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reluctantjoe · 1 year

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Just a Taste (William Agar & Caroline Lessing)

Summary: "There was always something whenever these meetings occurred - a tension too sharp. Inappropriate thoughts ran wildly and freely in Caroline’s mind at even hearing William’s determined voice. She wondered if it was ever the same for him." Warnings: 18+ ONLY. Plot with references to mature subjects. Allusions to Dom!William, Sub!Caroline. Mild injuries. Implied masturbation. Allusions to jealousy. Allusions to (somewhat) jealous sex. Allusions to extramarital affair. Teasing. Implied Sub!William, Dom!Caroline. Blood kink. Word Count: 1,347 Where To Read: Ao3 | Tumblr (you're here!) A/N: My first ever pairing fic! This is an alternative ending to 'The Madman's Trial' scene in 'Quacks' where Caroline is cleaning up William's injuries. And although I feel bad for doing so, I just can't help but ship them (Sorry, Robert.) - Caroline is too good for Robert and William is too good for Mina! In an alternate universe (or hypothetical second series), William and Caroline are a couple and living their best lives! Anyway, I hope those who read this enjoy it. As always, if I have missed any Warnings, then please let me know. Any reblogs and/or comments are greatly appreciated! Tag List: @jamiewintons | @pink-booty-butts

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Caroline sighed as the excess water from her cloth drained into the bowl. This had become part of her weekly routine at this point. Another blood-stained cloth from another incident was beginning to form against William’s blood-stained lips. Why, oh why did he insist on getting himself into these battles when the results were always the same?

She had to admire his willingness, though. He dared to try, and he was brave to do so, knowing the insane individuals he would meet up with could (and most likely, would) cause him harm. She just wished that they didn’t. Some small part of her wished he would give up - try something new. She was tired of this weekly occurrence, and her heart broke for him when William would look at her with defeated eyes once more - another attempt to cure the mad failed.

“I’m sorry,” William winced, the cut on his lip stinging from the cloth. As much as he tried to hide the thrill of, dare say, even speaking to Caroline, the guilt of her practically becoming his nurse carried deeply. “You should be with Robert, not cleaning up a failed alienist. But you are kind enough to do this, no matter the appearance I show you every week. Thank you, Caroline.”

Despite Caroline’s ashamed thoughts of wanting William to step away from this, even just for a day, she knew that isn’t what he needed to hear right now. He needed reassurance and she was more than happy to provide that - no matter the type or repercussions.

“William, as your friend, it is my duty to care. You are so brave and what you do is extraordinary. Besides, I like taking care of you.” Caroline’s eyes met William’s and locked for a second too long.

There was always something whenever these meetings occurred - a tension too sharp. Inappropriate thoughts ran wildly and freely in Caroline’s mind at even hearing William’s determined voice. She wondered if it was ever the same for him.

Have images such as her’s ever dared to preoccupy his mind? Has he ever touched himself? Touched himself to the thought of her? Did he ever imagine the words that would be spoken into her ear, as he would run his hands down her form? Too scandalous for words, would he care that she was taken by Robert? Or would that set jealousy within - causing him to want to prove how good he could make her feel; the pleasure he could bring by his praise and worship, and the most delicate yet precise touches to the most intimate part of her body?

William’s voice brought Caroline back to reality. “Are you okay?” He asked, concernedly, “You seem to be in deep thought, Caroline. I hope my injuries haven’t disgusted you.”

It was then that she was reminded of the fight he and Harold got into during the fake trial. How helpless the crowd was; how she was. How he was. The shouting and flailing around on the floor. The punches; the gasps. The bead of blood on William’s lip that was slowly appearing by the sheer force of Harold’s outburst…

“Caroline? Caroline, are you quite alright?”

“Yes!” Caroline cleared her throat and straightened up, the continuous bending down starting to ache her lower back. “Yes, William, I am fine. Your injuries haven’t disgusted me at all. Are you turning into a mad man too?”

William chuckled at Caroline’s joke. He appreciated the humour at this embarrassing and painful time, but he also noticed a slight sense of falseness. “You seem to be a little red. Are you feeling well? Would you like me to observe you? It is the last thing I can do, I can assure you.”

Caroline went back to the bowl to soak the cloth once more. “I was just thinking back to the trial. The pure lunacy of the man! You looked so…” She tried to contain herself and her thoughts. She didn’t want to skip too far ahead to what was a frightful time for William, but God, a gorgeous mess for her. “...helpless. When Harold pushed you onto the floor and hit you. The blood…”

“Yes, it wasn’t the best sight, was it? How embarrassing of me to think I could help.”

Caroline finally squeezed the excess water back into the bowl once more, but this time, placed the cloth onto the table. She faced William and walked back to him. While attending to him, Caroline was careful not to clean up everything so quickly. She bent down again and slowly traced her finger across William’s blooded lip.

“Caroline, what are you-”

She tilted William’s chip up with her other hand, making sure his eyes were only fixated on her. On her mesmerised face. On her finger with his blood.

William’s knuckles turned white by the act. He shifted but didn’t dare to look down, as though to dismiss the shiver he felt by this new intimidating position he found himself in. A gulp came next because should he speak, he was scared of the outcome. The thought of the noise he would make sent him deeper into his perplexed yet newly founded submissive state.

“Mm, yes.” Caroline turned her attention to her blooded finger, while still holding William’s chin with her other hand. “What is it I called you earlier, William?” She circled her finger with her thumb, spreading the fluid. “Helpless?”

Caroline faced William again, the most stunned expression greeting her. She finally dropped the hand at his chin and William breathed out deeply.

What just happened? What was Caroline up to? He was stunned. He tried to compose himself. William remembered his blood was still on Caroline. His face shot up, not knowing where to begin.

“You-”

“Poor thing.” William gulped. “Oh, don’t be so nervous, William. I’m not going to hurt you.” Caroline bent down once more, but this time, made sure to get as close to William’s ear without raising suspicion to the public.

“I have a blood kink,” She breathed into his ear.

Those words sent William insane. He tried to say something, anything, but he found his throat closed up and dry; the air nearly knocked out of him by Caroline’s statement.

Caroline returned to her standing position. With only the face that could only be described as enchanted, adorned by William, she decided to take it one step further. With hesitation, she looked around, almost as if to see if the coast was clear. She locked onto William’s eyes once more and slowly put her blooded finger into her mouth. William was in a daze; hypnotised, even, by Caroline’s action. Every movement she made with her finger until his blood was on her dominant tongue was tracked by his eyes.

William was out of it. He thought this was a dream. He thought he would wake up and have to take care of things. But what Caroline did next proved to be the opposite.

With one finger now licked clean of William’s blood, there was only her thumb to go. This new found confidence Caroline had was now desperate to be shown. With less hesitation this time, she quickly glanced around, and returned her gaze to William.

Quickly and quietly, she placed her thumb onto William’s lower lip. “Open up,” She whispered. Without even realising what was happening or what he was doing, William opened his mouth and felt Caroline’s thumb in his mouth. His blood in his mouth. Caroline’s thumb, with his blood, in his mouth. He ought to find it disgusting. But he was entranced. This feeling was foreign, yet he loved it. He couldn’t help but emit a strangled whine from his throat; he prayed Caroline didn’t hear.

After she was sure the rest of William’s blood was gone, Caroline slowly removed her thumb from William’s mouth. “There we go. Thank you for being so good while I cleaned you up, William. I’ll see you tomorrow, yes? Try not to get into too many fights before then. Otherwise I may just have to clean you up again.”

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bilmisler · 6 years

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Veba Hastalığı

https://bilmisler.com/veba-hastaligi/

Veba Hastalığı

VEBA (Yersinia pestis)

Giriş:

Veba insanlara vektörler aracılığı ile bulaşan, Yersinia pestis’in (Y.pestis) etken olduğu, literatür verilerine göre en virulan bakteriyel enfeksiyondur. Enfeksiyon başladıktan sonra, önce lenf düğümlerine daha sonra kana ve ardından da akciğerlere doğru yayılım göstermektedir. Akciğer yayılımı oluşunca “Pnömonik veba” olarak isimlendirilmektedir. Kolaylıkla insandan insana geçebilir. Vebanın bu türü orta çağlarda hatta Osmanlı döneminde bile “Kara ölüm” adıyla birçok insanın ölümüne neden olmuştur. Vebanın tüm türlerinde ani bir toksik şok meydana gelir ve hatta ölümle sonuçlanır. Diğer bakteriyel enfeksiyonlara nazaran sağlıklı olan kişilerde çok kısa sürede ölümün görülmesi dikkat çekicidir (2).

Tanımlama ve tarihçe

Yersinia cinsi üç’ü insan patojeni olmak üzere (Yersinia pestis, Yersinia enterocolitica ve Yersiniapseudotuberculosis) toplam 11 tür içermektedir (1).

Veba hastalığına neden olan etken Y. pestis’tir, ilk kez Hong Kong’da 1884 yılında görülmüştür. Bakteriyolog Alexandre Yersin 1894’te, vebaya yol açan Yersinia pestis isimli bakteriyi izole edip, tanımlamış. ve insanlara sıçan piresi (Xenopsylla cheopis) adı verilen bir kemirgen tarafından ısırılma ile geçmektedir/bulaşmaktadır. Vebanın yaşam döngüsüne bakıldığında pirelerin enfekte olmuş kemirgenler ile beslenmelerinden sonra enfekte olmaları ile döngü başlar. Y.pestis pirelerin bağırsaklarında çoğalır ve konağın ısırılması ile bulaşır. Bu pire ısırığı normalde bulaşıcı olmayan “bubonik veba” adı verilen lezyonlara neden olur (3).

Dünyada ve Türkiye’deki epidemiyolojisi

Veba öncelikli olarak kemirgenlerden, vahşi ve evcil hayvanlardan bulaşan zoonotik bir enfeksiyondur (4) ve pireler tarafından nakledilir; insanlar doğal hastalık döngüsüne katkıda bulunmayan tesadüf konakçı olarak kabul edilir. İnsanlara bulaş, enfekte ev kedilerinden, kemirgen pire ısırıkları, çizikler veya ısırıklar, enfekte hayvan dokularının doğrudan taşınması, enfekte olmuş hayvanlardan gelen solunum salgılarının inhalasyonu, enfekte insanlardan aerosol haline getirilmiş damlacıkların inhalasyonu, kontamine gıda tüketimi veya laboratuar maruziyeti yoluyla olmaktadır (5). Kuluçka süresi genellikle iki ila yedi gün arasındadır.

Y.pestis infeksiyonu iki tip olarak kendini gösterir: 1) Doğal rezervuarın sıçan olduğu Kentsel veba, 2) tavşan, tarla faresi, sincap ve evcil kedilerde infeksiyona neden olan Orman vebası.

Tarihe bakıldığında Y.pestis’in etken olduğu Veba en kötü ve ölümcül hastalıklar içerisinde yer alır. Epidemiyolojik veriler incelendiğinde İncil içinde Veba’dan söz edilmiştir. Bilinen üç veba pandemisini birincisi Mısır’dan başlayarak Avrupa, Kuzey Afrika, Güney ve Orta Asya ile Arabistan’a kadar yayılım göstermiştir. Daha sonraki pandemi 1320’li yıllarda kendini göstermiş beş yıldan uzun bir zamanda yalnızca Avrupa’da bile milyonlarca kişinin ölümüne neden olmuştur. Çin, Amerika, Avrupa ve Afrika’yı da esir alan Veba 1860’lı yıllarda yayılarak ölüm saçmaya devam etmiştir. CDC verilerine göre son on yılda yine Amerika Birleşik Devletleri’nden bildirilen çoğu orman vebası olarak tanımlanan vakalar olmuştur (510).

Tarihsel gelişim incelendiğinde Ülkemizde 18.yy’da Osmanlı İmparatorluğunu yıkıma uğratan ve 19.yy ortalarına kadar devam eden veba vakaları bildirilmiştir (11, 12).

Patogenez ve İmmün yanıt

Veba patogenezi pireden memeli konağına infeksiyonun geçişi ve infeksiyona karşı verilen konak yanıtından oluşmaktadır. Bubonik veba, Pnömonik veba ve Septisemik veba olarak iç klinik forma sahiptir.

Y.pestis konağa girdiğinde önce deri engelini aşar daha sonra konak ve pire arasındaki vücut sıcaklık ve ortam farkı bakterinin virulans faktörlerinin ortaya çıkmasına neden olur.

Y.pestis’in önemli virulans faktörlerinden biri olan F1 proteini jelimsi bir kapsül yapısı oluşturup bu yapı bakteriyi fagositozdan korur ve çoğalmasına neden olur. Fagositoza dirençli olmalaı patojenik Yersinia türleri için bilinen ortak bir özelliktir (13).

Bakteriler enfeksiyonu takiben, lenf nodlarına lenfatikler yoluyla göç ederler, burada yoğun bir inflamatuar reaksiyon başlar ve lenf nodlarında fagosite edilirler ancak yok olmaları mümkün olmaz. Veba etkeni olan Y.pestis, enzimatik sindirime dirençlidir ve oldukça sağlam bir kapsüle sahiptir; bunun sonucunda Y.pestis asıl olarak fagozom ve lizozomların birleşmesinden oluşan fagolizozom denilen yapılarda çoğalırlar (13, 14).

Yersinia virulan enzimler ve lipopolisakkaritlerin salınması ile bir toksisite meydana getirmektedir. Bakteriler daha sonra akciğer ve diğer organlara yayılım gösterir. Pire ısırması sonrasında hastalardaki kuluçka süresi iki ile yedi gündür. Ateş, titreme, halsizlik ve kasık bölgesinde çıkan ağrılı bubolar hastalığın başlıca bulgularıdır. Tedavi edilmediğinde sepsis meydana gelebilir hastalar septik şok sonucu hayatlarını kaybedebilir (15, 16).

Tanı ve tedavi

Mikrobiyoloji-Tanı Y. pestis gram negatif, hareketsiz, spor oluşturmayan, fakültatif anaerop çomaktır. Enterobacteriaceae ailesi içerisinde yer alan fermenter ve oksidaz negatiftir. Protein bir kapsüle sahip olan Y. pestis; Somatik O polisakkariti, kor polisakkariti ve endotoksin olarak Lipid A bileşenlerine sahiptir. Kanlı agar ve MacConkey agar gibi birçok kültür besiyerlerinde üreyebilir.

Veba’nın tanısının konulabilmesi için yüksek bir şüphe olmalıdır. Oldukça risklidir ve uzmanlık gerektirmektedir. Ateşli ve ağrılı lenfadenopati geçiren hastalar, endemik hastalık alanlarına seyahat etmeleri konusunda sorgulanmalıdır. Buna ek olarak, son 10 gün içinde hayvan veya kemirgen vektör teması, veba bulguları için şüphe uyandıran ipuçları olabilir. Vebanın teşhisi, organizmada mikroorganizmanın izole edilmesi ya da serolojik testlerle saptanabilir.

Laboratuvarın enfeksiyona yakalanmasını önlemek için uygun korunma önlemleri alabilmeleri için mikrobiyoloji personeline organizmayı barındırdığından şüphelenilen hasta ile ilgili bir numune gönderildiğinde mutlaka numune hakkında bilgi verilmelidir.

Y.pestis, balgamdan, beyin omurilik sıvısından (BOS) veya bubo aspirasyon örneğinden kültür edilerek izole edilebilir. Periferik kan örneğinin Wright-Giemsa boyasıyla incelenmesi ile çubuk şeklinde mikroorganizmaları görmek mümkün olabilir.

Serolojik tanıda, Y.pestis ‘in F-1 antijenine karşı oluşan antikor araştırılabilir.

Hızlı testler araştırıldığında; Balgamda veya serumda Y. pestis F1 antijeni 15 dakika içerisinde tespit edebilen hızlı bir tanı testi geliştirilmiştir.

Y.pestis ‘in polimeraz zincir reaksiyonu (PCR) veya enzim bağlı immünosorbent testlerle de tanısı yapılabilir ancak çok yaygın değildir (6, 16, 17).

Tedavi

Y.pestis’rn tedavisi Streptomisini ile yapılmaktadır. Bunun dışında Gentamisin,

Kloramfenikol, Trimetoprim-sülfametaksazol (SXT), veya tetrasiklin alternatif olarak tercih edilebilir (6).

Korunma

Kemirici hayvanların sayısının azaltılması, ormanlık alanların ilaçlanması ve mesleki olarak riskli grup içerisinde yer alan kişilerin aşılanması ile önlem sağlanabilir (6, 18).

Kaynaklar

Schubert S, Rakin A, Karch H, Carniel E, Heesemann J. Prevalence of the “High- Pathogenicity Island” of Yersinia Species among Escherichia coliStrains That Are Pathogenic to Humans. Infection and immunity. 1998;66(2):480-5.

Naphy WG, Spicer A. Plague: Black Death & Pestilence in Europe: The History Press Ltd; 2004.

Nyirenda SS, Hang’ombe BM, Kilonzo BS, Kangwa HL, Mulenga E, Moonga L. Potential Roles of Pigs, Small Ruminants, Rodents, and Their Flea Vectors in Plague Epidemiology in Sinda District, Eastern Zambia. Journal of medical entomology. 2017;54(3):719-25.

Raoult D, Mouffok N, Bitam I, Piarroux R, Drancourt M. Plague: history and contemporary analysis. Journal of infection. 2013;66(1):18-26.

Drancourt M, Raoult D. Molecular history of plague. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2016;22(11):911-5.

Yang R. Plague: Recognition, Treatment, and Prevention. Journal of clinical microbiology. 2018;56(1).

Peiffer-Smadja N, Thomas M. [The plague: A disease that is still haunting our

collective memory]. La Revue de medecine interne. 2017;38(6):402-6.

Kwit N, Nelson C, Kugeler K, Petersen J, Plante L, Yaglom H, et al. Human plague— United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(33):918-9.

Kugeler KJ, Staples JE, Hinckley AF, Gage KL, Mead PS. Epidemiology of human plague in the United States, 1900-2012. Emerging Infectious Diseases. 2015;21(1):16.

Mikhail A. The nature of plague in late eighteenth-century Egypt. Bulletin of the History of Medicine. 2008;82(2):249-75.

Drancourt M, Houhamdi L, Raoult D. Yersinia pestis as a telluric, human ectoparasite- borne organism. The Lancet infectious diseases. 2006;6(4):234-41.

Bulmus B. Plague, Quarantines and Geopolitics in the Ottoman Empire: Edinburgh University Press; 2017.

Montminy SW, Khan N, McGrath S, Walkowicz MJ, Sharp F, Conlon JE, et al. Virulence factors of Yersinia pestis are overcome by a strong lipopolysaccharide response. Nature immunology. 2006;7(10):1066.

Bi Y. Immunology of Yersinia pestis Infection. Advances in experimental medicine and biology. 2016;918:273-92.

Atkinson S, Williams P. Yersinia virulence factors – a sophisticated arsenal for combating host defences. F1000Research. 2016;5.

Nikiforov VV, Gao H, Zhou L, Anisimov A. Plague: Clinics, Diagnosis and Treatment. Advances in experimental medicine and biology. 2016;918:293-312.

Loiez C, Herwegh S, Wallet F, Armand S, Guinet F, Courcol RJ. Detection of Yersinia pestis in sputum by real-time PCR. Journal of clinical microbiology. 2003;41(10):4873-5.

Liu W, Ren J, Zhang J, Song X, Liu S, Chi X, et al. Identification and characterization of a neutralizing monoclonal antibody that provides complete protection against Yersinia pestis. PLoS One. 2017;12(5):e0177012.

#veba #veba hastalığı #vehastalığı hakkında detaylı bilgi

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