Severe form of plague (with pulmonary involvement)
This form of the disease proceeds with pronounced septicemia and has an extremely severe clinical picture. The patient presents with high fever, severe dyspnea, and cough. The cough produces a large amount of bloody sputum that is literally saturated with pathogenic bacteria.
The disease develops rapidly: the duration of the illness is only 2–3 days, and mortality reaches 100%.
Autopsy findings (pathological anatomy):
- Lungs: become dense. On cross-section, the tissue appears variegated, acquiring a characteristic gray-red color. Multiple foci of necrosis and suppuration are visible.
- Pleura: covered with fibrinous deposits.
- Respiratory tract: serous-hemorrhagic inflammation develops in the bronchi and trachea.
- Parenchymatous organs: fatty degeneration is revealed, and reactive inflammatory changes can often be found in the stroma.
Primary septic form of plague
This form clinically proceeds as classic septicemia. Its main feature is its fulminant character. The outcome of the disease occurs extremely quickly: patient death is recorded as early as 1–1.5 days after the onset of manifestations.
Due to such a rapid course, specific morphological changes in internal organs simply do not have time to develop. For this reason, post-mortem diagnosis at the macroscopic and microscopic levels is difficult.
The diagnosis of the primary septic form is established exclusively using bacteriological and bacterioscopic examinations of blood and tissues. Mortality for this form is also 100%.
Rules for autopsy of the deceased (quarantine infections)
Since plague is classified as a particularly dangerous quarantine infection with the highest contagiousness, the autopsy is subject to strict rules. The main tasks of the prosector are to prevent the spread of infection into the environment and to avoid self-infection.
Equipment of the pathologist: The doctor is required to use a special anti-plague suit covering the face, body, arms, and legs. If unavailable, a strict alternative is used: two closed gowns, oilcloth or plastic sleeves and apron, a cap, protective goggles, a mask made of 2–3 layers of gauze, two pairs of rubber gloves, and rubber boots (or galoshes). After the autopsy, all clothing is subject to destruction, and the doctor takes a shower and remains in quarantine until the epidemic is officially lifted.
Safety precautions during autopsy:
- In the hospital: A special dissection room is used. The sewerage system must be switched off to prevent wastewater from spreading the infection. All fluid (water, blood, secretions) is collected in a special container.
- Organ extraction: Internal organs must categorically not be removed from the corpse. All examinations are performed in situ (in open cavities).
- Body treatment: After the examination, the organs inside the body are covered with quicklime and poured over with a disinfectant (e.g., lysol). The corpse is tightly wrapped in lysol-soaked sheets or placed in a coffin with quicklime and the lid is nailed shut.
- Field conditions: The table is placed on the windward side. The burial grave must be at least 3 meters deep, with quicklime and soil poured in layers on the bottom. Personnel clothing is burned strictly in a closed room to prevent pathogens from spreading with the smoke.
Briefly: answers to topical questions
What macro- and microscopic changes are characteristic of lymph nodes in the bubonic form of plague?
The lymph nodes in the bubonic form of plague are characterized by the development of serous-hemorrhagic, and subsequently necrotic-hemorrhagic and purulent inflammation.
Macroscopic changes:
- Nodes are sharply enlarged (up to 8–10 cm), dense, fused together and with the skin.
- Surrounded by extreme edema; the overlying skin is cyanotic-red and glossy.
- On cross-section, the tissue is dark red with yellowish foci of necrosis and purulent fusion.
Microscopic changes:
- Serous inflammation quickly turns into serous-hemorrhagic.
- Tissue necrosis develops, the inflammation becomes necrotic-hemorrhagic, and suppuration joins in.
- A huge number of rapidly multiplying bacteria are found in the tissue.
What microorganism is the etiological agent (pathogen) of plague?
The etiological agent of plague is Yersinia pestis (plague bacillus).
This microorganism belongs to clinically significant species of the genus Yersinia. The bacterium is generally unstable in the environment and highly sensitive to disinfectants and boiling water. However, the pathogen tolerates low temperatures very well: in frozen corpses, it is able to remain viable for several months.
What is the nature of the exudate in the alveoli during microscopic examination of the lungs in plague?
During microscopic examination of the lungs, the alveoli are filled with serous-hemorrhagic exudate, and sometimes with liquid blood.
Characteristic features of the exudate:
- Contains a colossal amount of the pathogen, forming a peculiar "emulsion of microbes".
- At later stages, leukocytes with phagocytosed bacteria appear in it.
- A specific sign of antibiotic-untreated plague pneumonia is the complete absence of fibrin in the exudate, which serves as the main difference from lobar pneumonia.
In addition, the alveolar walls and interalveolar tissue undergo necrosis, and capillaries are thrombosed by necrotic masses and bacteria.
Class and exam questions
Why are there no typical macroscopic changes in the primary septic form of plague?
Due to the fulminant course of the disease (death occurs in 1–1.5 days), specific morphological changes in organs and tissues simply do not have time to form.
What do the lungs look like at autopsy in the pulmonary form of plague?
The lungs become dense, have a variegated gray-red appearance on cross-section, contain foci of necrosis and suppuration, and fibrinous deposits are found on the pleura.
Are organs extracted (evisceration) during the autopsy of individuals who died from plague?
No, internal organs are not removed from the corpse. The autopsy and examination are carried out directly in the open thoracic and abdominal cavities (in situ) to minimize the risk of spreading the infection.
What else to study on this topic
- Pathogenesis and morphology of smallpox (Variola vera)
- Yellow fever: liver damage and hemorrhagic syndrome
- Differences between sepsis and other infectious diseases
- SIRS syndrome and multiple organ dysfunction syndrome
Master the entire topic in the "Pathological Anatomy" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Plague" and 4,414 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 153 video lessons on the subject
Other topics in "Chapter 16. Infectious and Parasitic Diseases"
Free video lessons: pathological anatomyShort lessons with study notes — no registration required.
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.