Plague - an acute infectious disease; characterized by severe intoxication, fever, damage to the lymph nodes, skin and lungs.
The causative agent is a plague bacillus, motionless, 0.5 - 1.5 microns in size, gram-negative, unstable outside the body. Disinfectants, boiling, antibiotics have a devastating effect on it.
Plague is a quarantine disease. In natural foci, rodents are the sources and reservoirs of the pathogen. The main ones are marmots, gophers and gerbils; possible infection of people from mouse-like rodents (especially during the period of their mass reproduction) and rabbit-like. The source and reservoir of the pathogen can be rats (gray and black), less commonly house mice, cats, and camels.
Plague foci occur where a person becomes a source of the pathogen - a patient with primary or secondary pulmonary plague, and there is also a risk of infection in contact with the corpse of a deceased from the plague (during washing, funeral ritual).
The carriers of the causative agent of the infection are fleas of various species. Human infection occurs by a vector-borne transmission (when bitten by an infected flea); contact (when removing skins from plague-infected industrial rodents, hares, slaughtering and cutting meat of a sick camel, in contact with household items, patient's excreta containing pathogens); food (when eating foods seeded with plague pathogens, for example, insufficiently heat-treated meat of camels and groundhogs plague sick). Of particular danger are patients with pulmonary plague, from which the pathogen can be transmitted by airborne droplets.
The clinical picture . The duration of the incubation period ranges from several hours to 6 days, for vaccinated - up to 10 days. There are bubonic (skin-bubonic), pulmonary and septic forms of plague.
Usually the disease starts suddenly: there is severe chills, headache , muscle pain and a feeling of weakness, body temperature rises to 39 - 40 ° C. Patients are restless, fussy. The face is hyperemic, conjunctivitis is expressed, eyes are frantically sparkling, the tongue is covered with a thick white coating (“chalky”), swollen, and often its tremor occurs. The mucous membrane of the oral cavity is dry, tonsils are enlarged, ulcerated. In severe cases of the disease, cyanosis is noted, an expression of suffering and horror appears on the face, its features are sharpened. Insomnia, delirium , hallucinations , agitation, slurred speech, ataxia develop. Tachycardia reaches 120 - 160 beats per minute, pulse arrhythmia, a sharp drop in blood pressure, shortness of breath are observed. The liver and spleen are enlarged. Hemorrhagic or pustular rashes are often found on the skin. Sometimes on the skin at the site of penetration of the pathogen, primary affect is formed in the form of a spot, which gradually turns into a papule, vesicle, pustule. The pustule is sharply painful, it is soon opened, a slowly healing ulcer appears.
With the most common bubonic form, from the first day of the disease, severe pain is felt at the site of the developing bubo, which causes the patient to take a forced position; the lymph node is palpated in the form of a small painful compaction, which then enlarges, the surrounding fiber and skin infiltrate, merge into a dense conglomerate without clear contours, and a plague bubo is formed. The skin in the first days is not changed, then it becomes tense, acquires a crimson-cyanotic color, on the 6-8th days of illness in the center of the bubo softening and fluctuation appear. The patient's condition improves. On the 8-12th day of the disease, the bubo is opened, a thick yellowish-green pus is secreted, a slowly scarring ulcer is formed. With an unfavorable course of the disease, secondary plague pneumonia or hemorrhagic septicemia develops.
The pulmonary form of the plague proceeds most severely and is dangerous to others. It can develop primary or secondary as a complication of other forms. Intoxication is pronounced, severe chest pain, cough with bloody sputum, cyanosis , shortness of breath , tachycardia , tremor are noted. After 2-3 days, coma , pulmonary heart disease develop.
The septic form of the plague in severity is close to the pulmonary form, it can also be primary and secondary. In addition to severe intoxication, massive hemorrhages in the skin and mucous membranes, bleeding (gastrointestinal, pulmonary, renal, uterine) are characteristic. The diagnosis is established on the basis of the clinical picture, the data of the epidemiological history (stay before the disease on the territory of the natural focus, contact with rodents, flea bites, etc.) and laboratory results. Of greatest importance is the allocation of the plague pathogen from the material from the patient (detachable or punctate bubo, blood, sputum, nasopharyngeal swab, etc.).
Treatment . Patients are immediately hospitalized in special hospitals. Etiotropic therapy is carried out with tetracycline drugs, streptomycin, chloramphenicol, ampicillin in maximum doses for 7 to 10 days. Detoxification therapy is carried out (5% glucose solution with ascorbic acid, polyionic solutions, hemodez, reopoliglyukin; injected strophanthin, sulfocamphocaine , vicasol , etc.).
Prevention Activities are carried out in two main directions: monitoring the state of natural foci of plague and preventing the possible introduction of the disease from other countries. In the territory of natural foci, explanatory work is carried out among the population about measures for the prevention of plague, according to epidemic indications, specific prophylaxis is carried out with a live vaccine.
Of particular importance in the prevention of plague is the early detection of the first cases of human diseases. If you suspect a disease, you must immediately report this to higher health authorities and quickly begin to deploy anti-epidemic measures. A medical worker who has identified a patient with suspected plague should stop taking patients further, close doors and windows, put a post at the premises to stop walking patients and staff. The chief physician of the medical institution is notified by phone or through an on-call, through him they request protective clothing, emergency prophylactics (streptomycin, etc.), medicines, disinfectant solutions, patient care items. Prior to the arrival of the team of consultants, the doctor provides the patient with medical care, compiles a list of people who interacted with the patient. Persons suspected of having plague are immediately isolated and hospitalized. Persons in contact with the patient, infected things, a corpse, isolate for 6 days, in contact with patients with pulmonary plague are placed individually, conduct medical supervision with daily thermometry. These individuals, as well as the nursing staff, are given emergency chemoprophylaxis with tetracycline 0.5 g orally 3 times a day or chlortetracycline inside 0.5 g 3 times a day for 5 days. All staff serving the patients work in a full antiplague suit (pajamas or overalls, a dressing gown, a hood or a large scarf, a cotton-gauze mask or a respirator or gas mask, safety glasses, boots, socks, a hat, rubber gloves); after the end of work, the staff undergoes full sanitation, lives in a specially allocated room and is under systematic medical supervision.
Organize monitoring of the state of health of the population, all identified patients with fever are hospitalized to exclude plague. Conduct restrictive (quarantine) measures aimed at preventing the spread of infection outside the outbreak. In the outbreak, current and final disinfection, deratization and disinfestation are carried out both in the field and in the village (according to indications).