Plague

What is Plague -

Plague- acute, especially dangerous zoonotic vector-borne infection with severe intoxication and serous-hemorrhagic inflammation in the lymph nodes, lungs and other organs, as well as the possible development of sepsis.

Brief historical information
There is no other infectious disease in the history of mankind that would lead to such colossal devastation and mortality among the population as the plague. Since ancient times, information has been preserved about the plague, which occurred in people in the form of epidemics with a large number of deaths. It was noted that plague epidemics developed as a result of contact with sick animals. At times, the spread of the disease was pandemic-like. There are three known plague pandemics. The first, known as the Plague of Justinian, raged in Egypt and the Eastern Roman Empire from 527-565. The second, called the “great” or “black” death, in 1345-1350. covered Crimea, the Mediterranean and Western Europe; this most devastating pandemic has claimed about 60 million lives. The third pandemic began in 1895 in Hong Kong and then spread to India, where over 12 million people died. At the very beginning they were made important discoveries(the pathogen was isolated, the role of rats in the epidemiology of the plague was proven), which made it possible to organize prevention on a scientific basis. The causative agent of the plague was discovered by G.N. Minkh (1878) and independently of him A. Yersin and S. Kitazato (1894). Since the 14th century, the plague has repeatedly visited Russia in the form of epidemics. Working on outbreaks to prevent the spread of the disease and treat patients, Russian scientists D.K. made a great contribution to the study of the plague. Zabolotny, N.N. Klodnitsky, I.I. Mechnikov, N.F. Gamaleya and others. In the 20th century N.N. Zhukov-Verezhnikov, E.I. Korobkova and G.P. Rudnev developed the principles of pathogenesis, diagnosis and treatment of plague patients, and also created an anti-plague vaccine.

What provokes / Causes of the Plague:

The causative agent is a gram-negative, non-motile, facultative anaerobic bacterium Y. pestis of the Yersinia genus of the Enterobacteriaceae family. In many morphological and biochemical characteristics, the plague bacillus is similar to the pathogens of pseudotuberculosis, yersiniosis, tularemia and pasteurellosis, which cause severe diseases in both rodents and humans. It is distinguished by pronounced polymorphism, the most typical are ovoid rods that stain bipolarly. There are several subspecies of the pathogen, differing in virulence. Grows on regular nutrient media with the addition of hemolyzed blood or sodium sulfite to stimulate growth. Contains more than 30 antigens, exo- and endotoxins. Capsules protect bacteria from absorption by polymorphonuclear leukocytes, and V- and W-antigens protect them from lysis in the cytoplasm of phagocytes, which ensures their intracellular reproduction. The causative agent of plague is well preserved in the excreta of patients and objects of the external environment (in the pus of a bubo it persists for 20-30 days, in the corpses of people, camels, rodents - up to 60 days), but is highly sensitive to sunlight, atmospheric oxygen, elevated temperature, environmental reactions (especially acidic), chemicals (including disinfectants). Under the influence of mercuric chloride at a dilution of 1:1000, it dies in 1-2 minutes. Tolerates low temperatures and freezing well.

A sick person can, under certain conditions, become a source of infection: with the development of pneumonic plague, direct contact with the purulent contents of a plague bubo, as well as as a result of flea infection on a patient with plague septicemia. The corpses of people who died from the plague are often the direct cause of infection of others. Patients with pneumonic plague are especially dangerous.

Transmission mechanism diverse, most often transmissible, but airborne droplets are also possible (with pneumonic forms of plague, infection in laboratory conditions). The carriers of the pathogen are fleas (about 100 species) and some types of ticks, which support the epizootic process in nature and transmit the pathogen to synanthropic rodents, camels, cats and dogs, which can carry infected fleas to human habitation. A person becomes infected not so much through a flea bite as after rubbing its feces or masses regurgitated during feeding into the skin. Bacteria that multiply in the intestines of a flea secrete coagulase, which forms a “plug” (plague block) that prevents the flow of blood into its body. Attempts by a hungry insect to suck blood are accompanied by regurgitation of infected masses onto the surface of the skin at the site of the bite. These fleas are hungry and often try to suck the animal's blood. The contagiousness of fleas lasts on average about 7 weeks, and according to some data - up to 1 year.

Contact (through damaged skin and mucous membranes) when cutting carcasses and processing the skins of killed infected animals (hares, foxes, saigas, camels, etc.) and nutritional (by eating their meat) routes of plague infection are possible.

The natural susceptibility of people is very high, absolute in all age groups and through any route of infection. After an illness, relative immunity develops, which does not protect against re-infection. Repeated cases of the disease are not uncommon and are no less severe than the primary ones.

Basic epidemiological signs. Natural foci of plague occupy 6-7% of the globe's land mass and are registered on all continents, excluding Australia and Antarctica. Every year, several hundred cases of plague in humans are recorded worldwide. In the CIS countries, 43 natural plague foci have been identified with a total area of ​​more than 216 million hectares, located in lowland (steppe, semi-desert, desert) and high-mountain regions. There are two types of natural foci: foci of “wild” and foci of rat plague. In natural foci, plague manifests itself as an epizootic among rodents and lagomorphs. Infection from rodents sleeping in winter (marmots, gophers, etc.) occurs in warm time year, while from rodents and lagomorphs that do not sleep in winter (gerbils, voles, pikas, etc.), infection has two seasonal peaks, which is associated with the breeding periods of the animals. Men get sick more often than women due to professional activities and stay in a natural plague focus (transhumance, hunting). In anthropurgic foci, the role of infection reservoir is performed by black and gray rats. The epidemiology of bubonic and pneumonic plague has significant differences in its most important features. Bubonic plague is characterized by a relatively slow increase in disease, while pneumonic plague, due to the easy transmission of bacteria, can become widespread in a short time. Patients with the bubonic form of plague are low-contagious and practically non-infectious, since their secretions do not contain pathogens, and there are few or no pathogens in the material from the opened buboes. When the disease passes into the septic form, as well as when the bubonic form is complicated by secondary pneumonia, when the pathogen can be transmitted by airborne droplets, severe epidemics of primary pneumonic plague develop with very high contagiousness. Typically, pneumonic plague follows bubonic plague, spreads along with it and quickly becomes the leading epidemiological and clinical form. Recently, the idea that the causative agent of plague can for a long time be in the soil in an uncultivated state. Primary infection of rodents can occur when digging holes in infected areas of soil. This hypothesis is based both on experimental studies and observations on the futility of searching for the pathogen among rodents and their fleas during inter-epizootic periods.

Pathogenesis (what happens?) during the Plague:

Human adaptation mechanisms are practically not adapted to resist the introduction and development of the plague bacillus in the body. This is explained by the fact that the plague bacillus multiplies very quickly; bacteria produce large quantities of permeability factors (neuraminidase, fibrinolysin, pesticin), antiphagins that suppress phagocytosis (F1, HMWPs, V/W-Ar, PH6-Ag), which contributes to rapid and massive lymphogenous and hematogenous dissemination primarily into mononuclear organs phagocytic system with its subsequent activation. Massive antigenemia, the release of inflammatory mediators, including shockogenic cytokines, leads to the development of microcirculatory disorders, DIC syndrome, followed by infectious-toxic shock.

The clinical picture of the disease is largely determined by the site of introduction of the pathogen, penetrating through the skin, lungs or gastrointestinal tract.

The pathogenesis of plague includes three stages. First, the pathogen disseminates lymphogenously from the site of introduction to the lymph nodes, where it lingers for a short time. In this case, a plague bubo is formed with the development of inflammatory, hemorrhagic and necrotic changes in the lymph nodes. The bacteria then quickly enter the bloodstream. In the stage of bacteremia, severe toxicosis develops with changes in the rheological properties of blood, microcirculation disorders and hemorrhagic manifestations in various organs. And finally, after the pathogen overcomes the reticulohistiocytic barrier, it disseminates to various organs and systems with the development of sepsis.

Microcirculatory disorders cause changes in the heart muscle and blood vessels, as well as in the adrenal glands, which causes acute cardiovascular failure.

With the aerogenic route of infection, the alveoli are affected, and they develop inflammatory process with elements of necrosis. Subsequent bacteremia is accompanied by intense toxicosis and the development of septic-hemorrhagic manifestations in various organs and tissues.

The antibody response to plague is weak and forms in the late stages of the disease.

Symptoms of the Plague:

Incubation period is 3-6 days (in epidemics or septic forms it is reduced to 1-2 days); The maximum incubation period is 9 days.

Characterized by an acute onset of the disease, expressed by a rapid increase in body temperature to high numbers with stunning chills and the development of severe intoxication. Patients typically complain of pain in the sacrum, muscles and joints, and headaches. Vomiting (often bloody) and excruciating thirst occur. Already from the first hours of the disease develops psychomotor agitation. Patients are restless, overly active, try to run (“runs like crazy”), they experience hallucinations and delusions. Speech becomes slurred and gait is unsteady. In more rare cases, lethargy, apathy are possible, and weakness reaches such a degree that the patient cannot get out of bed. Externally, hyperemia and puffiness of the face and scleral injection are noted. There is an expression of suffering or horror on the face (“plague mask”). In more severe cases, a hemorrhagic rash may appear on the skin. Very characteristic signs of the disease are thickening and coating of the tongue with a thick white coating (“chalky tongue”). From the outside of cardio-vascular system note pronounced tachycardia (up to embryocardia), arrhythmia and progressive fall blood pressure. Even with local forms of the disease, tachypnea, as well as oliguria or anuria, develop.

This symptomatology manifests itself especially in initial period, for all forms of plague.

According to clinical classification plague proposed by G.P. Rudnev (1970), distinguish local forms of the disease (cutaneous, bubonic, cutaneous-bubonic), generalized forms (primary septic and secondary septic), externally disseminated forms (primary pulmonary, secondary pulmonary and intestinal).

Skin form. The formation of a carbuncle at the site of introduction of the pathogen is characteristic. Initially, a sharply painful pustule with dark red contents appears on the skin; it is localized on the edematous subcutaneous tissue and is surrounded by a zone of infiltration and hyperemia. After opening the pustule, an ulcer with a yellowish bottom is formed, which tends to increase in size. Subsequently, the bottom of the ulcer is covered with a black scab, after which scarring is formed.

Bubonic form. The most common form of plague. Defeat is characteristic lymph nodes, regional in relation to the place of introduction of the pathogen - inguinal, less often axillary and very rarely cervical. Usually the buboes are single, less often multiple. Against the background of severe intoxication, pain occurs in the area of ​​​​the future localization of the bubo. After 1-2 days, you can palpate sharply painful lymph nodes, first of a hard consistency, and then softening and becoming doughy. The nodes merge into a single conglomerate, inactive due to the presence of periadenitis, fluctuating upon palpation. The duration of the height of the disease is about a week, after which a period of convalescence begins. Lymph nodes can resolve on their own or become ulcerated and sclerotic due to serous-hemorrhagic inflammation and necrosis.

Cutaneous bubonic form. Represents a combination skin lesions and changes in the lymph nodes.

These local forms of the disease can develop into secondary plague sepsis and secondary pneumonia. Their clinical characteristics does not differ from primary septic and primary pulmonary forms of plague, respectively.

Primary septic form. Occurs after a short incubation period of 1-2 days and is characterized by lightning-fast development of intoxication, hemorrhagic manifestations (hemorrhages in the skin and mucous membranes, gastrointestinal and renal bleeding), rapid formation clinical picture infectious-toxic shock. Without treatment, it is fatal in 100% of cases.

Primary pulmonary form. Develops during aerogenic infection. The incubation period is short, from several hours to 2 days. The disease begins acutely with manifestations of the intoxication syndrome characteristic of the plague. On the 2-3rd day of illness appears coughing, there are sharp pains in the chest, shortness of breath. The cough is accompanied by the release of first glassy and then liquid, foamy, bloody sputum. Physical data from the lungs are scant; X-rays show signs of focal or lobar pneumonia. Cardiovascular insufficiency increases, expressed in tachycardia and a progressive drop in blood pressure, and the development of cyanosis. IN terminal stage Patients first develop a stuporous state, accompanied by increased shortness of breath and hemorrhagic manifestations in the form of petechiae or extensive hemorrhages, and then coma.

Intestinal form. Against the background of intoxication syndrome, patients experience severe abdominal pain, repeated vomiting and diarrhea with tenesmus and copious mucous-bloody stools. Since intestinal manifestations can be observed in other forms of the disease, until recently the question of the existence of intestinal plague as a independent form, apparently associated with enteral infection.

Differential diagnosis
Cutaneous, bubonic and cutaneous bubonic forms of plague should be distinguished from tularemia, carbuncles, various lymphadenopathy, pulmonary and septic forms - from inflammatory diseases lungs and sepsis, including meningococcal etiology.

With all forms of plague, already in the initial period, rapidly increasing signs of severe intoxication are alarming: high body temperature, tremendous chills, vomiting, excruciating thirst, psychomotor agitation, restlessness, delirium and hallucinations. When examining patients, attention is drawn to slurred speech, unsteady gait, puffy, hyperemic face with scleral injection, expression of suffering or horror (“plague mask”), “chalky tongue.” Signs of cardiovascular failure, tachypnea rapidly increase, and oliguria progresses.

Cutaneous, bubonic and cutaneous bubonic forms of plague are characterized by severe pain at the site of the lesion, stages in the development of the carbuncle (pustule - ulcer - black scab - scar), pronounced phenomena of periadenitis during the formation of the plague bubo.

Pulmonary and septic forms are distinguished by the lightning-fast development of severe intoxication, pronounced manifestations of hemorrhagic syndrome, and infectious-toxic shock. If the lungs are affected, sharp pain in the chest and severe cough, separation of glassy and then liquid foamy bloody sputum are noted. The scanty physical data do not correspond to the general extremely serious condition.

Diagnosis of Plague:

Laboratory diagnostics
Based on the use of microbiological, immunoserological, biological and genetic methods. The hemogram shows leukocytosis, neutrophilia with a shift to the left, and an increase in ESR. Isolation of the pathogen is carried out in specialized high-security laboratories for working with pathogens of particularly dangerous infections. Studies are carried out to confirm clinically significant cases of the disease, as well as to examine people with elevated temperature bodies located at the site of infection. Material from the sick and dead is subjected to bacteriological examination: punctates from buboes and carbuncles, discharge from ulcers, sputum and mucus from the oropharynx, blood. The passage is carried out on laboratory animals (guinea pigs, white mice), which die on the 5-7th day after infection.

From serological methods RNGA, RNAT, RNAG and RTPGA, ELISA are used.

Positive PCR results 5-6 hours after its administration indicate the presence of specific DNA of the plague microbe and confirm preliminary diagnosis. The final confirmation of the plague etiology of the disease is the isolation of a pure culture of the pathogen and its identification.

Plague treatment:

Plague patients are treated only in inpatient conditions. The choice of drugs for etiotropic therapy, their doses and regimens of use is determined by the form of the disease. The course of etiotropic therapy for all forms of the disease is 7-10 days. In this case the following is used:
for the skin form - cotrimoxazole 4 tablets per day;
for the bubonic form - chloramphenicol at a dose of 80 mg/kg/day and at the same time streptomycin at a dose of 50 mg/kg/day; drugs are administered intravenously; Tetracycline is also effective;
in pulmonary and septic forms of the disease, the combination of chloramphenicol with streptomycin is supplemented with the administration of doxycycline at a dose of 0.3 g/day or tetracycline at a dose of 4-6 g/day orally.

At the same time, massive detoxification therapy is carried out ( fresh frozen plasma, albumin, rheopolyglucin, hemodez, intravenous crystalloid solutions, extracorporeal detoxification methods), drugs are prescribed to improve microcirculation and repair (trental in combination with solcoseryl, picamilon), force diuresis, as well as cardiac glycosides, vascular and respiratory analeptics, antipyretic and symptomatic drugs .

The success of treatment depends on the timeliness of therapy. Etiotropic drugs are prescribed at the first suspicion of plague, based on clinical and epidemiological data.

Prevention of Plague:

Epidemiological surveillance
Volume, character and focus preventive measures determines the forecast of the epizootic and epidemic situation regarding plague in specific natural foci, taking into account data tracking the movement of morbidity in all countries of the world. All countries are required to report to WHO the emergence of plague diseases, the movement of morbidity, epizootics among rodents and measures to combat infection. The country has developed and operates a system for certification of natural plague foci, which made it possible to carry out epidemiological zoning of the territory.

Indications for preventive immunization of the population are an epizootic of plague among rodents, identification of domestic animals suffering from plague, and the possibility of infection being brought in by a sick person. Depending on the epidemic situation, vaccination is carried out in a strictly defined territory to the entire population (universally) and selectively to particularly endangered contingents - persons who have permanent or temporary connections with the territories where the epizootic is observed (livestock breeders, agronomists, hunters, harvesters, geologists, archaeologists, etc.). d.). In case of detection of a plague patient, all medical and preventive institutions must have a certain supply of medicines and means of personal protection and prevention, as well as a scheme for notifying personnel and transmitting information vertically. Measures to prevent people from becoming infected with plague in enzootic areas, people working with pathogens of particularly dangerous infections, as well as preventing the spread of infection beyond the foci to other areas of the country are carried out by anti-plague and other health care institutions.

Activities in the epidemic outbreak
When a person sick with plague or suspected of this infection appears, urgent measures are taken to localize and eliminate the outbreak. The boundaries of the territory where certain restrictive measures (quarantine) are introduced are determined based on the specific epidemiological and epizootological situation, possible operating factors of infection transmission, sanitary and hygienic conditions, intensity of population migration and transport connections with other territories. The general management of all activities in the plague outbreak is carried out by the Emergency Anti-Epidemic Commission. At the same time, the anti-epidemic regime is strictly observed using anti-plague suits. Quarantine is introduced by decision of the Emergency Anti-Epidemic Commission, covering the entire territory of the outbreak.

Patients with plague and patients suspected of having this disease are hospitalized in specially organized hospitals. Transportation of a plague patient must be carried out in accordance with current regulations. sanitary rules on biological safety. Patients with bubonic plague are placed in groups of several people in a room, while patients with the pulmonary form are placed only in separate rooms. Patients with bubonic plague are discharged no earlier than 4 weeks, with pneumonic plague - no earlier than 6 weeks from the date of clinical recovery and negative results of bacteriological examination. After the patient is discharged from the hospital, he is placed under medical supervision for 3 months.

Current and final disinfection is carried out in the outbreak. Persons who came into contact with plague patients, corpses, contaminated things, who participated in the forced slaughter of a sick animal, etc., are subject to isolation and medical observation (6 days). For pneumonic plague, individual isolation (for 6 days) and prophylaxis with antibiotics (streptomycin, rifampicin, etc.) are carried out for all persons who may have become infected.

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Plague is acute infection with natural focality. It is a particularly dangerous infection with a high mortality rate.

The main natural reservoir of plague is various species of rodents and lagomorphs, as well as predators that destroy these animals. The disease is transmitted by fleas, which regurgitate plague bacteria into the wound when they bite. Infection from a patient with pneumonic plague through airborne transmission also plays an important role in epidemiological terms. Susceptibility to the disease is extremely high. Survivors develop weak immunity to the disease, but does not protect against re-infection. Natural foci of plague have been registered in 50 countries, in Russia - in 14 regions (Stavropol, Caucasus, Transbaikalia, etc.).

Pathogenesis of plague

When a person is bitten by an infected flea, the pathogen reaches the regional lymph nodes through the bloodstream, where it is captured by mononuclear cells that perform protective function. Next, the process of phagocytosis should occur with the destruction of foreign bacteria, but the antigens located in the bacterial capsule interfere with this process. There is not only accumulation, but also active reproduction of plague bacilli. The lymph nodes themselves become inflamed, sharply increase in size, become denser, and tend to merge with each other—plague-specific formations—primary buboes—are formed. This period lasts 5-6 days.

Then the lymph nodes become necrotic and a generalization of the process may occur: the multiplied pathogen in huge quantities enters the bloodstream and spreads through the bloodstream throughout the body, affecting various organs and forming secondary buboes.

The septic form of plague causes capillary paresis, disseminated intravascular coagulation syndrome, and multiple organ failure. Death occurs from infectious-toxic shock.

Penetrating into the lungs, Yersinia causes a secondary pneumonic form of plague.

When transmitted by airborne droplets, a primary pulmonary form occurs, which is the most dangerous in epidemic terms. In this case, severe lobar or lobar pneumonia develops in the lungs with a fulminant course.

The main routes of transmission of the plague pathogen:

• transmissible - from sick animals to humans through flea bites
• airborne - from a person suffering from pneumonic plague
• contact-household - through the blood and secretions of animals and humans sick with plague
• food – when consuming infected animal meat

Plague symptoms

Start The plague is always acute, without warning signs. There is severe chills, a rapid increase in temperature to high numbers (39-40°), severe headache, disturbance of consciousness.

A person with the plague is initially restless, then lethargy appears. The face is puffy, hyperemic, then the features become sharper. The conjunctiva of the eyes is inflamed, there are dark circles under the eyes. The facial expression is pained.

Characterized by a coated (“chalky”) tongue. Dry mucous membranes. The pharynx is hyperemic, and enlarged tonsils may be noted. Symptoms of cardiovascular failure increase. After a day, specific symptoms of plague appear, depending on the form of the disease.

There are bubonic, cutaneous (cutaneous bubonic), pneumonic and septic forms of plague. The intestinal form of the disease is extremely rare.

• Bubonic form of plague: a bubo forms near the site of pathogen invasion ( swollen lymph node). On palpation, the bubo is dense, sharply painful, adherent to the skin and surrounding subcutaneous tissue.
  

• Pneumonic form (primary and secondary) of plague: chest pain, shortness of breath, cough with foamy sputum, there may be streaks of scarlet blood. Confusion increases. With minor auscultatory signs, the condition of the patients is extremely serious.
  

• Septic form of plague: lightning-fast development of infectious-toxic shock and death of the patient.
  

• Cutaneous form of plague: rare, usually develops into cutaneous bubonic plague. There are rapidly changing stages of transformation of skin elements: spot → papule → vesicle → pustule. If the outcome is favorable, a scar will subsequently form.
  

• The intestinal form of plague is manifested by abdominal pain, vomiting and loose stools mixed with blood.

Differential diagnosis

With bubonic plague differential diagnosis carried out with tularemia, in which the bubo is mobile and not so painful, well contoured; in the cutaneous form - with anthrax (no pain, rash of new vesicles near the drying scab) and glanders (painful nodules accompanied by inflammation lymphatic vessels– lymphangitis).

In the pneumonic form of plague - with various pneumonias of other etiologies.

In the septic form - with diseases of various origins, occurring with sepsis, phenomena of infectious-toxic shock. Epidemiological data play an important role.

Diagnosis of plague

Anamnesis data is ascertained: arrival from places endemic for plague, contact with plague patients, cutting up animal carcasses, etc.

Specific signs plague upon examination, the severity of the patient’s condition, rapid progression of the disease.

Conduct bacteriological analysis, serological study.

Treatment of plague

Etiotropic therapy of plague: purpose antibacterial drugs, as a rule, intramuscular injections of streptomycin every 12 hours and (or) intravenous injections of the tetracycline group every 6 hours. The drugs are discontinued 3-4 days after body temperature normalizes. For symptoms of meningitis, meningoencephalitis, chloramphenicol, which has the ability to penetrate the blood-brain barrier, is added to treatment.

Symptomatic and pathogenetic treatment of plague: infusion therapy, aimed at detoxifying the body, antipyretic drugs (analgin, parcetamol). If breathing is impaired, the patient is transferred to mechanical ventilation.

Prevention of plague

• In order to prevent plague in endemic areas, vaccination is carried out every 6 months (due to the instability of immunity).
• It is important to observe the rules of personal hygiene.
• Isolation of patients with suspected plague.
• When traveling to areas affected by the plague, persons who have been in contact with people with the plague need preventive prescription of tetracycline and monitoring their well-being.
• Control of rodents in natural areas.

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

Historical reference

In the entire history of modern mankind, there has never been such a ruthless disease as the plague. To this day, information has reached that in ancient times the disease claimed the lives of a large number of people. Epidemics usually began after direct contact with infected animals. Often the spread of the disease turned into a pandemic. History knows three such cases.

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

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

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

Why does plague develop?

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

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

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

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

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

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

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

Bubonic plague

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

Skin plague

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

Pneumonic plague

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

Septicemic plague

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

Diagnostic measures

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

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

What treatment is required?

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

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

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

Forecast and consequences

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

Plague is a potentially serious infectious disease 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 for short term the disease claimed tens of thousands of lives, and the death rate rose so quickly that authorities had trouble disposing 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 port cities Mediterranean and east to Persia. Christian authors, for example, John of Ephesus, considered the cause of the epidemic to be the wrath of God, and modern researchers are confident that its cause was rats (the constant passengers of sea ships) and unsanitary conditions life 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 across the continent from the 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 from a medical point of view. In 1768, the first edition of the Encyclopedia Britannica published the scientific opinion widespread among contemporaries about the emergence of plague fever from “poisonous miasma” or vapors brought from eastern countries with the 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.

Throughout the 18th century early XIX centuries the plague was recorded in the countries of the Middle East and North Africa, and in 1815−1836. appears in India. But these were only the first sparks of a new pandemic.

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. The following year, the Frenchman Paul-Louis Simon demonstrated the results of experiments that showed that fleas of the species Xenopsylla cheopis were 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:

Resistance external environment for the plague pathogen is low. Drying, sunlight, competition with putrefactive microbes kills 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, transmission between rodents and fleas accounts for most of the spread of Y. pestis. 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 along 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 eventually 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 look like this:

Treatment and prognosis

At the moment when the diagnosis of plague is suspected clinically and epidemiological grounds, appropriate samples for diagnosis should be obtained immediately. Antibacterial therapy 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. In the absence of medical care, the prognosis is 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 an analysis of the side effects of 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 research infectious materials must undergo antibacterial preventive 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 before 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, the cost of carrying out preventive measures, violation technological process 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.

The causative agent of plague is the plague bacillus. And the main reservoir of infection in nature are rodents and lagomorphs.

Predators that hunt animals of these species can also spread the infection.

The carrier of plague is a flea, whose bite infects a person. Human lice and ticks can also transmit the infection.

Penetration of the plague bacillus into the human body is also possible when processing the skins of infected animals or when eating the meat of an animal suffering from the plague.

The disease is transmitted from person to person by airborne droplets.

Humans are highly susceptible to plague infection!

Plague symptoms

There are many types of plague, but the most common is the bubonic form.

The plague is characterized by a sharp, sudden onset with severe chills and increased body temperature. They are accompanied by dizziness, weakness, muscle pain, nausea and vomiting.

The nervous system suffers; patients are frightened, restless, may become delirious, and tend to run away somewhere.

Coordination of movements, gait, and speech are impaired.

Bubonic plague is characterized by the development of a plague bubo. In the area where it appears, the patient experiences severe pain. A bubo gradually forms, a dense tumor with indistinct edges, sharply painful when touched. The skin over the bubo is initially of normal color, hot to the touch, then becomes dark red, with a bluish tint, and glossy.

There is also an increase in other groups of lymph nodes and secondary buboes are formed.

If left untreated, the buboes fester, then open and transform into fistulas. Then they gradually heal.

Complications of the plague

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

10% of patients have gangrene of the feet, fingers or skin.

Diagnosis of plague

Diagnosis of plague is based on epidemiological data. Currently, all natural plague foci are strictly registered. Characteristic clinical manifestations of the disease are also important for making a diagnosis. A bacterioscopic examination of bubo punctate and ulcer discharge is also carried out.

Treatment of plague

First of all, a person sick with plague must be hospitalized in an infectious diseases hospital.

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

A patient who has recovered from the plague is discharged from an infectious diseases hospital after complete recovery, the disappearance of symptoms of the disease and a threefold negative result of bacteriological culture.

For bubonic plague, discharge is carried out no earlier than 1 month from the moment of recovery.

Recovered people are registered at the dispensary for 3 months after the disappearance of the last signs of the disease.