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Infectious diseases. Plague is an acute infectious disease caused by the plague bacillus (most important)

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32. Plague is an acute infectious disease caused by a plague bacillus

Etiology. Yersinia pestis is an immobile, polymorphic, Gram-negative bacterium that does not form spores. It looks like a short stick with rounded dense ends and a swollen central part ("safety pin").

Epidemiology. A person becomes ill with plague after being bitten by a flea that previously sucked the blood of a sick rodent, or when processing the carcass of a sick animal. This usually results in the bubonic form of the plague. Infection from a sick person by aerogenic route is also possible, and the most severe pulmonary form of plague develops.

Pathomorphology and pathogenesis. The causative agents of plague, having entered the body of a flea with the blood of a sick animal, multiply in the digestive tract and clog the lumen of the anterior ventricle. When a flea bites a person, it regurgitates them, and the pathogens enter the lymphatic vessels of the skin, and then into the regional lymph nodes. In a severe form of bubonic plague, the lymph nodes lose their barrier function, and pathogens that have multiplied in them penetrate into the general bloodstream.

The primary form of pneumonic plague is caused by aerogenic infection from a sick person; it also develops in case of accidents during laboratory tests.

The reaction of tissues to the introduction of Y. pestis is manifested in their purulent melting.

Clinical manifestations. The incubation period for the bubonic form of plague is 2-6 days, and for the pulmonary form - 1-72 hours.

The bubonic form of plague begins acutely or subacutely. The first manifestations of the subacute form are an increase and compaction of one of the groups of lymph nodes and an increase in body temperature.

The acute form of bubonic plague, in addition to lymphadenitis, is manifested by high body temperature, tachycardia, myalgia. The disease progresses rapidly, there is a violation of consciousness, shock and death within 3-5 days.

The course of primary pneumonic plague is even more acute. The disease is manifested by nausea, vomiting, abdominal pain, bloody diarrhea, petechial rash or purpura.

Diagnosis. The diagnosis of sporadic cases of plague is based on a careful assessment of the history, physical examination findings, and the possibility of the disease.

Blood, sputum, purulent discharge and aspirate from enlarged lymph nodes should be examined bacterioscopically.

Treatment. Treatment with streptomycin for 5-10 days is indicated, under the influence of which a massive lysis of bacteria occurs, as a result of which reactive phenomena can be observed already at the beginning of treatment. After 2-3 days of treatment with streptomycin, tetracycline or levomycetin is additionally prescribed for 10 days. The bubonic form of plague responds well to treatment with tetracycline for 10 days or chloramphenicol.

Prevention. Primary immunization of adults and children over 11 years of age begins with a dose of 1 ml. After 4 weeks, the second dose is administered - 0,2 ml, and after another 6 months - the third (0,2 ml). In the future, three of the same doses are administered at 6-month intervals.

Author: Pavlova N.V.

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