"Black Death" - the disease of the Middle Ages. Bubonic plague

08.08.2020

plague doctor in the Middle Ages

No first hundred years in the people of the plague are associated with a special disease, carrying the lives of millions of people. Everyone knows the striking ability of the causative agent of this disease and its lightning spread. Everyone knows about this disease, it has been so rooted in the consciousness of man that all negative in life is associated with this word.

What is a plague and where does an infection come from? Why still does it exist in nature? What is the case of the causative agent and the path of his transfer? What are the forms of the disease and symptoms? What is the diagnosis and how is the treatment? Thanks to which prevention, in our time, you can save billions of human lives?

What is Chuma

Specialists argue that the epidemics of the plague was mentioned not only in historical reference books, but also in the Bible. Cases of the disease were regularly registered on all continents. But more interest is not an epidemic, but pandemics or outbreaks of infection, commonly distributed throughout the country and covering neighboring. In the entire history of the existence of people, they counted three.

The first outbreak of the plague or pandemic originated in the VI century in Europe and the Middle East. During its existence, the infection challenged more than 100 million people.
The second case when the disease covered a significant territory was noted in Europe, from where it got from Asia in 1348. At this time, more than 50 million people died, and the pandemic itself is known in history called "Plague - Black Death". She did not bypass the side and territory of Russia.
The third pandemic was rampant at the end of the XIX century in the east, mainly in India. A flash began in 1894 in Canton and Hong Kong. A large number of deaths were recorded. Despite all precautions from the local authorities, the number of deaths exceeded 87 million.

But it was during the third pandemic that he managed to carefully explore the dead people and reveal not only the source of infection, but also the carrier of the disease. The French scientist Alexander Yersen found that a person is infected with sick rodents. After a few decades, they created an effective vaccine against the plague, although it did not help humanity to completely get rid of the disease.

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

Where is the plague 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 with an infectious person, where the plague is still found.

According to experts, this disease is not yet eradicated completely. In which countries can be infected with plague?

Single cases of the disease are found in the USA and Peru.
The plague in Europe was practically not registered for several years, but here Asia the disease did not bypassed the party. Before visiting China, Mongolia, Vietnam and even Kazakhstan is better to make vaccinations.
In the territory of Russia, it is also better to be more nevertheless, because several cases of the plague annually register here (in Altai, Tyva, Dagestan) and it borders with dangerous countries in relation to infection.
Africa is considered dangerous, from the point of view of epidemiology, the continent, most modern heavy infections can be sick here. The plague is no exception, single cases of the disease have been registered here for the past few years.
There is an infection and on individual islands. For example, only two years ago the plague struck several dozen people in Madagascar.

The last hundred years of pandemic plague was observed, but the infection could not be eradicated completely.

It has not been a secret for a long time that many particularly dangerous infections to which the plague relates, the military is trying to use as biological weapons. During World War II in Japan, scientists brought a special kind of causative agent of the disease. By the ability to infect people, he was ten times more than a natural pathogens. And no one knows what war could have ended, if Japan had used this weapon.

Although the plague pandemic is not registered the last hundred years - completely dealt with bacteria that caused the disease, failed. There are natural sources of plague and anthropurgic, that is, natural and artificially created in the process of vital activity.

Why is the infection considered particularly dangerous? Plague is a disease with a high level of mortality. Until the creation of the vaccine, and it happened in 1926, mortality from different species The plague was at least 95%, that is, they survived units. Now the mortality does not exceed 10%.

Causative agent of plague

The causative agent of infection - Yersinia Pestis (a plague) Bacterry of the genus of Iranin, which is included in the large family of enterobacteria. To survive in natural conditions of this bacterium, it was necessary to adapt a long time, which led to the peculiarities of its development and livelihoods.

Growing on simple available nutrient media.
It can be of different shapes - from the filamentous to the spherical.
The plague in its structure contains more than 30 types of antigens, helping to survive in the body of the carrier and man.
Resistant to environmental factors, but instantly dies when boiling.
The bacteria has several pathogenic factors - this is an exo and endotoxins. It is they who lead to the defeat of organs of organs in the human body.
It is possible to deal with bacteria in an external environment using conventional disinfectants. Antibiotics are destructive on them.

Ways to transfer plague

Not only a person amazes this disease, in nature there are many other sources of infection. Large danger represent the sluggish options for the plague, when the affected animal can be overwhelmed, and after infecting others.

Plague - a disease with natural foci, striking, except for man and other beings, for example, pets - camels and cats. They are infected from other animals. Today, more than 300 types of bacteria carriers have been revealed.

In natural conditions, the natural carrier of the pathogen of the plague is:

susliki;
surki;
gerbil;
stores and rats;
guinea pigs.

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

pumpkin;
gray and black rat;
alexandrovskaya and Egyptian species of rats.

The carrier of the plague in all cases are flea. The contamination of a person occurs in the bite of this artistic, when infected flea, not finding a suitable animal, biting a person. Only one flea for the life cycle can infect about 10 people or animals. The susceptibility to the disease in people is high.

How is the plague?

Transmissive by or through the bites of an infected animal mainly fleas. This is the most common path.
Contact, which are infected during the cutting of carcasses of patients with pets, as a rule, is camels.
Despite the fact that the championship is given to the transmissive way to transfer the plague bacteria, an alimentary also plays a latter role. A person is infected during eating food, an infection causative.
To the methods of penetration of bacteria in the human body with a plamber there are an aerogenic path. During cough or chihanye, a sick person with ease infects everyone around, so they need to be kept in a separate box.

Pathogenesis of the plague and its classification

How does the pathogen of the plague in the human body behave? First clinical manifestations Diseases depend on the method of penetrating bacteria into the body. Therefore, there are different clinical forms of the disease.

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

In the future, Iracini is affected by lungs. In addition to infection with bacteria of the plague of lymph nodes and internal organs, blood or sepsis is infected. This leads to numerous complications and changes in the heart, lungs, kidneys.

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

easy;
bubonic.

They are considered the most common variants of the disease, although conditionally, because bacteria are not affected by some particular organ, and gradually the entire human body is involved in the inflammatory process. According to the severity, the disease is divided into a slight subclinical flow, medium-sized and heavy.

Symptoms of the plague

Plague is an acute natural-focal infection caused by Irani. It is characterized by such clinical signs as pronounced fever, leshes of lymph nodes and sepsis.

Any form of the disease begins with common symptoms. The incubation period of the plague lasts at least 6 days. For the disease, a sharp start is characterized.

The first signs of the plague in humans are as follows:

chills and practically a lightning increase in body temperature up to 39-40 ºC;
pronounced symptoms of intoxication - head and muscle pain, weakness;
dizziness;
defeat the nervous system of varying degrees of severity - from stunning and inhibition to nonsense and hallucinations;
the patient disrupts the coordination of movements.

It is characterized by a typical view of a sick person - a reddened face and conjunctiva, dry lips and a language that is increased and covered with white dense raids.

Due to the increase in the language, the speech of the patient of the plague becomes illegible. If the infection proceeds in a heavy form - a person's face with a blue tint or a shiny, on the face of an expression of suffering and horror.

Symptoms of bubonic plague

The name of the disease itself comes from the Arabic word "JUMBA", which means Bob or Bubon in translating. That is, it can be assumed that the first clinical sign "Black Death", which described our distant ancestors was an increase lymph nodesresembling the type of beans.

What is the difference between the bubonic plague from other disease options?

A typical clinical symptom of this type of plague is a bubo. What does he represent? - This is a pronounced and painful increase in lymph nodes. As a rule, these are single formations, but in very rare cases their number increases to two or more. The plague Bubon is often localized in the axillary, gentle and cervical area.
Even before the appearance of a bubon, a sick person appears a painfulness so pronounced that it is necessary to accept the forced position of the body to facilitate the state.
Another clinical symptom of the bubonic plague is the smaller the size of these formations, the more pain they cause when tonging.

How are the bubons form? This is a long process. It all begins with the occurrence of pain in the place of education. Then the lymph nodes are also increasing here, they become painful to the touch and launched with a fiber, a bubo is gradually formed. The skin above it is tense, painful and becomes intensive red staining. Approximately for 20 days there is a resolution of a bubon or its reverse development.

There are three options for further disappearance of the bubon:

long-term complete absorption;
opening;
sclerosis.

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

Symptoms of Light Chima

The second most common option of the plague is its easy form. This is the most difficult version of the development of the disease. There are 3 main periods of development of light plague:

elementary;
rapid period;
comporny or terminal.

In recent times, this species of the plague is taken from the life of millions of people, because the mortality of it is 99%.

Symptoms of light plague, the following.

More than 100 years ago, the light shape of the plague almost 100% of cases ended with death! Now the situation has changed, which is undoubtedly connected with the correct treatment tactics.

How other forms of plague occur

In addition to the two classical options for the flow of plague, there are other forms of the disease. As a rule, this is a complication of the main infection, but sometimes they proceed as primary independent.

Primary septic shape. The symptoms of this type of plague are slightly different from the two options described above. The infection is developing and flows rapidly. The incubation period is shortened and lasts no more than two days. High temperatures, weakness, nonsense and excitement are not all signs of a state of violation. 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 is almost never found.
Stretched or light course of the disease is observed with the skin of the plague. The causative agent penetrates the human body through damaged skin. At the site of the introduction of the pathogen of the plague, changes are observed - the formation of necrotic ulcers or the formation of a furuncle or carbuncule (this is inflammation of the skin and the surrounding fiber around the hair with the donation sites and the selection of pus). Ulcers heal long and gradually form a scar. The same changes may manifest themselves as secondary during the bubonic or light form of the plague.

Diagnosis of plague

The first stage in determining the presence of infection - epidemic. But so to make the diagnosis easily when several cases of the disease arose with the presence of typical clinical symptoms in patients. If the plague in this area has not yet met, and the number of cases is calculated by units - the diagnosis causes difficulties.

In the event of the development of infection, one of the first steps in the definition of the disease is a bacteriological method. If the plague of working with biological material is suspected for detecting the pathogen, it is carried out in special conditions, because the infection is easily and quickly distributed in the environment.

For research take almost any biological material:

wet;
blood;
punctrate bubones;
investigate the contents of peptic skin lesions;
urine;
vomit masses.

Almost everything that distinguishes the patient can be used for research. Since the illness of the plague in people proceeds hard and the person is very susceptible to infection, the taking of material is made in special clothes, and sowing on the nutrient media in equipped laboratories. Infected bacteria animals die in 3-5 days. In addition, when using the method of fluorescent antibodies, bacteria are glow.

Additionally, serological methods of research of the plague: ELISA, RNNGA.

Treatment

Any patient with suspected plague is subject to immediate hospitalization. Even in the case of the development of lung forms of human infection, completely isolate from others.

In the distant past, the only method of treating the plague was migration and processing of bubes, their removal. In an attempt to get rid of infections, people used only symptomatic methods, but unsuccessfully. After identifying the pathogen and the creation of antibacterial drugs, not only the number of patients, but also complications, decreased.

What do this disease treat?

The basis of treatment is antibacterial therapy, using tetracycline antibiotics in the appropriate dose. At the very beginning of treatment, maximum daily doses of drugs are used, with gradually reduced to minimal in case of temperature normalization. Before starting treatment, the sensitivity of the pathogen towards antibiotics is determined.
An important step of treating the plague in people is to carry out disinfect. Salt solutions are injected with patients.
Applied symptomatic treatment: Used diuretics in case of fluid delay, hormonal substances are used.
Use therapeutic anticipated serum.
Together with the main treatment, supporting therapy is applied - cardiac drugs, vitamins.
In addition to antibacterial drugs, local medicines are prescribed from the plague. Antibiotics handle plague bubons.
In the case of the development of septic form of the disease, plasmapheresis is used daily - this is a complex procedure for cleaning the blood of a patient person.

After the end of treatment, approximately 6 days later, a control study of biological materials is carried out.

Prevention of plague

The invention of antibacterial drugs would not solve the problem of the appearance and distribution of pandemic. This is just an effective way to cope with the already emerged of the disease and the prevention of its very terrible complication - death.

So how did they ever beat the plague? - After all, single cases per year without declared pandemics and the minimum amount of deaths after the suffered infection can be considered a victory. A large role belongs to the proper prevention of the disease. And she began the moment of the emergence of the second pandemic, in Europe.

In Venice, after the second wave of the spread of the plague in the XIV century, while the city remained a quarter of the population, the first quarantine measures were introduced for arrivals. Ships were kept in the port for 40 days and watched the team in order to prevent the spread of infection so that it does not penetrate other countries. And it worked, new cases of infection were no longer noted, although the second pandemic of the plague had already carried out most of the population of Europe.

How is the prevention of infection been carried out today?

Even with the occurrence of single cases of plague in any countries, all those who arrived from there are isolated and are observed for six days. If a person has revealed some signs of the disease, then preventive doses of antibacterial drugs are prescribed.
The prevention of plague includes complete insulation of patients with suspicion of an infection. People not only put in separate closed boxes, but in most cases try to isolate and that part of the hospital, where the patient is located.
A large role in preventing the emergence of infection belongs to the state-poid service. They annually control the foci of the emergence of plague, take water samples in a given locality, examine animals that may be a natural tank.
In the foci of the development of the disease, the destruction of plague carriers is carried out.
The measures for the prevention of the disease of the plague in the foci of the appearance of the disease include sanitary and educational work with the population. Explain the rules for the behavior of people at the next outbreak of infection and where to contact first.

But even all of the above was not enough for victory over the disease, if there was no vaccine against the plague. It is from the moment of its creation that the number of cases of the disease decreased dramatically, and there were no pandemics for more than 100 years.

Vaccination

Today to combat plague, except for general preventive MerApply more effective methodsthat helped forget for a long time about "black death".

In 1926, the Russian biologist V. A. Havkin invented invented in the world of vaccine from the plague. Since its inception and onset of universal vaccination in the foci of the appearance of infection of the epidemic, the plague remained far in the past. Who and how is vaccination? What are its pros and cons?

Nowadays, the lyophilisate or vaccine is used lively dry against the plague, this is a suspension of live bacteria, but a vaccine strain. The drug is bred immediately before use. It is used against the causative agent of the bubonic plague, as well as a light and septic form. This is a universal vaccine. The drug divided into solvent in various ways is introduced, which depends on the degree of dilution:

apply it subcutaneously needle or impulse method;
cOVER;
intraodelly;
use a vaccine against the plague even inhalation method.

The prevention of the disease is carried out by adults and children since the two-year-old age.

Indications and Contraindications for Vaccination

The vaccination from the plague makes one once and protects it for only 6 months. But certain groups of the population are subject to prevention, not vaccinating.

Today, this vaccination is not made as mandatory, in national calendar vaccinations, it is done only on strict testimony and only to certain citizens.

Grafting make the following categories of citizens:

everyone who lives on dangerous areas in epidemic relations, where the plague is found in our time;
health workers whose professional activities are directly related to work in the "hot spots", that is, in the occurrence of illness;
developers of vaccine and laboratories in contact with bacteria strains;
preventive vaccination makes people with high risk of infection working in the foci of the emergence of infection - these are geologists, workers of anticipate institutions, shepherds.

It is impossible to prevent these drugs to two years old, pregnant and lactating women, if the first symptoms of the plague have already appeared and everyone who has a reaction to the previous introduction of the vaccine. Reactions and complications for this vaccination practically does not occur. Of the cons of such prevention, it can be noted short action and the possible development of the disease after vaccination, which is extremely rare.

Can there be a plague at the grafts? Yes, this also happens if an already sick person or the vaccination turned out to be poor quality. This type of disease is characterized by a slow course with sluggish symptoms. The incubation period exceeds 10 days. The patients in patients are satisfactory, so it is almost impossible to suspect the development of the disease. The diagnosis is facilitated with the appearance of a painful bubon, although inflammation of tissues and lymph nodes is observed around. In case of late treatment or its complete absence further development Diseases fully corresponds to its usual classical flow.

Plague is currently not a sentence, but another dangerous infectionwith which you can cope. 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 insulation of the patient.

More than half of the European population in the Middle Ages (XIV century) twisted the plague, known as black death. The horror of these epidemics remained in the memory of people after several centuries and is even captured in the canvases of artists. Further, the plague has repeatedly visited Europe and carried human life, albeit not in such quantities.

Currently, the disease is placed. About 2 thousand people infect every year. Of them most of dies. Most cases of infection are noted in the Nordic regions of China and the countries of Central Asia. According to experts, there are no causes and conditions for the emergence of black death today.

The pathogen of the plague was opened in 1894. Studying the disease epidemics, Russian scientists have developed the principles for the development of the disease, its diagnosis and treatment, an anticipated vaccine was created.

Symptoms of the plague depend on the form of the disease. With damage to the lungs, patients become highly discharged, since the infection extends to the environment of air-droplet. With the bubonic form of the plague, patients are relaxed or not contagious at all. In the discharge of the affected lymph nodes, the pathogens are absent, or there are quite small.

Plague treatment has become much more efficient with the advent of modern antibacterial drugs. Mortality from the plague from this time decreased to 70%.

The prevention of plague includes a number of events that limit the spread of infection.

The plague is an acute infectious zoonotic transmissive disease, which in the CIS countries together with such diseases, like cholera, tularemia and natural smallpox are considered (Ooi).

Fig. 1. Picture "Triumph of Death". Peter Bruegel.

Causative agent of plague

In 1878, G. N. Minh and in 1894 A. Yersen and Sh. Kitazato, independently of each other discovered the pathogen of the plague. Subsequently, Russian scientists have studied the mechanism of development of the disease, the principles of diagnosis and treatment, created an anticipated vaccine.

The causative agent of the disease (Yersinia Pestis) is a bipolar stationary kokkobacillo, which has a delicate capsule and never forms a dispute. The ability to form a capsule and anti -ifaocitary mucus does not allow macrophages and leukocytes to actively struggle with the causative agent, as a result of which it is quickly multiplied in organs and tissues of a person and an animal, spreading with blood flow and lymphatic paths throughout the body.
The pathogens of the plague distinguish exotoxins and endotoxins. Ex-and endotoxins are contained in bodies and capsules bacteria.
Enzymes of bacteria aggression (hyaluronidase, coagulaz, fibrinolysin, hemolyasing) facilitate their penetration into the body. The wand is capable of penetrating even through intact skin.
In the ground, a plague does not lose its viability up to several months. In the corpses of animals and rodents survive up to one month.
Bacteria are resistant to low temperatures and freezing.
The plague pathogens are sensitive to high temperatures, an acidic reaction of the medium and the sun rays that kill them only for 2 to 3 hours.
Up to 30 days, the pathogens are preserved in the Gnomeh, up to 3 months - in milk, up to 50 days - in water.
Disinfectants destroy a plague wand in a few minutes.
The pathogens of the plague cause a disease in 250 species of animals. Among them are most rodents. Sample camels, foxes, cats and other animals are susceptible.

Fig. 2. On the photo a plague - bacteria, causing a plague - Yersinia Pestis.

Fig. 3. In the photo the pathogens of the plague. Intensity coloring by aniline dyes is the largest on the poles of bacteria.

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Fig. 4. In the photo, the pathogens of the plague - growth on dense medium Colonies. Initially, the colony looks like a broken glass. Next central part It is compacted, and the peripherals resembles a lace.

Epidemiology

Reservoir infection

Easily susceptible to a plague rodent chopstick (Tarbagans, crops, gerbils, gopters, rats and houses) and animals (camels, cats, foxes, hares, hedgehogs, etc.). White mice, guinea pigs, rabbits and monkeys are subject to infections from laboratory animals.

Dogs never get sickly, but transfer the pathogen through the bite of blood-sucking insects - flea. The animal died of the disease ceases to be a source of infection. If rodents infected with plaque chopsticks fell into a hibernation, then the disease acquires a latent current, and after hibernation, they again become pathogens. In total, there are up to 250 species of animals that are sick, and therefore are the source and reservoir of infection.

Fig. 5. Rodents - the reservoir and the source of the pathogen of the plague.

Fig. 6. In the photo signs of plague in rodents: increased lymph nodes and multiple hemorrhages under the skin.

Fig. 7. In the photo, a small carcanchik - a messenger of the disease of the plane in Central Asia.

Fig. 8. On the photo, a black rat is a carrier not only the plague, but also leptospirosis, leishmaniosis, salmonellosis, trichinellosis, etc.

Ways of infection

The main path of transmission of pathogens - through Bloch bites (transmissive path).
The infection can get into the human body when working with patients with animals: slaughter, removal and cutting the skins (contact path).
The pathogens can get into the human body with infected food products, as a result of their insufficient heat treatment.
From a patient with a pulmonary form of plague, infection is distributed by air-droplet.

Fig. 9. In the photo of flea on the skin of man.

Fig. 10. In the photo the moment of the bite of flea.

Fig. 11. The moment of bluff bite.

Pathoral carriers

The carriers of pathogens are flea (in nature there are more than 100 species of these arthropods insects),
The carriers of pathogens are some types of ticks.

Fig. 12. In the photo of Bloch - the main carrier of the plague. In nature, there are more than 100 species of these insects.

Fig. 13. In the photo, the susskic flea is the main carrier of the plague.

As the infection occurs

Infection occurs through the insect bite and rubbing its feces and the contents of the intestine while jeeping during the power supply. In reproduction of bacteria in the intestinal tube of fleas under the influence of coagulase (the enzyme isolated by pathogens) forms a "plug", which prevents human blood flow into its body. As a result, the flea jumps off a bunch of branched skin. Infected fleas remain high enough for 7 weeks and up to 1 year.

Fig. 14. In the photo, the appearance of the bite of flea is the pruneose irritation.

Fig. 15. In the photo, a characteristic series of fleas bites.

Fig. 16. View of the tibia in Bloch bites.

Fig. 17. View of the thigh in the bite of fleas.

Man like an infection source

With damage to the lungs, patients become highly discriminated. The infection extends to the environment by air-droplet.
With the bubonic form of the plague, patients are relaxed or not contagious at all. In the discharge of the affected lymph nodes, the pathogens are absent, or there are quite small.

The mechanisms of development of the plague

The ability of a plague sticks to form a capsule and anti-phaganic mucus does not allow macrophages and leukocytes to actively deal with it, as a result of which the pathogen is quickly multiplied in organs and tissues of a person and an animal.

The pathogens of the plague through damaged skin and further on the lymphatic paths penetrate the lymph nodes, which are inflamed and forming conglomerates, (bubons). Inflammation develops at the site of the insect bite.
The penetration of the causative agent into the bloodstream and its massive reproduction leads to the development of bacterial sepsis.
From a patient with a pulmonary form of plague, infection is distributed by air-droplet. Bacteria fall into the alveoli and cause heavy pneumonia.
In response to massive reproduction of bacteria, the patient's body produces a huge number of inflammation mediators. Develops disseminated intravascular coagulation syndrome (DVS syndrome), in which all internal organs are affected. Of particular danger to the body are hemorrhages in the muscles of the heart and adrenal glands. The developed infectious-toxic shock becomes the cause of the patient's death.

Fig. 18. In the photo, the bubonic plague. A typical increase in the lymph node in the axillary zone.

Symptoms of the plague

The disease is manifested after the penetration of the pathogen into the body for 3-6 days (rarely, but there are cases of occurrence of the disease for the 9th day). In case of infection in blood incubation period This is a few hours.
Clinical picture initial period

A sharp start, large numbers of temperature and octvinations.
Malgia (muscular pain).
Painful thirst.
Strong manifestation of weakness.
The rapid development of psychomotor excitation ("crazy" is called such patients). A horror mask appears on the face ("Mask of Plague"). Less often marks inhibition and apathy.
The face becomes hyperemic and thought-out.
The language is densely covered with a white bloom ("Cretaceous Language").
Multiple hemorrhages appear on the skin.
Cardiac rhythm is significantly part. Arrhythmia appears. Arterial pressure drops.
Breathing becomes superficial and rapid (Tahipne).
The amount of urine released sharply decreases. Anuria is developing (complete lack of urine release).

Fig. 19. In the photo, the help of the patient of the Chuma turns out to be physicians, dressed in anticipated costumes.

Forms of the disease of Chumoy

Local forms of the disease

Skin shape

At the site of the bite of flea or contact with infected animals on skin Covers Papula appears, which is quickly ulced. Next appears black scarp and scar. Most often, skin manifestations are the first signs of more terrible manifestations of the plague.

Bubonic form

SAMI frequent form manifestations of the disease. An increase in lymph nodes is manifested near the place of the insect bite (inguinal, axillary, cervical). One lymph node invested more often, less often - several. With the inflammation of several lymph nodes at once, a painful Bubon is formed. Initially, the lymph node of solid consistency, painful in palpation. Gradually, it softens, acquiring a tough consistency. Next, the lymph node is either dissolved, or is ulcerated and sclerosized. Of the affected lymphatic assembly, the infection may fall into the bloodstream, followed by the development of bacterial sepsis. The sharp phase of the bubonic form of the plague lasts about a week.

Fig. 20. On the photo of the affected cervical lymph nodes (bubones). Multiple hemorrhages of skin.

Fig. 21. In the photo, the bubonic form of plague is the defeat of the cervical lymph nodes. Multiple hemorrhages in skin cover.

Fig. 22. In the photo, the bubonic form of plague.

Common (generalized) forms

When the causative agent in the bloodstream, common (generalized) forms of plague are developing.

Primary-septic

If the infection, bypassing lymph nodes, immediately falls into the blood, then develops the primary-septic form of the disease. Inxication is developing lightning. With massive reproduction of pathogens in the patient's body, a huge number of inflammation mediators is produced. This leads to the development of disseminated intravascular coagulation syndrome (DVS syndrome), in which all internal organs are affected. Of particular danger to the body are hemorrhages in the muscles of the heart and adrenal glands. The developed infectious-toxic shock becomes the cause of the patient's death.

Secondary-septic form of the disease

In the spread of infection beyond the limits of the affected lymph nodes and the injection of causative agents in the bloodstream, infectious sepsis develops, which is manifested by a sharp deterioration in the state of the patient, the strengthening of the symptoms of intoxication and the development of the DVS syndrome. The developed infectious-toxic shock becomes the cause of the patient's death.

Fig. 23. In the photo, the septic form of plague is the consequences of the DVS syndrome.

Fig. 24. The septic form of plague is the consequences of the DVS syndrome.

Fig. 25. 59-year-old Paul Gaylord (resident of Portland, Oregon, USA). The bacteria of the plague fell into its body from the stray cat. As a result of the developed secondary-septic form of the disease, he was amputed fingers on their hands and legs.

Fig. 26. The consequences of the DVS syndrome.

External visual forms of the disease

Primary

The lung form of the plague is the most severe and dangerous form of the disease. The infection penetrates the alveoy of air-droplet. The lesion of the pulmonary fabric is accompanied by a cough and shortness of breath. Increased body temperature flows with strong chills. The sputum is at first a thick and transparent (vitreous) disease, then it becomes liquid and foam, with an admixture of blood. Scarce data of physical research do not correspond to the severity of the disease. Developed by DVS syndrome. Internal organs are affected. A special danger to the body represents hemorrhages in the heart muscle and adrenal glands. The death of the patient comes from infectious-toxic shock.

With damage to the lungs, patients become highly discriminated. They form around themselves the focus of a particularly dangerous infectious disease.

Secondary Light

It is an extremely dangerous and severe form of the disease. The pathogens penetrate the pulmonary fabric of the affected lymph nodes or with blood flow during bacterial sepsis. Clinic and outcome of the disease, as with primary lung form.

Intestinal form

The existence of this form of the disease is considered controversial. It is assumed that infection occurs with the use of infected products. Initially, on the background of intoxication syndrome, pain in stomach and vomiting appear. Next joins diarrhea and numerous urges (tenesmas). The chair is abundant mucous blood.

Fig. 27. Photo of an anticipated costume - a special equipment of medical workers in eliminating the focus of a particularly dangerous infectious disease.

Laboratory diagnostics of plague

The basis of the diagnosis of the plague is the rapid detection of the plague. Initially, bacterioscopy of smears is carried out. Further, the culture of the pathogen is distinguished, which inflicted experimental animals.

The content for the study is the contents of the bubon, sputum, blood, feces, pieces of fabric organs of dead and animal corpses.

Bacterioscopy.

The causative agent of plague (Yersinia Pestis) is a row-shaped bipolar kokkobacillina. Analysis on the detection of a plague by direct bacterioscopy is the simplest and fast way. The time waiting time is no more than 2 hours.

Sowing biological material

The culture of the pathogen of the plague is allocated in specialized regime laboratories designed to work with. The increase in the culture of the causative agent is two days. Next, a test for sensitivity to antibiotics is carried out.

Serological methods

The use of serological methods allows to determine the presence and growth of antibodies in the blood serum patient to the pathogen of the plague. The time of obtaining the result is 7 days.

Fig. 28. The diagnosis of plague is carried out in special regime laboratories.

Fig. 29. In the photo, the pathogens of the plague. Fluorilla microscopy.

Fig. 30. In the photo Culture Yersinia Pestis.

Immunity under the plague

Antibodies for the introduction of the pathogen of the plague are formed in a fairly late deadlines for the development of the disease. Immunity after the suffering disease is not long and not tense. There are repeated cases of the disease that proceed as hard as the first.

Treatment of plague

Before the treatment began, the patient is hospitalized in a separate boxing. Medical personnel serving the patient dress up in a special anticipated costume.

Antibacterial treatment

Antibacterial treatment begins at the first signs and manifestations of the disease. From antibiotics, preference is given to antibacterial drugs of the aminoglycoside group (streptomycin), tetracycline groups (vibromycin, morphocyclin), fluoroquinolone groups (ciprofloxacin), enseamycin groups (rifampicin). It has proven itself in the treatment of the skin form of the antibiotic of the amphenicol groups (curtainsazole). With septic forms of the disease, a combination of antibiotics is recommended. Course antibacterial therapy It is at least 7 - 10 days.

Treatment aimed at different stages of the development of the pathological process

The purpose of pathogenetic therapy is to reduce intoxication syndrome by removing toxins from the patient's blood.

The introduction of freshly frozen plasma, protein preparations, refooliglyukin and other drugs in combination with forced diuresis is shown.
Improving microcirculation is achieved with the use of a trental in combination with salc seriflee or piciculon.
When developing hemorrhages, the Ferrez plasma is immediately carried out in order to relieve disseminated intravascular coagulation syndrome.
When the pressure drops, a dumpamide is assigned. This state speaks of generalization and development of sepsis.

Symptomatic treatment

Symptomatic treatment is aimed at suppressing and eliminating the manifestations (symptoms) of plague and, as a result, facilitating the suffering of the patient. It is aimed at eliminating pain, cough, shortness of breath, choking, tachycardia, etc.

The patient is considered healthy if all the symptoms of the disease disappeared and 3 negative results of bacteriological research were obtained.

Anti-epidemic events

The identification of the patient of the plague is a signal to immediately conducting, which include:

conducting quarantine measures;
immediate isolation of the patient and carrying out the preventive antibacterial treatment of service personnel;
disinfection in the focus of the disease;
vaccination of persons in contact with patients.

After the vaccination of the anticipated vaccine, immunity remains during the year. Repeated after 6 months. Persons who threaten re-infection: shepherds, hunters, workers agriculture And employees of anticipate institutions.

Fig. 31. In the photo of a brigade of doctors dressed in anticipated costumes.

Forecast of the disease

The forecast of the Disease of the Chuma depends on the following factors:

forms of the disease
timeliness of the started treatment
the presence of the entire arsenal of medication and non-drug treatment.

The most favorable prognosis in patients with lesions of lymph nodes. Mortality in this form of the disease reaches 5%. With the septic form of the disease, the mortality rate reaches 95%.

Plague is and even when applying all necessary medicinal preparations And the manipulations of the disease often ends with the death of the patient. The pathogens of the plague constantly circulates in nature and is not amenable to complete destruction and control. The symptoms of the plague are diverse and depend on the form of the disease. The bubonic form of the plague is the most common.

Articles section "Especially dangerous infections"Most popular

It lasts from several hours to 3-6 days. The most common forms of plague are bubonic and light. Mortality at the bubonic form of the plague reached 95%, with a light - 98-99%. Currently with proper treatment Mortality is 5-10%

Epidemic of the plague in historical time

The most famous is the so-called "Justinian Plaby" (-), which arose in the Eastern Roman Empire and covered the entire Middle East. More than 20 million people died from this epidemic. In the X century there was a big epidemic of plague in Europe, in particular, in Poland and in Kievan Rus. In Kiev in two weeks, over 10,000 people died from the plague. In the XII century, the plague epidemic several times arose among the crusaders. In the XIII century in Poland and in Russia there were several plague flashes.

Modern condition

Every year, the number of fallen plans is about 2.5 thousand people, and without a tendency to decline.

According to reports, according to the World Health Organization since 1989 to 2004, about forty thousand cases in 24 countries were recorded, and the mortality rate was about seven percent of the number of ill. In some countries of Asia (Kazakhstan, China, Mongolia and Vietnam), Africa (Tanzania and Madagascar), the Western Hemisphere (USA, Peru) cases of people infection are recorded almost annually.

At the same time, in the territory of Russia cases of the disease of the Chuma were not recorded since 1979, although annually in the territory natural foci (with a total area of \u200b\u200bmore than 253 thousand square meters. km) in the risk of infection is over 20 thousand people.

In Russia from 2001 to 2006, 752 strains of the plague pathogen were recorded. At the moment, the most active natural foci are located in the territories of the Astrakhan region, the Kabardino-Balkarian and Karachay-Cherkess Republic, the Republics of Altai, Dagestan, Kalmykia, Tyva. Of particular alarms causes the lack of systematic observation of the activity of foci located in the Ingush and Chechen Republics.

For Russia, the situation is complicated by the annual detection of new meals in neighboring countries (Kazakhstan, Mongolia, China), imports through transport and trading flows from the countries of Southeast Asia of the Specific Carrier of Plagot - Bloch Xenopsylla Cheopis..

At the same time, in 2001-2003 in the Republic of Kazakhstan, 7 cases of Chuma (with one fatal outcome) were registered, in Mongolia - 23 (3 lethal exodus), in China, in China in 2001-2002, 109 people (9 lethal outcomes) were ill. The forecast of the epizootic and epidemic situation in neighboring the Russian Federation of natural foci of the Republic of Kazakhstan, China and Mongolia remains unfavorable.

Forecast

In conditions modern therapy Mortality for tambon form does not exceed 5-10%, but at other forms, the percentage of recovery is high enough if the treatment is started early. In some cases, a fleeting septic form of the disease is possible, which is weakly permanent diagnosis and treatment ("lightning form of plague").

Infection

The plague pathogen is resistant to low temperatures, is well preserved in sputum, but at a temperature of 55 ° C, it dies for 10-15 minutes, and with boiling - almost instantly. Enters the body through the skin (when the bite of fleas, as a rule, Xenopsylla Cheopis), the mucous membranes of the respiratory tract, the digestive tract, conjunctiva.

According to the main carrier, natural foci of the plague is divided into syssliki, dry, sandy, field and edible. In addition to wild rodents, the so-called synantropic rodents (in particular, rats and miserable) are sometimes included in the epizootic process, as well as some wild animals (hares, foxes), which are the object of hunting. Camels sick camels from Pets.

In the natural focus, the infection usually occurs through the bite of fleas previously nutritional on the sick rodent, the probability of infection increases significantly when the synanthropic rodents are incorporated. Infection occurs also when hunting rodents and their further processing. Massive disease People occur when climbing a sick camel, remove the skins, cutting, processing from it. An infected person, depending on the form of the disease, in turn, can be a transmitter of plague by air-drip, or through the bite of separate types of flea.

The fleas are a specific carrier of the pathogen of the plague. This is due to the features of the device. digestive system Bloch: Before the stomach, flea esophagus forms a thickening - goiter. With the bite of an infected animal (rat), the plague bacteria settles the flea in Zobu and begins to multiply intensively, completely blocking it. Blood can not get into the stomach, so such a flea is permanently tormented by a feeling of hunger. She moves from the host to the owner in the hope of getting his portion of blood and time to infect a sufficiently large number of people before dies (such fleas live no more than ten days).

In the bite of flea-infected bacteria in humans in the place of bite, there may be papula or pustula filled with hemorrhagic content (skin). The process is then propagated by lymphatic vessels without the manifestation of lymphangitis. The reproduction of bacteria in the macrophages of lymph nodes leads to their sharp increase, the merger and education of the conglomerate (bubonic form). Further generalization of infection, which is not strictly mandatory, especially in the conditions of modern antibacterial therapy, can lead to the development of septic form, accompanied by the defeat of almost all internal organs. However, from epidemiological positions, the "screenings" of infections in light fabric With the development of the mural form of the disease. Since the development of Playful pneumonia, the sick person itself becomes a source of infection, but from a person to a person, a light shape of the disease is already transmitted - an extremely dangerous, with a very fast flow.

Symptomatics

The bubonic form of the plague is characterized by the appearance of sharply painful conglomerates, most often inguinal lymph nodes on the one hand. The incubation period is 2-6 days (less often 1-12 days). Within a few days, the size of the conglomerate increases, the skin above it can become hyperemic. At the same time, an increase and other groups of lymph nodes appear - secondary buboons. The lymph nodes of the primary focus are softening, in their puncture, purulent or hemorrhagic contents are obtained, the microscopic analysis of which reveals a large amount of gram-negative with bipolar staining of the sticks. In the absence of antibacterial therapy, ventulous lymph nodes are opened. Then there is a gradual healing of fistula. The severity of the patients is gradually growing to the 4-5th day, the temperature can be increased, sometimes high fever immediately appears, but at first the patient's condition often remains as a whole satisfactory. This explains the fact that a person sick bubonic plague can fly from one part of the world to another, considering herself healthy.

However, at any time, the bubonic form of plague can cause the process to generalize and move into a secondary-septic or secondary-eagle form. In these cases, the patient's condition is very quickly becoming extremely difficult. Symptoms of intoxication increases by the hour. The temperature after the strongest chill rises to high febrile digits. All signs of sepsis are noted: muscle pain, sharp weakness, headache, dizziness, workload of consciousness, up to his loss, sometimes excitement (patient is torn in bed), insomnia. With the development of pneumonia, cyanosis is growing, cough appears with the separation of the foam bleeding sputum containing a huge number of chopsticks of the plague. It is this sputter and becomes a source of infections from a person to a person with a development now already primary lighting plague.

Septic and light shapes of the plague flow, like any heavy sepsis, with manifestations of disseminated intravascular coagulation syndrome: the appearance of small hemorrhages on the skin, it is possible to bleeding from the gastrointestinal tract (severe mass, mellum), pronounced tachycardia, fast and requiring corrections ( Dopamine) Fall arterial pressure. Auscultative - a picture of bilateral focal pneumonia.

Clinical picture

The clinical picture of the primary septic or primary light shape is not fundamentally different from the secondary forms, but the primary forms often have a shorter incubation period - up to several hours.

Diagnosis

Epidemiological history is played in the diagnosis in modern conditions. Arrival from zones endemic by plague (Vietnam, Burma, Bolivia, Ecuador, Turkmenistan, Karakalpakia, etc.), or from anticipate stations of the patient with the signs described above, or with signs of severe - with hemorrhages and bloody sputum - pneumonia with severe lymphadenopathy It is a very serious argument for the first contact doctor for making all the localization measures of the alleged plague and the exact diagnostics. It is necessary to emphasize that in the conditions of modern drug prevention, the likelihood of personnel disease, which some time has contacted with coughing patients with plague, quite small. Currently, cases of primary lighting plague (that is, cases of infection from man to man) among medical staff is not observed. The establishment of accurate diagnosis must be carried out with the help of bacteriological research. The material for them is the puncture of the ventilated lymphatic assembly, the sputum, the blood of the patient separated by fistula and ulcers.

Laboratory diagnostics It is carried out with the help of fluorescent specific antiserum, which stains the smears of the separated ulcers, the delicate of lymph nodes, culture obtained on the blood agar.

Treatment

In the Middle Ages, the plague was practically not treated, the actions were carried out mainly to cutting or causing plague bubons. No one knew the genuine cause of the disease, so there was no idea how to treat it. Doctors tried to use the most bizarre funds. The composition of one such drug included a mixture of 10-year-old molasses, finely chopped snakes, wines and 60 other components. According to another method, the patient in turn was to sleep on the left side, then on the right. Starting from the XIII century, the epidemic of plague is trying to limit with quarantines.

For the first time, a vaccine against the plague created in the early XX century Vladimir Khavkin.

Treatment of patients with Chuma is currently reduced to the use of antibiotics, sulfonamides and therapeutic anticipated serum. Prevention of possible foci of the disease is to carry out special quarantine events in port cities, the deratization of all vessels that run international flights, creating special anticipate institutions in steppe areas where rodents are found, identifying the epizootes of plague among rodents and the fight against them. Flashing diseases are still found in some countries of Asia, Africa and South America.

Anticipable Sanitary Activities in the Russian Federation

If suspicious of the plague, the sanitary and epidemiological station of the district is immediately informed. Fills the notice of the doctor who suspected an infection, and its shipment provides the chief physician of the institution, where such a patient was found.

The patient must be immediately hospitalized in the infectious hospital box. Doctor or medium medical worker medical institution When a patient is detected or suspicious to the disease, Chumay is obliged to stop the reception of patients and prohibit the entrance and exit from the medical institution. Staying in the office, the ward, a medical worker must inform him the chief doctor to identify him and require anticipate costumes and disorders.

In cases of reception of a patient with a lesion of lightly, a medical worker is obliged to handle with a solution of streptomycin, mouth, mouth and nose. In the absence of cough, you can restrict ourselves to the handling of the hands of the derazor. After taking measures to dismiss the illness with healthy in medical institution Or at home constitute a list of persons who have contact with patients, indicating the name, name, patronymic, age, place of work, profession, home addresses.

Before the arrival of the consultant from the opposition institution, the health worker remains in the focus. The question of its insulation is solved in each particular case individually. The consultant takes the material for bacteriological research, after which it is possible to begin specific treatment with antibiotic patients.

When identifying a patient in the train, an airplane, on a ship, at the airport, at the railway station, the actions of medical workers remain the same, although organizational measures will be different. It is important to emphasize that the disagreement of a suspicious patient with others should be started immediately after it is detected.

The chief doctor of the institution, having received a message about identifying a suspicious patient's plague, takes measures to stop communicating between the hospital branches, the floors of the polyclinic, prohibits the exit from the building where the patient was found. Simultaneously organizes the transfer of emergency message to a higher organization and an anticipated institution. The form of information may be arbitrary with the obligatory presentation of the following data: surname, name, patronymic, the age of ill, place of residence, profession and place of work, date of detection, time to start the disease, objective data, preliminary diagnosis adopted primary polisization of the focus, position and The surname of the doctor who has revealed the sick. Simultaneously with information, the head requests consultants and the necessary assistance.

However, in certain situations, it may be more appropriate to make hospitalization (before establishing an accurate diagnosis) in the institution where the patient is in the time of the presence of plague. Therapeutic measures are inseparable from the prevention of personnel infection, which should immediately wear 3-layer gauze masks, shoes, a handkerchief of 2 gauze layers, fully closing hair, and protective glasses to prevent splash splash on the mucous membrane of the eyes. According to the established B. Russian Federation The rules, personnel necessarily put on an anticipate suit or applies similar to the properties of anti-infectious protection special means. All personnel in contact with the patient remains for further assistance to him. A special medical post isolates the compartment, where there is a sick and attending his staff, from contact with other people. The toilet and procedural office must enter the isolated compartment. All the staff immediately gets preventive treatment Antibiotics, ongoing all the days he spends in an insulator.

Plague treatment is complex and includes the use of etiotropic, pathogenetic and symptomatic means. Antibiotics of streptomycin row are most effective for the treatment of plague: streptomycin, dihydrostreycin, Pasomycin. At the same time, streptomycin is most widely used. Under the bubonic form of the plague, intramuscularly streptomycin is introduced 3-4 times a day ( daily dose 3 g), tetracycline antibiotics (vibromycin, morphocyclin) in / in 4 g / day. When inxication in / in saline solutions, hemodez is introduced. The fall of blood pressure during the bubonic form should be regarded as a sign of process generalization, a sign of sepsis; At the same time, there is a need to carry out resuscitation activities, the introduction of dopamine, the establishment of a permanent catheter. In case of light and septic forms of plague, a dose of streptomycin increases to 4-5 g / day, and tetracycline - up to 6 g. With forms resistant to streptomycin, it is possible to introduce leftomycetin succinate to 6-8 g in / c. With the improvement of the state of the dose of antibiotics, reduce: streptomycin - up to 2 g / day until the temperature is normalized, but for at least 3 days, tetracyclines - up to 2 g / day daily inside, leftomycetin - up to 3 g / day, total 20-25 g / day A great success is used in the treatment of plague and bispetol.

With a light, septic form, the development of hemorrhage immediately proceed to the relief of the disseminated intravascular coagulation syndrome: they are carried out plastic bags (intermittent plasmapheresis in plastic bags can be carried out on any centrifuge with special or air cooling with the capacity of its glasses 0.5 liters or more) in the amount of removable Plasma 1-1.5 liters when replacing the same amount of fresh frozen plasma. In the presence of hemorrhagic syndrome The daily administration of fresh frozen plasma should not be less than 2 liters. Before reliving the acute manifestations of Sepsis Plasmapheresis spend daily. The disappearance of the signs of hemorrhagic syndrome, the stabilization of blood pressure is usually under sepsis are grounds for stopping plasmapheresis sessions. At the same time, the effect of plasmapheresis in the acute period of the disease is observed almost immediately, signs of intoxication decrease, the need for a dummy is reduced to stabilize blood pressure, muscular pain sneeze, shortness of breath.

In the medical personnel team, providing a patient with a pulmonary or septic form of plague, there must be a specialist in intensive therapy.

In literature

Giovanni Bokachcho, "Decameron" (-). The heroes of the work leave Florence infected by the disease, establishing a primitive quarantine.
Daniel Defo, "Diary of the Plague Year." Founded on real facts narration about the Great London epidemic of 1665.
Romain Rollan, Colanon Cola.
Edgar by, "Mask of Red Death", "King of Plague."
Sigrid Onset, "Christine, daughter of Lavrans".
Mark Twain, "Yankee from Connecticut at the court of King Arthur."
Jack London, "Alya Plague."
German Hesse, "Narcissus and Goldmund".
Karen Meithland ( english), Masquerade Liaztsov.
Rita Montaldi ( english), Francesco Sort ( english), "Imprimatur" (), the action takes place in Rome in 1683.
Gabriel Garcia Marquez, "Love during the Plague."
Terry Gudkind, "Fourth Rule of the Wizard or Wind Temple".
Jacob Revius ( english), "Plague."
Ann Benson "Plague Stories"
Connie Willis "The Book of the Judgment Day"
Salias de Tournemyir, Evgeny Andreevich in Moscow (from the time of the plague 1771)
Mordovtsev Daniel Lukich, "Valid Bed" ,. Epidemic Plague in Russia, XVIII century.

In cinema

Faust (director Friedrich Murnau) (). The plague epidemic broke out in Europe. Faust sacrifices his soul in exchange for the Mephistophelevsky gift to treat people from the plague.
Flesh and blood (director Paul Verkhovlen) (). The action occurs during the Italian wars. The dog infected with the disease is used as a biological weapon.
Seventh stamp (director Ingmar Bergman) (). The film takes place in the XIV century. Knight Antonius Block and his squire Jons are returning to their homeland from a cross campaign in the middle of the plague epidemic in Europe.
Fairy tale of travel director Alexander Mitty (). The heroes of Andrei Mironova and Tatiana Aksyuti wander through the light in search of the boy of May, overcoming all sorts of obstacles and temptations, while one of the days of Orlando (Andrei Mironov) does not wins the price of his life a terrible witch to the plague.
Tudora (television series) (2007-2010). Plague in England during the reign of Heinrich VIII.
Black Death (Black Death), 2010. Director Christopher Smith. The plot is based on the persecution of pagans and witches during the epidemic of the bubonic plague in England in the middle of the XIV century.
Witch time (Season of the Witch), 2011. Director Dominic Sena. XIV century. In Europe, rampates plague. The culprit of the deadly misfortune recognize the defenseless girl, suspecting her in witchcraft. The dying cardinal asks the Knight of Benmen (Nicholas Cage) to deliver the witch to a distant abbey, where her spells should be destroyed.
Magnificent Century (TV series) (Muhtesem Yüzyil), 2011. Directors: Dorul Taine, Yagmur Tain. Epidemic Plague in the Ottoman Empire.
"Devils" (The Devils), United Kingdom, 1971. Director Ken Russell. France, the city of Luden, 1525 - 1530. The main character The film, the governor of the city, the father of Urben Grandie, in the conditions of the boar of the plague, spends a lot of time among the suffering inhabitants, is in direct contact with dying, provides them with physical and spiritual assistance, makes a ritual service to mass burials.

"Visit to Minotaur", USSR, 1987. Director Eldor Uruzbayev. Antonio Stradivari and his family lives in medieval citycovered by plague. Antonio protects the house and family from an angry crowd, which considers it a sorcerer. Stradivari saves from his son's illness, but he goes to the monastery.

Apply to the ancient world. So, Rufus from Ephesus, who lived in the time of Emperor Trajan, referring to more ancient doctors (the names of which were not reached by NC), described several cases of the disease in a certain bubonic plague in Libya, Syria and Egypt.

The Philistines did not calm down and for the third time they transported a military trophy, and with him and a plague in the city of Askalon. In the same place, all the owner of the Film - the kings of the five cities of Filins were gathered, "and they decided to return the ark of the Israelis, because they realized that this was the only way to prevent the spread of the disease. And the head of the atmosphere that reigned in the doomed city ends. "And those who have not died, amazed were growing, so the cry of the city went to heaven" (1). Chapter 6 shows the advice of all the dominates of the Philistines, who called for priests and priests. Those advised to bring to God to the victim of the Means - put in the ark, before returning to his Israelis, gifts. "According to the number of dominates of Philistine five gold and five gold mice, devastating land; For the execution is alone on all of you, and on the dominates of yours "(1 sir.). This biblical tradition is interesting in many ways: it contains a hidden message about the epidemic that covers, most likely, all five cities of philisons. We could talk about the bubonic plague, hitting people from Mala to Velika and accompanied by the appearance of painful growths in the groin - bubons. The most noteworthy - the priests of Philistines, apparently, tied this disease with the presence of rodents: from here and gold sculptures of mice, "empty land".

There is another place in the Bible that consider a record certifying another case of the plague epidemic. In the fourth book of kingdoms (4car.) It is narrating on the campaign of the Assyrian king Sinaherib, who decided to devastate Jerusalem. The huge army surrounded the city, but did not take possession of them. And soon, Sinaiherib departed without a fight with the residues of the army, in which the "Angel of the Lord" struck 185 thousand soldiers per night (4car.).

Epidemic of the plague in historical time

Plague as a biological weapon

The use of the plague pathogen as biological weapons has deep historical roots. In particular, events in ancient China and medieval Europe showed the use of corpses of infectious animals (horses and cows), human bodies of Huns, Turks and Mongols to infect water sources and water supply systems. There are historical certificates on cases of catapulting of an infected material during the siege of some cities (siege of Cuff).

Modern condition

Every year, the number of fallen plans is about 2.5 thousand people, and without a tendency to decline.

According to reports, according to the World Health Organization since 1989 to 2004, about forty thousand cases in 24 countries were recorded, and the mortality was about 7% of the number of cases. In some countries of Asia (Kazakhstan, China, Mongolia and Vietnam), Africa (Congo, Tanzania and Madagascar), the Western Hemisphere (US, Peru) cases of people infection are registered almost annually.

At the same time, in the territory of Russia, annually in the territory of natural foci (with a total area of \u200b\u200bmore than 253 thousand km²) under the risk of infection there are more than 20 thousand people. For Russia, the situation is complicated by the annual detection of new meals in neighboring countries (Kazakhstan, Mongolia, China), imports through transport and trading flows from the countries of Southeast Asia of the Specific Carrier of Plagot - Bloch Xenopsylla Cheopis .

From 2001 to 2006, 752 strains of the plague of the plague were recorded in Russia. At the moment, the most active natural foci are located in the territories of the Astrakhan region, the Kabardino-Balkarian and Karachay-Cherkess Republic, the Republics of Altai, Dagestan, Kalmykia, Tyva. Of particular alarms causes the lack of systematic observation of the activity of foci located in the Ingush and Chechen Republics.

In July 2016, in Russia, a ten-year-old boy was delivered to the Hospital of Kosh-Agachsky District of the Republic of the Republic of Altai.

In 2001-2003, 7 cases of Chuma's disease were registered in the Republic of Kazakhstan (with one fatal outcome), in Mongolia - 23 (3 lethal exodus), in China, in 2001-2002, 109 people (9 lethal outcomes) were ill. The forecast of the epizootic and epidemic situation in neighboring the Russian Federation of natural foci of the Republic of Kazakhstan, China and Mongolia remains unfavorable.

At the end of August 2014, an outbreak of plague once again happened at Madagascar, which by the end of November 2014 took 40 lives from 119 sick.

Forecast

Under the conditions of modern therapy, the mortality rate during tambon form does not exceed 5-10%, but at other forms, the percentage of recovery is high enough if the treatment is started early. In some cases, a fleeting septic form of the disease is possible, which is weakly permanent diagnosis and treatment ("lightning form of plague").

Infection

The pathogel of the plague is resistant to low temperatures, is well maintained in sputum, but at a temperature of 55 ° C, it dies for 10-15 minutes. And when boiling is almost instant. The gate of infection - damaged skin (when the bite of fleas, as a rule, Xenopsylla Cheopis), the mucous membranes of the respiratory tract, the digestive tract, conjunctiva.

According to the main carrier, natural foci of the plague is divided into gosnikovy, dry, sandy, half and edible. In addition to wild rodents, the so-called synantropic rodents (in particular, rats and miserable) are sometimes included in the epizootic process, as well as some wild animals (hares, foxes), which are the object of hunting. Camels sick camels from Pets.

In the natural focus, infection usually occurs through the bite of fleas previously fed on a sick rodent. The probability of infection significantly increases with the inclusion in the epizoty of synanthropic rodents. Infection occurs also when hunting rodents and their further processing. Massive diseases of people occur when climbing the patient of the camel, remove the skins, cutting, recycling from it. An infected person in turn is a potential source of plague, the transfer of the pathogen from which another person or animal, depending on the form of the disease, can be carried out by air-drip, contact or transmissible way.

The fleas are a specific carrier of the pathogen of the plague. This is due to the characteristics of the device of the flea digestive system: before the stomach, flea esophagus forms thickening - goiter. With the bite of an infected animal (rat), the plague bacteria settles the flea in the goiter and begins to multiply intensively, fully clogging it (so on. "Plague block"). Blood can not get into the stomach, so flea joins the blood along with the causative agent back into the wound. And since such a flea is constantly tormented by a feeling of hunger, she moves from the owner to the owner in the hope of getting his portion of blood and manage to infect a large number of people before dying (such fleas live no more than ten days, but experiments on rodents showed that one flea May infect up to 11 hosts).

In the bite of flea-infected bacteria in humans in the place of bite, there may be papula or pustula filled with hemorrhagic content (skin). The process is then propagated by lymphatic vessels without the manifestation of lymphangitis. The reproduction of bacteria in the macrophages of lymph nodes leads to their sharp increase, the merger and education of the conglomerate ("Bubon"). Further generalization of infection, which is not strictly mandatory, especially in the conditions of modern antibacterial therapy, can lead to the development of septic form, accompanied by the defeat of almost all internal organs. With epidemiological positions, it is important that there is a plastic bacteremia, as a result, a sick person itself becomes a source of infection with contact or transmissible way. However, the most important role is played by the "seferences" of infections into a lightweight tissue with the development of a light-shaped disease. Since the development of plague pneumonia, a human form of illness is already transmitted to a person - an extremely dangerous, with a very rapid flow.

Symptomatics

However, at any time, the bubonic form of plague can cause the process to generalize and move into a secondary-septic or secondary-eagle form. In these cases, the patient's condition is very quickly becoming extremely difficult. Symptoms of intoxication increases by the hour. The temperature after the strongest chill rises to high febrile digits. All signs of sepsis are noted: muscle pain, sharp weakness, headache, dizziness, loading of consciousness, up to his loss, sometimes excitement (patient torn in bed), insomnia. With the development of pneumonia, cyanosis is growing, cough appears with the separation of the foam bleeding sputum containing a huge number of chopsticks of the plague. It is this sputter and becomes a source of infections from a person to a person with a development now already primary lighting plague.

Septic and light shapes of the plague flow, like any heavy sepsis, with manifestations of disseminated intravascular syndrome: the appearance of small hemorrhages on the skin, it is possible to bleeding from the gastrointestinal tract (severe mass, melon), pronounced tachycardia, fast and requiring corrections ( Dopamine) drop in blood pressure. Auscultative - a picture of bilateral focal pneumonia.

Clinical picture

Diagnosis

Epidemiological history is played in the diagnosis in modern conditions. Arrival from zones endemic in plague (Vietnam, Burma, Bolivia, Ecuador, Karakalpakia, etc.), or from anticipated stations of the patient with the signs described above, or with signs of severe - with hemorrhages and bloody moocroty - pneumonia with severe lymphadenopathy is for The first contact doctor has a sufficiently serious argument to make all the localization measures of the alleged plague and the exact diagnostics. It is necessary to emphasize that in the conditions of modern drug prevention, the likelihood of personnel disease, which some time has contacted with coughing patients with plague, quite small. Currently, cases of primary lighting plague (that is, cases of infection from man to man) among medical staff is not observed. The establishment of accurate diagnosis must be carried out with the help of bacteriological research. The material for them is the puncture of the ventilated lymphatic assembly, the sputum, the blood of the patient separated by fistula and ulcers.

Laboratory diagnostics is carried out with a fluorescent specific antiserum, which stains the smears of separated ulcers, the delicate of lymph nodes, culture obtained on the blood agar.

Treatment

Fracture in the therapy of the plague was achieved in 1947, when Soviet doctors were the first in the world to be applied to the treatment of plague in Manchuria Streptomicin. As a result, all the patients who were treated with streptomycin, including a patient with a light chum, who was already considered hopeless was recovered.

Treatment of patients with plates is currently carried out with the help of antibiotics, sulfonamides and therapeutic anticipated serum. Prevention of possible foci of the disease is to carry out special quarantine events in port cities, the deratization of all vessels that run international flights, creating special anticipate institutions in steppe areas where rodents are found, identifying the epizootes of plague among rodents and the fight against them.

Anticipable Sanitary Activities in Russia

The patient must be immediately hospitalized in the infectious hospital box. A physician or medium medical worker of a medical institution when detecting a patient or suspicious on the disease, Chumay is obliged to stop the reception of patients and prohibit entry and exit from the medical institution. Staying in the office, the Chamber, the medical worker must inform him the chief physician on the identification of the patient and require anticipate costumes and disinfectants.

In cases of reception of a patient with a lesion of lightly, a medical worker is obliged to handle with a solution of streptomycin, mouth, mouth and nose. In the absence of cough, it can be limited to the handling of the hands with disinfection solution. After taking measures to disunity with healthy in a medical institution or at home, they constitute a list of persons who have contact with patients, indicating the name, name, patronymic, age, place of work, profession, home addresses.

When identifying a patient in the train, an airplane, on a ship, at the airport, at the railway station, the actions of medical workers remain the same, although organizational measures will be different. It is important to emphasize that the insulation of a suspicious patient with the surrounding should be started immediately after it is detected.

However, in certain situations, it may be more appropriate to make hospitalization (before establishing an accurate diagnosis) in the institution where the patient is in the time of the presence of plague. Therapeutic measures are inseparable from the prevention of personnel infection, which should immediately wear 3-layer gauze masks, shoes, handkerchief of 2 layers of gauze, fully closing hair, and protective glasses to prevent splashing splash on the mucous membrane of the eye. According to the rules established in the Russian Federation, the staff is mandatory for an anticipated suit or applies special tools for anti-infective protection properties. All personnel in contact with the patient remains for further assistance to him. A special medical post isolates the compartment, where there is a sick and attending his staff, from contact with other people. The toilet and procedural office must enter the isolated compartment. All staff immediately receives preventive treatment with antibiotics, ongoing all the days he spends in an insulator.

Plague treatment is complex and includes the use of etiotropic, pathogenetic and symptomatic means. Antibiotics of streptomycin row are most effective for the treatment of plague: streptomycin, dihydrostreycin, Pasomycin. At the same time, streptomycin is most widely used. With the bubonic form of the plague, intramuscin is introduced by intramuscularly streptomycin 3-4 times a day (daily dose of 3 g), tetracycline antibiotics (vibromycin, morphocyclin) in / in 4 g / day. When inxication in / in saline solutions, hemodez is introduced. The fall of blood pressure during the bubonic form should be regarded as a sign of process generalization, a sign of sepsis; At the same time, there is a need to carry out resuscitation activities, the introduction of dopamine, the establishment of a permanent catheter. In case of light and septic forms of plague, a dose of streptomycin increases to 4-5 g / day, and tetracycline - up to 6 g. With forms resistant to streptomycin, it is possible to introduce leftomycetin succinate to 6-8 g in / c. With the improvement of the state of the dose of antibiotics, reduce: streptomycin - up to 2 g / day until the temperature is normalized, but for at least 3 days, tetracyclines - up to 2 g / day daily inside, leftomycetin - up to 3 g / day, total 20-25 g / day A great success is used in the treatment of plague and bispetol.

In case of light, septic form, the development of hemorrhage immediately proceed to the relief of the disseminated intravascular coagulation syndrome: they carry out plastic bags (intermittent plasmapheresis in plastic bags can be carried out on any centrifuge with special or air-cooled with the capacity of its glasses 0.5 liters or more) in the amount of removable Plasma 1-1.5 liters when replacing the same amount of fresh frozen plasma. In the presence of hemorrhagic syndrome, the daily introduction of fresh frozen plasma should not be less than 2 liters. Before reliving the acute manifestations of Sepsis Plasmapheresis spend daily. The disappearance of the signs of hemorrhagic syndrome, the stabilization of blood pressure is usually under sepsis are grounds for stopping plasmapheresis sessions. At the same time, the effect of plasmapheresis in the acute period of the disease is observed almost immediately, signs of intoxication decrease, the need for a dummy is reduced to stabilize blood pressure, muscular pain sneeze, shortness of breath.

In the medical personnel team, providing a patient with a pulmonary or septic form of plague, there must be a specialist in intensive therapy.

Notes

Disease Ontology Release 2019-05-13 - 2019-05-13 - 2019.
Jared Daimond, guns, microbes and steel. Ead of human societies.
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Plague
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Plague - doctors, students, patients Medical portal, abstracts, cribs doctors, disease treatment, diagnosis, prevention
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, from. five.
Papagrigorakis, manolis j.; Yapijakis, christos; Synodinos, Philippos N.; Baziotopoulou-Valavani, Effie (2006). "DNA EXIMINATION OF ANCIENT DENTAL PULP INCRIMINATES TYPHOID FEVER AS A PROBABLE CAUSE OF THE PLAGUE OF ATHENS". International Journal Of Infectious Diseases. 10 (3): 206-214.

The emasculate agent is a plague wand. And the main reservoir of infection in nature serve rodents and hares.

Also, predators who hunt animals of these species can distribute the infection.

The plague carrier is flea, when the bite of which is the contamination of a person. Also transmit infection can human lice and ticks.

Also penetration of the plague in the human body is possible when processing the skins of infected animals or when eating the meat of an animal, a chuma.

From person to man, the disease is transmitted by air-droplet.

A person has high susceptibility to Fozya infection!

Symptoms of the plague

There are quite a lot of plague varieties, but the bubonic form is most often found.

The plague is characterized by a sharp, sudden beginning with the strongest chills and an increase in body temperature. They are joined by dizziness, weakness, muscle pain, nausea and vomiting.

Suffering nervous system Patients are frightened, restless, can wander, tend to escape somewhere.

Coordination of movements, gait, speech.

For bubonic plague is characterized by the development or a plague bubon. In the field of his appearance, the patient is experiencing strong pain. A dense tumor with fuzzy edges is gradually formed, sharply painful when touched. The leather over the bowl is at the beginning of the usual color, hot to the touch, then it becomes dark red, with a blue tint, glans.

There is also an increase in other groups of lymphatic nodes formed secondary buboons.

In the absence of treatment, the bubers are applied, then open and transformed into fistulas. Then they gradually lose their healing.

Complications of plague

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

10% of patients have gangrene stop, fingers or skin.

Diagnosis of plague

The diagnosis of plague is based on epidemiological data. Currently, all natural foci of the plague is strictly registered. Also, for the formulation of the diagnosis, characteristic clinical manifestations of the disease are important. The bacterioscopic study of the bubon point and separated by an ulcer is also carried out.

Treatment of plague

First of all, the people, a sick plague, should be hospitalized into an infectious hospital.

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

The discharge of the patient who had a champ, from an infectious hospital, is made after complete recovery, the disappearance of symptoms of the disease and a three-year negative result of bacteriological sowing.

With a bubonic chum, the extract is carried out no earlier than after 1 month from the date of recovery.

Recovered people are on dispensary accounting from for 3 months after the disappearance of the last signs of the disease.

What is Chuma

Where is the plague now

Causative agent of plague

Ways to transfer plague

Pathogenesis of the plague and its classification

Symptoms of the plague

Symptoms of bubonic plague

Symptoms of Light Chima

How other forms of plague occur

Diagnosis of plague

Treatment

Prevention of plague

Vaccination

Indications and Contraindications for Vaccination

Causative agent of plague

Epidemiology

Reservoir infection

Ways of infection

Pathoral carriers

As the infection occurs

Man like an infection source

The mechanisms of development of the plague

Symptoms of the plague

Forms of the disease of Chumoy

Local forms of the disease

Skin shape

Bubonic form

Common (generalized) forms

Primary-septic

Secondary-septic form of the disease

External visual forms of the disease

Primary

Secondary Light

Intestinal form

Laboratory diagnostics of plague

Bacterioscopy.

Sowing biological material

Serological methods

Immunity under the plague

Treatment of plague

Antibacterial treatment

Treatment aimed at different stages of the development of the pathological process

Symptomatic treatment

Anti-epidemic events

Forecast of the disease

Epidemic of the plague in historical time

Modern condition

Forecast

Infection

Symptomatics

Clinical picture

Diagnosis

Treatment

Anticipable Sanitary Activities in the Russian Federation

In literature

In cinema

Epidemic of the plague in historical time

Plague as a biological weapon

Modern condition

Forecast

Infection

Symptomatics

Clinical picture

Diagnosis

Treatment

Anticipable Sanitary Activities in Russia

see also

Notes

Symptoms of the plague

Complications of plague

Diagnosis of plague

Treatment of plague

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