pus, which over time breaks out. Incorrect diagnosis or inadequate treatment of plague lead to the patient's death by 3-5 days after infection;
• the pulmonary plague is striking the lungs, patients complain about cough, abundant spending sputum, in which there are blood clots. If you do not start treatment in the first hours after infection, then all further activities will be ineffective and the patient will die within 48 hours;
• septic plague - symptoms indicate the spread of pathogens literally for all organs and systems. A person dies maximum during the day.

Doctors are known and the so-called small form of the disease. It is manifested by a slight rise in body temperature, an increase in lymph nodes and headache, but usually these signs disappear by themselves in several days.

Treatment of plague

The diagnosis of plague is carried out on the basis of laboratory sowing, immunological methods and polymerase chain reactions. If the patient has a bubonic plague or any other form of this infection, then it is immediately hospitalized. In the treatment of plague in such patients, the staff of the medical institution is obliged to comply with strict precautions. Doctors should wear 3-layer gauze bandages, protective glasses to prevent sputum on face, shoe covers and cap, fully closing hair. If there is an opportunity, special anticipate costumes are used. The compartment in which is the patient is isolated from other institutions.

If a man was found in a bubonic plague, it is introduced with streptomycin intramuscularly 3-4 times a day and tetracycline antibiotics intravenously. With intoxication, patients show saline solutions and hemodes. The decrease in blood pressure is considered as a reason for urgent therapy and resuscitation measures in the event of an increase in the intensity of the process. The pulmonary and septic shape of the plague require increasing doses of antibiotics, immediately relieving intravascular coagulation syndrome, introducing fresh blood plasma.

Thanks to the development of modern medicine, large-scale epidemics of the plague have become a big rarity, and at present patient mortality does not exceed 5-10%. It is fair for those cases when the plague treatment begins on time and complies with the established rules and standards. For this reason, with any suspicions for the presence in the body of pathogens, the plague doctors are obliged to conduct an urgent hospitalization of the patient and warn organs involved in the propagation of infectious diseases.

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The emasculate agent is a plague wand. And the main reservoir of infection in nature serve rodents and hares.

Also, predators who hunt animals of these species can distribute the infection.

The plague carrier is flea, when the bite of which is the contamination of a person. Also transmit infection can human lice and ticks.

Also penetration of the plague in the human body is possible when processing the skins of infected animals or when eating the meat of an animal, a chuma.

From person to man, the disease is transmitted by air-droplet.

A person has high susceptibility to Fozya infection!

Symptoms of the plague

There are quite a lot of plague varieties, but the bubonic form is most often found.

The plague is characterized by a sharp, sudden beginning with the strongest chills and an increase in body temperature. They are joined by dizziness, weakness, muscle pain, nausea and vomiting.

The nervous system of patients are frightened, restless, can wander, tend to escape somewhere.

Coordination of movements, gait, speech.

For bubonic plague is characterized by the development or a plague bubon. In the field of its appearance, the patient is experiencing severe pain. A dense tumor with fuzzy edges is gradually formed, sharply painful when touched. The leather over the bowl is at the beginning of the usual color, hot to the touch, then it becomes dark red, with a blue tint, glans.

There is also an increase in other groups of lymphatic nodes formed secondary buboons.

In the absence of treatment, the bubers are applied, then open and transformed into fistulas. Then they gradually lose their healing.

Complications of plague

In most cases, the disease is complicated by the DVS syndrome, that is, disseminated intravascular blood coagulation.

10% of patients have gangrene stop, fingers or skin.

Diagnosis of plague

The diagnosis of plague is based on epidemiological data. Currently, all natural foci of the plague is strictly registered. Also, for the formulation of the diagnosis, characteristic clinical manifestations of the disease are important. The bacterioscopic study of the bubon point and separated by an ulcer is also carried out.

Treatment of plague

First of all, the people, a sick plague, should be hospitalized into an infectious hospital.

The main drugs in the treatment of the disease are antibacterial agents.

The discharge of the patient who had a champ, from an infectious hospital, is made after complete recovery, the disappearance of symptoms of the disease and a three-year negative result of bacteriological sowing.

With a bubonic chum, the extract is carried out no earlier than after 1 month from the date of recovery.

Recovered people are on dispensary accounting from for 3 months after the disappearance of the last signs of the disease.

Apply to the ancient world. So, Rufus from Ephesus, who lived in the time of Emperor Trajan, referring to more ancient doctors (the names of which were not reached by NC), described several cases of the disease in a certain bubonic plague in Libya, Syria and Egypt.

The Philistines did not calm down and for the third time they transported a military trophy, and with him and a plague in the city of Askalon. In the same place, all the owner of the Film - the kings of the five cities of Filins were gathered, "and they decided to return the ark of the Israelis, because they realized that this was the only way to prevent the spread of the disease. And the head of the atmosphere that reigned in the doomed city ends. "And those who have not died, amazed were growing, so the cry of the city went to heaven" (1). Chapter 6 shows the advice of all the dominates of the Philistines, who called for priests and priests. Those advised to bring to God to the victim of the Means - put in the ark, before returning to his Israelis, gifts. "According to the number of dominates of Philistine five gold and five gold mice, devastating land; For the execution is alone on all of you, and on the dominates of yours "(1 sir.). This biblical tradition is interesting in many ways: it contains a hidden message about the epidemic that covers, most likely, all five cities of philisons. We could talk about the bubonic plague, hitting people from Mala to Velika and accompanied by the appearance of painful growths in the groin - bubons. The most noteworthy - the priests of Philistines, apparently, tied this disease with the presence of rodents: from here and gold sculptures of mice, "empty land".

There is another place in the Bible that consider a record certifying another case of the plague epidemic. In the fourth book of kingdoms (4car.) It is narrating on the campaign of the Assyrian king Sinaherib, who decided to devastate Jerusalem. The huge army surrounded the city, but did not take possession of them. And soon, Sinaiherib departed without a fight with the residues of the army, in which the "Angel of the Lord" struck 185 thousand soldiers per night (4car.).

Epidemic of the plague in historical time

Plague as a biological weapon

The use of the plague pathogen as biological weapons has deep historical roots. In particular, events in ancient China and medieval Europe showed the use of corpses of infectious animals (horses and cows), human bodies of Huns, Turks and Mongols to infect water sources and water supply systems. There are historical certificates on cases of catapulting of an infected material during the siege of some cities (siege of Cuff).

Modern condition

Every year, the number of fallen plans is about 2.5 thousand people, and without a tendency to decline.

According to reports, according to the World Health Organization since 1989 to 2004, about forty thousand cases in 24 countries were recorded, and the mortality was about 7% of the number of cases. In some countries of Asia (Kazakhstan, China, Mongolia and Vietnam), Africa (Congo, Tanzania and Madagascar), the Western Hemisphere (US, Peru) cases of people infection are registered almost annually.

At the same time, in the territory of Russia, annually in the territory of natural foci (with a total area of \u200b\u200bmore than 253 thousand km²) under the risk of infection there are more than 20 thousand people. For Russia, the situation is complicated by the annual detection of new meals in neighboring countries (Kazakhstan, Mongolia, China), imports through transport and trading flows from the countries of Southeast Asia of the Specific Carrier of Plagot - Bloch Xenopsylla Cheopis. .

From 2001 to 2006, 752 strains of the plague of the plague were recorded in Russia. At the moment, the most active natural foci are located in the territories of the Astrakhan region, the Kabardino-Balkarian and Karachay-Cherkess Republic, the Republics of Altai, Dagestan, Kalmykia, Tyva. Of particular alarms causes the lack of systematic observation of the activity of foci located in the Ingush and Chechen Republics.

In July 2016, in Russia, a ten-year-old boy was delivered to the Hospital of Kosh-Agachsky District of the Republic of the Republic of Altai.

In 2001-2003, 7 cases of Chuma's disease were registered in the Republic of Kazakhstan (with one fatal outcome), in Mongolia - 23 (3 lethal exodus), in China, in 2001-2002, 109 people (9 lethal outcomes) were ill. The forecast of the epizootic and epidemic situation in neighboring the Russian Federation of natural foci of the Republic of Kazakhstan, China and Mongolia remains unfavorable.

At the end of August 2014, an outbreak of plague once again happened at Madagascar, which by the end of November 2014 took 40 lives from 119 sick.

Forecast

Under the conditions of modern therapy, the mortality rate during tambon form does not exceed 5-10%, but at other forms, the percentage of recovery is high enough if the treatment is started early. In some cases, a fleeting septic form of the disease is possible, which is weakly permanent diagnosis and treatment ("lightning form of plague").

Infection

The pathogel of the plague is resistant to low temperatures, is well maintained in sputum, but at a temperature of 55 ° C, it dies for 10-15 minutes. And when boiling is almost instant. The gate of infection - damaged skin (when the bite of fleas, as a rule, Xenopsylla Cheopis.), the mucous membranes of the respiratory tract, the digestive tract, conjunctiva.

According to the main carrier, natural foci of the plague is divided into gosnikovy, dry, sandy, half and edible. In addition to wild rodents, the so-called synantropic rodents (in particular, rats and miserable) are sometimes included in the epizootic process, as well as some wild animals (hares, foxes), which are the object of hunting. Camels sick camels from Pets.

In the natural focus, infection usually occurs through the bite of fleas previously fed on a sick rodent. The probability of infection significantly increases with the inclusion in the epizoty of synanthropic rodents. Infection occurs also when hunting rodents and their further processing. Massive diseases of people occur when climbing the patient of the camel, remove the skins, cutting, recycling from it. An infected person in turn is a potential source of plague, the transfer of the pathogen from which another person or animal, depending on the form of the disease, can be carried out by air-drip, contact or transmissible way.

The fleas are a specific carrier of the pathogen of the plague. This is due to the characteristics of the device of the flea digestive system: before the stomach, flea esophagus forms thickening - goiter. With the bite of an infected animal (rat), the plague bacteria settles the flea in the goiter and begins to multiply intensively, fully clogging it (so on. "Plague block"). Blood can not get into the stomach, so flea joins the blood along with the causative agent back into the wound. And since such a flea is constantly tormented by a feeling of hunger, she moves from the owner to the owner in the hope of getting his portion of blood and manage to infect a large number of people before dying (such fleas live no more than ten days, but experiments on rodents showed that one flea May infect up to 11 hosts).

In the bite of flea-infected bacteria in humans in the place of bite, there may be papula or pustula filled with hemorrhagic content (skin). The process is then propagated by lymphatic vessels without the manifestation of lymphangitis. The reproduction of bacteria in the macrophages of lymph nodes leads to their sharp increase, the merger and education of the conglomerate ("Bubon"). Further generalization of infection, which is not strictly mandatory, especially in the conditions of modern antibacterial therapy, can lead to the development of septic form, accompanied by the defeat of almost all internal organs. With epidemiological positions, it is important that there is a plastic bacteremia, as a result, a sick person itself becomes a source of infection with contact or transmissible way. However, the most important role is played by the "seferences" of infections into a lightweight tissue with the development of a light-shaped disease. Since the development of plague pneumonia, a human form of illness is already transmitted to a person - an extremely dangerous, with a very rapid flow.

Symptomatics

The bubonic form of the plague is characterized by the appearance of sharply painful conglomerates, most often inguinal lymph nodes on the one hand. The incubation period is 2-6 days (less often 1-12 days). Within a few days, the size of the conglomerate increases, the skin above it can become hyperemic. At the same time, an increase and other groups of lymph nodes appear - secondary buboons. The lymph nodes of the primary focus are softening, in their puncture, purulent or hemorrhagic contents are obtained, the microscopic analysis of which reveals a large amount of gram-negative with bipolar staining of the sticks. In the absence of antibacterial therapy, ventulous lymph nodes are opened. Then there is a gradual healing of fistula. The severity of the patients is gradually growing to the 4-5th day, the temperature can be increased, sometimes high fever immediately appears, but at first the patient's condition often remains as a whole satisfactory. This explains the fact that a person sick bubonic plague can fly from one part of the world to another, considering herself healthy.

However, at any time, the bubonic form of plague can cause the process to generalize and move into a secondary-septic or secondary-eagle form. In these cases, the patient's condition is very quickly becoming extremely difficult. Symptoms of intoxication increases by the hour. The temperature after the strongest chill rises to high febrile digits. All signs of sepsis are noted: muscle pain, sharp weakness, headache, dizziness, loading of consciousness, up to his loss, sometimes excitement (patient torn in bed), insomnia. With the development of pneumonia, cyanosis is growing, cough appears with the separation of the foam bleeding sputum containing a huge number of chopsticks of the plague. It is this sputter and becomes a source of infections from a person to a person with a development now already primary lighting plague.

Septic and light shapes of the plague flow, like any heavy sepsis, with manifestations of disseminated intravascular syndrome: the appearance of small hemorrhages on the skin, it is possible to bleeding from the gastrointestinal tract (severe mass, melon), pronounced tachycardia, fast and requiring corrections ( Dopamine) drop in blood pressure. Auscultative - a picture of bilateral focal pneumonia.

Clinical picture

The clinical picture of the primary septic or primary light shape is not fundamentally different from the secondary forms, but the primary forms often have a shorter incubation period - up to several hours.

Diagnosis

Epidemiological history is played in the diagnosis in modern conditions. Arrival from zones endemic in plague (Vietnam, Burma, Bolivia, Ecuador, Karakalpakia, etc.), or from anticipated stations of the patient with the signs described above, or with signs of severe - with hemorrhages and bloody moocroty - pneumonia with severe lymphadenopathy is for The first contact doctor has a sufficiently serious argument to make all the localization measures of the alleged plague and the exact diagnostics. It is necessary to emphasize that in the conditions of modern drug prevention, the likelihood of personnel disease, which some time has contacted with coughing patients with plague, quite small. Currently, cases of primary lighting plague (that is, cases of infection from man to man) among medical staff is not observed. The establishment of accurate diagnosis must be carried out with the help of bacteriological research. The material for them is the puncture of the ventilated lymphatic assembly, the sputum, the blood of the patient separated by fistula and ulcers.

Laboratory diagnostics is carried out with a fluorescent specific antiserum, which stains the smears of separated ulcers, the delicate of lymph nodes, culture obtained on the blood agar.

Treatment

In the Middle Ages, the plague was practically not treated, the actions were carried out mainly to cutting or causing plague bubons. No one knew the genuine cause of the disease, so there was no idea how to treat it. Doctors tried to use the most bizarre funds. The composition of one such drug included a mixture of 10-year-old molasses, finely chopped snakes, wines and 60 other components. According to another method, the patient in turn was to sleep on the left side, then on the right. Starting from the XIII century, the epidemic of plague is trying to limit with quarantines.

Fracture in the therapy of the plague was achieved in 1947, when Soviet doctors were the first in the world to be applied to the treatment of plague in Manchuria Streptomicin. As a result, all the patients who were treated with streptomycin, including a patient with a light chum, who was already considered hopeless was recovered.

Treatment of patients with plates is currently carried out with the help of antibiotics, sulfonamides and therapeutic anticipated serum. Prevention of possible foci of the disease is to carry out special quarantine events in port cities, the deratization of all vessels that run international flights, creating special anticipate institutions in steppe areas where rodents are found, identifying the epizootes of plague among rodents and the fight against them.

Anticipable Sanitary Activities in Russia

If suspicious of the plague, the sanitary and epidemiological station of the district is immediately informed. Fills the notice of the doctor who suspected an infection, and its shipment provides the chief physician of the institution, where such a patient was found.

The patient must be immediately hospitalized in the infectious hospital box. A physician or medium medical worker of a medical institution when detecting a patient or suspicious on the disease, Chumay is obliged to stop the reception of patients and prohibit entry and exit from the medical institution. Staying in the office, the Chamber, the medical worker must inform him the chief physician on the identification of the patient and require anticipate costumes and disinfectants.

In cases of reception of a patient with a lesion of lightly, a medical worker is obliged to handle with a solution of streptomycin, mouth, mouth and nose. In the absence of cough, it can be limited to the handling of the hands with disinfection solution. After taking measures to disunity with healthy in a medical institution or at home, they constitute a list of persons who have contact with patients, indicating the name, name, patronymic, age, place of work, profession, home addresses.

Before the arrival of the consultant from the opposition institution, the health worker remains in the focus. The question of its insulation is solved in each particular case individually. The consultant takes the material for bacteriological research, after which it is possible to begin specific treatment with antibiotic patients.

When identifying a patient in the train, an airplane, on a ship, at the airport, at the railway station, the actions of medical workers remain the same, although organizational measures will be different. It is important to emphasize that the insulation of a suspicious patient with the surrounding should be started immediately after it is detected.

The chief doctor of the institution, having received a message about identifying a suspicious patient's plague, takes measures to stop communicating between the hospital branches, the floors of the polyclinic, prohibits the exit from the building where the patient was found. Simultaneously organizes the transfer of emergency message to a higher organization and an anticipated institution. The form of information may be arbitrary with the obligatory presentation of the following data: surname, name, patronymic, the age of ill, place of residence, profession and place of work, date of detection, time to start the disease, objective data, preliminary diagnosis adopted primary polisization of the focus, position and The surname of the doctor who has revealed the sick. Simultaneously with information, the head requests consultants and the necessary assistance.

However, in certain situations, it may be more appropriate to make hospitalization (before establishing an accurate diagnosis) in the institution where the patient is in the time of the presence of plague. Therapeutic measures are inseparable from the prevention of personnel infection, which should immediately wear 3-layer gauze masks, shoes, handkerchief of 2 layers of gauze, fully closing hair, and protective glasses to prevent splashing splash on the mucous membrane of the eye. According to the rules established in the Russian Federation, the staff is mandatory for an anticipated suit or applies special tools for anti-infective protection properties. All personnel in contact with the patient remains for further assistance to him. A special medical post isolates the compartment, where there is a sick and attending his staff, from contact with other people. The toilet and procedural office must enter the isolated compartment. All staff immediately receives preventive treatment with antibiotics, ongoing all the days he spends in an insulator.

Plague treatment is complex and includes the use of etiotropic, pathogenetic and symptomatic means. Antibiotics of streptomycin row are most effective for the treatment of plague: streptomycin, dihydrostreycin, Pasomycin. At the same time, streptomycin is most widely used. With the bubonic form of the plague, intramuscin is introduced by intramuscularly streptomycin 3-4 times a day (daily dose of 3 g), tetracycline antibiotics (vibromycin, morphocyclin) in / in 4 g / day. When inxication in / in saline solutions, hemodez is introduced. The fall of blood pressure during the bubonic form should be regarded as a sign of process generalization, a sign of sepsis; At the same time, there is a need to carry out resuscitation activities, the introduction of dopamine, the establishment of a permanent catheter. In case of light and septic forms of plague, a dose of streptomycin increases to 4-5 g / day, and tetracycline - up to 6 g. With forms resistant to streptomycin, it is possible to introduce leftomycetin succinate to 6-8 g in / c. With the improvement of the state of the dose of antibiotics, reduce: streptomycin - up to 2 g / day until the temperature is normalized, but for at least 3 days, tetracyclines - up to 2 g / day daily inside, leftomycetin - up to 3 g / day, total 20-25 g / day A great success is used in the treatment of plague and bispetol.

In case of light, septic form, the development of hemorrhage immediately proceed to the relief of the disseminated intravascular coagulation syndrome: they carry out plastic bags (intermittent plasmapheresis in plastic bags can be carried out on any centrifuge with special or air-cooled with the capacity of its glasses 0.5 liters or more) in the amount of removable Plasma 1-1.5 liters when replacing the same amount of fresh frozen plasma. In the presence of hemorrhagic syndrome, the daily introduction of fresh frozen plasma should not be less than 2 liters. Before reliving the acute manifestations of Sepsis Plasmapheresis spend daily. The disappearance of the signs of hemorrhagic syndrome, the stabilization of blood pressure is usually under 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 a dummy is reduced to stabilize blood pressure, muscular pain sneeze, shortness of breath.

In the medical personnel team, providing a patient with a pulmonary or septic form of plague, there must be a specialist in intensive therapy.

see also

• Inquisitio.
• Plague (group)

Notes

1. Disease Ontology Release 2019-05-13 - 2019-05-13 - 2019.
2. Jared Daimond, guns, microbes and steel. Ead of human societies.
3. , from. 142.
4. Plague
5. , from. 131.
6. Plague - doctors, students, patients Medical portal, abstracts, cribs doctors, disease treatment, diagnosis, prevention
7. , from. 7.
8. , from. 106.
9. , from. five.
10. Papagrigorakis, manolis j.; Yapijakis, christos; Synodinos, Philippos N.; Baziotopoulou-Valavani, Effie (2006). "DNA EXIMINATION 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.