The clinical picture of plague

The incubation period from several hours to 10 days, usually 4-5 days. For all forms of plague characterized by acute onset of the disease (without prodrome), chills, rapid increase of temperature to 38-39 degrees and above, headache, fatigue. At very high temperatures possible violent delirium. When skin form of plague consistently develop: the papules, vesicles, pustules, and ulcers; possible carbuncle. When the bubonic form of plague increase cervical, submandibular axillary, more hip and inguinal lymph nodes; they are painful, up to size of chicken eggs and more. Bubny can dissolve, and to sklerozirovanie, nekrotizirovanne and even to break. Possible bilateral and multiple bubny. Prognostically more dangerous than the top (cervical) bubny, and axillary most often lead to lung metastases, i.e. secondary pneumonic plague, which is manifested by fever, cough, pneumonia emitting bloody sputum. In people exposed to sick, more likely to develop primary pneumonic plague is the most contagious and severe form. Most often characterized by bilateral lobar pneumonia with high temperature, toxicity, cough with bloody sputum, later delirium, riot, asphyxia, possible coma. Without treatment in 3-4 days - death in 100% of cases. In septic form of plague typical rich hemorrhages in the skin and mucous membranes, hematemesis, sputum, urine, and intestinal form - severe bloody diarrhea. All forms of plague occur very hard; the selection of patients are very contagious. The prognosis is usually heavy.
Diagnosis of plague is based on epidemiological anamnesis, clinical and laboratory data. Differentiate the plague with severe pneumonia and sepsis other etiology, low glanders, anthrax, tularemia, banal lymphadenitis and others, paying special attention to the history (visitors of the centres, hunters of rodents and so on). In laboratory diagnosis using microscopy, bacteriological and biological methods. The study are sputum, blood, urine, feces, punctat bubo and other Materials from patients with infected objects take strict precautions are in sterile glassware and with their full description (passport) delivered on separate transport to the laboratory.

Clinical presentation and course
The incubation period - from several hours up to 6 days, usually 3, rarely up to 8-10 days.
The disease begins suddenly, often with strong multiple chills; temperature rises rapidly to 38-39 degrees and above. Typical violent headache, flushing of the face and especially conjunctive, increasing General fatigue, muscle pain, possible vomiting. Language like "netart chalk", swell up, speech slurred. Because of the staggering gait, and slurred speech patients plague remind drunk. Heavier patients in delirium, restless.
In very severe patients later marked cyanosis, pointed facial features, sometimes the appearance of a pained expression, sometimes horror (facies pestica). Abruptly broken heart rate, its content, rhythm, frequency (120-160 beats and more in 1 minute), cardiac tone deaf, blood pressure progressively reduced. For the patients pulse rate can be characterized as pulsus frequens, often dicrotus, sometimes filiformis.
In addition to the General symptoms, signs, specific forms of plague.
According to the classification, P. Rudnev (1936), reflecting topico process and the degree of infektsionisti patients, plague is divided into a local form (usually with peripheral relatively scarce external dissemination): skin, bubonic, skin-bubonic; internal-disseminated and generalized forms: primary and secondary septic-septic; outwardly diseminarea form (Central, often with abundant external dissemination): primary-pulmonary, secondary-pulmonary and intestinal.
Clinical forms of plague in this classification are arranged in order of increasing their epidemiological importance. The exception is only the intestinal form, occurring very rarely. The most frequent are the bubonic form, rarely, pulmonary, the most rare and septic skin forms of plague.
When skin form, usually turning into a skin-bubonic, the skin on the rise: the spot, papules, vesicles, pustules, and ulcers.
However, all these steps are not mandatory. The pustules are filled with bloody content. Area of redness stands above the adjacent healthy skin (purple shaft). Carbuncle characteristic pain. When the pustule bursts, is a plague with yellowish infiltrated the bottom, then covered with dark scab. For ulcers typical duration of flow, slow healing with scar formation. But when any form of plague can be secondary manifestations on the skin; hemorrhagic and pustular rash, erythema, bullous education, etc. Can occur secondary carbuncles and pustules hematogenous Genesis.
Cardinal symptom bubonic form - bubo (Fig.5). In the place where it should appear, the patient feels a sharp pain that makes it difficult motion with his hand, foot, and so on Primary bubny first order usually develop during the first days of the disease. The timing of the emergence of secondary Bubnov (not mandatory) uncertain. Lymphangitis usually not. The most frequent bubny lower extremities (more than 55% of cases), then the axillary (15-20%), neck (5%), parotid, etc. Axillary bubny give metstaticski maximum complications secondary pulmonary plague and therefore especially dangerous. The skin over bubanee in the first period is not changed, later blush (soon cyanotic shade), stretches, shiny. In the first days of the disease bubo felt in the form of small seal, sharply painful.

Fig. 5. Plague femoral bubo.

Then lymph node swelling surrounding tissue sometimes swells. Seal at first as though the cartilage consistency, later becoming testovaty; then bubo found lots fluctuations. Perident when shumnom the bubo is constant, and the lack of clear contours buboes should be considered as very important for this form of plague sign. Outcomes buboes: complete resorption, pussy softening (sometimes, ulceration and formation of poorly healing fistula); hardening, often stable, long (so-called sclerosis).
When pitting buboes maybe in a future accession extensive adenilson. The juxtaposition of secondary infection occurs frequently, and healing comes slowly and with scar formation. Can meet multiple-plague bubny.
Typical temperature curve when the bubonic form of plague there. The height of the clinical symptoms observed in this form of plague for about 4-5 days of illness. When remitting of the process the patient's condition may deteriorate, mainly because of the complications that dramatically change the forecast.
From complications epidemiologically in the first place it is necessary to put the secondary pneumonic plague, which dramatically increases the overall picture of the disease. Clinically: fever, sharp stabbing pain in the chest, cough emitting bloody sputum, and rich content plague Bacillus, with percussion and auscultation diagnose lobular, rarely pseudoliberal, pneumonia. When recovery resolution comes slowly. When the bubonic form of plague may develop secondary septicaemic plague, especially in the most severe patients. Possible secondary plague meningitis, usually fatal. Possible and numerous non-specific complications.
Primary pulmonary plague. There are three main periods of the disease: initial feverish excitement, the height of the disease and Zaporozhye (terminal) with progressive shortness of breath, cyanosis, sometimes coma. Very dangerous second period with a maximum allocation of the plague Bacillus. Indicate more often sudden start - chills (sometimes sharp, repeated) with the rapid rise of temperature, severe head pain, repeated vomiting, later sharp chest pain, tachycardia, shortness of breath, often crazy even later, the prostration and, finally, coma, resulting in death. The amount of sputum vary; sometimes sputum not outstanding. Sputum first frothy, glassy, transparent, then bloody, later, as if pure bloody, usually a liquid consistence. In atypical cases of sputum may be rusty. Typical scarcity objectively identify local data that does not correspond to the very grave condition of the patient.
For the period of the midst of primary pulmonary plague characteristic total oppressed, then excitedly-nothing condition, high temperature, signs of pneumonia, a frequent cough, abundant Department bloody sputum, unclean deaf heart sounds, undue tachycardia, arrhythmia and often vomiting with some blood. Finally develops the spoor, increasing shortness of breath, his face becomes bluish. Strength of the patient fade, pulse quickens and becomes filiform. Some patients fall into coma, others are killed during the repeated attempts to get up and running. The disease lasts 3-5 days, rarely longer, and without treatment ends with death. Some patients before the temperature drops sharply.
Intestinal form described profuse diarrhea, sometimes with significant admixture in Calais blood and mucus; from faeces you can plant the culture of the pathogen. Defecation is accompanied by painful tenesmus, possible sharp pain in podlojecna area, nausea, repeated vomiting. All this is accompanied by fever, loss of appetite, severe weakness. Usually death occurs soon.
In primary septic form of plague typical multiple hemorrhages in the skin and mucous membranes. Heavy fever plague septicemia combined with bleeding from the kidneys, intestines and bloody vomiting. Typical fast generalization of the process, dissemination of the pathogen in the body, massive intoxication, early appearance and then the abundance of plague bacilli in the bloodstream. Septic form usually quickly leads to death.