Symptoms of plague

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

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

Regardless of the form of the disease, plague usually begins suddenly, and the symptoms of 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. The skin is hot, dry, the face is red and puffy, the sclera is injected, the conjunctiva and mucous membranes of the oropharynx are hyperemic, often with pinpoint hemorrhages, the tongue is dry, thickened, covered with a thick white coating ("chalky"). Later, in severe cases, the face becomes haggard, with a cyanotic tint, dark circles under the eyes. Facial features become sharper, an expression of suffering and horror appears ("plague mask"). As the disease progresses, consciousness is impaired, hallucinations, delirium, and agitation may develop. Speech becomes slurred; coordination of movements is impaired. The appearance and behavior of patients resemble a state of alcoholic intoxication. Arterial hypotension, tachycardia, dyspnea, cyanosis are characteristic. In severe cases of the disease, bleeding and vomiting with blood are possible. The liver and spleen are enlarged.

Oliguria is noted. The temperature remains constantly high for 3-10 days.

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

The cutaneous form of plague is rare (3-5%). At the site of the infection entry point, a spot appears, then a papule, a vesicle (phlyctena) filled with serous-hemorrhagic contents, surrounded by an infiltrated area with hyperemia and edema - these are typical symptoms of the cutaneous form of plague. Phlyctena is characterized by sharp pain. When it opens, an ulcer with a dark scab at the bottom is formed. The plague ulcer is characterized by a long course, heals slowly, forming a scar. If this form is complicated by septicemia, secondary pustules and ulcers appear. The development of a regional bubo (cutaneous-bubonic form) is possible.

The bubonic form of plague is the most common (about 80%) and is characterized by a relatively benign course. From the first days of the disease, sharp pain appears in the area of the regional lymph nodes, which makes movement difficult and forces the patient to take a forced position. The primary bubo is usually single, multiple buboes are observed less often. In most cases, the inguinal and femoral, somewhat less often the axillary and cervical lymph nodes are affected. The size of the bubo varies from a walnut to a medium-sized apple. Specific symptoms of this form of plague are sharp pain, dense consistency, fusion with underlying tissues, smoothing of the contours due to the development of periadenitis. The bubo begins to form on the second day of the disease. As it develops, the skin above it turns red, shines, often has a cyanotic tint. At first it is dense, then it softens, fluctuation appears, the contours become unclear. On the 10th-12th day of the disease, it opens up - a fistula and ulceration are formed. In the case of a benign course of the disease and modern antibiotic therapy, its resorption or sclerosis is observed. As a result of hematogenous introduction of the pathogen, secondary buboes can form, which appear later and are distinguished by insignificant sizes, less painfulness and, as a rule, do not suppurate. A formidable complication of this form can be the development of a secondary pulmonary or secondary septic form, which sharply worsens the patient's condition, up to a fatal outcome.

The primary pulmonary form of plague is rare, occurring in 5-10% of cases during epidemics, and is the most dangerous epidemiologically and severe clinical form of the disease. It begins acutely and violently. Against the background of a pronounced intoxication syndrome, the following plague symptoms appear from the first days: dry cough, severe shortness of breath, cutting pain in the chest. The cough then becomes productive, with the release of sputum, the amount of which can vary from a few spits to huge amounts, it is rarely absent altogether. The sputum, at first foamy, glassy, transparent, then acquires a bloody appearance, later becomes purely bloody, contains a huge number of plague bacteria. Usually it is of a liquid consistency - one of the diagnostic signs. Physical data are scanty: slight shortening of percussion sound over the affected lobe, scanty fine-bubble rales on auscultation, which clearly does not correspond to the general severe condition of the patient. The terminal period is characterized by increasing dyspnea, cyanosis, development of stupor, pulmonary edema and ISS. Arterial pressure drops, pulse quickens and becomes threadlike, heart sounds are muffled, hyperthermia is replaced by hypothermia. Without treatment, the disease is fatal within 2-6 days. With early use of antibiotics, the course of the disease is benign, differs little from pneumonia of other etiologies, as a result of which late recognition of the pulmonary form of plague and cases of the disease in the patient's environment are possible.

Plague of the primary septic form is rare - when a massive dose of the pathogen enters the body, most often by airborne droplets. It begins suddenly, pronounced intoxication phenomena and rapidly progressing clinical symptoms of plague appear: multiple hemorrhages on the skin and mucous membranes, bleeding from internal organs ("black plague", "black death"), mental disorders. Signs of cardiovascular failure progress. The patient dies within a few hours from ITS. There are no changes in the site of pathogen introduction and in the regional lymph nodes.

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

The secondary pulmonary form of 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 expressed by an increase in intoxication symptoms, the appearance of chest pain, coughing with subsequent release of bloody sputum. Physical data allow diagnosing lobular, less often pseudo-lobar pneumonia. The course of the disease during treatment can be benign, with a slow recovery. The addition of pneumonia to low-infectious forms of plague makes patients the most dangerous in epidemiological terms, so each such patient must be identified and isolated.

Some authors distinguish the intestinal form separately, but most clinicians tend to consider the intestinal symptoms of plague (sharp abdominal pain, profuse mucous-bloody stool, bloody vomiting) as manifestations of the primary or secondary septic form.

In repeated cases of the disease, as well as in plague in vaccinated or chemoprophylactic people, all symptoms begin and develop gradually and are tolerated more easily. In practice, such conditions are called "minor" or "ambulatory" plague.

Complications of plague

Specific complications are distinguished: ITS, cardiopulmonary failure, meningitis, thrombohemorrhagic syndrome, which lead to the death of patients, and non-specific complications caused by endogenous flora (phlegmon, erysipelas, pharyngitis, etc.), which are often observed against the background of an improvement in the condition.

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Mortality and causes of death

In the primary pulmonary and primary septic forms, the mortality rate without treatment reaches 100%, usually by the 5th day of the disease. In the bubonic form of plague, the mortality rate without treatment is 20-40%; this is due to the fact that severe symptoms of plague appear due to the development of the secondary pulmonary or secondary septic form of the disease.