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

Disease Facts:

• The plague affects the lymph nodes, lungs, and other internal organs. As a result of infection, sepsis develops. The general condition of the body is extremely difficult. The body is subject to constant bouts of fever.
• The period of development of the plague after infection is on average about three days, depending on the general condition of the body.
• At the moment, mortality from this disease is no more than 10% of all identified cases.
• There are about 2 thousand cases of the disease per year. According to the WHO, in 2013, 783 cases of infection were officially registered, of which 126 cases resulted in death.
• Outbreaks of the disease are mainly affected by African countries and a number of countries in South America. Endemic countries are DR Congo, the island of Madagascar and Peru.

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

THE REASONS

The main cause of plague is flea bites. This factor is due to the specific structure digestive system these insects. After an infected rodent is bitten by a flea, the plague bacterium settles in its crop and blocks the passage of blood to the stomach. As a result, the insect experiences constant feeling starvation and before his death he manages to bite, thereby infecting up to 10 hosts, belching the drunk blood together with the plague bacteria into a bite.

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

Causes of infection:

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

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

CLASSIFICATION

Varieties of plague are divided into two main types.

• Localized type- the disease develops after the plague germs get under the skin:
  • Skin plague. There is no primary protective reaction, only in 3% of cases there is reddening of the affected areas of the skin with seals. Without visible external signs, the disease progresses, eventually forming a carbuncle, then an ulcer, which scars when healed.
  • Bubonic plague . The most common form of the disease. It affects the lymph nodes, forming "buboes". It is characterized by painful inflammatory processes in them. It affects the groin area, armpits. Accompanied by severe fever and general intoxication of the body.
  • bubonic plague. Plague bacteria move along with the lymph, end up in the lymph nodes, causing an inflammatory process that affects neighboring tissues. "Buboes" ripen, while the rate of development of the pathology decreases.
• Generalized type- the pathogen enters the body by airborne droplets, as well as through the membranes of the mucous surfaces of the body:
  • septic plague. The causative agent penetrates through the mucous membranes. High virulence of the microbe and a weakened organism - lung causes getting into the patient's blood, bypassing all his defense mechanisms. A fatal outcome with this form of the disease can occur within less than 24 hours, the so-called. "lightning plague".
  • Pneumonic plague. Entry into the body occurs by airborne droplets, infection with dirty hands and objects, as well as through the conjunctiva of the eyes. This form is primary pneumonia, and also has a high epidemic threshold due to abundant sputum discharge containing pathogenic bacteria during coughing.

SYMPTOMS

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

Clinical history of plague:

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

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

DIAGNOSTICS

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

Diagnostics is carried out in the following ways:

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

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

TREATMENT

Plague since 1947 treated with antibiotics aminoglycoside groups a wide range actions.

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

Course of therapy:

• The use of antibacterial drugs based on sulfamethoxazole and trimethoprim.
• Intravenous administration of chloramphenicol simultaneously with streptomycin.
• detoxification procedures.
• Improvement of microcirculation and reparation. Achieved by input.
• Reception of cardiac glycosides.
• The use of respiratory analeptics.
• The use of antipyretics.

Treatment is most effective and does not cause any consequences in the initial stages of plague.

COMPLICATIONS

Because the disease is included in the group of fatal, the main complications in case of an incorrect diagnosis or the absence of a full-fledged treatment may be the transformation of plague from a mild form to a more severe one. So, skin plague can develop to septic, and bubonic to pneumonic.

Also, complications of plague affect:

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

Although a plague patient receives immunity, however, he is not completely insured against new cases of infection, especially if he neglects preventive measures.

PREVENTION

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

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

• "Guidelines for the diagnosis, treatment and prevention of plague", approved by the USSR Ministry of Health on September 14, 1976.
• Sanitary and epidemiological rules SP 3.1.7.1380-03 dated 06/06/2003, approved by the Decree of the Chief State Sanitary Doctor regarding "Plague Prevention".

A set of measures:

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

PROGNOSIS FOR RECOVERY

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

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

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The Black Death is a disease that is now legendary. In fact, this is the name of the plague epidemic that struck Europe, Asia, North Africa and even Greenland in the 14th century. The pathology proceeded mainly in the bubonic form. The territorial focus of the disease has become. Many people know where this place is located. Gobi belongs to Eurasia. The Black Sea arose precisely there because of the Little Ice Age that occurred, which served as the impetus for a sharp and dangerous climate change.

It took the lives of 60 million people. At the same time, in some regions the number of deaths reached two-thirds of the population. Due to the unpredictability of the disease, as well as the impossibility at that time to cure it, religious ideas began to flourish among people. Belief in a higher power has become commonplace. At the same time, the persecution of the so-called "poisoners", "witches", "sorcerers" began, which, according to religious fanatics, sent an epidemic to people.

This period has remained in history as a time of impatient people who were struck by fear, hatred, mistrust and numerous superstitions. In fact, there is, of course, a scientific explanation for the outbreak of bubonic plague.

The myth of the bubonic plague

When historians were looking for ways to spread the disease to Europe, they settled on the opinion that the plague appeared in Tatarstan. More precisely, it was brought by the Tatars.

In 1348, led by Khan Dzhanybek, during the siege of the Genoese fortress of Kafa (Feodosia), the corpses of people who had previously died from the plague were thrown there. After the liberation, the Europeans began to leave the city, spreading the disease throughout Europe.

But the so-called "plague in Tatarstan" turned out to be nothing more than the speculation of people who do not know how to explain the sudden and deadly outbreak of the "black death".

The theory was defeated as it became known that the pandemic is not transmitted between people. It could be infected from small rodents or insects.

Such a "general" theory existed enough long time and contained many mysteries. In fact, the plague epidemic, as it turned out later, began for several reasons.

Natural causes of the pandemic

In addition to dramatic climate change in Eurasia, the bubonic plague outbreak was preceded by several other environmental factors. Among them:

• global drought in China followed by massive famine;
• in Henan mass ;
• rains and hurricanes dominated Beijing for a long time.

Like the "Plague of Justinian", as the first pandemic in history is called, the "Black Death" overtook people after massive natural disasters. She even went the same way as her predecessor.

The decrease in the immunity of people, provoked by an environmental factor, has led to a massive incidence. The catastrophe reached such proportions that the heads of the churches had to open rooms for the sick population.

The plague in the Middle Ages also had socio-economic prerequisites.

Socio-economic causes of bubonic plague

Natural factors could not provoke such a serious outbreak on their own. They were supported by the following socio-economic prerequisites:

• military operations in France, Spain, Italy;
• the domination of the Mongol-Tatar yoke over part of Eastern Europe;
• increased trade;
• rapidly growing poverty;
• too high population density.

Another important factor that provoked the invasion of the plague was the belief that implied that healthy believers should wash as little as possible. According to the saints of that time, the contemplation of one's own naked body leads a person into temptation. Some followers of the church were so imbued with this opinion that they never immersed themselves in water even once in their entire conscious life.

Europe in the 14th century was not considered a pure power. The population did not follow the disposal of garbage. Waste was thrown directly from the windows, slops and the contents of chamber pots were poured onto the road, and the blood of livestock flowed there. All this later ended up in the river, from which people took water for cooking and even drinking.

Like the Plague of Justinian, the Black Death was caused by large numbers of rodents that lived in close contact with humans. In the literature of that time, you can find many entries on what to do in the event of an animal bite. As you know, rats and marmots are carriers of the disease, so people were terribly afraid of even one of their species. In an effort to overcome rodents, many have forgotten about everything, including their family.

How it all began

The point of origin of the disease was the Gobi desert. Where is the place, which was the immediate focus, is unknown. It is assumed that the Tatars who lived nearby declared a hunt for marmots, which are carriers of the plague. The meat and fur of these animals were highly valued. Under such conditions, infection was inevitable.

Many rodents, due to drought and other negative weather conditions, left their shelters and moved closer to people, where more food could be found.

Hebei Province in China was the first to be hit. At least 90% of the population died there. This is another reason that gave rise to the opinion that the Tatars provoked the outbreak of the plague. They could lead the disease along the well-known Silk Road.

Then the plague reached India, after which it moved to Europe. Surprisingly, only one source of that time mentions the true nature of the disease. It is believed that people were struck by the bubonic form of the plague.

In countries that were not affected by the pandemic, real panic arose in the Middle Ages. The heads of state sent messengers for information about the disease and forced specialists to invent a cure for it. The population of some states, remaining in ignorance, willingly believed the rumors that snakes were raining on the infected lands, a fiery wind was blowing, and acid balls were falling from the sky.

Low temperatures, a long stay outside the host's body, thawing cannot destroy the Black Death pathogen. But it's effective against him. solar exposure and drying.

Bubonic plague begins to develop from the moment you are bitten by an infected flea. Bacteria enter the lymph nodes and begin their vital activity. Suddenly, a person is overcome by chills, his body temperature rises, the headache becomes unbearable, and facial features become unrecognizable, black spots appear under the eyes. On the second day after infection, the bubo itself appears. This is the name of the enlarged lymph node.

A person infected with the plague can be identified immediately. "Black Death" is a disease that changes the face and body beyond recognition. Blisters become noticeable already on the second day, and the general condition of the patient cannot be called adequate.

The symptoms of plague in a person of the Middle Ages are surprisingly different from those of a modern patient.

Clinical picture of the bubonic plague of the Middle Ages

"Black Death" is a disease that in the Middle Ages was identified by such signs:

• severe fever, chills;
• aggressiveness;
• continuous feeling of fear;
• severe pain in the chest;
• dyspnea;
• cough with bloody secretions;
• blood and waste products became black;
• a dark coating could be seen on the tongue;
• ulcers and buboes arising on the body exuded an unpleasant odor;
• clouding of consciousness.

These symptoms were seen as a sign of imminent and imminent death. If a person received such a sentence, he already knew that he had very little time left. No one tried to deal with such symptoms, they were considered the will of God and the church.

Treatment of bubonic plague in the Middle Ages

Medieval medicine was far from ideal. The doctor who came to see the patient paid more attention to talking about whether he confessed than to the treatment itself. This was due to the religious insanity of the population. The salvation of the soul was considered a much more important task than the healing of the body. Accordingly, surgical intervention was practically not practiced.

The methods of treating plague were as follows:

• cutting tumors and cauterizing them with a red-hot iron;
• use of antidotes;
• applying reptile skin to buboes;
• pulling out the disease with the help of magnets.

At the same time, medieval medicine was not hopeless. Some doctors of that time advised patients to eat well and wait until the body copes with the plague on its own. This is the most adequate theory of treatment. Of course, in the conditions of that time, cases of recovery were isolated, but still they took place.

Only mediocre doctors or young people who wanted to gain fame in an extremely risky way were taken for the treatment of the disease. They wore a mask that looked like a bird's head with a pronounced beak. However, such protection did not save everyone, so many doctors died after their patients.

The authorities of the powers advised people to adhere to the following methods of dealing with the epidemic:

• Escape for a long distance. At the same time, it was necessary to overcome as many kilometers as possible very quickly. It was necessary to stay at a safe distance from the disease as long as possible.
• Through the infected places to drive herds of horses. It was believed that the breath of these animals purifies the air. For the same purpose, it was advised to let different insects. In a room where a person recently died of the plague, a saucer of milk was placed, because it was believed that it absorbs the disease. Also popular were methods such as breeding spiders in the house and burning a large number of fires near the living quarters.
• Do whatever is necessary to kill the smell of the plague. It was believed that if a person does not feel the stench coming from infected people, he is sufficiently protected. That is why many carried bouquets of flowers with them.

Doctors also advised not to sleep after dawn, not to have an intimate relationship and not to think about the epidemic and death. Today, this approach seems crazy, but in the Middle Ages, people found solace in it.

Of course, religion was an important factor influencing life during the epidemic.

Religion during the bubonic plague

"Black Death" is a disease that frightened people with its obscurity. Therefore, against this background, various religious beliefs arose:

• Plague is a punishment for ordinary human sins, disobedience, bad attitude towards loved ones, the desire to succumb to temptations.
• The plague arose as a result of the neglect of faith.
• The epidemic began due to the fact that shoes with pointed toes came into fashion, which greatly angered God.

Priests who were obliged to listen to the confessions of dying people often became infected and died. Therefore, often the cities were left without church ministers, because they were afraid for their lives.

Against the backdrop of a tense situation, various groups or sects appeared, each of which in its own way explained the cause of the epidemic. In addition, various superstitions were widespread among the population, which were considered pure truth.

Superstitions during the bubonic plague

In any, even the most insignificant event, during the epidemic, people saw peculiar signs of fate. Some superstitions were quite surprising:

• If a completely naked woman plows the land around the house, and the rest of the family at this time will be indoors, the plague will leave nearby places.
• If you make a scarecrow symbolizing the plague and burn it, the disease will recede.
• To prevent the disease from attacking, you need to carry silver or mercury with you.

Many legends were formed around the image of the plague. People really believed in them. They were afraid to once again open the door of their house, so as not to let the plague spirit inside. Even native people swore among themselves, each sought to save himself and only himself.

The situation in society

Oppressed and frightened people over time came to the conclusion that the plague was spread by the so-called outcasts who wished the death of the entire population. The pursuit of the suspects began. They were forcibly dragged to the infirmary. Many of the people identified as suspects have committed suicide. A suicide epidemic has hit Europe. The problem has reached such proportions that the authorities have threatened those who commit suicide to put their corpses on public display.

Since many people were sure that they had very little time left to live, they indulged in all serious things: they were addicted to alcohol, they were looking for entertainment with women of easy virtue. This lifestyle further intensified the epidemic.

The pandemic has reached such proportions that the corpses were taken out at night, dumping them in special pits and burying them.

Sometimes it happened that plague patients appeared in society on purpose, trying to infect as many enemies as possible. It was also due to the fact that it was believed that the plague would recede if it was passed on to another.

In the atmosphere of that time, any person who, by any sign, stood out from the crowd, could be considered a poisoner.

Consequences of the Black Death

The Black Death had significant consequences in all spheres of life. The most significant of them:

• The ratio of blood groups has changed significantly.
• Instability in the political sphere of life.
• Many villages were deserted.
• The beginning of feudal relations was laid. Many people in whose workshops their sons worked were forced to hire outside craftsmen.
• Since there were not enough male labor resources to work in the production sector, women began to master this type of activity.
• Medicine has moved to a new stage of development. All sorts of diseases began to be studied and cures for them were invented.
• The servants and the lower strata of the population, due to the lack of people, began to demand a better position for themselves. Many insolvent people turned out to be heirs of rich deceased relatives.
• Attempts were made to mechanize production.
• Housing and rent prices have dropped significantly.
• The self-consciousness of the population, which did not want to blindly obey the government, grew at a tremendous pace. This resulted in various riots and revolutions.
• Significantly weakened the influence of the church on the population. People saw the helplessness of the priests in the fight against the plague, they stopped trusting them. Rituals and beliefs previously forbidden by the church came into use again. The age of "witches" and "sorcerers" began. The number of priests has dropped significantly. These positions were often filled with people who were uneducated and unsuitable for their age. Many did not understand why death takes away not only criminals, but also good, kind people. In this regard, Europe doubted the power of God.
• After such a large-scale pandemic, the plague did not completely leave the population. Periodically, epidemics broke out in different cities, taking the lives of people with them.

Today, many researchers doubt that the second pandemic proceeded precisely in the form of bubonic plague.

Opinions on the second pandemic

There are doubts that the "black death" is a synonym for the period of prosperity of the bubonic plague. There are explanations for this:

• Plague patients rarely reported symptoms such as fever and sore throat. However, modern scholars note that there are many errors in the narratives of that time. Moreover, some works are fictional and contradict not only other stories, but also themselves.
• The third pandemic was able to defeat only 3% of the population, while the "black death" mowed down at least a third of Europe. But this also has an explanation. During the second pandemic, terrible unsanitary conditions were observed, causing more problems than illness.
• The buboes arising from the defeat of a person were located under the armpits and in the neck. It would be logical if they appeared on the legs, since it is there that the flea is easiest to get. However, this fact is not perfect either. It turns out that along with the spreader of the plague is a human louse. And there were many such insects in the Middle Ages.
• Usually epidemics are preceded by a mass death of rats. This phenomenon was not observed in the Middle Ages. This fact can also be disputed, given the presence of human lice.
• The flea, which is the carrier of the disease, feels best in warm and humid climates. The pandemic flourished even in the coldest winters.
• The spread of the epidemic was at a record high.

As a result of the research, it was found that the genome of modern plague strains is identical to the disease of the Middle Ages, which proves that it was the bubonic form of the pathology that became the "black death" for people of that time. Therefore, any other opinions are automatically moved to the wrong category. But a more detailed study of the issue is still ongoing.

Plague is a potentially serious infectious disease caused by the plague bacillus, which is pathogenic for humans and animals. Before the invention of antibiotics, disease caused very high level mortality and in medieval Europe irrevocably changed the social and economic structure of society.

Big Pandemics

The plague has left an indelible dark mark on the history of mankind, and it is not for nothing that many peoples associate it with death. Even a summary of the misfortunes suffered can take several volumes, and the history goes back millennia.

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 pestilence. But the indisputable proof of its early existence is the analysis of the DNA of people of the Bronze Age, 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 the historian Procopius and other sources, the outbreak began in Egypt and moved along the sea trade routes, hitting Constantinople in 542. There, in a short time, the disease claimed tens of thousands of lives, and the death rate grew so rapidly 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 the plague raged in Constantinople at the same time. Over the next 50 years, the pandemic spread west to Mediterranean port cities and east to Persia. Christian authors, for example, John of Ephesus, considered the wrath of God to be the cause of the epidemic, and modern researchers are sure that rats (the constant passengers of ships) and unsanitary living conditions of that era were the cause of it.

Black Death of Europe

The next pandemic covered Europe in the 14th century and was even worse 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 data that Around 25 million people died during the Black Death., although it is currently impossible to determine the exact amount. The plague, like last time, was brought by merchants on ships. Researchers suggest that the disease came to the southern ports of present-day France and Italy from the Genoese colonies of the Crimea, spreading from Central Asia.

The consequences of this catastrophe not only left an imprint on the religious and mystical features of the worldview of Europeans, but also led to a change in the socio-economic formation.

The peasants, who constituted the main labor force, became critically small. To maintain the previous standard of living, it was necessary to increase labor productivity and change the technological structure. This need served as an impetus for the development of capitalist relations in feudal society.

Great Plague of London

Over the next three centuries, small pockets of the disease were observed throughout the continent from the British Isles to Russia. Another epidemic broke out in London in 1664-1666. The number of deaths is estimated between 75 and 100 thousand people. The plague spread rapidly:

• in 1666-1670 - in Cologne and on the territory of 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 who died, in Vienna - 76 thousand, in Prague - 83 thousand. By the end of the 17th century, the epidemic began to fade little by little. The last outbreak was in the port city of Marseille in 1720, where it killed 40,000 people. After that, the disease was not recorded in Europe (with the exception of the Caucasus).

The retreat of the pandemic can be explained by progress in the field of sanitation and the use of quarantine measures, the fight against rats as plague vectors, 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 Encyclopædia Britannica published the scientific opinion common among contemporaries about the origin of plague fever from "poisonous miasms" or vapors brought from eastern countries with air.

The best treatment was considered to be the expulsion of the "poison", which was achieved by either natural rupture of the tumors, or, if necessary, their incision and drainage. Other recommended remedies were:

• bloodletting;
• vomit;
• sweating;
• purgation.

During the 18th and early 19th centuries 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.

The 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 the distribution centers for the new epidemic, which by 1922 was being imported by ships around the world - more widely than in any previous era. As a result, about 10 million people from various cities and countries died:

Almost all European ports were hit, but of the affected regions, India found itself in the most dire situation. It was only towards the end of the 19th century that the germ theory was developed, and it was finally established which pathogen was responsible for so many deaths. It remains only to determine how the bacillus infects a person. It has long been observed that in many areas of epidemics the unusual death of rats precedes outbreaks of plague. The disease in people appeared some time later.

In 1897, the Japanese physician Ogata Masanori, examining the focus of the disease on the island of Farmosa, proved that rats carry the plague bacillus. The following year, the Frenchman Paul-Louis Simon demonstrated the results of experiments that showed that in a population of rats, fleas of the species Xenopsylla cheopis are carriers of plague. So the ways of infecting people were finally described.

Since then, efforts have been made to exterminate rats in ports and on ships around the world, and insecticides have been used to bait rodents in outbreak areas. Beginning in the 1930s, doctors began to use sulfur-containing preparations 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.

Especially dangerous infection

Plague is one of the deadliest diseases in human history. The human body is extremely susceptible to disease, infection can occur both directly and indirectly. A defeated plague could 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 bioterrorism threats.

Methods of infection

The causative agent of the plague - Y. pestis, motionless rod-shaped anaerobic bacterium with bipolar staining, capable of producing antiphagocytic mucosa. Closest relatives:

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

In the wild and rural areas, most of the distribution of Y. pestis is through transmission between rodents and fleas. In cities, synanthropic rodents, primarily gray and brown rats, are the main vectors.

The plague wand easily migrates from the urban environment to nature and back. It is transmitted to humans, usually through the bites of infected fleas. But there are also reports of more than 200 species of mammals (including dogs and cats) that can carry the coli. Half of them are rodents and lagomorphs.

That's why The main rules of conduct in areas at risk of an outbreak of the disease will be:

• exclusion of contact with wild animals;
• caution when feeding rodents and rabbits.

Pathogenesis and forms of the disease

The plague bacillus is characterized by a remarkably stable and strong ability to multiply in the tissues of the host and lead him to 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 response, blocking the fight of macrophages against infection.

Thus, the host's immune response is weakened, the bacteria quickly colonize the lymph nodes, causing painful swelling, and eventually destroy the affected tissues. Sometimes they enter the bloodstream, which leads to blood poisoning. In 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 passes into septic or pulmonary. Clinical manifestations for these three types look like this:

Treatment and prognosis

At the time when the diagnosis of plague is suspected on clinical and epidemiological grounds, appropriate specimens for diagnosis should be obtained immediately. Antibacterial therapy is prescribed without waiting for a response from the laboratory. Suspicious patients with signs of pneumonia are isolated and treated with airborne precautions. The most applicable schemes:

Other classes of antibiotics (penicillins, cephalosporins, macrolides) have had mixed success in treating this disease. Their use is ineffective and questionable. During therapy, it is necessary to foresee the possibility of complications in the form of sepsis. In the absence of medical care, the forecasts are not encouraging:

• pulmonary form - lethality 100%;
• bubonic - from 50 to 60%;
• septic - 100%.

Preparations 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 the analysis side effects the most effective drugs:

Experience has shown that a well-administered aminoglycoside is most effective and safe for both mother and fetus. It is also recommended for the treatment of children. Due to the relative safety, possibility of intravenous and intramuscular administration, gentamicin is the antibiotic of choice for the treatment of children and pregnant women.

Preventive therapy

Persons who have been in personal contact with patients with pneumonia or who are likely to have been exposed to Y. pestis-infected fleas, had direct contact with body fluids or tissues of an infected mammal, or were exposed during laboratory research infectious materials should receive antibiotic prophylaxis if contact has taken place within the previous 6 days. Preferred antimicrobial agents for this purpose are tetracycline, chloramphenicol or one of the effective sulfonamides.

Pre-infection administration of an antibiotic may be indicated in cases where people need to be in plague-prone areas for short periods. This also applies to living in environments where infection is difficult or impossible to prevent.

Precautions for hospitals include a quarantine regime for all patients with 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 infection of personnel by airborne droplets. In addition to those listed, they include the restriction of the patient's movement outside the room, as well as the mandatory wearing of a mask in the presence of other persons.

Possibility of vaccination

Around the world, live attenuated and formalin-killed Y. pestis vaccines are available for use in various ways. They are characterized by immunogenic and moderately high reactivity. It is important to know that they do not protect against primary pneumonia. In general, vaccination of communities against epizootic impacts is not possible.

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

Distemper 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 distemper is recorded among domestic, wild and industrial 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 preventive measures, and a violation of the growing process.

The disease is caused by a 115-160 nm RNA-containing virus from the Paramyxoviridae family. Dogs, foxes, arctic foxes, Ussuri raccoons, otters, jackals, hyenas and wolves are susceptible to it. For different types In animals, the pathogenicity of the virus is different - from the latent asymptomatic course of the disease to acute 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.

Plague is now a disease whose symptoms are well understood. Its foci remained in the wild and preserved in the permanent habitats of rodents. The current statistics are as follows: around the world in one year, up to about 3 thousand people are in contact with this disease and about 200 of them die. Most of the cases are in Central Asia and Africa.

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

Brief historical information
There is no other 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 of 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. swept 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, important discoveries were made (the pathogen 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 objects of the external environment (in bubo pus it remains for 20-30 days, in the corpses of people, camels, rodents - up to 60 days), but is highly sensitive to sunbeams, atmospheric oxygen, elevated temperature, reaction of the environment (especially acidic), 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 with pneumonic plague are especially dangerous.

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 to 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 for 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 activities 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 become widespread in a short time. 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. AT recent times the idea that the plague agent can be in the soil in an uncultivated state for a long time is being intensively developed. Primary infection of rodents in this case can occur when digging holes in infected areas of soil. This hypothesis is based both on experimental studies and observations on the ineffectiveness of the search for the pathogen among rodents and their fleas in 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 the 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 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 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 the late stages of the disease.

Plague Symptoms

The incubation period is 3-6 days (with 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 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. Highly characteristic features diseases are thickening and lining of the tongue with a thick white coating (“chalky tongue”). From the side of cardio-vascular system note pronounced tachycardia (up to embryocardia), arrhythmia and a progressive fall blood pressure. 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 the clinical classification of 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 of 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 characteristics do 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 appears coughing, there are sharp pains in the 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. AT 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 lymphadenopathies, pulmonary and septic forms - from inflammatory diseases lungs and sepsis, including meningococcal etiology.

With all forms of plague, already in the initial period, rapidly growing signs of severe intoxication are alarming: heat body, tremendous chills, vomiting, excruciating thirst, psychomotor agitation, 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”. Signs of cardiovascular insufficiency, tachypnea are rapidly growing, oliguria is progressing.

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 by the lightning-fast development of severe intoxication, pronounced 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 fever who are in the focus 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:
in the 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 preventive immunization of the population are the epizootic 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, urgent measures are taken to localize and eliminate 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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Plague is a particularly dangerous infectious disease. Plague is known in two main forms - bubonic and pneumonic. The causative agent of the plague is the plague bacillus, resistant to low temperatures, but dying when boiled.

Plague carriers are small rodents, rats, marmots, ground squirrels. Transmission of infection from one animal to another is carried out by flea bites. From them, microbes are transmitted to humans, and then the further spread of the epidemic occurs by airborne droplets. There are known cases of plague infection when cutting meat and skinning, as well as eating infected food.

Human susceptibility to this disease is very high, especially for the pneumonic form of plague, which is very dangerous. The incubation period for plague lasts 3-6 days. The disease is characterized by an acute onset: the patient's body temperature quickly rises, severe chills appear, and dizziness. In addition, the patient complains of weakness, nausea and muscle pain. As a result of severe intoxication of the body, the patient begins vomiting and digestion appears.

Many patients have a blackout of consciousness, the occurrence of hallucinations.

Patients are often delirious and have psychomotor agitation. A plague patient has a peculiar staggering gait, reddened conjunctiva and slurred speech. Facial features become pointed, and black circles appear under the eyes.

The skin is dry and hot on palpation, it has extensive hemorrhages. Plague is especially dangerous because as a result of this disease, damage to the cardiovascular system occurs. Auscultation reveals the expansion of the boundaries of the heart and the deafness of heart tones.

In addition, arrhythmia and tachycardia appear, as well as a drop in blood pressure. The patient's tongue increases in size, covered with a dense white coating. The mucous membranes of the mouth are dry. On examination, a significant increase in the tonsils is noticeable. They are covered with ulcers, and hemorrhages are visible on the soft palate.

severe forms

Severe forms of the disease are characterized by severe vomiting and frequent stools mixed with blood and mucus. When examining urine, an admixture of blood and traces of protein are found in it.

With the bubonic form of the plague, regional muscle nodes are affected at the sites of flea bites. The patient complains about severe pain, in particular in the region of the inguinal lymph glands, even when their enlargement is not observed.

Then hemorrhagic inflammation of a necrotic nature begins to progress in the lymph glands. As a result, the glands are soldered to each other, as well as to the skin and subcutaneous tissue resulting in buboes. The skin over the affected area looks hyperemic, and then an ulcer appears on it, through which a bubo is opened, the contents of which contain a large number of plague sticks.

The pulmonary form of plague gives hemorrhagic inflammation of the pulmonary foci with small necrosis. The patient complains of pain in the chest, shortness of breath and palpitations. Shortly after the onset of the disease, the patient develops a cough with a viscous transparent sputum.

Against the background of general intoxication of the body, the patient develops toxic shock. With the pneumonic form of plague, death occurs on the third or fifth day from the onset of the disease.

If plague is suspected, the patient should be hospitalized. With the bubonic form of the plague, intramuscular injections of streptomycin are prescribed 3 times a day. The daily dose of the drug is 3 g. In addition, tetracycline antibiotics - vibromycin, morphocycline, the daily rate of which is 4-6 g. In the pneumonic form of plague, the patient is shown streptomycin in an amount of 5 g per day and 6 g of tetracycline per day.

Plague is one of the most dangerous infections

Plague is one of the most dangerous infections united in the quarantine group. The causative agent of the disease persists at low temperatures, but dies with direct exposure to sunlight.