Plague - Causes, Symptoms and Treatment .MF .
plague ( "Black Death», Pestis) - very dangerous, sharp, natural-focal zooantraponoznaya * bacterial infection with multiple transmission paths, and is characterized by feverish intoxication syndrome, and primary lesion of the skin and lungs.
brief historical sketch: without exaggeration, can be added to the following characteristics of the prefix "most" - the oldest, most dangerous, and to this day, beating records on the severity and the highest mortality rate, as well as by the level of contagiousness (infectiousness) - in all these areas plague virtuallyno equal.More
absolutely illiterate natives from generation to generation passed on everyday experience: the appearance of dead rats in the hut, the whole tribe to leave the area, imposing a taboo and never coming back.
3 major plague pandemics recorded in the history of the world:
• In the III century was the first description of the territories of what is now Libya, Syria, Egypt.
• Pandemic in the VI in the Roman Empire until the end of the re
• The end of the 19th century - the third pandemic, the most common in maritime ports.Also this century was a turning point, because in this period has been opened himself plague pathogen Yersinia French scientists in 1894.
Long before these pandemics were many epidemics that have no account ... One of the largest was in France in the 16th century, where he lived one of the most famous psychics, astrologers and physicians - Nostradamus.He successfully fought the "black death" with the help of herbal medicine and its prescription reached our days: sawdust young cypress, Florentine iris, dianthus, fragrant calamus and woody aloe - with all of these components were mixed rose petals and from this mixture is made into tablets "pinkpills. "Unfortunately, his wife and children, Nostradamus could not save from the plague ...
Many cities where reigned death, subjected to the burning, and the local doctors are trying to help infected, wore special anti-plague "armor": leather coat to the heels,a mask with a long nose - in the nose department placed a variety of herbs and when inhaling heated air causes evaporation of antiseptic substances contained in the herbs, the inhaled air was practically sterile.This mask has been protected with crystal lenses in the ears were stuck rags and mouth rubbed raw garlic.
It would seem that the era of "antibiotics" forever eliminate the danger of the plague, thought so for a short time until scientists Bacon was not modeled genetic mutant plague - antibiotic-resistant strain.Also, vigilance can not be reduced because there have always been natural foci (territorial aggression).Social upheavals and economic depression are predisposing factors in the spread of this infection.
causative agent of plague
Pathogen - Yersinia Pestis, looks like an egg-shaped wand, T-, and the dispute has no flagella, but the body forms a capsule.On nutrient media gives the characteristic height: broth agar - plague stalactites on solid media, the first 10 hours as a "broken glass", after 18 hours in the form of "lace handkerchiefs» and by 40 h formed "adult colonies."
causative agent of plague
There are a number of structural characteristics, which are components of pathogenicity factors:
• Capsule - inhibits the activity of macrophages.
• Pili (small villi) - inhibit phagocytosis and cause the introduction of the pathogen in macrophages.
• Plazmokoagulaza (tazhe coagulase) - leads to clotting plasma and impaired blood rheology.
• neuraminidase - provides adhesion fixation pathogen due to release its receptors on the surface.
• pN6 specific antigen - are synthesized at a temperature of 36 ° C and has a cytotoxic activity and antiagotsitarnoy.
• Antigens W and V - provide a reproduction of the pathogen within the macrophages.
• catalase activity provided by adenylate cyclase - suppresses the oxidative burst in macrophages, which reduces their protective ability.
• aminopeptidase - provide proteolysis (cleavage) at the cell surface, innaktivatsiyu regulatory proteins and growth factors.
• Pestitsin - biologically active components of Y. pestis which suppress the growth of other members of the genus Yersinia (yersiniosis).
• Fibrinolizin - provides the splitting of a blood clot, which subsequently aggravated violation of coagulation.
• Hyaluronidase - ensures the destruction of intercellular communication, which further facilitates its penetration into the tissue glublezhaschie.
• endogenous purines (the role of their presence is not completely clear, but they decay form uric acid, which is potentially toxic).
• Endotoxin - lipopolysaccharide complex has toxic and allergenic effects.
• Rapid growth at 36,7-37 ° C - this feature in conjunction with antifaotsitarnymi factors (listed above) makes the growth and multiplication of the causative agent of plague almost besperpyatstvennym.
• Ability to absorb pathogen (collect / gather) hemin (a derivative of the gem - the non-protein part of the transporter Fe3 + in the blood) - this property provides pathogen multiplication in the tissues.
• Mouse toxin (C = lethal toxin) - has cardiotoxic (heart disease), hepatotoxicity (liver damage) and kapilyarotoksicheskim action (breaks vascular permeability and cause thrombocytopathy).This factor appears blockade transfer of electrolytes in the mitochondria, ie, blockade of the energy depot.
All pathogenicity (malware) is controlled by genes (there are 3), - for them and influenced Bacon, modeled antibiotic-resistant mutant plague and thus warn mankind of the threat of moving under inappropriate and uncontrolled use of antibiotics.
Stability plague pathogen:
• The sputum is stored 10 days;
• In underwear, clothing and household items, stained mucus - weeks (90 days);
• In the water - 90 days;
• The buried corpses - up to a year;
• In open spaces, the warm - up to 2 months;
• The bubo pus (enlarged lymph node) - 40 days;
• In pochve- 7 months;
• Freezing and thawing, as well as low temperatures - have little effect on the pathogen;
are ruinous: direct UV radiation and disinfectants - cause instant death, at 60 ° C - die within 30 minutes at 100 ° C - the death is instantaneous.
plague refers to the natural focal infections, ie there is geographically dangerous epidemic in relation to areas in the territory of the Russian Federation of 12: in the North Caucasus, Kabardino-Balkaria, Dagestan, Zabaykayle, Tuva, Altai, Kalmykia, and SiberiaAstrakhan region.Natural foci globally exist on all continents except Australia: in Asia, Afghanistan, Mongolia, China, Africa and South America.
addition to natural focal (natural) areas, as isolated synanthropic foci (antropouricheskie) - City, port, ship.
susceptibility is high, no sex and age restrictions.
Causes plague infection
source and reservoir (guardian) infections - rodents, lagomorphs, camels, dogs, cats, sick people.The carrier - a flea preserving infectivity to a year.Plague microbe multiplies in the digestive tube and fleas in the front part of it forms a "plague block" - a stopper of a large number of the pathogen.At a sting, with the reverse blood flow, this cork is washed off of the bacteria - so there is an infection.
Ways of infection:
• Transmissible (through flea bites);
• contact - through the damaged skin and mucous membranes when removing the skins from infected animals at slaughter and cutting of carcasses, as well as by contact with body fluids of a sick person;
• Contact-home - through household items, infected biological fluids of infected animals / person;
• Airborne (through the air, from pneumonic plague patient);
• Alimentary - by eating contaminated food.
Symptoms of plague
incubation period is counted from the moment of introduction of the pathogen to the first clinical manifestations in plague this period can last from a few hours to 12 days.The pathogen often penetrate through the affected skin or mucous membranes of the digestive / respiratory traktovzahvatyvaetsya tissue macrophages, and part of the pathogen remains in the entrance gate, and some macrophages transferred to regional (nearby) lymph nodes.But as long as the originator dominates phagocytosis and inhibits its action, the body does not detect the pathogen as a foreign object.However, phagocytosis is suppressed not to the end of the pathogens are killed, and after the death occurs exotoxin isolation and to reach its threshold concentration of clinical manifestations begin.
period of clinical manifestations always begins acutely, suddenly, with the first symptoms of intoxication in the form of chills, high fever & gt; 39 ° C, keep for 10 days and / or to the death, severe weakness, body aches, thirst, nausea, vomitinglitso becomes cyanotic, with dark circles under the eyes - these changes against the backdrop of the expression of suffering and terror, called the "mask of the plague."Tongue coated thick white coating - "Chalk language."Is there a standard pathogenetic symptom (ie, due to the specific mechanism of action of the pathogen formed 4 standard symptoms in varying degrees of symptoms):
• In place of the entrance gate is formed the primary focus, which can pereterpevat phasing and stop at one of them: the spot - papaula -vesicle.
• Increasing the regional lymph nodes (forming a "plague bubo") up to an impressive size (≈yabloko) due to the propagation of the pathogen in it, and the formation of inflammatory and edematous reaction.But it often happens that the process is so lightning fast that death occurs before the development of plague bubo.
• ITSH (toxic shock) is caused by degranulation of neutrophils (NF) and the death of the pathogen with endotoxin release.It is characterized by a certain degree of symptoms and the main diagnostic criteria are: changes in the nervous system (state of mind) + ↑ or ↓ t ° body + hemorrhagic rash (petechial rash in the oropharynx) + bleeding in mucous + disorder of the peripheral circulation (coldness, pallor or blue extremities, nasolabial triangle, face) + changes in heart rate and blood pressure (↓) + change in intracranial pressure (↓) + formation of kidney failure, manifested as a reduction in the daily urine output + change in acid-base balance (acid-base balance) in the direction acidosis
• DIC(disseminated intravascular coagulation) - a very difficult state, which is based on disruption and coagulation anticoagulative system.DIC occurs in parallel with the development of ITSH and appears ↓ Tr + ↑ + ↓ clotting time degree reduction clot + prokoagulyatsionny positive test.
clinical forms of the disease:
• localized (cutaneous, bubonic);
• generalized (pulmonary, septic).
forms of the disease are listed in the order in which the disease can develop in the absence of treatment.
Cutaneous : in place of the entrance gate there are tissue changes (one of the 4 standard symptoms), or in severe cases, may develop lightning conflict (bubble) filled with serous-hemorrhagic content, surrounded by infiltrative area with hyperemia and edema.On palpation is painful education, and at the opening formed ulcer with a black necrosis (scab) on the bottom - from here the name "Black Death."This ulcer heals very slowly and always leaves scars after healing, and, because of slow healing, often formed secondary bacterial infections.
Bubonic form : «Plague bubo" - an enlarged lymph node, either one or several of them.The increase may be the size of a walnut - to apple, the skin is shiny and red with a cyanotic shade, texture dense, painful palpation, with the surrounding tissues are not soldered, clear boundaries due to concomitant periadenita (inflammation of the tissues okololimfaticheskih) na 4 day bubo softensand there is a fluctuation (a feeling of anxiety or hesitation when tapped), on day 10 the lymphatic center opened and forms a fistula with the expression.This form can lead to secondary bacterial septic complications, and to plague septic complications (ie plague bacteraemia) with the introduction of the agent of the plague in all organs and tissues.
Septic form : is characterized by the rapid development of TIN and DIC, the fore multiple hemorrhages in the skin and mucous membranes, open bleeding in internal organs.This form is the primary - by ingestion of a massive dose of the pathogen, and secondary - with secondary bacterial complications.
Pneumonic the most dangerous in the epidemiological sense.Start acute, as in any other form, to the 4 standard clinical symptoms joins and acts on the first pan pulmonary symptoms (due to melting of the walls of the alveoli): there is a dry cough, which is 1-2 days become productive - frothy sputum first, vitreous, prozranaya and consistency as water and then becomes pure blood, with countless vozbuditeya.This form, as well as septic, can be either primary - if inhalable infections and secondary - a complication of other forms of the above.
1. Analysis of clinical and epidemiological data: in addition to standard clinical manifestations are exploring the place of residence or seat at the moment and whether it is a place of natural foci.
2. Laboratory criteria:
- OAK: ↑ A ^ and Hf with a shift formula to the left (ie the ↑ P / I, C / I, etc.), ESR ↑;Increased neutrophils accounted for compensatory stage, as soon as the depot is depleted, the NF ↓ (neutropenia).
- KHS estimate the parameters: the number of bicarbonate buffer bases, O₂ and blood oxygen tanks, etc.
- OAM: proteinuria, hematuria, bacteriuria - all this will indicate only the degree of the compensatory response and obsemenёnnosti.
- X-ray diagnostics: ↓ mediastinal lymph nodes, focal / lobular / psevdolabulyarnaya pneumonia, RDS (respiratory distress syndrome).
- Lumbar puncture with meningeal signs (neck stiffness, positive simtopmy Keringa and Brudzinskogo), which show a 3-ёhznachny neutrophilic pleocytosis + ↑ [protein] + ↓ [gluon].
- Research bubo punctate / ulcers / carbuncle / sputum / nasopharyngeal swab / blood / urine / feces / cerebrospinal fluid - ie where the dominant symptoms, and biological material we send to bacteriological and bakteriskopicheskie study - preliminary result within an hour, andfinal after 12 hours (when a stalactite plague - this makes the diagnosis undisputed).
- PHA (passive hemagglutination), REEF, IFA, IHA
causative agent of plague (electron microscopy)
If you suspect a plague laboratory tests carried out in the anti-plague suits, in specialized laboratory conditions, using specially allocated utensils andBix, as well as the obligatory presence of disinfectants.
Treatment Treatment is combined with bed rest and gentle feeding (Table A).
1. Etiotropic treatment (directed against the pathogen) - this phase should start only when a suspected plague, without waiting for bacteriological confirmation.At a certain form of different combinations of drugs, alternating, the most successful combination in this case with each other:
- Tsiftriakson or Ciprofloxacin + streptomycin or gentamicin or rifampicin
- rifampicin + streptomycin
2. Pathogenetic treatment: control of acidosis,cardiovascular and respiratory failure, ITSH and DIC.At the same time the treatment is administered colloids (reopoligljukin, plasma) and crystalloid (10% glucose)
3. Symptomatic therapy as symptoms of certain dominant symptoms.
development of irreversible stages ITSH and ICE decompensation by the organs and systems, secondary bacterial complications, death.
nonspecific: surveillance of natural foci;
therapists Shabanova IE