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Treatment of plague. "Black Death" - a disease of the Middle Ages

is a highly contagious bacterial infection with multiple routes of transmission and epidemic spread, occurring with feverish intoxication syndrome, damage to the lymph nodes, lungs and skin. The clinical course of various forms of plague is characterized by high fever, severe intoxication, agitation, excruciating thirst, vomiting, regional lymphadenitis, hemorrhagic rash, disseminated intravascular coagulation syndrome, as well as its own specific symptoms (necrotizing ulcers, plague buboes, ITS, hemoptysis). Diagnosis of plague is carried out using laboratory methods (bacterial culture, ELISA, RNGA, PCR). Treatment is carried out under conditions of strict isolation: tetracycline antibiotics, detoxification, pathogenetic and symptomatic therapy are indicated.

ICD-10

A20

General information

Plague is an acute infectious disease, transmitted primarily through a transmissible mechanism, manifested by inflammation of the lymph nodes, lungs, and other organs, which is serous-hemorrhagic in nature, or occurs in a septic form. Plague belongs to the group of especially dangerous infections.

Plague belongs to the group of particularly dangerous infections. In the past, pandemics of the “Black Death,” as the plague was called, claimed millions of lives. History describes three global outbreaks of plague: in the 6th century. in the Eastern Roman Empire (“the Plague of Justinian”); in the 14th century in Crimea, the Mediterranean and Western Europe; in the late 19th century in Hong Kong. Currently, thanks to the development of effective anti-epidemic measures and an anti-plague vaccine, only sporadic cases of infection are recorded in natural foci. In Russia, plague-endemic areas include the Caspian lowland, Stavropol region, Eastern Urals, Altai and Transbaikalia.

Causes of the plague

Characteristics of the pathogen

Yersinia pestis is a nonmotile, facultative anaerobic, gram-negative, rod-shaped bacterium of the genus Enterobacteriaceae. The plague bacillus can remain viable for a long time in the secretions of sick people and corpses (in bubonic pus Yersinia live up to 20-30 days, in the corpses of people and dead animals - up to 60 days), and can withstand freezing. This bacterium is quite sensitive to environmental factors (sunlight, atmospheric oxygen, heating, changes in environmental acidity, disinfection).

Routes of infection

The reservoir and source of plague are wild rodents (marmots, voles, gerbils, pikas). In different natural foci, different types of rodents can serve as reservoirs; in urban conditions, mainly rats. Dogs resistant to human plague can serve as a source of pathogen for fleas. In rare cases (with the pneumonic form of plague, or in direct contact with bubonic pus), a person can become the source of infection; fleas can also receive the pathogen from patients with the septic form of plague. Often infection occurs directly from plague-infected corpses.

Plague is transmitted through a variety of mechanisms, the leading place among which is transmissible. The carriers of the plague pathogen are fleas and ticks of some species. Fleas infect animals that carry the pathogen through migration, also spreading fleas. People become infected by rubbing flea excrement into their skin while scratching. Insects remain infective for about 7 weeks (there is evidence of fleas being contagious throughout the year).

Infection with plague can also occur through contact (through damaged skin when interacting with dead animals, cutting up carcasses, harvesting skins, etc.), or nutritionally (by eating the meat of sick animals).

People have an absolute natural susceptibility to infection; the disease develops when infected by any route and at any age. Post-infectious immunity is relative and does not protect against re-infection, but repeated cases of plague usually occur in a milder form.

Classification

Plague is classified into clinical forms depending on the predominant symptoms. There are local, generalized and externally disseminated forms:

  • Local plague is divided into cutaneous, bubonic and cutaneous bubonic.
  • Generalized plague is primary and secondary septic.
  • The externally disseminated form is divided into primary and secondary pulmonary, as well as intestinal.

Plague symptoms

The incubation period of the plague on average takes about 3-6 days (maximum up to 9 days). In mass epidemics or in the case of generalized forms, the incubation period can be shortened to one to two days. The onset of the disease is acute, characterized by the rapid development of fever, accompanied by stunning chills and severe intoxication syndrome.

Patients may complain of pain in the muscles, joints, and sacral region. Vomiting appears (often with blood), thirst (painful). From the very first hours, patients are in an excited state, and perception disorders (delusions, hallucinations) may be noted. Coordination is impaired and speech intelligibility is lost. Lethargy and apathy occur noticeably less often, patients weaken to the point of being unable to get out of bed.

The patient's face is puffy, hyperemic, the sclera is injected. In severe cases, hemorrhagic rashes are observed. A characteristic sign of the plague is a “chalky tongue” - dry, thickened, densely covered with a bright white coating. Physical examination shows severe tachycardia, progressive hypotension, shortness of breath and oliguria (up to anuria). In the initial period of plague, this symptomatic picture is observed in all clinical forms of plague.

Cutaneous form

Bubonic form

It is the most common form of plague. Buboes are specifically modified lymph nodes. Thus, with this form of infection, the predominant clinical manifestation is purulent lymphadenitis, regional in relation to the area of ​​introduction of the pathogen. Buboes, as a rule, are single, in some cases they can be multiple. Initially, there is soreness in the area of ​​the lymph node; after 1-2 days, palpation reveals enlarged, painful lymph nodes, initially dense, which, as the process progresses, soften to a pasty consistency, merging into a single conglomerate welded to the surrounding tissues. The further course of the bubo can lead either to its independent resorption or to the formation of an ulcer, an area of ​​sclerosis or necrosis. The height of the disease continues for a week, then a period of convalescence begins, and clinical symptoms gradually subside.

Cutaneous bubonic form

Characterized by a combination of skin manifestations with lymphadenopathy. Local forms of plague can progress to secondary septic and secondary pneumonic forms. The clinical course of these forms does not differ from their primary counterparts.

Primary septic form

It develops at lightning speed, after a shortened incubation (1-2 days), is characterized by a rapid increase in severe intoxication, severe hemorrhagic syndrome (numerous hemorrhages in the skin, mucous membranes, conjunctiva, intestinal and renal bleeding), and the rapid development of infectious-toxic shock. The septic form of plague without proper timely medical care ends in death.

Primary pulmonary form

Occurs in the case of an aerogenic route of infection, the incubation period is also reduced and can be several hours or last about two days. The onset is acute, characteristic of all forms of plague - increasing intoxication, fever. Pulmonary symptoms appear on the second or third day of the disease: there is a strong debilitating cough, first with transparent glassy sputum, later with foamy, bloody sputum, chest pain, and difficulty breathing. Progressive intoxication contributes to the development of acute cardiovascular failure. The outcome of this condition can be stupor and subsequent coma.

Intestinal form

It is characterized by intense sharp pain in the abdomen with severe general intoxication and fever, soon followed by frequent vomiting and diarrhea. The stool is profuse, mixed with mucus and blood. Often - tenesmus (painful urge to defecate). Considering the widespread prevalence of other intestinal infections, the question has not yet been resolved: is intestinal plague an independent form of the disease that develops as a result of microorganisms entering the intestines, or is it associated with the activation of intestinal flora.

Diagnostics

Due to the special danger of infection and extremely high susceptibility to the microorganism, the pathogen is isolated in specially equipped laboratories. Material is collected from buboes, carbuncles, ulcers, sputum and mucus from the oropharynx. It is possible to isolate the pathogen from the blood. Specific bacteriological diagnostics are carried out to confirm the clinical diagnosis, or, in case of prolonged intense fever in patients, in an epidemiological focus.

Serological diagnosis of plague can be made using RNGA, ELISA, RNAT, RNAG and RTPGA. It is possible to isolate the DNA of the plague bacillus using PCR. Nonspecific diagnostic methods - blood test, urine test (a picture of acute bacterial infection is noted), in the pulmonary form - chest x-ray (signs of pneumonia are noted).

Treatment of plague

Treatment is carried out in specialized infectious diseases departments of the hospital, under conditions of strict isolation. Etiotropic therapy is carried out with antibacterial agents in accordance with the clinical form of the disease. The duration of the course takes 7-10 days.

  1. Specific therapy. For the cutaneous form, co-trimoxazole is prescribed, for the bubonic form, intravenous chloramphenicol with streptomycin. Tetracycline antibiotics can also be used. Tetracycline or doxycycline is supplemented with a complex of chloramphenicol and streptomycin for plague pneumonia and sepsis.
  2. Nonspecific therapy. Includes a complex of detoxification measures (intravenous infusion of saline solutions, dextran, albumin, plasma) in combination with forced diuresis, agents that help improve microcirculation (pentoxifylline). If necessary, cardiovascular, bronchodilator, and antipyretic drugs are prescribed.

Forecast

Currently, in modern hospitals, when antibacterial agents are used, the mortality rate from plague is quite low - no more than 5-10%. Early medical care and prevention of generalization contribute to recovery without significant consequences. In rare cases, transient plague sepsis (fulminant form of plague) develops, which is difficult to diagnose and treat, often resulting in rapid death.

Prevention

Currently, in developed countries, infection is practically absent, therefore, the main preventive measures are aimed at eliminating the import of the pathogen from epidemiologically dangerous regions and sanitizing natural foci. Specific prevention consists of vaccination with a live plague vaccine, administered to the population in areas with an unfavorable epidemiological situation (prevalence of plague among rodents, cases of infection of domestic animals) and to persons traveling to regions with an increased risk of infection.

Identification of a plague patient is an indication for taking urgent measures to isolate him. In case of forced contact with sick people, personal preventative means are used - anti-plague suits. Contact persons are observed for 6 days; in case of contact with a patient with pneumonic plague, prophylactic antibiotic therapy is administered. Patients are discharged from the hospital no earlier than 4 weeks after clinical recovery and negative tests for bacterial excretion (for the pulmonary form - after 6 weeks).

Plague (pestis) is an acute zoonotic natural focal infectious disease with a predominantly transmissible pathogen transmission mechanism, which is characterized by intoxication, damage to the lymph nodes, skin and lungs. It is classified as a particularly dangerous, conventional disease.

Codes according to ICD -10

A20.0. Bubonic plague.
A20.1. Cellulocutaneous plague.
A20.2. Pneumonic plague.
A20.3. Plague meningitis.
A20.7. Septicemic plague.
A20.8. Other forms of plague (abortive, asymptomatic, minor).
A20.9. Unspecified plague.

Etiology (causes) of plague

The causative agent is a gram-negative small polymorphic non-motile bacillus Yersinia pestis of the Enterobacteriaceae family of the genus Yersinia. It has a mucous capsule and does not form spores. Facultative anaerobe. Dyed with bipolar aniline dyes (more intense at the edges). There are rat, marmot, gopher, field and sand lance varieties of the plague bacterium. Grows on simple nutrient media with the addition of hemolyzed blood or sodium sulfate, the optimal temperature for growth is 28 ° C. It occurs in the form of virulent (R-forms) and avirulent (S-forms) strains. Yersinia pestis has more than 20 antigens, including a thermolabile capsular antigen, which protects the pathogen from phagocytosis by polymorphonuclear leukocytes, a thermostable somatic antigen, which includes V- and W-antigens, which protect the microbe from lysis in the cytoplasm of mononuclear cells, ensuring intracellular reproduction, LPS etc. The pathogenicity factors of the pathogen are exo- and endotoxin, as well as aggression enzymes: coagulase, fibrinolysin and pesticins. The microbe is stable in the environment: it persists in soil for up to 7 months; in corpses buried in the ground, up to a year; in bubo pus - up to 20–40 days; on household items, in water - up to 30–90 days; tolerates freezing well. When heated (at 60 °C it dies in 30 s, at 100 °C - instantly), drying, exposure to direct sunlight and disinfectants (alcohol, chloramine, etc.), the pathogen is quickly destroyed. It is classified as pathogenicity group 1.

Epidemiology of the plague

The leading role in preserving the pathogen in nature is played by rodents, the main ones being marmots (tarbagans), ground squirrels, voles, gerbils, as well as lagomorphs (hares, pikas). The main reservoir and source in anthropurgic foci are gray and black rats, less often - house mice, camels, dogs and cats. A person suffering from pneumonic plague is especially dangerous. Among animals, the main distributor (carrier) of plague is the flea, which can transmit the pathogen 3–5 days after infection and remains infective for up to a year. Transmission mechanisms are varied:

  • transmissible - when bitten by an infected flea;
  • contact - through damaged skin and mucous membranes when skinning sick animals; slaughter and cutting of camel, hare carcasses, as well as rats, tarbagans, which are used as food in some countries; in contact with the secretions of a sick person or objects contaminated by him;
  • fecal-oral - when eating insufficiently heat-treated meat from infected animals;
  • aspiration - from a person suffering from pulmonary forms of plague.

Diseases in humans are preceded by epizootics among rodents. The seasonality of the disease depends on the climate zone and in countries with a temperate climate is recorded from May to September. Human susceptibility is absolute in all age groups and for any mechanism of infection. A patient with the bubonic form of plague before the opening of the bubo does not pose a danger to others, but when it passes into the septic or pneumonic form, he becomes highly infectious, releasing the pathogen with sputum, bubo secretions, urine, and feces. Immunity is unstable, repeated cases of the disease have been described.

Natural foci of infection exist on all continents, with the exception of Australia: in Asia, Afghanistan, Mongolia, China, Africa, South America, where about 2 thousand cases are registered annually. In Russia, there are about 12 natural focal zones: in the North Caucasus, Kabardino-Balkaria, Dagestan, Transbaikalia, Tuva, Altai, Kalmykia, Siberia and the Astrakhan region. Anti-plague specialists and epidemiologists are monitoring the epidemic situation in these regions. Over the past 30 years, cluster outbreaks have not been registered in the country, and the incidence rate has remained low - 12–15 episodes per year. Each case of human illness must be reported to the territorial center of Rospotrebnadzor in the form of an emergency notification, followed by the announcement of quarantine. International rules specify quarantine lasting 6 days, observation of persons in contact with the plague is 9 days.

Currently, the plague is included in the list of diseases, the causative agent of which can be used as a means of bacteriological weapons (bioterrorism). Laboratories have obtained highly virulent strains that are resistant to common antibiotics. In Russia there is a network of scientific and practical institutions to combat infection: anti-plague institutes in Saratov, Rostov, Stavropol, Irkutsk and anti-plague stations in the regions.

Plague prevention measures

Nonspecific

  • Epidemiological surveillance of natural plague foci.
  • Reducing the number of rodents, carrying out deratization and disinfestation.
  • Constant monitoring of the population at risk of infection.
  • Preparing medical institutions and medical personnel to work with plague patients, conducting awareness-raising work among the population.
  • Prevention of pathogen importation from other countries. The measures to be taken are set out in the International Health Regulations and the Sanitation Regulations.

Specific

Specific prevention consists of annual immunization with a live anti-plague vaccine of persons living in epizootic outbreaks or traveling there. People who come into contact with plague patients, their belongings, and animal corpses are given emergency chemoprophylaxis (Table 17-22).

Table 17-22. Schemes for the use of antibacterial drugs for emergency prevention of plague

Preparation Directions for use Single dose, g Frequency of application per day Course duration, days
Ciprofloxacin Inside 0,5 2 5
Ofloxacin Inside 0,2 2 5
Pefloxacin Inside 0,4 2 5
Doxycycline Inside 0,2 1 7
Rifampicin Inside 0,3 2 7
Rifampicin + ampicillin Inside 0,3 + 1,0 1 + 2 7
Rifampicin + ciprofloxacin Inside 0,3 + 0,25 1 5
Rifampicin + ofloxacin Inside 0,3 + 0,2 1 5
Rifampicin + pefloxacin Inside 0,3 + 0,4 1 5
Gentamicin V/m 0,08 3 5
Amikacin V/m 0,5 2 5
Streptomycin V/m 0,5 2 5
Ceftriaxone V/m 1 1 5
Cefotaxime V/m 1 2 7
Ceftazidime V/m 1 2 7

Pathogenesis of plague

The causative agent of plague enters the human body most often through the skin, less often through the mucous membranes of the respiratory tract and digestive tract. Changes in the skin at the site of pathogen penetration (primary focus - phlyctena) rarely develop. Lymphogenously from the site of introduction, the bacterium enters the regional lymph node, where it multiplies, which is accompanied by the development of serous-hemorrhagic inflammation, spreading to surrounding tissues, necrosis and suppuration with the formation of a plague bubo. When the lymphatic barrier breaks through, hematogenous dissemination of the pathogen occurs. Entry of the pathogen via the aerogenic route promotes the development of an inflammatory process in the lungs with melting of the walls of the alveoli and concomitant mediastinal lymphadenitis. Intoxication syndrome is characteristic of all forms of the disease, is caused by the complex action of pathogen toxins and is characterized by neurotoxicosis, ITS and thrombohemorrhagic syndrome.

Clinical picture (symptoms) of plague

The incubation period lasts from several hours to 9 days or more (on average 2–4 days), shortening in the primary pulmonary form and lengthening in vaccinated individuals.
or receiving prophylactic medications.

Classification

There are localized (cutaneous, bubonic, cutaneous bubonic) and generalized forms of plague: primary septicemic, primary pulmonary, secondary septic, secondary pulmonary and intestinal.

Main symptoms and dynamics of their development

Regardless of the form of the disease, plague usually begins suddenly, and the clinical picture from the first days of the disease is characterized by a pronounced intoxication syndrome: chills, high fever (≥39 ° C), severe weakness, headache, body aches, thirst, nausea, and sometimes vomiting. The skin is hot, dry, the face is red and puffy, the sclera is injected, the conjunctiva and mucous membranes of the oropharynx are hyperemic, often with pinpoint hemorrhages, the tongue is dry, thickened, covered with a thick white coating (“chalky”). Later, in severe cases, the face becomes haggard, with a cyanotic tint, and dark circles under the eyes. Facial features become sharper, an expression of suffering and horror appears (“plague mask”). As the disease progresses, consciousness is impaired, hallucinations, delusions, and agitation may develop. Speech becomes slurred; coordination of movements is impaired. The appearance and behavior of patients resemble a state of alcohol intoxication. Characterized by arterial hypotension, tachycardia, shortness of breath, cyanosis. In severe cases of the disease, bleeding and vomiting mixed with blood are possible. The liver and spleen are enlarged. Oliguria is noted. The temperature remains constantly high for 3–10 days. In the peripheral blood - neutrophilic leukocytosis with a shift to the left. In addition to the described general manifestations of plague, lesions characteristic of individual clinical forms of the disease develop.

Cutaneous form is rare (3–5%). At the site of the entrance gate of the infection, a spot appears, then a papule, a vesicle (phlyctena), filled with serous-hemorrhagic contents, surrounded by an infiltrated zone with hyperemia and edema. Phlyctena is characterized by severe pain. When it is opened, an ulcer forms with a dark scab at the bottom. A plague ulcer has a long course and heals slowly, forming a scar. If this form is complicated by septicemia, secondary pustules and ulcers occur. The development of a regional bubo (cutaneous bubonic form) is possible.

Bubonic form occurs most often (about 80%) and is distinguished by its relatively benign course. From the first days of the disease, sharp pain appears in the area of ​​the regional lymph nodes, which makes movement difficult and forces the patient to take a forced position. The primary bubo, as a rule, is single; multiple buboes are less often observed. In most cases, the inguinal and femoral lymph nodes are affected, and somewhat less frequently, the axillary and cervical lymph nodes. The size of the bubo varies from a walnut to a medium-sized apple. Vivid features are sharp pain, dense consistency, adhesion to the underlying tissues, smoothness of contours due to the development of periadenitis. The bubo begins to form on the second day of illness. As it develops, the skin over it turns red, shiny, and often has a cyanotic tint. At the beginning it is dense, then it softens, fluctuation appears, and the contours become unclear. On the 10th–12th day of illness it opens - a fistula and ulceration form. With a benign course of the disease and modern antibiotic therapy, its resorption or sclerosis is observed. As a result of hematogenous introduction of the pathogen, secondary buboes can form, which appear later and are small in size, less painful and, as a rule, do not suppurate. A serious complication of this form can be the development of a secondary pulmonary or secondary septic form, which sharply worsens the patient’s condition, even leading to death.

Primary pulmonary form It occurs rarely, during periods of epidemics in 5–10% of cases and represents the most dangerous epidemiologically and severe clinical form of the disease. It begins sharply, violently. Against the background of a pronounced intoxication syndrome, a dry cough, severe shortness of breath, and cutting pain in the chest appear from the first days. The cough then becomes productive, with the production of sputum, the amount of which can vary from a few spits to huge quantities, it is rarely absent at all. The sputum, at first foamy, glassy, ​​transparent, then takes on a bloody appearance, later becomes purely bloody, and contains a huge amount of plague bacteria. It usually has a liquid consistency - one of the diagnostic signs. Physical data are scanty: a slight shortening of the percussion sound over the affected lobe; on auscultation, there are not a lot of fine wheezes, which clearly does not correspond to the general serious condition of the patient. The terminal period is characterized by an increase in shortness of breath, cyanosis, development of stupor, pulmonary edema and ITS. Blood pressure drops, the pulse quickens and becomes thread-like, heart sounds are muffled, hyperthermia is replaced by hypothermia. Without treatment, the disease ends in death within 2–6 days. With early use of antibiotics, the course of the disease is benign and differs little from pneumonia of other etiologies, as a result of which late recognition of the pneumonic form of plague and cases of the disease in the patient’s environment are possible.

Primary septic form It happens rarely - when a massive dose of the pathogen enters the body, usually by airborne droplets. It begins suddenly, with pronounced symptoms of intoxication and the subsequent rapid development of clinical symptoms: multiple hemorrhages on the skin and mucous membranes, bleeding from internal organs (“black plague”, “black death”), mental disorders. Signs of cardiovascular failure progress. The patient's death occurs within a few hours from ITS. There are no changes at the site of introduction of the pathogen and in the regional lymph nodes.

Secondary septic form complicates other clinical forms of infection, usually bubonic. Generalization of the process significantly worsens the general condition of the patient and increases his epidemiological danger to others. The symptoms are similar to the clinical picture described above, but differ in the presence of secondary buboes and a longer duration. With this form of the disease, secondary plague meningitis often develops.

Secondary pulmonary form as a complication occurs in localized forms of plague in 5–10% of cases and sharply worsens the overall picture of the disease. Objectively, this is expressed by an increase in symptoms of intoxication, the appearance of chest pain, coughing, followed by the release of bloody sputum. Physical data make it possible to diagnose lobular, less often pseudolobar pneumonia. The course of the disease during treatment can be benign, with a slow recovery. The addition of pneumonia to low-infectious forms of plague makes patients the most dangerous epidemiologically, so each such patient must be identified and isolated.

Some authors distinguish the intestinal form separately, but most clinicians tend to consider intestinal symptoms (severe abdominal pain, profuse mucous-bloody stool, bloody vomiting) as manifestations of the primary or secondary septic form.

With repeated cases of the disease, as well as with plague in people who have been vaccinated or received chemoprophylaxis, all symptoms begin and develop gradually and are more easily tolerated. In practice, such conditions are called “minor” or “outpatient” plague.

Complications of the plague

There are specific complications: ITS, cardiopulmonary failure, meningitis, thrombohemorrhagic syndrome, which lead to the death of patients, and nonspecific complications caused by endogenous flora (phlegmon, erysipelas, pharyngitis, etc.), which are often observed against the background of improvement of the condition.

Mortality and causes of death

In the primary pulmonary and primary septic form without treatment, mortality reaches 100%, most often by the 5th day of illness. In the bubonic form of plague, the mortality rate without treatment is 20–40%, which is due to the development of a secondary pulmonary or secondary septic form of the disease.

Diagnosis of plague

Clinical diagnosis

Clinical and epidemiological data allow one to suspect the plague: severe intoxication, the presence of an ulcer, bubo, severe pneumonia, hemorrhagic septicemia in persons located in the natural focal zone for the plague, living in places where epizootics (deaths) among rodents were observed or there is an indication of registered cases of illness. Every suspicious patient should be examined.

Specific and nonspecific laboratory diagnostics

The blood picture is characterized by significant leukocytosis, neutrophilia with a shift to the left and an increase in ESR. Protein is found in the urine. During an X-ray examination of the chest organs, in addition to enlarged mediastinal lymph nodes, one can see focal, lobular, less often pseudolobar pneumonia, and in severe cases - RDS. In the presence of meningeal signs (stiff neck muscles, positive Kernig's sign), a spinal puncture is necessary. In the CSF, three-digit neutrophilic pleocytosis, a moderate increase in protein content and a decrease in glucose levels are more often detected. For specific diagnostics, bubo punctate, ulcer discharge, carbuncle, sputum, nasopharyngeal smear, blood, urine, feces, CSF, and sectional material are examined. The rules for collecting material and its transportation are strictly regulated by the International Health Regulations. The material is collected using special dishes, containers, and disinfectants. The staff works in anti-plague suits. A preliminary conclusion is given on the basis of microscopy of smears stained with Gram, methylene blue, or treated with a specific luminescent serum. Detection of ovoid bipolar rods with intense staining at the poles (bipolar staining) suggests a diagnosis of plague within an hour. For final confirmation of the diagnosis, isolation and identification of the culture, the material is sown on agar in a Petri dish or in broth. After 12–14 hours, characteristic growth appears in the form of broken glass (“lace”) on agar or “stalactites” in the broth. The final identification of the culture is made on the 3rd–5th day.

The diagnosis can be confirmed by serological studies of paired sera in the RPGA, but this method has a secondary diagnostic value. Pathoanatomical changes in intraperitoneally infected mice and guinea pigs are studied after 3–7 days, with the inoculation of biological material. Similar methods of laboratory isolation and identification of the pathogen are used to identify plague epizootics in nature. For research, materials are taken from rodents and their corpses, as well as fleas.

Differential diagnosis

The list of nosologies with which differential diagnosis must be carried out depends on the clinical form of the disease. The cutaneous form of plague is differentiated from the cutaneous form of anthrax, bubonic - from the cutaneous form of tularemia, acute purulent lymphadenitis, sodoku, benign lymphoreticulosis, venereal granuloma; pulmonary form - from lobar pneumonia, pulmonary form of anthrax. The septic form of plague must be distinguished from meningococcemia and other hemorrhagic septicemia. Diagnosis of the first cases of the disease is especially difficult. Epidemiological data are of great importance: stay in foci of infection, contact with rodents with pneumonia. It should be borne in mind that early use of antibiotics modifies the course of the disease. Even the pneumonic form of plague in these cases can be benign, but the patients still remain infectious. Considering these features, in the presence of epidemic data, in all cases of diseases occurring with high fever, intoxication, lesions of the skin, lymph nodes and lungs, plague should be excluded. In such situations, it is necessary to conduct laboratory tests and involve anti-plague service specialists. The criteria for differential diagnosis are presented in the table (Tables 17-23).

Table 17-23. Differential diagnosis of plague

Nosological form General symptoms Differential criteria
Anthrax, cutaneous form Fever, intoxication, carbuncle, lymphadenitis Unlike the plague, fever and intoxication appear on the 2nd–3rd day of illness, the carbuncle and surrounding area of ​​edema are painless, there is eccentric growth of the ulcer
Tularemia, bubonic form Fever, intoxication, bubo, hepatolienal syndrome Unlike the plague, fever and intoxication are moderate, the bubo is slightly painful, mobile, with clear contours; suppuration is possible in the 3rd–4th week and later, after the temperature has normalized and the patient’s condition is satisfactory, there may be secondary buboes
Purulent lymphadenitis Polyadenitis with local soreness, fever, intoxication and suppuration Unlike the plague, there is always a local purulent focus (felon, festering abrasion, wound, thrombophlebitis). The appearance of local symptoms is preceded by fever, usually moderate. Intoxication is mild. There is no periadenitis. The skin over the lymph node is bright red, its enlargement is moderate. There is no hepatolienal syndrome
Lobar pneumonia Acute onset, fever, intoxication, possible sputum mixed with blood. Physical signs of pneumonia Unlike the plague, intoxication increases by the 3rd–5th day of illness. The symptoms of encephalopathy are not typical. Physical signs of pneumonia are clearly expressed, sputum is scanty, “rusty”, viscous

Indications for consultation with other specialists

Consultations are usually carried out to clarify the diagnosis. If the bubonic form is suspected, a consultation with a surgeon is indicated; if the pulmonary form is suspected, a consultation with a pulmonologist is indicated.

An example of a diagnosis formulation

A20.0. Plague, bubonic form. Complication: meningitis. Heavy current.
All patients with suspected plague are subject to emergency hospitalization on special transport to an infectious diseases hospital, in a separate box, in compliance with all anti-epidemic measures. Personnel caring for plague patients must wear a protective anti-plague suit. Household items in the ward and the patient's excretions are subject to disinfection.

Treatment of plague

Mode. Diet

Bed rest during the febrile period. There is no special diet provided. It is advisable to have a gentle diet (table A).

Drug therapy

Etiotropic therapy should be started if plague is suspected, without waiting for bacteriological confirmation of the diagnosis. It includes the use of antibacterial drugs. When studying natural strains of plague bacteria in Russia, no resistance to common antimicrobial drugs was found. Etiotropic treatment is carried out according to approved schemes (Tables 17-24–17-26).

Table 17-24. Scheme for the use of antibacterial drugs in the treatment of bubonic plague

Preparation Directions for use Single dose, g Frequency of application per day Course duration, days
Doxycycline Inside 0,2 2 10
Ciprofloxacin Inside 0,5 2 7–10
Pefloxacin Inside 0,4 2 7–10
Ofloxacin Inside 0,4 2 7–10
Gentamicin V/m 0,16 3 7
Amikacin V/m 0,5 2 7
Streptomycin V/m 0,5 2 7
Tobramycin V/m 0,1 2 7
Ceftriaxone V/m 2 1 7
Cefotaxime V/m 2 3–4 7–10
Ceftazidime V/m 2 2 7–10
Ampicillin/sulbactam V/m 2/1 3 7–10
Aztreons V/m 2 3 7–10

Table 17-25. Scheme for the use of antibacterial drugs in the treatment of pneumonic and septic forms of plague

Preparation Directions for use Single dose, g Frequency of application per day Course duration, days
Ciprofloxacin* Inside 0,75 2 10–14
Pefloxacin* Inside 0,8 2 10–14
Ofloxacin* Inside 0,4 2 10–14
Doxycycline* Inside 0.2 at the 1st appointment, then 0.1 each 2 10–14
Gentamicin V/m 0,16 3 10
Amikacin V/m 0,5 3 10
Streptomycin V/m 0,5 3 10
Ciprofloxacin IV 0,2 2 7
Ceftriaxone V/m, i.v. 2 2 7–10
Cefotaxime V/m, i.v. 3 3 10
Ceftazidime V/m, i.v. 2 3 10
Chloramphenicol (chloramphenicol sodium succinate**) V/m, i.v. 25–35 mg/kg 3 7


** Used to treat plague affecting the central nervous system.

Table 17-26. Schemes for the use of combinations of antibacterial drugs in the treatment of pneumonic and septic forms of plague

Preparation Directions for use Single dose, g Frequency of application per day Course duration, days
Ceftriaxone + streptomycin (or amikacin) V/m, i.v. 1+0,5 2 10
Ceftriaxone + gentamicin V/m, i.v. 1+0,08 2 10
Ceftriaxone + rifampicin IV, inside 1+0,3 2 10
Ciprofloxacin* + rifampicin Inside, inside 0,5+0,3 2 10
Ciprofloxacin + streptomycin (or amikacin) Inside, intravenously, intramuscularly 0,5+0,5 2 10
Ciprofloxacin + gentamicin Inside, intravenously, intramuscularly 0,5+0,08 2 10
Ciprofloxacin* + ceftriaxone IV, IV, IM 0,1–0,2+1 2 10
Rifampicin + gentamicin Inside, intravenously, intramuscularly 0,3+0,08 2 10
Rifampicin + streptomycin (or amikacin) Inside, intravenously, intramuscularly 0,3+0,5 2 10

* There are injection forms of the drug for parenteral administration.

In severe cases, it is recommended to use compatible combinations of antibacterial agents in the doses indicated in the regimens during the first four days of illness. In the following days, treatment is continued with one drug. For the first 2–3 days, the medications are administered parenterally, and subsequently switch to oral administration.

Along with specific treatment, pathogenetic treatment is carried out aimed at combating acidosis, cardiovascular failure and DN, microcirculation disorders, cerebral edema, and hemorrhagic syndrome.

Detoxification therapy consists of intravenous infusions of colloidal (reopolyglucin, plasma) and crystalloid solutions (glucose 5–10%, polyionic solutions) up to 40–50 ml/kg per day. The previously used anti-plague serum and specific gamma globulin turned out to be ineffective during the observation process, and at present they are not used in practice, nor is the plague bacteriophage used. Patients are discharged after complete recovery (for the bubonic form no earlier than the 4th week, for the pulmonary form - no earlier than the 6th week from the day of clinical recovery) and a three-fold negative result obtained after culture of bubo punctate, sputum or blood, which is carried out on 2- th, 4th, 6th days after cessation of treatment. After discharge, medical observation is carried out for 3 months.

The Black Death is a disease that is currently the subject of legends. This is actually the name given to the plague that struck Europe, Asia, North Africa and even Greenland in the 14th century. The pathology proceeded mainly in the bubonic form. The territorial focus of the disease has become where this place is, many people know. The Gobi belongs to Eurasia. The Black Sea arose precisely there due to the Little Ice Age, which served as an impetus for sudden and dangerous climate change.

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

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

The Myth of the Bubonic Plague

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

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

But the so-called “plague in Tatarstan” turned out to be nothing more than a speculation of people who do not know how to explain the sudden and deadly outbreak of the “Black Death”.

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

This “general” theory existed for quite a long time and contained many mysteries. In fact, the plague epidemic, as it turned out later, began for several reasons.

Natural causes of the pandemic

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

  • global drought in China followed by widespread famine;
  • in Henan province massive;
  • Rain and hurricanes prevailed in Beijing for a long time.

Like the Plague of Justinian, as the first pandemic in history was called, the Black Death overtook people after massive natural disasters. She even followed the same path as her predecessor.

The decrease in people's immunity, provoked by environmental factors, has led to mass morbidity. The disaster reached such proportions that church leaders had to open rooms for the sick population.

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

Socio-economic causes of bubonic plague

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

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

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

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

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

How it all started

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

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

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

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

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

Low temperatures, a long stay outside the host's body, and thawing cannot destroy the causative agent of the Black Death. But sun exposure and drying are effective against it.

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

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

The symptoms of plague in a medieval person are surprisingly different from those of a modern patient.

Clinical picture of the bubonic plague of the Middle Ages

“Black Death” is a disease that in the Middle Ages was identified by the following signs:

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

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

Treatment of bubonic plague in the Middle Ages

Medieval medicine was far from ideal. The doctor who came to examine the patient paid more attention to talking about whether he had confessed than to directly treating him. This was due to the religious madness of the population. Saving the soul was considered a much more important task than healing the body. Accordingly, surgical intervention was practically not practiced.

Treatment methods for plague were as follows:

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

However, medieval medicine was not hopeless. Some doctors of that time advised patients to stick to a good diet and wait for the body to cope with the plague on its own. This is the most adequate theory of treatment. Of course, under the conditions of that time, cases of recovery were isolated, but they still took place.

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

Government authorities advised people to adhere to the following methods of combating the epidemic:

  • Long distance escape. At the same time, it was necessary to cover as many kilometers as possible very quickly. It was necessary to remain at a safe distance from the disease for as long as possible.
  • Drive herds of horses through contaminated areas. It was believed that the breath of these animals purifies the air. For the same purpose, it was advised to allow various insects into houses. A saucer of milk was placed in a room where a person had recently died of the plague, as it was believed to absorb the disease. Methods such as breeding spiders in the house and burning large numbers of fires near the living space were also popular.
  • Do whatever is necessary to kill the smell of the plague. It was believed that if a person does not feel the stench emanating from infected people, he is sufficiently protected. That is why many carried bouquets of flowers with them.

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

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

Religion during the bubonic plague epidemic

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

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

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

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

Superstitions during the bubonic plague epidemic

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

  • If a completely naked woman plows the ground around the house, and the rest of the family members are indoors at this time, the plague will leave the surrounding areas.
  • If you make an effigy symbolizing the plague and burn it, the disease will recede.
  • To prevent the disease from attacking, you need to carry silver or mercury with you.

Many legends developed around the image of the plague. People really believed in them. They were afraid to open the door of their house again, so as not to let the plague spirit inside. Even relatives fought among themselves, everyone tried to save themselves and only themselves.

The situation in society

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

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

The pandemic reached such proportions that the corpses were taken out at night, dumped in special pits and buried.

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

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

Consequences of the Black Death

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

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

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

Opinions on the second pandemic

There are doubts that the "Black Death" is synonymous with the period of prosperity of the bubonic plague. There are explanations for this:

  • Plague patients rarely experienced symptoms such as fever and sore throat. However, modern scholars note that there are many errors in the narratives of that time. Moreover, some works are fictional and contradict not only other stories, but also themselves.
  • The third pandemic was able to kill only 3% of the population, while the Black Death wiped out at least a third of Europe. But there is an explanation for this too. During the second pandemic, there was terrible unsanitary conditions that caused more problems than illness.
  • The buboes that arise when a person is affected are located under the armpits and in the neck area. It would be logical if they appeared on the legs, since that is where it is easiest for a flea to get into. However, this fact is not flawless. It turns out that, along with the plague, the human louse is also a spreader. And there were many such insects in the Middle Ages.
  • An epidemic is usually preceded by the mass death of rats. This phenomenon was not observed in the Middle Ages. This fact can also be disputed given the presence of human lice.
  • The flea, which is the carrier of the disease, feels best in a warm and humid climate. The pandemic flourished even in the coldest winters.
  • The speed of the epidemic's spread was record-breaking.

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

A ten-year-old boy with bubonic plague was taken to the hospital in the Kosh-Agach district of the Altai Republic, reports lenta.ru.

The child was admitted to the infectious diseases department of the district hospital on July 12 with a temperature of about 40 degrees. He is currently in moderate condition. “Specialists found out that he had contact with 17 people, six of whom were children. All of them are placed in isolation and are under observation. So far, they have shown no signs of infection,” the hospital noted.

Health workers suggested that the boy could have contracted the plague while camping in the mountains. It is noted that in the region the disease was recorded in marmots.

Bubonic plague is an infectious disease that has claimed more human lives throughout history than all other diseases combined. Despite all the advances in medicine, it is impossible to completely get rid of the plague, since the causative agent of the disease - the bacterium Yersinia pestis - lives in natural reservoirs, where it infects its main carriers - marmots, gophers and other rodents. These reservoirs exist all over the world and destroying them all is unrealistic.

OpenClipart-Vectors, 2013

Therefore, about three thousand cases of bubonic plague are registered annually in the world, and outbreaks occur even in highly developed countries. Thus, in October 2015, it was reported that a teenage girl from Oregon in the USA was infected with bubonic plague.

However, in countries with underdeveloped healthcare systems, plague outbreaks occur much more often and lead to greater casualties. Thus, in 2014, an outbreak of bubonic plague was registered in Madagascar, which killed 40 people.

In August 2013, doctors confirmed a case of bubonic plague in Kyrgyzstan: 15-year-old Temirbek Isakunov contracted the dangerous disease after eating marmot kebab with his friends.


The marmot is a carrier of plague. PublicDomainPictures, 2010

She commented on this incident on her blog:

The media begins to noisily discuss the possible consequences of the cases of bubonic plague that have appeared in Kyrgyzstan, or more precisely, in how many days will it begin in our country from the Kyrgyz who came to us and cough on us. In this regard, let me remind you that:

1. The danger of the appearance of plague on the territory of Russia is constant, since the plague is a zoonosis, that is, a disease the main reservoir of which is animals. These are gophers and a number of other species living in deserts, semi-deserts, steppes, etc. There are more than a thousand permanent plague foci on the territory of Russia, and there are also a lot of foci in the republics of the former USSR and other neighbors of Russia.

2. The main methods for controlling plague are as follows:

A) Limiting the number of natural hosts (poisoning gophers),

B) Vaccination of those who have to work in these outbreaks,

B) Border control of those entering (people and animals)

3. Human diseases of the plague are inevitable for countries with outbreaks. In Russia, the plague causes about one death per year; in the USA, as far as I remember, about 10 die per year.

4. Plague is a particularly dangerous disease due to its high mortality rate. If it is detected, emergency anti-epidemic measures are taken. The plague has a very bad reputation, since in medieval Europe one third of the population died from its epidemics. However, among infectious diseases it now accounts for only a small proportion of deaths. Malaria accounts for the largest number of deaths (more than a million per year).

5. Methods of combating the plague epidemic are very simple. They identify the sick person, drag him into quarantine and treat him, at the same time they grab and drag into quarantine everyone with whom he has been in contact for the last few days. If one of those people gets sick, they seize and isolate those with whom he was in contact. So, in the conditions of a state that is organized enough to carry out such a thing, outbreaks are nipped in the bud.

6. An interesting feature of the plague is that there is one pathogen, but two diseases: pneumonic plague and bubonic plague. The form of development of the disease depends on where the pathogen enters: into the blood or into the lungs.

7. If the pathogen enters the lungs, pneumonic plague develops. It progresses as a rapidly developing acute respiratory infection, followed by hemoptysis and death. From the moment of infection to the first pronounced symptoms - about a day, until death - about 3. Mortality - 100%. It can be successfully treated with some modern antibiotics, but only if treatment is not started too late. Therefore, in the case of pneumonic plague, the outcome depends on the timeliness of hospitalization and the start of treatment, and literally minutes count.


The causative agent of plague is Yersinia pestis. Larry Stauffer, 2002

8. If the pathogen enters the bloodstream, bubonic plague develops - a severe blood fever with a mortality rate (in the absence of antibiotic treatment) of about 50%. The duration of the disease from infection to recovery or death is about a couple of weeks. It got its name from the characteristic giant enlargement of the axillary lymph nodes to formations similar in size and shape to a bunch of grapes.

9. The two indicated forms of plague with the same pathogen are associated with a transmission option. With pneumonic plague, the patient sneezes and coughs, droplets of saliva containing the pathogen scatter and infect others, getting into the lungs. In bubonic plague, the carrier is blood-sucking insects: fleas, lice, etc. People are often infected through bloodsuckers from mice and rats suffering from the plague. By the way, plague epidemics in medieval Europe were also associated with the fact that there were a lot of brown rats. In recent years, they have been replaced by another species, white and larger, which is less susceptible to plague.

In principle, it is possible for the plague to transition during epidemics from the bubonic to the pneumonic form and back, but due to these features, epidemics usually occur either only as bubonic, or only as pneumonic.

There is a third, more exotic form of plague - intestinal, when the pathogen enters the stomach, but for this you have to go to India, to the sacred waters of the Ganges...

10. If a plague patient is identified (including a deceased person), due to the above, fun begins, accompanied by panic: platoons of police with machine guns that surround the building with identified contacts, and serious people in anti-plague suits with flamethrowers, scared to death of them (joke).. Over the past 50 years, there have been several (about three) cases of detection of plague being brought into Moscow and several false panics.

11. There is no need to be more scared than usual by people who cough and sneeze. Spraying nearby eastern people with insect repellents from spray cans is the same.

It could be worse

In addition to the plague, outbreaks of an even more dangerous disease - anthrax - are regularly recorded in the vastness of our homeland. The source of this infection is domestic animals: cattle, sheep, goats, pigs. Infection can occur when caring for sick animals, slaughtering livestock, processing meat, as well as through contact with animal products (hides, skins, fur products, wool, bristles) contaminated with spores of the anthrax microbe.

Infection can also occur through soil in which spores of the anthrax pathogen persist for many years. Spores enter the skin through microtraumas; When contaminated foods are consumed, an intestinal form occurs. The high lethality of the pulmonary and intestinal forms, as well as the ability of the pathogen spores to remain viable for many years, are the reason for the use of the anthrax bacillus as a biological weapon.


William Rafti, 2003

The largest epidemic of this disease occurred in 1979 in Sverdlovsk. Since then, small outbreaks of this disease have occurred regularly. Thus, in August 2012, an outbreak of anthrax with fatal cases was recorded in the Altai Territory - in the village of Marushka and the village of Druzhba.

In August 2010, an anthrax outbreak was recorded in the Tyukalinsky district of the Omsk region. The epidemic began with the death of horses on a private farm, which the owners did not report. The dead animals were not even properly buried. As a result, at least six people fell ill, at least one of whom, 49-year-old Alexander Lopatin, died.

In addition, rumors of smallpox cases regularly arise, although the World Health Organization has officially declared the disease eradicated. However, rumors, as a rule, are not confirmed, and one of the last outbreaks of smallpox was recorded in Moscow in the fifties of the last century. He talks about her:

I got vaccinated today at clinic 13 (it was moved from Neglinnaya to Trubnaya St., 19с1, by the way, a long time ago). While they were waiting for the sister, the doctor, an elderly but cheerful, clear-eyed aunt, told a story about the smallpox epidemic in Moscow in the 50s.

I found it on Wiki and am posting it here:

In the winter of 1959 we found ourselves in a bad situation. Moscow artist Kokorekin visited India. He happened to be present at the burning of a deceased Brahmin. Having gained impressions and gifts for his mistress and wife, he returned to Moscow a day earlier than his wife was waiting for him. He spent this day with his mistress, to whom he gave gifts and in whose arms he spent the night, not without pleasure. Having timed the plane's arrival from Delhi, he arrived home the next day. After giving the gifts to his wife, he felt bad, his temperature rose, his wife called an ambulance and he was taken to the infectious diseases department of the Botkin Hospital.

A girl infected with smallpox (Bangladesh). James Hicks, 1975

The senior surgeon on duty, Alexey Akimovich Vasiliev, in whose team I was on duty that day, was called for a consultation in the infectious diseases department with Kokorekin, regarding the imposition of a tracheostomy on him due to breathing problems. Vasilyev, having examined the patient, decided that there was no need to apply a tracheostomy and went to the emergency room. By morning the patient became ill and died.

The pathologist who performed the autopsy invited the head of the department, Academician Nikolai Aleksandrovich Kraevsky, into the dissecting room. An old pathologist from Leningrad came to visit Nikolai Alexandrovich and was invited to the dissecting table. The old man looked at the corpse and said, “Yes, my friend, variola vera is black smallpox.” The old man was right.

They reported to Shabanov. The machine of Soviet health care began to spin. They imposed a quarantine on the infectious diseases department, and the KGB began tracing Kokorekin’s contacts. The story of his early arrival in Moscow and a night of bliss with his mistress came to light. As it turned out, the wife and mistress behaved in the same way - both ran to thrift stores to hand over gifts. There were several cases of smallpox in Moscow, which ended in death. The hospital was quarantined, and it was decided to vaccinate the entire population of Moscow with smallpox vaccine.

There was no vaccine in Moscow, but there was one in the Far East. The weather was bad and no planes were flying. Finally the vaccine arrived and vaccinations began. I suffered it very hard, I did not have immunity against smallpox, although I was vaccinated in 1952, when an epidemic of smallpox began in Tajikistan, brought from Afghanistan in the traditional way - carpets were thrown across the border on which patients with smallpox lay.

Update: I found the details here. It turns out that the ill-fated Kokorekin was present not only at the burning of the Brahmin, who definitely died of smallpox, but also the Brahmin’s hut. And I thought - how did he manage to get infected, how? After all, before burning the body is wrapped in several layers of cloth, and the high temperature of the fire should have killed all the vibrios. But vibrio is “resistant to environmental influences, especially to drying and low temperatures. It can persist for a long time, for a number of months, in crusts and scales taken from pockmarks on the skin of patients” (wiki). In that hut there were millions of flakes of skin and dust with vibrios - that’s how I became infected.

And it was after this incident and thanks to the USSR that they adopted a program to eradicate smallpox throughout the world. In the wild forests of India, tribes were shown photographs of people suffering from smallpox. So they got rid of it!

acute infectious disease caused by bacteria Yersinia pestis and manifests itself in two main forms - bubonic and pulmonary. In nature, plague is common among rodents, from which it is transmitted to humans through the bite of infected fleas. The predominant form of plague in humans, bubonic plague, is characterized by inflammation of the lymph nodes (most often the groin); In appearance, the enlarged lymph nodes resemble beans, which is where the name of the disease comes from: “Jumma” - Arabic. "bean".

Historical aspect.

In the history of mankind, devastating plague epidemics have left in people’s memory the idea of ​​this disease as a terrible disaster, surpassing in damage caused the destructive consequences of malaria or typhus epidemics that “decimated” entire armies for past civilizations. One of the most amazing facts in the history of plague epidemics is their resumption over vast territories after long periods (centuries) of relative prosperity. The three worst plague pandemics are separated by periods of 800 and 500 years.

Some experts believe that the first historical references to the plague are contained in the fifth and sixth chapters of the First Book of Kings, which describe an epidemic in which the Philistines were stricken with "growths." These same authors admit that the “growths” mean plague buboes, and the “five golden growths and five golden mice” demanded from the Philistines indicate that already in ancient times they probably guessed about the connection between the plague and rodents. It is generally accepted that the philosopher and physician Sushruta, who lived in India in the 5th century. AD, also knew about the connection between plague epidemics and rodents.

Rufus of Ephesus (1st century AD) described a large epidemic of an infectious disease, accompanied by the development of buboes and high mortality, in the territory of modern Egypt, Libya and Syria. The first huge pandemic recorded in the chronicles occurred during the reign of Justinian, in 542. The second major pandemic, known as the Black Death, swept across the world in the 14th century, with a maximum incidence of 1347–1350. It killed about a quarter of Europe's population and led to changes in the spiritual, social and economic spheres of society. The Great Plague epidemic in England in 1665 was limited mainly to London. A severe outbreak of plague occurred in Marseilles in 1720. Following these epidemics, local outbreaks were noted in a number of port cities around the world; the plague, however, did not spread deep into the continents. The third major pandemic began in the 19th century. in China and reached Hong Kong in 1894. On ships, along with infected rats, the plague quickly spread from this large port to India, the Near and Middle East, Brazil, California and other regions of the world. Over a 20-year period, about 10 million people died from the pandemic.

Epidemiology.

The main carriers of plague pathogens are rodents, mainly rats, ground squirrels, coyotes, ground squirrels, jerboas - about 300 species in total. Plague is always transmitted to humans from a natural reservoir - from infected animals. In cities, plague bacteria persist among rats and mice; It is rats that serve as the main source of human infection. In rural areas, the main carriers of infection are field or forest rodents that live in the area. In some regions of Siberia, Manchuria, South Africa, South America and the United States, the incidence of plague is endemic: cases of infection are limited to certain areas where animals are distributed. In the United States, diseases were noted mainly in the southwestern part of the country: California, Nevada, Colorado, Arizona and New Mexico.

Cases of the plague are believed to occur in almost every country, with relatively high incidence rates reported in India, Burma, Vietnam, Brazil, Peru, Tanzania, Madagascar and the Philippines. Susceptibility to plague does not vary by race, age, or gender. Bubonic plague is more common in areas with average temperatures below 27°C; at 29°C epidemics begin to wane. The pneumonic form of plague is observed mainly in the cool seasons of the year and occurs mainly in countries with a temperate, humid climate. However, in 1994, an outbreak of pneumonic plague occurred in Surat (India), located in the tropical part of the country.

The incubation period lasts 2–10 days. Bubonic plague is characterized by a sudden onset in the form of severe chills, rapid fever, severe headache, dizziness, thirst, and vomiting. Inflammation develops in the regional lymph nodes closest to the site of the flea bite; they increase in size, forming buboes, and become very painful. Most often the lymph nodes of the groin area are affected, but sometimes also the axillary, cervical and other lymph nodes. As a consequence of severe intoxication, patients quickly develop a state of complete prostration (stupefaction and lethargy), confusion and coma. Some patients, on the contrary, experience agitation, delusions, hallucinations, and a desire to escape. Plague is a short-lived disease: death or a turning point in the disease occurs within a few days. In the septic form of plague, the clinical picture of infectious-toxic shock develops so quickly that patients die from cardiovascular failure and hemorrhagic syndrome even before the development of buboes. Bubonic plague can be complicated by pneumonia, which at one time almost always led to death. In major epidemics of bubonic plague, the mortality rate reached 90%.

The pneumonic form of plague is characterized by the fact that within the first 24 hours after a sudden onset, severe chills and a rapid rise in temperature cause chest pain and bloody, frothy sputum. The course of this form of the disease is very rapid: before the era of antibiotics, patients died within 2–4 days. Currently, if the disease can be recognized early and antibiotics started within the first 24 hours, recovery occurs in many cases.

Treatment and prevention.

With the introduction of antibiotics, the prognosis of the disease has become more favorable, although absolutely reliable treatments do not exist. It is very important to start treatment as early as possible. Streptomycin is most effective against all forms of plague and has fewer side effects compared to other antibiotics. Those who travel to “plague areas” are recommended to take daily prophylactic tetracycline during the period of possible infection.

Plague is included in the group of especially dangerous infections. Therefore, measures to prevent its spread are of paramount importance. In endemic areas, rat extermination must be carried out. Suspected cases of plague should be reported immediately to local health authorities. Patients with pneumonic plague should be immediately isolated from others, since this form of infection is the most contagious. It is recommended that all those in contact with the patient be subjected to quarantine examination.