Plague is a bacterial disease. Plague: forms, symptoms, diagnosis and treatment

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

What is a plague?

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

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


Plague is the causative agent

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

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

Plague - how bacteria enter the human body

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

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

  1. Transmissible- entry into the bloodstream after the bite of an infected insect.
  2. Contact- upon contact of a person who has microtraumas on the skin or mucous membranes with the bodies of infected animals (for example, when cutting carcasses, processing skins).
  3. Alimentary- through the mucosa gastrointestinal tract when eating the meat of sick animals that have not undergone sufficient heat treatment, or other contaminated products.
  4. Contact household- at the touch of a sick person, contact with his biological fluids, using utensils, 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 depends on what form of the disease will develop, with the defeat of which organs, with what manifestations. The following main forms of human plague are distinguished:

  • bubonic;
  • pulmonary;
  • septic;
  • intestinal.

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

  • heat body;
  • chills;
  • headache;
  • muscle and joint pain;
  • nausea;
  • vomit;
  • severe weakness.

As the disease progresses, 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”). In the future, the patient's consciousness is disturbed, speech becomes illegible, coordination of movements is disturbed, delirium and hallucinations appear. In addition, specific lesions develop, depending on the form of the plague.

Bubonic plague - symptoms

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


Pneumonic plague

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

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

septic form of plague

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

Intestinal form of plague

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

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

Plague - Diagnosis

Plays a significant role in the diagnosis of "plague" laboratory diagnostics carried out by the following methods:

  • serological;
  • bacteriological;
  • microscopic.

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


Plague - treatment

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

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

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

Measures to prevent plague in the human body

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

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

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

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

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

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

Plague - incidence statistics

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

Plague in human history

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

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

Plague today

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

plague doctor in the middle ages

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

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

What is plague

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

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

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

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

Where is the plague found now?

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

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

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

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

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

Although plague pandemics have not been recorded for the last hundred years - to completely crack down on bacteria, disease-causing, failed. Eat natural springs plagues and anthropurgic, that is, natural and artificially created in the process of life.

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

plague agent

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

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

Plague transmission routes

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

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

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

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

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

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

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

How is the plague transmitted?

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

Plague pathogenesis and its classification

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

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

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

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

  • pulmonary;
  • bubonic.

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

plague symptoms

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

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

The first signs of plague in humans are as follows:

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

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

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

Symptoms of bubonic plague

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

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

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

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

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

  • long-term complete resorption;
  • opening;
  • sclerosis.

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

Symptoms of pneumonic plague

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

  • elementary;
  • peak period;
  • soporous or terminal.

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

The symptoms of pneumonic plague are as follows.

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

How other forms of plague proceed

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

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

Plague diagnosis

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

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

Almost any biological material is taken for research:

  • sputum;
  • blood;
  • puncture buboes;
  • explore content ulcerative lesions skin;
  • urine;
  • vomit masses.

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

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

Treatment

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

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

What is the treatment for this disease?

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

After the end of treatment, after about 6 days, a follow-up study is carried out. biological materials.

Plague Prevention

The invention of antibacterial drugs would not solve the problem of the emergence and spread of pandemics. It's just effective way to cope with the disease that has already arisen and the prevention of its most formidable complication - death.

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

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

How is infection prevention carried out today?

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

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

Vaccination

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

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

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

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

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

Indications and contraindications for vaccination

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

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

Vaccination is given to the following categories of citizens:

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

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

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

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

Also in ancient world Few diseases have caused the same panic and destruction as the bubonic plague. This dreaded bacterial infection was commonly spread by rats and other rodents. But when it entered the human body, it quickly spread throughout the body and often proved fatal. Death could come in a matter of days. Let's take a look at six of the most infamous outbreaks of this disease.

Justinian I is often cited as the most powerful Byzantine emperor, but his reign coincided with one of the first well-documented outbreaks of the plague. The pandemic is thought to have originated in Africa and then spread to Europe via infected rats on merchant ships. The plague reached the Byzantine capital of Constantinople in 541 AD and was soon claiming 10,000 lives a day. This led to unburied bodies being piled inside buildings and even outdoors.

According to the ancient historian Procopius, the victims exhibited many of the classic symptoms of bubonic plague, including sudden fever and swollen lymph nodes. Justinian also fell ill, but he was able to recover, which cannot be said about the third part of the inhabitants of Constantinople who were not so lucky. Even after the plague had subsided in Byzantium, it continued to appear in Europe, Africa and Asia for several more years, causing massive famine and devastation. It is believed that at least 25 million people died, but the actual number could be much higher.

In 1347, the disease again invaded Europe from the East, most likely along with Italian sailors who were returning home from the Crimea. As a result, the Black Death tore apart the entire continent for half a decade. Entire cities were decimated and people spent most of their time trying to bury all the dead in mass graves. Medieval doctors tried to fight the disease with bloodletting and other crude methods, but most people were sure that this was God's punishment for their sins. Some Christians even blamed the Jews for everything and began mass pogroms. The Black Death subsided in the West around 1353, but not before taking 50 million people with it—more than half the population of Europe. While the pandemic wreaked havoc across the continent, some historians believe the labor shortage it caused was a boon for the lower working classes.

Even after the Black Death had receded, the bubonic plague continued to rear its ugly head in Europe from time to time for several more centuries. One of the most devastating outbreaks began in 1629, when troops taking part in the Thirty Years' War brought the infection to the Italian city of Mantua. Over the next two years, the plague spread throughout the countryside, but also affected such big cities like Verona, Milan, Venice and Florence. In Milan and Venice, city officials quarantined the sick and completely burned their clothes and possessions to prevent the spread of the disease.

The Venetians even banished some of the plague victims to the islands of the neighboring lagoon. These brutal measures may have helped contain the disease, but up to that time 280,000 people had died, including more than half of the inhabitants of Verona. The Republic of Venice lost a third of its population - 140 thousand people. Some scholars argue that this outbreak undermined the strength of the city-state, leading to its decline as a major player on the world stage.

Plague besieged London several times during the 16th and 17th centuries, but most famous case happened in 1665-1666. It first arose in the London suburb of St. Giles, and then spread to the dirty quarters of the capital. The peak occurred in September 1665, when 8,000 people died every week. Rich people, including King Charles II, fled to the villages, and the main victims of the plague were poor people. As the disease spread, the authorities in London tried to keep the infected in their homes, which were marked with a red cross. Before the outbreak subsided in 1666, an estimated 75,000 to 100,000 people died. Later that year, London faced another tragedy when the Great Fire destroyed much of the city's inner city.

Last in medieval Europe A major outbreak of plague began in 1720 in the French port city of Marseille. The disease arrived on a merchant ship that picked up infected passengers on a trip to the Middle East. The ship was quarantined, but its owner, who also happened to be Marseille's deputy mayor, persuaded officials to let him unload the goods. The rats that lived in it soon spread throughout the city, which caused an epidemic. People were dying by the thousands, and the piles of bodies on the street were so large that the authorities forced the prisoners to dispose of them. In neighboring Provence, a "plague wall" was even built to contain the infection, but it also spread to the south of France. The disease finally disappeared in 1722, but by that time about 100 thousand people had died.

The plague of Justinian and the Black Death are considered to be the first two pandemics. The most recent, the so-called Third Pandemic, broke out in 1855 in the Chinese province of Yunnan. Over the next few decades, the disease spread across the globe, and by the early 20th century, infected rats on ships had carried it across all six continents. Worldwide, this outbreak killed 15 million people before it was eradicated in 1950. Most of the victims were in China and India, but there were also scattered cases from South Africa to America. Despite heavy casualties, the Third Pandemic led to several breakthroughs in medical understanding of the disease. In 1894, Hong Kong physician Alexander Yersin determined which bacilli were causing the disease. A few years later, another doctor finally confirmed that flea bites, which were carried by rats, were the main cause of the spread of infection among humans.

  • What is Plague
  • What Causes the Plague
  • Plague Symptoms
  • Plague Diagnosis
  • Plague Treatment
  • Plague Prevention
  • Which Doctors Should You See If You Have 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 possible development sepsis.

Brief historical information
There is no other like it in the history of mankind. infectious disease, which would lead to such colossal devastation and mortality among the population as the plague. Since ancient times, information has been preserved about the disease of plague, which occurred in people in the form of epidemics with a large number deaths. It is noted that plague epidemics developed as a result of contacts with sick animals. At times, the spread of the disease was in the nature of pandemics. There are three known plague pandemics. The first, known as the "Plague of Justinian", raged in Egypt and the Eastern Roman Empire in 527-565. The second, called the "great", or "black" death, in 1345-1350. covered the Crimea, the Mediterranean and Western Europe; this most devastating pandemic claimed about 60 million lives. The third pandemic began in 1895 in Hong Kong, then spread to India, where more than 12 million people died. At the very beginning, they made important discoveries(the causative agent was isolated, the role of rats in the epidemiology of plague was proved), 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. Yersen 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. 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 patients with plague, and also created an anti-plague vaccine.

What Causes the Plague

The causative agent is a gram-negative immobile 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 characterized by pronounced polymorphism, the most typical are ovoid rods that stain bipolarly. There are several subspecies of the pathogen, different in virulence. Grows on conventional nutrient media supplemented with 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 environmental objects (in bubo pus 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 sour), chemicals(including disinfectants). Under the action of sublimate in a dilution of 1: 1000, it dies in 1-2 minutes. It tolerates low temperatures, freezing.

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, and also 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 are at particular risk pulmonary form plague.

Transfer mechanism diverse, most often transmissible, but airborne droplets are also possible (with pulmonary forms of plague, infection in the laboratory). The carriers of the pathogen are fleas (about 100 species) and some types of mites that support the epizootic process in nature and transmit the pathogen synanthropic rodents, camels, cats and dogs, which can carry infected fleas to human habitation. A person becomes infected not so much with a flea bite, but 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 blood from entering its body. Attempts of a hungry insect to bloodsuck are accompanied by regurgitation of infected masses on the surface of the skin at the site of the bite. These fleas are hungry and often try to suck the animal's blood. Flea contagiousness persists on average for about 7 weeks, and according to some sources - up to 1 year.

Possible contact (through damaged skin and mucous membranes) when cutting carcasses and processing the skins of slaughtered infected animals (hares, foxes, saigas, camels, etc.) and alimentary (when eating their meat) ways of infection with plague.

The natural susceptibility of people is very high, absolute in all age groups and any route of infection. After the 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 signs. Natural foci of plague occupy 6-7% of the earth's land area and have been recorded on all continents, excluding Australia and Antarctica. Every year, several hundred cases of plague in humans are recorded in the world. In the CIS countries, 43 natural plague foci with a total area of ​​more than 216 million hectares have been identified, located in the plains (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, ground squirrels, etc.) occurs in the warm season, while from rodents and hares (gerbils, voles, pikas, etc.) not sleeping in winter, infection has two seasonal peaks, which is associated with breeding periods animals. Men get sick more often than women due to professional activity and stay in the natural focus of the plague (transhumance, hunting). In anthropurgic foci, black and gray rats play the role of a reservoir of infection. The epidemiology of the bubonic and pneumonic forms of plague has significant differences in the 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 get widespread. Patients with the bubonic form of plague are slightly contagious and practically non-infectious, since their secretions do not contain pathogens, and there are few or none at all in the material from the opened buboes. When the disease passes into a 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 pulmonary plague develop with very high contagiousness. Usually pneumonic plague follows bubonic, spreads along with it and quickly becomes the leading epidemiological and clinical form. Recently, the idea that the causative agent of the plague can for a long time be in the soil in an uncultivated state. Primary infection of rodents in this case can occur when digging holes in infected areas of soil. This hypothesis is based on experimental studies, and observations about the ineffectiveness of the search for the pathogen among rodents and their fleas in the inter-epizootic periods.

Pathogenesis (what happens?) during the Plague

Human adaptive mechanisms are practically not adapted to resist the introduction and development of the plague bacillus in the body. This is due to the fact that the plague bacillus multiplies very quickly; bacteria in large quantities produce 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 to mononuclear- phagocytic system with its subsequent activation. Massive antigenemia, the release of inflammatory mediators, including shockogenic cytokines, leads to the development of microcirculatory disorders, DIC, followed by an 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 scheme of plague pathogenesis includes three stages. First, the pathogen from the site of introduction lymphogenously disseminates 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. Then the bacteria quickly enter the bloodstream. In the bacteremia stage, severe toxicosis develops with changes rheological properties blood, microcirculation disorders and hemorrhagic manifestations in various bodies. 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 leads to acute cardiovascular failure.

With the aerogenic route of infection, the alveoli are affected, an inflammatory process develops in them 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 in plague is weak and is formed in late dates diseases.

Plague Symptoms

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

Characterized by an acute onset of the disease, expressed by a rapid increase in body temperature to high numbers with tremendous chills and the development of severe intoxication. Typical complaints of patients on pain in the sacrum, muscles and joints, headache. There is vomiting (often bloody), excruciating thirst. From the first hours of the disease, psychomotor agitation develops. Patients are restless, overly active, trying to escape ("runs like crazy"), they have hallucinations, delirium. Speech becomes slurred, gait unsteady. In more rare cases, lethargy, apathy, and weakness reaches such an extent that the patient cannot get out of bed. Outwardly, hyperemia and puffiness of the face, injection of the sclera are noted. On the face is an expression of suffering or horror ("plague mask"). In more severe cases, a hemorrhagic rash is possible on the skin. Very characteristic signs of the disease are thickening and furnishing of the tongue with a thick white coating (“chalky tongue”). On the part of the cardiovascular system, marked tachycardia (up to embryocardia), arrhythmia and a progressive drop in blood pressure are noted. Even with local forms of the disease, tachypnea develops, as well as oliguria or anuria.

This symptomatology is manifested, especially in the initial period, in all forms of plague.

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

skin form. Characterized by the formation of a carbuncle at the site of the introduction of the pathogen. 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 the opening of the pustule, an ulcer with a yellowish bottom is formed, prone to increase in size. In the future, the bottom of the ulcer is covered with a black scab, after the rejection of which scars form.

bubonic form. The most common form of the plague. Characteristic is the defeat of the lymph nodes, regional in relation to the place of introduction of the pathogen - inguinal, less often axillary and very rarely cervical. Usually buboes are single, rarely multiple. Against the background of severe intoxication, pain occurs in the area of ​​​​the future localization of the bubo. After 1-2 days, sharply painful lymph nodes can be palpated, first of a hard consistency, and then softening and becoming pasty. The nodes merge into a single conglomerate, inactive due to the presence of periadenitis, fluctuating on palpation. The duration of the peak of the disease is about a week, after which a period of convalescence begins. The lymph nodes can independently resolve or ulcerate and sclerosis due to serous-hemorrhagic inflammation and necrosis.

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

These local forms of the disease can progress to secondary plague sepsis and secondary pneumonia. Their clinical characteristic does not differ from the 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 a 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, 100% of cases are fatal.

Primary pulmonary form. Develops with 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 strong cough appears, there are sharp pains in chest, shortness of breath. Cough is accompanied by the release of first vitreous, and then liquid, foamy, bloody sputum. Physical data from the lungs are scarce, signs of focal or lobar pneumonia are found on the radiograph. Cardiovascular insufficiency is increasing, expressed in tachycardia and a progressive drop in blood pressure, the development of cyanosis. IN terminal stage in patients, a soporous condition develops first, accompanied by increased dyspnea and hemorrhagic manifestations in the form of petechiae or extensive hemorrhages, and then coma.

intestinal form. Against the background of the syndrome of intoxication, patients experience sharp pains in the abdomen, repeated vomiting and diarrhea with tenesmus and copious mucus-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 an independent form, apparently associated with enteric infection, remains controversial.

Differential Diagnosis
Skin, bubonic and skin-bubonic forms of plague should be distinguished from tularemia, carbuncles, various lymphadenopathy, pulmonary and septic forms - from inflammatory diseases of the lungs and sepsis, including meningococcal etiology.

In all forms of plague, already in the initial period, rapidly growing signs of severe intoxication are alarming: high body temperature, tremendous chills, vomiting, excruciating thirst, psychomotor agitation, motor restlessness, delirium and hallucinations. When examining patients, attention is drawn to slurred speech, a shaky gait, a puffy hyperemic face with an injection of sclera, an expression of suffering or horror (“plague mask”), “chalky tongue”. Symptoms are growing fast cardiovascular insufficiency, tachypnea, oliguria progresses.

Skin, bubonic and skin-bubonic forms of plague are characterized by severe pain at the site of the lesion, staging 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 lightning-fast development severe intoxication, severe manifestations hemorrhagic syndrome, infectious-toxic shock. When the lungs are affected, sharp pains in the chest and a strong cough, separation of vitreous, and then liquid, foamy, bloody sputum are noted. Meager physical data do not correspond to the general extremely difficult condition.

Plague Diagnosis

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

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

Positive results of PCR 5-6 hours after its setting indicate the presence of specific DNA of the plague microbe and confirm the 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 stationary conditions. The choice of drugs for etiotropic therapy, their doses and regimens determines the form of the disease. The course of etiotropic therapy for all forms of the disease is 7-10 days. In this case, apply:
at skin form- cotrimoxazole 4 tablets per day;
in the bubonic form - levomycetin 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 appointment of doxycycline at a dose of 0.3 g / day or tetracycline 4-6 g / day orally.

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

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

Plague Prevention

Epidemiological surveillance
The volume, nature and direction of preventive measures determines the prognosis of the epizootic and epidemic situation for plague in specific natural foci, taking into account the monitoring data on the movement of morbidity in all countries of the world. All countries are required to report to WHO on the occurrence of plague, the movement of diseases, epizootics among rodents and measures to combat infection. The system of certification of natural plague foci has been developed and is functioning in the country, which made it possible to carry out epidemiological zoning of the territory.

Indications for carrying out preventive immunization of the population are the epidemic of plague among rodents, the identification of plague-stricken domestic animals and the possibility of importation of infection by a sick person. Depending on the epidemic situation, vaccination is carried out in a strictly defined area for the entire population (without exception) and selectively especially threatened contingents - persons who have a permanent or temporary connection with the territories where an epizootic is observed (livestock breeders, agronomists, hunters, purveyors, geologists, archaeologists, etc.). d.). All medical institutions should have a certain stock of medicines and means of personal protection and prevention, as well as a scheme for alerting personnel and transmitting information vertically, in case a plague patient is detected. Measures to prevent infection of people with plague in enzootic areas, persons working with pathogens of especially dangerous infections, as well as prevention of the spread of infection beyond the foci to other regions of the country are carried out by anti-plague and other health care institutions.

Activities in the epidemic focus
When a plague patient or suspected of this infection appears, take Urgent measures for localization and elimination of the focus. The boundaries of the territory where certain restrictive measures (quarantine) are introduced are determined based on the specific epidemiological and epizootological situation, possible active factors of infection transmission, sanitary and hygienic conditions, the intensity of population migration and transport links with other territories. General management of all activities in the focus of the plague is carried out by the Extraordinary Anti-Epidemic Commission. At the same time, the anti-epidemic regime with the use of anti-plague suits is strictly observed. Quarantine is introduced by the decision of the Extraordinary Anti-Epidemiological Commission, covering the entire territory of the outbreak.

Plague patients and patients with suspicion of this disease are hospitalized in specially organized hospitals. Transportation of a plague patient must be carried out in accordance with the current sanitary rules for biological safety. Patients with bubonic plague place several people in a ward, patients with a pulmonary form - only in separate wards. Discharge patients with bubonic plague not earlier than 4 weeks, with pulmonary - not earlier than 6 weeks from the day of clinical recovery and negative results of bacteriological examination. After the patient is discharged from the hospital, medical observation is established for him for 3 months.

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