Symptoms of yersiniosis and diagnosis of infectious disease

Yersiniosis is a group of diseases caused by bacteria of the same name, characterized by variable clinical symptoms: damage to the gastrointestinal tract, joints, liver, and the appearance of a rash. It does not pose a danger to human life, but a protracted course and the development of relapses are typical.

Routes of infection

Yersiniosis is a classic zoonotic infection, that is, the source of the pathogen is animals. Among the most likely sources of infection are the following:

• rodents (all mouse-like wild and domestic animals, guinea pigs);
• dogs of any breed;
• small and large livestock (especially pigs and cows).

Particularly dangerous in this regard:

• semi-finished meat products or poorly fried meat (“rare steak”);
• root vegetables and vegetables (carrots, beets, cabbage, green onions);
• lactic acid products (yogurt, cottage cheese, whey, cheeses).

Infection is less likely through drinking dirty water and poor personal hygiene, although rare intra-family outbreaks have been described.

Susceptibility to yersiniosis in people of any age is low. There are often asymptomatic forms of the disease that are not diagnosed. Severe forms are observed in individuals with chronic pathology.

The highest incidence of yersiniosis is observed in European countries in winter and autumn, when food stored in basements and vegetable stores is used.

Growth and reproduction of bacteria

The causative agent of yersiniosis – Yersinia enterocolitica and Yersinia pseudotuberculosis – are unpretentious and quite resistant bacteria. They can withstand low temperatures (including in the refrigerator), repeated freezing and thawing. They die under the influence of high temperatures (drying, boiling, heating), and treatment with disinfectants.

In domestic conditions, the reproduction of Yersinia and the increase in the likelihood of developing infection are facilitated by:

• storing prepared and raw foods in the refrigerator on the same shelf;
• refusal to use individual containers;
• neglect of sanitary standards (cleaning shelves with detergents).

The following rules help prevent the growth of these bacteria and reduce the risk of developing yersiniosis:

• storing prepared meals in closed containers;
• mandatory thorough washing, treatment with boiling water of vegetables, berries and fruits, especially those stored for a long time;
• Regular washing and cleaning of not only the refrigerator, but also all work surfaces, as well as cutting boards.

Simple observance of sanitary rules helps to avoid the development of the disease.

Symptoms

In the symptoms of yersiniosis, it is advisable to distinguish gastrointestinal and generalized forms, as well as secondary focal ones. Each option has its own typical clinical symptoms. All clinical syndromes develop against the background of severe general intoxication: fever, weakness, decreased performance and decreased appetite.

Intestinal manifestations

Changes in the digestive canal are nonspecific. Gastrointestinal disturbances should be considered if the patient develops:

• nausea and episodes of vomiting;
• abdominal pain of varying intensity and diffuse nature;
• sometimes there may be manifestations of acute appendicitis (inflammatory process of the appendix of the cecum) and ileitis (inflammation of the ileum);
• diarrhea is often without pathological impurities (blood and mucus).

It is impossible to suspect yersiniosis only based on changes in the gastrointestinal tract.

Extraintestinal manifestations

The variety of extraintestinal symptoms and the combination of certain clinical syndromes determine the preliminary diagnosis of yersiniosis.

The most typical for yersinia infection:

• catarrhal syndrome - runny nose, moderate sore throat when swallowing;
• polymorphic rash (measles-like, ring-shaped, pinpoint);
• arthralgic – moderate pain in large and medium-sized joints, combined with swelling and limitation of movement;
• swollen lymph nodes;
• an increase in the size of the spleen and liver.

In especially severe cases, a septic condition develops.

There are no clinical features of the course of yersiniosis that are typical only for children.

Pathogen diagnostic methods

If yersiniosis is suspected, the patient is hospitalized in an infectious diseases hospital. Treatment on an outpatient basis can be carried out only when the patient’s condition has stabilized and recovery has begun.

Confirmation of the diagnosis is based on identifying the pathogen itself in the patient’s biological fluids or specific antibodies in the blood serum.

In domestic clinical practice, serological tests are more often used, which involve the detection of antibodies to Yersinia in the patient’s blood.

The most promising and informative, as well as the fastest, is the PCR (polymerase chain reaction) method. The disadvantage of this method is its high price and limited availability.

Treatment

An integrated approach is envisaged. A patient with yersiniosis is prescribed:

• antibiotics (tetracyclines or cephalosporins) or fluoroquinolones for a long period - until the 10th day of temperature normalization;
• detoxification with crystalloid and colloid solutions;
• multivitamin complexes;
• hepatoprotectors;
• pro- and prebiotics;
• antioxidants.

In most cases, conservative therapy is sufficient. In situations where appendicitis develops, surgical intervention is required.

If you consult a doctor in a timely manner, therapy for yersiniosis ends with the patient’s complete recovery.

Possible complications and prognosis for life

• Complications of yersiniosis are numerous. The most likely among them are:
• A feature of yersinia infection is also the tendency to develop relapses (probability up to 55%) and slow recovery (full recovery may take 4-6 months).
• Only the most severe - septic - form poses a danger to human life, since the probability of death is 50%.

Prevention of yersinia infection

Consists of the usual sanitary and hygienic rules:

• wash and rinse all berries, fruits and vegetables with boiling water;
• observe heat treatment of culinary dishes;
• Avoid using raw vegetables that have been stored in the cellar for a long time.

Prevention of yersiniosis also involves the destruction of rodents in residential areas.

Source: https://ProKishechnik.info/zabolevaniya/iersinioz.html

Yersiniosis in children and adults - treatment, symptoms, diagnosis and prevention of the disease

Yersiniosis is an acute infectious disease that leads to damage to the gastrointestinal tract and negative effects on other human organs and systems.

Type of infection and route of infection

The causative agent of the disease is intestinal bacteria Enterobacteriaceae from the genus Yersinia. They are gram-negative rods up to 0.9 microns in size, growing on regular and depleted nutrient media.

The most favorable temperature for them is in the range from +4 to +8 degrees, at which they are able to survive for a long time and actively reproduce on various foods.

The mechanism of transmission of yersioniasis infection is close to pseudotuberculosis.

Some strains of bacteria are resistant to pasteurization, but boiling kills any of them within a few seconds. They are also sensitive to the effects of disinfectants.

The peak incidence is usually observed in November and spring. People of any age are susceptible to the disease; yersiniosis is often found in children. Women are more resistant to pathogens than men.

Pathogens enter the human body through the fecal-oral or alimentary route, through a transfusion of contaminated blood, or directly under the skin through injury or injection. Transmission of intestinal yersiniosis infection can occur through contaminated foods that have not undergone heat treatment - meat, vegetables and milk, as well as water from open sources.

Symptoms of yersiniosis

The incubation period of yersiniosis pathogens lasts 1-6 days. Symptoms of yersiniosis are nonspecific. The disease is characterized by polymorphism of clinical manifestations:

• begins acutely, with the appearance of chills, headaches, weakness and malaise;
• possible pain in muscles and joints, sore throat, loss of appetite and insomnia;
• body temperature is subfebrile, can sometimes rise to 38-40 degrees;
• symptoms of general intoxication of the body are combined with signs of gastrointestinal damage - abdominal pain, nausea, diarrhea, vomiting;
• the skin becomes dry and a scaly, dotted or small-spotted rash may appear on it;
• Relative tachycardia and hypotension may occur;
• During the course of the disease, symptoms are possible that indicate damage to various internal organs - dark urine, heaviness or pain in the right hypochondrium, etc.;
• icteric staining of the sclera and skin indicates an enlarged liver; headaches may intensify over time, and focal and meningeal symptoms of central nervous system damage may appear;
• damage to the genitourinary system is accompanied by pain during urination and a decrease in daily diuresis up to complete anuria;
• as the disease progresses, pain in the abdominal area intensifies, signs of peritoneal irritation appear;
• in the second week, signs of acute arthritis may appear with damage to large joints, swelling of the face and elements of urticaria, hyperemia and pain in the eyes.

Forms of yersiniosis disease and their complications

The clinical classification of yersiniosis has not yet been fully developed. Taking into account the leading syndrome, it is customary to distinguish 2 groups of clinical forms:

• localized (gastroenterocolitic):
• generalized (icteric, septic, exanthem and arthralgic).

The clinical picture of yersiniosis of the localized form is limited primarily to damage to the gastrointestinal tract; generalized forms are accompanied by damage to other organs and systems.

1. The gastroenterocolitic form of siniosis is the most common disease, accounting for almost 70% of all cases. The disease begins acutely, with an increase in temperature to 38-39 degrees, accompanied by headaches, anorexia, chills, malaise, abdominal pain and loose stools - up to 15 times a day. The duration of the disease is 2-14 days; severe forms are rare. It can occur in the form of enterocolitis, enteritis and gastroenterocolitis. In most cases, the syndrome of general intoxication is mild, abdominal pain is of low intensity, and the frequency of stools is 2-4 times per bowel movement.
2. The icteric form is a complication of yersiniosis and can develop simultaneously with the gastroenterocolitic form or 2-4 days after the onset of intestinal dysfunction. Signs of liver damage come to the fore, and toxic hepatitis develops. Patients complain of pain and a feeling of heaviness in the right hypochondrium, sometimes itching of the skin appears. The disease is accompanied by yellowness of the sclera and skin, the size of the liver increases, pain appears on palpation, discoloration of feces and darkening of urine are observed. Hypertransaminasemia and hyperbilirubinemia are determined.
3. The exanthema variety of the disease is manifested by exanthema and intoxication syndrome. With this form of yersiniosis, a rash appears on the skin on the 1st-6th day of illness; it can be dotted, large or small-spotted, with or without itching. After a few days, the rash usually disappears without a trace, and pityriasis-like peeling appears in its place.
4. The arthralgic form occurs with intoxication, fever and severe pain in the joints, which, however, do not change externally. Arthralgia can cause immobility and insomnia.
5. The septic type of the disease is quite rare and is the most dangerous, with mortality accounting for up to 30% of cases. It manifests itself as high fever with a daily range of up to 2 degrees, chills, enlarged liver and spleen. Damage to other organs is possible. The consequences of septic yersiniosis are endocarditis, nephritis with acute renal failure, pneumonia, hepatitis, meningitis, meningoencephalitis. Sometimes the result of a complication of yersiniosis is mocarditis - inflammation of the heart muscle. It is manifested by heart rhythm disturbances and tachycardia.
6. The secondary focal form can occur independently or as a complication of other forms. In the second case, primary and secondary signs of the disease can be separated by a long period of well-being. Secondary manifestations are signs of damage to individual organs, causing concomitant diseases - the liver, thyroid gland (autoimmune thyroiditis), joints (arthritis), meninges (meningitis).

Complications of yersiniosis most often occur in the second or third week of the disease. Among them: exanthema (erythema nodosum, urticaria), arthritis of the joints (usually large ones), Quincke's edema, myocarditis, urethritis, appendicitis and conjunctivitis.

If you notice similar symptoms, consult a doctor immediately. It is easier to prevent a disease than to deal with the consequences.

Diagnosis of yersiniosis

Diagnosis of yersiniosis is carried out on the basis of the symptoms of the onset of the disease - fever, intoxication and signs of an acute form of gastroenterocolitis in combination with jaundice, exanthema and arthralgia. The most common are enteritis, terminal ileitis, enterocolitis and mesadenitis. Less common forms are sepsis, tonsillitis and secondary foci of infection.

Enteritis and enterocolitis are the most common, they manifest themselves in inflammation of the large and small intestines, accompanied by loose, foul-smelling stools up to 10-15 times a day, sometimes with mucus and blood.

The duration of diarrhea, depending on the severity of the disease, ranges from 1 day to several months.

Almost all forms of the disease are accompanied by enlarged lymph nodes. Pathogens are able to concentrate in the lymph nodes with the formation of microabscesses - purulent inflammations. To confirm the diagnosis, tests for yersiniosis are performed.

Tests for yersiniosis

Diagnosis of yersiniosis is based on bacteriological and serological research methods. The culture technique is the same as for pseudotuberculosis.

For the purpose of laboratory confirmation of the diagnosis, cultures of feces, cerebrospinal fluid and blood are performed on nutrient media.

From a series of serological methods, agglutination reactions, latex agglutination, indirect hemagglutination with erythrocyte diagnostics and enzyme-linked immunosorbent assay are used.

In uncomplicated forms of the disease, laboratory data are not specific. The leukocyte level is normal or slightly increased.

ESR in reactive arthritis can reach 100 mm/h, but antinuclear antibodies and rheumatoid factor are usually absent.

Blood, lymph node tissue, cerebrospinal fluid, peritoneal fluid, and abscess contents are subjected to standard clinical microbiology techniques.

When X-ray studies of the intestinal area, a sharp narrowing of the affected part of the ileum is observed, the relief of the mucous membrane is often smoothed (the so-called “cord” symptom). At the following stages, it is possible to develop a granulomatous-ulcerative lesion in the ileum, which is morphologically indistinguishable from Crohn's disease.

The presence of yersiniosis is signaled by the accelerated positive dynamics of clinical signs and morphological changes in the terminal ileum during treatment with antibacterial drugs, while glucocorticoids and mesalazine are effective in Crohn's disease.

Difficulties may arise in the differential diagnosis of hepatitis of viral etiology and yersinia hepatitis.

Yersiniosis hepatitis can manifest itself both as an independent variant and in a generalized form of yersiniosis.

From the first stages of the disease, an increase in the blood bilirubin content and pronounced signs of intoxication are observed, while the activity of transaminases slightly increases.

Treatment of yersiniosis

How to treat yersiniosis is determined for each patient by the doctor individually. Treatment of yersiniosis is prescribed depending on the form of the disease and its clinical picture. Uncomplicated forms of intestinal yersiniosis require treatment with etiotropic drugs and detoxification therapy for 7-10 days, depending on the severity of the patient’s condition, orally or parenterally.

Yersiniosis is also treated with antibiotics.

The septic form of yersiniosis, secondary foci of infection and intestinal forms of the disease against a background of weakened immunity are treated with 2-3 types of antibacterial agents for 12-14 days, with detoxification therapy and the prescription of drugs that promote rehydration. If necessary, probiotics and multienzyme preparations can be used.

Danger

Diagnosing yersiniosis in children is more difficult, since the development of infection can occur like a common cold, accompanied by sore throat, cough, and fever.

In advanced forms of the disease, infection of the liver occurs with bacteria, and yellowing of the skin and whites of the eyes is noted.

Specific prevention of yersiniosis has not yet been developed. All preventive measures are based on the epidemiological characteristics of the infection.

They come down to the fight against rodents as the main carriers of infectious diseases. In vegetable stores, warehouses and stores, rodents are periodically exterminated.

In order to timely identify individuals with yersiniosis among domestic animals and birds, scheduled and extraordinary veterinary examinations are periodically carried out on farms. Dairy plants establish control over the processing of dairy products.

When storing fruits and vegetables, attention is paid to the quality of preventive measures for disinfection and deratization of vegetable stores when a new crop arrives. Current disinfection and deratization is carried out in winter and autumn.

Places for storing any products that are not subject to heat treatment are subject to careful control; catering establishments monitor compliance with technological and sanitary conditions during storage and preparation of food.

In case of a separate disease or outbreak, the food enterprise from which the product that caused the infection came is identified.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

The text was approved by the general practitioner Mamedov Sabuhi Vugarovich

Source: https://illness.DocDoc.ru/iersinioz

Yersiniosis - symptoms, treatment, causes of the disease, first signs

Treatment of yersiniosis in children should only be carried out by a doctor. Self-medication can lead to complications and irreversible processes. Children are also prescribed antibacterial drugs, since only they help destroy the causative agent of the disease.

In most cases, children are treated in a hospital (even with a mild form of the disease). It is difficult for a child’s body to cope with the consequences of intoxication, so complications may arise. Young patients are prescribed anti-inflammatory, antihistamine and other drugs. All medications should be taken only as prescribed by a doctor.

If complications occur, additional treatment methods and medications may be used. For example, when diarrhea occurs, a child must be prescribed a medicine that can stop it. Severe diarrhea increases dehydration and worsens the overall condition.

In children under one year of age, yersiniosis can cause liver enlargement due to intoxication of the body. This complication requires immediate intervention from a doctor, otherwise the child’s functioning of this important organ may be disrupted in the future.

Prevention of yersiniosis

To reduce the risk of disease, you must adhere to simple rules of hygiene and nutrition:

• Always wash your hands before eating.
• Wash vegetables, fruits, herbs, etc. thoroughly.
• Eat only meat that has been inspected by the sanitary service.
• Don't give rodents a chance to live in your home.

The main prevention of yersiniosis is clean hands. Also, always monitor the quality of the products you consume.

If you are wondering whether yersiniosis in adults needs to be treated or not, remember that the disease can lead to serious complications. In addition, the reproduction and activity of microorganisms can only be stopped with antibiotics. Treatment of yersiniosis requires an integrated approach. Do not self-medicate or resort to folk remedies without consulting a doctor.

Medicines

vsezavisimosti.ru

What medications to take for yersiniosis depend on the form and severity of the disease. Most often, the infection affects only the organs of the gastrointestinal tract, but there are also more complex varieties of this disease.

For example, the affected area of ​​generalized yersiniosis can cover any organs. In worst cases, the infection spreads to the cardiovascular and nervous systems.

In addition, autoimmune diseases are often encountered as a complication of yersiniosis, which also need to be treated at their initial stage.

When the first symptoms of the disease occur, you must contact a specialist to prescribe effective treatment. An infectious disease specialist treats yersiniosis. Timely treatment will prevent the disease from developing into a more severe form.

If you start treating the disease in time, you can only get by with medication. As a rule, to cure yersiniosis, injections are prescribed first. In more severe cases, surgery may be necessary.

Since yersiniosis is an infectious disease, antibiotics are mandatory for its treatment. In order to determine which antibiotic for yersiniosis will be more effective in each specific case, it is necessary to take tests and determine the level of sensitivity of the pathogen to a particular drug.

Also common drugs for yersiniosis are those that belong to one of 3 groups of antibiotics:

• Tetracycline. They are excellent bacteriostatics, but side effects include a high level of toxicity. Therefore, the drug has a limited prescription to treat yersiniosis. Antibiotics of this group should strictly not be used by persons under 18 years of age, pregnant women and women during lactation, as well as persons with reduced immunity.
• Cephalosporins. They destroy the walls of infectious agents, due to which they are highly effective. At the same time, their level of toxicity is low enough that it can be used by a wider range of people.
• Fluoroquinolones. By influencing enzymes, they prevent the synthesis of new bacteria. This type of drug has good distribution properties and affects the entire body at once. This is very important if the disease affects several organs at once, in addition to the gastrointestinal tract.

The drugs can be taken in the form of tablets or injections, which in turn can be administered either intramuscularly or intravenously. For yersiniosis, injections will be most effective, as they are better absorbed and act faster on bacteria. The duration of treatment of yersiniosis with antibiotics is at least 7 days, depending on the drug chosen and the severity of the disease.

In case of chronic yersiniosis, it should be taken into account that bacteria can develop resistance to one or another type of drug, so during periodic treatment it is necessary to replace drugs. During long-term treatment, antibiotic groups can be replaced several times to increase its effectiveness.

With long-term use of antibiotics, patients often experience the development of dysbiosis. Therefore, simultaneously with them it is necessary to prescribe drugs with a high content of beneficial bacteria. The most effective are: Acipol, Linex, Bifiform.

To prevent the disease from developing into a more severe form, a course of anti-inflammatory drugs is usually prescribed. Most often, they do not contain hormones. If hormonal drugs are prescribed, their dosage is calculated according to the principle of gradual withdrawal of the drug. The duration of such treatment usually does not exceed 14 days.

To treat autoimmune diseases that can develop against the background of yersiniosis, it is necessary to take glucocorticoid medications that will prevent the development of this type of disease.

Intestinal infections are often accompanied by high fluid loss due to symptoms such as vomiting and loose stools. Therefore, when dehydration is established, drugs of the rehydroid group are prescribed in order to replenish lost fluid. This group of drugs is taken until these symptoms disappear and for a short time after that.

To increase immunity, a decrease in which often accompanies yersiniosis, vitamins, enzymes and immunomodulators are used. It also helps replenish the body's losses due to illness.

Folk remedies

legkopolezno.ru

If symptoms of yersiniosis appear, you should not self-medicate. Contact your doctor who will prescribe medication. Traditional medicine cannot be used as monotherapy for the treatment of yersiniosis.

Medicinal herbs and other non-traditional methods are used as adjuncts to primary drug therapy. Decoctions and tinctures are used for the following purposes:

• to strengthen the immune system;
• to remove toxins;
• to improve the functioning of the digestive tract and so on.

Before you start testing the effectiveness of folk remedies, consult your doctor. This will help you avoid complications. In addition, it is worth remembering that some medicinal herbs have contraindications.

Strengthening the immune system

To speed up the healing process, you can strengthen the body's defenses with the help of alternative medicine. Well suited for these purposes:

• rose hip;
• aloe;
• echinacea;
• ginseng and other herbs.

Most of these products are absolutely safe for health. For example, rosehip decoction can be taken even by children. To enhance the properties of aloe, it is better to mix it with honey.

Medicinal herbs in the treatment of yersiniosis

After stopping the acute period of the disease, the doctor may allow the use of decoctions of medicinal herbs and other folk remedies that improve metabolic processes and help restore the functioning of the gastrointestinal tract.

Medicinal herbs are often used that have anti-inflammatory and analgesic properties.

Unconventional methods help to quickly cleanse the body of toxins and reduce the negative effects of antibiotics, which are necessarily prescribed in the treatment of yersiniosis.

More often, traditional medicine suggests using the following medicinal plants to speed up recovery:

• chamomile;
• chicory;
• birch buds;
• Potentilla;
• celandine;
• calendula;
• yarrow and so on.

Do not self-medicate or try to cure yersiniosis yourself with folk remedies. This will inevitably lead to complications with your health.

Consult your doctor before using any alternative treatments. Even harmless methods can complicate the course of the disease.

Remember that some herbs need to be used with extreme caution as they are poisonous (eg celandine) and may cause side effects.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Source: https://yellmed.ru/bolezni/iersinioz

Yersiniosis intestinal

Syn: yersiniosis

Yersiniosis is an acute infectious disease characterized by primary damage to the gastrointestinal tract and severe toxic and allergic symptoms.

Historical information. The first information about the causative agent of yersiniosis was obtained in the USA, where from 1923 to 1957 about 15 strains of the bacterium were isolated from humans, classified at that time as atypical variants of the pseudotuberculosis microbe.

The founders of the study of the causative agents of yersiniosis are J. Shleifstein and M. Coleman, who described them in 1939 under the name “unidentified microorganisms.”

Subsequently, the name of the bacteria changed several times until the modern name Yersinia enterocolitica was established.

Since the late 60s, there has been a wide spread of animal and human diseases caused by Y. enterocolitica. According to WHO, in 1966, only 23 cases of yersiniosis in humans were described in the world.

Currently, this infection is constantly being recorded in many countries in Europe, America, Asia and Africa.

Etiology. The causative agent of yersiniosis belongs to the family of intestinal bacteria Enterobacteriaceae, genus jersinia.

Yersinia are gram-negative rods measuring (1.8-2.7) x (0.7-0.9) microns. They grow on both regular and nutrient-depleted media.

The biochemical activity of the causative agent of yersiniosis is higher than that of the pseudotuberculosis bacterium; there are 5 biochemical variants.

When bacterial cells are destroyed, endotoxin is released. For most strains of Y.

enterocolitica of various serovars are characterized by adhesion, colonization on the surface of the intestinal epithelium and enterotoxigenicity with the production of large amounts of heat-stable enterotoxin.

Yersinia also has the ability to invade and reproduce intracellularly, but their invasive properties are expressed to a much lesser extent than those of the pseudoguberculosis bacterium.

Like the causative agents of pseudotuberculosis, Yersinia are psychrophiles. At refrigerator temperatures (+4-8 °C) they are able to survive for a long time and multiply on vegetables, root vegetables and other food products. When boiled they die within a few seconds. Sensitive to the action of conventional disinfectants.

Epidemiology. The causative agent of yersiniosis is widespread in nature. It was found in soil, water, and isolated from the body of many animal species.

However, the main reservoir of the pathogen in nature is obviously small rodents, which, by infecting various environmental objects, food products, and water, contribute to the spread of infection among other animals.

Soil also serves as a reservoir for Yersinia, which is explained by the presence of properties typical of saprophytes. On this basis, the disease can be classified as saprozoonosis.

The main source of infection for humans are domestic animals, less commonly synanthropic rodents. A sick person and a bacteria excretor as sources of infection are incomparably less important.

The main route of spread of foodborne infection. Yersinia transmission factors most often include infected meat products, vegetables, root vegetables, milk, and water.

Pathogenesis and pathological picture. Having penetrated the body through the mouth, Yersinia enters the stomach, where they partially die under the influence of an acidic environment. Bacteria that have overcome the protective barrier of the stomach invade the mucous membrane of the ileum and its lymphoid formations.

At the site of the entrance gate of infection, an inflammatory process of varying severity develops (terminal ileitis). Through the lymphatic vessels, Yersinia penetrates the mesenteric lymph nodes and causes mesadenitis. The appendix and cecum may be involved in the pathological process.

Against the background of infectious and inflammatory changes, toxic and allergic processes associated with toxinemia develop. At this stage, the infectious process, acquiring the features of a localized form, can be completed.

In case of a breakthrough of the intestinal lymphatic barrier, bacteremia occurs, causing the development of generalized forms of the disease.

Toxic-allergic damage to many organs and systems is observed, primarily the liver and spleen; the development of polylymphadenitis, polyarthritis, osteitis, myositis, nephritis, urethritis, meningitis, etc. is possible.

Immunopathological reactions in some patients with yersiniosis can serve as an impetus for the development of systemic diseases (type of collagenosis).

The final link in the pathogenesis of yersiniosis is the liberation of the body from the pathogen, leading to recovery. The developing immunity in yersiniosis is not strong enough, which is associated with the frequent development of exacerbations and relapses of the disease.

Data on pathomorphological changes in yersiniosis were obtained from surgical interventions and autopsies in individuals who died from severe forms of the disease.

In severe generalized forms, hemorrhagic edema and necrosis of the ileal mucosa are noted, in the mesentery there are enlarged, hyperemic lymph nodes, in the liver and spleen there are multiple small necrotic foci or abscesses, from the contents of which Yersinia are isolated.

Clinical picture. The duration of the incubation period ranges from 1 to 6 days. Yersiniosis is characterized by polymorphism of clinical manifestations. The most common lesions of the gastrointestinal tract are in combination with intoxication syndrome - gastroenteritis, enterocolitis, gastroenterocolitis.

The disease begins acutely: chills occur, body temperature rises to 38-39 °C. Patients are concerned about headache, weakness, myalgia and arthralgia. Simultaneously with the intoxication syndrome, nausea occurs; in some patients, vomiting and abdominal pain occur, which are cramping or constant.

The pain is localized in the epigastrium, around the navel, in the right iliac region, sometimes in the right hypochondrium. The stool is liquid, viscous, with a pungent odor. In some patients, when the colon is involved in the pathological process, an admixture of mucus is found in the stool, and less often - blood. The frequency of stool is from 2-3 to 15 times a day. The duration of the disease is 2-15 days.

Along with the benign course, there are severe forms of the disease with severe intoxication and dehydration.

The clinical manifestations of acute terminal ileitis, mesadenitis and appendicitis do not differ significantly from the course of the corresponding variants of pseudotuberculosis infection.

Along with abdominal (gastrointestinal) manifestations, toxic-allergic symptoms develop in yersiniosis.

Upon objective examination in the 1st week of the disease, the skin of patients is of normal color or somewhat pale. Some of them develop a pinpoint or small-spotted rash on symmetrical areas of the skin of the trunk and limbs, which disappears within a few hours to 3-4 days.

Conjunctival hyperemia and scleral vascular injection are often observed. The mucous membrane of the pharynx is diffusely hyperemic. On palpation, moderately enlarged and painful peripheral lymph nodes are found. Lability and increased heart rate corresponding to body temperature are determined.

Blood pressure is slightly reduced.

In patients with low nutrition, enlarged and painful mesenteric lymph nodes can be felt. Usually the liver is involved in the pathological process. It increases and becomes accessible for palpation by the end of the 1st week of the disease.

In some patients, damage to the liver parenchyma leads to the appearance of icterus of the sclera and skin, hyperbilirubinemia, urobilin and bilirubinuria, and moderate hypertransaminasemia. Sometimes splenomegaly occurs.

The disease is often accompanied by the development of the “infectious-toxic kidney” symptom complex. In some cases of severe disease, signs of serous meningitis are observed.

In the peripheral blood, leukocytosis, neutrophilia, band shift, increased ESR, and sometimes eosinophilia are observed.

At the 2nd and 3rd weeks of the disease, symptoms appear that indicate an immunoallergic restructuring in the body.

During this period, urticarial, macular, maculopapular rashes often occur, localized on the torso and limbs, often in the area of ​​large joints; Erythema nodosum.

Some patients develop infectious-allergic polyarthritis: 2-4 joints are involved in the process, swelling, redness, and increased temperature are noted in the area of ​​the affected joints.

Flow. Exacerbations and relapses often complicate the course of yersiniosis. They occur in 1/3 of patients and are characterized by a repeated wave of fever and symptoms of damage to the gastrointestinal tract in combination with extra-abdominal manifestations, typical of the peak period.

During the period of convalescence, body temperature drops to normal, symptoms of intoxication disappear, and the functions of internal organs normalize. In some patients, from the 2-3rd week of illness, pityriasis-like peeling of the skin appears on the torso, face and neck and lamellar peeling on the palms and soles.

There is no generally accepted clinical classification of yersiniosis. There are localized and generalized forms. According to the greatest severity of a particular pathological syndrome, gastrointestinal, abdominal (appendicular) and generalized (secondary focal, septic) forms and bacterial excretion are distinguished.

Based on the severity of the course, they distinguish between mild, moderate and severe, which is determined by the severity of the intoxication syndrome and the degree of involvement of internal organs in the pathological process. More often the disease occurs in mild and moderate forms.

In all forms of manifest course of yersinia infection, the duration of the disease usually does not exceed 1.5 months.

However, sometimes a protracted course of the disease occurs (1.5-3 months) and in rare cases - more than 3-6 months (chronic).

The presence of chronic diseases of the gastrointestinal tract and connective tissue, etiologically associated with previous yersiniosis, is regarded as a clinical picture of the consequences of yersiniosis (residual phase).

Fever of remitting or irregular type is accompanied by tremendous chills and sweat. Jaundice is common. A roseolous, maculopapular or hemorrhagic rash is often observed on the skin. In all cases of septic form, hepatosplenomegaly is detected.

Anemia, neutrophilic leukocytosis, and a significant increase in ESR are observed in the peripheral blood. The course of the disease often has an unfavorable outcome.

Bacterial excretion is characterized by the absence of clinical symptoms of the disease in the presence of Yersinia discharge from feces. Bacterial excretion can be either short-term (acute) or long-term (chronic) - for several months. Bacterial excretors of Yersinia are actively detected during examination of workers at food enterprises and contact workers in outbreaks.

Forecast. In most cases, with the exception of the septic form, favorable.

Diagnostics. Of the clinical signs, the combination of gastrointestinal tract damage syndrome and “extraintestinal” toxic-allergic symptoms has the greatest diagnostic significance.

Epidemiological anamnesis data are of great importance in recognizing yersiniosis, especially in case of a group nature of the incidence.

However, specific diagnostic methods - bacteriological and serological - are decisive in establishing the final diagnosis.

The main materials for bacteriological research are feces, blood, cerebrospinal fluid, lymph nodes resected during surgery and the appendix.

Serological diagnosis is of great importance for confirming not only the clinical diagnosis, but also the etiological role of the isolated Yersinia. It is carried out using RA and RNGA using the paired serum method. Sera taken at the beginning and at the 3rd week of illness are examined. A titer of 1:80 or higher is considered diagnostic for RA, and a titer of 1:160 or higher for RNGA.

Histological examination of biopsy samples of lymph nodes and other organs is also of certain importance in diagnosis.

Differential diagnosis. Determined by the clinical variant of the disease. Most often there is a need to differentiate this disease from acute intestinal infections, pseudotuberculosis, appendicitis, infectious polyarthritis, rheumatism, viral hepatitis, sepsis of other etiologies, etc.

Treatment. Antibiotics, sulfonamides and chemotherapy drugs are used as etiotropic agents.

Of the antibiotics, the most effective are chloramphenicol (0.5 g 4 times a day), tetracycline drugs, aminoglycosides, streptomycin, and in severe forms - cephalosporins.

Among sulfonamide drugs, biseptol is most often used, among chemotherapy drugs - nitrofuran (0.1 g 4 times a day). The duration of etiotropic therapy depends on the form of the disease, usually 7-14 days, for generalized forms - at least 14 days.

Pathogenetic therapy involves the administration of detoxification, restorative and stimulant agents. In some cases, glucose-electrolyte and polyion solutions are used for rehydration. An important role belongs to hyposensitizing agents. Surgical treatment is performed according to indications.

Prevention. A set of measures is being carried out similar to those carried out for pseudotuberculosis and salmonellosis.

Next chapter

Source: https://med.wikireading.ru/954

Yersiniosis: symptoms, forms, diagnosis, treatment, complications

Among intestinal infections, a special place is occupied by yersiniosis, a contagious disease caused by pathogenic bacteria of the genus Yersinia.

The peculiarity of these diseases lies in the variety of clinical manifestations, including both symptoms from the gastrointestinal tract and signs of damage to organs located outside the abdominal cavity.

In this article we will look at the disease caused by Yersinia enterocolitica. Other yersinioses are pseudotuberculosis and plague - we will consider them separately.

The causative agent of yersiniosis

The direct cause of yersiniosis is the gram-negative bacillus Yersinia enterocolitica. According to its microbiological characteristics, it belongs to the Enterobacteriaceae family, which also includes the causative agents of shigellosis, salmonellosis, escherichiosis and many other bacterial intestinal infections.

Yersinia enterocolitica grows on media with a depleted composition. At room temperature it is mobile, but at 37 degrees and above (which corresponds to the body temperature of a febrile patient) it is motionless.

The bacterium multiplies well in cool conditions, including in household refrigerators and vegetable stores.

Epidemiology

The natural reservoir for the bacterium is soil. For normal life activity, Yersinia does not necessarily need to enter the body of an animal or a person. However, a high incidence of yersiniosis is often observed in the population of rodents, cattle, pigs, cats and dogs.

Infection with yersiniosis occurs through eating vegetables, fruits, herbs and salads that contain particles of infected soil. Another possible transmission factor is unpasteurized and unsterilized milk. The incidence of yersiniosis is sporadic and almost never takes the form of outbreaks or epidemics.

Pathogenesis

The mechanism of development of yersiniosis occurs in several phases:

• Bacteria populate the epithelial cells of the lymphoid formations of the small intestine and invade them;
• Once in the blood, Yersinia spreads throughout the body and settles in the internal organs;
• Death of bacteria due to the work of the immune system and antibacterial therapy.

It should be noted that Yersinia enterocolitica, unlike the causative agent of pseudotuberculosis, is less prone to spread to internal organs.

Due to the antigenic structure of Yersinia, a toxic-allergic syndrome develops, which often takes on the character of an autoimmune process.

Clinical picture and symptoms of yersiniosis

The duration of the incubation period for yersiniosis ranges from 14-16 hours to 6 days. After this, one of the following forms of the disease develops:

Form	Option	Character of the current
Gastrointestinal	Gastroenteritis, enterocolitis, gastroenterocolitis	Acute
Abdominal	Mesenteric lymphadenitis, terminal ileitis, acute appendicitis	Lingering
Generalized	Mixed, septic	Chronic
Secondary focal	Arthritis, erythema nodosum, Reiter's syndrome and others	Chronic

All cases begin with symptoms of a common intestinal infection, and then organ damage occurs.

Regardless of the form of the disease, the disease always begins acutely. Within a few hours, or less often days, the following symptoms of yersiniosis appear:

• Abdominal pain, mainly in the middle and upper sections;
• Loose stools;
• Increased body temperature;
• Pain in muscles and joints;
• Enlarged lymph nodes;
• Skin rash.

Gastrointestinal form of yersiniosis

In its clinical course, this form of the disease is not much different from ordinary food poisoning. However, it is characterized by catarrhal phenomena of varying severity (lacrimation, redness of the eyes, runny nose, sore throat) and urination disorders.

In patients with the gastrointestinal form, in addition to the catarrhal phenomena described by you, there is pallor or redness of the face, as well as enlargement of the axillary and inguinal lymph nodes. By the 5th-6th day of illness, the pattern of the tongue becomes coarse-grained and often reddish, which in appearance resembles a raspberry (“raspberry tongue”).

On days 2-4 of the disease, another typical symptom of yersiniosis appears - a scarlet-like rash. A profuse, pinpoint or spotty rash (less commonly, like urticaria) appears on the hands, palms, soles, chest and thighs, which persists for a couple of days and disappears with characteristic peeling.

Palpation of the abdomen reveals some pain in the lower right part, as well as an enlarged liver.

Abdominal form of yersiniosis

This type of yersiniosis is more common in children. It can occur in the form of mesenteric lymphadenitis (mesadenitis), terminal ileitis or acute appendicitis.

• Mesadenitis , or inflammation of the lymph nodes of the mesentery of the small intestine. It is characterized by high body temperature, chills, increasing pain in the right lower abdomen and around the navel, nausea, vomiting, and loose, loose stools. In addition, other manifestations of yersiniosis, especially a rash, may occur.
• Yersinia acute appendicitis in its clinical course is no different from that for other causes.
• Terminal ileitis , or inflammation of the final sections of the small intestine. As a rule, it develops during remission or during relapse. It is characterized by increasing pain in the lower abdomen, more on the right, tension in the muscles of the abdominal wall, nausea, vomiting, diarrhea and enlarged liver.

The development of the abdominal form is due to the fact that Yersinia purposefully penetrates the lymphoid formations of the intestine. In the small intestine they occur approximately every 1-2 cm, while the appendix consists almost entirely of lymphoid tissue.

Of course, yersiniosis in children can occur in other forms, but the abdominal form is the most common in pediatric practice.

Secondary focal form

It develops when Yersinia affects distant organs. This form is characterized by a long, often multi-year course and is very difficult to treat.

• Erythema nodosum is a skin manifestation of this infection, characterized by the appearance of large bluish-purple elements on the legs, rising above the skin level. The secondary focal form can occur either after a previous gastrointestinal form or independently (which happens less frequently).
• Arthritis with yersiniosis can affect both large and small joints, which requires careful differential diagnosis with rheumatoid arthritis, osteoarthritis and other rheumatological diseases.
• Reiter's syndrome is a serious disease that combines three problems: inflammation of the urethra and lower genitourinary tract (urethritis, prostatitis, prostatovesiculitis), pathology of the choroid (uveitis) and arthritis.

Complications of yersiniosis

Due to the variety of clinical manifestations and multiple organ damage, the infection can lead to the following complications:

• Myocarditis;
• Vasculitis;
• Acute pyelonephritis, occurring in most patients;
• Pneumonia;
• Meningitis;
• Meningoencephalitis;
• Peripheral neuropathies;
• Peritonitis due to perforation of the intestinal wall;
• Infectious toxic shock (rare).

In children, yersiniosis can be complicated by Kawasaki syndrome, an acute disease with typical damage to blood vessels, including the coronary arteries of the heart. The disease is accompanied by redness of both eyes, dense swelling of the hands and feet, a rash on the body and inflammation of the cervical lymph nodes.

Diagnostics

Yersiniosis should be suspected if the patient, in addition to the symptoms of acute intestinal infection, experiences catarrhal symptoms, skin rash (mainly on the hands and feet), pain in muscles and joints, and an increase in palpable lymph nodes. Further diagnosis of yersiniosis is carried out using:

1. Serological studies that determine antibody titers - RA, RSK, RPGA and others. The paired serum method is used, in which the level of antibodies to Yersinia is determined at intervals of 10-14 days.
2. Bacteriological studies, including stool culture on nutrient media.

Due to the variety of clinical manifestations, it is impossible to make a diagnosis based on symptoms alone.

This infection should be differentiated from salmonellosis, shigellosis, scarlet fever, viral hepatitis, rheumatoid arthritis and many other diseases.

Treatment of yersiniosis

If this infection is suspected, especially if the test results are positive, it is necessary to begin antibacterial therapy as quickly as possible. The drugs of choice are fluoroquinolones and 3rd generation cephalosporins. A combination of these antibiotics with tetracyclines is acceptable. Treatment should continue for at least 10-14 days.

All patients are prescribed desensitizing therapy, which reduces the severity of toxic-allergic syndrome. For this purpose, antihistamines are prescribed for a period of 10 to 15 days.

The phenomena of gastroenteritis require nonspecific symptomatic treatment, which includes:

• Replenishing lost fluid using both Regidron solution and droppers;
• Antispasmodics (No-Shpa, papaverine), eliminating abdominal pain;
• Enzyme preparations (Panzym, Mezim, Enzistal, Creon);
• Intestinal sorbents (Smecta, Neosmectin, Enterosgel);

If necessary, the patient is injected with yersinia bacteriophage, a special drug that specifically destroys bacterial cells.

When treating a secondary focal form, consultation with other specialists - a rheumatologist, dermatologist and others - may be required.

Thus, yersiniosis is an infectious disease that has a variety of clinical manifestations. Prevention of this disease includes eating only high-quality food products that undergo proper sanitary control.

Source: https://zhivotu.net/iersinioz/