Symptoms of the plague

The plague has an incubation period that lasts from several hours to 9 days or more (an average of 2-4 days), contracting in the primary pulmonary form and extending to vaccinated or receiving preventive drugs, after which the typical symptoms of plague appear.

Plague is divided into: localized (cutaneous, bubonic, dermal-bubonic) and generalized forms) primary-septic, primary-pulmonary, secondary-septic, secondary-pulmonary and intestinal).

Regardless of the form of the disease, the plague usually begins suddenly, and the symptoms of the plague from the first days of the disease are characterized by a pronounced intoxication syndrome: chills, high fever (> 39 ° C), severe weakness, headache, body aches, thirst, nausea and sometimes vomiting. Skin hot, dry, red face puffy, sclera injected, conjunctiva and mucous membranes of the oropharynx hyperemic, often with pinpoint hemorrhages, tongue dry, thickened, covered with thick white coating ("chalk" shade, dark circles under the eyes. The facial features are sharpened, an expression of suffering and horror appears ("plague mask"). As the disease develops, consciousness breaks down, hallucinations, delusions, and excitement can develop. Speech becomes vague; coordination of movements is disrupted. Appearance and behavior of patients resemble the state of alcoholic intoxication. Characterized by arterial hypotension, tachycardia, dyspnea, cyanosis. In severe disease, bleeding may occur, vomiting with an admixture of blood. The liver and spleen are enlarged.

Mark oliguria. The temperature remains constantly high for 3-10 days.

In peripheral blood - neutrophilic leukocytosis with a shift of the formula to the left. In addition to the described common manifestations of the plague, develop lesions that are characteristic of individual clinical forms of the disease.

The cutaneous form of the plague is rare (3-5%). At the entrance gate of the infection, a spot appears, then the papule, vesicle (flicten), filled with serous-hemorrhagic contents, surrounded by an infiltrated zone with hyperemia and edema are typical symptoms of dermal plague. Fliktena is marked by a sharp pain. When it is opened, an ulcer with a dark scab on the bottom is formed. The plague is distinguished by a long course, heals slowly, forming a scar. If this form is complicated by septicemia, secondary pustules and ulcers occur. It is possible to develop a regional bubo (skin-bubonic form).

The bubonic form of the plague is most often encountered (about 80%) and differs in the relative goodness of the flow. From the first days of illness in the region of regional lymph nodes there is a sharp soreness, which makes it difficult to move and causes the patient to take a forced position. Primary bubo, as a rule, is single, fewer buboes are observed less often. In most cases, inguinal and femoral, somewhat less often axillary and cervical lymph nodes are affected. The sizes of a bubo vary from a walnut to an apple of the average sizes. Specific symptoms of plague of this form - sharp soreness, dense consistency, adhesion to underlying tissues, smooth contours due to the development of periadenitis. Bubon begins to form on the second day of the disease. As the development of the skin over him blushes, shines, often has a cyanotic shade. In the beginning it is dense, then its softening occurs, there is a fluctuation, the contours become fuzzy. On the 10-12th day of the disease, it is opened - a fistula is formed, ulceration. In the benign course of the disease and modern antibiotic therapy, its resorption or sclerosis is observed. As a result of hematogenous drift of the causative agent, secondary buboes can be formed, which appear later and differ in small sizes, less painful and, as a rule, do not get inflamed. A formidable complication of this form may be the development of secondary pulmonary or secondary septic form, which sharply worsens the patient's condition, up to a lethal outcome.

Primary pulmonary form of the plague is rare, in epidemics in 5-10% of cases and represents the most dangerous epidemiological and severe clinical form of the disease. It begins sharply, roughly. Against the backdrop of a pronounced intoxication syndrome, from the first days there are such symptoms of plague as: dry cough, severe shortness of breath, cutting pains in the chest. The cough then becomes productive, with sputum secretion, the amount of which can range from several spittles to huge amounts, it is seldom absent at all. Sputum, initially frothy, vitreous, transparent, then acquires a bloody appearance, later becomes purely bloody, contains a huge number of plague bacteria. Usually it is a liquid consistency - one of the diagnostic features. The physical data are meager: a slight shortening of the percussion sound over the affected lobe, with auscultation, uneventful small bubbling rales, which clearly does not correspond to the general severe condition of the patient. The terminal period is characterized by an increase in dyspnea, cyanosis, the development of sopor, pulmonary edema and ITSH. The arthritic pressure drops, the pulse becomes fast and becomes filiform, the heart sounds deaf, hyperthermia is replaced by hypothermia. In the absence of treatment, the disease ends lethally within 2-6 days. With the early use of antibiotics, the course of the disease is benign, differs little from the pneumonia of another etiology, as a result of which the later recognition of the pulmonary form of the plague and the cases of the disease in the patient's environment are possible.

The plague of the primary-septic form is rare - when a massive dose of the pathogen enters the body, more often by airborne droplets. It begins suddenly, there are pronounced intoxication phenomena and rapidly progressing clinical symptoms of plague: multiple hemorrhages on the skin and mucous membranes, bleeding from internal organs ("black plague", "black death"), mental disorders. Progress signs of cardiovascular failure. Death of the patient comes in a few hours from the ITH. Changes in the site of the pathogen and in the regional lymph nodes are absent.

The second-septic plague complicates other clinical forms of infection, usually bubonic. The generalization of the process significantly worsens the general condition of the patient and increases his epidemiological danger to others. Symptoms of plague are similar to the above described clinical picture, but differ in the presence of secondary buboes and longer flow. With this form of the disease, secondary plague meningitis often develops.

The secondary-pulmonary form of the plague as a complication occurs in localized forms of plague in 5-10% of cases and sharply worsens the overall picture of the disease. Objectively, this is manifested by an increase in the symptoms of intoxication, the appearance of pain in the chest, a cough and the subsequent release of bloody sputum. The physical data allow to diagnose lobular, less often pseudoblury pneumonia. The course of the disease during treatment can be benign, with a slow recovery. The adherence of pneumonia to mildly infectious forms of plague makes the patients the most dangerous in the epidemiological sense, therefore each such patient must be identified and isolated.

Some authors separate the intestinal form, but most clinicians tend to treat the intestinal symptoms of plague (abdominal pains, mucocutaneous plentiful stools, bloody vomiting) as manifestations of the primary or secondary septic form.

In case of repeated cases of the disease, as well as in case of plague in vaccinated or chemoprophylaxis-treated people, all the symptoms begin and develop gradually and are transferred more easily. In practice, such states were called "small", or "outpatient", plague.

Complications of the plague

Isolate specific complications: ITSH, cardiopulmonary insufficiency, meningitis, thrombohemorrhagic syndrome, which lead to the death of patients, and nonspecific, caused by endogenous flora (phlegmon, erysipelas, pharyngitis, etc.), which is often observed against the background of improvement.

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Mortality and causes of death

With primary-pulmonary and primary-septic form without treatment, lethality reaches 100%, more often by the 5th day of the disease. With the bubonic form of plague, the lethality without treatment is 20-40%; this is due to the fact that severe symptoms of plague appear, due to the development of a secondary-pulmonary or secondary-septic form of the disease.