Plague

PlaguePLAGUE (pestis) - sharp natural focal infectious disease caused by the Bacillus of plague - Yersinia pestis. Especially dangerous infections. On the globe there are still a few natural foci, where plague occurs constantly in a small percentage of rodents living there. Plague among the people were often due to migration of rats, inspired in natural foci. From rodents to humans germs are transmitted through fleas that when the mass deaths of animals are changing their owner. In addition, a possible route of contamination during processing hunters the skins of dead infected animals. Fundamentally different is infection from person to person, carried out by airborne droplets. Sporadic cases of plague reported in different countries, including the United States. Etiology, pathogenesis. The causative agent of plague sustainable and low temperatures, well preserved in the sputum, but at a temperature of 55'C dies within 10-15 minutes, and boiling almost immediately. Enters the body through the skin (through the bite of fleas), the mucous membranes of the respiratory tract, digestive tract, conjunctiva. When the bite of an infected plagued bacteria fleas in humans at the site of the bite may occur papule or pustule filled with hemorrhagic content (skin form). The process then spreads through lymphatic vessels without signs of lymphangitis. Bacterial growth in macrophages of lymph nodes leads to a dramatic increase, merger and formation conglomerate (bubonic form). Further generalization of infection, which is not strictly necessary, especially in the conditions of modern antibiotic therapy can lead to the development of septic form, accompanied by the defeat of almost all internal organs. However, epidemiological positions essential "screenings" infection in the lung tissue (pulmonary form of the disease. Since the development of plague pneumonia sick man himself becomes the source of infection, but from person to person already passed the pulmonary form of the disease is extremely dangerous, with a very rapid current. The symptoms for. The bubonic form of plague is characterized by the appearance of a sharply painful conglomerates, often inguinal lymph nodes on one side. The incubation period is 2-6 days (more rarely 1-12 days). Within a few days the size of the conglomerate increase, the skin over it may become damaged. At the same time you receive a increase and other groups of lymph nodes secondary bubany. Lymph nodes primary tumor are softening, when they get a puncture suppurative or hemorrhagic content, microscopic analysis reveals a large number of gram-negative bipolar staining sticks. In the absence of antibiotic therapy festering lymph nodes are opened. Then a gradual healing of the fistula. The severity of the patients is gradually increasing to 4-5th day, the temperature can be increased, sometimes you may receive high fever, but the first time the condition of patients often remains generally satisfactory. This explains the fact that ill bubonic plague people can fly from one part of the world to another, considering themselves healthy. However, at any time of the bubonic form of plague can cause the generalization process and go into secondary septic or secondary pulmonary form. In these cases, the condition of patients very quickly becomes extremely difficult. Symptoms of intoxication are increasing by the hour. Temperature after a severe fever rises to high febrilnykh digits. Marked with all the signs of sepsis: muscle pain, severe weakness, headache, dizziness, congestion of consciousness, until his loss, sometimes excitation (desperately sick in bed), insomnia. With the development of pneumonia is increasing cyanosis appears cough with the Department of frothy blood-tinged sputum containing a huge number of sticks plague. This sputum and becomes a source of infection from person to person with the development now of primary pneumonic plague. Septicaemic and pneumonic forms of plague occur, as with any severe sepsis with evidence of disseminated intravascular coagulation: may cause small hemorrhages on the skin, possible bleeding from the gastrointestinal tract (vomiting, bloody masses, melena), expressed tachycardia, fast and requiring corrections (dopamine) a drop in blood pressure. Auscultatory picture of bilateral focal pneumonia. The clinical picture of primary septic or primary pulmonary form does not differ essentially from the secondary forms, but the primary forms often have a shorter incubation period up to several hours. Diagnosis. The most important role in the diagnosis in modern conditions plays an epidemiological anamnesis. Coming from areas endemic for plague (Vietnam, Burma, Bolivia, Ecuador, Turkmenistan, Karakalpak ASSR, and others), or with anti-plague stations of the patient with the above signs of bubonic form or with signs of severe - with hemorrhages and bloody sputum of pneumonia in severe lymphadenopathy is for the doctor of first contact a serious argument for the adoption of all measures of localization of suspected plague and the exact diagnosis. It should be emphasized that in the conditions of modern drug prevention of the risk of staff, who for some time was in close contact with coughing patients with plague, is quite small. Currently, cases of primary pneumonic plague (i.e., infections from person to person) among medical personnel is not observed. Establishing an accurate diagnosis should be carried out with the help of bacteriological research. The material is punctate festering lymph node, sputum, blood of the patient, the fistula discharge and ulcers. Laboratory diagnosis is carried out using a fluorescent specific antisera, which paint strokes alienate ulcers, punctate lymph nodes, culture obtained on blood agar. Treatment. If you suspect plague the patient should be immediately hospitalized in the case of infectious hospital. However, in some situations it may be more reasonable to implement hospitalization (before the establishment of the exact diagnosis) at the facility where the patient at the time of assumption of the existence of the plague. Therapeutic activities are inseparable from the prevention personnel, who should wear 3-ply gauze masks, boot covers, headscarf from 2 layers of gauze, completely covering the hair, and goggles to prevent splashing of sputum on the mucous membrane of the eye. When possible, the staff puts on antiplague suit.


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