Plague – Potentially Severe Infectious
disease caused by a plague bacillus pathogenic for humans and
animals. Before the invention of antibiotics, the disease caused a very
high mortality rates and in medieval Europe are irrevocably
changed the social and economic structure of society.
The plague left an indelible gloomy footprint in
the history of mankind, and not without reason among many nations she
associated with death. Even a summary of the transferred
unhappiness may take several volumes, but history has
The sources of the ancient time indicate that the disease was
known in North Africa and the Middle East. Supposed to
what exactly is it described in the biblical book of Kings as a mor. But
undisputed evidence of her early existence – DNA analysis
people of the Bronze Age, confirming the presence of the plague wand in
Asia and Europe between 3 thousand and 800 years BC. Unfortunately,
the nature of these flashes cannot be verified.
In the time of Justinian
The first reliably confirmed pandemic occurred in the period
of the Byzantine Emperor Justinian in the 6th century
According to the historian Procopius and other sources, flash
started in Egypt and moved along the sea trade routes, hitting
Constantinople in 542. There in a short time the disease took
tens of thousands of lives, and the death rate grew so fast that the authorities
having trouble getting rid of corpses.
Judging by the descriptions of symptoms and modes of transmission of the disease, it is quite
probably all forms of the plague raged in Constantinople
at the same time. Over the next 50 years, the pandemic spread
to the west in the port cities of the Mediterranean and to the east to Persia.
Christian authors, for example, John of Ephesus, considered the cause
the wrath of God’s epidemic, and modern researchers are confident that
it was caused by rats (immutable passengers of ships) and
unsanitary conditions of life of that era.
Black Death of Europe
The next pandemic covered Europe in the 14th century and was even worse
previous. The death toll has reached, according to various sources, from 2/3 to ¾
population in affected countries. Есть данные, что во
the time of the black death died about 25 million
человек, хотя определение точного количества сейчас
is impossible. Plague, as last time, brought merchants to
ships. Researchers suggest that in the southern ports of the current
France and Italy, the branch fell from the Genoese colonies of Crimea,
having spread from Central Asia.
The consequences of this disaster not only left an imprint on
religious and mystical features of the Europeans worldview, but also
led to a change in the socio-economic structure.
The peasants who formed the main labor force became critically
few. To maintain the previous level of life it took an increase
labor productivity and changes in the technological structure. This
the need has triggered the development of capitalist
relations in feudal society.
Great Plague of London
Over the next three centuries, small foci of disease
were observed throughout the continent from the British Isles to Russia.
Another epidemic broke out in London in 1664–1666. Number
deaths are expected between 75 and 100 thousand people.
The plague was spreading rapidly:
- in 1666–1670 – in Cologne and across the Rhine Valley;
- in 1667—1669 – in the Netherlands;
- in 1675−1684 – in Poland, Hungary, Austria, Germany, Turkey and
Briefly about the losses: in Malta – 11 thousand people died, in Vienna –
76 thousand, in Prague – 83 thousand. By the end of the seventeenth century, the epidemic had become
gradually fade away. The last flash was in the port city
Marseilles in 1720, where 40 thousand people were killed. After this disease
not recorded in Europe (with the exception of the Caucasus).
The retreat of a pandemic can be explained by the progress in
sanitation and quarantine measures, fighting rats as
carriers of the plague, the abandonment of the old trade routes. During
outbreaks in Europe the causes of the disease were not well understood with
medical point of view. In 1768 the first edition of the British
Encyclopedias published common among contemporaries
scientific opinion about the occurrence of plague fever from “poisonous
miasms “or vapors brought from eastern countries with air.
The best treatment was considered the expulsion of “poison”
which was achieved by either natural rupture of tumors,
or, if necessary, their incision and drainage.
Other recommended means were:
- bowel cleansing.
During the XVIII and early XIX centuries. the plague was fixed in
countries of the Middle East and North Africa, and in the years 1815−1836.
appears in India. But это были только первые искры уже новой
Last in new time
Moving through the Himalayas and gaining momentum in the Chinese
Yunnan Province, in 1894, the plague reached Guangzhou and Hong Kong. These
port cities have become the distribution centers of the new epidemic,
which by 1922 was imported by sea by courts around the world –
more widely than in any previous era. As a result
killed about 10 million people from various cities and
- Cape Town
- San Francisco.
- Guayaquil (Ecuador).
- Colombo (Sri Lanka).
- Pensacola, FL
Almost all European ports were hit, but from the affected
regions of India was in the most terrible situation. Only by the end
XIX in microbial theory got its development, and it was finally
it is determined which pathogen is guilty of so many
deaths It remains only to determine how the bacillus
infects a person. It has long been observed that in many areas
epidemics unusual death of rats precedes outbreaks of the plague. Disease
people appeared some time later.
In 1897, the Japanese doctor Ogata Masanori, investigating the focus
diseases on the island of Pharmaza, proved that the plague bacillus carry
rats. The following year, Frenchman Paul-Louis Simon demonstrated
the results of experiments that showed that in a population of rats
plague carriers are fleas of the species Xenopsylla cheopis. So were
finally described ways of infecting people.
Since then, the world began to carry out activities to destroy
rats in ports and ships, and insecticides used to
harassment of rodents in areas of outbreaks of infection. Since the 1930s
the doctors for the treatment of the population appeared sulfur-containing drugs,
and later – antibiotics. The effectiveness of the measures taken says
reducing the number of deaths over the next decades.
Plague is one of the deadliest diseases in history.
of humanity. The human body is extremely susceptible to illness,
infection can occur both directly and indirectly.
A defeated plague can appear after decades of silence with more
greater epidemic potential and significantly affect
population of entire regions. Due to the easy spread of it,
along with anthrax, botulism, smallpox, tularemia and viral
hemorrhagic fevers (Ebola and Marburg) are included in group A
Ways of infection
The causative agent of the plague – Y. Pestis, fixed rod-shaped
anaerobic bacterium with bipolar staining capable
produce antiphagocytic mucosa. Most
- Yersinia pseudotuberculosis – pathogen
- Yersinia enterocolitica – pathogen
Resistance to the external environment of the plague pathogen is not high.
Drying, sunlight, competition with putrefactive germs
kill him. Minute boiling sticks in water leads to her
doom But она способна выжить на влажном белье, одежде с мокротой,
pus and blood, long term stored in water and food
In the wild and in the countryside, most
distribution of Y. Pestis accounts for transmission between rodents and
fleas. In cities, the main carriers are synanthropic
грызуны, в первую очередь серые и коричневые rats.
The plague wand easily migrates from the urban environment to nature and
back. As a rule, it is transmitted to humans through bites.
infected fleas. But также есть сведения о более чем 200 видах
mammals (including dogs and cats) capable of being carriers
sticks. Half of them are rodents and lagomorphs.
Поэтому главными правилами поведения на территориях
The risk of an outbreak will be:
- exclusion of contact with wild animals;
- caution when feeding rodents and rabbits.
Pathogenesis and forms of the disease
The plague bacillus is remarkably stable and strong.
the ability to multiply in the tissues of the carrier and bring it to
of death. After entering the human body, Y. Pestis migrates along
lymphatic system to lymph nodes. There the bacillus begins
produce proteins that disrupt the inflammatory reactions,
blocking the fight of macrophages with infection.
Thus, the host’s immune response
weakened, bacteria quickly colonize lymph nodes,
causing painful swelling, and ultimately destroys the affected tissue.
Sometimes they enter the bloodstream, which leads to infection of the blood.
For pathological and anatomical studies of their accumulation
found in the following organs:
- in the lymph nodes;
- in the bone marrow;
- the liver.
Заболевание in person имеет три клинические формы: бубонную,
pulmonary and septic. Pandemics most often cause the first two.
Bubonic without treatment becomes septic or pulmonary.
Clinical manifestations for these three types look
- Bubonic plague. Most известная форма в
popular knowledge, and not without reason – it is about three
quarters of all cases of plague. It is the most harmless form: in
modern statistics lethality of outcomes is negligible, and in the past
killed only half of their victims. Typically, incubation
the period is two to six days after infection. Then
the disease manifests itself with chills, vomiting, headache and
dizziness, photophobia, back pain, apathy or even
nonsense. Most характерные признаки — последующее появление
one or two swollen lymph nodes (or buboes) are usually
under mice and groin. The temperature quickly rises to 40 ° C or
above, then slightly falls on the second or third day amid
pronounced loss of strength. This форма чумы не передаётся от человека к
man without intermediaries (rodents or fleas).
- Pneumonic plague. Characterized by wide grip
human bacilli. Physical manifestations are bright and
resemble severe pneumonia: fever, weakness, shortness of breath,
high fever followed by pulmonary edema. Death happens
surely within two or three days if not organized
timely treatment. Other manifestations include: stupor, wobbly
gait, speech disorders, memory loss. Extreme pneumonia
contagious and can be transmitted from person to person in droplets
when coughing or sneezing.
- Septic plague Симптомы in person могут быть аналогичны
those that are observed in other fevers: tularemia, dengue. AT
in the case of septic plague, the bloodstream is so strongly affected by Y.
Pestis, that death can occur even before manifestations of bubonic or
pulmonary form. By itself, it may occur or as
complication of bubonic plague, or as a result of an infected bite
Treatment and prognosis
AT момент, когда диагноз чумы заunderозрен на клинических и
epidemiological grounds, appropriate samples for
diagnostics should be obtained immediately. Antibacterial
therapy is prescribed without waiting for a response from the laboratory.
Suspicious patients with signs of pneumonia are isolated and treated with
precautions against airborne contamination.
Most применимые схемы:
- Aminoglycosides: streptomycin and gentamicin.
Streptomycin is the most effective antibiotic against Y.
Pestis and the drug of choice for the treatment of plague (especially
pneumonic form). Therapeutic effect can be expected with 30
mg / kg / day (up to 2 g / day) in divided doses, administered
intramuscularly. To continue the course of the drug is administered for 10
days after initiation of therapy or up to 3 days after return
temperature to normal values.
- Хлорамфеникол — underходящая альтернатива аминогликозидам при
treatment of bubonic and septic plague and is the drug of choice
for treating patients with invasion of Y. Pestis into tissue
spaces in which other drugs do not pass or pass
poor (for example, plague meningitis, pleurisy or endophthalmitis).
The dosage should be 50 mg / kg / for 10 days. Can
used in conjunction with aminoglycosides.
- Tetracyclines. These антибиотики являются
bacteriostatic, but quite effective in primary
treatment of patients with simple plague. Single dose
oral administration – 15 mg / kg of tetracycline (not more than 1 g), for
the course – 25-50 mg / kg / day for 10 days. Tetracyclines
Can also be used with other antibiotics.
- Sulfonamides are widely used to treat this.
diseases, however in some studies more
high mortality, an increase in the number of complications and more
prolonged fever compared with previous drugs
groups. Sulfadimezin is administered in the form of a loading dose of 2-4 g, then
dose of 1 g every 4-6 hours for 10 days. Children have stress
the dose is 75 mg / kg, then 150 mg / kg / day, orally in six
doses. The combined drug trimethoprim-sulfamethoxazole
used in both the treatment and prevention of plague.
Other classes of antibiotics (penicillins, cephalosporins,
macrolides) have varying success in treating this disease. Their
application is ineffective and doubtful. AT ходе терапии необходимо
provide for the possibility of complications in the form of sepsis.
In the absence of medical care, forecasts are not
- pulmonary form – mortality rate of 100%;
- bubonic – from 50 to 60%;
- septic – 100%.
Preparations for children and pregnant women
With proper and early treatment, complications can be prevented.
plague during pregnancy. AT этом случае выбор
antibiotics is based on the analysis of the side effects of the most
- streptomycin may be ototoxic and
nephrotoxic to the fetus;
- tetracycline has an adverse effect on development
- chloramphenicol carries a low risk of “gray baby” syndrome or
underавления костного мозга.
Experience has shown that competently assigned aminoglycoside is the most
effective and safe for both mother and fetus. Him
It is recommended to use for the treatment of children. Because of the relative
safety, intravenous and intramuscular administration
gentamicin is the preferred antibiotic for treating children
and pregnant women.
Persons who are in personal contact with patients with pneumonia or
лица, которые, вероятно, underвергались воздействию блох,
infected with Y. Pestis, had direct contact with fluids
организма или тканями заражённого млекопитающего или underверглись
infection during laboratory studies of infectious
materials must undergo antibacterial prophylactic
therapy in case the contact took place in the previous 6 days.
Preferred antimicrobial agents for this purpose
are tetracycline, chloramphenicol or one of the effective
Antibiotic administration before infection may be indicated in those
cases where people must be in short periods
areas affected by plague. This also applies to
stay in conditions where infection is difficult or impossible
Hospital precautions include quarantine
Regime for all diseased plague. To them
- prescribed washing procedures
- wearing latex gloves;
- use of a medical mask;
- protection of the mucous membranes of the eyes, nose and mouth during procedures,
which can cause excretion of body fluids of the patient.
In addition, a patient with suspected pneumonic plague infection
must be in a separate room and treated with measures
precautions regarding the possibility of contamination of personnel
by airborne droplets. In addition to these, they include
restriction of patient’s movement outside the room as well
mandatory wearing a mask in the presence of others.
Around the world, live attenuated and formalin-killed Y vaccines.
Pestis are differently available for use. They differ
immunogenic and moderately high reactivity. Important
Be aware that they do not protect against primary pneumonia. Generally
vaccination of communities from epizootic effects is not
In addition, this measure is little used during plague outbreaks.
human because the development of a protective immune response
It takes a month or more. The vaccine is shown to people directly
in contact with the bacterium. These may be employees.
research laboratories or persons studying infected
This disease (Pestis carnivorum) is known among home
dogs called distemper and not related to Y. Pestis. It
manifested lesion of the central nervous system, inflammation
mucous membranes of the eyes and respiratory tract. Unlike the plague
human has a viral nature.
Now the plague of carnivores
recorded among domestic, wild and industrial animals
breeding in all countries of the world. Economic damage is expressed in
losses from culling and slaughter, reducing the volume and quality of fur,
costs of preventive measures, violation
technological process of growing.
The disease is caused by an RNA-containing virus of 115–160 nm in size from
Paramyxoviridae family. To him are susceptible dogs, foxes, foxes,
Ussuri raccoons, otters, jackals, hyenas and wolves. For different types
animal pathogenicity of the virus is different – from the hidden asymptomatic
course of the disease to acute with 100% mortality. Most
ferrets are sensitive to it. The plague carnivorous virus is very
virulent, but not dangerous for humans.
Currently, the plague is a disease whose symptoms are good.
studied. Its foci remained in the wild and conserved in
permanent habitat of rodents. Modern statistics
such is: in the whole world in one year approximately up to 3 thousand people
in contact with this disease and about 200 of them die.
Most cases occur in Central Asia and Africa.