Plague is a viral or bacterial disease. Diagnosis of plague

Plague is a deadly disease that has no age or gender differences. It has multiple routes of infection and is characterized by severe symptoms. The vector of infection is black rats. It is not for nothing that the plague has such a popular name - the Black Death. In the 13th – 16th centuries, the plague took the lives of 25 million people over the 300 years of its invasion in Europe alone. Treatment for the plague was ineffective for a long time, the mortality rate reached 99 - 100%.

A brief excursion into history

History does not know of a single disease that has claimed more human lives than the Black Death - the plague. 3 major plague pandemics have been officially recorded.

The Black Death was first mentioned in historical documents dating back to 1334. The plague was recorded in the south and east of China, India and Turkestan. The infection then spread to the territory where Libya, Egypt and Syria are now located. By the end of 1348, the disease had struck the population of Italy. In this country it was particularly rampant, and no treatment yielded results. Some documents refer to the first plague pandemic as the “Florentine Plague.” Neither doctors nor church ministers could help the desperate population. The Black Death fueled an anti-Semitic movement against the Jewish population. Many believed that it was because of the Jews that punishment came from above. The massacre of Jews in the 13th century reached a special scale - all Jewish settlements were killed in 3 cities of France.

The second plague lasted until the end of Justinian's reign. Therefore, in the 16th century, the Black Death received such a name - the “Justinian pandemic.” During this period, a quarantine was established for ships arriving at the ports. They had to stay in the port for 40 days. This reduced the spread of the plague throughout the cities, but treatment of the disease was still unsuccessful. Often there were no living people left on ships that were in quarantine - the plague killed everyone. It was observed that the plague had receded after the Fire of London. Cities where the Black Death reigned began to be burned. A cure for the plague was not found until 1666. But few people noticed that soap and water became the real weapons against the plague.

Susceptibility to the disease is very high - the Black Death has no gender or age restrictions. Plague is a natural focal infection. Natural plague zones exist on all continents. They are not only available in Australia. For example, on the territory of the Russian Federation there are 12 dangerous zones where there are foci of plague.

In addition to territorial zones, narrower synanthropic zones are also distinguished:

• urban hotspots
• port outbreaks
• ship fires

Rodents are considered the sources and keepers of the infection, and fleas are considered to be the carriers, remaining infectious for up to 12 months. The plague infection is located and multiplies in the digestive tube of the flea. A plug with a large number of plague microbes forms in the front part of the flea - a plague block. Here's how rats become infected with plague:

• flea bites rodent
• Bacteria are washed away from the plague block
• with reverse blood flow, the bacterium is transmitted into the blood of the rodent, making it a source of infection

Paths of infection by plague

The National Guide to Infectious Diseases defines plague as a zoonotic disease that is not transmitted from person to person. That is, a person can catch an infection from an animal, but no one can become infected from a person. This is not a completely accurate definition. Most scientists attribute the Black Death to zoonotic diseases, when the infection is transmitted from both animals and people.

The disease can be transmitted to people in the following ways:

• Flea bites are transmissible;
• Through infected animals upon contact with damaged skin or mucous membranes;
• Upon contact with biological fluids of an infected person (urine, secretions, sweat) - contact;
• Through household items with which an infected person or animal has come into contact - household contact.
• Through the air in the pneumonic form of plague - airborne;
• When consuming contaminated food.

The causative agent of the disease

In appearance, the causative agent of plague, the bacterium Yersinia pestis, resembles a stick. It does not have flagella or spores, but when it enters the body, it forms a capsule and begins to grow and multiply quickly. 40 hours after settlement, entire colonies of adult bacteria form in the body. The bacterium is highly contagious. This is facilitated by a number of predisposing factors:

• The capsule that envelops the bacterium protects it from antibodies.
• Small villi help to penetrate into the environment.
• The capsule contains substances such as coagulose, which interfere with blood clotting.
• Antigens to the antibodies that the body is trying to produce are produced at a temperature of 36 degrees and are very active.
• Some substances found in bacteria suppress the oxidative process, reducing the body's protective activity.

That is, all the features of the bacterium Yersinia pestis contribute to its virtually unhindered growth and reproduction. The causative agent of this disease is very stable. It remains infectious for a long time:

• The bacterium lives in the sputum of a sick person for 10 days;
• On clothes, handkerchiefs, underwear of a patient that came into contact with the secretions of an infectious person - up to 90 days;
• In water, the bacterium remains alive for 90 days;
• In the pus of the wound of an infected patient - 40 days;
• In soil, the bacterium remains deadly for up to 7 months;
• The death of the bacterium does not occur even at low temperatures and freezing;
• It can only be killed by direct exposure to ultraviolet radiation and the use of disinfectants - it dies in 30 minutes. At a high temperature of 100 degrees, death occurs instantly. It is for this reason that some historians claim that the plague in London was eliminated by the famous Fire of London, during which most of the city was completely destroyed.

But the real salvation from the plague - the antibiotic that conquered the Black Death - was developed by Bacon.

Symptoms of the Black Death

The incubation period of plague lasts from the moment the pathogen enters the body until the first clinical manifestations - from several hours to two weeks. The first pathogens that enter the body of a healthy person remain at the entry point (for example, on a bite wound); some move to the lymph nodes. The period of clinical manifestation of the disease begins.

The first signs of plague are clearly expressed:

• Chills and fever suddenly appear.
• The high fever lasts until death or at least 10 days.
• There is severe weakness and aches throughout the body.
• Thirst and nausea are symptoms of any type of plague.
• In the pneumonic form of plague, the main symptoms are coughing up blood and constant, incessant vomiting of blood.
• Also, the main signs of the plague are a special facial expression, which is called the “plague mask.” Dark circles appear on the face under the eyes, facial expressions take on an expression of horror and fear, suffering. The tongue is covered with a thick coating - a chalky tongue.

Standard symptoms of the disease can be easily separated into a separate group. There are 4 of them:

• At the site of entry of the pathogen, a spot appears, which is characterized by stages: it transforms into a rash that rises slightly above the skin - a papule, then into a vesicle filled with liquid.
• Formation of a plague bubo on the second day of the disease in the area of ​​the lymph nodes. Lymph nodes during bubonic plague greatly increase in size. The pathogen multiplies in them and an inflammatory-edematous reaction occurs.
• The appearance of a person changes: pallor or blueness of the limbs, nasolabial triangle, and face is observed. The pulse changes and blood pressure decreases.
• When sick, blood clotting decreases.

Forms of the disease

Taking into account the methods of infection of the disease, its localization and prevalence, the following forms of plague are distinguished:

Some researchers also identify a mixed form of the disease, when one type transforms into another. The most common are pneumonic and bubonic plague. Death from the plague has always been very high and reached 95 - 99%. Today, when ways to combat the plague have been found, it is treated, but the mortality rate reaches 5 - 10%.

Diagnosis and treatment

Many cities that were overwhelmed by the plague were burned. Doctors who tried to help infected people dressed in anti-plague suits. These were floor-length leather raincoats. A mask with a long beak was put on the face, into which various herbs with antiseptic properties were placed. When the doctor inhaled, the herbs sterilized the air. Doctors put garlic in their mouths, rubbed their lips with it, plugged their ears with rags, covered their eyes with crystal lenses - all entry points were closed for the pathogen, contact was as limited as possible. Such protection actually protected against infection for a short time.

Today, the diagnosis of this dangerous infectious disease includes a number of studies. It is carried out in anti-plague suits, in specially equipped laboratories.

• Comprehensive examination of those places where symptoms dominate: enlarged lymph nodes, nasopharynx, blood, urine, feces.
• Standard laboratory tests of sputum are carried out.
• X-ray diagnostics of lymph nodes, focal rashes.
• Be sure to examine the patient’s place of residence, etc.

Treatment is carried out in several directions: etiotropic (against the pathogen), pathogenic (combat general symptoms), symptomatic therapy. People suspected of having the plague must be treated with antibiotics.

Disease prevention

Prevention and treatment of the disease can be specific and emergency.

• Specific prevention includes the use of antibiotics.
• Emergency prevention is vaccination, which few people consider to be an effective method of saving oneself from the plague.

Plague is a zoonotic disease, so vaccination does not create lasting immunity to the disease, as, for example, smallpox vaccination once helped. Vaccination against plague only reduces the risk of contracting the plague. Therefore, vaccination against plague is not included in the list of mandatory vaccinations.

The vaccine is recommended to be given to those who are at risk: medical personnel in plague outbreaks, laboratory workers, people in those professions who, due to the nature of their work, encounter foci of infection: archaeologists, geologists, ecologists, etc.

Mass prevention through vaccination is considered inappropriate even in areas that have acute outbreaks of this disease.

• Firstly, immunity against the disease after vaccination does not last long.
• Secondly, no studies have been conducted to confirm the effectiveness of mass vaccination, so it is unknown how the plague will behave once it enters the vaccinated body. In Vietnam, where a plague epidemic was recorded, vaccination did not help protect against this disease.
• It is also necessary to take into account that the plague vaccine is very expensive.

Vaccination is carried out with a live vaccine, which is administered subcutaneously to people from 7 to 60 years old and subcutaneously to children from 2 to 7 years old, as well as pregnant and elderly people. Revaccination against plague is carried out a year later. But once again we draw your attention to the fact that vaccination against the plague does not save you from the disease, but only reduces the risk of contracting the infection. It should also be borne in mind that the vaccine was developed against bubonic plague and is not at all effective against the pneumonic form of the disease.

With the introduction of antibiotics to combat the plague, the danger of this disease has greatly decreased. But there is no certainty that the black death will not return again. The problem of the plague remains relevant today. Over the past 60 years, 4 thousand cases of plague have been registered in the territory of the former USSR. There is still no consensus on how to carry out treatment and prevention, on the benefits of vaccination, or on ways to combat vectors of infection.

Zoonotic natural focal bacterial infection, characterized by fever, severe intoxication, serous-hemorrhagic damage to the lymphatic system, lungs and other organs, sepsis and high mortality. The ease of infection, the presence of many transmission mechanisms, the speed of spread, severe course, high mortality - features that allow us to classify the plague as one of those infectious diseases that were able to seriously affect the health of the population and quickly spread internationally; These diseases are included in the list of events that can create a public health emergency and are therefore regulated by the International Health Regulations 2005.

Humanity knows such devastating plague pandemics:

• in 527-565 there was a “Justinian plague” (an epidemic in the Mediterranean countries, the Byzantine Empire under Emperor Justinian), according to rough estimates, up to 45-50 million people died, although some authors write about 100 million dead;
• in 1334, the second pandemic began in China - the “Black Death”, which led to significant population extinction in Europe and Asia, killing about 50-60 million people;
• in 1894, the third pandemic began from China and within 20 years covered all continents, killing 10 million people; At the same time, Yersen and Kitazato isolated the causative agent of the plague.

In the 20th century cases of plague did not occur so often (from 1958 to 2010, about 50 thousand cases of plague were recorded in the world, the last outbreak occurred in 2010 in Peru), however, due to the existing natural foci, it is impossible to completely eliminate this disease. The most important natural foci are found in Africa, America, and Asia.

The causative agent of plague is Yersinia pestis, belongs to the genus Yersinia, family Enterobacteriaceae. Today there is scientific evidence that the plague bacillus was formed from the causative agent of pseudotuberculosis. Y. pestis is a small ovoid-shaped rod, stains bipolarly, gram-negative, does not form spores, is immobile, has a capsule, grows well on simple nutrient media (MPB, MPA at pH 7.0-7.2), temperature optimum - 18-22 °C. Y. pestis is resistant to the environment, tolerates low temperatures well, can survive in soil and water for up to 9 months, in tinder for up to 6 months, in the contents of buboes for up to 4 months, persists for a long time in sputum, but cannot withstand drying, at 55 °C dies within 10-15 minutes. Disinfectants used in standard concentrations have a reliable bactericidal effect.

The plague bacillus has a complex antigenic structure (18-20 antigens) and a large number of aggression factors. The virulence of the pathogen is determined by fraction I (surface, capsular substance), which is formed only in the body of warm-blooded animals, as well as somatic antigens V and IV. Today there are 3 biovars of Y. pes. with minor genetic variations between them: ancient, medieval and oriental; they circulate in specific geographic regions. There is an opinion that the sequential appearance of these biovars determined the sequence of three historical plague pandemics.

According to classical concepts, plague is a natural focal disease. The source of infection is various species of rodents (about 300 species) living in steppe and desert zones (ground squirrels, marmots, tarbagans, gerbils, voles, etc.), and in anthropurgic cells - rats and mice. The plague bacillus persists in nature due to periodic epizootics in rodents. The main mechanism of infection transmission is transmissible, through fleas. After infection with the blood of an infected rodent, the plague microbe multiplies in the digestive system of the flea, and subsequently a “plague block” is formed when plague bacilli accumulate and fill the lumen of the digestive tract. When sucking blood again, the flea regurgitates the microorganisms that have accumulated, which leads to infection of another rodent or person. After infection, a flea becomes dangerous after approximately 5 days and can store the pathogen within itself for more than 1 year.

Infection is also possible as a result of hunting rodents for the purpose of eating them or removing valuable fur. Slaughter and skinning of an animal carcass can lead to damage to human skin and facilitate the entry of the plague pathogen into the blood of a sick animal. Eating insufficiently heat-treated meat can lead to nutritional infection of a person with plague. In addition to rodents, some other species of animals, such as camels, can become infected and sick in semi-desert zones. From sick camels, humans become infected through direct contact; from domestic animals, cats suffer from the plague, which can also be a source of infection for humans; The route of transmission is through scratches and bites, although an aerogenic mechanism of infection is also possible.

Particularly dangerous for others is the pneumonic form of plague, due to the transmission of the pathogen by airborne droplets. It is this fact that is used when using plague as a biological weapon, when infection of a large number of people is possible as a result of spraying an aerosol containing this pathogen into the air. In other clinical forms of plague in humans, the contagiousness of patients is much lower. Human susceptibility to plague is very high. The infectiousness index is almost 100%. Immunity is persistent, long-term, antibacterial and antitoxic, predominantly cellular.

Y. pes. known as one of the most invasive bacteria. Human adaptation mechanisms are practically not adapted to resist its penetration and development in the body. Therefore, the plague bacillus multiplies very quickly. Bacteria produce large quantities of permeability factors (neuraminidase, fibrinolysin, coagulase, etc.), antiphagins that reduce phagocytosis, factors that suppress the production of endogenous γ-interferon, protease, which activates plasminogen and destroys complement. All this contributes to rapid and massive lymphogenous and hematogenous dissemination into the organs of the SMF with subsequent activation of macrophages.

Endotoxin (lipopolysucrid) plays an important role in the pathogenesis of septic plague and disseminated intravascular coagulation syndrome. Severe antigenemia, the release of inflammatory mediators, including shockogenic cytokines, cause the development of microcirculatory disorders, DIC syndrome with the subsequent development of infectious-toxic shock.

The clinical picture of the disease is mainly determined by the place of penetration of the pathogen - through the skin, lungs or digestive tract.

The pathogenesis of plague has three stages. First, the pathogen from the site of inoculation penetrates lymphogenously into the regional lymph nodes, where it lingers for a short time. In this case, a primary plague bubo is formed with the development of inflammatory, hemorrhagic and necrotic changes in the lymph nodes. Buboes reach 5-8 cm in diameter; the lymph nodes are welded together, of a dough-like consistency, immobile, dark red in color when cut, with foci of necrosis. The tissue around the bubo is edematous. As a reaction to necrosis, purulent inflammation and melting of the lymph node tissue develop, and ulcers appear. With lymphogenous spread, new buboes of the second and third order appear, in which there are the same morphological changes as in the bubo of the first order. Hematogenous spread leads to the rapid development of plague bacteremia and septicemia, which are manifested by a rash, multiple hemorrhages, hematogenous damage to the lymph nodes, spleen, secondary plague pneumonia, degeneration and necrosis of parenchymal organs. At the stage of bacteremia, severe toxicosis develops with changes in the rheological properties of the blood, microcirculation disorders and hemorrhagic manifestations in various organs. Microcirculatory disorders cause changes in the heart muscle and blood vessels, as well as in the adrenal glands, which provokes acute cardiovascular failure. The spleen is septic, sharply enlarged (2-4 times), flabby, produces abundant scraping of the pulp with foci of necrosis and a leukocyte reaction to necrosis.

Secondary plague pneumonia, developing as a result of hematogenous embolic infection, is focal in nature. In the lungs, as a result of serous-hemorrhagic inflammation, many dark red foci with areas of necrosis appear, where a large number of pathogens can be found. Sometimes, during the initial inoculation of plague microbes into the skin, in addition to the bubo, changes develop at the site of introduction, i.e. primary affect arises. The latter is represented by a plague phlyctena (a bladder with serous-hemorrhagic contents) or a plague hemorrhagic carbuncle. Lymphangitis appears between the primary affect and the tambourine. At the site of the carbuncle, swelling and thickening of the skin are observed, which becomes dark red; The section shows bloody impregnation of all layers of the skin, as well as foci of necrosis surrounded by accumulations of leukocytes. Subsequently, the carbuncle becomes covered with ulcers. Septicemia develops with the same changes in organs as with bubonic plague.

With the aerogenic route of infection, the alveoli are primarily affected. They develop an inflammatory process with elements of necrosis - pleuropneumonia occurs. On the section, the lung tissue is gray-yellow; at the onset of the disease, tissue plethora is noted; the lumen of the alveoli contains serous-hemorrhagic exudate. Serous-hemorrhagic pleurisy also develops. Subsequently, stasis and hemorrhage occur, and foci of necrosis and secondary suppuration develop. Further bacteremia is accompanied by intense toxicosis and the development of septic-hemorrhagic manifestations in various organs and tissues. The appearance of antibodies in plague is observed in the late stages of the disease.

According to the International Classification of Diseases, the following forms of plague are distinguished:

• bubonic plague with the characteristic development of lymphadenitis or plague bubo;
• cellular cutaneous plague is an acute infectious disease manifested by severe intoxication, damage to the skin, lymph nodes, lungs and other organs;
• pneumonic plague is the most dangerous form of plague caused by damage to the lungs; usually the patient dies within 48 hours, only treatment started at the earliest stage is effective;
• plague meningitis is a rare form of plague that can develop from the very beginning of the disease, but usually against the background of inadequate antibacterial therapy;
• primary septicemic plague - with this type of plague, microbes spread hematogenously throughout the body, the person dies within two days;
• other forms of plague;
• unspecified plague.

According to the degree of severity, they are distinguished: mild (only in people born in endemic regions or in vaccinated people), moderate, severe. The incubation period lasts 3-6 days, sometimes from several hours to 1-2 days, for vaccinated people - up to 10 days. In severe cases, the disease begins suddenly with chills and an increase in body temperature to 39.5-40 ° C. From the first hours, patients complain of severe headache, lethargy, dizziness, and muscle pain. The face is hyperemic, the eyes are red due to the injection of conjunctival vessels. In severe cases of the disease, facial features become sharper, cyanosis appears, dark circles under the eyes, and an expression of suffering and horror (facies pestica). The tongue is swollen, dry, with cracks, covered with a thick layer of white plaque, enlarged in size. The palatine tonsils are also enlarged, swollen, with ulcers. Due to dryness of the mucous membranes of the oral cavity, thickening and dryness of the tongue, the speech of patients becomes unintelligible. A petechial rash may appear on the skin. The pulse is frequent (up to 120-140 per minute), weak in filling, often arrhythmic, sometimes thread-like. Heart sounds are muffled, the boundaries are expanded. Blood pressure decreases, collapse often occurs, and ITS occurs. Shortness of breath is pronounced. The abdomen is swollen and painful, the liver and spleen are enlarged. In severe cases, bloody vomiting and loose stools mixed with mucus and blood are possible. Diuresis decreases.

Due to damage to the central nervous system, the patient's behavior changes. Restlessness, fussiness, excess mobility, and tongue tremor appear. Speech becomes unintelligible, gait becomes unsteady, and coordination of movements is impaired. Sometimes others perceive such a patient as drunk. Already on the first day of illness, consciousness becomes darkened, delirium and hallucinations occur.

With mild and moderate severity, the level of fever and intoxication is correspondingly lower. Against the background of these general manifestations of plague, lesions characteristic of various clinical forms develop.

Bubonic plague occurs more often (80% of plague cases) and is accompanied by the development of lymphadenitis. The disease begins acutely with an increase in body temperature to 39.5-40 ° C and severe local pain at the site of bubo formation. This pain makes movements difficult and forces the patient to limit them and acquire an uncomfortable position. The axillary, femoral and inguinal lymph nodes are most often affected, which is due to frequent inoculation of the pathogen into the skin of the lower and upper extremities, which are more accessible to a flea bite. The entire topographic-anatomical group of lymph nodes and adjacent tissues are involved in the process. Lymph nodes increase in size; at first they are contoured, protrude above the skin, and are painless on palpation. The skin over the bubo is hot to the touch, stretched, shiny, red, and over time becomes purple-bluish. Edema of the subcutaneous fatty tissue and periadenitis gradually develop, as a result of which the lymph nodes merge into a continuous conglomerate. The formed bubo does not have clear contours, is motionless, and sharply painful on palpation. In the center of the bubo, cartilaginous formations are palpated, along the periphery there is mild swelling. The size of the bubo is 1-10 cm in diameter. There is no lymphangitis. The completion of the bubo is different - resorption, suppuration, sclerosis.

Quite often, on the 6-8th day of illness, the bubo can fester. The skin above it acquires a blue-brown color and becomes thin, a fluctuation appears in the center, and subsequently a fistula is formed through which purulent-bloody fluid is released. The reverse process in the bubo lasts 3-4 weeks. From the moment the bubo is opened, the patient's condition improves. If antibacterial therapy is started in a timely manner, complete resorption or sclerosis of the bubo occurs.

Buboes located in the neck area have a severe course. If axillary buboes threaten to break through into the lungs, they pose a risk of developing secondary pneumonic plague. If the pathogen overcomes the lymphatic barrier, it enters the general bloodstream and leads to the generalization of the infectious process with the formation of foci of infection in the internal organs. Other clinical forms of plague are developing.

Cellulocutaneous plague happens rarely (3-4%). At the site of entry of the pathogen, a red, painful spot appears, quickly and successively turning into a papule, vesicle and pustule with dark bloody contents, surrounded by a purple shaft area. In place of the pustule, an ulcer with a yellow bottom forms, which is subsequently covered with a dark scab. The ulcer is sharply painful and heals slowly with the formation of a scar. At the same time, the development of a regional bubo occurs with corresponding febrile and intoxicating manifestations.

Pneumonic plague Both primary and secondary lesions have a similar clinical picture. Lung damage is the most dangerous, both epidemiologically and clinically. The disease is characterized by an extremely severe course and high mortality. The incubation period lasts from several hours to 1-2 days. The disease begins suddenly, with a rapid increase in body temperature to 39.5-40 ° C and above, accompanied by chills, unbearable headache, and vomiting. Already from the first hours of the disease, sharp chest pain, cough, shortness of breath, and delirium appear. The cough is initially dry, but very quickly becomes wet with the release of mucous, transparent sputum. Subsequently, it becomes liquid, foamy, bloody and then bloody. The amount of sputum varies from a few spits (“dry plague”) to significant production (400-500 ml or more per day). Shortness of breath and tachycardia rapidly increase (pulse - 120-140 per minute). Physical data from the lungs during this period do not correspond to the serious condition of the patient. Breathing becomes harsh, and auscultation in some patients may reveal crepitations or fine bubbling rales. During the peak period, intoxication increases. Consciousness is sharply disturbed, the patients’ agitation increases, delusions and hallucinations occur. The pulse is frequent, arrhythmic, blood pressure decreases. Severe shortness of breath (respiratory rate - 40-60 per minute) and tachypnea. The face is puffy, with cyanosis, a petechial rash and massive hemorrhages appear in the skin. A large amount of bloody sputum is produced. In the lungs, signs of pneumonia are determined - local dullness of percussion sound, abundant fine-bubble moist rales. X-ray examination reveals multiple small foci of pneumonia, merging in places. Lobar lesions in plague are not observed in the lungs. In the terminal stage, a stuporous state develops due to cerebral edema-swelling (ONS). The skin becomes bluish due to the presence of hemorrhages. The face takes on an earthy hue, its features are sharpened, its eyes are sunken. There is an expression of horror on his face. Breathing is shallow, pulse is thready, blood pressure drops to critical levels. Prostration and coma develop. Patients die on the third to fifth day from the onset of the disease due to acute respiratory failure and infectious-toxic shock.

Rarely (1-3%) observed septicemic plague, mainly in people over 60 years of age. Already from the first hours of the disease, signs of ITS appear, which is the cause of death of the patient. The incubation period lasts several hours. The development of the disease is rapid. The onset is sudden: consciousness quickly becomes clouded, agitation, disorientation, slurred speech, tremor of the tongue, hands, and unsteady gait appear. The face is puffy, hyperemic. The symptoms of the disease progress quickly. Buboes do not have time to form. A few hours after the onset of the disease, against the background of severe intoxication, hemorrhagic syndrome develops with massive hemorrhages in the skin and mucous membranes. Nasal, pulmonary, and uterine bleeding, bloody vomiting, blood in the stool, and gross hematuria appear. Pneumonia sets in very quickly. Meningoencephalitis often develops (it is then that this option must be coded as plague meningitis according to ICD-10). Manifestations of ITS, AHF and ARF are increasing: tachycardia, thready pulse, decreased blood pressure, shortness of breath, tachypnea. Patients die within 1-3 days.

The form that occurs during alimentary infection is very rare. According to ICD-10, it belongs to other forms of plague. Some authors tend to consider it as a manifestation of the septic form. Clinical signs are cutting pain in the abdomen, tenesmus, nausea, vomiting, and bloody diarrhea. In Southeast Asia, a pharyngeal form of plague is described, which also belongs to other forms of plague. The entrance gate is the mucous membrane of the oral part of the throat; submandibular buboes are formed. Even a subclinical course of the disease has been described in a natural plague focus; Pharyngeal bacteria carriage is sometimes detected in contact persons.

How to treat plague?

Treatment of plague definitely requires hospitalization. Hospitalization is carried out in specialized hospitals located in a strict anti-epidemic regime. If plague is suspected, etiotropic therapy is immediately prescribed without waiting for laboratory confirmation results. The earlier etiotropic therapy is started, the more favorable the prognosis of the disease. The main drug for the treatment of plague in adults, according to WHO recommendations, is streptomycin. It is administered intramuscularly or intravenously for 7-14 days or at least until the 5th day of normal body temperature. It is not recommended to exceed the daily dose of 2.0 g.

In the absence of severe acute renal failure (ARF), it is possible to use gentamicin, which is administered intravenously for 10 days. If aminoglycosides cannot be used due to intolerance or severe acute renal failure, oral doxycycline is indicated for 10 days. If the plague pathogen is resistant to streptomycin and doxycycline, chloramphenicol (chloramphenicol) (chloramphenicol) is also prescribed orally.

The scope of pathogenetic therapy is determined by the clinical form and severity of the disease. In case of development of infectious-toxic shock, treatment is carried out according to modern recommendations. Detoxification therapy is mandatory. Rheopolyglucin, 5% glucose solution, saline solutions, diuretics, and, if necessary, glucocorticosteroids are administered intravenously. Necessary measures are correction of cardiovascular activity, respiratory support, and strict control of water balance. In recent years, plasmapheresis has been used to combat toxicosis.

What diseases can it be associated with?

Complications of plague depend on the clinical form. With bubonic plague, it is possible for a secondary infection to develop, as well as the development of a secondary one. The course of pneumonic plague is complicated by hemorrhagic pulmonary edema, acute respiratory failure and infectious-toxic shock. With septicemic plague, ITS, acute heart failure (AHF), and bleeding can develop.

In the absence of adequate treatment, the mortality rate for bubonic plague reaches 70%, and with treatment - 10-20%. The mortality rate for pneumonic plague in the case of treatment is 30-50%, and in the absence of it - 100%. The mortality rate for septicemic plague in the absence of treatment is also 100%.

Treating plague at home

Treatment of plague is carried out exclusively in a medical hospital, where the patient is provided with proper care and thereby ensures his isolation from healthy people.

Convalescents are discharged after complete clinical recovery and a three-fold negative result of bacteriological examination (smears from the mouth, sputum), but not earlier than 4 weeks from the moment of recovery in the bubonic form and 6 weeks in the pulmonary form.

What drugs are used to treat plague?

Etiotropic therapy:

• - 1.0 g every 12 hours intramuscularly or intravenously for 7-14 days or at least until the 5th day of normal body temperature; It is not recommended to exceed the daily dose of 2.0 g;
• - based on a daily dose of 0.002 g/kg body weight, which is divided into three equal parts and administered intravenously every 8 hours for 10 days; use is permissible in the absence of pronounced acute renal failure;
• - 0.1 g 2 times a day or orally for 10 days; relevant when it is impossible to use aminoglycosides due to their intolerance or severe acute renal failure;
• - 0.5-1.0 g every 6 hours; relevant in case of resistance of the plague pathogen to streptomycin and doxycycline, as well as in case of plague meningitis
• - 0.5-1.0 g every 6 hours; relevant in case of resistance of the plague pathogen to streptomycin and doxycycline, as well as in case of plague meningitis.

Detoxification therapy:

• , 5% glucose solution, saline solutions, diuretics, glucocorticosteroids are administered intravenously;

Treatment of plague with traditional methods

Plague is an aggressive and rapidly developing disease, the use of folk remedies in the treatment of which can be the same delay that will subsequently lead to death. Plant extracts are not able to have a sufficient effect on the plague bacillus, especially in a short time, therefore, with any disturbing symptoms and the slightest suspicion of plague, it is recommended to urgently seek medical help rather than try traditional medicine recipes.

Treatment of plague during pregnancy

Plague is a disease characterized by a high toxic effect, which for a pregnant woman usually means miscarriage. Treatment of plague in a pregnant woman, first of all, the goal is to preserve the life of the mother. After termination of pregnancy, treatment is carried out according to the standard regimen.

Planning a pregnancy and its course should be that period in a woman’s life when she in every possible way protects herself from negative influences. Plague for today

does not pose a danger to residents of our region, with the exception of the risk of its importation from enzootic foci and from abroad. This is prevented by workers of various anti-plague institutions. For immediate protection during a disease outbreak, WHO does not recommend vaccination. Vaccination is used only as a preventive measure for high-risk groups (for example, laboratory workers). If plague occurs among the population, anti-epidemic measures are taken aimed at localizing and eliminating the epidemic focus. They include:

• identifying patients and hospitalizing them in special ward-boxes with special ventilation and a strict anti-epidemic regime;
• establishment of territorial state quarantine for cases of pneumonic plague and regular quarantine for other forms without pulmonary lesions;
• identification and isolation of all persons who were in contact with patients (they are isolated in pharmacist medical institutions for 6 days and given emergency prophylaxis with antibiotics - ciprofloxacin or doxycycline for 6 days);
• conducting door-to-door visits to identify patients with fever and their hospitalization in pharmacies;
• final disinfection in the plague outbreak with disinfectants and using steam and steam-formalin chambers, as well as disinsection and deratization in and around the populated area.

The personnel works in protective suits for working with category IV pathogens (anti-plague suits). In enzootic foci of plague, sanitary education work is of great importance.

A clinical blood test reveals significant leukocytosis with a shift to the left and an increase in ESR. In the urine there is protein, red blood cells, granular and hyaline casts. Oliguria develops.

The detection of an ovoid gram-negative rod, bipolarly stained, in a smear provides grounds for establishing a preliminary diagnosis of plague. WHO recommends rapid substrate-impregnated assays for use in the field to rapidly identify antigens in patients. Bacteriological examination is very important: sowing the material on Marten or Hottinger agar with sodium sulfite. To study the properties of the plague pathogen with a culture isolated from a patient, biological tests are carried out (intraperitoneal, subcutaneous, intradermal injection of material into guinea pigs or white mice). Serological tests play an important role: RPGA, RGPGA, RNAg, RNAb, ELISA with mono- or polyclonal antibodies. For express diagnostics, RIF is used, the result is obtained in 15 minutes. This test has 100% sensitivity and specificity.

All studies to detect plague are carried out in laboratories adapted, according to WHO definition, for working with pathogens of pathogenicity group IV (in Ukraine these are laboratories of especially dangerous infections), work in which is regulated by special instructions. The material is taken and sent to the laboratory in a suit according to the rules established for quarantine infections.

Treatment of other diseases starting with the letter - h

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Plague (“Black Death”, Pestis) is a particularly dangerous, acute, naturally focal zoonotic* bacterial infection, with multiple routes of transmission, and characterized by a feverish-intoxication syndrome, as well as predominant damage to the skin and lungs.

A brief historical sketch: without exaggeration, we can add the prefix “most” to the following characteristics - the oldest, most dangerous to this day, breaking records for the severity of the disease and the highest mortality rate, as well as for the level of contagiousness (infectiousness) - in all these points the plague has practically no equal .
The still completely illiterate natives passed on their everyday experience from generation to generation: when dead rats appeared in a hut, the entire tribe left the area, imposing a taboo and never returning.

The 3 largest plague pandemics have been recorded in the history of the world:

In the 3rd century there was the first description, in the territories where Libya, Syria, and Egypt are now located.
The pandemic in the 6th century in the Roman Empire until the end of Justinian’s reign is the “Justinian pandemic.” During this period, thanks to the accumulated experience, quarantine began to be introduced for 40 days in order to prevent the spread of infection.
Late 19th century - third pandemic, most common in seaports. Also, this century became a turning point, because during this period the causative agent of the plague itself was discovered by the French scientist Yersin in 1894.

Long before these pandemics, there were many epidemics that are countless... One of the largest was in France, in the 16th century, where one of the most famous psychics, doctors and astrologers lived - Nostradamus. He successfully fought the “Black Death” with the help of herbal medicine, and his recipe has survived to this day: sawdust of young cypress, Florentine iris, cloves, fragrant calamus and woody aloe - rose petals were mixed with all these components and “rose” tablets were made from this mixture pills." Unfortunately, Nostradamus was unable to save his wife and children from the plague...

Many cities where death reigned were burned, and local doctors, trying to help the infected, wore special anti-plague “armor”: a leather cloak to the very toes, a mask with a long nose - various herbs were placed in this nasal section and, when inhaled, heated air caused evaporation of antiseptic substances contained in herbs, the inhaled air was practically sterile. This mask was protected by crystal lenses, rags were stuck in the ears, and the mouth was rubbed with raw garlic.

It would seem that the era of “antibiotics” would forever eliminate the danger of the plague, they thought so for a short time, until the scientist Bacon modeled a genetic mutant of the plague - an antibiotic-resistant strain. Also, vigilance cannot be reduced because there have always been and are natural foci (territorially aggressive). Social upheaval and economic depression are predisposing factors in the spread of this infection.

The causative agent is Yersinia Pestis, it looks like an ovoid rod, G-, does not have spores or flagella, but forms a capsule in the body. On nutrient media it gives characteristic growth: on broth agar - plague stalactites, on solid media, the first 10 hours in the form of “broken glass”, after 18 hours in the form of “lace handkerchiefs”, and by 40 hours “adult colonies” are formed.

There are a number of structural characteristics that are components of pathogenicity factors:

Capsule – inhibits the activity of macrophages.
Pili (small villi) - inhibit phagocytosis and cause the penetration of the pathogen into macrophages.
Plasmocoagulase (also coagulase) - leads to plasma coagulation and disruption of the rheological properties of blood.
Neurominidase – ensures adhesion and attachment of the pathogen due to the release of its receptors on the surface.
The specific antigen pH6 is synthesized at a temperature of 36°C and has antiagocyte and cytotoxic activity.
Antigens W and V – ensure the reproduction of the pathogen inside macrophages.
Catalase activity provided by adenylate cyclase suppresses the oxidative burst in macrophages, which reduces their protective ability.
Aminopeptidases – provide proteolysis (cleavage) on the cell surface, inactivation of regulatory proteins and growth factors.
Pesticin is a biologically active component of Y.pestis that inhibits the growth of other representatives of the genus Yersinia (Yersiniosis).
Fibrinolysin - ensures the breakdown of the blood clot, which subsequently aggravates the clotting disorder.
Hyaluronidase - ensures the destruction of intercellular connections, which further facilitates its penetration into the underlying tissues.
Endogenous purines (the role of their presence is not completely clear, but upon breakdown they form uric acid, which is potentially toxic).
Endotoxin is a lipopolysaccharide complex that has toxic and allergenic effects.
Rapid growth at a temperature of 36.7-37°C - this feature, in combination with antiphaocytic factors (listed above), makes the growth and reproduction of the plague pathogen practically unimpeded.
The ability of the pathogen to sorb (accumulate/collect) hemin (derived from heme - the non-protein part of the Fe3+ transporter in the blood) - this property ensures the reproduction of the pathogen in tissues.
Mouse toxin (lethal = C-toxin) – has cardiotoxic (heart damage), hepatotoxic (liver damage) and capillary toxic effects (impairs vascular permeability and causes thrombocytopathies). This factor is manifested by a blockade of the transfer of electrolytes in mitochondria, i.e. blockade of the energy depot.

All pathogenicity (harmfulness) is controlled by genes (there are only 3 of them) - Bacon influenced them by modeling an antibiotic-resistant mutant of the plague and thus warned humanity about a moving threat in conditions of inappropriate and uncontrolled use of antibiotics.

Resistance of the plague pathogen:

Retains in sputum for 10 days;
On linen, clothes and household items stained with mucus - for weeks (90 days);
In water – 90 days;
In buried corpses - up to a year;
In open warm spaces – up to 2 months;
In bubo pus (enlarged lymph node) – 40 days;
In soil - 7 months;
Freezing and thawing, as well as low temperatures, have little effect on the pathogen;

The following are destructive: direct UV radiation and disinfectants cause instant death, at 60°C - death within 30 minutes, at 100°C - instantaneous death.

Plague refers to natural focal infections, that is, there are territorially dangerous zones in epidemic terms; there are 12 of them on the territory of the Russian Federation: in the North Caucasus, Kabardino-Balkaria, Dagestan, Transbaikalia, Tuva, Altai, Kalmykia, Siberia and the Astrakhan region . Globally, natural foci exist on all continents except Australia: Asia, Afghanistan, Mongolia, China, Africa and South America.

In addition to natural focal (natural) zones, synanthropic foci (anthropouric) are also distinguished - urban, port, ship.
Susceptibility is high, without gender or age restrictions.

Causes of plague infection

The source and reservoir (guardian) of infection are rodents, lagomorphs, camels, dogs, cats, sick people. The carrier is a flea, which remains infective for up to a year. The plague microbe multiplies in the digestive tube of fleas and in the front part of it forms a “plague block” - a plug of a huge amount of the pathogen. When bitten, with the reverse flow of blood, some of the bacteria are washed off from this plug - this is how infection occurs.

Routes of infection:

Transmissible (through flea bites);
Contact – through damaged skin and mucous membranes when skinning infected animals, during slaughter and cutting of carcasses, as well as through contact with biological fluids of a sick person;
Contact household – through household items contaminated with biological media of infected animals/humans;
Airborne (through the air, from a patient with pneumonic plague);
Nutritional – when eating contaminated foods.

Plague symptoms

The incubation period is considered from the moment of introduction of the pathogen to the first clinical manifestations; with plague, this period can last from several hours to 12 days. The pathogen more often penetrates through the affected skin or mucous membranes of the digestive/respiratory tract; it is captured by tissue macrophages, and part of the pathogen remains at the entrance gate, and part is transferred by macrophages to regional (nearby) lymph nodes. But as long as the pathogen dominates phagocytosis and suppresses its action, the body does not identify the pathogen as a foreign object. But phagocytosis is not completely suppressed, some of the pathogens die and after death, an exotoxin is released and upon reaching its threshold concentration, clinical manifestations begin.

The period of clinical manifestations always begins acutely, suddenly, with the first symptoms of intoxication in the form of chills, high fever >39°C lasting for 10 days and/or until death, severe weakness, body aches, thirst, nausea, vomiting; cyanotic, with dark circles under the eyes - these changes against the background of an expression of suffering and horror are called the “mask of plague.” The tongue is covered with a thick, white coating - “chalky tongue”. There is a standard pathogenetic symptom complex (that is, due to the specific mechanism of action of the pathogen, 4 standard symptoms are formed in varying degrees of manifestation):

At the site of the entrance gate, a primary focus is formed, which can undergo stages and stop at one of them: spot - papula - vesicle.
Enlargement of regional lymph nodes (formation of a “plague bubo”) to impressive sizes (≈apple) due to the multiplication of the pathogen in it and the formation of an inflammatory-edematous reaction. But it often happens that the process proceeds so quickly that death occurs even before the development of the plague bubo.
ITS (infectious-toxic shock) develops as a result of degranulation of neutrophils (NF) and the death of the pathogen with the release of endotoxin. It is characterized by a certain degree of manifestation and the main diagnostic criteria are: changes in the nervous system (state of consciousness) + or ↓t° of the body + hemorrhagic rash (pinpoint rashes in the oropharynx) + hemorrhages in the mucous membranes + peripheral circulatory disorders (coldness, pallor or blue discoloration of the extremities, nasolabial triangle, face) + changes in pulse and blood pressure (↓) + changes in intracranial pressure (↓) + the formation of renal failure, manifested as a decrease in daily diuresis + changes in acid-base balance (acid-base status) towards acidosis
DIC syndrome (disseminated intravascular coagulation) is a very serious condition, which is based on disorganization of the coagulation and anticoagulation systems. DIC occurs in parallel with the development of ITS and manifests itself ↓Tr +clotting time + ↓degree of clot contraction + positive procoagulation test.

Clinical forms of the disease:

Localized (cutaneous, bubonic);
generalized (pulmonary, septic).

The forms of the disease are indicated in the order in which the disease can develop in the absence of treatment.

Cutaneous form: tissue changes occur at the site of the entrance gate (one of 4 standard symptoms); in severe or fulminant cases, a phlyctena (blister) filled with serous-hemorrhagic contents, surrounded by an infiltrative zone with hyperemia and edema, may develop. When palpated, this formation is painful, and when opened, an ulcer forms with black necrosis (eschar) at the bottom - hence the name “black death”. This ulcer heals very slowly and always leaves scars after healing and, due to slow healing, secondary bacterial infections often form.

Bubonic form: “Plague bubo” is an enlarged lymph node, either one or several. The increase can be from the size of a walnut to an apple, the skin is shiny and red with a cyanotic tint, the consistency is dense, palpation is painful, it is not fused with the surrounding tissues, the boundaries are clear due to concomitant periadenitis (inflammation of the peri-lymphatic tissues), on the 4th day the bubo softens and fluctuation appears (a feeling of excitement or hesitation when tapping), on the 10th day this lymphatic focus is opened and a fistula with ulceration is formed. This form can lead to both secondary bacterial septic complications and septic plague complications (i.e. plague bacteremia) with the introduction of the plague pathogen into any organs and tissues.

Septic form: characterized by the rapid development of INS and DIC syndrome, multiple hemorrhages on the skin and mucous membranes come to the fore, and bleeding begins in the internal organs. This form can be primary - when a massive dose of the pathogen is ingested, and secondary - when there are secondary bacterial complications.

Pulmonary form the most dangerous in an epidemiological sense. The onset is acute, as in any other form; pulmonary symptoms (due to the melting of the walls of the alveoli) join the 4 standard clinical symptoms and appear at the first stage: a dry cough appears, which after 1-2 days becomes productive - the sputum is initially foamy, glassy , clear and consistency like water, and then becomes purely bloody, with countless amounts of excitability. This form, like the septic one, can be either primary - with aerogenic infections, or secondary - a complication of the other forms listed above.

Diagnosis of plague

1. Analysis of clinical and epidemiological data: in addition to standard clinical manifestations, the place of residence or current location is examined and whether this place corresponds to a natural outbreak.
2. Laboratory criteria:
- UAC: Lts and Nf with a shift of the formula to the left (i.e. P/i, S/i, etc.), ESR; The increase in neutrophils occurs at the compensatory stage, as soon as the depot is depleted, Nf ↓ (neutropenia).
- evaluate acid-base balance parameters: the amount of bicarbonate, buffer bases, O₂ and oxygen capacity of the blood, etc.
- OAM: proteinuria, hematuria, bacteriuria - all this will only indicate the degree of compensatory reaction and contamination.
- X-ray diagnostics: ↓mediastinal lymph nodes, focal/lobular/pseudolabular pneumonia, RDS (respiratory distress syndrome).
- Lumbar puncture for meningeal symptoms (stiff neck, positive Kering and Brudzinski symptoms), which reveals: 3-digit neutrophilic pleocytosis + [protein] + ↓[glu].
- Examination of bubo punctate / ulcers / carbuncle / sputum / nasopharyngeal smear / blood / urine / feces / cerebrospinal fluid - that is, where the symptoms dominate, and the biological material is sent for bacteriological and bacteriscopic examination - the preliminary result is in an hour, and the final after 12 hours (when plague stalactites appear, this makes the diagnosis indisputable).
- RPHA (passive hemagglutination reaction), RIF, ELISA, RNGA

If plague is suspected, laboratory tests are carried out in anti-plague suits, in specialized laboratory conditions, using specially designated dishes and containers, as well as with the mandatory availability of disinfectants.

Treatment of plague

Treatment is combined with bed rest and gentle nutrition (table A).

1. Etiotropic treatment (directed against the pathogen) - this stage should be started only with one suspicion of plague, without waiting for bacteriological confirmation. For a certain form, different combinations of drugs are used, alternating them with each other, the most successful combinations in this case:
- Ciftriaxone or Ciprofloxacin + streptomycin, or gentamicin, or rifampicin
- Rifampicin + Streptomycin

2. Pathogenetic treatment: combating acidosis, cardiovascular and respiratory failure, ITS and disseminated intravascular coagulation syndrome. During this treatment, colloid solutions (reopolyglucin, plasma) and crystalloid solutions (10% glucose) are administered.
3. Symptomatic therapy as certain dominant symptoms appear.

Complications of the plague

Development of irreversible stages of ITS and DIC, decompensation of organs and systems, secondary bacterial complications, death.

Prevention of plague

Nonspecific: epidemiological surveillance of natural foci; reducing the number of rodents with disinsection; constant monitoring of the population at risk; preparing medical institutions and medical personnel to work with plague patients; prevention of import from other countries.
Specific: annual immunization with live anti-plague vaccine of persons living in risk areas or traveling there; People who come into contact with plague patients, their belongings, or animal corpses are given emergency antibiotic prophylaxis with the same drugs used for treatment.
Post-infectious immunity is believed to be strong and lifelong, but cases of reinfection have been reported.

*National Infectious Disease Guidelines classify plague as a zoonotic disease, meaning one that cannot spread from person to person. But can this be considered legitimate, remembering the epidemic history of Europe in the 14th century, when in 1346-1351, out of a population of 100 million, only 70 million remained? I don’t think this characterization is appropriate, since only those diseases that are transmitted from animals are called “zoonosis.” to animals and humans is an “infectious dead end”, i.e. without the possibility of infecting other people, and “zooanthraponosis” implies infection not only between animals, but also between people.

General practitioner Shabanova I.E.

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, which is resistant to low temperatures, but dies when boiled.

Plague carriers are small rodents, rats, marmots, and gophers. Transmission of infection from one animal to another occurs through flea bites. From them, microbes are transmitted to humans, and then further spread of the epidemic occurs through airborne droplets. There are known cases of infection with the plague 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 and dizziness appear. 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 indigestion appears.

Many patients experience blackouts and hallucinations.

Patients are often delirious and experience psychomotor agitation. A patient with plague has a specific unsteady 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, and there are extensive hemorrhages. Plague is especially dangerous because the disease causes damage to the cardiovascular system. Auscultation reveals expansion of the borders of the heart and dullness of heart sounds.

In addition, arrhythmia and tachycardia appear, as well as a drop in blood pressure. The patient's tongue increases in size and becomes covered with a dense white coating. The mucous membranes of the mouth are dry. On examination, a significant enlargement of 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.

In the bubonic form of plague, regional muscle nodes at the sites of flea bites are affected. The patient complains of severe pain, particularly in the area of ​​the inguinal lymph glands, even when there is no increase in their size.

Then hemorrhagic inflammation of a necrotic nature begins to progress in the lymph glands. As a result, the glands become fused with each other, as well as with the skin and subcutaneous tissue, resulting in the appearance of 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 bacilli.

The pneumonic form of plague produces hemorrhagic inflammation of pulmonary foci with minor necrosis. The patient complains of chest pain, shortness of breath and palpitations. Soon after the onset of the disease, the patient develops a cough with the production of viscous, transparent sputum.

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

If plague is suspected, the patient should be hospitalized. For bubonic plague, intramuscular injections of streptomycin are prescribed 3 times a day. The daily dose of the drug is 3 g. In addition, tetracycline antibiotics are administered intravenously - vibromycin, morphocycline, the daily dose of which is 4-6 g. In case of intoxication of the body, it is necessary to administer saline solutions and hemodesa. For pneumonic plague, the patient is prescribed streptomycin in the amount of 5 g per day and 6 g of tetracycline per day.