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At the same time, there is an increase in other groups of lymph nodes - secondary buboes. The lymph nodes of the primary focus undergo softening, when they are punctured, purulent or hemorrhagic contents are obtained, the microscopic analysis of which reveals a large number of gram-negative rods with bipolar staining.

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In the absence of antibiotic therapy, suppurated lymph nodes are opened. Then there is a gradual healing of fistulas. The severity of the patient's condition gradually increases by the 4th-5th day, the temperature may be elevated, sometimes a high fever appears immediately, but at first the condition of the patients often remains generally satisfactory.
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However, at any time, the bubonic form of the plague can cause a generalization of the process and go into a secondary septic or secondary pulmonary form. In these cases, the condition of the patients very quickly becomes extremely severe. Symptoms of intoxication increase by the hour. The temperature after a severe chill rises to high febrile figures.
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All signs of sepsis are noted: muscle pain, severe weakness, headache, dizziness, congestion of consciousness, up to its loss, sometimes excitement (the patient rushes about in bed), insomnia. C developedcyanosis increases with pneumonia, a cough appears with the separation of foamy bloody sputum containing a huge amount of plague rods.

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It is this sputum that becomes the source of infection from person to person with the development of now primary pneumonic plague. Septic and pulmonary forms of plague proceed, like any severe sepsis, with manifestations of disseminated intravascular coagulation syndrome: small hemorrhages on the skin are possible, bleeding from the gastrointestinal tract (vomiting bloody masses, melena), severe tachycardia, rapid and requiring correction ( dopamine) drop in blood pressure. Auscultatory - a picture of bilateral focal pneumonia.

The clinical picture of the primary septic or primary pulmonary form is not fundamentally different from the secondary forms, but the primary forms often have a shorter incubation period - up to several hours.
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The most important role in the diagnosis in modern conditions is played by the epidemiological history. Arrival from plague-endemic zones (Vietnam, Burma, Bolivia, Ecuador, Karakalpakia, etc.), or from anti-plague stations of a patient with the signs of cialis pill form described above or with signs of the most severe - with hemorrhages and bloody sputum - pneumonia with severe lymphadenopathy is for a doctor of the first contact is a sufficiently serious argument for taking all measures to localize the alleged plague and its accurate diagnosis.

The material for them is the punctate of a festering lymph node, sputum, blood of the patient, discharge from fistulas and ulcers.
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It should be emphasized that in the conditions of modern medical prophylaxis, the probability of illness of personnel who have been in contact with a coughing plague patient for some time is very small. Currently, there are no cases of primary pneumonic plague (that is, cases of infection from person to person) among medical personnel. Establishing an accurate diagnosis must be carried out with the help of bacteriological studies.

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    Laboratory diagnostics is carried out using a fluorescent specific antiserum, which stains smears of discharge from ulcers, punctate of lymph nodes, culture obtained on blood agar.

    At the site of a flea bite or contact with an infected animal, a papule appears on the skin, which quickly ulcerates. Then a black scab and scar appear. Most often, skin manifestations are the first signs of more formidable manifestations of the plague.

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    The most common manifestation of the disease. An increase in lymph nodes appears near the site of an insect bite (inguinal, axillary, cervical).

    More often one lymph node becomes inflamed, less often - several. With inflammation of several lymph nodes at once, a painful bubo is formed. Initially, the lymph node is of a solid consistency, painful on palpation. Gradually, it softens, acquiring a pasty consistency.

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    Further, the lymph node either resolves or ulcerates and sclerosis. From the affected lymph node, the infection can enter the bloodstream, with the subsequent development of bacterial sepsis. The acute phase of the bubonic form of plague lasts about a week.

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In the photo, the affected cervical lymph nodes (buboes). Multiple hemorrhages of the skin.

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In the photo, the bubonic form of the plague is a lesion of the cervical lymph nodes. Multiple hemorrhages in the skin. When the pathogen enters the bloodstream, widespread (generalized) forms of plague develop.

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    If the infection, bypassing the lymph nodes, immediately enters the bloodstream, then the primary septic form of the disease develops. Intoxication develops with lightning speed.

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    With the massive reproduction of pathogens in the patient's body, a huge number of inflammatory mediators are produced.

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    This leads to the development of disseminated intravascular coagulation syndrome (DIC), in which all internal organs are affected. Of particular danger to the body are hemorrhages in the heart muscle and adrenal glands.

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    The developed infectious-toxic shock causes the death of the patient.

Secondary septic form of the disease.
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