What is plague? Plague disease - is there a risk of getting sick these days? What is plague in humans?
Plague - potentially severe infection, caused by the plague bacillus, pathogenic for humans and animals. Before the invention of antibiotics, disease was very high level mortality in Medieval Europe irrevocably changed the social and economic structure of society.
Great pandemics
The plague has left an indelible dark mark on the history of mankind, and it is not without reason that many peoples associate it with death. Even summary the misfortunes suffered can fill several volumes, and the history goes back thousands of years.
Ancient sources indicate that the disease was known in North Africa and the Middle East. It is assumed that this is what is described in the biblical book of Kings as a pestilence. But indisputable proof of its early existence is the DNA analysis of Bronze Age people, confirming the presence of the plague bacillus in Asia and Europe between 3 thousand and 800 BC. Unfortunately, the nature of these outbreaks cannot be verified.
During the time of Justinian
The first reliably confirmed pandemic occurred during the reign of the Byzantine Emperor Justinian in the 6th century AD.
According to historian Procopius and other sources, the outbreak began in Egypt and moved along maritime trade routes, striking Constantinople in 542. There, the disease claimed tens of thousands of lives in a short period of time, and the death rate grew so quickly that the authorities had problems getting rid of the corpses.
Judging by the descriptions of the symptoms and modes of transmission of the disease, it is likely that all forms of plague were raging in Constantinople at the same time. Over the next 50 years, the pandemic spread west to Mediterranean port cities and east to Persia. Christian authors, for example, John of Ephesus, considered the cause of the epidemic to be the wrath of God, and modern researchers are confident that it was caused by rats (constant passengers on sea ships) and the unsanitary living conditions of that era.
Black Death of Europe
The next pandemic hit Europe in the 14th century and was even more terrible than the previous one. The death toll reached, according to various sources, from 2/3 to ¾ of the population in the affected countries. There is evidence that During the rampant Black Death, about 25 million people died, although determining the exact amount is currently impossible. The plague, like last time, was brought by merchants on ships. Researchers suggest that the disease came to the southern ports of what is now France and Italy from the Genoese colonies of Crimea, spreading from Central Asia.
The consequences of this catastrophe not only left an imprint on the religious and mystical characteristics of the Europeans’ worldview, but also led to a change in the socio-economic formation.
The peasants who made up the main workforce became critically small. To maintain the same standard of living, it was necessary to increase labor productivity and change the technological structure. This need gave impetus to the development of capitalist relations in feudal society.
Great Plague of London
Over the next three centuries, small outbreaks of the disease were observed throughout the continent from British Isles to Russia. Another epidemic broke out in London in 1664-1666. The number of deaths is expected to be between 75 and 100 thousand people. The plague spread rapidly:
- in 1666-1670 - in Cologne and throughout the Rhine Valley;
- in 1667-1669 - in the Netherlands;
- in 1675−1684 - in Poland, Hungary, Austria, Germany, Turkey and North Africa;
Briefly about the losses: in Malta - 11 thousand people died, in Vienna - 76 thousand, in Prague - 83 thousand. By the end of the 17th century, the epidemic began to gradually subside. The last outbreak was in the port city of Marseille in 1720, where it killed 40,000 people. After this, the disease was not recorded in Europe (with the exception of the Caucasus).
The decline of the pandemic can be explained by progress in sanitation and the use of quarantine measures, the fight against rats as carriers of the plague, and the abandonment of old trade routes. During the outbreaks in Europe, the causes of the disease were not well understood medical point vision. In 1768, the first edition of the Encyclopædia Britannica published the popular scientific opinion among contemporaries that plague fever arose from “poisonous miasma” or vapors carried from eastern countries with air.
The best treatment was considered to be expulsion of the "poison", which was achieved either by natural rupture of the tumors or, if necessary, by incising and draining them. Other recommended remedies were:
- bloodletting;
- vomit;
- sweating;
- purgation.
During the 18th and early 19th centuries. the plague was recorded in the countries of the Middle East and North Africa, and in 1815−1836. appears in India. But these were only the first sparks of a new pandemic.
Latest in modern times
Having crossed the Himalayas and gained momentum in the Chinese province of Yunnan, in 1894 the plague reached Guangzhou and Hong Kong. These port cities became distribution centers for the new epidemic, which by 1922 was being imported by shipping throughout the world, more widely than in any previous era. As a result, about 10 million people from a variety of cities and countries died:
Almost all European ports were hit, but of the affected regions, India found itself in the worst situation. Only towards the end of the 19th century did the germ theory develop, and it was finally established which pathogen was responsible for so many deaths. All that remains is to determine how the bacillus infects humans. It has long been observed that in many epidemic areas unusual deaths of rats precede outbreaks of plague. The disease appeared in people some time later.
In 1897, the Japanese doctor Ogata Masanori, examining the outbreak of the disease on the island of Farmosa, proved that the plague bacillus was carried by rats. IN next year Frenchman Paul-Louis Simon demonstrated the results of experiments that showed that fleas of the species Xenopsylla cheopis are carriers of plague in the rat population. This is how the routes of human infection were finally described.
Since then, measures have been taken around the world to exterminate rats in ports and on ships, and insecticides have been used to poison rodents in areas of outbreaks. Since the 1930s, doctors have used sulfur-containing drugs to treat the population, and later antibiotics. The effectiveness of the measures taken is evidenced by the reduction in the number of deaths over the next decades.
Particularly dangerous infection
Plague is one of the deadliest diseases in human history. The human body is extremely susceptible to the disease, infection can occur both directly and indirectly. A defeated plague may emerge after decades of silence with even greater epidemic potential and significantly affect the population of entire regions. Due to its easy spread, it, along with botulism, smallpox, tularemia and viral hemorrhagic fevers(Ebola and Marburg) are included in group A of bioterrorism threats.
Methods of infection
The causative agent of plague is Y. pestis, a nonmotile rod-shaped anaerobic bacterium with bipolar staining, capable of producing an antiphagocytic mucous membrane. Closest relatives:
The resistance of the plague pathogen to the external environment is low. Drying, sunlight, competition with putrefactive microbes kill it. Boiling a stick in water for a minute leads to its death. But it is able to survive on wet linen, clothes with sputum, pus and blood, and is stored for a long time in water and food.
IN wildlife And rural areas Most of the spread of Y. pestis occurs through transmission between rodents and fleas. In cities, the main carriers are synanthropic rodents, primarily gray and brown rats.
The plague bacterium easily migrates from the urban environment to nature and back. It is usually transmitted to humans through the bites of infected fleas. But there is also information about more than 200 species of mammals (including dogs and cats) that can be carriers of the stick. Half of them are rodents and lagomorphs.
That's why The main rules of conduct in areas at risk of a disease outbreak will be:
- avoiding contact with wild animals;
- Be careful when feeding rodents and rabbits.
Pathogenesis and forms of the disease
The plague bacillus is characterized by a surprisingly stable and strong ability to multiply in the tissues of the host and lead to his death. After entering the human body, Y. Pestis migrates through the lymphatic system to the lymph nodes. There, the bacillus begins to produce proteins that disrupt the inflammatory reactions, blocking the fight of macrophages against infection.
Thus, the host's immune response is weakened, bacteria quickly colonize the lymph nodes, causing painful swelling, and ultimately destroying the affected tissue. Sometimes they enter the bloodstream, leading to blood poisoning. During pathological and anatomical studies, their accumulations are found in the following organs:
- in the lymph nodes;
- spleen;
- in the bone marrow;
- liver.
The disease in humans has three clinical forms: bubonic, pulmonary and septic. Pandemics are most often caused by the first two. Bubonic without treatment turns into septic or pulmonary. Clinical manifestations for these three types they look like this:
Treatment and prognosis
Whenever a diagnosis of plague is suspected on clinical and epidemiological grounds, appropriate specimens for diagnosis should be obtained immediately. Antibacterial therapy is prescribed without waiting for a response from the laboratory. Suspicious patients with signs of pneumonia are isolated and treated with airborne precautions. The most applicable schemes:
Other classes of antibiotics (penicillins, cephalosporins, macrolides) have had varying success in treating this disease. Their use is ineffective and questionable. During therapy, it is necessary to provide for the possibility of complications such as sepsis. With absence medical care The forecasts are not encouraging:
- pulmonary form - mortality 100%;
- bubonic - from 50 to 60%;
- septic - 100%.
Medicines for children and pregnant women
With proper and early treatment, complications of plague during pregnancy can be prevented. In this case the choice of antibiotics is based on analysis side effects the most effective drugs:
Experience has shown that a properly prescribed aminoglycoside is the most effective and safe for both the mother and the fetus. It is also recommended for use in the treatment of children. Due to its relative safety and the possibility of intravenous and intramuscular administration, gentamicin is the preferred antibiotic for the treatment of children and pregnant women.
Preventive therapy
Persons who are in personal contact with persons with pneumonia or persons who are likely to have been exposed to fleas infected with Y. pestis, have had direct contact with body fluids or tissues of an infected mammal, or have been exposed to infection during laboratory testing of infectious materials should receive antibacterial prophylactic therapy in case the contact took place in the previous 6 days. The preferred antimicrobial agents for this purpose are tetracycline, chloramphenicol or one of the effective sulfonamides.
Administration of an antibiotic prior to infection may be indicated in cases where people must remain in plague-prone areas for short periods. This also applies to being in an environment where infection is difficult or impossible to prevent.
Precautionary measures for hospitals include a quarantine regime for all cases of plague. These include:
In addition, a patient with suspected pneumonic plague infection should be kept in a separate room and treated with precautions regarding the possibility of airborne infection of personnel. In addition to those listed, they include restricting the patient’s movement outside the room, as well as mandatory wearing of a mask in the presence of other persons.
Possibility of vaccination
Live attenuated and formalin-killed Y. pestis vaccines are available for use in different ways around the world. They are distinguished by their immunogenic and moderately high reactivity. It is important to know that they do not protect against primary pneumonia. In general, it is not possible to vaccinate communities against epizootic impacts.
Additionally, this measure is little used during human plague outbreaks because it takes a month or more for a protective immune response to develop. The vaccine is indicated for people in direct contact with the bacterium. These may be employees of research laboratories or people studying infected animal colonies.
Distemper of carnivores
This disease (Pestis carnivorum) is known among domestic dogs as distemper and is not related to Y. pestis. It is manifested by damage to the central nervous system, inflammation of the mucous membranes of the eyes and respiratory tract. Unlike human plague, it is viral in nature.
Currently, canine plague is recorded among domestic, wild and industrially bred animals in all countries of the world. Economic damage is expressed in losses from culling and slaughter, a decrease in the volume and quality of fur, and the costs of preventive measures practices, violation of the technological process of growing.
The disease is caused by an RNA virus 115−160 nm in size from the Paramyxoviridae family. Dogs, foxes, arctic foxes, Ussuri raccoons, otters, jackals, hyenas and wolves are susceptible to it. For different types In animals, the pathogenicity of the virus varies - from a latent asymptomatic course of the disease to an acute one with 100% mortality. Ferrets are the most sensitive to it. The canine distemper virus is very virulent, but does not pose a danger to humans.
Currently, the plague is a disease whose symptoms are well studied. Its foci remain in the wild and are preserved in permanent habitats of rodents. Modern statistics are as follows: throughout the world in one year, approximately 3 thousand people come into contact with this disease and about 200 of them die. Most cases occur in Central Asia and Africa.
Instructions
Plague is caused by the bacterium Yersinia, which tolerates low temperatures very well and persists for a long time in the corpses of sick animals. The disease is transmitted by fleas, which become infected by feeding on the blood of a sick animal. A person becomes infected not so much by a flea bite as by rubbing its secretions into the skin. You can become infected by being bitten by a sick animal or cutting its skin, as well as by airborne droplets from a person suffering from the plague.
The incubation (latent) period for plague ranges from several hours to 5 days, rarely it increases to 12 days. The disease begins acutely, with a rise in temperature to 40 degrees, severe chills and weakness, then headache and muscle pain, dizziness, and vomiting. Changes occur in the nervous system - patients with plague are excited, extremely restless, delirium, confusion, impaired coordination and gait are possible.
Plague comes in several forms, the most common being bubonic. With this form of plague general symptoms Intoxication is accompanied by inflammation of the lymph nodes (formation of plague buboes). They increase greatly in size, are sharply painful on palpation, the skin over the inflamed lymph nodes becomes dark red, and then bluish, hot to the touch. Buboes can suppurate and then open on their own to form fistulas. Over time, fistulas heal with the formation of scars.
With bubonic plague, the mortality rate reaches 60%; death in the absence of treatment occurs before the 5th day from the onset of the disease. With the pneumonic form of plague, plague pneumonia develops, a cough begins, then sputum with blood. This type of plague is practically incurable, because the patient can only be helped in the first hours of the disease; death occurs in the first two days after infection.
With the septic form of plague, blood poisoning occurs, and the patient dies a few hours after infection. There is also a small form of plague, its symptoms are a slight increase in temperature, enlarged lymph nodes, headache and weakness. It is registered in areas where plague is endemic (unfavorable) and, with appropriate treatment, is cured within a week.
If plague is detected, the patient is isolated in infectious diseases hospital, medical personnel must perform all manipulations in anti-plague suits. Antibiotics are used for treatment; after recovery, patients are monitored by an infectious disease specialist for 3 months. To prevent the plague, there is an anti-plague vaccine; when used, the incidence is reduced by 10 times; it is used to vaccinate people working in endemic areas.
The culprits of the most massive deaths in history are not the politicians who started the wars. Pandemics of terrible diseases were the causes of the most widespread death and suffering of people. How did it happen and where is plague, smallpox, typhus, leprosy, cholera now?
PLAGUE
Historical facts about the plague
The plague pandemic brought the most massive mortality in the middle of the 14th century, sweeping across Eurasia and, according to the most conservative estimates of historians, killing 60 million people. If we consider that at that time the world's population was only 450 million, then one can imagine the catastrophic scale of the “Black Death,” as this disease was called. In Europe, the population decreased by about a third, and the labor shortage was felt here for at least another 100 years, farms were abandoned, the economy was in a terrible state. In all subsequent centuries, major outbreaks of plague were also observed, the last of which was noted in 1910-1911 in the northeastern part of China.
Origin of the name of the plague
The names come from Arabic. The Arabs called the plague “jummah,” which translated means “ball” or “bean.” The reason for this was the appearance of the inflamed lymph node of a plague patient - the bubo.
Methods of spread and symptoms of plague
There are three forms of plague: bubonic, pneumonic and septicemic. All of them are caused by one bacterium Yersinia pestis, or, more simply put, a plague stick. Its carriers are rodents with anti-plague immunity. And the fleas that have bitten these rats, also through a bite, transmit it to humans. The bacterium infects the flea's esophagus, as a result of which it becomes blocked, and the insect becomes eternally hungry, bites everyone and immediately infects it through the resulting wound.
Methods of combating plague
In medieval times the plague swollen lymph nodes(buboes) were cut out or cauterized by opening them. Plague was considered a type of poisoning in which some poisonous miasma entered the human body, so treatment consisted of taking antidotes known at that time, for example, crushed jewelry. Nowadays, the plague is successfully overcome with the help of common antibiotics.
The plague is now
Every year, about 2.5 thousand people become infected with the plague, but this is no longer in the form of a mass epidemic, but cases all over the world. But the plague bacillus is constantly evolving, and old medicines are not effective. Therefore, although everything, one might say, is under the control of doctors, the threat of catastrophe still exists. An example of this is the death of a person registered in Madagascar in 2007 from a strain of the plague bacillus, in which 8 types of antibiotics did not help.
SMALLPOX
Historical facts about smallpox
During the Middle Ages, there were not many women who did not have signs of smallpox lesions on their faces (pockmarks), and the rest had to hide the scars under a thick layer of makeup. This influenced the fashion of excessive interest in cosmetics, which has survived to this day. According to philologists, all women today with letter combinations in their surnames “ryab” (Ryabko, Ryabinina, etc.), shadar and often generous (Shchedrins, Shadrins), Koryav (Koryavko, Koryaeva, Koryachko) had ancestors sporting pockmarks (rowans, generous, etc., depending on the dialect). Approximate statistics exist for the 17th-18th centuries and indicate that in Europe alone there were 10 million new smallpox patients, and for 1.5 million of them it was fatal. Thanks to this infection a white man colonized both Americas. For example, the Spaniards brought smallpox to Mexico in the 16th century, because of which about 3 million of the local population died - the invaders had no one left to fight with.
Origin of the name smallpox
“Smallpox” and “rash” have the same root. In English, smallpox is called smallpox. And syphilis is called a great rash (great pox).
Methods of spread and symptoms of smallpox
After hitting human body, smallpox varionas (Variola major and Variola) lead to the appearance of blisters-pustules on the skin, the places of formation of which then scar, if the person survives, of course. The disease spreads through airborne droplets, and the virus also remains active in scales from the skin of an infected person.
Methods to combat smallpox
The Hindus brought rich gifts to the smallpox goddess Mariatela to appease her. Residents of Japan, Europe and Africa believed in the smallpox demon's fear of the color red: patients had to wear red clothes and be in a room with red walls. In the twentieth century, smallpox began to be treated with antiviral drugs.
Smallpox in modern times
In 1979, WHO officially announced that smallpox had been completely eradicated thanks to vaccination of the population. But in countries such as the USA and Russia, pathogens are still stored. This is done "for scientific research“, and the question of the complete destruction of these reserves is constantly being postponed. It is possible that North Korea and Iran are secretly storing smallpox virions. Any international conflict could give rise to the use of these viruses as weapons. So it's better to get vaccinated against smallpox.
CHOLERA
Historical facts about cholera
Until the end of the 18th century, this intestinal infection largely bypassed Europe and raged in the Ganges delta. But then there were changes in climate, invasions of European colonialists in Asia, transportation of goods and people improved, and this all changed the situation: in 1817-1961, six cholera pandemics occurred in Europe. The most massive one (the third) took the lives of 2.5 million people.
Origin of the name cholera
The words “cholera” come from the Greek “bile” and “flow” (in reality, all the fluid from the inside flowed out of the patient). The second name for cholera due to the characteristic blue color of the skin of patients is “blue death”.
Methods of spread and symptoms of cholera
Vibrio cholera is a bacterium called Vibrio choleare that lives in water bodies. When she gets into small intestine to a person, it releases enterotoxin, which leads to profuse diarrhea and then vomiting. In severe cases of the disease, the body becomes dehydrated so quickly that the patient dies a few hours after the first symptoms appear.
Methods to combat cholera
They applied samovars or irons to the feet of the sick to warm them, gave them chicory and malt infusions to drink, and rubbed their bodies with camphor oil. During the epidemic, they believed that it was possible to scare away the disease with a belt made of red flannel or wool. Nowadays, people with cholera are effectively treated with antibiotics, and for dehydration they are given oral fluids or special salt solutions are administered intravenously.
Cholera now
WHO says the world is now in its seventh cholera pandemic, dating back to 1961. So far, it is mainly residents of poor countries who get sick, primarily in South Asia and Africa, where 3-5 million people get sick every year and 100-120 thousand of them do not survive. Also, according to experts, due to global negative changes in environment serious problems will soon arise with clean water and in developed countries. Besides global warming will influence the fact that in nature, foci of cholera will appear in more northern regions of the planet. Unfortunately, there is no vaccine against cholera.
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Historical facts about typhus
Until the second half of the 19th century, this was the name given to all diseases in which severe fever and confusion were observed. Among them, the most dangerous were typhus, typhoid and relapsing fever. Sypnoy, for example, in 1812 almost halved Napoleon’s 600,000-strong army, which invaded Russian territory, which was one of the reasons for his defeat. And a century later, in 1917-1921, 3 million citizens died of typhus Russian Empire. Relapsing fever mainly caused grief to the inhabitants of Africa and Asia; in 1917-1918, about half a million people in India alone died from it.
Origin of the name typhus
The name of the disease comes from the Greek “typhos”, which means “fog”, “confused consciousness”.
Methods of spread and symptoms of typhus
Typhus causes small pink rashes on the skin. When the attack returns after the first attack, the patient seems to feel better for 4-8 days, but then the disease knocks him down again. Typhoid fever is an intestinal infection that is accompanied by diarrhea.
The bacteria that cause typhus and relapsing fever are carried by lice, and for this reason, outbreaks of these infections break out in crowded places during humanitarian disasters. When bitten by one of these creatures, it is important not to scratch – it is through scratched wounds that the infection enters the blood. Typhoid fever is caused by the Salmonella typhi bacillus, which, when ingested through food and water, leads to damage to the intestines, liver and spleen.
Methods to combat typhus
During the Middle Ages, it was believed that the source of infection was the stench that emanated from the patient. Judges in Britain who had to deal with criminals with typhus wore boutonnieres of strong-smelling flowers as a means of protection, and also distributed them to those who came to court. The benefit from this was only aesthetic. Since the 17th century, attempts have been made to combat typhus with the help of cinchona bark, imported from South America. This is how they treated all diseases that caused fever. Nowadays, antibiotics are quite successful in treating typhus.
Typhoid in now
Relapsing fever and typhus were removed from the WHO list of particularly dangerous diseases in 1970. This happened thanks to active struggle with pediculosis (lice), which was carried out throughout the planet. But typhoid fever continues to cause troubles for people. The most suitable conditions for the development of an epidemic are heat, insufficient drinking water and problems with hygiene. Therefore, the main candidates for the outbreak of typhoid epidemics are Africa, South Asia and Latin America. Reviewed by Ministry of Health specialists every year typhoid fever 20 million people become infected and for 800 thousand of them it is fatal.
LEPROSY
Historical facts about leprosy
Also called leprosy, it is a “slow disease.” Unlike the plague, for example, it did not spread in the form of pandemics, but quietly and gradually conquered space. At the beginning of the 13th century, there were 19 thousand leper colonies in Europe (an institution for isolating lepers and fighting the disease) and the victims were millions. By the beginning of the 14th century, the mortality rate from leprosy had dropped sharply, but hardly because they had learned to treat patients. Just incubation period for this disease the lifespan is 2-20 years. Infections like plague and cholera that raged in Europe killed many people even before he was classified as a leper. Thanks to the development of medicine and hygiene, there are now no more than 200 thousand lepers in the world. They mainly live in the countries of Asia, Africa and Latin America.
Origin of the name leprosy
The name comes from the Greek word “leprosy,” which translates to “a disease that makes the skin scaly.” Leprosy was called in Rus' - from the word “kazit”, i.e. lead to distortion and disfigurement. This disease also has a number of other names, such as Phoenician disease, “lazy death”, Hansen’s disease, etc.
Methods of spread and symptoms of leprosy
It is possible to become infected with leprosy only by long-term contact with the skin of a carrier of the infection, as well as by ingestion of liquid secretions (saliva or from the nose). Then it goes away quite long time(the recorded record is 40 years), after which Hansen's bacillus (Mucobacterium leprae) will first disfigure a person, covering him with spots and growths on the skin, and then make him an invalid rotting alive. Also, the peripheral nervous system is damaged and the patient loses the ability to feel pain. You can take and cut off a part of your body without understanding where it went.
Methods to combat leprosy
During the Middle Ages, lepers were declared dead while they were still alive and placed in leprosariums - a kind of concentration camps, where patients were doomed to a slow death. They tried to treat the infected with solutions that included gold, bloodletting and baths with the blood of giant turtles. Nowadays, this disease can be completely eliminated with the help of antibiotics.
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Plague (pestis) is an acute zoonotic natural focal infectious disease with a predominantly transmissible pathogen transmission mechanism, which is characterized by intoxication, damage to the lymph nodes, skin and lungs. It is classified as a particularly dangerous, conventional disease.
Codes according to ICD -10
A20.0. Bubonic plague.
A20.1. Cellulocutaneous plague.
A20.2. Pneumonic plague.
A20.3. Plague meningitis.
A20.7. Septicemic plague.
A20.8. Other forms of plague (abortive, asymptomatic, minor).
A20.9. Unspecified plague.
Etiology (causes) of plague
The causative agent is a gram-negative small polymorphic non-motile bacillus Yersinia pestis of the Enterobacteriaceae family of the genus Yersinia. It has a mucous capsule and does not form spores. Facultative anaerobe. Dyed with bipolar aniline dyes (more intense at the edges). There are rat, marmot, gopher, field and sand lance varieties of the plague bacterium. Grows on simple nutrient media with the addition of hemolyzed blood or sodium sulfate, the optimal temperature for growth is 28 ° C. It occurs in the form of virulent (R-forms) and avirulent (S-forms) strains. Yersinia pestis has more than 20 antigens, including a thermolabile capsular antigen, which protects the pathogen from phagocytosis by polymorphonuclear leukocytes, a thermostable somatic antigen, which includes V- and W-antigens, which protect the microbe from lysis in the cytoplasm of mononuclear cells, ensuring intracellular reproduction, LPS etc. The pathogenicity factors of the pathogen are exo- and endotoxin, as well as aggression enzymes: coagulase, fibrinolysin and pesticins. The microbe is stable in the environment: it persists in soil for up to 7 months; in corpses buried in the ground, up to a year; in bubo pus - up to 20–40 days; on household items, in water - up to 30–90 days; tolerates freezing well. When heated (at 60 °C it dies in 30 s, at 100 °C - instantly), drying, exposure to direct sunlight and disinfectants (alcohol, chloramine, etc.), the pathogen is quickly destroyed. It is classified as pathogenicity group 1.
Epidemiology of the plague
The leading role in preserving the pathogen in nature is played by rodents, the main ones being marmots (tarbagans), ground squirrels, voles, gerbils, as well as lagomorphs (hares, pikas). The main reservoir and source in anthropurgic foci are gray and black rats, less often - house mice, camels, dogs and cats. A person suffering from pneumonic plague is especially dangerous. Among animals, the main distributor (carrier) of plague is the flea, which can transmit the pathogen 3–5 days after infection and remains infective for up to a year. Transmission mechanisms are varied:
- transmissible - when bitten by an infected flea;
- contact - through damaged skin and mucous membranes when skinning sick animals; slaughter and cutting of camel, hare carcasses, as well as rats, tarbagans, which are eaten in some countries; in contact with the secretions of a sick person or objects contaminated by him;
- fecal-oral - when eating insufficiently heat-treated meat from infected animals;
- aspiration - from a person suffering from pulmonary forms of plague.
Diseases in humans are preceded by epizootics among rodents. The seasonality of the disease depends on climate zone and in countries with temperate climates it is recorded from May to September. Human susceptibility is absolute in all age groups and for any mechanism of infection. A patient with the bubonic form of plague before the opening of the bubo does not pose a danger to others, but when it passes into the septic or pneumonic form, he becomes highly infectious, releasing the pathogen with sputum, bubo secretions, urine, and feces. Immunity is unstable, repeated cases of the disease have been described.
Natural foci of infection exist on all continents, with the exception of Australia: in Asia, Afghanistan, Mongolia, China, Africa, South America, where about 2 thousand cases are registered annually. In Russia, there are about 12 natural focal zones: in the North Caucasus, Kabardino-Balkaria, Dagestan, Transbaikalia, Tuva, Altai, Kalmykia, Siberia and Astrakhan region. Anti-plague specialists and epidemiologists are monitoring the epidemic situation in these regions. Over the past 30 years, cluster outbreaks have not been registered in the country, and the incidence rate has remained low - 12–15 episodes per year. Each case of human illness must be reported to the territorial center of Rospotrebnadzor in the form of an emergency notification, followed by the announcement of quarantine. International rules specify quarantine lasting 6 days, observation of persons in contact with the plague is 9 days.
Currently, the plague is included in the list of diseases, the causative agent of which can be used as a means of bacteriological weapons (bioterrorism). Laboratories have obtained highly virulent strains that are resistant to common antibiotics. In Russia there is a network of scientific and practical institutions to combat infection: anti-plague institutes in Saratov, Rostov, Stavropol, Irkutsk and anti-plague stations in the regions.
Plague prevention measures
Nonspecific
- Epidemiological surveillance of natural plague foci.
- Reducing the number of rodents, carrying out deratization and disinfestation.
- Constant monitoring of the population at risk of infection.
- Preparing medical institutions and medical personnel to work with plague patients, conducting awareness-raising work among the population.
- Prevention of pathogen importation from other countries. The measures to be taken are set out in the International Health Regulations and the Sanitation Regulations.
Specific
Specific prevention consists of annual immunization with a live anti-plague vaccine of persons living in epizootic outbreaks or traveling there. People who come into contact with plague patients, their belongings, and animal corpses are given emergency chemoprophylaxis (Table 17-22).
Table 17-22. Schemes for the use of antibacterial drugs for emergency prevention plague
| A drug | Mode of application | Single dose, g | Frequency of application per day | Course duration, days |
| Ciprofloxacin | Inside | 0,5 | 2 | 5 |
| Ofloxacin | Inside | 0,2 | 2 | 5 |
| Pefloxacin | Inside | 0,4 | 2 | 5 |
| Doxycycline | Inside | 0,2 | 1 | 7 |
| Rifampicin | Inside | 0,3 | 2 | 7 |
| Rifampicin + ampicillin | Inside | 0,3 + 1,0 | 1 + 2 | 7 |
| Rifampicin + ciprofloxacin | Inside | 0,3 + 0,25 | 1 | 5 |
| Rifampicin + ofloxacin | Inside | 0,3 + 0,2 | 1 | 5 |
| Rifampicin + pefloxacin | Inside | 0,3 + 0,4 | 1 | 5 |
| Gentamicin | V/m | 0,08 | 3 | 5 |
| Amikacin | V/m | 0,5 | 2 | 5 |
| Streptomycin | V/m | 0,5 | 2 | 5 |
| Ceftriaxone | V/m | 1 | 1 | 5 |
| Cefotaxime | V/m | 1 | 2 | 7 |
| Ceftazidime | V/m | 1 | 2 | 7 |
Pathogenesis of plague
The causative agent of plague enters the human body most often through the skin, less often through the mucous membranes of the respiratory tract and digestive tract. Changes in the skin at the site of pathogen penetration (primary focus - phlyctena) rarely develop. Lymphogenously from the site of introduction, the bacterium enters the regional lymph node, where it multiplies, which is accompanied by the development of serous-hemorrhagic inflammation, spreading to surrounding tissues, necrosis and suppuration with the formation of a plague bubo. When the lymphatic barrier breaks through, hematogenous dissemination of the pathogen occurs. Entry of the pathogen via the aerogenic route promotes the development of an inflammatory process in the lungs with melting of the walls of the alveoli and concomitant mediastinal lymphadenitis. Intoxication syndrome is characteristic of all forms of the disease, is caused by the complex action of pathogen toxins and is characterized by neurotoxicosis, ITS and thrombohemorrhagic syndrome.
Clinical picture (symptoms) of plague
The incubation period lasts from several hours to 9 days or more (on average 2–4 days), shortening in the primary pulmonary form and lengthening in vaccinated individuals.
or receiving prophylactic medications.
Classification
There are localized (cutaneous, bubonic, cutaneous bubonic) and generalized forms of plague: primary septicemic, primary pulmonary, secondary septic, secondary pulmonary and intestinal.
Main symptoms and dynamics of their development
Regardless of the form of the disease, plague usually begins suddenly, and the clinical picture from the first days of the disease is characterized by a pronounced intoxication syndrome: chills, high fever (≥39 ° C), severe weakness, headache, body aches, thirst, nausea, and sometimes vomiting. The skin is hot, dry, the face is red and puffy, the sclera is injected, the conjunctiva and mucous membranes of the oropharynx are hyperemic, often with pinpoint hemorrhages, the tongue is dry, thickened, covered with a thick white coating (“chalky”). Later, in severe cases, the face becomes haggard, with a cyanotic tint, and dark circles under the eyes. Facial features become sharper, an expression of suffering and horror appears (“plague mask”). As the disease progresses, consciousness is impaired, hallucinations, delusions, and agitation may develop. Speech becomes slurred; coordination of movements is impaired. Appearance and the behavior of patients resembles the condition alcohol intoxication. Characteristic arterial hypotension, tachycardia, shortness of breath, cyanosis. In severe cases of the disease, bleeding and vomiting mixed with blood are possible. The liver and spleen are enlarged. Oliguria is noted. The temperature remains constant high current 3–10 days. In the peripheral blood - neutrophilic leukocytosis with a shift to the left. In addition to the described general manifestations of plague, lesions characteristic of individual clinical forms of the disease develop.
Cutaneous form is rare (3–5%). At the site of the entrance gate of the infection, a spot appears, then a papule, a vesicle (phlyctena), filled with serous-hemorrhagic contents, surrounded by an infiltrated zone with hyperemia and edema. Phlyctena is characterized by severe pain. When it is opened, an ulcer forms with a dark scab at the bottom. A plague ulcer has a long course and heals slowly, forming a scar. If this form is complicated by septicemia, secondary pustules and ulcers occur. The development of a regional bubo (cutaneous bubonic form) is possible.
Bubonic form occurs most often (about 80%) and is distinguished by its relatively benign course. From the first days of the disease, sharp pain appears in the area of the regional lymph nodes, which makes movement difficult and forces the patient to take a forced position. The primary bubo, as a rule, is single; multiple buboes are less often observed. In most cases, the inguinal and femoral lymph nodes are affected, and somewhat less frequently, the axillary and cervical lymph nodes. The size of the bubo varies from a walnut to a medium-sized apple. Vivid features are sharp pain, dense consistency, adhesion to the underlying tissues, smoothness of contours due to the development of periadenitis. The bubo begins to form on the second day of illness. As it develops, the skin over it turns red, shiny, and often has a cyanotic tint. At the beginning it is dense, then it softens, fluctuation appears, and the contours become unclear. On the 10th–12th day of illness it opens - a fistula and ulceration form. With a benign course of the disease and modern antibiotic therapy, its resorption or sclerosis is observed. As a result of hematogenous introduction of the pathogen, secondary buboes can form, which appear later and are small in size, less painful and, as a rule, do not suppurate. A serious complication of this form can be the development of a secondary pulmonary or secondary septic form, which sharply worsens the patient’s condition, even leading to death.
Primary pulmonary form It occurs rarely, during periods of epidemics in 5–10% of cases and represents the most dangerous epidemiologically and severe clinical form of the disease. It begins sharply, violently. Against the background of a pronounced intoxication syndrome, a dry cough, severe shortness of breath, cutting pains in the chest. The cough then becomes productive, with the production of sputum, the amount of which can vary from a few spits to huge quantities, it is rarely absent at all. The sputum, at first foamy, glassy, transparent, then takes on a bloody appearance, later becomes purely bloody, and contains a huge amount of plague bacteria. It usually has a liquid consistency - one of diagnostic signs. Physical data are scanty: a slight shortening of the percussion sound over the affected lobe; on auscultation, there are not a lot of fine wheezes, which clearly does not correspond to the general serious condition of the patient. The terminal period is characterized by an increase in shortness of breath, cyanosis, development of stupor, pulmonary edema and ITS. Blood pressure drops, the pulse quickens and becomes thread-like, heart sounds are muffled, hyperthermia is replaced by hypothermia. Without treatment, the disease ends in death within 2–6 days. With early use of antibiotics, the course of the disease is benign and differs little from pneumonia of other etiologies, as a result of which late recognition of the pneumonic form of plague and cases of the disease in the patient’s environment are possible.
Primary septic form It happens rarely - when a massive dose of the pathogen enters the body, usually by airborne droplets. It begins suddenly, with pronounced symptoms of intoxication and subsequent rapid development clinical symptoms: multiple hemorrhages on the skin and mucous membranes, bleeding from internal organs (“black plague”, “ Black Death»), mental disorders. Signs of cardiovascular failure progress. The patient's death occurs within a few hours from ITS. Changes in the place of introduction of the pathogen and in regional lymph nodes none.
Secondary septic form complicates other clinical forms of infection, usually bubonic. Generalization of the process significantly worsens the general condition of the patient and increases his epidemiological danger to others. The symptoms are similar to the clinical picture described above, but differ in the presence of secondary buboes and a longer duration. With this form of the disease, secondary plague meningitis often develops.
Secondary pulmonary form as a complication occurs in localized forms of plague in 5–10% of cases and sharply worsens the overall picture of the disease. Objectively, this is expressed by an increase in symptoms of intoxication, the appearance of chest pain, coughing, followed by the release of bloody sputum. Physical data make it possible to diagnose lobular, less often pseudolobar pneumonia. The course of the disease during treatment can be benign, with a slow recovery. The addition of pneumonia to low-infectious forms of plague makes patients the most dangerous in epidemiological terms, so each such patient must be identified and isolated.
Some authors distinguish the intestinal form separately, but most clinicians tend to consider intestinal symptoms ( sharp pains in the abdomen, profuse mucous-bloody stool, bloody vomiting) as manifestations of the primary or secondary septic form.
With repeated cases of the disease, as well as with plague in people who have been vaccinated or received chemoprophylaxis, all symptoms begin and develop gradually and are more easily tolerated. In practice, such conditions are called “minor” or “outpatient” plague.
Complications of the plague
Highlight specific complications: ITS, cardiopulmonary failure, meningitis, thrombohemorrhagic syndrome, which lead to the death of patients, and nonspecific, caused by endogenous flora (phlegmon, erysipelas, pharyngitis, etc.), which is often observed against the background of improvement.
Mortality and causes of death
In the primary pulmonary and primary septic form without treatment, mortality reaches 100%, most often by the 5th day of illness. In the bubonic form of plague, the mortality rate without treatment is 20–40%, which is due to the development of a secondary pulmonary or secondary septic form of the disease.
Diagnosis of plague
Clinical diagnosis
Clinical and epidemiological data allow one to suspect the plague: severe intoxication, the presence of an ulcer, bubo, severe pneumonia, hemorrhagic septicemia in persons located in a natural focal zone for plague, living in places where epizootics (deaths) among rodents were observed or there is an indication of registered cases of the disease. Every suspicious patient should be examined.
Specific and nonspecific laboratory diagnostics
The blood picture is characterized by significant leukocytosis, neutrophilia with a shift to the left and an increase in ESR. Protein is found in the urine. At x-ray examination of the chest organs, in addition to enlarged mediastinal lymph nodes, you can see focal, lobular, less often pseudolobar pneumonia, and in severe cases - RDS. In the presence of meningeal signs (stiff neck muscles, positive symptom Kernig) is necessary spinal tap. In the CSF, three-digit neutrophilic pleocytosis, a moderate increase in protein content and a decrease in glucose levels are more often detected. For specific diagnostics bubo punctate, ulcer discharge, carbuncle, sputum, nasopharyngeal swab, blood, urine, feces, CSF, sectional material are examined. The rules for collecting material and its transportation are strictly regulated by the International Health Regulations. The material is collected using special dishes, containers, and disinfectants. The staff works in anti-plague suits. A preliminary conclusion is given on the basis of microscopy of smears stained with Gram, methylene blue, or treated with a specific luminescent serum. Detection of ovoid bipolar rods with intense staining at the poles (bipolar staining) suggests a diagnosis of plague within an hour. For final confirmation of the diagnosis, isolation and identification of the culture, the material is sown on agar in a Petri dish or in broth. After 12–14 hours, characteristic growth appears in the form of broken glass (“lace”) on agar or “stalactites” in the broth. The final identification of the culture is made on the 3rd–5th day.
The diagnosis can be confirmed serological studies paired sera in RPGA, however, this method has a secondary diagnostic value. Pathoanatomical changes in intraperitoneally infected mice are studied, guinea pigs after 3–7 days, with sowing biological material. Similar methods of laboratory isolation and identification of the pathogen are used to identify plague epizootics in nature. For research, materials are taken from rodents and their corpses, as well as fleas.
Differential diagnosis
The list of nosologies with which differential diagnosis must be carried out depends on the clinical form of the disease. The cutaneous form of plague is differentiated from the cutaneous form of anthrax, bubonic - from the cutaneous form of tularemia, acute purulent lymphadenitis, sodoku, benign lymphoreticulosis, venereal granuloma; pulmonary form - from lobar pneumonia, pulmonary anthrax. The septic form of plague must be distinguished from meningococcemia and other hemorrhagic septicemia. Diagnosis of the first cases of the disease is especially difficult. Epidemiological data are of great importance: stay in foci of infection, contact with rodents with pneumonia. It should be borne in mind that early application antibiotics modify the course of the disease. Even the pneumonic form of plague in these cases can be benign, but the patients still remain infectious. Considering these features, in the presence of epidemic data, in all cases of diseases occurring with high fever, intoxication, lesions of the skin, lymph nodes and lungs, plague should be excluded. In such situations, it is necessary to conduct laboratory tests and involve anti-plague service specialists. The criteria for differential diagnosis are presented in the table (Tables 17-23).
Table 17-23. Differential diagnosis of plague
| Nosological form | General symptoms | Differential criteria |
| Anthrax, cutaneous form | Fever, intoxication, carbuncle, lymphadenitis | Unlike the plague, fever and intoxication appear on the 2nd–3rd day of illness, the carbuncle and the surrounding area of edema are painless, there is eccentric growth of the ulcer |
| Tularemia, bubonic form | Fever, intoxication, bubo, hepatolienal syndrome | Unlike the plague, fever and intoxication are moderate, the bubo is slightly painful, mobile, with clear contours; suppuration is possible in the 3rd–4th week and later, after the temperature has normalized and the patient’s condition is satisfactory, there may be secondary buboes |
| Purulent lymphadenitis | Polyadenitis with local soreness, fever, intoxication and suppuration | Unlike the plague, there is always a local purulent focus (felon, suppurating abrasion, wound, thrombophlebitis). The appearance of local symptoms is preceded by fever, usually moderate. Intoxication is mild. There is no periadenitis. The skin over the lymph node is bright red, its enlargement is moderate. There is no hepatolienal syndrome |
| Lobar pneumonia | Acute onset, fever, intoxication, possible sputum mixed with blood. Physical signs of pneumonia | Unlike the plague, intoxication increases by the 3rd–5th day of illness. The symptoms of encephalopathy are not typical. Physical signs of pneumonia are clearly expressed, sputum is scanty, “rusty”, viscous |
Indications for consultation with other specialists
Consultations are usually carried out to clarify the diagnosis. If the bubonic form is suspected, a consultation with a surgeon is indicated; if the pulmonary form is suspected, a consultation with a pulmonologist is indicated.
An example of a diagnosis formulation
A20.0. Plague, bubonic form. Complication: meningitis. Heavy current.
All patients with suspected plague are subject to emergency hospitalization on special transport to an infectious diseases hospital, in a separate box, in compliance with all anti-epidemic measures. Personnel caring for plague patients must wear a protective anti-plague suit. Household items in the ward and the patient's excretions are subject to disinfection.
Treatment of plague
Mode. Diet
Bed rest during the febrile period. There is no special diet provided. It is advisable to have a gentle diet (table A).
Drug therapy
Etiotropic therapy should be started if plague is suspected, without waiting for bacteriological confirmation of the diagnosis. It includes the use of antibacterial drugs. When studying natural strains of plague bacteria in Russia, no resistance to common antimicrobial drugs was found. Etiotropic treatment is carried out according to approved schemes (Tables 17-24–17-26).
Table 17-24. Scheme for the use of antibacterial drugs in the treatment of bubonic plague
| A drug | Mode of application | Single dose, g | Frequency of application per day | Course duration, days |
| Doxycycline | Inside | 0,2 | 2 | 10 |
| Ciprofloxacin | Inside | 0,5 | 2 | 7–10 |
| Pefloxacin | Inside | 0,4 | 2 | 7–10 |
| Ofloxacin | Inside | 0,4 | 2 | 7–10 |
| Gentamicin | V/m | 0,16 | 3 | 7 |
| Amikacin | V/m | 0,5 | 2 | 7 |
| Streptomycin | V/m | 0,5 | 2 | 7 |
| Tobramycin | V/m | 0,1 | 2 | 7 |
| Ceftriaxone | V/m | 2 | 1 | 7 |
| Cefotaxime | V/m | 2 | 3–4 | 7–10 |
| Ceftazidime | V/m | 2 | 2 | 7–10 |
| Ampicillin/sulbactam | V/m | 2/1 | 3 | 7–10 |
| Aztreons | V/m | 2 | 3 | 7–10 |
Table 17-25. Scheme for the use of antibacterial drugs in the treatment of pneumonic and septic forms of plague
| A drug | Mode of application | Single dose, g | Frequency of application per day | Course duration, days |
| Ciprofloxacin* | Inside | 0,75 | 2 | 10–14 |
| Pefloxacin* | Inside | 0,8 | 2 | 10–14 |
| Ofloxacin* | Inside | 0,4 | 2 | 10–14 |
| Doxycycline* | Inside | 0.2 at the 1st appointment, then 0.1 each | 2 | 10–14 |
| Gentamicin | V/m | 0,16 | 3 | 10 |
| Amikacin | V/m | 0,5 | 3 | 10 |
| Streptomycin | V/m | 0,5 | 3 | 10 |
| Ciprofloxacin | IV | 0,2 | 2 | 7 |
| Ceftriaxone | V/m, i.v. | 2 | 2 | 7–10 |
| Cefotaxime | V/m, i.v. | 3 | 3 | 10 |
| Ceftazidime | V/m, i.v. | 2 | 3 | 10 |
| Chloramphenicol (chloramphenicol sodium succinate**) | V/m, i.v. | 25–35 mg/kg | 3 | 7 |
** Used to treat plague affecting the central nervous system.
Table 17-26. Schemes for the use of combinations of antibacterial drugs in the treatment of pneumonic and septic forms of plague
| A drug | Mode of application | Single dose, g | Frequency of application per day | Course duration, days |
| Ceftriaxone + streptomycin (or amikacin) | V/m, i.v. | 1+0,5 | 2 | 10 |
| Ceftriaxone + gentamicin | V/m, i.v. | 1+0,08 | 2 | 10 |
| Ceftriaxone + rifampicin | IV, inside | 1+0,3 | 2 | 10 |
| Ciprofloxacin* + rifampicin | Inside, inside | 0,5+0,3 | 2 | 10 |
| Ciprofloxacin + streptomycin (or amikacin) | Inside, intravenously, intramuscularly | 0,5+0,5 | 2 | 10 |
| Ciprofloxacin + gentamicin | Inside, intravenously, intramuscularly | 0,5+0,08 | 2 | 10 |
| Ciprofloxacin* + ceftriaxone | IV, IV, IM | 0,1–0,2+1 | 2 | 10 |
| Rifampicin + gentamicin | Inside, intravenously, intramuscularly | 0,3+0,08 | 2 | 10 |
| Rifampicin + streptomycin (or amikacin) | Inside, intravenously, intramuscularly | 0,3+0,5 | 2 | 10 |
* There are injection forms of the drug for parenteral administration.
In severe cases, it is recommended to use it during the first four days diseases of compatible combinations antibacterial agents in the doses indicated in the regimens. In the following days, treatment is continued with one drug. For the first 2–3 days, the medications are administered parenterally, and subsequently switch to oral administration.
Along with specific pathogenetic treatment is carried out aimed at combating acidosis, cardiovascular failure and DN, microcirculation disorders, cerebral edema, hemorrhagic syndrome.
Detoxification therapy consists of intravenous infusions colloidal (reopolyglucin, plasma) and crystalloid solutions (glucose 5–10%, polyionic solutions) up to 40–50 ml/kg per day. The previously used anti-plague serum and specific gamma globulin turned out to be ineffective during the observation process, and at present they are not used in practice, nor is the plague bacteriophage used. Patients are discharged after complete recovery (for the bubonic form no earlier than the 4th week, for the pulmonary form - no earlier than the 6th week from the day of clinical recovery) and a three-fold negative result obtained after culture of bubo punctate, sputum or blood, which is carried out on 2- th, 4th, 6th days after cessation of treatment. After discharge, medical observation is carried out for 3 months.
The plague has deep historical roots. Humanity first encountered the disease in the 14th century. The epidemic, which was dubbed the “Black Death,” claimed more than 50 million human lives, which was equal to a quarter of the population medieval Europe. The mortality rate was about 99%.
Facts about the disease:
- Plague affects lymph nodes, lungs, etc. internal organs. As a result of infection, sepsis develops. The general condition of the body is extremely difficult. The body is subjected to constant attacks of fever.
- The period of development of plague after infection is on average about three days, depending on general condition body.
- On this moment The mortality rate from this disease is no more than 10% of all identified cases.
- There are about 2 thousand cases of the disease per year. According to WHO, in 2013, 783 cases of infection were officially registered, of which 126 cases resulted in death.
- Outbreaks of the disease mainly affect African countries and a number of countries in South America. Endemic countries are the Democratic Republic of Congo, the island of Madagascar and Peru.
IN Russian Federation The last known case of plague was documented in 1979. Every year, more than 20 thousand people are at risk, being in the zone of natural foci of infection with a total area of more than 250 thousand km2.
CAUSES
The main cause of plague is flea bites. This factor is due to the specific structure of the digestive system of these insects. After a flea bites an infected rodent, the plague bacterium settles in its crop and blocks the passage of blood to the stomach. As a result, the insect experiences a constant feeling of hunger and, before it dies, manages to bite, thereby infecting up to 10 hosts, regurgitating the blood it drinks along with plague bacteria into the bite.
After a bite, the bacterium enters the nearest lymph node, where it actively multiplies without antibacterial treatment affects the entire body.
Causes of infection:
- bites of small rodents;
- contact with infected domestic animals, stray dogs;
- direct contact with an infected person;
- cutting up carcasses of animals affected by disease;
- treatment of the skin of killed animals that carry the disease;
- contact of bacteria with the human mucosa during autopsy of corpses of those who died from the plague;
- eating meat from infected animals;
- the entry of particles of saliva of an infected person into oral cavity healthy person by airborne droplets;
- military conflicts and terrorist attacks using bacteriological weapons.
The plague bacterium is highly resistant to low temperatures, multiplies vigorously in a humid environment, but does not tolerate high temperatures (above 60 degrees), and dies almost instantly in boiling water.
CLASSIFICATION
Varieties of plague are divided into two main types.
- Localized type- the disease develops after plague microbes get under the skin:
- Skin plague. There is no primary protective reaction, only in 3% of cases redness of the affected areas of the skin with induration occurs. Without visible external signs, the disease progresses, eventually forming a carbuncle, then an ulcer, which scars as it heals.
- Bubonic plague . The most common form of the disease. It affects the lymph nodes, forming “buboes”. Characterized by painful inflammatory processes in them. Affects the groin area and armpits. Accompanied by severe fever and general intoxication of the body.
- Bubonic skin plague. Plague bacteria travel with the lymph, end up in the lymph nodes, causing inflammatory process affecting adjacent tissues. The “buboes” mature, and the rate of development of the pathology decreases.
- Generalized type- the pathogen enters the body by airborne droplets, as well as through the membranes of the mucous surfaces of the body:
- Septicemic plague. The pathogen penetrates through the mucous membranes. High virulence of the microbe and a weakened body - causes of lung entering the patient’s bloodstream, bypassing all his defense mechanisms. A fatal outcome with this form of the disease can occur in less than 24 hours, the so-called. "lightning plague"
- Pneumonic plague. Entry into the body occurs through airborne droplets, infection through dirty hands and objects, as well as through the conjunctiva of the eyes. This form is primary pneumonia, and also has a high epidemic threshold due to heavy discharge sputum containing pathogenic bacteria during coughing.
SYMPTOMS
The incubation period of the plague ranges from 72 to 150 hours. Most often it appears on the third day. The disease is characterized sudden manifestation without primary symptoms.
Clinical history of plague:
- a sharp jump in body temperature up to 40 degrees;
- acute headaches;
- nausea;
- reddish tint to the face and eyeballs;
- muscle discomfort;
- white coating on the tongue;
- enlarged nostrils;
- dry skin of lips;
- manifestations of a rash on the body;
- feeling of thirst;
- insomnia;
- causeless excitement;
- difficulties in coordinating movements;
- delusions (often of an erotic nature);
- impaired digestion;
- difficulty urinating;
- high fever;
- cough with sputum containing blood clots;
- bleeding from the gastrointestinal tract;
- tachycardia;
- low blood pressure.
Hidden primary symptoms lead to outbreaks of disease epidemics. Thus, a potential carrier of plague can travel long distances, feeling absolutely healthy, while infecting everyone who comes into contact with the plague bacteria.
DIAGNOSTICS
Returning from travel to areas endemic for the spread of plague, with the slightest signs of the disease - urgent reason to isolate the patient. Based on the medical history, all persons who have had any contact with the potentially affected person are identified.
Diagnostics is carried out in the following ways:
- bacterial culture from blood, sputum and lymph node tissue samples;
- immunological diagnostics;
- polymerase chain reaction;
- passage on laboratory animals;
- serological technique;
- isolation of pure culture with subsequent identification;
- laboratory diagnostics based on fluorescent antiserum.
In modern medical conditions direct transmission from the patient to the attending physician and hospital staff is practically impossible. However, everything laboratory tests are carried out in specialized premises for working with particularly dangerous infectious diseases.
TREATMENT
Since 1947 plague treatable with antibiotics aminoglycoside groups wide range actions.
Inpatient treatment is used in isolated wards of infectious diseases departments in compliance with all safety rules when working with plague patients.
Course of therapy:
- The use of antibacterial drugs based on sulfamethoxazole and trimethoprim.
- Intravenous administration of chloramphenicol simultaneously with streptomycin.
- Detoxification procedures.
- Improving microcirculation and repair. Achieved by entering .
- Taking cardiac glycosides.
- Use of respiratory analeptics.
- Use of antipyretics.
Treatment is most effective and does not cause any consequences in the initial stages of plague.
COMPLICATIONS
Because the disease is included in the group of fatal, the main complications in case of an incorrect diagnosis or absence full treatment there may be a transformation of the plague from light form to heavier ones. Thus, cutaneous plague can develop into septicemic plague, and bubonic plague into pneumonic plague.
Complications from plague also affect:
- Cardiovascular system (pericarditis develops).
- Central nervous system(purulent meningoencephalitis).
Although a patient who has recovered from the plague receives immunity, he is not completely immune from new cases of infection, especially if preventive measures are taken carelessly.
PREVENTION
At the state level, a whole range of directive preventive measures for the plague has been developed.
The following decrees and rules are in effect on the territory of the Russian Federation:
- “Instructional and methodological guidelines for the diagnosis, treatment and prevention of plague”, approved by the USSR Ministry of Health on September 14, 1976.
- Sanitary and epidemiological rules SP 3.1.7.1380-03 dated 06.06.2003, approved by the Resolution of the Chief State Sanitary Doctor in the part “Prevention of plague”.
Set of measures:
- epidemiological surveillance of natural foci of disease;
- disinsection, reducing the number of potential disease carriers;
- a set of quarantine measures;
- training and preparing the population to respond to outbreaks of plague;
- careful handling of animal corpses;
- vaccination of medical staff;
- use of anti-plague suits.
PROGNOSIS FOR RECOVERY
Death rate from plague modern stage therapy use is about 10%. If treatment is started at a later stage or is absent altogether, the risks increase to 30-40%.
With the right choice of treatment methods the body recovers in a short time, functionality is fully restored.
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