Plague (Latin pestis - infection) is an acute natural focal infectious disease of the group of quarantine infections, occurring with an extremely severe general condition, fever, damage to the lymph nodes, lungs and other internal organs, often with the development of sepsis. The disease is characterized by high mortality and extremely high contagiousness.

The causative agent is the plague bacillus (lat. Yersinia pestis), discovered in 1894 simultaneously by two scientists: the Frenchman Alexandre Yersin and the Japanese Kitazato Shibasaburo.

The incubation period lasts from several hours to 3-6 days. The most common forms of plague are bubonic and pneumonic. The mortality rate for the bubonic form of plague reached 95%, and for the pneumonic form - 98-99%. Currently, with proper treatment, the mortality rate is 5-10%

The famous plague epidemics, which claimed millions of lives, left a deep mark on the history of mankind.

plague bacillus under fluorescence microscopy.

History The emergence of the plague

Some researchers have suggested that the plague occurred approximately 1500–2000 years ago as a result of a mutation of pseudotuberculosis (Yersinia pseudotuberculosus), shortly before the first known human plague pandemics . At the same time, the majority of the scientific community considers the plague causative agent to be a much more ancient microorganism [source not specified 478 days].

From the book by Daniel M. - Secret paths of the carriers of death. — M. Progress, 1990, p.101 ISBN 5-01-002041-6:

The plague arose on Earth before man appeared, and its origins must be sought in distant geological epochs, when the ancestors of modern rodents began to appear—about 50 million years ago in the Oligocene. At that time there already existed genera of fleas similar to those living today, as evidenced by the remains of fossil insects in amber.

The ancestral home of the plague is the endless steppes and deserts of Central Asia, where the disease developed and was maintained among local species of gerbils, marmots and ground squirrels. Another ancient center of plague was the Central African savannas and North African deserts and semi-deserts. And although some authors stubbornly defended the opinion that the plague was brought to the North American continent during its colonization by whites, recently more and more evidence has appeared that it penetrated into the Western Hemisphere in distant geological epochs through Siberia and Alaska and was an important regulator of populations steppe rodents in North America since the Pleistocene.

In these parts of the world - and especially in Asia - the first plague epidemics occurred among people. Initially, obviously, these were local epidemics and their size was limited by the fact that vast spaces were inhabited by a relatively small number of people, who also had practically no contact with each other. The real tragedies began when the population and the level of its material development rose to a higher level.

M. V. Supotnitsky in his monograph cites evidence of plague epidemics starting from 1200 BC. e.

Plague in Sumerian-Akkadian mythology

The most ancient literary evidence of plague epidemics belongs to the epic of Gilgamesh, the semi-legendary ruler of the city of Uruk, a folk hero whose exploits and adventures are described in an epic poem in the Assyro-Babylonian language. The twelfth tile (the epic is written in cuneiform on clay tiles) depicts Gilgamesh's despair after the death of his friend Enkidu. Devastated by the loss of his friend and grim news from the underworld, Gilgamesh was once again confronted with evidence of death in Uruk. The god of war and pestilence, Erra, visited the city, from whom there was no escape. The dead lay in houses, the dead lay in wide streets and squares, the dead floated in the waters of the Euphrates. In the face of all these horrors, Gilgamesh turned to the god Shamash... “Nothing can be done, Gilgamesh,” answered the god Shamash. “You are a hero and ruler!” But man's days are numbered. And the king will also lie down and never rise again.” And Gilgamesh, shocked by the monstrous consequences of the plague epidemic, went in search of the secret of immortality. After long wanderings, he met Utnapishtim, who survived the worldwide Babylonian-Assyrian flood (and the gods granted him eternal life), and described to him the horrors of the plague in the following words: “My Uruk people are dying, the dead lie in the squares, the dead are floating in the waters of the Euphrates!” Probably, these references to the plague do not concern just one epidemic, they generalize the experience of previous generations of people.

Plague in the Bible

The Bible is one of the oldest sources that have come down to us, which records the occurrence of a plague epidemic. The first book of Kings (chapter 5) describes the war between the Israelites and the Philistines. Israelis are plagued by military failures. Having lost the battle, the Israelites, in order to raise their spirits, bring to their camp the ark of the covenant of the Lord - a cabinet with sacred relics. But this does not help them either - the Philistines again win, capture the ark and, with great triumph, deliver it to the city of Azoth. There they place the ark at the feet of the statue of their god Dagon. And soon a terrible blow falls on the city of Azot and its entire surrounding area: a disease breaks out among the people, growths-ulcers appear in their groin area, and the Azotians die from this disease. Those who survived are firmly convinced that this disease is God's punishment, and they seek to get rid of the ark of the Lord and send it to another province of Philisteia - to the city of Gath. But the story of this terrible disease is completely repeated in Gath. This is how it is literally said in verse nine: “After they sent it (the ark), the hand of the Lord was upon the city—a very great terror, and the Lord struck the inhabitants of the city, from small to large, and growths appeared on them.” The Philistines did not calm down and for the third time transported the trophy of war, and with it the plague, to the city of Ascalon. All the Philistine rulers later gathered there - the kings of the five cities of Philistia - and they decided to return the ark to the Israelites, because they realized that this was the only way to prevent the spread of the disease. And chapter 5 ends with a description of the atmosphere that reigned in the doomed city. “And those who did not die were smitten with growths, so that the cry of the city went up to heaven.” Chapter 6 depicts the council of all the rulers of the Philistines, to which priests and soothsayers were called. They advised to bring a trespass offering to God - to put gifts in the ark before returning it to the Israelites. “According to the number of the rulers of the Philistines, there are five golden growths and five golden mice that devastate the land; for the punishment is the same for all of you and for your rulers.” This biblical tradition is interesting in many respects: it contains a hidden message about an epidemic that most likely swept through all five cities of Philistia. We could be talking about the bubonic plague, which affected people young and old and was accompanied by the appearance of painful growths in the groin - buboes. The most remarkable thing is that the Philistine priests apparently associated this disease with the presence of rodents: hence the golden sculptures of mice “ravaging the earth.”

There is another passage in the Bible that is considered to be a record of another instance of the plague. The Fourth Book of Kings (chapter 19, verses 35 and 36) tells of the campaign of the Assyrian king Sennacherib, who decided to devastate Jerusalem. A huge army surrounded the city, but did not capture it. And soon Sennacherib retreated without a fight with the remnants of the army, which was greatly weakened by the plague: 185,000 soldiers died overnight.

Plague epidemics in historical times

The most famous is the so-called “Justinian Plague” (551-580), which originated in the Eastern Roman Empire and swept the entire Middle East. More than 20 million people died from this epidemic. In the 10th century there was a large plague epidemic in Europe, in particular in Poland and Kievan Rus. In 1090, over 10,000 people died from the plague in Kyiv in two weeks. In the 12th century, plague epidemics occurred several times among the Crusaders. In the 13th century there were several plague outbreaks in Poland and Rus'.

In the 14th century, a terrible epidemic of the “Black Death”, brought from Eastern China, swept across Europe. In 1348, almost 15 million people died from it, which was a quarter of the entire population of Europe. By 1352, 25 million people, a third of the population, had died in Europe.

In 1346 the plague was brought to Crimea, and in 1351 to Poland and Rus'. Subsequently, outbreaks of plague were observed in Russia in 1603, 1654, 1738-1740 and 1769. An epidemic of bubonic plague swept through London in 1664–1665, killing more than 20% of the city's population. Isolated cases of infection with bubonic plague are still being recorded.

In the Middle Ages, the spread of the plague was facilitated by the unsanitary conditions that reigned in cities. There was no sewage system, and all the waste flowed right along the streets, which served as an ideal environment for rats to live. Alberti described Siena as “losing a lot... due to the lack of cesspools. That is why the whole city emits a stench not only during the first and last watch of the night, when vessels with accumulated sewage are poured out of the windows, but also at other times it is disgusting and very polluted.” In addition, in many places, cats were declared the cause of the plague, allegedly being servants of the devil and infecting people. The mass extermination of cats led to an even greater increase in the number of rats. The cause of infection is most often the bites of fleas that previously lived on infected rats.

Plague as a biological weapon

The use of the plague pathogen as a biological weapon has deep historical roots. In particular, events in ancient China and medieval Europe showed the use of the corpses of infected animals (horses and cows), human bodies by the Huns, Turks and Mongols to contaminate water sources and water supply systems. There are historical reports of cases of ejection of infected material during the siege of some cities.

During the Second World War, the Japanese armed forces developed samples of biological weapons intended for the mass release of specially prepared plague carriers - infected fleas. When developing samples of biological weapons, special detachment 731, headed by General Ishii Shiro, deliberately infected civilians and prisoners of China, Korea and Manchuria for further medical research and experiments, studying the prospects for using biological agents as weapons of mass destruction. (English) The group developed a strain of plague that was 60 times more virulent than the original strain of plague, a kind of absolutely effective weapon of mass destruction with natural spread. Various aerial bombs and projectiles have been developed to drop and disperse infected carriers, such as ground bombs, aerosol bombs, and fragmentation projectiles that damage human tissue. Ceramic bombs were popular, taking into account the peculiarities of the use of living organisms - fleas and the need to maintain their activity and viability under discharge conditions, for which special life support conditions were created (in particular, oxygen was pumped in).

Current state

Every year the number of people infected with the plague is about 2.5 thousand people, with no downward trend.

According to available data, according to the World Health Organization, from 1989 to 2004, about forty thousand cases were recorded in 24 countries, with a mortality rate of about seven percent of the number of cases. In a number of countries in Asia (Kazakhstan, China, Mongolia and Vietnam), Africa (Tanzania and Madagascar), and the Western Hemisphere (USA, Peru), cases of human infection are recorded almost every year.

At the same time, no cases of plague have been recorded on the territory of Russia since 1979, although every year in the territory of natural foci (with a total area of more than 253 thousand sq. km) over 20 thousand people are at risk of infection.

In Russia, from 2001 to 2006, 752 strains of the plague pathogen were recorded. At the moment, the most active natural foci are located in the territories of the Astrakhan region, the Kabardino-Balkarian and Karachay-Cherkess republics, the republics of Altai, Dagestan, Kalmykia, and Tuva. Of particular concern is the lack of systematic monitoring of the activity of outbreaks located in the Ingush and Chechen Republics.

For Russia, the situation is complicated by the annual identification of new cases in states neighboring Russia (Kazakhstan, Mongolia, China), and the importation of a specific carrier of the plague, the flea Xenopsylla cheopis, through transport and trade flows from the countries of Southeast Asia.

At the same time, in 2001-2003, 7 cases of plague were registered in the Republic of Kazakhstan (with one death), in Mongolia - 23 (3 deaths), in China in 2001-2002, 109 people fell ill (9 deaths). The forecast for the epizootic and epidemic situation in the natural foci of the Republic of Kazakhstan, China and Mongolia adjacent to the Russian Federation remains unfavorable.

In the summer of 2009, the city of Ziketan was quarantined in the Hainan Tibet Autonomous Region, as an outbreak of pneumonic plague was detected there, from which several people died.

Forecast

Under modern therapy, mortality in the bubonic form does not exceed 5-10%, but in other forms the recovery rate is quite high if treatment is started early. In some cases, a transient septic form of the disease is possible, which is poorly amenable to intravital diagnosis and treatment (“fulminant form of plague”).

The flea xenopsylla cheopis is the main carrier of plague, SEM image

Infection

The flea xenopsylla cheopis is the main carrier of plague, SEM image

The causative agent of plague is resistant to low temperatures, is well preserved in sputum, but at a temperature of 55 ° C it dies within 10-15 minutes, and when boiled - almost immediately. It enters the body through the skin (from a flea bite, usually Xenopsylla cheopis), mucous membranes of the respiratory tract, digestive tract, and conjunctiva.

Based on the main carrier, natural plague foci are divided into ground squirrels, marmots, gerbils, voles and pikas. In addition to wild rodents, the epizootic process sometimes includes so-called synanthropic rodents (in particular, rats and mice), as well as some wild animals (hares, foxes) that are the object of hunting. Among domestic animals, camels suffer from the plague.

In a natural outbreak, infection usually occurs through the bite of a flea that previously fed on a sick rodent; the likelihood of infection increases significantly when synanthropic rodents are included in the epizootic. Infection also occurs during hunting of rodents and their further processing. Massive diseases of people occur when a sick camel is slaughtered, skinned, butchered, or processed. An infected person, depending on the form of the disease, in turn, can transmit plague through airborne droplets or through the bite of certain types of fleas.

Fleas are a specific carrier of the plague pathogen. This is due to the peculiarities of the digestive system of fleas: just before the stomach, the flea’s esophagus forms a thickening - a goiter. When an infected animal (rat) is bitten, the plague bacterium settles in the flea's crop and begins to multiply intensively, completely clogging it. Blood cannot enter the stomach, so such a flea is constantly tormented by a feeling of hunger. She moves from host to host in the hope of getting her share of blood and manages to infect a fairly large number of people before dying (such fleas live no more than ten days).

When a person is bitten by fleas infected with plague bacteria, a papule or pustule filled with hemorrhagic contents (cutaneous form) may appear at the site of the bite. Then the process spreads through the lymphatic vessels without the manifestation of lymphangitis. The proliferation of bacteria in macrophages of the lymph nodes leads to their sharp increase, fusion and formation of a conglomerate (bubonic form). Further generalization of the infection, which is not strictly necessary, especially in the conditions of modern antibacterial therapy, can lead to the development of a septic form, accompanied by damage to almost all internal organs. However, from an epidemiological point of view, the most important role is played by the “screening out” of infection into the lung tissue with the development of the pulmonary form of the disease. From the moment plague pneumonia develops, the sick person himself becomes a source of infection, but at the same time, the pulmonary form of the disease is already transmitted from person to person - extremely dangerous, with a very rapid course.

Symptoms

The bubonic form of plague is characterized by the appearance of sharply painful conglomerates, most often in the inguinal lymph nodes on one side. The incubation period is 2-6 days (less often 1-12 days). Over the course of several days, the size of the conglomerate increases, and the skin over it may become hyperemic. At the same time, an increase in other groups of lymph nodes—secondary buboes—appears. The lymph nodes of the primary focus undergo softening; upon puncture, purulent or hemorrhagic contents are obtained, microscopic analysis of which reveals a large number of gram-negative rods with bipolar staining. In the absence of antibacterial therapy, festering lymph nodes are opened. Then gradual healing of the fistula occurs. The severity of the patients' condition gradually increases by the 4th-5th day, the temperature may be elevated, sometimes a high fever immediately appears, but at first the condition of the patients often remains generally satisfactory. This explains the fact that a person sick with bubonic plague can fly from one part of the world to another, considering himself healthy.

However, at any time, the bubonic form of plague can cause generalization of the process and turn into a secondary septic or secondary pulmonary form. In these cases, the condition of the patients very quickly becomes extremely serious. Symptoms of intoxication increase by the hour. The temperature after severe chills rises to high febrile levels. All signs of sepsis are noted: muscle pain, severe weakness, headache, dizziness, congestion of consciousness, up to its loss, sometimes agitation (the patient rushes about in bed), insomnia. With the development of pneumonia, cyanosis increases, a cough appears with the release of foamy, bloody sputum containing a huge amount of plague bacilli. It is this sputum that becomes the source of infection from person to person with the development of the now primary pneumonic plague.

Septic and pneumonic forms of plague occur, like any severe sepsis, with manifestations of disseminated intravascular coagulation syndrome: minor hemorrhages on the skin are possible, bleeding from the gastrointestinal tract is possible (vomiting of bloody masses, melena), severe tachycardia, rapid and requiring correction ( dopamine) drop in blood pressure. Auscultation reveals a picture of bilateral focal pneumonia.

Clinical picture

The clinical picture of the primary septic or primary pulmonary form is not fundamentally different from the secondary forms, but the primary forms often have a shorter incubation period - up to several hours.

Diagnosis

The most important role in diagnosis in modern conditions is played by epidemiological anamnesis. Arrival from zones endemic for plague (Vietnam, Burma, Bolivia, Ecuador, Turkmenistan, Karakalpakstan, etc.), or from anti-plague stations of a patient with the above-described signs of the bubonic form or with signs of the most severe - with hemorrhages and bloody sputum - pneumonia with severe lymphadenopathy is a sufficiently serious argument for the doctor of first contact to take all measures to localize the suspected plague and accurately diagnose it. It should be especially emphasized that in the conditions of modern drug prevention, the likelihood of illness among personnel who have been in contact with a coughing plague patient for some time is very small. Currently, there are no cases of primary pneumonic plague (that is, cases of infection from person to person) among medical personnel. An accurate diagnosis must be made using bacteriological studies. The material for them is the punctate of a suppurating lymph node, sputum, the patient’s blood, discharge from fistulas and ulcers.

Laboratory diagnosis is carried out using a fluorescent specific antiserum, which is used to stain smears of discharge from ulcers, punctate lymph nodes, and cultures obtained on blood agar.

Treatment (briefly)

In the Middle Ages, the plague was practically not treated; actions were reduced mainly to cutting out or cauterizing the plague buboes. No one knew the real cause of the disease, so there was no idea how to treat it. Doctors tried to use the most bizarre means. One such drug included a mixture of 10-year-old molasses, finely chopped snakes, wine and 60 other ingredients. According to another method, the patient had to take turns sleeping on his left side, then on his right. Since the 13th century, attempts have been made to limit the plague epidemic through quarantines.

Vladimir Khavkin was the first to create a vaccine against plague at the beginning of the 20th century.

Treatment of plague patients is currently reduced to the use of antibiotics, sulfonamides and medicinal anti-plague serum. Prevention of possible outbreaks of the disease consists of carrying out special quarantine measures in port cities, deratization of all ships that sail on international flights, creating special anti-plague institutions in steppe areas where rodents are found, identifying plague epizootics among rodents and combating them. Outbreaks of the disease still occur in some countries in Asia, Africa and South America.

Treatment (details)

If plague is suspected, the sanitary-epidemiological station of the area is immediately notified. The notification is filled out by the doctor who suspects an infection, and its forwarding is ensured by the chief physician of the institution where such a patient was found.

The patient should be immediately hospitalized in the infectious diseases hospital. A doctor or paramedical worker of a medical institution, upon discovering a patient or suspected of having the plague, is obliged to stop further admission of patients and prohibit entry and exit from the medical institution. While remaining in the office or ward, the medical worker must inform the chief physician in a way accessible to him about the identification of the patient and demand anti-plague suits and disinfectants.

In cases of receiving a patient with lung damage, before putting on a full anti-plague suit, the medical worker is obliged to treat the mucous membranes of the eyes, mouth and nose with streptomycin solution. If there is no cough, you can limit yourself to treating your hands with a disinfectant solution. After taking measures to separate the sick person from the healthy, a list of persons who had contact with the patient is compiled in a medical institution or at home, indicating the last name, first name, patronymic, age, place of work, profession, home address.

Until the consultant from the anti-plague institution arrives, the health worker remains in the outbreak. The issue of its isolation is decided in each specific case individually. The consultant takes the material for bacteriological examination, after which specific treatment of the patient with antibiotics can begin.

When identifying a patient on a train, plane, ship, airport, or railway station, the actions of medical workers remain the same, although the organizational measures will be different. It is important to emphasize that the separation of a suspicious patient from others should begin immediately after his identification.

The head doctor of the institution, having received a message about the identification of a patient suspected of plague, takes measures to stop communication between the hospital departments and clinic floors, and prohibits leaving the building where the patient was found. At the same time, organizes the transmission of emergency messages to a higher organization and the anti-plague institution. The form of information can be arbitrary with the obligatory presentation of the following data: last name, first name, patronymic, age of the patient, place of residence, profession and place of work, date of detection, time of onset of the disease, objective data, preliminary diagnosis, primary measures taken to localize the outbreak, position and the name of the doctor who diagnosed the patient. Along with the information, the manager requests consultants and the necessary assistance.

However, in some situations, it may be more appropriate to carry out hospitalization (before establishing an accurate diagnosis) in the institution where the patient is at the time of the assumption that he has plague. Therapeutic measures are inseparable from the prevention of infection of personnel, who must immediately put on 3-layer gauze masks, shoe covers, a scarf made of 2 layers of gauze that completely covers the hair, and protective glasses to prevent splashes of sputum from entering the mucous membrane of the eyes. According to the rules established in the Russian Federation, personnel must wear an anti-plague suit or use special means of anti-infective protection with similar properties. All personnel who had contact with the patient remain to provide further assistance to him. A special medical post isolates the compartment where the patient and the personnel treating him are located from contact with other people. The isolated compartment should include a toilet and a treatment room. All personnel immediately receive prophylactic antibiotic treatment, continuing throughout the days they spend in isolation.

Treatment of plague is complex and includes the use of etiotropic, pathogenetic and symptomatic agents. Antibiotics of the streptomycin series are most effective for treating plague: streptomycin, dihydrostreptomycin, pasomycin. In this case, streptomycin is most widely used. In the bubonic form of plague, the patient is administered streptomycin intramuscularly 3-4 times a day (daily dose 3 g), tetracycline antibiotics (vibromycin, morphocycline) intramuscularly at 4 g/day. In case of intoxication, saline solutions and hemodez are administered intravenously. A drop in blood pressure in the bubonic form should in itself be regarded as a sign of generalization of the process, a sign of sepsis; in this case, there is a need for resuscitation measures, administration of dopamine, and installation of a permanent catheter. For pneumonic and septic forms of plague, the dose of streptomycin is increased to 4-5 g/day, and tetracycline - to 6 g. For forms resistant to streptomycin, chloramphenicol succinate can be administered up to 6-8 g intravenously. When the condition improves, the dose of antibiotics is reduced: streptomycin - up to 2 g / day until the temperature normalizes, but for at least 3 days, tetracyclines - up to 2 g / day daily orally, chloramphenicol - up to 3 g / day, for a total of 20-25 g. Biseptol is also used with great success in the treatment of plague.

In case of pulmonary, septic form, development of hemorrhage, they immediately begin to relieve disseminated intravascular coagulation syndrome: plasmapheresis is performed (intermittent plasmapheresis in plastic bags can be carried out on any centrifuge with special or air cooling with a capacity of its glasses of 0.5 liters or more) in the volume removed plasma 1-1.5 liters when replaced with the same amount of fresh frozen plasma. In the presence of hemorrhagic syndrome, daily administration of fresh frozen plasma should not be less than 2 liters. Until the acute manifestations of sepsis are relieved, plasmapheresis is performed daily. The disappearance of signs of hemorrhagic syndrome and stabilization of blood pressure, usually in sepsis, are grounds for stopping plasmapheresis sessions. At the same time, the effect of plasmapheresis in the acute period of the disease is observed almost immediately, signs of intoxication decrease, the need for dopamine to stabilize blood pressure decreases, muscle pain subsides, and shortness of breath decreases.

The team of medical personnel providing treatment to a patient with pneumonic or septic form of plague must include an intensive care specialist.

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.

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.
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.
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?

Isolated cases of the disease occur in the USA and Peru.
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.
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.
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.
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 mortality 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.

Grows on simple available nutrient media.
It comes in different shapes - from thread-like to spherical.
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.
It is resistant to environmental factors, but dies instantly when boiled.
The plague bacterium has several pathogenicity factors - these are exotoxins and endotoxins. They lead to damage to organ systems in the human body.
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?

Transmissible or through the bites of an infected animal, mainly by fleas. This is the most common way.
Contact, which is infected during the cutting of carcasses of sick domestic animals, as a rule, these are camels.
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.
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?

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.
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.
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.

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.
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?

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.
An important step in the treatment of plague in humans is detoxification. Patients are injected with saline solutions.
Symptomatic treatment is used: diuretics are used in case of fluid retention, hormonal substances are used.
They use therapeutic anti-plague serum.
Along with the main treatment, supportive therapy is used - heart medications, vitamins.
In addition to antibacterial drugs, local anti-plague medications are prescribed. Plague buboes are treated with antibiotics.
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?

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.
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.
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.
In areas where the disease develops, plague carriers are destroyed.
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.

Abstract on the topic:

Plague

Plan:

1. History
- 1.1 The emergence of the plague
- 1.2 Plague in Sumerian-Akkadian mythology
- 1.3 Plague in the Bible
- 1.4 Plague epidemics in historical times
- 1.5 Plague as a biological weapon
- 1.6 Current state
- 1.7 Forecast
2 Infection
3 Symptoms
- 3.1 Clinical picture
- 3.2 Diagnosis
4 Treatment (briefly)
5 Treatment (details)
6 In literature
7 In cinema

9 Scientific literature

Introduction

Plague(lat. pestis - infection) is an acute natural focal infectious disease of the group of quarantine infections, occurring with an extremely severe general condition, fever, damage to the lymph nodes, lungs and other internal organs, often with the development of sepsis. The disease is characterized by high mortality and extremely high contagiousness.

The causative agent is the plague bacillus (lat. Yersinia pestis), discovered in 1894 simultaneously by two scientists: the Frenchman Alexandre Yersin and the Japanese Kitazato Shibasaburo.

The famous plague epidemics, which claimed millions of lives, left a deep mark on the history of mankind.

1. History

1.1. The emergence of the plague

Some researchers have expressed the opinion that the plague occurred approximately 1500-2000 years ago as a result of a mutation of pseudotuberculosis ( Yersinia pseudotuberculosus), shortly before the first known human plague pandemics. At the same time, the majority of the scientific community considers the plague causative agent to be a much more ancient microorganism.

From the book Daniel M. - Secret paths of the carriers of death. - M. Progress, 1990, p.101 ISBN 5-01-002041-6:

The plague arose on Earth before man appeared, and its origins must be sought in distant geological epochs, when the ancestors of modern rodents began to appear - about 50 million years ago in the Oligocene. At that time there already existed genera of fleas similar to those living today, as evidenced by the remains of fossil insects in amber.

The ancestral home of the plague is the endless steppes and deserts of Central Asia, where this disease developed and was maintained among local species of gerbils, marmots and ground squirrels. Another ancient center of plague was the Central African savannas and North African deserts and semi-deserts. And although some authors stubbornly defended the opinion that the plague was brought to the North American continent during its colonization by whites, recently more and more evidence has appeared that it penetrated into the Western Hemisphere in distant geological epochs through Siberia and Alaska and was an important regulator of populations steppe rodents in North America since the Pleistocene.

In these parts of the world - and especially in Asia - the first plague epidemics occurred among people. Initially, obviously, these were local epidemics and their size was limited by the fact that vast spaces were inhabited by a relatively small number of people, who also had practically no contact with each other. The real tragedies began when the population and the level of its material development rose to a higher level.

M. V. Supotnitsky in his monograph cites evidence of plague epidemics starting from 1200 BC. e.

1.2. Plague in Sumerian-Akkadian mythology

When writing this section, materials from the book Daniel M. - Secret Paths of the Carriers of Death were used. - M. Progress, 1990, p.105 ISBN 5-01-002041-6

1.3. Plague in the Bible

When writing this section, materials from the book Daniel M. - Secret Paths of the Carriers of Death were used. - M. Progress, 1990, p.102 ISBN 5-01-002041-6

The Bible is one of the oldest sources that have come down to us, which records the occurrence of a plague epidemic. The first book of Kings (chapter 5) describes the war between the Israelites and the Philistines. Israelis are plagued by military failures. Having lost the battle, the Israelis, in order to raise their spirits, bring to their camp the ark of the covenant of the Lord - a cabinet with sacred relics. But this does not help them - the Philistines again win, capture the ark and, with great triumph, deliver it to the city of Azoth. There they place the ark at the feet of the statue of their god Dagon. And soon a terrible blow falls on the city of Azot and its entire surrounding area: a disease breaks out among the people, growths-ulcers appear in their groin area, and the Azotians die from this disease. Those who survived are firmly convinced that this disease is God's punishment, and they seek to get rid of the ark of the Lord and send it to another province of Philisteia - to the city of Gath. But the story of this terrible disease is completely repeated in Gath. This is how it is literally said in verse nine: “After they had sent it (the ark), the hand of the Lord was upon the city—a very great terror, and the Lord struck down the inhabitants of the city, from the smallest to the greatest, and growths appeared on them.” The Philistines did not calm down and for the third time transported the trophy of war, and with it the plague, to the city of Ascalon. All the Philistine rulers later gathered there - the kings of the five cities of Philistia - and they decided to return the ark to the Israelites, because they realized that this was the only way to prevent the spread of the disease. And chapter 5 ends with a description of the atmosphere that reigned in the doomed city. “And those who did not die were smitten with growths, so that the cry of the city went up to heaven.” Chapter 6 depicts the council of all the rulers of the Philistines, to which priests and soothsayers were called. They advised to bring a trespass offering to God - to put gifts in the ark before returning it to the Israelites. “According to the number of the rulers of the Philistines, there are five golden growths and five golden mice that devastate the land; for the punishment is the same for all of you and for your rulers.” This biblical tradition is interesting in many respects: it contains a hidden message about an epidemic that most likely swept through all five cities of Philistia. We could be talking about the bubonic plague, which affected people young and old and was accompanied by the appearance of painful growths in the groin - buboes. The most remarkable thing is that the Philistine priests apparently associated this disease with the presence of rodents: hence the golden sculptures of mice “ravaging the earth.”

1.4. Plague epidemics in historical times

In 1346 the plague was brought to Crimea, and in 1351 to Poland and Rus'. Subsequently, outbreaks of plague were observed in Russia in 1603, 1654, 1738-1740 and 1769. An epidemic of bubonic plague swept through London in 1664-1665, killing more than 20% of the city's population. Isolated cases of infection with bubonic plague are still being recorded.

Up to thirty-four million people in Europe died from the plague 1347-1351

The cause of infection is most often the bites of fleas that previously lived on infected rats.

1.5. Plague as a biological weapon

Ceramic bomb containing plague-infected material - a flea colony

During World War II, the Japanese armed forces developed samples of biological weapons intended for the mass release of specially prepared plague carriers - infected fleas. When developing samples of biological weapons, special detachment 731, headed by General Ishii Shiro, deliberately infected civilians and prisoners of China, Korea and Manchuria for further medical research and experiments, studying the prospects for using biological agents as weapons of mass destruction. (English) The group developed a strain of plague that was 60 times more virulent than the original strain of plague, a kind of absolutely effective weapon of mass destruction with natural spread. Various aerial bombs and projectiles have been developed to drop and disperse infected carriers, such as ground bombs, aerosol bombs, and fragmentation projectiles that damage human tissue. Ceramic bombs were popular, taking into account the peculiarities of the use of living organisms - fleas and the need to maintain their activity and viability under discharge conditions, for which special life support conditions were created (in particular, oxygen was pumped in).

1.6. Current state

Every year the number of people infected with the plague is about 2.5 thousand people, with no downward trend.

For Russia, the situation is complicated by the annual identification of new cases in states neighboring Russia (Kazakhstan, Mongolia, China), and the importation of a specific carrier of the plague - fleas - through transport and trade flows from the countries of Southeast Asia. Xenopsylla cheopis.

In the summer of 2009, the city of Ziketan was quarantined in the Hainan Tibet Autonomous Region, as an outbreak of pneumonic plague was detected there, from which several people died.

1.7. Forecast

2. Infection

The flea xenopsylla cheopis is the main carrier of plague, SEM image

The causative agent of plague is resistant to low temperatures, preserves well in sputum, but at a temperature of 55 ° C it dies within 10-15 minutes, and when boiled - almost immediately. It enters the body through the skin (from a flea bite, usually Xenopsylla cheopis), mucous membranes of the respiratory tract, digestive tract, and conjunctiva.

Fleas are a specific carrier of the plague pathogen. This is due to the peculiarities of the digestive system of fleas: just before the stomach, the flea's esophagus forms a thickening - a goiter. When an infected animal (rat) is bitten, the plague bacterium settles in the flea's crop and begins to multiply intensively, completely clogging it. Blood cannot enter the stomach, so such a flea is constantly tormented by a feeling of hunger. She moves from host to host in the hope of getting her share of blood and manages to infect a fairly large number of people before dying (such fleas live no more than ten days).

3. Symptoms

The bubonic form of plague is characterized by the appearance of sharply painful conglomerates, most often in the inguinal lymph nodes on one side. The incubation period is 2-6 days (less often 1-12 days). Over the course of several days, the size of the conglomerate increases, and the skin over it may become hyperemic. At the same time, an increase in other groups of lymph nodes appears - secondary buboes. The lymph nodes of the primary focus undergo softening; upon puncture, purulent or hemorrhagic contents are obtained, microscopic analysis of which reveals a large number of gram-negative rods with bipolar staining. In the absence of antibacterial therapy, festering lymph nodes are opened. Then gradual healing of the fistula occurs. The severity of the patients' condition gradually increases by the 4-5th day, the temperature may be elevated, sometimes a high fever immediately appears, but at first the condition of the patients often remains generally satisfactory. This explains the fact that a person sick with bubonic plague can fly from one part of the world to another, considering himself healthy.

3.1. Clinical picture

3.2. Diagnosis

The most important role in diagnosis in modern conditions is played by epidemiological anamnesis. Arrival from zones endemic for plague (Vietnam, Burma, Bolivia, Ecuador, Turkmenistan, Karakalpakstan, etc.), or from anti-plague stations of a patient with the signs of the bubonic form described above or with signs of the most severe - with hemorrhages and bloody sputum - pneumonia with severe lymphadenopathy is a sufficiently serious argument for the doctor of first contact to take all measures to localize the suspected plague and accurately diagnose it. It should be especially emphasized that in the conditions of modern drug prevention, the likelihood of illness among personnel who have been in contact with a coughing plague patient for some time is very small. Currently, there are no cases of primary pneumonic plague (that is, cases of infection from person to person) among medical personnel. An accurate diagnosis must be made using bacteriological studies. The material for them is the punctate of a suppurating lymph node, sputum, the patient’s blood, discharge from fistulas and ulcers.

Laboratory diagnosis is carried out using a fluorescent specific antiserum, which is used to stain smears of discharge from ulcers, punctate lymph nodes, and cultures obtained on blood agar.

4. Treatment (briefly)

Vladimir Khavkin was the first to create a vaccine against plague at the beginning of the 20th century.

5. Treatment (in detail)

Treatment of plague is complex and includes the use of etiotropic, pathogenetic and symptomatic agents. Antibiotics of the streptomycin series are most effective for treating plague: streptomycin, dihydrostreptomycin, pasomycin. In this case, streptomycin is most widely used. For the bubonic form of plague, the patient is administered streptomycin intramuscularly 3-4 times a day (daily dose 3 g), tetracycline antibiotics (vibromycin, morphocycline) intramuscularly at 4 g/day. In case of intoxication, saline solutions and hemodez are administered intravenously. A drop in blood pressure in the bubonic form should in itself be regarded as a sign of generalization of the process, a sign of sepsis; in this case, there is a need for resuscitation measures, administration of dopamine, and installation of a permanent catheter. For pneumonic and septic forms of plague, the dose of streptomycin is increased to 4-5 g/day, and tetracycline - to 6 g. For forms resistant to streptomycin, chloramphenicol succinate can be administered up to 6-8 g intravenously. When the condition improves, the dose of antibiotics is reduced: streptomycin - up to 2 g / day until the temperature normalizes, but for at least 3 days, tetracyclines - up to 2 g / day daily orally, chloramphenicol - up to 3 g / day, for a total of 20-25 g. Biseptol is also used with great success in the treatment of plague.

The team of medical personnel providing treatment to a patient with pneumonic or septic form of plague must include an intensive care specialist.

6. In literature

Giovanni Boccaccio, "Decameron" (1352 - 1354). The heroes of the work leave Florence, infected with the disease, establishing a primitive quarantine.
Daniel Defoe, "Diary of a Plague City". Based on true facts, the story of the Great London Epidemic of 1665.
Rolland, Romain, "Nikolka Peach".
Camus, Albert, "The Plague" 1947).
Poe, Edgar Mask of the Red Death.
Undset, Sigrid, Christine, daughter of Lavrans
Pushkin A.S. "Feast in Time of Plague".
Twain, Mark, "A Connecticut Yankee in King Arthur's Court."
London, Jack, "The Scarlet Plague".

7. In cinema

Flesh and Blood (directed by Paul Verhoeven) (1985). The action takes place during the Italian Wars. A dog infected with the disease is used as a bacteriological weapon.

Notes

Plague - For doctors, students, patients, medical portal, abstracts, cheat sheets for doctors, diseases, treatment, diagnosis, prevention - likar.org.ua/content/view/2770/339/lang,ru
Achtman M, Zurth K, Morelli G, Torrea G, Guiyoule A, Carniel E. Yersinia pestis, the cause of plague, is a recently emerged clone of Yersinia pseudotuberculosis. Proc Natl Acad Sci U S A. 1999 Nov 23;96(24):14043-8. - www.ncbi.nlm.nih.gov/pubmed/10570195
From the book by Daniel M. Secret paths of the carriers of death. - M. Progress, 1990, p. 105
Old Testament / First Book of Samuel / Chapter 5 - www.ubrus.org/bible-pages/?part_id=9&page_id=5
Old Testament / First Book of Kings / Chapter 6 - www.ubrus.org/bible-pages/?part_id=9&page_id=6
Old Testament / The Fourth Book of Kings / Chapter 19 - www.ubrus.org/bible-pages/?part_id=12&page_id=19
Europe’s Plagues Came From China, Study Finds - www.nytimes.com/2010/11/01/health/01plague.html?_r=1&ref=science (English). // The New York Times, 10/31/2010
B. Bayer, W. Birstein and others. History of mankind 2002 ISBN 5-17-012785-5
Alberti Leon Battista. Ten books about architecture. T. II. M., 1937, p. 130
Material on use as a biological weapon from the English Wiki
Essays on the history of the plague (about biological weapons) - supotnitskiy.webspecialist.ru/images/book3-34-1.gif
1 2 Letter of the Ministry of Health of the Russian Federation dated April 22, 2004 N 2510/3173-04-27 “On the Prevention of Plague”
1 2 Order of the territorial administration of Rospotrebnadzor for the Moscow Region dated 02.05.2006 N 100 “On the organization and implementation of measures for the prevention of plague in the Moscow region”
A second death from pneumonic plague was recorded in Qinghai - russian.people.com.cn/31516/6717104.html, People's Daily(August 3, 2009).
In China they fear an epidemic of pneumonic plague - www.bbc.co.uk/russian/international/2009/08/090802_china_plague.shtml
M. V. Supotnitsky. “Black Death” - the mechanism of a pandemic catastrophe - supotnitskiy.ru/stat/stat8.htm

9. Scientific literature

- www.it-med.ru/library/ch/chuma_1.htm Domaradsky I. V. Plague. - M., 1998.
- www.plosone.org/article/info:doi/10.1371/journal.pone.0006000 Li Y, Cui Y, Hauck Y, Platonov ME, Dai E, Song Y, Guo Z, Pourcel C, Dentovskaya SV, Anisimov AP, Yang R, Vergnaud G. Genotyping and phylogenetic analysis of Yersinia pestis by MLVA: insights into the worldwide expansion of Central Asia plague foci. PLoS One. 2009 Jun 22;4(6):e6000.
- jmm.sgmjournals.org/cgi/content/full/55/11/1461 Anisimov AP, Amoako KK. Treatment of plague: promising alternatives to antibiotics. J Med Microbiol. 2006 Nov;55(Pt 11):1461-75. Review.
Zhukov-Verezhnikov N.N., Diagnosis of plague and cholera, M., 1944
Supotnitsky M.V., Supotnitskaya N.S. Essays on the history of the plague: In 2 books. - supotnitskiy.ru/book/book3.htm M.: University Book, 2006. ISBN 5-9502-0093-4 (book 1), ISBN 5-9502-0094-2 (book 2), ISBN 5-9502 -0061-6. This is the only book that describes all the plague epidemics from antiquity to the present day.
Daniel M. - Secret paths of the carriers of death. - Progress, 1990. ISBN 5-01-002041-6
V. V. Suntsov, N. I. Suntsova. Plague. Origin and evolution of the epizootic system (ecological, geographical and social aspects). UDC 579.843.95-036.21:576.12. ISBN 5-87317-312-5. Moscow: KMK Publishing House, 2006. - 247 pp. - macroevolution.narod.ru/suntsov.htm

The disease is provoked by the plague bacillus (lat. Yersinia pestis), discovered in 1894 independently by the French scientist A. Yersin (1863-1943) and the Japanese scientist S. Kitazato (1852-1931).

Plague manifests itself in a severe general condition, fever, damage to the lymph nodes, lungs and other internal organs. The disease is extremely contagious, belongs to the group of quarantine infections, and has a high mortality rate.

The incubation period lasts from several hours to 3-6 days. Chills appear, heart rate increases, blood pressure decreases, and the temperature rises sharply to 39ºC. The disease is accompanied by delirium, confusion, and loss of coordination.

There are several forms of plague: bubonic, pneumonic, septicemic and mild (minor plague).

With bubonic plague, the lymph nodes (called buboes) become enlarged, inflamed, and filled with pus. The liver and spleen may become enlarged. Without treatment, death occurs on the 3-5th day, mortality exceeds 60%. It is possible for this form to transform into a secondary pulmonary or secondary septic form.
Pneumonic plague affects the lungs. Its distinctive symptoms include cough and hemoptysis. Fever, headache, increased heart rate and breathing are also present.
The septic form of plague occurs with hemorrhages on the skin, bleeding of the gastrointestinal tract, tachycardia, and decreased blood pressure. Death occurs within a maximum of 24 hours, sometimes before signs of bubonic or pneumonic plague appear.
A mild (minor) form of plague can occur in areas where plague is endemic. These include: Vietnam, Burma, Bolivia, Ecuador, Turkmenistan, etc., in Russia - the Caspian Lowland, the East Ural region, Stavropol, Transbaikalia, Altai and some other regions. Its symptoms are swollen lymph nodes, headache, and increased body temperature. They usually disappear within a week.

Natural sources of the plague bacillus are rodents (rats, mice, hares, gophers, marmots, squirrels), as well as wild dogs, cats and camels. They become infected with the disease through their own bites or from fleas that carry it.

Yersinia pestis
Photo: shutterstock.com

Another route of transmission of infection is contact and airborne droplets (from a sick person).

The plague microbe is not afraid of low temperatures and freezing; it can survive in animal corpses for up to 60 days, but it dies when disinfectants are used and when boiled.

"Black Death"

Known plague pandemics in history:

“Justinian Plague” in the Eastern Roman Empire (551-580), killed over 100 million people;
pandemic of the 14th century — “Black Death” (1346-1352, 25 million - a third of the population of Europe);
plague epidemics in London (1664-1665 - 20% of the population), Marseilles and some cities of Provence (1720-1722 - 100 thousand people) and Moscow (1771-1772 - about 57 thousand people);
at the end of the 19th century the third pandemic began in Asia (more than 12 million people);
in the twentieth century epidemics in India (more than 12.5 thousand victims).

Such a high mortality rate in the Middle Ages is explained by the lack of proper treatment (cutting out and cauterizing plague buboes) and non-compliance with quarantine measures. There is also evidence of the use of plague-infected material as a biological weapon.

Plague today

Currently, about 2.5 thousand cases of illness are registered annually in the world.

According to WHO, from 1989 to 2004, about 40 thousand cases were recorded in 24 countries, the mortality rate was about 7%. There have been no cases of the disease in Russia since 1979, but in natural foci there is a risk of infection for more than 20 thousand people. The situation is complicated by the annual detection of cases in neighboring countries (Mongolia, Kazakhstan, China).

Plague is treated with antibiotics (this was first achieved in 1947 with streptomycin, developed by the Research Institute of Epidemiology and Hygiene of the Red Army), sulfonamides and anti-plague serum. The patient and people in contact with him are isolated (especially in the pulmonary form).

For prevention, rodent control and the creation of anti-plague institutions in endemic areas are used. There is also a vaccine that reduces the severity of the disease, but does not protect 100%.

The bubonic plague killed 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, the Crimean Tatars, led by Khan Dzhanybek, during the siege of the Genoese fortress of Kafa (Feodosia), 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 of the 14th century, 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 there is a massive locust invasion;
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.

Modern characteristics of the bubonic plague

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.

Symptoms of plague in humans

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 space were also popular.
Do whatever is necessary to cover up 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 to put 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 rat flea, the human louse is the spreader of the plague. 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.