Diagnosis of plague

Especially difficult for a first diagnosis of the disease. In the midst of an epidemic diagnosis is facilitated by the discovery of similar features with the already proven cases. Important epidemiological anamnesis (the presence of such diseases, hunting tarbasanu, contact with rodents and other). You need to use and laboratory methods.
Laboratory diagnostics. For research on the plague from sick people take punctat from buboes, the contents of pustules, and ulcers, sputum (pulmonary form) and blood. From the corpses of people who died from the plague, and rodents taking pieces organs (liver, spleen, lymph node), and from the decayed corpses, bone marrow (the piece tubular bones). Collected fleas are divided by types and, pounding in a mortar 50 - 100 fleas, investigate the obtained suspension.
From material prepared smears, dried, fixed them in ethanol or a mixture Nikiforova (10-20 minutes)and then painted by gram stain or blue Leffler. Detection of gram-negative bipolar painted sticks ovoid shape (Fig. 1) you can make a preliminary diagnosis of plague in the clinical and epidemiological data. The final diagnosis is based on the selection and identify the causative agent of plague.
For bacteriological examination produce a crop on agar of Hottinger with the addition of growth stimulants (blood, sodium sulfite, a stimulant Carnosine and others). In the study of the decayed corpse material and mucus to inhibit the growth of foreign microflora added to the agar gentian violet 1 : 100 000, boric acid (0,08-0,1% solution). If you suspect the presence of bacteriophage crops on agar make with anciferova serum, two drops of which are applied to the surface of the agar, pound a spatula, dried and do the sowing.
When growing crops when temperature 28 degrees during 12-24-48 hour. in positive cases, there is the initial growth of handkerchiefs" (Fig. 6), and then formed typical colonies (Fig. 2). Culture identified as P. pestis, if it is on agar forms a characteristic of the colony grows in the form of delicate flakes in broth, lidiruet pest bacteriophage at temperature 22 degrees, infected laboratory animals typical causes of pathological changes.
Be sure biological research material. The bioassays put it on Guinea pigs and white mice, which infect subcutaneously or intraperitoneally, and in the case of contamination of the material by other organisms through skalpirovaniya the skin.
Depending on the method of infected animals die from the plague through 3-9 days. The dead animals are marked hemorrhagic inflammation, bleeding.
In smears many plague Bacillus, the crops have abundant growth. Culture plague Bacillus easily differentiated from other pathogenic bacteria. Harder to distinguish them from pseudotuberculosis pathogen rodents. The latter has the mobility, not lidiruet pest bacteriophage to the title, ferments glycerin and rhamnose in the first day, virulent in an S-shape, not agglutinated anti-plague serum against faction I. Differentiation is done by a combination of traits.
A number of methods for rapid laboratory diagnosis of plague (using fluorescent antibodies, using a bacteriophage made on dense nutrient medium at the time of sowing, using alizarin suspension agglutinins and others).

Fig. 6. Initial growth of the colonies of the plague microbe (h).

Differential diagnosis. Unlike pulmonary plague, with lobar pneumonia objective data, especially auscultatory, consistently presented brighter and fuller. Herpes simplex typical for lobar pneumonia. In this disease flushing cheeks usually more pronounced on the side of the affected lung; such selectivity when plague pneumonia not. Changes of nervous, cardiovascular system during the plague pneumonia expressed sharply and appear sooner, and with lobar pneumonia are increasing more often to 4-5th day of illness.
Difficult for the differential diagnosis of cases of bronchopneumonia, especially severe flu-like. The most typical of pulmonary plague remains the clear predominance of the General symptoms of intoxication over the local signs of inflammation in the lungs. However, the data percussion and auscultation may be similar.
Pneumonic plague may be mixed with pulmonary form of anthrax due to severe General condition, pneumonia, selection, bloody sputum, shorts disease and frequency of death. Anthrax pneumonia characterized by clear catarrhal phenomena in the upper respiratory tract in the beginning of the illness (cough, hoarseness, watery eyes), relatively abundant data percussion and auscultation, epidemiological anamnesis. When skin form of anthrax localization on exposed parts of the body is observed more often than plague, typically no pain skin manifestations, additional eruption of vesicles around the scab and scab more dark, even black. Even more considerable, sometimes dramatic swelling and clear lymphangitis, but the overall reaction and the temperature is below. Regional lymphadenitis anthrax are rarer than plague, and the whole process in the future flows more easily.
When comparing tularemia buboes with a pest should be considered sharper contours of the first, less pain, and his relative rarity of peradenia, data analysis, blood, blood pressure, no dangerous complications and generally favorable clinical outcome (G. P. Rudnev). In endemic areas necessary bacterioscopic and bacteriological studies and animal infections. Skin ulcers with tularemia less painful, often with lymphangitis and less by the weight of the overall picture of the disease. Pneumonic tularemia differs easier for and generally favorable outcome. The Department? same bloody sputum may occasionally observed in patients with tularemia pneumonia.
For acute Sapa characterized by a moderate rise in temperature, rarely followed by chills. Typical also rhinitis, often one-sided. Inflammation of the pleura rarely found in patients sapnai pneumonia, in which phlegm, and if sometimes contains a mixture of blood, but less abundant and more viscous, dense. When Sapa characterized by pain in the bones, joints and muscles, frequent abscesses, sometimes deep and numerous; secondary skin rashes more numerous and polymorphic.
When banal acute suppurative lymphadenitis often there are limphangit and local swelling; frequent inflammatory processes in place, the entrance gate of the infection. The total state easier, temperature, below and no severe disorders of the cardiovascular and Central nervous system. For differential diagnosis should also account for venereal bubny, gidradenit, lymph glands tubercular character, sore throat Vincent, partiti, vulgar, furuncles, carbuncles, melodos, chlamydia, malaria, fever, meningitis and other