Bubonic plague - signs, symptoms and treatment. Should I be afraid of infection with the bacterium Yersinia Pestis? What kind of disease is the plague? How does the plague proceed?

– highly contagious bacterial infection with multiple routes of transmission and epidemic spread, occurring with feverish intoxication syndrome, damage to the lymph nodes, lungs and skin. Clinical course various forms plague is typical high fever, severe intoxication, agitation, excruciating thirst, vomiting, regional lymphadenitis, hemorrhagic rash, disseminated intravascular coagulation syndrome, as well as specific symptoms(necrotic ulcers, plague buboes, ITS, hemoptysis). Diagnosis of plague is carried out using laboratory methods (bacterial culture, ELISA, RNGA, PCR). Treatment is carried out under conditions of strict isolation: tetracycline antibiotics, detoxification, pathogenetic and symptomatic therapy are indicated.

ICD-10

A20

General information

Plague is an acute infection, transmitted predominantly by a transmissible mechanism, manifested by inflammation of the lymph nodes, lungs, and other organs, which is serous-hemorrhagic in nature, or occurs in a septic form. Plague treats the group especially dangerous infections.

Plague belongs to the group of especially dangerous infections. In the past, pandemics of the “Black Death,” as the plague was called, claimed millions of lives. History describes three global outbreaks of plague: in the 6th century. in the Eastern Roman Empire (“Justinian Plague”); in the 14th century in Crimea, the Mediterranean and Western Europe; in the late 19th century in Hong Kong. Currently, thanks to the development of effective anti-epidemic measures and an anti-plague vaccine, only sporadic cases of infection are recorded in natural foci. In Russia, plague-endemic areas include the Caspian lowland, Stavropol region, Eastern Urals, Altai and Transbaikalia.

Characteristics of the pathogen

Yersinia pestis is a nonmotile, facultative anaerobic Gram-negative rod-shaped bacterium from the genus Enterobacteriaceae. The plague bacillus can remain viable for a long time in the secretions of sick people and corpses (in bubonic pus Yersinia live up to 20-30 days, in the corpses of people and dead animals - up to 60 days), and can withstand freezing. To factors external environment (Sun rays, atmospheric oxygen, heating, changing the acidity of the environment, disinfection) this bacterium is quite sensitive.

The reservoir and source of plague are wild rodents (marmots, voles, gerbils, pikas). In various natural foci, they can serve as a reservoir. different types rodents, in urban conditions - mainly rats. Dogs resistant to human plague can serve as a source of pathogen for fleas. In rare cases (with the pneumonic form of plague, or in direct contact with bubonic pus), a person can become the source of infection; fleas can also receive the pathogen from patients with the septic form of plague. Often infection occurs directly from plague-infected corpses.

Plague is transmitted using a variety of mechanisms, the leading place among which is transmissible. The carriers of the plague pathogen are fleas and ticks of some species. Fleas infect animals that carry the pathogen through migration, also spreading fleas. People become infected by rubbing flea excrement into their skin while scratching. Insects remain infective for about 7 weeks (there is evidence of fleas being contagious throughout the year).

Infection with plague can also occur through contact (through damaged skin when interacting with dead animals, cutting up carcasses, harvesting skins, etc.), or nutritionally (by eating the meat of sick animals).

People have an absolute natural susceptibility to infection; the disease develops when infected by any route and at any age. Post-infectious immunity is relative and does not protect against re-infection, but repeated cases of plague usually occur in more severe cases. mild form.

Plague classification

Plague is classified into clinical forms depending on the predominant symptoms. There are local, generalized and externally disseminated forms. Local plague is divided into cutaneous, bubonic and cutaneous bubonic, generalized plague is primary and secondary septic, the externally disseminated form is divided into primary and secondary pulmonary, as well as intestinal.

Plague symptoms

The incubation period of the plague on average takes about 3-6 days (maximum up to 9 days). In case of mass epidemics or in the case of generalized forms incubation period may be shortened to one to two days. The onset of the disease is acute, characterized by the rapid development of fever, accompanied by stunning chills and severe intoxication syndrome.

Patients may complain of pain in the muscles, joints, and sacral region. Vomiting appears (often with blood), thirst (painful). From the very first hours, patients are in an excited state, and perception disorders (delusions, hallucinations) may be noted. Coordination is impaired and speech intelligibility is lost. Lethargy and apathy occur noticeably less often, patients weaken to the point of being unable to get out of bed.

The patient's face is puffy, hyperemic, the sclera is injected. In severe cases, hemorrhagic rashes are observed. A characteristic sign of the plague is a “chalky tongue” - dry, thickened, densely covered with a bright white coating. Physical examination shows severe tachycardia, progressive hypotension, shortness of breath and oliguria (up to anuria). In the initial period of plague, this symptomatic picture is observed in all clinical forms of plague.

Cutaneous form manifests itself in the form of a carbuncle in the area of introduction of the pathogen. The carbuncle progresses, passing through the following stages in succession: first, a pustule forms on the hyperemic, edematous skin (pronouncedly painful, filled with hemorrhagic contents), which, after opening, leaves an ulcer with raised edges and a yellowish bottom. The ulcer tends to get bigger. Soon a necrotic black scab forms in its center, quickly filling the entire bottom of the ulcer. After the scab is sloughed off, the carbuncle heals, leaving a rough scar.

Bubonic form is the most common form of plague. Buboes are specifically modified lymph nodes. Thus, with this form of infection, the predominant clinical manifestation purulent lymphadenitis is regional in relation to the area of penetration of the pathogen. Buboes, as a rule, are single, in some cases they can be multiple. Initially, there is soreness in the area of the lymph node; after 1-2 days, palpation reveals enlarged, painful lymph nodes, initially dense, which, as the process progresses, soften to a pasty consistency, merging into a single conglomerate welded to the surrounding tissues. The further course of the bubo can lead either to its independent resorption or to the formation of an ulcer, an area of sclerosis or necrosis. The height of the disease continues for a week, then a period of convalescence begins, and clinical symptoms gradually subsides.

Cutaneous bubonic form characterized by a combination of skin manifestations with lymphadenopathy. Local forms of plague can progress to secondary septic and secondary pneumonic forms. Clinical course these forms are no different from their primary counterparts.

Primary septic form develops at lightning speed, after a shortened incubation (1-2 days), is characterized by a rapid increase in severe intoxication, severe hemorrhagic syndrome (numerous hemorrhages in skin, mucous membranes, conjunctiva, intestinal and renal bleeding), rapid development of infectious-toxic shock. The septic form of plague without proper timely medical care ends in death.

Primary pulmonary form occurs in the case of an aerogenic route of infection, the incubation period is also reduced and can be several hours or last about two days. The onset is acute, characteristic of all forms of plague - increasing intoxication, fever. Pulmonary symptoms appear on the second or third day of the disease: there is a strong debilitating cough, first with transparent glassy sputum, later with foamy bloody sputum, chest pain, difficulty breathing. Progressive intoxication contributes to the development of acute cardiovascular failure. The outcome of this condition can be stupor and subsequent coma.

Intestinal form characterized by intense sharp pain in the abdomen with severe general intoxication and fever, soon joins frequent vomiting, diarrhea. The stool is profuse, mixed with mucus and blood. Often - tenesmus (painful urge to defecate). Given the widespread use of other intestinal infections, at present the question has not been resolved: is intestinal plague an independent form of the disease that developed as a result of microorganisms entering the intestines, or is it associated with the activation intestinal flora.

Diagnosis of plague

Due to the special danger of infection and the extremely high susceptibility to the microorganism, the pathogen is isolated in specially equipped laboratories. Material is collected from buboes, carbuncles, ulcers, sputum and mucus from the oropharynx. It is possible to isolate the pathogen from the blood. Specific bacteriological diagnostics produce for confirmation clinical diagnosis, or, with prolonged intense fever in patients, in an epidemiological focus.

Serological diagnosis of plague can be made using RNGA, ELISA, RNAT, RNAG and RTPGA. It is possible to isolate the DNA of the plague bacillus using PCR. Nonspecific diagnostic methods - blood test, urine test (a picture of acute bacterial infection is noted), in the pulmonary form - chest X-ray (signs of pneumonia are noted).

Treatment of plague

Treatment is carried out in specialized infectious diseases departments of the hospital, under conditions of strict isolation. Etiotropic therapy is carried out with antibacterial agents in accordance with clinical form diseases. The duration of the course takes 7-10 days.

For the cutaneous form, co-trimoxazole is prescribed, for the bubonic form, intravenous chloramphenicol with streptomycin. Tetracycline antibiotics can also be used. Tetracycline or doxycycline is supplemented with a complex of chloramphenicol and streptomycin for plague pneumonia and sepsis.

Nonspecific therapy includes a complex of detoxification measures ( intravenous infusion saline solutions, dextran, albumin, plasma) in combination with forcing diuresis, agents that help improve microcirculation (pentoxifylline). If necessary, cardiovascular, bronchodilator, and antipyretic drugs are prescribed.

Prognosis for plague

Currently, in modern hospitals when using antibacterial agents The mortality rate from the plague is quite low - no more than 5-10%. Early health care, prevention of generalization contributes to recovery without significant consequences. In rare cases, transient plague sepsis (fulminant form of plague) develops, which is difficult to diagnose and treat, often resulting in rapid death.

Prevention of plague

Currently, in developed countries there is practically no infection, so the main preventive actions are aimed at eliminating the import of the pathogen from epidemiologically dangerous regions and sanitizing natural foci. Specific prevention consists of vaccination with a live plague vaccine, administered to the population in areas with an unfavorable epidemiological situation (prevalence of plague among rodents, cases of infection of domestic animals) and to persons traveling to regions with increased danger infection.

Identification of a plague patient is an indication for taking urgent measures by isolating it. In case of forced contact with patients, they use means individual prevention– anti-plague suits. Contact persons are observed for 6 days; in case of contact with a patient with pneumonic plague, prophylactic antibiotic therapy is administered. Patients are discharged from the hospital no earlier than 4 weeks after clinical recovery and negative tests for bacterial excretion (for pulmonary form - after 6 weeks).

Plague is a serious infectious disease that occurs with increased body temperature and damage to the lungs and lymph nodes. Often, against the background of this disease, an inflammatory process develops in all tissues of the body. The disease has a high mortality threshold.

Historical reference

Throughout history modern humanity there was no such merciless disease as the plague. To this day, information has reached that in ancient times the disease claimed the lives of a large number of people. Epidemics usually began after direct contact with infected animals. Often the spread of the disease turned into a pandemic. History knows three such cases.

The first was called the Justinian Plague. This case of pandemic was recorded in Egypt (527-565). The second was called Great. The plague raged in Europe for five years, taking the lives of about 60 million people. The third pandemic occurred in Hong Kong in 1895. It later spread to India, where more than 10 million people died.

One of the largest epidemics was in France, where the famous psychic Nostradamus lived at that time. He tried to fight the Black Death with the help of herbal medicine. He mixed Florentine iris, cypress sawdust, cloves, aloe and fragrant calamus with rose petals. From the resulting mixture, the psychic made so-called pink pills. Unfortunately, the plague in Europe claimed his wife and children.

Many cities where death reigned were completely burned. Doctors, trying to help the sick, dressed in anti-plague armor (long leather cloak, mask with a long nose). Doctors placed various herbal teas. Oral cavity They rubbed it with garlic and stuck rags in their ears.

Why does plague develop?

Virus or illness? This disease is caused by a microorganism called Yersonina pestis. This bacterium remains viable for a long period of time. It exhibits resistance to the heating process. The plague bacterium is quite sensitive to environmental factors (oxygen, sunlight, changes in acidity).

The source of the disease is wild rodents, usually rats. In rare cases, humans act as a carrier of the bacterium.

All people have a natural susceptibility to infection. Pathology can develop against the background of infection in absolutely any way. Post-infectious immunity is relative. However, repeated cases of infection usually occur in an uncomplicated form.

What are the signs of the plague: symptoms of the disease

The incubation period of the disease ranges from 3 to approximately 6 days, but in a pandemic it can be reduced to a day. The plague begins acutely and is accompanied by sharp increase temperature, Patients complain of discomfort in the joints, vomiting with blood. In the first hours of infection, signs are observed. The person becomes overly active, he is haunted by the desire to run somewhere, then hallucinations and delusions begin to appear. The infected person cannot speak or move clearly.

From external symptoms One can note facial hyperemia. The facial expression takes on a characteristic pained look. The tongue gradually increases in size and a white coating appears on it. The occurrence of tachycardia and a decrease in blood pressure are also noted.

Doctors distinguish several forms of this disease: bubonic, cutaneous, septic, pulmonary. Each option is different characteristic features. We will talk about them later in this article.

Bubonic plague

Bubonic plague is the most common form of the disease. Buboes refer to specific changes in the lymph nodes. They are, as a rule, singular in nature. Initially, there is soreness in the area of the lymph nodes. After 1-2 days they increase in size, acquire a dough-like consistency, and the temperature rises sharply. The further course of the disease can lead to either spontaneous resorption of the bubo or the formation of an ulcer.

Skin plague

This form of pathology is characterized by the appearance of carbuncles in the area where the pathogen has entered the body. Plague disease is accompanied by the formation of painful pustules with reddish contents on the skin. Around them there is an area of infiltration and hyperemia. If you open a pustule yourself, an ulcer appears in its place. yellow pus. After some time, the bottom becomes covered with a black scab, which is gradually torn away, leaving behind scars.

Pneumonic plague

Pneumonic plague is the most dangerous form of the disease from an epidemic point of view. The incubation period ranges from several hours to two days. On the second day after infection, a severe cough appears, pain in the chest area, and shortness of breath occur. An x-ray shows signs of pneumonia. The cough is usually accompanied by foamy and bloody discharge. As the condition worsens, disturbances in consciousness and functioning of the main systems of internal organs are observed.

Septicemic plague

The disease is characterized by rapid development. Septicemic plague is a rare pathology that is characterized by the appearance of hemorrhages in the skin and mucous membranes. Symptoms of general intoxication gradually increase. The breakdown of bacterial cells in the blood increases the content of toxic substances. As a result, the patient's condition deteriorates sharply.

Diagnostic measures

Due to the special danger of this pathology and high susceptibility to bacteria, isolation of the pathogen is carried out exclusively in laboratory conditions. Specialists collect material from carbuncles, sputum, buboes and ulcers. Isolation of the pathogen from the blood is allowed.

Serological diagnosis is carried out using the following tests: RNAG, ELISA, RNGA. It is possible to isolate pathogen DNA using PCR. Nonspecific diagnostic methods include blood and urine tests, and chest x-rays.

What treatment is required?

Patients diagnosed with plague, the symptoms of which appear within a few days, are placed in special boxes. As a rule, this is a single room, equipped with a separate toilet and always with double doors. Etiotropic therapy is carried out with antibiotics in accordance with the clinical form of the disease. The duration of treatment is usually 7-10 days.

For the cutaneous form, Co-trimoxazole is prescribed, for the bubonic form, Levomycetin is prescribed. To treat the pulmonary and septic variants of the disease, Streptomycin and Doxycycline are used.

Additionally, symptomatic therapy is provided. Antipyretics are used to reduce fever. Steroid hormones are prescribed to restore blood pressure. Sometimes it is necessary to support the functioning of the lungs and replace their functions.

Forecast and consequences

Currently, provided that the doctor’s recommendations for treatment are followed, the mortality rate from plague is quite low (5-10%). Timely medical care and prevention of generalization contribute to recovery without serious health consequences. In rare cases, fulminant sepsis is diagnosed, which is difficult to treat and often leads to death.

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

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

Plague epidemics in historical times

Several major epidemics have occurred mid-17th century century. In Russia the victims epidemics of 1654-1655 became about 700 thousand people. The Great London Epidemic of 1664-1665 killed almost a quarter of the city's population.

Plague as a biological weapon

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

Current state

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

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

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

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

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

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

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

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

Forecast

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

Infection

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

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

IN 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 included in epizootic synanthropic rodents. Infection also occurs during hunting of rodents and their further processing. Massive human diseases occur when a sick camel is slaughtered, skinned, butchered, or processed. 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: just before the stomach, the flea's esophagus forms a thickening - a goiter. When an infected animal (rat) is bitten, the plague bacterium settles in the flea’s crop and begins to multiply intensively, completely clogging it (the so-called “plague block”). Blood cannot enter the stomach, so the flea regurgitates the blood along with the pathogen back into the wound. And since such a flea is constantly tormented by a feeling of hunger, it moves from owner to owner in the hope of getting its share of blood and manages to infect a large number of people before dying (such fleas live no more than ten days, but experiments on rodents have shown that one flea can infect up to 11 hosts).

When bitten by fleas infected with plague bacteria, a person may experience papule or pustule, filled with hemorrhagic contents (cutaneous form). The process then spreads across lymphatic vessels without manifestation lymphangitis. Reproduction of bacteria in macrophages lymph nodes leads to their sharp increase, merger and formation of a conglomerate (“ bubo"). Further generalization of the infection, which is not strictly necessary, especially in modern conditions antibacterial therapy, can lead to the development of a septic form, accompanied by damage to almost all internal organs. From an epidemiological point of view, it is important that the plague develops bacteremia As a result, the sick person himself becomes a source of infection through contact or transmission. However vital role play “screenings” of infection into the lung tissue with the development pulmonary form of disease. Since the development of plague pneumonia from person to person by airborne droplets The pulmonary form of the disease is already being transmitted - extremely dangerous, with a very rapid course.

Symptoms

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

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

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

Clinical picture

The clinical picture of the primary septic or primary pulmonary form is not fundamentally different from the 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 plays epidemiological anamnesis. Coming from areas endemic for plague ( Vietnam , Burma , Bolivia , Ecuador , Karakalpakstan etc.), or from anti-plague stations of a patient with the above-described signs of the bubonic form or with the most severe signs - with hemorrhages and bloody sputum - pneumonia with pronounced lymphadenopathy is a sufficiently serious argument for the doctor of first contact to take all measures to localize the suspected plague and accurately diagnose it. It should be especially emphasized that in the conditions of modern drug prevention, the likelihood of illness among personnel who have been in contact with a coughing plague patient for some time is very small. Currently, cases of primary pneumonic plague (that is, cases of infection from person to person) among medical personnel not visible. Establishing the exact diagnosis must be carried out using bacteriological studies. The material for them is punctate suppurating lymph node, sputum , blood patient, discharge fistulas and ulcers.

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

Treatment

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

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

Treatment of plague patients is currently carried out using antibiotics , sulfonamides and therapeutic anti-plague serum. Prevention of possible foci of the disease consists of carrying out special quarantine events in port cities, deratization of all ships that operate on international flights, the creation of special anti-plague institutions in steppe areas where rodents are found, the identification epizootic plague among rodents and the fight against them.

Anti-plague sanitary measures in Russia

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

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

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

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

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

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

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

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

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

The team of medical personnel providing treatment to a patient with pneumonic or septic form of plague must include an intensive care specialist.

Notes

Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
, With. 142.
Plague - Medical encyclopedia
, With. 131.
Plague — For doctors, students, patients medical portal, abstracts, cheat sheets for doctors, disease treatment, diagnosis, prevention
, 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 (English) . // The New York Times, 10/31/2010
B. Bayer, U. Birstein and others. History of mankind 2002 ISBN 5-17-012785-5
Anisimov E.V. 1346–1354 “Black Death” in Europe and Rus'// Chronology of Russian history. Russia and the world.
, With. 264.
, With. 500-545.
WHO: Plague in the Democratic Republic of the Congo (Russian). Archived from the original on August 2, 2012.
Letter of the Ministry of Health of the Russian Federation dated April 22, 2004 N 2510/3173-04-27 “On the Prevention of Plague”
Order of the territorial administration of Rospotrebnadzor for the Moscow Region dated 02.05.2006 N 100 “On the organization and implementation of measures for the prevention of plague in the Moscow region”
On July 13, 2016, in Altai, a ten-year-old boy fell ill with bubonic plague
A second case of death from pneumonic plague was recorded in Qinghai. People's Daily(August 3, 2009).
China fears an epidemic of pneumonic plague
Plague is raging in Madagascar (undefined) . Retrieved December 13, 2013.
WHO reported the threat of rapid spread of plague in Madagascar
The number of plague infections in Madagascar exceeded 2 thousand, Rosbalt. Retrieved November 12, 2017.
Plague - for doctors, students, patients, medical portal, abstracts, cheat sheets for doctors, disease treatment, diagnosis, prevention
, With. 623.

Literature

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

Symptoms of bubonic plague
Diagnosis of bubonic plague
Photo of bubonic plague

Bubonic plague is a group of plagues spread by the bacteria Yersinia pestis, which is carried by rodents through fleas. A terrible acutely infectious disease, has a high mortality rate and is spreading epidemically. Characterized by very serious condition, accompanied inflammatory processes in the lymph nodes.

Symptoms of bubonic plague

The incubation period lasts 2-3 days if they did not receive immunoglobulin before infection, but if a person received immunotherapy before infection, the incubation period can last up to a week. When bitten by an insect (flea), a red spot is observed at this place, which subsequently fills with blood and pus, then this swollen place bursts and an ulcer forms.

Main symptoms:

Increased body temperature
Enlarged and dense lymph nodes are located in groups - buboes
Severe headaches
Nausea and vomiting
Powerlessness
Dizziness
Insomnia
Hallucinations
Tachycardia
Decreased blood pressure
White thick coating on the tongue

When these compacted buboes (dense lymph nodes) are felt, they cause painful sensations. At the beginning of the infection, the symptoms are very pronounced, the face is pale, and the conjunctiva is red; this phenomenon is called the “scared plague face” - facies pestica.

Diagnosis of bubonic plague

For diagnosis, bubo juice is inoculated on blood agar by puncture. They take general tests including seed tank. Based on clinical history and biological research the patient is diagnosed.

If you do not resort to immediate treatment, there is a high probability of death. When using antibiotic therapy, intoxication appears, then improvement gradually appears, but in some cases suppuration may occur in the lymph nodes.

Prevention and treatment of bubonic plague

It is necessary to isolate the patient as soon as possible and begin treatment in a hospital, as well as isolate and examine persons who were in contact with him. The attending physicians are dressed in special uniforms, so-called anti-plague clothing, so that they do not become infected. Where the patient who exposed himself to bubonic plague lived, it is necessary to carry out disinfection. A quarantine is imposed on the locality.

If immediate assistance is not provided, the patient dies.