The plague is all about the disease, a summary. Bubonic plague: symptoms and treatment

The plague disease, which humanity encountered about one and a half thousand years ago, previously caused large outbreaks of morbidity, claiming tens and hundreds of millions of lives. History does not know anything more merciless and devastating, and so far, despite the development of medicine, it has not been completely possible to cope with it.

What is plague?

Plague is a disease in humans of a naturally focal infectious nature, in many cases resulting in death. This is a highly contagious pathology, and susceptibility to it is universal. After suffering and curing the plague, stable immunity does not form, that is, the risk remains reinfection(however, the second time the disease is somewhat easier).

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

Plague is a pathogen

For a long time it was not clear what caused 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 - the plague bacillus (Yersinia pestis). The pathogen has been well studied, several subspecies have been identified and the following features have been established:

• may have different shape– from thread-like to spherical;
• long-term preservation of viability in the secretions of sick people;
• good tolerance to low temperatures and freezing;
• high sensitivity to disinfectants, sunlight, acidic environment, elevated temperatures;
• contains about thirty antigenic structures, secretes endo- and exotoxins.

Plague - ways bacteria penetrate 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 bodies of animal carriers, which include wild rodents (gophers, marmots, voles), gray and black rats, house mice, cats, lagomorphs, and camels. The carriers (distributors) of pathogens are fleas of various types and several types of blood-sucking ticks, which become infected with the pathogen when feeding on sick animals containing the plague bacillus in the blood.

A distinction is made between transmission of the pathogen through fleas from animal carriers to humans and from person to person. We list the possible ways of plague entering the human body:

1. Transmissible– entry into the bloodstream after the bite of an infected insect.
2. Contact– when a person who has microtrauma on the skin or mucous membranes comes into contact with the bodies of infected animals (for example, when cutting carcasses, processing hides).
3. Nutritional– through the mucous membrane gastrointestinal tract when eating meat from sick animals that have not undergone sufficient heat treatment, or other contaminated products.
4. Contact and household– when touched by a sick person, contacting him biological fluids, use of dishes, personal hygiene items and the like.
5. Aerosol– from person to person through mucous membranes respiratory tract when coughing, sneezing, close conversation.

Plague - symptoms in humans

The place of introduction of the pathogen determines what form of the disease will develop, with damage to which organs, and 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, and abortive. Plague disease has an incubation period of 3 to 6 days, sometimes 1-2 days (in the case of a primarily 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 intoxication syndrome, manifested in the following:

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

As the disease progresses, it changes appearance patient: 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”). Subsequently, the patient's consciousness is impaired, speech becomes unintelligible, coordination of movements is impaired, delusions 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 disease, which develops in 80% of those infected when pathogenic bacteria penetrate through the mucous membranes and skin. IN in this case the infection spreads through the lymphatic system, causing damage to the inguinal lymph nodes, and in rare cases, the axillary or cervical lymph nodes. The resulting buboes can be single or 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 disease develops after aerogenic infection (primary) or as a complication of the bubonic form (secondary). This is the most dangerous variety, and specific signs of plague in humans in this case are observed approximately 2-3 days after the onset of acute intoxication symptoms. The pathogen infects the walls of the pulmonary alveoli, causing necrotic phenomena. Distinctive manifestations are:

• rapid breathing, shortness of breath;
• cough;
• secretion of sputum - initially foamy, transparent, then streaked with blood;
• chest pain;
• tachycardia;
• a fall blood pressure.

Septicemic form of plague

The primary septic form of plague, which develops when a massive dose of microbes enters the bloodstream, is rare, but is very severe. Signs of intoxication occur at lightning speed, as the pathogen spreads to all organs. Numerous hemorrhages are observed in the skin and mucous tissues, conjunctiva, intestinal and renal bleeding, with rapid development. Sometimes this form occurs as a secondary complication of other types 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 the disease in people against the background of general intoxication and fever are recorded:

• sharp pains in a stomach;
• repeated bloody vomiting;
• diarrhea with mucous-bloody stools;
• Tenesmus is a painful urge to have a bowel movement.

Plague - diagnosis

Laboratory diagnostics, carried out using the following methods, play a significant role in diagnosing “plague”:

• serological;
• bacteriological;
• microscopic.

For research, they take blood, punctures from buboes, discharge from ulcers, sputum, oropharyngeal discharge, and vomit. To check for 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 taken. It is important to establish the fact of an insect bite, contact with sick animals or people, and visiting areas where plague is endemic.

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. Treatment of plague in humans is based on the following measures:

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

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

Measures to prevent plague from entering the human body

To prevent the spread of infection, nonspecific 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 transport arriving from plague-prone regions.

In addition, work is constantly carried out in natural foci of the disease: counting the number of wild rodents, examining them to identify the plague bacterium, exterminating infected individuals, and fighting fleas. If even one patient is detected in a locality, the following anti-epidemic measures are carried out:

• imposing a 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 areas of disease.

For prophylactic purposes, people who have been in contact with plague patients are given anti-plague serum in combination with antibiotics. Vaccination against plague to a person with a live plague vaccine is given in the following cases:

• when you are in natural foci of infection or are about to travel to a disadvantaged area;
• during work involving possible contact with sources of infection;
• when a widespread infection is detected among animals in the vicinity of populated areas.

Plague - incidence statistics

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

Plague in human history

The plague has left devastating traces in the history of mankind. The following epidemics are considered the largest:

• “The Plague of Justinian” (551-580), which began in Egypt and killed more than 100 million people;
• the Black Death epidemic (XIV century) in Europe, brought from Eastern 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 (late 19th century) in Asia – more than 5 million people died.

Plague today

Bubonic plague is now found on every continent except Australia and Antarctica. Between 2010 and 2015, more than 3 thousand cases of the disease were diagnosed, while death was observed in 584 infected people. The most cases were registered in Madagascar (more than 2 thousand). Foci of the plague have been recorded in countries such as Bolivia, the USA, Peru, Kyrgyzstan, Kazakhstan, Russia and others. Regions of Russia endemic for plague are: Altai, East Ural region, Stavropol region, Transbaikalia, Caspian lowland.

Plague - potentially severe infection, caused by the plague bacillus, pathogenic for humans and animals. Before the invention of antibiotics, the disease caused a very high mortality rate and irrevocably changed the social and economic structure of society in Medieval Europe.

Big 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 a brief summary of the misfortunes suffered can take several volumes, but the history goes back thousands of years.

Ancient sources indicate that the disease was known in North Africa and the Middle East. It is assumed that this is what is described in the biblical book of Kings as a pestilence. But indisputable proof of its early existence is the DNA analysis of Bronze Age people, confirming the presence of the plague bacillus in Asia and Europe between 3 thousand and 800 BC. Unfortunately, the nature of these outbreaks cannot be verified.

During the time of Justinian

The first reliably confirmed pandemic occurred during the reign of the Byzantine Emperor Justinian in the 6th century AD.

According to historian Procopius and other sources, the outbreak began in Egypt and moved along maritime trade routes, striking Constantinople in 542. There, the disease claimed tens of thousands of lives in a short period of time, and the death rate grew so quickly that the authorities had problems getting rid of the corpses.

Judging by the descriptions of the symptoms and modes of transmission of the disease, it is likely that all forms of plague were raging in Constantinople at the same time. Over the next 50 years, the pandemic spread west to 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 it was caused by rats (constant passengers on sea ships) and the unsanitary living conditions of that era.

Black Death of Europe

The next pandemic hit Europe in the 14th century and was even more terrible than the previous one. The death toll reached, according to various sources, from 2/3 to ¾ of the population in the affected countries. There is evidence that During the rampant Black Death, about 25 million people died, although determining the exact amount is currently impossible. The plague, like last time, was brought by merchants on ships. Researchers suggest that the herb 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.

Peasants who made up the main labor, has become critically low. 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 and 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. It remains only 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:

The resistance of the plague pathogen to the external environment is low. Drying, sunlight, competition with putrefactive microbes kill it. Boiling a stick in water for a minute leads to its death. But it is able to survive on wet linen, clothes with sputum, pus and blood, and is stored for a long time in water and food.

In wildlife and rural areas, 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 they look like this:

Treatment and prognosis

Whenever a diagnosis of plague is suspected on clinical and epidemiological grounds, appropriate specimens for diagnosis should be obtained immediately. Antibacterial therapy 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 in the form of 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.

Preventative 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 prior to infection may be indicated in cases where people must remain in plague-prone areas for short periods. This also applies to being in an environment where infection is difficult or impossible to prevent.

Precautionary measures for hospitals include a quarantine regime for all cases of plague. These include:

In addition, a patient with suspected pneumonic plague infection should be kept in a separate room and treated with precautions regarding the possibility of airborne infection of personnel. In addition to those listed, they include restricting the patient’s movement outside the room, as well as mandatory wearing of a mask in the presence of other persons.

Possibility of vaccination

Live attenuated and formalin-killed Y. pestis vaccines are available for use in different ways around the world. They are distinguished by their immunogenic and moderately high reactivity. It is important to know that they do not protect against primary pneumonia. In general, it is not possible to vaccinate communities against epizootic impacts.

Additionally, this measure is little used during human plague outbreaks because it takes a month or more for a protective immune response to develop. The vaccine is indicated for people in direct contact with the bacterium. These may be employees of research laboratories or people studying infected animal colonies.

Distemper of carnivores

This disease (Pestis carnivorum) is known among domestic dogs as distemper and is not related to Y. pestis. It is manifested by damage to the central nervous system, inflammation of the mucous membranes of the eyes and respiratory tract. Unlike human plague, it is viral in nature.

Currently, canine plague is recorded among domestic, wild and industrially bred animals in all countries of the world. Economic damage is expressed in losses from culling and slaughter, a decrease in the volume and quality of fur, the cost of carrying out preventive measures, and disruption of the technological process of growing.

The disease is caused by an RNA virus 115−160 nm in size from the Paramyxoviridae family. Dogs, foxes, arctic foxes, Ussuri raccoons, otters, jackals, hyenas and wolves are susceptible to it. For different animal species, the pathogenicity of the virus is different - 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.

Plague I Plague (pestis)

With the most common bubonic form of Ch., from the first day of the illness, a strong feeling is felt at the site of the developing bubo, which forces the patient to take a forced position; palpable in the form of a small painful compaction, which then enlarges, the surrounding area and skin are infiltrated, merge into a dense, lumpy conglomerate without clear contours with lymph nodes, and a plague bubo is formed. not visible. in the first days it is not changed, then it becomes tense, acquires a purplish-bluish color, and softening appears in the center of the bubo. On the 8-12th day of illness, the bubo opens and a thick yellowish-green color is released. When treated with antibiotics, resorption or sclerosis of the bubo more often occurs. At favorable course illness, after opening the bubo, the temperature decreases, a gradual decline occurs.

The pulmonary form of Ch. is the most severe and dangerous for others. It can develop primarily or secondarily like other forms. pronounced, with strong pain in the chest, with bloody sputum, shortness of breath, and tremor. After 2-3 days, pulmonary-heart failure develops (see Pulmonary (Pulmonary heart)) .

The septic form of Ch. is close in severity to the pulmonary form; it can also be primary and secondary. In addition to severe intoxication, severe hemorrhagic phenomena are characteristic in the form of massive hemorrhages in the skin and mucous membranes, various kinds bleeding (gastrointestinal, pulmonary, renal, uterine).

Complications. Sometimes purulent, caused by the plague bacillus, develops. The addition of a secondary purulent infection is noted - pneumonia, pyelonephritis, otitis, etc.

Diagnosis set on the basis clinical picture, epidemiological history data (pre-disease stay in the territory of a natural outbreak, contact with rodents, flea bites, etc.) and laboratory test results. Highest value has plague bacillus from material from the patient (discharge or bubo, sputum, from the nasopharynx, etc.). Serological diagnostic methods are also used.

Most often, the differential bubonic form of Ch. is carried out with tularemia (Tularemia) and purulent lymphadenitis. With tularemia, it is less pronounced, the buboes are little painful, have clear contours, and rarely suppurate. Purulent lymphadenitis is characterized by lymphangitis, local edema, inflammatory processes at the site of the entrance gate of infection, moderately severe. The pulmonary form of anthrax must be differentiated from the pulmonary form of anthrax (Anthrax) , lobar pneumonia (see Pneumonia) .

Treatment. Patients are immediately isolated in a hospital (see Isolation of infectious patients) . Etiotropic therapy is carried out with tetracycline drugs for 7-10 days. Carry out detoxification therapy (5% glucose solution with ascorbic acid, polyionic, hemodez, rheopolyglucin; strophanthin, sulfocamphocaine, vikasol, etc. are administered).

Forecast. With timely treatment, the detail can be reduced to 5-10%.

Prevention. Activities are carried out in two main directions: monitoring the state of natural foci of Ch. and preventing the possible introduction of the disease from other countries (see Sanitary protection of the territory) . Epidemiological surveillance in natural outbreaks of plague includes a systematic examination of the territory by employees of anti-plague institutions in order to detect the disease among rodents and exterminate rodents (see Deratization). . Rodent burrows are treated with disinfectants (see Disinfestation) . In the territory of natural foci, explanatory work is constantly carried out among the population about measures to prevent Ch., according to epidemic indications carried out by a specific live vaccine (see Immunization) .

Of particular importance in the prevention of infection is the early detection of the first cases of human disease. If you suspect it, you must immediately report it to your superiors and quickly begin to deploy anti-epidemic measures. Having identified a patient with suspected Ch., he must stop further admission of patients, close the doors and windows, and place him outside the room to stop the movement of patients and staff. The head of the medical institution is notified by telephone or by messenger, and through him they request protective clothing, emergency prophylactic means (streptomycin, etc.), medicines, disinfectants, and patient care items. Before the team of consultants arrives, the patient receives medical care and compiles a list of people who have had contact with the patient. Those suspected of Ch. are immediately isolated and hospitalized. Persons who came into contact with a sick person, contaminated things, or a corpse are isolated for 6 days (see Observation) , Those in contact with patients with the pulmonary form of Ch. are placed individually and undergo medical observation with daily thermometry. These individuals, as well as the attending medical staff, are given emergency chemoprophylaxis with tetracycline 0.5 G orally 3 times a day or chlortetracycline orally 0.5 G 3 times a day for 5 days. All medical personnel serving patients work in full anti-plague suit (pajamas or overalls, robe, hood or large headscarf, cotton-gauze mask or respirator or gas mask, goggles, boots, socks, cap, rubber gloves); After finishing work, the medical staff undergoes complete sanitization, lives in a specially designated room and is under systematic medical supervision.

Monitoring of the health status of the population is organized, all identified patients with fever are hospitalized to exclude plague. Restrictive (quarantine) measures are taken to prevent the spread of infection beyond the outbreak. In the outbreak, current and final disinfection, deratization and disinfestation are carried out both in the field and in the populated area (according to indications).

Bibliography: Guide to Zoonoses, ed. IN AND. Pokrovsky, s. 157, L., 1983; , ed. E.P. Shuvalova, s. 127, M., 1989.

II Plague (pestis)

infectious natural focal from the group of bacterial zoonoses, caused by; transmitted to humans by contact, airborne droplets and alimentary routes, as well as by carriers - fleas; classified as quarantine infections.

Bubonic plague(p. bubonica) is a clinical form of Ch., developing when the pathogen penetrates the skin and is characterized by the formation of sharply painful buboes, high fever and severe intoxication.

Secondary septic plague(p. secundarioseptica) is a clinical form of Ch., developing during hematogenous generalization of the process from the primary affect (bubo), the presence of which distinguishes this form from primary septic Ch.

Bubonic skin plague(p. cutaneobubonica) is a clinical form of Ch., similar to bubonic Ch., but differs from it in the formation of pustules, ulcers or carbuncles on the skin at the site of penetration of the pathogen.

Secondary pneumonic plague(p. pulmonalis secundaria) - a clinical form of Ch., resulting from hematogenous introduction of the pathogen into the lungs from a primary affect (bubo), characterized by extreme severity with the development of hemorrhagic pneumonia; poses a high epidemiological risk.

Primary pneumonic plague(p. pulmonalis primaria) is a clinical form of Ch., arising from the aspiration route of infection, characterized by extreme severity, rapid development of hemorrhagic pneumonia with severe intoxication; poses a high epidemiological risk.

Primary septic plague(p. primarioseptica) is a clinical form of Ch., developing with massive infection and low body resistance, characterized by rapid hematogenous generalization of infection without local phenomena, severe intoxication, severe hemorrhagic syndrome, disorders of the central nervous system. and cardiovascular system.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary medical terms. - M.: Soviet encyclopedia. - 1982-1984.

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 possible development 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.

The emergence of Plague disease

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 serious illnesses both in 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 external environment(in the pus of a bubo it remains 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.

Epidemiology

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 sensitivity of people is very high, absolute in all age groups and for 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.

Main epidemiological features. Natural hotbeds Plagues occupy 6-7% of the globe's land area and have been reported 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 that do not sleep in winter (marmots, gophers, etc.) occurs in the warm season, while from rodents and lagomorphs that do not sleep in winter (gerbils, voles, pikas, etc.), infection has two seasonal peaks, which is associated with breeding periods animals. Men get sick more often than women due to professional activity and staying in a natural source of plague (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 short time become widespread. 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 plague causative agent can remain in the soil for a long time in an uncultivated state has been intensively developed. 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.

Course of the disease 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 place of introduction of the pathogen penetrating through 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 an inflammatory process with elements of necrosis develops in them. 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 Plague disease

The 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, psychomotor agitation develops. 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 features diseases are thickening and coating of the tongue with a thick white coating (“chalky tongue”). From the cardiovascular system, pronounced tachycardia (up to embryocardia), arrhythmia and a progressive drop in blood pressure are noted. 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).

Cutaneous 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. Characterized by damage to lymph nodes regional to the site 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 do not differ from primary septic and primary pulmonary forms of plague, respectively.

Primary septic form. It 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), and the rapid formation of a clinical picture of 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, a severe cough appears, sharp pain occurs 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 the 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 also be observed in other forms of the disease, until recently it remains controversial issue about the existence of intestinal plague as 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, motor restlessness, delusions and hallucinations. When examining patients, attention is drawn to slurred speech, an unsteady gait, a puffy, hyperemic face with scleral injection, an expression of suffering or horror (“plague mask”), and a “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 disease

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. Passage is carried out on laboratory animals ( Guinea pigs, white mice), dying on the 5-7th day after infection.

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

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.

Treatment of Plague disease

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), forcing diuresis, as well as cardiac glycosides, vascular and respiratory analeptics, antipyretics and symptomatic agents.

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 disease

Epidemiological surveillance

The volume, nature and direction of preventive measures are determined by the forecast of the epizootic and epidemic situation regarding plague in specific natural foci, taking into account data on 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.

Preventive actions

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.

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

The main natural reservoir of plague is different kinds 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. Noted severe chills, rapid increase in temperature to high numbers (39-40°), severe headache, impaired consciousness.

A person sick 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. Extremely rare intestinal form diseases.

• Bubonic form of plague: a bubo (inflamed lymph node) forms near the site of pathogen invasion. 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. At favorable outcome, a scar is subsequently formed.
  

• 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. Important role epidemiological data play a 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 of 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.