Causes, symptoms and treatment of plague. The plague has come to Russia. The first case was a ten-year-old boy. The method of infecting a person with plague

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Plague is a deadly disease caused by the plague bacterium Yersinia pestis). It can be transmitted to humans through rodents, fleas, poorly cooked food, and even through inhaled air. Improvements in sanitation and living standards have made plague outbreaks extremely rare, although they still occur in some parts of the world. Protect yourself and your loved ones from potential exposure to plague by avoiding contact with animals that carry it, strictly observe hygiene rules, and seek medical attention immediately if you suspect that you may have contracted the disease.

Steps

Part 1

Plague Prevention

Eliminate suitable rodent habitats around your home. The plague spreads among rats, which become infected as a result of the bites of fleas using these rodents as hosts. Eliminate possible rat habitats in and around your home. Check for traces of rats in utility rooms, dense thickets of bushes, basements, garages and attics.

The presence of rats can be judged by the excrement left by them. If you find rat droppings, remove it immediately. Be careful, as the plague bacillus can survive and be transmitted to you by touching infected excrement.
Before cleaning up rat droppings, be sure to wear gloves and cover your mouth and nose (for example, with a gauze bandage or handkerchief) to avoid contact with pathogenic bacteria.

Do not touch sick or dead animals. After the death of an animal, an active plague bacillus may remain in its tissues or in the fleas living on it. Stay away from sick or dead animals that show signs of plague. Plague can be transmitted to a living host through infected tissues and fluids.

Use a flea repellent when you go outside. Apply DEET spray or ointment if you are going to be outside for a long time. The plague is often spread through the bites of fleas that live in the fur of rodents and feed on infected blood. Diethyltoluamide and other repellents will repel fleas and help avoid infestation.

Wash regularly and thoroughly. Wash your hands and face with disinfectant soap and water several times a day, and every time you return from outdoors or come into contact with animals or their droppings. The plague bacillus can enter the body through the delicate tissues of the mouth, nose, and eyes. Follow the basic rules of hygiene carefully and be aware of the risk factors around you.
- Try to touch your face as little as possible. The disease easily penetrates sensitive tissues, and you never know if you have recently touched something that could have pathogenic bacteria on it.
Be aware of the symptoms of the plague. Plague may not be accompanied by any symptoms for several days. Within a week, the patient begins to develop flu-like symptoms, including chills, fever, cold sweats, nausea, and vomiting. As the disease progresses, the lymph nodes become swollen and tender as the body fights off the infection. In the later stages, the plague is accompanied by sepsis, that is, infection of the blood, and decomposition of body tissues. Eventually death comes.

The disease plague, which mankind faced about one and a half thousand years ago, previously caused large outbreaks of the disease, claiming tens and hundreds of millions of lives. More merciless and devastating history does not know, and so far, despite the development of medicine, it has not been completely managed to cope with it.

What is a plague?

Plague is a disease in humans, which is of a natural focal infectious nature, in many cases ending in death. This is a highly contagious pathology, and susceptibility to it is universal. After the transferred and cured plague, stable immunity is not formed, that is, there is a risk of re-infection (however, the disease is somewhat easier the second time).

The exact origin of the name of the disease has not been established, while the word "plague" in Turkish means "round, bump", from Greek - "shaft", from Latin - "blow, wound". In ancient and modern scientific sources, one can find such a definition as the bubonic plague disease. This is due to the fact that one of the hallmarks of the disease is a bubo - a rounded swelling in the inflamed area. In this case, there are other forms of infection, without the formation of buboes.

Plague is the causative agent

For a long time it was not clear what causes bubonic plague; the pathogen was discovered and associated with the disease only at the end of the 19th century. It turned out to be a gram-negative bacterium from the family of enterobacteria - plague bacillus (Yersinia pestis). The pathogen is well studied, its several subspecies have been identified and the following features have been established:

may have a different shape - from filiform to spherical;
long-term preservation of viability in the discharge of sick people;
good tolerance to low temperatures, freezing;
high sensitivity to disinfectants, sunlight, acid reaction of the environment, elevated temperatures;
contains about thirty antigenic structures, releases endo- and exotoxins.

Plague - how bacteria enter the human body

It is important to know how the plague is transmitted from person to person, as well as from other living beings. The plague bacillus circulates in natural infectious foci in the organisms of carrier animals, which include wild rodents (ground squirrels, marmots, voles), gray and black rats, house mice, cats, hares, camels. Carriers (distributors) of pathogens are fleas of various types and several types of blood-sucking ticks, which become infected with the causative agent of the disease when feeding on sick animals containing the plague bacillus in the blood.

Distinguish between the transmission of the pathogen through fleas from animal carriers to humans and from person to person. We list the possible ways the plague enters the human body:

Transmissible- entering the bloodstream after the bite of an infected insect.
Contact- upon contact of a person who has microtraumas on the skin or mucous membranes with the bodies of infected animals (for example, when cutting carcasses, processing skins).
Alimentary- through the mucous membrane of the gastrointestinal tract when eating the meat of sick animals that have not undergone sufficient heat treatment, or other contaminated products.
Contact household- when touching a sick person, contacting with his biological fluids, using dishes, personal hygiene items, etc.
Aerosol- from person to person through the mucous membranes of the respiratory tract when coughing, sneezing, close conversation.

Plague - symptoms in humans

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

bubonic;
pulmonary;
septic;
intestinal.

In addition, there are such rare forms of pathology as skin, pharyngeal, meningeal, asymptomatic, abortive. Plague disease has an incubation period of 3 to 6 days, sometimes - 1-2 days (with a primary pulmonary or septic form) or 7-9 days (in vaccinated or already recovered patients). All forms are characterized by a sudden onset with severe symptoms and an intoxication syndrome, manifested as follows:

high body temperature;
chills;
headache;
muscle and joint pain;
nausea;
vomit;
severe weakness.

As the disease develops, the appearance of the patient changes: the face becomes puffy, hyperemic, the whites of the eyes turn red, the lips and tongue become dry, dark circles appear under the eyes, the face expresses fear, horror (“plague mask”). In the future, the patient's consciousness is disturbed, speech becomes illegible, coordination of movements is disturbed, delirium and hallucinations appear. In addition, specific lesions develop, depending on the form of the plague.

Bubonic plague - symptoms

Statistics show that bubonic plague is the most common type of the disease, which develops in 80% of those infected when the pathogenic bacterium penetrates through the mucous membranes and skin. In this case, the infection spreads through the lymphatic system, causing damage to the inguinal lymph nodes, in rare cases, the axillary or cervical. The resulting buboes are single and multiple, their size can vary from 3 to 10 cm, and in their development they often go through several stages:

Pneumonic plague

This form is diagnosed in 5-10% of patients, while the plague develops after aerogenic infection (primary) or as a complication of the bubonic form (secondary). This is the most dangerous variety, and the specific signs of plague in humans in this case are observed approximately 2-3 days after the onset of acute intoxication symptoms. The causative agent affects the walls of the pulmonary alveoli, causing necrotic phenomena. The salient features are:

rapid breathing, shortness of breath;
cough;
sputum secretion - at first foamy, transparent, then - with streaks of blood;
chest pain;
tachycardia;
drop in blood pressure.

septic form of plague

The primary septic form of plague, which develops when a massive dose of microbes enters the bloodstream, is rare, but it is very difficult. Intoxication symptoms occur at lightning speed, as the pathogen spreads to all organs. There are numerous hemorrhages in the skin and mucous tissues, conjunctiva, intestinal and renal bleeding, rapid development. Sometimes this form proceeds as a secondary complication of other varieties of plague, which is manifested by the formation of secondary buboes.

Intestinal form of plague

Not all experts distinguish the intestinal variety of plague separately, considering it as one of the manifestations of the septic form. When intestinal plague develops, the following signs of illness in people against the background of general intoxication and fever are recorded:

sharp pains in the abdomen;
repeated hematemesis;
diarrhea with bloody stools;
tenesmus - painful urge to empty the intestines.

Plague - Diagnosis

A significant role is played in the diagnosis of plague by laboratory diagnostics, carried out by the following methods:

serological;
bacteriological;
microscopic.

For research, blood, punctates from buboes, discharge of ulcers, sputum, discharge from the oropharynx, and vomit are taken. To check the presence of the pathogen, the selected material can be grown on special nutrient media. In addition, x-rays of the lymph nodes and lungs are performed. It is important to establish the fact of a bite by insects, contact with sick animals or people, visiting areas endemic for plague.

Plague - treatment

If a pathology is suspected or diagnosed, the patient is urgently hospitalized in an infectious diseases hospital in an isolated box, from which direct air outflow is excluded. The treatment of plague in humans is based on the following activities:

taking antibiotics, depending on the form of the disease (Tetracycline, Streptomycin);
detoxification therapy (Albumin, Reopoliglyukin, Gemodez);
the use of drugs to improve microcirculation and reparation (Trental, Picamilon);
antipyretic and symptomatic therapy;
maintenance therapy (vitamins, heart drugs);
- with septic lesions.

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

Measures to prevent plague in the human body

To prevent the spread of infection, non-specific preventive measures are taken, including:

analysis of information on the incidence of plague in different countries;
identification, isolation and treatment of people with suspected pathology;
disinfection of vehicles arriving from regions unfavorable for plague.

In addition, work is constantly being carried out in natural foci of the disease: counting the number of wild rodents, examining them for the detection of plague bacteria, the destruction of infected individuals, and the fight against fleas. If even one patient is detected in the village, the following anti-epidemic measures are taken:

the imposition of quarantine with a ban on the entry and exit of people for several days;
isolation of people who have been in contact with plague patients;
disinfection in the foci of the disease.

People who have been in contact with plague patients are given anti-plague serum in combination with antibiotics for prophylactic purposes. Human plague vaccination with live plague vaccine is given in such cases:

when staying in natural foci of infection or the upcoming departure to a disadvantaged area;
during work associated with possible contact with sources of infection;
with a widespread infection among animals in the vicinity of settlements.

Plague - incidence statistics

Thanks to the development of medicine and the maintenance of interstate preventive measures, plague rarely occurs on a large scale. In ancient times, when no cures for this infection were invented, the mortality rate was almost one hundred percent. Now these figures do not exceed 5-10%. At the same time, how many people have died from the plague in the world in recent times cannot but be alarming.

Plague in human history

The plague has left devastating traces in human history. The largest epidemics are considered to be:

"Justinian Plague" (551-580), which began in Egypt, from which more than 100 million people died;
the epidemic of the "black death" (XIV century) in Europe, brought from East China, which claimed about 40 million lives;
plague in Russia (1654-1655) - about 700 thousand deaths;
plague in Marseille (1720-1722) - 100 thousand people died;
plague pandemic (end of the 19th century) in Asia - more than 5 million people died.

Plague today

Bubonic plague is now found on every continent except Australia and Antarctica. In the period from 2010 to 2015, more than 3 thousand cases of the disease were diagnosed, while a fatal outcome was observed in 584 infected. Most cases were registered in Madagascar (more than 2 thousand). Plague foci have been noted in countries such as Bolivia, the USA, Peru, Kyrgyzstan, Kazakhstan, Russia and others. Plague-endemic regions of Russia are: Altai, the East Ural region, Stavropol, Transbaikalia, and the Caspian lowland.

Plague is a serious infectious disease related to quarantine diseases. Caused by the bacterium Yersinia pestis. The plague agent was discovered in 1894 independently by the French scientist A. Yersin (1863-1943) and the Japanese scientist S. Kitasato (1852-1931).

The plague microbe is sensitive to common disinfectants and dies within 1 minute in boiling water. However, in the corpses of animals, it can persist for up to 60 days, it tolerates low temperatures and freezing well.

The first plague pandemic, which entered the literature under the name "Justinian plague", arose in the 6th century in the Eastern Roman Empire. During this pandemic, about 100 million people died in 50 years. The second pandemic began in the XIV century in the Crimea, quickly spreading to the Mediterranean and Western Europe. Over 5 years of the epidemic, about 60 million people died. At the end of the 19th century, a third pandemic arose, which began in Hong Kong, the culprits of which were rats from ships. This led to the outbreak of epidemics in more than 100 ports in many countries. In India alone, this epidemic claimed 12 million lives.

In Russia, plague-endemic regions are the Caspian lowland, as well as the East Ural region, Stavropol, Transbaikalia and Altai.

Sources of infection

The infection is most often carried by rodents - rats and mice, as well as squirrels and wild dogs. Plague is transmitted to humans through the bite of an infected animal or fleas living on it. You can also get infected by contact and airborne droplets from a sick person.

What is happening?

The incubation period of the plague is usually 2 to 5 days, rarely from a few hours to 12 days. The disease begins with chills, a sharp rise in temperature to 39 0 C, the pulse quickens, blood pressure drops. There is delirium, confusion, impaired coordination.

There are several forms of plague: bubonic, pneumonic, septic and mild (the so-called small plague).

At bubonic form lymph nodes (buboes) enlarge, become extremely painful, hard, but not hot (surrounded by swollen tissue). The liver and spleen may be enlarged, which is noticeable on examination. Lymph nodes fill with pus and may rupture. The death of a patient with the bubonic form of plague without treatment occurs between the third and fifth day of illness. More than 60% of patients die.

At pneumonic plague lung damage occurs. In the first 24 hours, the patient develops a cough, at first clear sputum is soon stained with blood. The patient dies within 48 hours, only treatment started at the earliest stages of the disease is effective.

At septic form microbes spread with blood throughout the body, and a person dies within a maximum of a day.

In areas endemic for plague, there may be small form plague. Manifested by an increase in lymph nodes, fever, headache; these symptoms resolve within a week.

Diagnosis and treatment

To diagnose plague, they carry out:

laboratory culture and isolation of bacteria from blood, sputum or lymph node tissue;
immunological diagnostics;
PCR (polymerase chain reaction).

If the plague is suspected, the patient is isolated, and the staff must wear anti-plague suits. After discharge, a person is under the supervision of doctors for 3 months.

If treatment is started in a timely manner, then the plague is quite successfully treated with appropriate antibiotics.

An anti-plague vaccine exists, but it does not protect 100% of the disease. The incidence among the vaccinated is reduced by 5-10 times, and the disease itself proceeds in a milder form.

plague doctor in the middle ages

For more than a hundred years, people have associated plague with a special disease that claims the lives of millions of people. Everyone knows the damaging ability of the causative agent of this disease and its lightning-fast spread. Everyone knows about this disease, it is so rooted in the human mind that everything negative in life is associated with this word.

What is plague and where does the infection come from? Why does it still exist in nature? What is the causative agent of the disease and how is it transmitted? What are the forms of the disease and symptoms? What is the diagnosis and how is the treatment carried out? Thanks to what kind of prevention in our time it is possible to save billions of human lives?

What is plague

Experts say that plague epidemics were mentioned not only in historical reference books, but also in the Bible. Cases of the disease were regularly recorded on all continents. But of greater interest are not epidemics, but pandemics or outbreaks of infection that are widespread throughout almost the entire territory of the country and cover neighboring ones. In the entire history of the existence of people, they counted three.

The first outbreak of plague or pandemic occurred in the VI century in Europe and the Middle East. During its existence, the infection has claimed the lives of more than 100 million people.
The second case, when the disease covered a significant territory, was noted in Europe, from where it reached from Asia in 1348. At this time, more than 50 million people died, and the pandemic itself is known in history as the "plague - black death." She did not bypass the territory of Russia.
The third pandemic raged at the end of the 19th century in the East, mainly in India. An outbreak began in 1894 in Canton and Hong Kong. A large number of deaths have been recorded. Despite all the precautions from the local authorities, the number of deaths exceeded 87 million.

But it was during the third pandemic that it was possible to carefully examine the dead people and identify not only the source of the infection, but also the carrier of the disease. The French scientist Alexandre Yersin found that a person becomes infected from sick rodents. A few decades later, they created an effective vaccine against the plague, although this did not help humanity completely get rid of the disease.

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

Where is the plague found now?

The centers of infection in our time are not marked in red on the usual tourist map. Therefore, before traveling to other countries, it is better to consult an infectious disease specialist where plague is still found.

According to experts, this disease has not yet been completely eradicated. In which countries can you get plague?

Isolated cases of the disease occur in the United States and Peru.
Plague in Europe has practically not been recorded for the past few years, but the disease has not bypassed Asia. Before visiting China, Mongolia, Vietnam and even Kazakhstan, it is better to get vaccinated.
On the territory of Russia, it is also better to play it safe, because several cases of plague are recorded here every year (in Altai, Tyva, Dagestan) and it borders on countries that are dangerous for infection.
Africa is considered a dangerous continent from the point of view of epidemiology, most of today's severe infections can be contracted here. Plague is no exception; isolated cases of the disease have been recorded here over the past few years.
There is an infection on individual islands. For example, just two years ago, a plague struck several dozen people in Madagascar.

The last hundred years of plague pandemics have not been observed, but the infection has not been completely eradicated.

It has long been no secret that many of the most dangerous infections, which include the plague, are being used by the military as biological weapons. During the Second World War in Japan, scientists brought out a special type of pathogen. In terms of its ability to infect people, it surpassed natural pathogens tenfold. And no one knows how the war could have ended if Japan had used this weapon.

Although plague pandemics have not been recorded for the last hundred years, it has not been possible to completely eradicate the bacteria that cause the disease. There are natural sources of plague and anthropurgic, that is, natural and artificially created in the process of life.

Why is infection considered especially dangerous? Plague is a disease with a high lethality rate. Until the creation of the vaccine, and this happened in 1926, the mortality rate from various types of plague was at least 95%, that is, only a few survived. Now lethality does not exceed 10%.

plague agent

The causative agent of the infection is yersinia pestis (plague bacillus), a bacterium of the genus Yersinia, which is part of a large family of enterobacteria. In order to survive in natural conditions, this bacterium had to adapt for a long time, which led to the peculiarities of its development and vital activity.

Grows on simple available nutrient media.
It happens in different shapes - from filiform to spherical.
The plague bacillus in its structure contains more than 30 types of antigens that help it survive in the body of the carrier and humans.
Resistant to environmental factors, but instantly dies when boiled.
The plague bacterium has several pathogenicity factors - these are exo and endotoxins. They lead to damage to organ systems in the human body.
You can fight bacteria in the external environment with the help of conventional disinfectants. Antibiotics also kill them.

Plague transmission routes

Not only humans are affected by this disease, there are many other sources of infection in nature. The sluggish variants of the plague pose a great danger, when the affected animal can overwinter, and then infect others.

Plague is a disease with natural foci that affects, in addition to humans and other creatures, for example, domestic animals - camels and cats. They get infected from other animals. To date, more than 300 species of bacterial carriers have been identified.

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

gophers;
marmots;
gerbils;
voles and rats;
Guinea pigs.

In urban environments, special types of rats and mice are a reservoir of bacteria:

pasyuk;
gray and black rat;
Alexandrovskaya and Egyptian species of rats.

The carrier of plague in all cases are fleas. Human infection occurs when this arthropod bites, when an infected flea, not finding a suitable animal, bites a person. Just one flea in its life cycle can infect about 10 people or animals. The susceptibility to the disease in humans is high.

How is the plague transmitted?

Transmissible or through the bites of an infected animal, mainly fleas. This is the most common way.
Contact, which is infected during the cutting of carcasses of sick domestic animals, as a rule, these are camels.
Despite the fact that the primacy is given to the transmissible route of transmission of plague bacteria, the alimentary one also plays an important role. A person becomes infected while eating food contaminated with the pathogen.
The methods of penetration of bacteria into the human body during plague include the aerogenic route. While coughing or sneezing, a sick person easily infects everyone around them, so they need to be kept in a separate box.

Plague pathogenesis and its classification

How does the causative agent of plague behave in the human body? The first clinical manifestations of the disease depend on the way bacteria enter the body. Therefore, there are different clinical forms of the disease.

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

In the future, Yersinia affects the lungs. In addition to infection with plague bacteria of the lymph nodes and internal organs, blood poisoning or sepsis occurs. This leads to numerous complications and changes in the heart, lungs, kidneys.

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

pulmonary;
bubonic.

They are considered the most common variants of the disease, although conditionally, because the bacteria do not affect any particular organ, but gradually the entire human body is involved in the inflammatory process. According to the degree of severity, the disease is divided into mild subclinical course, moderate and severe.

plague symptoms

Plague is an acute natural focal infection caused by Yersinia. It is characterized by such clinical signs as severe fever, damage to the lymph nodes and sepsis.

Any form of the disease begins with general symptoms. The incubation period of the plague lasts at least 6 days. The disease is characterized by an acute onset.

The first signs of plague in humans are as follows:

chills and almost lightning-fast increase in body temperature up to 39–40 ºC;
severe symptoms of intoxication - headache and muscle pain, weakness;
dizziness;
damage to the nervous system of varying severity - from stunning and lethargy to delirium and hallucinations;
the patient has impaired coordination of movements.

A typical appearance of a sick person is characteristic - a reddened face and conjunctiva, dry lips and a tongue that is enlarged and lined with a white thick coating.

Due to the enlargement of the tongue, the speech of the plague patient becomes illegible. If the infection proceeds in a severe form, the person's face is puffy with a blue tint or bluish, the face has an expression of suffering and horror.

Symptoms of bubonic plague

The name of the disease itself comes from the Arabic word "jumba", which means bean or bubo. That is, it can be assumed that the first clinical sign of the "black death", which was described by our distant ancestors, was an increase in lymph nodes that resembled the appearance of beans.

How is bubonic plague different from other variants of the disease?

A typical clinical symptom of this type of plague is bubo. What does he represent? - this is a pronounced and painful enlargement of the lymph nodes. As a rule, these are single formations, but in very rare cases their number increases to two or more. The plague bubo is more often localized in the axillary, inguinal and cervical region.
Even before the appearance of bubo, a sick person develops soreness so pronounced that one has to take a forced position of the body to alleviate the condition.
Another clinical symptom of bubonic plague is that the smaller the size of these formations, the more pain they cause when touched.

How are buboes formed? This is a long process. It all starts with the onset of pain at the site of formation. Then the lymph nodes increase here, they become painful to the touch and soldered with fiber, a bubo is gradually formed. The skin over it is tense, painful and becomes intensely red. Within about 20 days, the bubo resolves or reverses.

There are three options for the further disappearance of the bubo:

long-term complete resorption;
opening;
sclerosis.

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

Symptoms of pneumonic plague

The second most common variant of the plague is its pneumonic form. This is the most severe variant of the development of the disease. There are 3 main periods of development of pneumonic plague:

elementary;
peak period;
soporous or terminal.

In recent times, it was this type of plague that killed millions of people, because the mortality rate from it is 99%.

The symptoms of pneumonic plague are as follows.

More than 100 years ago, the pneumonic form of plague ended in death in almost 100% of cases! Now the situation has changed, which is undoubtedly due to the correct treatment tactics.

How other forms of plague proceed

In addition to the two classic variants of the course of the plague, there are other forms of the disease. As a rule, this is a complication of the underlying infection, but sometimes they occur as primary independent ones.

Primary septic form. The symptoms of this type of plague are slightly different from the two variants described above. The infection develops and proceeds rapidly. The incubation period is shortened and lasts no more than two days. High fever, weakness, delirium and agitation are not all signs of a state disorder. Inflammation of the brain and infectious-toxic shock develops, then coma and death. In general, the disease lasts no more than three days. In relation to this type of disease, the prognosis is unfavorable, recovery almost never occurs.
An erased or mild course of the disease is observed with a skin variant of the plague. The pathogen enters the human body through broken skin. At the site of the introduction of the plague pathogen, changes are observed - the formation of necrotic ulcers or the formation of a boil or carbuncle (this is inflammation of the skin and surrounding tissue around the hair with areas of necrosis and pus release). Ulcers heal for a long time and a scar gradually forms. The same changes may appear as secondary in bubonic or pneumonic plague.

Plague diagnosis

The first stage in determining the presence of infection is epidemic. But it is easy to make a diagnosis this way when there are several cases of the disease with the presence of typical clinical symptoms in patients. If the plague has not been seen in a given area for a long time, and the number of cases is calculated in units, the diagnosis is difficult.

In the case of the onset of infection, one of the first steps in determining the disease is the bacteriological method. If plague is suspected, work with biological material to detect the pathogen is carried out under special conditions, because the infection spreads easily and quickly in the environment.

Almost any biological material is taken for research:

sputum;
blood;
puncture buboes;
examine the contents of ulcerative skin lesions;
urine;
vomit masses.

Almost everything that the patient secretes can be used for research. Since the plague in humans is severe and the person is very susceptible to infection, the material is taken in special clothes, and inoculation on nutrient media in equipped laboratories. Animals infected with bacterial cultures die in 3–5 days. In addition, when using the method of fluorescent antibodies, bacteria glow.

Additionally, serological methods for the study of plague are used: ELISA, RNTGA.

Treatment

Any patient with suspected plague is subject to immediate hospitalization. Even in the case of the development of mild forms of infection, a person is completely isolated from others.

In the distant past, the only method of treating the plague was cauterization and processing of buboes, their removal. In an attempt to get rid of the infection, people used only symptomatic methods, but to no avail. After identifying the pathogen and creating antibacterial drugs, not only the number of patients decreased, but also complications.

What is the treatment for this disease?

The basis of treatment is antibiotic therapy, tetracycline antibiotics are used in the appropriate dose. At the very beginning of treatment, the maximum daily doses of drugs are used, with their gradual decrease to the minimum in case of normalization of temperature. Before starting treatment, the sensitivity of the pathogen to antibiotics is determined.
An important step in the treatment of plague in humans is detoxification. Patients are given saline solutions.
Symptomatic treatment is used: diuretics are used in case of fluid retention, hormonal substances are used.
Use therapeutic anti-plague serum.
Along with the main treatment, supportive therapy is used - heart drugs, vitamins.
In addition to antibacterial drugs, local drugs for plague are prescribed. Plague buboes are treated with antibiotics.
In the case of the development of a septic form of the disease, plasmapheresis is used daily - this is a complex procedure for cleaning the blood of a sick person.

After the end of treatment, after approximately 6 days, conduct a control study of biological materials.

Plague Prevention

The invention of antibacterial drugs would not solve the problem of the emergence and spread of pandemics. This is just an effective way to cope with an already existing disease and prevent its most formidable complication - death.

So how did you defeat the plague? - after all, isolated cases per year without declared pandemics and the minimum number of deaths after an infection can be considered a victory. An important role belongs to the correct prevention of the disease. And it began the moment the second pandemic arose, back in Europe.

In Venice, after the second wave of the spread of the plague, back in the 14th century, while only a quarter of the population remained in the city, the first quarantine measures were introduced for arrivals. Ships with cargo were kept in the port for 40 days and the crew was monitored to prevent the spread of infection so that it did not enter from other countries. And it worked, no new cases of infection were noted, although the second plague pandemic had already claimed most of the population of Europe.

How is infection prevention carried out today?

Even if isolated cases of plague occur in any country, all those arriving from there are isolated and observed for six days. If a person has some signs of the disease, then prophylactic doses of antibacterial drugs are prescribed.
The prevention of plague includes the complete isolation of patients with suspected infection. People are not only placed in separate closed boxes, but in most cases they try to isolate the part of the hospital where the patient is located.
The State Sanitary and Epidemiological Service plays an important role in preventing the occurrence of infection. They annually control the outbreaks of the plague, take water samples in the area, examine animals that may turn out to be a natural reservoir.
In the foci of the development of the disease, the destruction of plague carriers is carried out.
Measures to prevent plague in the outbreaks of the disease include sanitary and educational work with the population. They explain the rules of behavior for people in case of another outbreak of infection and where to go first.

But even all of the above was not enough to defeat the disease if the plague vaccine had not been invented. It was from the moment of its creation that the number of cases of the disease has sharply decreased, and there have been no pandemics for more than 100 years.

Vaccination

Today, in addition to general preventive measures, more effective methods are used to combat the plague, which helped to forget about the "black death" for a long time.

In 1926, the Russian biologist V. A. Khavkin invented the world's first plague vaccine. From the moment of its creation and the beginning of universal vaccination in the foci of the appearance of infection, plague epidemics have remained far in the past. Who is vaccinated and how? What are its pros and cons?

Nowadays, a lyophilisate or a live dry vaccine against plague is used, this is a suspension of live bacteria, but a vaccine strain. The drug is diluted immediately before use. It is used against the causative agent of bubonic plague, as well as pulmonary and septic forms. This is a universal vaccine. A drug diluted in a solvent is administered in various ways, which depends on the degree of dilution:

apply it subcutaneously with a needle or needleless method;
skin;
intradermally;
use the plague vaccine even by inhalation.

Prevention of the disease is carried out for adults and children from the age of two.

Indications and contraindications for vaccination

Plague vaccination is done once and it protects for only 6 months. But not every person is vaccinated, certain groups of the population are subject to prevention.

Today, this vaccination is not included as mandatory in the national vaccination calendar, it is done only according to strict indications and only to certain citizens.

Vaccination is given to the following categories of citizens:

to all who live in epidemically dangerous areas, where the plague occurs in our time;
health workers whose professional activities are directly related to work in "hot spots", that is, in places where the disease occurs;
vaccine developers and laboratory workers in contact with bacterial strains;
prophylactic vaccination is given to people with a high risk of infection, working in the foci of infection - these are geologists, employees of anti-plague institutions, shepherds.

It is impossible to carry out prophylaxis with this drug for children under two years of age, pregnant and lactating women, if a person has already had the first symptoms of plague, and everyone who has had a reaction to a previous vaccine administration. There are practically no reactions and complications to this vaccination. Of the minuses of such prevention, one can note its short effect and the possible development of the disease after vaccination, which is extremely rare.

Can plague occur in vaccinated people? Yes, this also happens if an already sick person is vaccinated or the vaccine turned out to be of poor quality. This type of disease is characterized by a slow course with sluggish symptoms. The incubation period exceeds 10 days. The condition of the patients is satisfactory, so it is almost impossible to suspect the development of the disease. Diagnosis is facilitated with the appearance of a painful bubo, although there is no inflammation of the tissues and lymph nodes around. In the case of delayed treatment or its complete absence, the further development of the disease is fully consistent with its usual classical course.

Plague is currently not a sentence, but another dangerous infection that can be dealt with. And although in the recent past, all people and health workers were afraid of this disease, today, the basis of its treatment is prevention, timely diagnosis and complete isolation of the patient.

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

Disease Facts:

The plague affects the lymph nodes, lungs, and other internal organs. As a result of infection, sepsis develops. The general condition of the body is extremely difficult. The body is subject to constant bouts of fever.
The period of development of the plague after infection is on average about three days, depending on the general condition of the body.
At the moment, mortality 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 the WHO, in 2013, 783 cases of infection were officially registered, of which 126 cases resulted in death.
Outbreaks of the disease are mainly affected by African countries and a number of countries in South America. Endemic countries are DR Congo, the island of Madagascar and Peru.

In the Russian Federation, the last known case of plague was documented in 1979. Every year, more than 20 thousand people fall into the risk group, being in the zone of natural foci of infection with a total area of more than 250 thousand km2.

THE REASONS

The main cause of plague is flea bites. This factor is due to the specific structure of the digestive system of these insects. After an infected rodent is bitten by a flea, 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 manages to bite before its death, thereby infecting up to 10 hosts, burping up the drunk blood along with the plague bacteria into a bite.

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

Causes of infection:

bites of small rodents;
contact with infected pets, stray dogs;
direct contact with an infected person;
butchering the carcasses of diseased animals;
treatment of the skin of slaughtered animals - carriers of the disease;
the ingestion of bacteria on the mucous membrane of a person during the autopsy of the corpses of those who died from the plague;
eating the meat of infected animals;
the ingress of particles of saliva of an infected person into the oral cavity of a healthy person by airborne droplets;
military conflicts and terrorist attacks using bacteriological weapons.

The plague bacterium has a high resistance to low temperatures, it multiplies intensively in a humid environment, but it does not tolerate high temperatures (above 60 degrees), it dies almost instantly in boiling water.

CLASSIFICATION

Varieties of plague are divided into two main types.

Localized type- the disease develops after the plague germs get under the skin:
- Skin plague. There is no primary protective reaction, only in 3% of cases there is reddening of the affected areas of the skin with seals. Without visible external signs, the disease progresses, eventually forming a carbuncle, then an ulcer, which scars when healed.
- Bubonic plague . The most common form of the disease. It affects the lymph nodes, forming "buboes". It is characterized by painful inflammatory processes in them. It affects the groin area, armpits. Accompanied by severe fever and general intoxication of the body.
- bubonic plague. Plague bacteria move along with the lymph, end up in the lymph nodes, causing an inflammatory process that affects neighboring tissues. "Buboes" ripen, while 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:
- septic plague. The causative agent penetrates through the mucous membranes. The high virulence of the microbe and the weakened organism are the reasons for the easy entry into the patient's bloodstream, bypassing all its defense mechanisms. A fatal outcome with this form of the disease can occur within less than 24 hours, the so-called. "lightning plague".
- Pneumonic plague. Entry into the body occurs by airborne droplets, infection with 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 abundant sputum discharge containing pathogenic bacteria during coughing.

SYMPTOMS

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

Clinical history of plague:

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

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

DIAGNOSTICS

Return from travels in areas endemic for the spread of plague, with the slightest sign of disease - urgent reason to isolate the patient. Based on the anamnesis, all persons who have been in contact with the potentially affected person to some extent are identified.

Diagnostics is carried out in the following ways:

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

In today's medical environment, direct transmission from the patient to the attending physician and hospital staff is almost impossible. However, all laboratory studies are carried out in specialized rooms to work with especially dangerous infectious diseases.

TREATMENT

Plague since 1947 treated with antibiotics group of aminoglycosides with a wide spectrum of action.

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

Course of therapy:

The use of antibacterial drugs based on sulfamethoxazole and trimethoprim.
Intravenous administration of chloramphenicol simultaneously with streptomycin.
detoxification procedures.
Improvement of microcirculation and reparation. Achieved by input.
Reception of cardiac glycosides.
The use of respiratory analeptics.
The 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 the absence of a full-fledged treatment may be the transformation of plague from a mild form to a more severe one. So, skin plague can develop to septic, and bubonic to pneumonic.

Also, complications of plague affect:

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

A plague patient, although he receives immunity, is not completely insured against new cases of infection, especially if preventive measures are neglected.

PREVENTION

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

The following decrees and rules apply on the territory of the Russian Federation:

"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 Decree of the Chief State Sanitary Doctor regarding "Plague Prevention".

A set of measures:

epidemiological surveillance of natural foci of the disease;
disinsection, reduction in the number of potential carriers of the disease;
complex of quarantine measures;
educating and preparing the population for action in the event of outbreaks of plague;
careful handling of animal carcasses;
vaccination of medical staff;
use of anti-plague suits.

PROGNOSIS FOR RECOVERY

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

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

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