Causes, symptoms and treatment of plague
Different forms of plague – bubonic, dermal, as well as skin-bubonic, must be distinguished from such diseases as tularemia, lymphadenopathy, and carbuncles. A septic and pulmonary form may have symptoms resembling lung diseases, sepsis, and meningococcal etiology.
All forms of the plague are characterized by severe intoxication, the progressive signs of which appear at the very beginning of the disease. At the person the temperature rises, there is a chill, it tears, thirst searches. Also alarming are psychomotor agitation, anxiety, hallucinations and nonsense. When you look at it, you can see indistinct speech, an uncertain gait, the face becomes puffy, an expression of suffering and horror appears on it, and the language is white. Cardiovascular insufficiency, oliguria, tachypnea.
Cutaneous and bubonic forms of the plague can be identified by sharp soreness in the affected areas, it is easy to determine the stages of development of carbuncle (first pustule, then ulcer, then – black scab and scar) , periadenitis is observed in the formation of the bubon.
The pulmonary and septic forms are accompanied by extremely rapid development of intoxication, as well as manifestations of hemorrhagic syndrome and infectious-toxic shock. The defeat of the lungs is accompanied by a sharp pain in the chest and a severe cough with a vitreous, and after a frothy sputum with blood. The physical data often do not correspond to the appreciable severe condition of the patient.
This type of diagnosis is based on the use of biological and microbiological, immunoserological and genetic methods. The hemogram shows leukocytosis and neutrophilia with a shift to the left, and an increase in ESR. The causative agent is isolated in the specialized specialized laboratories, created specifically to work with the causative agents of the most dangerous infections. Studies are conducted to confirm clinically expressed cases of plague, and examine people who are in the source of infection, and their body temperature is higher than normal. Material taken from plague patients or those who die from this disease is subjected to bacteriological analysis. Of carbuncles and buboes take punctate, also investigate the separation of ulcers, phlegm, mucus and blood. Experiments are carried out with laboratory animals that can survive for about 7 days after infection with the plague.
As for serological methods, they use RNAG, RNGA, RNAT, RTPGA, ELISA. If PCR gives a positive result, then 6 hours after staging it is possible to talk about the presence of the DNA of the plague microbe and confirm the preliminary diagnosis. To finally confirm the presence of plague etiology, isolate the pure culture of the pathogen and identify it.
Treatment of the plague
Patients can be treated exclusively in a hospital setting. Drugs for etiotropic therapy, their doses, and treatment regimens are determined depending on the form of the disease. Usually the course of therapy is from 7 to 10 days, regardless of the form of the disease. The following drugs are used:
cutaneous form – cotrimoxazole (4 tablets per day).
bubonic form – levomycetin (dose : 80 mg / kg per day) and simultaneously use streptomycin (dose: 50 mg / kg per day). The drugs are administered intravenously. The effectiveness of tetracycline has been noted. Pulmonary and septic forms – a combination of levomycetin with streptomycin + doxycycline (dose: 0.3 grams per day) or tetracycline (4-6 g / day), are taken orally. In addition, massive disintoxication therapy is carried out: albumin, fresh frozen plasma, reopolyglucin, crystalloid solutions intravenously, hemodez, extracorporeal detoxification methods. Appointed drugs that improve microcirculation: picamylon, trental in combination with solcoseryl. Forcing diuresis, cardiac glycosides, as well as respiratory and vascular analeptics, symptomatic and antipyretic drugs.
As a rule, the success of the treatment depends on the timing of the therapy. Etiotropic drugs are usually prescribed at the first suspicions of plague, based on clinical epidemiological data.
Prevention of plague
Forecast of epidemic and epizootic situation in individual natural foci determines the nature, direction and scope of measures for the prevention of the disease. This takes into account the data obtained from monitoring the increase in the number of plague-infected people around the world. All countries should report to the WHO on cases of plague, infection, epizootics among animals, and on measures taken to combat the disease. Usually a passport system is being developed in the country, fixing the natural foci of plague and
The leading role in the complex of preventive measures is performed by measures that prevent the import of infection from other countries, as well as preventing the development of plague in the enzootic foci . In order to avoid importation of the infection, international sanitary regulations have been created. And in the enzootic foci, the number and species composition of the rodents are monitored, and animal studies are conducted to identify infection. If an epizootic was discovered, then deratization and various disinfestations are carried out. Sinanthropic rodents are exterminated without detection of infected individuals, if among those trapped, infected more than 15%. Rodents and ectoparasites on the plains and near human settlements destroy special antiplague ones, and in the settlements themselves – the departments of the Center for Sanitary and Epidemiological Surveillance.
If plague epizootics are seen in rodents or cases have been identified among domestic animals, and , if the importation of infection by an infected person is probable, prophylactic immunization of the population is carried out. Vaccination can be carried out in whole or selectively – to individuals who have a connection with those territories where there is an epizootic (hunters, agronomists, geologists, archaeologists). In all medical and preventive institutions there should be a supply of medicines, as well as remedies and preventive measures, and it is necessary to develop a scheme for transmitting information and alerting the personnel. Preventive measures in the enzootic areas, as well as for people who are in contact with the causative agents of dangerous infections, are carried out by various antiplague and many other health facilities.
Activities in the epidemic focus
If it was identified case of plague, or there is a suspicion that a person is a carrier of the infection, urgent measures must be taken to localize and eliminate the focus. Based on the epidemiological or epizootological situation determine the size of the territory on which it is necessary to introduce restrictive measures – quarantine. Also take into account the possible factors by which infection can be transmitted, sanitary conditions, the number of migrants and transport connections with nearby territories.
Supervises activities in the area of the foci of infection Emergency antiepidemic commission. Strictly adhere to the anti-epidemic regime, commission staff must use protective suits. The Extraordinary Commission makes a decision on the introduction of quarantine throughout the site of the outbreak.
Specialized hospitals are created for plague patients and those with suspicious symptoms. Transport infected people in a strictly defined manner, according to the current sanitary rules for biological safety. Infected with bubonic plague can be placed on several people in one ward, and patients with pulmonary form need to be distributed to individual rooms. To write out the person who has transferred bubonic plague, is authorized not less than in 4 weeks from the moment of clinical convalescence (presence of negative results of bacteriological analyzes). With pulmonary plague, a person must stay in the hospital after recovery for at least 6 weeks. After the patient leaves the hospital, he is followed up for 3 months.
The focus of infection is carefully disinfected (current and final). Those persons who have come into contact with infected people, their belongings, corpses, as well as the participants in the slaughter of sick animals are segregated for 6 days and are subject to medical supervision. In the case of pulmonary plague, individual isolation for 6 days of all individuals who may have been infected and provide them with a prophylactic antibiotic (rifampicin, streptomycin and the like) is necessary.