This disease was recorded as early as 2000 years ago. There were three pandemics in the world. The first time it happened in the 6th century AD, it was introduced to Europe from the Mediterranean region, causing nearly 654.38 billion deaths. The second time occurred in14th century, and spread to Europe, Asia and Africa. The third time was in18th century, which affected 32 countries. /kloc-The epidemic was introduced into China in the 4th century. 1793, the book Dead Mouse written by Shi Daonan in Yunnan described that "the mouse died in a few days, and people died like jam". It fully shows that it was very popular in China at that time. After liberation, human plague has been basically eliminated in China, but natural foci still exist. Hegemonists have listed Yersinia pestis as one of the biological warfare agents, so the prevention and control of plague is still of great significance to China's national defense and construction.
[etiology]
Yersinia pestis belongs to Yersinia. Gram-negative Bacillus pumilus, about 1 ~ 1.5 μ m long, about 0.5 ~ 0.7 μ m wide, with deep staining at both ends. No flagella, no activity, no spore formation. There are capsules in animals and early cultures. Can grow on flexible medium. It is polymorphic in old culture medium and suppurative lesions.
The antigenic components of this strain: ① capsular FI (component I) antigen, which is divided into two types, one is polysaccharide protein (F-I) and the other is protein (F-IB). Strong antigenicity, high specificity, phagocytosis of white blood cells, can be detected by agglutination, complement binding or indirect hemagglutination; ② Virulence V/W antigen, on the cell surface, V antigen is protein, which can make the body produce protective antibody, while W antigen is lipoprotein, which cannot make the body produce protective force. V/W antigen conjugate can promote the formation of capsule, inhibit phagocytosis and protect the growth and reproduction of bacteria in cells, so it is related to bacterial invasion.
Yersinia pestis produces two kinds of toxins, one is mouse toxin or exotoxin (toxic protein), which is very toxic to mice and rats, and the other is endotoxin (lipopolysaccharide), which is more toxic than other gram-negative bacteria and can cause fever, Dic, hemolysis of tissues and organs, toxic shock, local and systemic Shwartzman reaction.
Yersinia pestis can survive 10 ~ 20 days in purulent sputum, weeks to months in corpse and more than 1 month in flea feces. Very sensitive to light, heat, drying and general disinfectants. Death will occur after 4-5 hours of direct sunlight, and heating at 55℃ 15 minutes or 100℃ 1 minute, 5% carbolic acid, 5% lysol, 0. 1 mercuric chloride and 5 ~1minute.
[epidemiology]
(1) Infectious plague is a typical natural focus disease, which generally spreads from mouse to mouse and then from human to human. The infectious sources (storage hosts) of plague among rats are wild rats, gophers, foxes, wolves, cats and leopards, among which house rats and marmots are the most important. Rattus flavipectus, Rattus norvegicus and Rattus norvegicus are important sources of human plague infection. All types of patients can be the source of infection, and pneumonic plague is the most important. Blood in the early stage of septic plague is contagious. The bubonic plague only acts as a source of infection after the abscess breaks or when it is eaten by fleas.
(2) Transmission route The spread of plague between animals and people is mainly carried out by rats and fleas. When rat fleas suck the blood of mice containing germs, bacteria multiply in the stomach of fleas, forming bacterial plugs to block the front stomach. When the flea sucks blood again, the bacteria vomit with the sucked blood and are injected into animals or human bodies. Flea feces also contain Yersinia pestis, which can enter the skin due to itching. This "rat → flea → human" mode of transmission is the main mode of transmission of plague.
A few people can be infected by contact with the sputum and pus of patients or the skin, blood and meat of sick animals through damaged skin or mucosa.
Pneumonic plague patients can spread through droplets, leading to human pneumonic plague epidemic.
(III) Population Susceptibility People are generally susceptible to plague, regardless of gender or age. You can gain lasting immunity after illness. Vaccination can give you some immunity.
(4) epidemic characteristics
1. Plague natural foci There are many natural foci all over the world, and the plague of wild rats has existed for a long time. Human plague is mostly transmitted from wild rats to domestic rats and from domestic rats to humans. I am occasionally infected by hunting (catching marmots), investigation, construction and military activities.
2. The epidemic situation is mostly spread by vehicles in epidemic areas, forming exogenous plague, resulting in epidemic situation and epidemic situation.
3. The seasonality is related to the activities of rodents and the reproduction of rat fleas. Human plague usually occurs from June to September. Pneumonic plague was prevalent after 10 months.
4. Hidden infection was found in the epidemic area of asymptomatic throat carriers.
[Pathogenesis and pathological changes]
After invading the skin, Yersinia pestis is swallowed by the phagocytes of the capsule and V/W antigen, and then spreads locally, and then quickly spreads to local lymph nodes through lymphatic vessels under the action of hyaluronic acid and cellulose decomposer, causing primary lymphadenitis (bubonic plague). A large number of bacteria and toxins propagated in lymph nodes enter the blood, causing systemic infection, septicemia and severe poisoning symptoms. Spleen, liver, lung and central nervous system can all be involved. Bacteria spread to the lungs and secondary pneumonic plague occurred. If the bacteria are inhaled directly through the respiratory tract, the bacteria will first multiply in the local lymphoid tissue. Then spread to the lungs, causing primary pneumonic plague.
On the basis of primary pneumonic plague, bacteria invade the blood stream and form septicemia, which is called secondary septicemia plague. A small number of people with extremely serious infection, bacteria quickly enter the blood directly and multiply in it, which is called primary septicemia plague, and the mortality rate is extremely high.
The basic pathological changes of plague are vascular and lymphatic endothelial cell injury and acute hemorrhagic necrotizing lesions. Lymph nodes often fuse with surrounding tissues to form large and small masses, which are dark red or grayish yellow; Extensive bleeding in spleen and bone marrow; There are bleeding spots on the skin mucosa and bloody effusion in the serous cavity; Hemorrhagic inflammation can be seen in heart, liver and kidney. Pneumonic plague is bronchopneumonia or lobar pneumonia, with hemorrhagic serous exudation in bronchi and alveoli and scattered necrotic nodules caused by bacterial embolism.
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1. An acute infectious disease. Symptoms are high fever, red papules all over the body, herpes and pustules. It takes about ten days to scab, and scars will be left after scabbing, commonly known as "pockmarked". The disease has now been eradicated. (See "Supplement 1")
The male flower of corn is called smallpox because it grows on the top of plants.
3. refers to snow, snowflakes
4. Also known as "Tianhua". Buddhist language. Fairy flowers in heaven
5. Also known as the ceiling. The components used to cover the upper part of beams in buildings can generally be divided into hard ceilings and soft ceilings. The hard ceiling is divided into several squares with wooden strips, which is also called wellhead flowering. Each square is covered with boards, which are called ceilings. The circular center of the ceiling is often painted with dragons, dragons and phoenixes, auspicious flowers and other patterns. Soft smallpox, also known as sea flower, is a low-level smallpox with wooden lattice as the skeleton, covered with linen and paper, and painted with colorful pictures or woven fabrics.
Supplementary 1 smallpox is a severe infectious disease caused by smallpox virus, and it is also the first infectious disease that has been eliminated by human beings in the world so far. It is reported that on February 2 1 65438 last year, US President Bush took the lead in vaccinating against smallpox in order to prevent the attack of biological weapons. Because smallpox virus, like Bacillus anthracis, is very powerful as a biological weapon and is called "the nuclear bomb of the poor". In our country, smallpox was eradicated decades ago. Now, not only do ordinary people know nothing about smallpox, but many doctors only know its name and can't see it. Let's briefly introduce the knowledge about smallpox.
The appearance of smallpox virus is brick-shaped, about 200 μ m× 300 μ m, and it has strong resistance to drying and low temperature. It can survive on crust, dust and clothes for months to a year and a half. Smallpox virus is highly contagious. People who have never suffered from smallpox or have not been vaccinated against smallpox can be infected with smallpox regardless of sex and age, including newborns. Smallpox is mainly transmitted by inhalation of droplets or direct contact. When a person is infected with smallpox virus, there is an incubation period of about 10 days. After the incubation period, the patient is very ill, mostly accompanied by headache, backache, chills or chills. At the beginning of high fever, the body temperature can be as high as 465438 0℃. Accompanied by nausea, vomiting, constipation, insomnia and so on. Children often vomit and twitch. Three to five days after onset, the patient developed rashes on forehead, cheeks, wrists, arms, trunk and lower limbs. First it was a red rash, then it turned into a papule. After 2 ~ 3 days, the papules turn into herpes, and then from herpes to pustular herpes. 2 ~ 3 days after pustule formation, it gradually dries up and forms a thick scab. After about 1 month, the scab skin began to fall off, leaving scars, commonly known as "pockmarked". Patients with severe smallpox are often accompanied by complications, such as sepsis, osteomyelitis, encephalitis, meningitis, pneumonia, bronchitis, otitis media, laryngitis, blindness, abortion, etc., which are the main causes of death from smallpox.
Smallpox patients should be strictly isolated, and patients' clothes, quilts, utensils, excreta and secretions should be thoroughly disinfected. In addition to symptomatic treatment and supportive treatment, the key point is to prevent complications and keep the mouth, nose, pharynx and eyes clean. Vaccination against smallpox is the most effective way to prevent smallpox.
Smallpox is one of the most infectious diseases in the world, and it is a severe infectious disease caused by smallpox virus. It can multiply rapidly and spread in the air at an alarming rate. Suppose 3000 people in Oklahoma are infected with smallpox virus, and the virus will spread to all parts of the United States within 12 days, affecting millions of people.
The clinical manifestations of smallpox are mainly severe toxic blood symptoms (chills, high fever, fatigue, headache, soreness of limbs and back, convulsions and coma when the body temperature rises sharply), skin rashes, papules, herpes, pustules, and finally scabs, scabs and acne scars. Smallpox is fierce and developing rapidly, and the mortality rate is as high as 30% within 15~20 days after it infects non-immune people.
Because smallpox virus is contagious in people, is vaccinia vaccine effective? Prevent smallpox infection for life, so there is no smallpox in the world since 1977.
1979101October 26th, smallpox was eradicated all over the world.
1979101On 26th October, the United Nations World Health Organization announced in Nairobi that smallpox had been eradicated all over the world, and held a celebration ceremony for this purpose.
In recent two years, inspectors from the World Health Organization conducted a survey on the last four East African countries that have not yet declared smallpox eradication-Kenya, Ethiopia, Somalia and Djibouti, and found that these four countries have indeed eliminated the disease, so they released this historic news.
Smallpox is one of the infectious diseases that seriously harm human beings in the world. Millions of people have been killed or disfigured for thousands of years. 180 years ago, Britain invented a vaccinia vaccine to prevent smallpox. The mortality rate of smallpox patients is still as high as one third. Later, developed countries gradually controlled the disease, but it is still prevalent in rural Africa. Since 1967, the last large-scale smallpox eradication campaign has been carried out. At present, smallpox virus is only preserved in seven laboratories in some countries for research.
The Great Medical Discovery-Devil Smallpox
One out of every four patients dies, and the remaining three will leave ugly acne marks. Smallpox is a terrible disease, which has existed almost since human history. Egyptian mummies preserved more than 0/000 years ago BC have smallpox-like pockmarks. According to legend, the once powerful Roman Empire was unable to contain smallpox because of its rampant spread, which led to the shrinking of its national prestige.
For centuries, the widespread prevalence of smallpox has made people panic and tremble.
In 846, smallpox suddenly became popular in the middle of Norman invasion from the Seine River valley in Paris, France. This made Norman leaders panic, and also stunned the fearless soldiers who had been fighting for war. In order to prevent the spread of infectious diseases from hurting themselves, the cruel leader took ruthless measures. He ordered the killing of all smallpox patients and all those who took care of them. This terrible means was considered to be the only feasible way to put out the smallpox epidemic at that time.
However, smallpox will not tolerate anyone. It will also invade palaces and farmhouses without mercy. No nation or tribe, regardless of title, age or gender, can escape the attack of smallpox.
There was once a king's wife in Europe. She had smallpox. Before she died, she asked her husband to grant her last wish. She demanded that all doctors should be put to death if they could not save her life. The queen finally died, so the king ordered all the doctors to be hacked to death with swords for the sake of the queen's wish.
Geoffrey, a British historian, called smallpox "a loyal accomplice to death". He wrote: "The mortality rate of plague or other epidemics is high, but its occurrence is limited. In people's memory, it only happened once or twice here. However, smallpox has appeared among us one after another, and the long-term terror has made the sick people miserable. Some patients will always leave ugly acne marks on their faces even if they survive. People who are ill are not only covered with acne marks, but many people are even deaf, blind or infected with tuberculosis. "
18th century, smallpox spread in Europe, with the death toll as high as1500,000.
Successful vaccination
The human pox vaccine originated in China.
Smallpox, also known as acne, is a highly contagious acute eruptive disease. As early as the Jin Dynasty, Ge Hong, a famous pharmacist, recorded it in Elbow Urgent Prescription. He said: "When I get sick when I am old, I will still get sores on my head and body, and I will feel like a fire sore for a while. You will all wear white pulp and be born with it. " "Dramatists will die more." At the same time, he traced the origin of smallpox. It is pointed out that this disease began in the Jianwu period of Guangwudi in the Eastern Han Dynasty (AD 23-26). This is the earliest smallpox record in China and the world. The book also said: "In the four years of Yonghui, this sore spread from west to east and spread all over the world." This is the earliest smallpox epidemic record in the world. The book Smallpox also contains specific therapeutic drugs.
In the 9th century, smallpox was rampant in Europe. When the Germans invaded France, the soldiers were infected with smallpox, and the commander ordered cruel measures to kill all the patients. In order to prevent its infection, smallpox eventually prevailed, but in India, the superstitious method of "Goddess of Smallpox" naturally didn't help.
China, on the other hand, not only paid attention to the treatment of smallpox very early, but also actively took preventive measures. According to Zhu Chuntuo, a medical scientist in the Qing Dynasty, in The Final Word of Acne Rash, during the period of Song Zhenzong (998- 1022) or Renzong (AD 1023- 1063), there was a doctor who could grow acne in Emei Mountain, Sichuan Province, who was praised as an imperial doctor and was later hired. Later, Wang Su lived to be 67. This legend may be incorrect, but it cannot be ruled out that there was the possibility of budding human pox vaccination in the Song Dynasty. In the Ming Dynasty, with the deepening understanding of infectious diseases and rich experience in treating acne rash, human pox vaccination was officially invented.
Yu Maokun, a physician in the Qing Dynasty, made it clear in the Collection of Golden Classics of Vaccination: "Vaccination began in the Qin Long period of the Ming Dynasty (A.D. 1567- 1572), Taiping County, Ningguo Prefecture, and its surname was lost. It was the home of Dantu and spread all over the world. Up to now, most people in Ningguo have planted flowers. During the Qianlong period, Ayla Zhang, a physician, also said in his New Book of Vaccination: "Yu Zu was taught by Mr. Nie Jiuwu to vaccinate from generation to generation. "He also said:" Eight or nine thousand people have been vaccinated, but there are still twenty or thirty people who can't be saved. "These records show that since16th century, China has gradually popularized the human pox vaccine and passed it on from generation to generation.
Zhang Lu, a physician in the early Qing Dynasty, summarized many inoculation methods such as pox slurry, dried vaccine and pox coat in Yitong. The specific methods are as follows: use cotton to take acne slurry and stuff it into the nostrils of children, or grind acne scabs and blow them into the nasal cavity of children with silver tubes; Or take off the underwear of children with acne and give it to healthy children to infect them. In a word, smallpox can be prevented by making it produce the above antibodies.
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Cholera is a serious intestinal infectious disease caused by Vibrio cholerae. The clinical manifestations are severe painless diarrhea, watery stool, severe dehydration, muscle spasm and peripheral circulation failure. After liberation, the disease has been eliminated in China, but it still occurs and spreads abroad. Therefore, we must always be alert to the occurrence of this disease and do a good job in prevention.
1, etiology
Vibrio cholerae can be divided into two biotypes, one is the cholera pathogen in the classical biotype, and the other is the Vibrio paracholera pathogen in the Eirto biotype. These two biotypes are almost the same in morphology and serology except for some biological characteristics. Vibrio cholerae is gram-negative and sensitive to dryness, sunlight, heat, acid and general disinfectants. The pathogenicity of Vibrio cholerae is endotoxin and exotoxin. Normal stomach acid can kill Vibrio. When the gastric acid is temporarily low or the number of invading viruses and bacteria increases, vibrios not killed by gastric acid will enter the small intestine, multiply rapidly in alkaline intestinal juice, and produce a large number of strong exotoxins. This exotoxin acts on the small intestinal mucosa, causing a large amount of intestinal juice secretion, which exceeds the reabsorption capacity of the intestinal tube, causing severe diarrhea and vomiting in clinic, resulting in a significant decrease in plasma volume and blood concentration and peripheral circulation failure. Due to severe diarrhea and vomiting, electrolyte loss, potassium deficiency and sodium deficiency, muscle spasm, acidosis and even shock and acute renal failure.
2. Clinical manifestations
The incubation period varies from several hours to six days, and the patient suddenly begins to get sick. 100% of patients had diarrhea. Diarrhea is painless and there is no sense of urgency after diarrhea. It is even difficult to count the stools several times a day, and the amount is very large, ranging from 2000 to 4000ml to 4000 ml a day. In severe cases, it started as a yellow water sample and soon became a rice swill water sample. After diarrhea, a few patients have watery stool or tarry stool with blood. Rice-like, due to severe diarrhea and vomiting, a large number of fluids and electrolytes in the body are lost, leading to dehydration, which is characterized by thirst, slight sunken eye sockets, dry lips, irritable tongue, sunken eye sockets, sunken cheeks, listlessness, dry and shriveled skin, loss of elasticity, hoarseness, cold limbs, hypothermia, concentrated enemy fluid, weak pulse, dull heart and decreased blood pressure. Gradually return to normal, some patients have fever reaction, generally 38 ~ 39℃, lasting 1 ~ 3 days, cholera symptoms are mostly mild, similar to intestinal tract.
According to the degree of dehydration, blood pressure, pulse and urine volume are divided into four types.
(1) Mild, only short-term diarrhea, no typical rice swill stool, no obvious dehydration, normal blood pressure pulse and slightly less urine.
(2) Medium-sized, with typical symptoms, typical stool, obvious dehydration, rapid pulse, decreased blood pressure and less urine output, below 500ml a day.
(3) Severe illness: the patient is extremely weak or unconscious, with severe dehydration and shock, accelerated or inaccessible pulse, decreased or undetectable blood pressure, little or no urine, and may die several hours after typical symptoms appear.
(4) fulminant type: it is called dry cholera, which has a sudden onset and dies of circulatory failure before the typical symptoms of diarrhea and vomiting appear.
Step 3 diagnose
In summer and autumn, we should ask in detail about the activities of patients with coagulable diseases in the week before onset, whether they come from epidemic areas, whether they have had contact with patients with this disease and their pollutants, and whether they have been vaccinated. Epidemiological data combined with clinical and laboratory examination can make a diagnosis. Anyone who has diarrhea symptoms or unknown causes in clinic should take stool or vomit samples as soon as possible for pathogen diagnosis, including microscopic examination, culture, separation and agglutination test.
(1) Diagnostic criteria:
① Anyone who has symptoms such as diarrhea and vomiting and is positive for Vibrio cholerae in stool culture.
(2) The epidemic area has typical cholera symptoms, and the stool culture is negative during the cholera epidemic period, and there is no other reason to check.
(2) Suspicious criteria:
(1) All cases of typical diarrhea and vomiting in non-epidemic areas should be diagnosed before etiological examination.
(2) During the cholera epidemic, those who had contact with cholera patients and had diarrhea symptoms but could not find other reasons.
4. Treatment and care
(1) General treatment and nursing:
(1) Strictly isolate according to digestive tract infectious diseases. The isolation can only be lifted if the symptoms disappear for 6 days and Vibrio faecalis is negative for 3 times in a row. Patients' articles and excreta need strict disinfection, which can be disinfected with double amount of 20% bleaching emulsion or 2 ~ 3% Lysol and 0.5% chloramine, or with the new drug "84" disinfectant. Ward staff must strictly abide by the disinfection and isolation system to prevent cross-infection.
2 rest. Severe patients must stay in bed until their symptoms improve.
3 diet. Stop eating when vomiting is serious, give a liquid diet when vomiting stops and diarrhea is relieved, and slowly increase the diet when patients can tolerate it.
④ Supplementing water is the basic method to treat cholera. Mild patients can take oral rehydration, while severe patients need intravenous rehydration. After the symptoms improve, they will change to oral rehydration.
⑤ Specimen collection. Samples of vomit and feces were collected immediately after the patient was admitted to the hospital, and sent for routine examination and bacterial culture, and attention was paid to the inspection immediately after the samples were collected.
⑥ Observe the changes of the disease closely. Measure vital signs 1 time every 4 hours, accurately record the amount of in and out, and prompt the frequency, amount and characteristics of defecation.
(2) Treatment and nursing of infusion:
① infusion volume: according to the degree of dehydration, fluid should be replenished quickly within 2 hours after admission to correct hypovolemic shock and acidosis. Light rehydration should be 3000~4000ml, children's weight per kilogram should be 100 ~ 500 ml, medium rehydration should be 4000~8000ml, children's weight per kilogram should be150 ~ 250ml, and heavy rehydration should be 800 ml.
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