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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 struck 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 followers of the church 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 began

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 insanity 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 area 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 went to great lengths: 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 warm and humid climates. 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.

plague doctor in the middle ages

For hundreds of years now, people have associated the plague with a special disease that claims the lives of millions of people. Everyone knows the destructive ability of the causative agent of this disease and its lightning-fast spread. Everyone knows about this disease; it is so ingrained in the human mind that everything negative in life is associated with this word.

What is plague and where does the infection come from? Why does it still exist in nature? What is the causative agent of the disease and how is it transmitted? What forms of the disease and symptoms exist? What does the diagnosis consist of and how is treatment carried out? Thanks to what kind of prevention is it possible to save billions of human lives in our time?

What is plague

Experts say that plague epidemics were mentioned not only in historical reference books, but also in the Bible. Cases of the disease were regularly reported on all continents. But what is of greater interest is not epidemics, but pandemics or outbreaks of infection, widespread throughout almost the entire territory of the country and covering neighboring ones. In the entire history of human existence, there have been three of them.

1. The first outbreak of plague or pandemic occurred in the 6th century in Europe and the Middle East. During its existence, the infection has claimed the lives of more than 100 million people.
2. The second case of the disease spreading over a large area was in Europe, where it arrived from Asia in 1348. At this time, more than 50 million people died, and the pandemic itself is known in history as the “plague - the Black Death.” It did not bypass the territory of Russia either.
3. The third pandemic raged at the end of the 19th century in the East, mainly in India. The outbreak began in 1894 in Canton and Hong Kong. A large number of deaths were recorded. Despite all the precautions taken by local authorities, the number of deaths exceeded 87 million.

But it was during the third pandemic that it was possible to thoroughly examine the dead people and identify not only the source of infection, but also the carrier of the disease. French scientist Alexandre Yersin found that humans become infected from sick rodents. Several decades later, an effective vaccine against the plague was created, although this did not help humanity completely get rid of the disease.

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

Where does the plague occur now?

Foci of infection in our time are not marked in red on a regular tourist map. Therefore, before traveling to other countries, it is better to consult an infectious disease specialist where the plague is still found.

According to experts, this disease has not yet been completely eradicated. In which countries can you get the plague?

1. Isolated cases of the disease are found in the USA and Peru.
2. The plague has practically not been recorded in Europe for the last few years, but the disease has not spared Asia. Before visiting China, Mongolia, Vietnam and even Kazakhstan, it is better to get vaccinated.
3. On the territory of Russia, it is also better to play it safe, because several cases of plague are registered here every year (in Altai, Tyva, Dagestan) and it borders on countries that are dangerous in terms of infection.
4. Africa is considered a dangerous continent from an epidemiological point of view; most modern severe infections can be contracted here. The plague is no exception; isolated cases of the disease have been reported here over the past few years.
5. The infection also occurs on some islands. For example, just two years ago, the plague struck several dozen people in Madagascar.

There have been no plague pandemics over the last hundred years, but the infection has not been completely eradicated.

It has long been no secret that the military is trying to use many especially dangerous infections, which include the plague, as biological weapons. During World War II in Japan, scientists developed a special type of pathogen. Its ability to infect people is tens of times greater than that of natural pathogens. And no one knows how the war could have ended if Japan had used these weapons.

Although plague pandemics have not been recorded for the last hundred years, it was not possible to completely eliminate the bacteria that cause the disease. There are natural sources of plague and anthropurgic, that is, natural and artificially created in the process of life.

Why is the infection considered particularly dangerous? Plague is a disease with a high fatality rate. Before the vaccine was created, and this happened in 1926, the mortality rate from various types of plague was at least 95%, that is, only a few survived. Now the mortality rate does not exceed 10%.

Plague agent

The causative agent of the infection is yersinia pestis (plague bacillus), a bacterium of the genus Yersinia, which is part of the large family of enterobacteria. In order to survive in natural conditions, this bacterium had to adapt for a long time, which led to the peculiarities of its development and life activity.

1. Grows on simple available nutrient media.
2. It comes in different shapes - from thread-like to spherical.
3. The plague bacillus in its structure contains more than 30 types of antigens, which help it survive in the body of the carrier and humans.
4. It is resistant to environmental factors, but dies instantly when boiled.
5. The plague bacterium has several pathogenicity factors - these are exotoxins and endotoxins. They lead to damage to organ systems in the human body.
6. You can fight bacteria in the external environment using conventional disinfectants. Antibiotics also have a detrimental effect on them.

Paths of transmission of plague

This disease affects not only humans; there are many other sources of infection in nature. The greatest danger is posed by sluggish variants of plague, when the affected animal can overwinter and then infect others.

Plague is a disease with natural focality, affecting, in addition to humans, other creatures, for example, domestic animals - camels and cats. They become infected from other animals. To date, more than 300 types of bacteria carriers have been identified.

Under natural conditions, the natural carriers of the plague pathogen are:

• gophers;
• marmots;
• gerbils;
• voles and rats;
• Guinea pigs.

In urban environments, special species of rats and mice are the reservoir of bacteria:

• pasyuk;
• gray and black rat;
• Alexandrovskaya and Egyptian species of rats.

The carrier of plague in all cases is fleas. Infection of a person occurs through the bite of this arthropod, when an infected flea, not finding a suitable animal, bites a person. Just one flea can infect about 10 people or animals during its life cycle. Human susceptibility to the disease is high.

How is the plague transmitted?

1. Transmissible or through the bites of an infected animal, mainly by fleas. This is the most common way.
2. Contact, which is infected during the cutting of carcasses of sick domestic animals, as a rule, these are camels.
3. Despite the fact that primacy is given to the transmissible route of transmission of plague bacteria, the nutritional route also plays an important role. A person becomes infected by eating food contaminated with the infectious agent.
4. The methods of penetration of bacteria into the human body during plague include the aerogenic route. When a sick person coughs or sneezes, they can easily infect everyone around them, so they need to be kept in a separate box.

Pathogenesis of plague and its classification

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

Having penetrated the body, the pathogen penetrates through the bloodstream into the nearest lymph nodes, where it remains and multiplies safely. It is here that the first local inflammation of the lymph nodes occurs with the formation of a bubo, due to the fact that blood cells cannot fully destroy bacteria. Damage to the lymph nodes leads to a decrease in the body's protective functions, which contributes to the spread of the pathogen to all systems.

Later, Yersinia affects the lungs. In addition to infection of lymph nodes and internal organs by plague bacteria, blood poisoning or sepsis occurs. This leads to numerous complications and changes in the heart, lungs, and kidneys.

What types of plague are there? Doctors distinguish two main types of disease:

• pulmonary;
• bubonic.

They are considered the most common variants of the disease, although conditionally, because bacteria do not infect any specific organ, but gradually the entire human body is involved in the inflammatory process. According to severity, the disease is divided into mild subclinical, moderate and severe.

Plague symptoms

Plague is an acute natural focal infection caused by Yersinia. It is characterized by clinical signs such as severe fever, lymph node damage and sepsis.

Any form of the disease begins with general symptoms. The incubation period of the plague lasts at least 6 days. The disease is characterized by an acute onset.

The first signs of plague in humans are as follows:

• chills and almost lightning-fast increase in body temperature to 39–40 ºC;
• severe symptoms of intoxication - headaches and muscle pain, weakness;
• dizziness;
• damage to the nervous system of varying severity - from stupor and lethargy to delirium and hallucinations;
• The patient's coordination of movements is impaired.

The typical appearance of a sick person is characteristic - a reddened face and conjunctiva, dry lips and a tongue that is enlarged and covered with a thick white coating.

Due to the enlargement of the tongue, the speech of a plague patient becomes unintelligible. If the infection is severe, the person’s face is puffy with a blue or cyanotic tint, and there is an expression of suffering and horror on the face.

Symptoms of bubonic plague

The name of the disease itself comes from the Arabic word “jumba”, which means bean or bubo. That is, it can be assumed that the first clinical sign of the “Black Death”, which our distant ancestors described, was an increase in lymph nodes that resembled the appearance of beans.

How does bubonic plague differ from other variants of the disease?

1. The typical clinical symptom of this type of plague is bubo. What is he? - This is a pronounced and painful enlargement of the lymph nodes. As a rule, these are single formations, but in very rare cases their number increases to two or more. The plague bubo is most often localized in the axillary, groin and cervical region.
2. Even before the appearance of the bubo, the sick person develops pain so severe that he has to take a forced position of the body to alleviate the condition.
3. Another clinical symptom of bubonic plague is that the smaller the size of these formations, the more pain they cause when touched.

How are buboes formed? This is a long process. It all starts with pain at the site of the formation. Then the lymph nodes enlarge here, they become painful to the touch and fused with fiber, and a bubo gradually forms. The skin over it is tense, painful and becomes intensely red. Within approximately 20 days, the bubo resolves or reverses its development.

There are three options for the further disappearance of the bubo:

• long-term complete resorption;
• opening;
• sclerosis.

In modern conditions, with the right approach to treating the disease, and most importantly, with timely initiation of therapy, the number of deaths from bubonic plague does not exceed 7–10%.

Symptoms of pneumonic plague

The second most common type of plague is its pneumonic form. This is the most severe variant of the development of the disease. There are 3 main periods of development of pneumonic plague:

• elementary;
• peak period;
• soporous or terminal.

In recent times, it was this type of plague that claimed the lives of millions of people, because the mortality rate from it is 99%.

The symptoms of pneumonic plague are as follows.

More than 100 years ago, the pneumonic form of plague ended in death in almost 100% of cases! Now the situation has changed, which is undoubtedly due to the correct treatment tactics.

How other forms of plague occur

In addition to the two classic variants of the course of the plague, there are other forms of the disease. As a rule, this is a complication of the underlying infection, but sometimes they occur independently as primary ones.

1. Primary septic form. The symptoms of this type of plague are slightly different from the two options described above. The infection develops and progresses rapidly. The incubation period is shortened and lasts no more than two days. High temperature, weakness, delirium and agitation are not all signs of a disorder. Inflammation of the brain and infectious-toxic shock develop, followed by coma and death. In general, the illness lasts no more than three days. The prognosis for this type of disease is unfavorable, and recovery is almost non-existent.
2. A mild or mild course of the disease is observed with the cutaneous variant of the plague. The pathogen enters the human body through damaged skin. At the site of introduction of the plague pathogen, changes are observed - the formation of necrotic ulcers or the formation of a boil or carbuncle (this is inflammation of the skin and surrounding tissue around the hair with areas of necrosis and discharge of pus). Ulcers take a long time to heal and a scar gradually forms. The same changes can appear as secondary changes in bubonic or pneumonic plague.

Diagnosis of plague

The first stage in determining the presence of infection is epidemic. But it is easy to make a diagnosis when several cases of the disease have arisen with the presence of typical clinical symptoms in patients. If the plague has not been encountered in a given area for a long time, and the number of cases is counted in single units, diagnosis is difficult.

When an infection begins to develop, one of the first steps in determining the disease is the bacteriological method. If plague is suspected, work with biological material to detect the pathogen is carried out under special conditions, because the infection spreads easily and quickly in the environment.

Almost any biological material is taken for research:

• sputum;
• blood;
• buboes are punctured;
• examine the contents of ulcerative skin lesions;
• urine;
• vomit.

Almost everything that the patient secretes can be used for research. Since the plague disease in humans is severe and the person is very susceptible to infection, the material is taken in special clothing and cultured on nutrient media in equipped laboratories. Animals infected with bacterial cultures die within 3–5 days. In addition, when using the fluorescent antibody method, the bacteria glow.

Additionally, serological methods for studying plague are used: ELISA, RNTGA.

Treatment

Any patient with suspected plague must be immediately hospitalized. Even if mild forms of infection develop, the person is completely isolated from others.

In the distant past, the only method of treating plague was cauterization and treatment of the buboes, and their removal. In an attempt to get rid of the infection, people used only symptomatic methods, but without success. After identifying the pathogen and creating antibacterial drugs, not only the number of patients decreased, but also complications.

How is this disease treated?

1. The basis of treatment is antibacterial therapy using tetracycline antibiotics in the appropriate dose. At the very beginning of treatment, maximum daily doses of drugs are used, with a gradual reduction to minimum doses if the temperature normalizes. Before starting treatment, the sensitivity of the pathogen to antibiotics is determined.
2. An important step in the treatment of plague in humans is detoxification. Patients are injected with saline solutions.
3. Symptomatic treatment is used: diuretics are used in case of fluid retention, hormonal substances are used.
4. They use therapeutic anti-plague serum.
5. Along with the main treatment, supportive therapy is used - heart medications, vitamins.
6. In addition to antibacterial drugs, local anti-plague medications are prescribed. Plague buboes are treated with antibiotics.
7. In the case of the development of a septic form of the disease, plasmapheresis is used daily - this is a complex procedure for purifying the blood of a sick person.

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

Prevention of plague

The invention of antibacterial drugs would not solve the problem of the emergence and spread of pandemics. This is just an effective way to cope with an already existing disease and prevent its most dangerous complication - death.

So how did they defeat the plague? - after all, isolated cases per year without declared pandemics and a minimal number of deaths after an infection can be considered a victory. A big role belongs to proper disease prevention. And it began when the second pandemic emerged, back in Europe.

In Venice, after the second wave of the spread of the plague back in the 14th century, while only a quarter of the population remained in the city, the first quarantine measures were introduced for arrivals. Ships with cargo were kept in port for 40 days and the crew were monitored to prevent the spread of infection so that it did not penetrate from other countries. And it worked, there were no more new cases of infection, although the second plague pandemic had already claimed most of the population of Europe.

How is infection prevented today?

1. Even if isolated cases of plague occur in any country, all those arriving from there are isolated and observed for six days. If a person has some signs of the disease, then prophylactic doses of antibacterial drugs are prescribed.
2. Plague prevention includes complete isolation of patients with suspected infection. People are not only placed in separate closed boxes, but in most cases they try to isolate the part of the hospital where the patient is located.
3. The State Sanitary and Epidemiological Service plays a major role in preventing the occurrence of infection. They annually monitor outbreaks of plague, take water samples in the area, and examine animals that may be a natural reservoir.
4. In areas where the disease develops, plague carriers are destroyed.
5. Measures to prevent plague in areas where the disease appears include sanitary and educational work with the population. They explain the rules of behavior for people in the event of another outbreak of infection and where to go first.

But even all of the above was not enough to defeat the disease if a vaccine against the plague had not been invented. Since its creation, the number of cases of the disease has sharply decreased, and there have been no pandemics for more than 100 years.

Vaccination

Today, to combat the plague, in addition to general preventive measures, more effective methods are used that have helped to forget about the “Black Death” for a long time.

In 1926, Russian biologist V.A. Khavkin invented the world's first vaccine against plague. Since its creation and the beginning of universal vaccination in hotbeds of infection, plague epidemics have become a thing of the past. Who is vaccinated and how? What are its pros and cons?

Nowadays, they use lyophilisate or live dry vaccine against plague; this is a suspension of live bacteria, but of the vaccine strain. The drug is diluted immediately before use. It is used against the causative agent of bubonic plague, as well as pneumonic and septic forms. This is a universal vaccine. The drug diluted in a solvent is administered in various ways, which depends on the degree of dilution:

• apply it subcutaneously using a needle or needle-free method;
• cutaneously;
• intradermally;
• They even use the plague vaccine by inhalation.

Prevention of the disease is carried out for adults and children starting from the age of two.

Indications and contraindications for vaccination

The plague vaccine is given once and protects for only 6 months. But not every person is vaccinated; certain groups of the population are subject to prevention.

Today, this vaccination is not included as mandatory in the national vaccination calendar; it is done only according to strict indications and only to certain citizens.

Vaccination is given to the following categories of citizens:

• to everyone who lives in epidemically dangerous areas, where the plague still occurs in our time;
• health workers whose professional activities are directly related to work in “hot spots”, that is, in places where the disease occurs;
• vaccine developers and laboratory workers exposed to bacterial strains;
• Preventive vaccination is given to people at high risk of infection who work in hotspots of infection - these are geologists, workers of anti-plague institutions, shepherds.

Prophylaxis with this drug should not be given to children under two years of age, to pregnant and lactating women if the person has already developed the first symptoms of plague, and to anyone who has had a reaction to a previous vaccine administration. There are practically no reactions or complications to this vaccine. The disadvantages of such prophylaxis include its short effect and the possible development of the disease after vaccination, which is extremely rare.

Can plague occur in vaccinated people? Yes, this also happens if an already sick person is vaccinated or the vaccination turns out to be of poor quality. This type of disease is characterized by a slow course with sluggish symptoms. The incubation period exceeds 10 days. The condition of the patients is satisfactory, so it is almost impossible to suspect the development of the disease. Diagnosis is facilitated by the appearance of a painful bubo, although there is no inflammation of the tissues or lymph nodes around. In case of delayed treatment or its complete absence, the further development of the disease fully corresponds to its usual classical course.

The plague is currently not a death sentence, but just another dangerous infection that can be dealt with. And although in the recent past all people and health workers were afraid of this disease, today the basis of its treatment is prevention, timely diagnosis and complete isolation of the patient.

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

Brief historical information

There is no other infectious disease in the history of mankind that would lead to such colossal devastation and mortality among the population as the plague. Since ancient times, information has been preserved about the plague, which occurred in people in the form of epidemics with a large number of deaths. It was noted that plague epidemics developed as a result of contact with sick animals. At times, the spread of the disease was pandemic-like. There are three known plague pandemics. The first, known as the Plague of Justinian, raged in Egypt and the Eastern Roman Empire from 527-565. The second, called the “great” or “black” death, in 1345-1350. covered Crimea, the Mediterranean and Western Europe; this most devastating pandemic has claimed about 60 million lives. The third pandemic began in 1895 in Hong Kong and then spread to India, where over 12 million people died. At its very beginning, important discoveries were made (the pathogen was isolated, the role of rats in the epidemiology of the plague was proven), which made it possible to organize prevention on a scientific basis. The causative agent of the plague was discovered by G.N. Minkh (1878) and independently of him A. Yersin and S. Kitazato (1894). Since the 14th century, the plague has repeatedly visited Russia in the form of epidemics. Working on outbreaks to prevent the spread of the disease and treat patients, Russian scientists D.K. made a great contribution to the study of the plague. Zabolotny, N.N. Klodnitsky, I.I. Mechnikov, N.F. Gamaleya and others. In the 20th century N.N. Zhukov-Verezhnikov, E.I. Korobkova and G.P. Rudnev developed the principles of pathogenesis, diagnosis and treatment of plague patients, and also created an anti-plague vaccine.

The emergence of Plague disease

The causative agent is a gram-negative, non-motile, facultative anaerobic bacterium Y. pestis of the Yersinia genus of the Enterobacteriaceae family. In many morphological and biochemical characteristics, the plague bacillus is similar to the pathogens of pseudotuberculosis, yersiniosis, tularemia and pasteurellosis, which cause severe diseases in both rodents and humans. It is distinguished by pronounced polymorphism, the most typical are ovoid rods that stain bipolarly. There are several subspecies of the pathogen, differing in virulence. Grows on regular nutrient media with the addition of hemolyzed blood or sodium sulfite to stimulate growth. Contains more than 30 antigens, exo- and endotoxins. Capsules protect bacteria from absorption by polymorphonuclear leukocytes, and V- and W-antigens protect them from lysis in the cytoplasm of phagocytes, which ensures their intracellular reproduction. The causative agent of plague is well preserved in the excreta of patients and objects of the external environment (in the pus of a bubo it persists for 20-30 days, in the corpses of people, camels, rodents - up to 60 days), but is highly sensitive to sunlight, atmospheric oxygen, elevated temperature, environmental reactions (especially acidic), chemicals (including disinfectants). Under the influence of mercuric chloride at a dilution of 1:1000, it dies in 1-2 minutes. Tolerates low temperatures and freezing well.

Epidemiology

A sick person can, under certain conditions, become a source of infection: with the development of pneumonic plague, direct contact with the purulent contents of a plague bubo, as well as as a result of flea infection on a patient with plague septicemia. The corpses of people who died from the plague are often the direct cause of infection of others. Patients with pneumonic plague are especially dangerous.

Transmission mechanism diverse, most often transmissible, but airborne droplets are also possible (with pneumonic forms of plague, infection in laboratory conditions). The carriers of the pathogen are fleas (about 100 species) and some types of ticks, which support the epizootic process in nature and transmit the pathogen to synanthropic rodents, camels, cats and dogs, which can carry infected fleas to human habitation. A person becomes infected not so much through a flea bite as after rubbing its feces or masses regurgitated during feeding into the skin. Bacteria that multiply in the intestines of a flea secrete coagulase, which forms a “plug” (plague block) that prevents the flow of blood into its body. Attempts by a hungry insect to suck blood are accompanied by regurgitation of infected masses onto the surface of the skin at the site of the bite. These fleas are hungry and often try to suck the animal's blood. The contagiousness of fleas lasts on average about 7 weeks, and according to some data - up to 1 year.

Contact (through damaged skin and mucous membranes) when cutting carcasses and processing the skins of killed infected animals (hares, foxes, saigas, camels, etc.) and nutritional (by eating their meat) routes of plague infection are possible.

The natural susceptibility of people is very high, absolute in all age groups and through any route of infection. After an illness, relative immunity develops, which does not protect against re-infection. Repeated cases of the disease are not uncommon and are no less severe than the primary ones.

Main epidemiological features. Natural foci of plague occupy 6-7% of the globe's land mass and are registered on all continents, excluding Australia and Antarctica. Every year, several hundred cases of plague in humans are recorded worldwide. In the CIS countries, 43 natural plague foci have been identified with a total area of ​​more than 216 million hectares, located in lowland (steppe, semi-desert, desert) and high-mountain regions. There are two types of natural foci: foci of “wild” and foci of rat plague. In natural foci, plague manifests itself as an epizootic among rodents and lagomorphs. Infection from rodents that do not sleep in winter (marmots, gophers, etc.) occurs in the warm season, while from rodents and lagomorphs that do not sleep in winter (gerbils, voles, pikas, etc.), infection has two seasonal peaks, which is associated with breeding periods animals. Men get sick more often than women due to professional activities and stay in a natural plague focus (transhumance, hunting). In anthropurgic foci, the role of infection reservoir is performed by black and gray rats. The epidemiology of bubonic and pneumonic plague has significant differences in its most important features. Bubonic plague is characterized by a relatively slow increase in disease, while pneumonic plague, due to the easy transmission of bacteria, can become widespread in a short time. Patients with the bubonic form of plague are low-contagious and practically non-infectious, since their secretions do not contain pathogens, and there are few or no pathogens in the material from the opened buboes. When the disease passes into the septic form, as well as when the bubonic form is complicated by secondary pneumonia, when the pathogen can be transmitted by airborne droplets, severe epidemics of primary pneumonic plague develop with very high contagiousness. Typically, pneumonic plague follows bubonic plague, spreads along with it and quickly becomes the leading epidemiological and clinical form. Recently, the idea that the plague causative agent can remain in the soil for a long time in an uncultivated state has been intensively developed. Primary infection of rodents can occur when digging holes in infected areas of soil. This hypothesis is based both on experimental studies and observations on the futility of searching for the pathogen among rodents and their fleas during inter-epizootic periods.

Course of the disease Plague

Human adaptation mechanisms are practically not adapted to resist the introduction and development of the plague bacillus in the body. This is explained by the fact that the plague bacillus multiplies very quickly; bacteria produce large quantities of permeability factors (neuraminidase, fibrinolysin, pesticin), antiphagins that suppress phagocytosis (F1, HMWPs, V/W-Ar, PH6-Ag), which contributes to rapid and massive lymphogenous and hematogenous dissemination primarily into mononuclear organs phagocytic system with its subsequent activation. Massive antigenemia, the release of inflammatory mediators, including shockogenic cytokines, leads to the development of microcirculatory disorders, DIC syndrome, followed by infectious-toxic shock.

The clinical picture of the disease is largely determined by the site of introduction of the pathogen, penetrating through the skin, lungs or gastrointestinal tract.

The pathogenesis of plague includes three stages. First, the pathogen disseminates lymphogenously from the site of introduction to the lymph nodes, where it lingers for a short time. In this case, a plague bubo is formed with the development of inflammatory, hemorrhagic and necrotic changes in the lymph nodes. The bacteria then quickly enter the bloodstream. 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. And finally, after the pathogen overcomes the reticulohistiocytic barrier, it disseminates to various organs and systems with the development of sepsis.

Microcirculatory disorders cause changes in the heart muscle and blood vessels, as well as in the adrenal glands, which causes acute cardiovascular failure.

With the aerogenic route of infection, the alveoli are affected, and an inflammatory process with elements of necrosis develops in them. Subsequent bacteremia is accompanied by intense toxicosis and the development of septic-hemorrhagic manifestations in various organs and tissues.

The antibody response to plague is weak and forms in the late stages of the disease.

Symptoms of Plague disease

The incubation period is 3-6 days (in epidemics or septic forms it is reduced to 1-2 days); The maximum incubation period is 9 days.

Characterized by an acute onset of the disease, expressed by a rapid increase in body temperature to high numbers with stunning chills and the development of severe intoxication. Patients typically complain of pain in the sacrum, muscles and joints, and headaches. Vomiting (often bloody) and excruciating thirst occur. Already from the first hours of the disease, psychomotor agitation develops. Patients are restless, overly active, try to run (“runs like crazy”), they experience hallucinations and delusions. Speech becomes slurred and gait is unsteady. In more rare cases, lethargy, apathy are possible, and weakness reaches such a degree that the patient cannot get out of bed. Externally, hyperemia and puffiness of the face and scleral injection are noted. There is an expression of suffering or horror on the face (“plague mask”). In more severe cases, a hemorrhagic rash may appear on the skin. Very characteristic signs of the disease are thickening and coating of the tongue with a thick white coating (“chalky tongue”). From the cardiovascular system, pronounced tachycardia (up to embryocardia), arrhythmia and a progressive drop in blood pressure are noted. Even with local forms of the disease, tachypnea, as well as oliguria or anuria, develop.

This symptomatology manifests itself, especially in the initial period, in all forms of plague.

According to the clinical classification of plague proposed by G.P. Rudnev (1970), distinguish local forms of the disease (cutaneous, bubonic, cutaneous-bubonic), generalized forms (primary septic and secondary septic), externally disseminated forms (primary pulmonary, secondary pulmonary and intestinal).

Cutaneous form. The formation of a carbuncle at the site of introduction of the pathogen is characteristic. Initially, a sharply painful pustule with dark red contents appears on the skin; it is localized on the edematous subcutaneous tissue and is surrounded by a zone of infiltration and hyperemia. After opening the pustule, an ulcer with a yellowish bottom is formed, which tends to increase in size. Subsequently, the bottom of the ulcer is covered with a black scab, after which scarring is formed.

Bubonic form. The most common form of plague. Characterized by damage to lymph nodes regional to the site of introduction of the pathogen - inguinal, less often axillary and very rarely cervical. Usually the buboes are single, less often multiple. Against the background of severe intoxication, pain occurs in the area of ​​​​the future localization of the bubo. After 1-2 days, you can palpate sharply painful lymph nodes, first of a hard consistency, and then softening and becoming doughy. The nodes merge into a single conglomerate, inactive due to the presence of periadenitis, fluctuating upon palpation. The duration of the height of the disease is about a week, after which a period of convalescence begins. Lymph nodes can resolve on their own or become ulcerated and sclerotic due to serous-hemorrhagic inflammation and necrosis.

Cutaneous bubonic form. It is a combination of skin lesions and changes in the lymph nodes.

These local forms of the disease can develop into secondary plague sepsis and secondary pneumonia. Their clinical characteristics do not differ from primary septic and primary pulmonary forms of plague, respectively.

Primary septic form. It occurs after a short incubation period of 1-2 days and is characterized by lightning-fast development of intoxication, hemorrhagic manifestations (hemorrhages in the skin and mucous membranes, gastrointestinal and renal bleeding), and the rapid formation of a clinical picture of infectious-toxic shock. Without treatment, it is fatal in 100% of cases.

Primary pulmonary form. Develops during aerogenic infection. The incubation period is short, from several hours to 2 days. The disease begins acutely with manifestations of the intoxication syndrome characteristic of the plague. On the 2-3rd day of illness, a severe cough appears, sharp pain in the chest, and shortness of breath occur. The cough is accompanied by the release of first glassy and then liquid, foamy, bloody sputum. Physical data from the lungs are scant; X-rays show signs of focal or lobar pneumonia. Cardiovascular insufficiency increases, expressed in tachycardia and a progressive drop in blood pressure, and the development of cyanosis. In the terminal stage, patients first develop a stuporous state, accompanied by increased shortness of breath and hemorrhagic manifestations in the form of petechiae or extensive hemorrhages, and then coma.

Intestinal form. Against the background of intoxication syndrome, patients experience severe abdominal pain, repeated vomiting and diarrhea with tenesmus and copious mucous-bloody stools. Since intestinal manifestations can be observed in other forms of the disease, until recently the question of the existence of intestinal plague as an independent form, apparently associated with enteral infection, remains controversial.

Differential diagnosis

Cutaneous, bubonic and cutaneous bubonic forms of plague should be distinguished from tularemia, carbuncles, various lymphadenopathy, pulmonary and septic forms - from inflammatory lung diseases and sepsis, including meningococcal etiology.

With all forms of plague, already in the initial period, rapidly increasing signs of severe intoxication are alarming: high body temperature, tremendous chills, vomiting, excruciating thirst, psychomotor agitation, restlessness, delirium and hallucinations. When examining patients, attention is drawn to slurred speech, an unsteady gait, a puffy, hyperemic face with scleral injection, an expression of suffering or horror (“plague mask”), and a “chalky tongue.” Signs of cardiovascular failure, tachypnea rapidly increase, and oliguria progresses.

Cutaneous, bubonic and cutaneous bubonic forms of plague are characterized by severe pain at the site of the lesion, stages in the development of the carbuncle (pustule - ulcer - black scab - scar), pronounced phenomena of periadenitis during the formation of the plague bubo.

Pulmonary and septic forms are distinguished by the lightning-fast development of severe intoxication, pronounced manifestations of hemorrhagic syndrome, and infectious-toxic shock. If the lungs are affected, sharp pain in the chest and severe cough, separation of glassy and then liquid foamy bloody sputum are noted. The scanty physical data do not correspond to the general extremely serious condition.

Diagnosis of Plague disease

Laboratory diagnostics

Based on the use of microbiological, immunoserological, biological and genetic methods. The hemogram shows leukocytosis, neutrophilia with a shift to the left, and an increase in ESR. Isolation of the pathogen is carried out in specialized high-security laboratories for working with pathogens of particularly dangerous infections. Studies are carried out to confirm clinically significant cases of the disease, as well as to examine persons with elevated body temperature who are at the source of infection. Material from the sick and dead is subjected to bacteriological examination: punctates from buboes and carbuncles, discharge from ulcers, sputum and mucus from the oropharynx, blood. The passage is carried out on laboratory animals (guinea pigs, white mice), which die on the 5-7th day after infection.

Among the serological methods used are RNGA, RNAT, RNAG and RTPGA, ELISA.

Positive PCR results 5-6 hours after its administration indicate the presence of specific DNA of the plague microbe and confirm the preliminary diagnosis. The final confirmation of the plague etiology of the disease is the isolation of a pure culture of the pathogen and its identification.

Treatment of Plague disease

Plague patients are treated only in hospital settings. The choice of drugs for etiotropic therapy, their doses and regimens of use is determined by the form of the disease. The course of etiotropic therapy for all forms of the disease is 7-10 days. In this case the following is used:

For the skin form - cotrimoxazole 4 tablets per day;

For the bubonic form - chloramphenicol at a dose of 80 mg/kg/day and at the same time streptomycin at a dose of 50 mg/kg/day; drugs are administered intravenously; Tetracycline is also effective;

In pulmonary and septic forms of the disease, the combination of chloramphenicol with streptomycin is supplemented with the administration of doxycycline at a dose of 0.3 g/day or tetracycline at a dose of 4-6 g/day orally.

At the same time, massive detoxification therapy is carried out (fresh frozen plasma, albumin, rheopolyglucin, hemodez, intravenous crystalloid solutions, extracorporeal detoxification methods), drugs are prescribed to improve microcirculation and repair (trental in combination with solcoseryl, picamilon), forcing diuresis, as well as cardiac glycosides, vascular and respiratory analeptics, antipyretics and symptomatic agents.

The success of treatment depends on the timeliness of therapy. Etiotropic drugs are prescribed at the first suspicion of plague, based on clinical and epidemiological data.

Prevention of Plague disease

Epidemiological surveillance

The volume, nature and direction of preventive measures are determined by the forecast of the epizootic and epidemic situation regarding plague in specific natural foci, taking into account data on tracking the movement of morbidity in all countries of the world. All countries are required to report to WHO the emergence of plague diseases, the movement of morbidity, epizootics among rodents and measures to combat infection. The country has developed and operates a system for certification of natural plague foci, which made it possible to carry out epidemiological zoning of the territory.

Preventive actions

Indications for preventive immunization of the population are an epizootic of plague among rodents, identification of domestic animals suffering from plague, and the possibility of infection being brought in by a sick person. Depending on the epidemic situation, vaccination is carried out in a strictly defined territory to the entire population (universally) and selectively to particularly endangered contingents - persons who have permanent or temporary connections with the territories where the epizootic is observed (livestock breeders, agronomists, hunters, harvesters, geologists, archaeologists, etc.). d.). In case of detection of a plague patient, all medical and preventive institutions must have a certain supply of medicines and means of personal protection and prevention, as well as a scheme for notifying personnel and transmitting information vertically. Measures to prevent people from becoming infected with plague in enzootic areas, people working with pathogens of particularly dangerous infections, as well as preventing the spread of infection beyond the foci to other areas of the country are carried out by anti-plague and other health care institutions.

Activities in the epidemic outbreak

When a person sick with plague or suspected of this infection appears, urgent measures are taken to localize and eliminate the outbreak. The boundaries of the territory where certain restrictive measures (quarantine) are introduced are determined based on the specific epidemiological and epizootological situation, possible operating factors of infection transmission, sanitary and hygienic conditions, intensity of population migration and transport connections with other territories. The general management of all activities in the plague outbreak is carried out by the Emergency Anti-Epidemic Commission. At the same time, the anti-epidemic regime is strictly observed using anti-plague suits. Quarantine is introduced by decision of the Emergency Anti-Epidemic Commission, covering the entire territory of the outbreak.

Patients with plague and patients suspected of having this disease are hospitalized in specially organized hospitals. Transportation of a plague patient must be carried out in accordance with current sanitary rules for biological safety. Patients with bubonic plague are placed in groups of several people in a room, while patients with the pulmonary form are placed only in separate rooms. Patients with bubonic plague are discharged no earlier than 4 weeks, with pneumonic plague - no earlier than 6 weeks from the date of clinical recovery and negative results of bacteriological examination. After the patient is discharged from the hospital, he is placed under medical supervision for 3 months.

Current and final disinfection is carried out in the outbreak. Persons who came into contact with plague patients, corpses, contaminated things, who participated in the forced slaughter of a sick animal, etc., are subject to isolation and medical observation (6 days). For pneumonic plague, individual isolation (for 6 days) and prophylaxis with antibiotics (streptomycin, rifampicin, etc.) are carried out for all persons who may have become infected.

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, they began to introduce quarantine 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-, has no 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 lightning fast 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 DIC 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 outbreaks; 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.