Plague

Description:

Plague (Latin – pestis, English -  plaque, a synonym – black death) is the acute anthropozoonotic disease of the infectious nature affecting lymph nodes, easy and other bodies.
Other such disease affecting with scale of distribution and similar level of a lethality is not known to mankind. Plague proceeds in the form of epidemics from time to time reaching pandemics. In the history data about 3 pandemics of plague remained.
The first pandemic is known under the name "yustianovy" of plague. It was registered in 527-565 in the territory of the Roman Empire. The following disease outbreak which reached pandemic level raged in the Crimea, Western Europe and the Mediterranean in 1345-1350. Having claimed the lives about 60 million inhabitants of these territories, the pandemic under the name "black death" remained in the history as the most devastating. The third pandemic is registered in India and Hong Kong in 1895, having claimed according to the estimates of 12 million lives. During the third epidemic the causative agent of plague, a way of transmission of infection was allocated and studied and the main anti-epidemic actions are developed.
For the last 25-30 years epidemics in 13 countries of Africa, South America, Asia were observed. The lethality made 8,9%. In Africa incidence drops generally to 3 countries – Tanzania, Zaire, Madagascar.
Since 1979 activation of the natural centers of plague in the territory of China, and since 1989 – and Mangoliya is noted. In India till 1994 only sporadic cases were observed, but the outbreak of pulmonary plague was registered, the lethality made 6,2%.

Plague reasons:

The activator – Pasteurella (Iersinia) pestis – a plague microbe which belongs to a sort of enterobakteriya.
Allocate natural, primary ("wild plague") and synanthropic, secondary ("city plague") the plague centers. A tank in natural sources – wild rodents (gophers, sandworts, hamsters), in Africa – some species of rats. In the synanthropic centers a tank and a source of an infection – gray, black and red rats. A carrier of a plague bacterium – a rat flea. The person sick with a pulmonary form of plague, is also a source to an infection. The person catches through a sting of rat fleas, during the cutting of meat, removal of skins, at contact with the products and other objects inseminated by Iersinia pestis, an air way.

Pathogeny:

On site there is no implementation of a microorganism any skin changes. Process is developed in the next to the place of implementation a lymph node where sites of a necrosis and hemorrhage are formed that is result of effect of plague toxin. The periadenitis develops. Suppuration and opening of buboes is possible.
A little the pathogeny at a pulmonary form of plague differs. Secondary pulmonary plague arises when entering with a blood flow in lungs of plague bacteria from skin or a bubo. Develops hemorrhagic - necrotic infectious process, so-called secondary plague pneumonia.
It is not excluded perhaps development of pulmonary plague as primary process, in that case iyersiniya get to pulmonary fabric by the drop mechanism of infection.

Plague symptoms:

The incubation interval at plague process lasts from 3 to 6 days. The disease begins sharply, with intoxication phenomena, Patients are uneasy, feel a headache, the hyperemia of the person and a conjunctiva takes place, multiple petechias are noted. The cardiovascular system is surprised, it is frequent – a spleen.
The skin form meets only in 3-4% of cases of plague. There are necrotic ulcers, furuncles, a hemorrhagic anthrax which are noted by the expressed morbidity and an infiltrirovanny bottom.
At bubonic plague so-called buboes which represent the inflamed lymph node, painful at a palpation form. Further the soldered conglomerate with the periadenitis phenomena is formed. Skin over it red, intense. For 3-12 day the bubo can be opened with formation of dense pus. More often femoral and inguinal lymph nodes are surprised.
At a primary and septic form of plague formation of the multiple centers of an infection is observed. Heavy general intoxication and a hemorrhagic syndrome is characteristic.
At primary pulmonary plague the incubation interval lasts from  several hours to 3 days. In the first period of a disease the feverish excitement proceeding 8-12 hours is observed. The heat of a disease is observed during the second period lasting up to 2 days. Cough amplifies, the phlegm becomes liquid, foamy, rusty, then with blood.
In the third period consciousness therefore it is called the soporous period of plague is broken. It proceeds 2-3 days and terminates in a coma.

Diagnosis:

For confirmation of the diagnosis the bakissledovaniye of punctates and separated an anthrax, ulcers of skin, a phlegm and blood is carried out.
Serological tests are carried out: the reaction of binding complement (RBC), RNGA and a biological method – infection of white mice and Guinea pigs with material from patients.

Treatment of Plague:

Scheme of treatment of a bubonic form of plague: streptomycin 3-4 гр intramusculary before decrease in body temperature and 5 days after its normalization; tetracycline 4-6 гр a day 2 days; Kanamycinum 1,5 гр a day 10 days intramusculary.

At a pulmonary and septic form apply Kanamycinum intramusculary to 2 гр in days within 10 days; streptomycin intramusculary 4-6 гр in days before decrease in temperature and 1 week after its normalization; tetracyclines – Oxytetracyclinum, Morphocyclinum of 25 000 PIECES 2 р / day.
Specific therapy consists in administration of antiplague gamma-globulin of 6-10 doses 2 times a day before decrease in the phenomena of intoxication.
Apply dezitoksikatsionny solutions, cardiotonic means, corticosteroids to stopping of infectious and toxic shock, carry out breath function maintenance.

The extract of patients is made after a 3-hkratny negative take of bacteriological and biological researches on plague. Material for analyses gets in 2-4-6 days after the end of antibiotic treatment.

Prevention:

For the emergency prevention of plague prescription of antibiotics is reasonable.
Scheme of an antibiotikoprofilaktika:
Ciprofloxacin in a dose 0,25 twice orally for 7 days;
Ofloxacin in a dose 0,2 twice orally for 7 days;
Doxycycline in a dose 0,1 twice orally for 7 days;
Gentamycin in a dose 0,08 twice intramusculary for 5 days;
Rifampicin in a basin 0,3 twice orally for 7 days;
Minocycline in a dose 0,2 in the first reception, and then on 0,1 twice orally for 7 days;
Tseftriakson in a dose 0,1 once a day intramusculary for 5 days.

There are also alternative schemes of the emergency antibiotikoprofilaktika.

At contact with patients (suspicious for infection)  plague recommended processing by dezsredstvo of open parts of a body, alcohol or 1% chloroamine solution is for this purpose used.  
The mouth and throat will caress spirit solution, in a nose it is necessary to dig in 1% protargol solution. In eyes and in a nose it is possible to dig in streptomycin of 25 mg/l, gentamycin of 4 mg/l, sisomicin of 5 mg/l.