Yersiniosis. Causes, symptoms, diagnosis and treatment of pathology

The period of time from the moment of penetration of harmful microbes into the patient’s body until the appearance of the first symptoms of yersiniosis can take from 15 hours to 6 days, but on average it does not exceed 2 – 3 days. This stage of yersiniosis is called the incubation period. At this stage, the pathogen enters the gastrointestinal system, actively multiplies there and gradually damages the intestinal epithelium. The larger the single dose of the infectious agent and the more virulent ( more contagious) microbe, the faster the disease will manifest itself clinically. In addition, the rate of onset of symptoms also depends on the state of the patient’s immune system. The weaker the immune system, the sooner the patient will experience discomfort in the stomach.

In the vast majority of cases, yersiniosis begins with symptoms of acute gastroenteritis ( inflammation of the mucous membrane of the stomach and small intestine), which is characterized by fever, acute onset, abdominal pain, nausea, vomiting, diarrhea, etc. After these symptoms occur, yersiniosis can further proceed either as an acute intestinal infection ( in this case, only the gastrointestinal system is affected), which happens most often, or as a generalized infection ( in which there is additional damage to various organs that are not part of the gastrointestinal tract). This stage of yersiniosis is called the height of the disease. It is at this stage that for yersiniosis, depending on the symptoms, the clinical form is established ( gastrointestinal, abdominal, generalized, secondary focal) and severity ( worn, light, medium, heavy).

Symptom	The mechanism of its development	How does this symptom manifest itself?
Stomach ache	Abdominal pain with yersiniosis is caused by damage to sensory nerve endings localized in the intestinal wall. The damage itself is caused by an inflammatory process caused by pathogenic bacteria that damage the intestinal tissue.	Painful sensations are most often projected to the epigastric region ( anatomical region located just below the xiphoid process of the sternum), periumbilical area of ​​the abdomen and/or right iliac region ( lower right corner of the abdomen). The intensity, duration, and nature of abdominal pain are always different and depend on many factors ( the dose of the infectious agent, the state of immunity, the form of the disease, the presence of other inflammatory diseases in the gastrointestinal system, etc.), which does not allow us to accurately describe them.
Nausea	All symptoms ( nausea, vomiting, general weakness, decreased ability to work, muscle pain) are signs of general intoxication of the body with decay products of its own tissues and bacterial cells dying as a result of the immune response. All these products have a harmful effect on various structures of the brain, resulting in these symptoms.	Nausea, vomiting, general weakness, decreased ability to work, and muscle pain are symptoms that are nonspecific for yersiniosis. They usually appear in all its forms, in addition they can be observed in many other infectious diseases. Typically, all of these symptoms occur suddenly, along with abdominal pain, fever and diarrhea, and serve as indicators of an intestinal infection. The sequence of appearance of each of the symptoms of intoxication of the body ( nausea, vomiting, general weakness, decreased ability to work, muscle pain) and their intensity are always individual. The duration of such symptoms is most often determined by the form of the disease. So, for example, in the gastrointestinal form of yersiniosis, these symptoms begin to disappear by the 5th - 6th day of the disease, and in the generalized form they last for more than 1 - 2 weeks.
Vomit
General weakness
Decreased ability to work
Muscle pain
Fever	Fever in yersiniosis is a consequence of exposure to inflammatory substances released from damaged organs ( small and large intestines, appendix, joints, etc.), on the temperature center of the hypothalamus. As a result of constant stimulation, the temperature center begins to activate the sympathetic nervous system, which leads to an increase in body temperature. One of the mechanisms for its increase is a reflex spasm of the peripheral subcutaneous vessels, as a result of which there is a decrease in heat transfer to the external environment and an increase in heat production through contraction of skeletal muscles. These two mechanisms underlie the appearance of chills.	Body temperature most often increases from 2 to 3 days of infection. It fluctuates between 37 and 38 degrees. Slightly less frequently, fever can reach significant levels ( 39 – 41°C), especially in the generalized form of the disease. At high numbers, fever is often associated with chills. The duration of fever in gastrointestinal and abdominal forms of the disease does not exceed 5–8 days. With a mixed version of the generalized form of yersiniosis, high body temperature can last about 14 days.
Chills (trembling when body temperature rises)
Diarrhea	Diarrhea with yersiniosis is caused by inflammatory processes in the wall of the small and large intestines. During inflammation, a large amount of mucus, protein exudate, and pus are released into the intestinal lumen, which become part of the feces. In addition, harmful bacteria damage the membranes of intestinal epithelial cells, as a result of which the transmembrane transport of electrolytes is disrupted, which leads to a disorder of osmotic balance - the environment in the intestinal cavity becomes more osmotic than the environment inside the intestinal cells. This condition leads to the release of fluid from the intestinal wall into the intestinal cavity, which is accompanied by copious loose stools.	Diarrhea in the gastrointestinal form of yersiniosis occurs along with nausea, vomiting, general weakness, decreased ability to work, muscle pain, abdominal pain, and fever. The stools are mushy, sometimes liquid, foul-smelling, mixed with mucus and blood. Purulent discharge is usually not detected. The frequency of stool varies from 4 to 20 times a day. The average duration of diarrhea does not exceed 4–5 days. With the abdominal form, diarrhea ends on the 3rd – 4th day, and the nature of bowel movements is exactly the same as with the gastrointestinal form. Diarrhea in generalized and secondary focal forms of yersiniosis is not a dominant symptom and usually occurs in the initial stages of the disease, then giving way to other manifestations of this infection.
Joint pain	The appearance of joint pain and exanthema is associated with the development of slow-type hypersensitivity reactions to antigens during the disease process ( pathogen molecules that are recognized by the patient's immune system) Yersinia. The essence of these reactions is as follows. Particles of dead harmful microbes ( as well as the microbes themselves) during infection circulate in small quantities in the circulatory system, through which they are sometimes carried to other organs and tissues ( for example, in joints, skin, mucous membranes of the respiratory tract, etc.), where their deposition occurs. Cells of the immune system that live in places where such antigens are deposited recognize them and trigger inflammatory reactions, resulting in partial damage to their own tissues.	Skin rash and joint pain in the generalized and gastrointestinal form appear, as a rule, on days 2–4 of the disease. Exanthematous rashes can have a varied character ( spotted, dotted, maculopapular, etc.). They are localized on the skin of the palms, chest, feet, back of the hands, and thighs. Regression ( reverse development) rash is noted after several ( 3 - 6 ) days. The rash leaves behind peeling skin. Joint pain in these forms can be of varying intensity and occur at different intervals throughout the day. Most often, with yersiniosis, small ( phalangeal, wrist) and large ( ankle, scapuloclavicular, knee, shoulder) joints. Duration of arthralgia ( joint pain) can take from a couple of days to several months ( especially in generalized and secondary focal forms). Exanthema and pain in the joints can also appear with the abdominal form of yersiniosis, but they are not the main ones, so they are clinically rare.
Exanthema (skin rash)

Diagnosis of yersiniosis

The diagnosis of yersiniosis is made based on data from clinical, laboratory and instrumental studies. Clinical studies include the collection of anamnestic information and an external examination of the patient. Anamnestic data is information about the disease ( symptoms, course of the disease, time of appearance of the first signs of pathology, etc.) and about the circumstances that could contribute to its development ( drinking water from natural water sources, insufficient heat treatment of food, contact with infected animals, etc.). There are no external specific signs for yersiniosis, however, upon external examination, a skin rash can be detected in the patient ( on days 2–6 of illness), pale skin, red tongue ( raspberry tongue) on days 5–6 of illness ( with gastrointestinal form), lacrimation, hyperemia ( redness) conjunctiva of the eyes.

In some cases, patients may experience yellowing of the skin ( jaundice), which may be a consequence of damage to liver tissue. On palpation ( feeling with fingers) abdomen, pain in the epigastric region is often detected ( a place on the abdomen located just below the sternum), navel and right iliac region. Sometimes hepatomegaly can be detected ( liver enlargement), hepatosplenomegaly ( ), lymphadenopathy ( enlargement of lymph nodes in size) cervical nodes.

In the abdominal form, enlarged lymph nodes can be palpated ( feel with your fingers) to the right of the navel. Clinical studies are necessary in order for the doctor to fully understand what exactly is happening to the patient, find out the full clinical picture of the disease and determine further tactics for managing the patient. After clinical studies, the patient should usually be prescribed laboratory tests ( general blood test, biochemical blood test, immunological blood test, microbiological analysis, etc.), which are simply necessary to confirm or refute the diagnosis of yersiniosis. It is this group of studies that is basic in the diagnosis of this disease.

For yersiniosis, the attending physician may also prescribe the patient to undergo some instrumental examinations ( for example, computed tomography, ultrasound, electrocardiogram, radiography, etc.). These tests cannot detect the causative agent of the disease in the patient's body. The doctor needs them in order to exclude other pathologies during the diagnosis process that may have symptoms similar to yersiniosis, as well as to detect various complications.

Basic laboratory methods for diagnosing yersiniosis

Diagnostic method	Methodology	What signs of disease does this method reveal?
General blood analysis	For these two types of studies ( general and biochemical blood tests) blood is taken from the patient's ulnar vein into a special plastic tube - a vacutainer. Then the blood samples will be placed into special hematological and biochemical analyzers, which determine the main indicators for these types of studies. A complete blood count usually calculates the number of different blood cells ( erythrocytes, leukocytes, platelets, monocytes, lymphocytes, etc.) and some other indicators, such as total hemoglobin content, hematocrit ( percentage of red blood cells to whole blood), ESR ( erythrocyte sedimentation rate). In biochemical analysis, the analyzer determines the concentration in the blood of various enzymes, proteins, minerals and metabolic products.	A general blood test for yersiniosis can reveal anemia ( ), leukocytosis ( increased levels of leukocytes in the blood), lymphopenia ( decreased level of lymphocytes in the blood), eosinophilia ( increase in the number of eosinophils in the blood), increase in ESR ( ), rod shift ( an increase in the content of segmented neutrophils and a decrease in the content of band neutrophils).
Blood chemistry		A biochemical blood test can detect an increase in alanine aminotransferase activity ( ALAT), aspartate aminotransferase ( ASAT), alkaline phosphatase, increase in the concentration of C-reactive protein, total bilirubin, decrease in albumin concentration.
Immunological blood test	During an immunological analysis, a blood sample is taken in the same way as for general or biochemical studies. The essence of this study is to find antigens using certain methods ( Yersinia particles) in the patient's blood. It can also be used to detect antibodies ( protein defense molecules that are produced by cells of the immune system during infection) to harmful microbes in the blood. The main immunological methods used to detect such antigens and/or antibodies are ELISA ( linked immunosorbent assay) , RIF ( immunofluorescence reaction), RAL ( latex agglutination reaction) and etc.	Antigens of the causative agent of yersiniosis can be detected in the blood of patients, usually from the 10th day of the disease. Antibodies ( protein defense molecules that are produced by cells of the immune system during infection) need to be searched from the 14th day of illness. In this case, 10 days after the first immunological blood test for antibodies, it is necessary to schedule a repeat test to assess the level of antibodies and the dynamics of their growth/decrease.
Genetic analysis	Genetic analysis makes it possible to detect in any pathological material ( blood, vomit, feces, etc.), taken from the patient, DNA of the causative agent of yersiniosis. This study is highly accurate and is based on the PCR method ( polymerase chain reaction) .	DNA ( Deoxyribonucleic acid) is a molecule that carries encoded genetic information, which contains information about the individual growth of a particular biological organism. All contain a DNA molecule dead or alive) yersinia, therefore, if using genetic analysis it is determined that it is present in the material, then, therefore, we can conclude that the patient has yersiniosis.
Microbiological analysis	With the help of microbiological research it is possible to isolate from clinical material ( blood, vomit, feces, washings from the back of the throat, etc.) in its pure form as the causative agent of yersiniosis. The essence of this study is as follows. Pathological material taken from the patient will interfere with ( sow) to special plant environments in which this pathogen can freely grow and reproduce. After a certain period of time, bacterial colonies are assessed and identified.	Microbiological analysis is the main method for diagnosing yersiniosis, since the detection of harmful microbes in clinical material will be direct evidence of yersiniosis in the patient. It is recommended to send samples for microbiological testing to a bacteriological laboratory no later than 7 days from the onset of the disease. This analysis can also be used to study environmental objects ( e.g. water, food), which could cause infection.

Differential diagnosis of yersiniosis

Differential diagnosis of the most common form ( gastrointestinal) yersiniosis is mainly carried out with salmonellosis, food toxic infections ( PTI) and dysentery. With these pathologies, the patient, as a rule, does not have catarrhal ( cough, runny nose), skin ( skin rash), dysuric ( pain, burning sensation when urinating, urinary incontinence, increased/decreased urination, etc.), articular ( joint pain) disorders, hepatosplenomegaly ( enlarged liver and spleen), lymphadenopathy ( swollen lymph nodes), jaundice ( yellowing of the skin and sclera of the eyes). Fever with yersiniosis is quite long-lasting ( 1 – 2 weeks), while with dysentery, IPT and salmonellosis its duration does not exceed several days. Abdominal pain in the first case ( with yersiniosis) are cramp-like in nature and are projected in the peri-umbilical and right iliac regions of the abdomen, whereas in the second case ( for dysentery, PTI and salmonellosis) they can have a different character and be localized either in the lower ( for dysentery), or in the upper and middle abdomen ( for PTI and salmonellosis).

Stool with dysentery is very scanty with blood and mucus; with PTI and salmonellosis, it has a greenish color and a fetid odor. Yersiniosis is characterized by the appearance of liquid fecal masses, which, in some cases, may contain small streaks of blood and mucus. The abdominal form of yersiniosis is usually differentiated from acute appendicitis, which is not characterized by symptoms of hepatitis ( liver enlargement, pain in the right hypochondrium, jaundice, etc.), enlarged mesenteric lymph nodes, increased blood ESR ( in the absence of complications), exanthema ( skin rash). Acute appendicitis in the vast majority of cases begins with pain in the right iliac region, to which symptoms of general intoxication are added over time ( fever, nausea, vomiting, headache, weakness, etc.). With the abdominal form, the opposite is true - first symptoms of intoxication appear, and then they are accompanied by painful sensations in the abdomen.

Abdominal pain with yersiniosis is cramping, with acute appendicitis it is constant. The first pathology is characterized by epidemiological outbreaks and seasonality of incidence ( get sick more often in spring, early summer, late winter), and for the second, the absence of such. Leather ( palms, neck, face, feet) and mucous membranes ( eyes, mouth) with the abdominal form of yersiniosis are often hyperemic ( Red). In acute appendicitis, they are either unchanged or pale in color. Differential diagnosis of generalized and secondary focal forms of yersiniosis presents enormous difficulties, especially if it is done with the same clinical forms of pseudotuberculosis. This is explained by the pronounced polymorphic ( diverse) symptoms. The results of laboratory tests are decisive here.

Complications of yersiniosis

Serious complications can occur with yersiniosis. Some of these complications can lead to additional complications, which are sometimes even more serious and can be fatal. For example, one of the frequent complications of the abdominal form of yersiniosis is phlegmonous appendicitis ( ). In some cases, with this pathology, a breakthrough of the contents of the appendix may occur ( pus) into the abdominal cavity, which means peritonitis ( inflammation of the peritoneum) – additional life-threatening condition.

Most complications of yersiniosis ( peritonitis, appendicitis, intestinal perforation, intestinal obstruction, sepsis) require surgery and cannot be cured by the usual therapeutic agents used in its treatment. Many complications of this infectious disease can lead to ( especially if they are not detected in a timely manner) subsequently to adverse consequences affecting not only the gastrointestinal tract, but also other organs and tissues important to the body ( brain, kidneys, heart, blood vessels, lungs, etc.). The basis for the prevention of complications arising from yersiniosis is measures for timely diagnosis and effective antibacterial treatment. To prevent such complications, the patient just needs to see a doctor if he develops ( in a patient) the first symptoms of yersiniosis. In these cases, you should not try to cure yourself, since the antibacterial drugs that are used to treat this disease may be ineffective in certain cases.

The most common complications of yersiniosis are the following pathologies:

• sepsis;
• peritonitis;
• appendicitis;
• Kawasaki syndrome;
• intestinal perforation;
• intestinal obstruction;
• meningoencephalitis.

Sepsis

Sepsis is a very dangerous pathological syndrome in which the functions of many organs and tissues of the body are disrupted. Sepsis develops in response to the release, spread and multiplication of bacteria ( in this case yersinium) in the patient's blood. The penetration of a large number of bacteria into the bloodstream causes an excessive systemic inflammatory response from the body, in which a huge amount of inflammatory mediators are released into the blood ( inflammatory substances that are produced mainly by cells of the immune system). This massive inflammatory response is called systemic inflammatory response syndrome ( SSVR). This syndrome can also develop in other pathological conditions, for example, serious mechanical trauma, burns, intoxication, etc. Sepsis is SIRS that develops in response to a systemic infection. With yersiniosis it is very rare.

The main symptoms of yersinia sepsis are:

• heat ( above 38°C, in some cases body temperature may drop below 36°C);
• chills;
• arterial hypotension ( lowering blood pressure);
• disturbance of consciousness;
• dyspnea;
• tachycardia ( );
• general weakness;
• decrease in daily diuresis ( volume of urine excreted by patients per day);
• pale skin;
• anemia ( decrease in the number of red blood cells and hemoglobin);
• leukocytosis ( increase in the number of leukocytes in the blood);
• thrombocytopenia ( decrease in the number of platelets in the blood);
• lymphopenia ( decrease in the number of lymphocytes in the blood);
• increase in ESR ( erythrocyte sedimentation rate);
• changes in some biochemical blood parameters ( increased levels of bilirubin, creatinine, lactate, C-reactive protein, procalcitonin, presepsin in the blood).

Peritonitis

Peritonitis is an inflammation of the leaves ( parietal and/or organ) peritoneum. The peritoneum is a thin layer lining the abdominal cavity from the inside ( and abdominal organs externally). Normally this cavity is sterile. Under certain circumstances, infection from the gastrointestinal tract ( for example, from the small or large intestine) can spread to the peritoneum. With yersiniosis, secondary peritonitis usually develops. This means that for the development of inflammation of the peritoneal layers, there must be an infectious focus in the abdominal organs, from where the infection can directly spread to them. In most cases, peritonitis is observed in abdominal and generalized forms of yersiniosis. This complication is one of the most severe in surgical practice, as it is accompanied by serious symptoms ( ), dysfunction of various organs ( heart, kidneys, liver, lungs, brain, etc.) and can be fatal even with treatment.

Appendicitis

Appendicitis is a pathology in which inflammation of the tissues of the appendix is ​​observed ( appendix) cecum. The appendix is ​​a cavity elongated anatomical formation located in the right iliac region ( lower right corner of the abdominal cavity). This organ performs an immunological function and is not involved in the digestion of food entering the gastrointestinal system. Inflammation of the appendix of the cecum is a common manifestation of the abdominal form of yersiniosis. It occurs when Yersinia penetrates from the cavity of the cecum into the appendix. Inflammatory changes in the appendix in the abdominal form of yersiniosis can be of a different nature. The most common is usually catarrhal inflammation, in which the tissue of the appendix swells a little, turns red, and a small amount of mucus accumulates in its lumen.

There are also situations when catarrhal pathological ones are replaced by purulent and putrefactive ones. In such cases, the appendix significantly increases in size, pus accumulates in its lumen, numerous hemorrhages occur, and numerous erosions and ulcers appear on the walls. In the absence of therapeutic intervention, the organ gradually begins to die ( become necrotic). Such changes are characteristic of phlegmonous and gangrenous forms of appendicitis. Suppuration of the appendix is ​​a fairly common complication of the abdominal form of yersiniosis. This complication is very dangerous, as it can lead to peritonitis ( inflammation of the peritoneum), abscesses ( purulent cavities filled with pus) abdominal cavity, pylephlebitis ( inflammation of the portal vein), phlegmon ( inflammation of subcutaneous adipose tissue) and etc.

Kawasaki syndrome

Kawasaki syndrome ( mucocutaneous lymphonodular syndrome) is a systemic cardiovascular disease in which numerous arteries in the body are damaged ( medium and small diameter). As a result of such damage, generalized ( common) vasculitis ( inflammation of the walls of blood vessels), characterized by the appearance of various symptoms in the patient and leading to serious complications in the future ( for example, coronary artery aneurysms, myocarditis, coronary heart disease, myocardial infarction, heart failure, etc.). The cause of this syndrome in patients with yersiniosis has not yet been established. It is assumed that autoimmune disorders make a certain contribution to its occurrence ( disorders of the immune system) and genetic predisposition.

The main symptoms of Kawasaki syndrome are:

• prolonged fever ( up to several weeks);
• chills;
• redness of the tongue ( raspberry tongue);
• lymphadenitis ( an increase in the size of the cervical lymph nodes);
• inflammation of the mucous membrane of the eyes ( conjunctivitis);
• redness of the oral mucosa;
• redness and swelling of the skin of the legs and hands;
• peeling of the skin of the fingers and toes;
• dryness and cracks on the lips;
• arthralgia ( joint pain);
• rash on the skin of the groin area, trunk and limbs;
• pain in the heart area;
• cough;
• runny nose;
• dyspnea;
• gastrointestinal symptoms ( nausea, vomiting, diarrhea, abdominal pain, etc.).

Intestinal perforation

Intestinal perforation is a pathology in which a hole is formed in its wall ( one or more) of various sizes. Perforation of the intestinal wall is the result of necrotic changes ( that is, the processes of dying) in her tissues. This condition is very dangerous for the patient, since due to perforation, intestinal contents can enter the sterile environment of the abdominal cavity, resulting in peritonitis ( inflammatory process in the peritoneum). In addition, perforation may cause internal bleeding into the abdominal cavity, which is not so easy to stop. Intestinal perforation with yersiniosis occurs as a result of an excessively violent inflammatory process in its cavity, during which harmful bacteria seriously damage its tissue. First, ulcerations form in the intestinal wall, which are replaced by deep ulcers. Destruction of the bottom of such ulcers leads to perforation of the intestinal wall itself. The formation of pathological holes can occur anywhere - in the large or small intestine and in absolutely any part of them.

Most often, with yersiniosis, perforation of the ileum and cecum occurs. Symptoms of intestinal perforation are similar to those of peritonitis ( fever, chills, cutting pain in the abdomen, shortness of breath, nausea, vomiting, impaired consciousness, decreased blood pressure, increased heart rate, etc.). At its core, intestinal perforation is a complication that leads to an even more serious surgical pathology – peritonitis. It is very difficult to recognize the presence of perforation only by symptoms, so this complication is diagnosed quite late, which creates the preconditions for an unfavorable prognosis for the clinical course of yersiniosis.

Intestinal obstruction

Intestinal obstruction can be a complication not only of yersiniosis, but also of its other complications ( for example, peritonitis, sepsis, etc.). When it occurs, the patient’s movement of feces through the gastrointestinal system is disrupted, which is accompanied by the appearance of serious metabolic disorders, pain shock and autointoxication syndrome ( self-poisoning). Metabolic disorders include a decrease in protein intake into the body, loss of potassium, chlorine, water, and disturbances in carbohydrate and lipid metabolism. Loss of electrolytes ( potassium, sodium, chlorine) and water with intestinal obstruction, mainly due to vomiting and constant effusion ( coming out) intravascular fluid into the intestinal lumen. Violation of water-electrolyte metabolism leads to disorders in the cardiovascular system that are detrimental to the body. In such patients, blood pressure decreases, heart rhythm is disturbed, and the delivery of oxygen and other nutrients to peripheral organs and tissues slows down. Damage to the intestinal wall and its stretching by feces accumulating in the intestinal lumen is accompanied by damage to the nerve endings, which inevitably leads to the development of severe pain in the abdomen ( painful shock).

Autointoxication syndrome occurs due to the fact that long-term stagnation of feces occurs in the intestinal cavity, which serves as a favorable background for the development of diverse microflora, which produce a large amount of toxins in the process of their life. These toxic substances freely enter the bloodstream and then, spreading through the blood, adversely affect various tissues and organs. The mechanism of development of intestinal obstruction in yersiniosis is explained by several mechanisms. The first of these is paralytic. Some factors ( bacterial toxins, inflammation of the peritoneum, decreased amount of potassium in the blood, etc.) can negatively affect the neuromuscular system of the intestine and disrupt its normal functioning, which will affect its motility ( contractile movements of the smooth muscles of the intestine, ensuring the mixing of food and its movement through the gastrointestinal system).

The second mechanism for the development of intestinal obstruction is mechanical. Inflammatory processes caused by Yersinia in the intestines can lead to serious damage to its walls, as a result of which they can stick together and form adhesions ( fusions). Such adhesions within the intestine can mechanically block passage ( promotion) intestinal contents. Adhesions can also occur outside the intestine ( between its loops). This is often observed with peritonitis ( inflammation of the peritoneum). Intra-abdominal adhesions can compress the intestine from the outside and block the movement of feces through it and cause acute intestinal obstruction.

The main clinical manifestations of intestinal obstruction are:

• abdominal pain varies in nature and intensity;
• nausea;
• vomit;
• stool retention;
• visible asymmetry ( unevenness of relief) anterior abdominal wall;
• decreased blood pressure;
• tachycardia ( increased heart rate);
• dyspnea.

Meningoencephalitis

Meningoencephalitis ( inflammation of the brain and its membranes) is a rather serious complication of yersiniosis and is usually observed in its generalized form. The development of this complication is associated with the penetration of bacteria and their toxins through the bloodstream into various structures of the brain. Meningoencephalitis is accompanied by the appearance in the patient of fever, nausea, vomiting, headache, dizziness, convulsions, incoordination of movements, motor disturbances ( paresis, paralysis) activity and skin sensitivity, impaired consciousness ( excitement, delirium, hallucinations, etc.), photophobia, etc. Late diagnosis of meningoencephalitis can lead to disastrous consequences, since long-term inflammation of brain tissue can disrupt the functioning of the nervous system. First of all, this can affect the psyche and mental development of the patient. In addition, he may subsequently develop paralysis of the limbs, epilepsy, impaired vision, hearing, and skin sensitivity.

Treatment of yersiniosis

Treatment of uncomplicated forms of yersiniosis is medicinal. This infectious disease is treated using various means ( antibiotics, probiotics, eubiotics, enzymes, detoxification agents, non-steroidal anti-inflammatory drugs). The basic medications in the treatment of this disease are antibiotics, which are designed to destroy pathogenic bacteria that multiply in the patient’s intestines. The selection of antibiotics should always be carried out in accordance with the results of the antibiogram performed by the microbiological laboratory. An antibioticogram is a special bacteriological analysis that determines how sensitive pathogenic bacteria are to various types of antibiotics. To help antibiotics for yersiniosis, additional medications are prescribed that perform various tasks. Probiotics and eubiotics are necessary to restore and replenish normal intestinal microflora, which is often suppressed during intestinal infection. In addition, taking antibiotics also inhibits the growth of the patient’s own microflora. Patients need enzymes to facilitate digestion processes in the small intestine, since during the period of infection they are often seriously impaired.

Nonsteroidal anti-inflammatory drugs reduce symptoms of intoxication ( reduce temperature, increase performance). Detoxification agents help remove bacterial toxins from the body. When treating the secondary focal form of yersiniosis, glucocorticoids and immunostimulants are often prescribed. The former have a pronounced anti-inflammatory and immunosuppressive effect ( lower the immune response) effect. Immunostimulants are needed to increase general resistance ( resistance) of the body, they stimulate the proliferation of cells of the immune system and improve their interaction with each other. Treatment of complicated forms of yersiniosis, in addition to the above medications, may also include surgical treatment. Surgical intervention, in most cases, is necessary for peritonitis, intestinal perforation, intestinal obstruction, and some forms of appendicitis ( phlegmonous, gangrenous appendicitis).

Medicines used in the treatment of yersiniosis

Drug group name	Drug name	Method of using this drug
Antibiotics	Pefloxacin	This drug is prescribed 400 mg 2 times a day.
	Ofloxacin	The drug should be used in such a way that the maximum daily dose does not exceed 800 mg. Usually take 200 – 400 mg 2 times a day.
	Ciprofloxacin	Most often it is prescribed in a dose of 500 mg and a frequency of use 2 times a day.
	Chloramphenicol	Chloramphenicol is mainly prescribed when a patient has yersinia meningitis ( or meningoencephalitis). The dose of the drug is calculated based on the patient’s weight. It is recommended to prescribe 70–100 mg per day for each kilogram of body weight.
	Cefotaxime	Prescribe 2 grams 3 times a day in the form of intravenous or intramuscular injections ( injections).
	Ceftriaxone	Prescribe 2 grams 1 time per day in the form of intravenous or intramuscular injections ( injections).
	Co-trimoxazole	Children under 12 years old are recommended to take 1 tablet 2 times a day, over 12 years old - 1 - 3 tablets 2 times a day.
Nonsteroidal anti-inflammatory drugs	Ibuprofen	Patients over 12 years of age can take one tablet ( 200 mg) 3 – 4 times a day. The maximum daily dose for them is 1200 mg ( that is, you can’t take more than 6 tablets per day). Children from 6 to 12 years old are allowed to take exactly the same tablets no more than 3 to 4 times a day ( maximum daily dose 600 – 800 mg).
	Diclofenac	Adult patients are most often prescribed 100–150 mg of the drug per day. For children and adolescents, the dose of the drug is calculated based on the basic principle of 1 - 2 mg per 1 kg of body weight.
	Ketoprofen Organics	Available in the form of film-coated tablets and capsules. When using the first form of release, you should take this drug one tablet twice a day. When using the second dosage form, the recommended dosage regimen for adults and children over 14 years of age should be 4 capsules per day. You can take no more than two capsules at a time. The maximum daily dose of the drug is 200 mg.
Glucocorticoids	Prednisolone	Dosages of these drugs ( prednisolone, hydrocortisone) are selected individually depending on age, body weight, the nature of the pathology, its severity, the presence of concomitant diseases and complications.
	Hydrocortisone
Immunostimulants	Methyluracil	Adults are prescribed 500 mg 1 – 6 times a day. The maximum daily dose should not exceed 3 grams. Children are most often prescribed 250 mg of the drug, which is taken no more than 3 times a day.
	Sodium nucleinate	The daily dose should not be higher than 1 – 2 grams. Doctors recommend taking this drug 3 to 4 times a day. Each tablet contains 250 mg of the drug.
	Pentoxyl	Pentoxyl is prescribed 200–400 mg 3–4 times a day.
	Imunofan	Prescribe 100 mcg once a day. This drug is used in the form of a spray. One click on the spray is accompanied by the release of 50 mcg of the drug. It is sprayed into the nasal cavity. Thus, in order for the daily dose to be 100 mcg, the patient needs to make one press on the spray bottle in each of the nasal passages.
Probiotics and eubiotics	Linux	1 – 2 capsules 3 times a day.
	Acipol	Patients from 3 months to 3 years, one capsule 2 – 3 times a day. Patients over three years of age are recommended to take 1 capsule 3–4 times a day.
	Bifidumbacterin	Children over 7 years of age and adults are prescribed 2 sachets of this drug. Frequency of administration – 2 – 4 times a day. Children under seven years of age are prescribed one sachet 3 to 4 times a day.
Detoxification agents	Gemodez-N	Sold in the form of a solution for infusion. The drug solution is administered intravenously ( drip). Hemodez-n can be used 1 – 2 times per day. The maximum single dose for adults is 400 ml. For children, the volume of the drug is calculated depending on their body weight ( 2.5 ml per kg body weight). The maximum single dose depends on the age of the child.
	Neohemodesis	Available in the same form as gemodez-n ( as a solution for infusion). For adults, a single dose should not exceed 500 ml, and for children from 5 to 10 ml per kg of body weight. In most cases, the drug is administered 1–2 times a day.
Enzymes	Pancreatin	Adults should take pancreatin one tablet 3 times a day. For children, the dosage is selected individually.
	Pankreoflat	Adults are prescribed 1 - 2 tablets. They are taken after every meal. For children, the dosage is selected individually.
	Abomin	Abomin is usually prescribed one tablet three times a day.

When is hospitalization necessary for yersiniosis?

Treatment of yersiniosis, in most cases, requires hospitalization. Patients are usually hospitalized for epidemiological and clinical reasons. According to epidemiological indications, those persons who were in contact with the source of the disease are placed in the hospital ( for example, sick animals, people) or stayed in those places ( for example, in catering establishments, fruit and vegetable processing centers, fruit and vegetable warehouses, etc.), where cases of yersiniosis have been reported. The total time of hospitalization in the absence of signs of an infectious disease should not exceed 6 days.

Bacteria carriers ( those people who have a pathogen in the intestines, but do not have symptoms of the disease), mostly treated on an outpatient basis. If the work of these persons is related to food preparation, then they are temporarily transferred to another workplace. Clinical indications for hospitalization are the severity of the disease, the presence of complications, and the presence of concomitant pathology of various organs and tissues. Discharge from the hospital is possible only on the basis of complete clinical recovery with a one-time bacteriological study confirming the absence of Yersinia in the patient’s intestines.

Can yersiniosis go away without treatment?

Erased forms of yersiniosis can resolve in the patient in the form of an ordinary intestinal infection ( in the form of ordinary gastroenteritis). This happens sometimes. However, the main clinical forms of yersiniosis must necessarily be subject to drug treatment. The fact is that yersiniosis is one of those infections that can lead to numerous unpleasant complications. Some of them ( for example, peritonitis, sepsis, intestinal obstruction, etc.) are life-threatening, others can disturb the patient for a long time ( Reiter's syndrome, autoimmune thyroiditis, Crohn's disease, autoimmune arthritis, erythema nodosum, etc.).

Yersinia infection can become chronic; this is especially often observed in people who were either not treated at all, or in those who did not promptly contact their doctor for qualified help. In addition, it is also worth remembering that a wait-and-see attitude towards infectious diseases often seriously increases the patient’s risk of developing various complications, as well as prolongs the overall recovery period and contributes to the appearance of long-term undesirable consequences.

Prevention of yersiniosis

Prevention of yersiniosis includes a variety of measures. In most cases, they are aimed at preventing the spread of infection among farm animals, which are the main carriers of yersiniosis in nature, and preventing contamination of food products ( milk, fruits, vegetables, meat, etc.) Yersinia. Anti-epidemic measures taken to stop the spread and destruction in the epidemic focus are also important in the prevention of this infectious disease ( ) the causative agent of yersiniosis.

Preventive measures for yersiniosis can be divided into the following groups:

• activities related to the prevention of infection of animals with Yersinia;
• activities related to the prevention of food contamination with Yersinia;
• anti-epidemic measures.

Activities related to the prevention of infection of animals with Yersinia

Since animals are the main sources of yersinia, an appropriate direction in the prevention of yersiniosis is to prevent infection of these animals with these microbes. First of all, this applies to farm animals, with which people constantly come into contact and use for food enrichment. To prevent infection of animals, farmers must strictly comply with all sanitary and veterinary requirements and rules for animal care, which are specified in regulatory documents. These rules contain specific recommendations regarding the necessary conditions for keeping animals, their feeding, timely recognition of yersiniosis, its treatment, and isolation of the source of the pathogen. They also specify the requirements for high-quality cleaning and disinfection of places where pets are kept, disinsection and deratization of the premises where they live, and areas that are located near the farm.

Activities related to the prevention of infection of animals with Yersinia should also include microbiological control over the contamination of feed used to feed animals. Farm employees are required to know basic information about yersiniosis, which is one of the most common intestinal infections.

Activities related to the prevention of food contamination with Yersinia

Food ( milk, fruits, vegetables, meat, etc.) serve as important transmission factors ( that is, elements of the environment through which an infectious agent is transmitted from a source of infection to a susceptible organism) yersiniosis, therefore the conditions of their storage, transportation, culinary processing and sale play a significant role in the spread of this infection. Activities related to the prevention of food contamination with Yersinia include sanitary control ( from the relevant government control bodies) over the condition of fruit and vegetable, dairy, meat warehouses, premises, tools and equipment necessary for processing fruits, vegetables, meat, and dairy products. These measures should also include sanitary control over the condition of transport necessary for the transportation of food and primary matter ( not yet processed products).

Extremely important in preventing the transmission of yersiniosis is compliance with the correct storage and distribution conditions ( temperature, humidity, shelf life in warehouse) food products. These conditions are enshrined in special regulatory documents ( GOST). To prevent contamination of products with Yersinia, it is necessary to carry out timely deratization actions aimed at combating rodents, which can serve as potential carriers of various infectious diseases ( including yersiniosis).

Deratization measures must be carried out not only in warehouses where primary products are located, but also in the territories of primary processing enterprises, catering establishments, medical institutions, food industry enterprises, etc. In addition to these measures, bacteriological control over the contamination of rodents with Yersinia is also necessary. The same control is used to analyze the presence of harmful bacteria on the surface of fruits, vegetables, dishes, household products, and equipment of fruit and vegetable stores.

Anti-epidemic measures

Anti-epidemic measures are a set of measures aimed at identifying and eliminating the epidemic focus ( that is, the territory in which the source of infection resides and can transmit the infectious principle to other people) diseases. Anti-epidemic measures are usually carried out when seasonal outbreaks of yersiniosis are detected among the population. These include active recognition of patients and carriers ( and their isolation) in one team or another ( for example, among catering workers, in whose canteens cases of infection were detected among visitors), taking food products for laboratory examination, carrying out washes from surfaces on which products are processed, sanitary inspection of food storage areas. In such cases, close attention is paid to inspecting the facility to ensure it is kept clean and inhabited by rodents. When rodents are detected, appropriate unscheduled deratization measures are carried out. In the process of epidemiological analysis at a facility where cases of yersiniosis have been reported, the sale of products that have not undergone heat treatment is prohibited.

After identifying transmission factors ( that is, elements of the external environment through which an infectious agent is transmitted from the source of infection to a susceptible organism) of harmful bacteria in all areas of the catering unit, total disinfection is organized with the treatment of all working and non-working surfaces, equipment, food containers, and utensils. Those who have recovered from yersiniosis are discharged from an inpatient facility ( infectious diseases hospital) only after complete clinical recovery with control bacteriological examinations of stool carried out before discharge. Children and adolescents who have suffered yersiniosis are sent for follow-up to a local pediatrician ( family doctor).

If there are no signs of recurrence ( recurrence of disease symptoms) and complications, the duration of clinical examination is 21 days. Thus, anti-epidemic measures are necessary to prevent transmission of infection from an infected person ( or carrier) healthy. Such measures also help to block the food route of transmission of the causative agent of yersiniosis, which is achieved by excluding from the sale of food products and ready-made meals contaminated with the pathogen. It should be noted that specific prophylactic agents ( vaccines) have not been developed against yersiniosis.

Forecast of yersiniosis

The prognosis for yersiniosis is, in most cases, favorable. The disease does not last long and with timely treatment goes away quickly. Fatalities are extremely rare. Death with yersiniosis is mainly due to complications ( peritonitis, sepsis, intestinal obstruction, intestinal perforation, meningoencephalitis, etc.), which can develop during the course of this disease. The duration of this infectious disease often depends on the clinical form of the disease. So, for example, with the gastrointestinal form, complete recovery occurs in 3–4 weeks; with the abdominal or generalized form, recovery can take several months. The long recovery period for abdominal and generalized forms of yersiniosis is explained by the possible development of various additional complications in these forms, which can affect the overall course of the pathology. For example, with a generalized form of yersiniosis, the patient may often develop myocarditis ( inflammation of the heart muscle), pyelonephritis ( inflammation of the kidney tissue), pneumonia ( pneumonia), hepatitis ( inflammation of liver tissue), meningoencephalitis ( inflammation of the brain and its membranes), which is associated with the penetration of Yersinia into the relevant organs.

In the abdominal form, other complications are more common, for example, peritonitis ( inflammation of the peritoneum), phlegmonous appendicitis ( purulent inflammation of the appendix of the cecum), intestinal obstruction, intestinal perforation. In addition, there are so-called erased forms of yersiniosis, which have almost no clinical manifestations or are accompanied by the appearance of mild and quickly disappearing symptoms in the patient. The recovery time for such yersiniosis may take even less time than the average period required for recovery from the gastrointestinal form.

The biggest problem with yersiniosis is that even after recovery, the patient remains at risk of chronicity of the process, the level of which is very difficult to predict. In addition, there is also a risk of developing long-term consequences in the form of various systemic ( autoimmune) diseases ( Reiter's syndrome, autoimmune thyroiditis, Crohn's disease, arthritis, erythema nodosum, etc.). Such diseases appear mainly during the first 5 years from the moment of convalescence ( recovery) and serve as characteristic features of the secondary focal form of yersiniosis. Depending on the number and severity of clinical manifestations, treatment of this form can be delayed for many years.

What foods can cause yersiniosis?

Yersinia are quite viable microorganisms and survive in various environmental conditions. They reproduce easily in soil and surface water. The soil serves as a natural habitat for them. A person more often becomes infected with Yersinia either by drinking contaminated water or by eating poorly washed vegetables ( for example, cabbage, radishes, cucumbers, tomatoes, carrots, onions, etc.), fruits ( apples, plums, apricots, strawberries, pears, etc.). Yersiniosis can also develop when eating insufficiently thermally processed meat ( made from rabbit, cattle, pig, poultry, deer meat), dairy products and milk.

Particular attention should still be paid to vegetables, since they are not always given close attention during their pre-processing ( washing, cleaning) in the process of preparing salads. It is in salads that this pathogen multiplies very well. Therefore, it is necessary not only to wash vegetables well, but also to observe the permissible shelf life of salads ( which catering establishments often do not follow). In addition, people consume many vegetables raw and, in addition, do not always observe the rules of personal hygiene. All this creates additional risks of yersiniosis.

Is yersiniosis contagious?

Transmission of yersiniosis from humans ( source of infection) to person ( susceptible organism) is possible, but is not the main mechanism for the spread of this infection in nature. In principle, you can get infected from a sick person quite easily, especially if he does not follow the rules of personal hygiene ( for example, does not wash hands after performing natural needs). Transmission of infection from a sick person can occur either directly ( for example, through a handshake), or indirectly ( mainly through food).
In these same ways, you can easily become infected from a bacteria carrier. The difference between a sick person and a bacteria carrier is that the former, unlike the latter, has certain symptoms of the disease.

In bacterial carriers, Yersinia live and multiply in the intestines, but their total number does not exceed the threshold level required for the development of the disease. Bacterial carriage usually occurs either in healthy individuals who have never had yersiniosis or in those who have ever had it. In the first case, the mechanism of development of bacterial carriage is due to a certain individual immunological tolerance ( stability) of the body to the infectious agent itself. In the second case, bacterial carriage occurs as a result of irrational pharmacotherapy, early discharge of the patient, lack of laboratory control upon discharge of the patient, and the presence of immunodeficiency. Although bacteria carriers release much less of the pathogen into the external environment, they pose the greatest danger to others, since they ( bacteria carriers) is difficult to detect.
diets differ from each other not only in purpose, but also in other criteria ( for example, daily nutrient content, total energy value of the diet, permitted and prohibited foods). The doctor should choose a diet taking into account the patient’s general condition, the severity of his illness, the presence of complications and the presence of concomitant pathologies of other organs and tissues.

How does yersiniosis occur in children?

In children under 3–4 years of age, the gastrointestinal form of yersiniosis most often occurs. The disease is accompanied by more severe and prolonged symptoms. The clinical picture is dominated by a strong intoxication syndrome with high body temperature, adynamia ( decreased physical activity), vomiting and diarrhea. Quite often, such children experience convulsions, loss of consciousness, and blood pressure decreases significantly.
Yersiniosis in older children ( from 4 years) proceeds exactly the same as in adults and has the same complications ( sepsis, peritonitis, Kawasaki syndrome, appendicitis, intestinal perforation, intestinal obstruction, meningoencephalitis, autoimmune disorders).

Numerous pathogenic microorganisms cause a wide variety of diseases. These include yersiniosis.
Its diagnosis causes certain difficulties even for specialists.
In its course, it is similar to intestinal infection, mononucleosis, numerous acute respiratory viral infections and other similar diseases, due to which two thirds of the sick are misdiagnosed and receive inadequate treatment.

Yersiniosis - what is it?

The disease owes its name to the sonorous name of its main pathogen - Yersinii.
Three types of bacteria are capable of causing pathological disorders with the development of the disease: Y. enterocolitica - the causative agent of intestinal yersiniosis, Y. Pseudotuberculosis - causes symptoms of pseudotuberculosis, and Y. pestis - as the cause of bubonic plague.
Intestinal yersiniosis is an acute lesion of the organs and systems of the gastrointestinal tract by infectious toxic factors Y. enterocolitica, often occurring in waves with periods of exacerbation and remission. It may have a relapsing course.
The causative agent of yersiniosis is a mobile non-capsular rod that does not form spores. It is a close relative of Salmonella, Escherichia, cholera, tularemia and Brucella.
The comfort temperature for its life activity is 22 – 28 C, but it also feels good at lower heat values ​​(down to 0 C). Boiling, drying, exposure to ultraviolet radiation or most disinfectants (after 1 - 2 hours) are detrimental to it.
Has tropism for the intestinal epithelium. The gastrointestinal tract, joints, skin are most often affected, and other locations are less common.
Pseudotuberculosis and yersiniosis are clinically similar. The difference lies in the more erased course of the latter. Its development is also more typical for certain blue-collar professions.

Classification

The disease yersiniosis, the forms of which are very diverse, is divided into:

• gastrointestinal (localized, gastrointestinal)
• abdominal (appendicular, pseudoappendicular)
• generalized (septic variant)
• secondary focal (polyarthritis, gastroenteritis, hepatitis, myocarditis, meningitis, Reiter's syndrome)
• bacterial carriage (acute and chronic)

Classification of yersiniosis according to its course:

• lightning fast
• acute (up to 3 months)
• prolonged (up to 6 months)
• chronic (up to 2 years)
• wavy
• acyclic
• recurrent
• erased
• latent

By severity:

• light
• average
• heavy
• extremely heavy

Classification according to the presence of complications:

• complicated (pneumonia, osteomyelitis, purulent lesions, nephritis, acute renal failure)
• uncomplicated course.

How can you get infected?

The causative agent of intestinal yersiniosis is widespread in countries with temperate climates.
The natural reservoir and main source are wild and domestic animals, as well as rodents and birds. Therefore, the infection is classified as a zoonotic disease. However, you can become infected from a person not only with an open, but also with a latent (erased) form of yersiniosis. The reasons for this are the regular excretion of the microbe with its physiological feces (feces, urine).
The mechanism of infection is fecal-oral, through the mouth due to dirty hands or eating food contaminated with yersiniosis bacilli (meat, dairy products, vegetables, fruits).
The main risk group is people who are constantly in contact with fauna and its derivatives (livestock breeders, meat processing operators).
Also, through manure, bacteria enter the soil in the fields and then into the water, which contributes to the contamination of vegetables and fruits when they ripen or are watered.
In addition, sick rats and mice often have access to vegetable stores, contaminating the entire crop with their paws. This contributes to an increase in the incidence of yersiniosis in adults, especially among city residents who consume such products or use catering services.
There are known cases of infection of entire families, as well as the spread of infection within a hospital after hospitalization of the sick person. The sources of such contact-household transmission will be both the patient himself and the person caring for him.
The age criterion is not important, everyone gets sick, yersiniosis is especially severe in children under 3 years of age, usually associated with the start of complementary feeding.
The incidence of yersiniosis is slightly higher in the autumn.

Stages of development of the pathological process

Man is designed in such a way that his stomach contains hydrochloric acid, one of the functions of which is to disinfect the food he eats. Upon receipt of products contaminated with Yersinia, the death of some pathogens is observed.
However, not all microbes die, and the survivors move along the digestive tube into the intestine.
Their main target is the epithelium of the small intestine, namely the distal section, where it is populated and colonized by pathogens of yersiniosis. The incubation period, which lasts throughout this time, ranges from 1 to 10 days.
The subsequent process of disease development depends both on the protective properties of the host macroorganism and on the characteristics of the yersiniosis strain.
Infectious factors, such as a large number of pathogens and their high virulence, will contribute to the further spread of the microbe through the lymphatic system of the gastrointestinal tract with the development of inflammation in the mesenteric lymph nodes. This will manifest itself as gastrointestinal or abdominal forms of yersiniosis.
If the immune forces of the macroorganism are also reduced, then generalization of the pathological process is observed due to the development of bacteremia when Yersinia enters the general bloodstream.
From here, the microbe can enter any organs and systems that have lymphoid tissue - regional lymph nodes, liver, spleen.
The undulating course may be associated with the characteristics of the phagocytosis of the macroorganism, namely, with the inability of its macrophages to digest infectious agents. In this case, it is possible for them to remain and accumulate for a long time in macrophages with periodic release into the blood when the latter are destroyed and the appearance of repeated foci of infection with the development of chronic yersiniosis.

Possible complications and consequences of the disease

The connective tissue of the human body is similar in structure to the antigenic derivatives of Yersinia. As a result, when there is a failure in the immune response to the cells of the synovium of the joints, the endothelium, and the interstitium of many organs and systems where it is widely represented, the body begins to produce autoantibodies. They become fixed in the interstitium and form pathological autoimmune complexes. This also damages tissues with the formation of organ dysfunctions and the development of a clinical picture of autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, vasculitis and similar changes.
Morphological changes at the cellular level after yersiniosis are manifested by the development of inflammation with signs of epithelial cell rejection and ulcers due to the direct effects of yersiniosis endotoxins.
The liver and spleen are enlarged in size and have direct signs of damage in the form of small foci of necrosis. Lymph nodes of the mesentery and on the periphery are also enlarged.
Characteristic complications are usually characteristic of the severe course of the disease. These include infectious toxic shock, disseminated intravascular coagulation syndrome, intestinal perforation in necrotizing ileitis, peritonitis, adhesive disease, and sepsis. Generalization of the process is characterized by a high mortality rate of up to 60%.
Aggravating factors are late referral to specialists with a delayed start of treatment, immunodeficiency and exacerbation of concomitant pathology.

Features of the development of immunity in yersiniosis

Immune changes are not fully understood. It was revealed that during the height of the disease there is a decrease in the number of cells responsible for the cellular response, and antibodies to yersiniosis, on the contrary, increase. With a favorable outcome, there is a gradual growth of T cells with their gradual normalization.
If the level of T-lymphocytes does not rise to normal, this indicates the possibility of relapse of the disease or its chronicity.
The onset of an immune response with the production of specific humoral protective factors - antibodies - is observed already from the first week; by the end of the month from the onset of the disease their maximum value is reached.
Immunity for intestinal yersiniosis is unstable, for a short time. On the contrary, with pseudotuberculosis it persists for a long time, but is type-specific.
It should be noted that healthy people often experience an infectious process without any symptoms. But people with problems in their immune status, as well as weakened children, suffer the disease with difficulty. Such patients have a tendency to develop a relapse of yersiniosis.

Who should I go to for treatment?

Considering the versatile manifestation of yersiniosis, its different forms, as well as possible complications and consequences, diagnosis and treatment are carried out jointly by an infectious disease specialist, a gastroenterologist, an immunologist and a family doctor.

Yersiniosis and pregnancy

The general effect of the pathogen on the course of pregnancy is negative. Multiple organ disorders are possible in both the mother and fetus. To prevent these consequences, it is necessary to use modern broad-spectrum antibiotics.

Sanitary rules for yersiniosis

Unfortunately, vaccination against yersiniosis is not provided.
Therefore, all measures are aimed at preventing the development of infection. These include sanitary and epidemiological work on:

• control over water drainage and sewerage,
• compliance with the rules of storage and sale of food products,
• animal control.

Regular health education work is also carried out among the population, especially in endemic areas.

Symptoms

Symptoms of yersiniosis are the following:

• severe chills;
• general weakness and aches in muscles and joints;
• the appearance of tachycardia;
• discomfort and sore throat;
• significant decrease in appetite;
• temperature rise to subfebrile levels. In some cases up to 39-40°C;
• the skin turns yellow. This process is also observed on the sclera of the eyes;
• digestive disorders, which are characterized by the appearance of diarrhea, vomiting, nausea, cramping abdominal pain;
• prolonged insomnia;
• headache;
• damage to the skin, which is characterized by the appearance of a rash;
• slight decrease in blood pressure;
• discomfort and pain in the right hypochondrium. In this case, a person experiences a dark coloration of urine;
• the patient's liver increases significantly in size.

The appearance of certain signs of yersiniosis depends on the severity of the disease and its specific form. However, some symptoms in children or adults are present in all cases, while others are rare.

To avoid the development of complications or the occurrence of a chronic form of yersiniosis, its treatment occurs in a hospital setting with the use of serious medications, even with a mild form of the disease.

Gastroenterocolitic form of yersiniosis

The characteristic symptoms of yersiniosis of this form in adults and children develop with the appearance of high fever. It can reach 38-39°C.

A sick person also exhibits the following symptoms:

• Strong headache;
• appearance of weakness;
• pain throughout the body;
• prolonged insomnia;
• chills;
• complete lack of appetite;
• cramping abdominal pain. Moreover, they can be of varying intensity. Most often, unpleasant sensations are observed in the right side or near the navel;
• the appearance of diarrhea, with the discharge having a liquid consistency, an unpleasant odor, often mixed with blood or mucus. In some cases, bowel movements become more frequent up to 10-15 times per day;
• frequent urge to vomit;
• nausea.

The gastroenterocolitic form of yersiniosis sometimes occurs without fever. Often it can be low-grade fever. In this case, bowel movements become more frequent up to 3 times a day. Abdominal pain is minor, and the general condition of the patient can be considered satisfactory.

In many cases, a person complains of a sore throat and cough, which are characteristic of colds. A few days after the development of the first symptoms of yersiniosis, a skin rash forms. Most often it is localized on the palms or soles of the feet. The rash is small-spotted and often peels off.

As the disease progresses, the liver and spleen become significantly enlarged.

Symptoms of yersiniosis in adults - icteric form

This form of the disease is accompanied by the following symptoms:

• there is some heaviness and pain in the right side;
• the sclera of the eyes become yellow. The same process is observed throughout the skin;
• the liver increases significantly in size;
• the skin begins to itch;
• during palpation of the abdominal cavity, pain is felt on the right side;
• urine becomes dark, and feces, on the contrary, become discolored.

Often these symptoms are accompanied by other signs that are characteristic of intestinal dysfunction.

Exanthemal form of yersiniosis - characteristic signs

This form of yersiniosis is characterized by the appearance of symptoms of intoxication of the body. A person feels pain and general weakness throughout the body. In this case, chills are observed, and the temperature may rise slightly.

The exanthem form is always accompanied by skin formations. A rash appears, which can be in the form of small dots or spots of different sizes. These formations usually do not itch and disappear after 3-5 days. In their place, the skin becomes dry and flaky.

Arthralgic form - first symptoms

Yersiniosis of this form is accompanied by severe intoxication and fever. A sick person has pain in his joints, he feels weak, and has chills.

There are complaints of insomnia. In some cases, the disease can partially or completely immobilize the patient. Even with severe pain, the joints do not stand out externally.

In addition to the above symptoms, the patient may experience other signs of yersiniosis, but they will not be as pronounced.

The main signs of the septic form of yersiniosis

The septic form of yersiniosis is not common. It is accompanied by serious disruptions to the functioning of many organs and systems. In this case it is observed:

• temperature increase. At the same time, throughout the day, indicators can fluctuate with an interval of 2°C;
• the appearance of chills;
• prostration;
• muscle pain;
• enlarged liver and spleen;
• heartache;
• damage to the respiratory system, which is accompanied by dry wheezing;
• development of the inflammatory process of the meninges.

Abdominal form of yersiniosis

Characterized by the appearance of chills and intoxication. In this case, the body temperature most often rises, and disturbances in the functioning of the digestive system are observed.

After a few days, other symptoms appear:

• pain in the right side or near the navel, which is characteristic of appendicitis;
• the patient has difficulty turning over from the right side to the left;
• discomfort when palpating the abdominal area. In this case, severe pain appears on the right side;
• in a horizontal body position, a person has difficulty raising his right leg.

Generalized form of yersiniosis - the main signs of the disease

This form of yersiniosis is characterized by mixed symptoms. The following symptoms may appear:

• acute onset of the disease, which is accompanied by high fever, chills and muscle weakness;
• the appearance of symptoms of intoxication of the body;
• development of a characteristic rash that may itch. Over time, it disappears and periodically appears again. After it, dry and flaky areas remain on the skin;
• the appearance of joint pain;
• discomfort in the abdomen, the appearance of pain during palpation of the abdominal cavity;
• yellowness of the skin and sclera of the eyes;
• the appearance of dry wheezing in the lungs, which may indicate the development of pneumonia;
• stabbing pain in the heart. Often accompanied by tachycardia.

Secondary focal form of the disease

This form of yersiniosis develops as a result of improper treatment of the initial stages of the disease. Most often it occurs with severe symptoms that develop against the background of damage to internal organs. These include:

• lesions and pathological changes in the interphalangeal, hip, intervertebral and other joints, which are characterized by severe pain. They become asymmetrical;
• formation of subcutaneous soft plaques and nodes on the thighs, buttocks, legs. They are very painful. Most often they reach significant sizes. Their number can exceed 10 pieces. After 2-3 weeks, the nodules resolve;
• stabbing pain in the chest;
• inflammation of the outer membrane of the eye;
• the appearance of pain during urination.

Symptoms of chronic yersiniosis

The development of the chronic form of the disease is facilitated by untimely treatment of the disease during the period of pronounced symptoms. This condition is characterized by periodic exacerbation of all symptoms followed by remission.

Throughout the entire period, the patient experiences the following symptoms:

• temperature rise to subfebrile levels. This is especially observed in the evening;
• prostration;
• constant discomfort and pain in the joints;
• periodic abdominal cramps;
• pain in all muscles;
• a sick person may feel sick, sometimes have diarrhea and vomiting.

Symptoms of yersiniosis in children

All signs of yersiniosis in children are more pronounced than in adults. The younger the child, the greater the danger this disease poses. Yersiniosis in childhood is characterized by:

• severe intoxication, chills;
• temperature increase. Sometimes even up to 38-39°C;
• the child becomes restless and inactive;
• in some cases, convulsions appear, the baby may lose consciousness;
• dehydration of the body;
• there is an increase in lymph nodes and spleen;
• severe abdominal pain, nausea and vomiting appear;
• severe diarrhea develops. In this case, the discharge contains impurities of blood and mucus.

Without timely and correct treatment, children quickly develop complications, which are characterized by damage to many internal organs.

Diagnostics

If signs of yersiniosis appear, you should first contact a gastroenterologist and infectious disease specialist. It is also important to consult with a cardiologist, neurologist and nephrologist, especially if treatment of the disease has not yielded results and some complications have arisen.

Diagnosis of yersiniosis includes the following steps:

• bacterial culture of sputum or nasopharyngeal swab;
• blood test for yersiniosis;
• cerebrospinal fluid examination;
• analysis of urine, bile and feces for yersiniosis;
• ECG, EchoCG;
• colonoscopy;
• ultrasound diagnostics of the abdominal organs;
• immunological methods (ELISA, RIF, NIF, RCA and others);
• serological methods (RPGA, RIGA, RA, PCR and others);
• X-ray of the chest and other parts of the body for damage to bone tissue and joints;
• diagnostic laparoscopy;r
• sigmoidoscopy;
• sonography.

Differential diagnosis of yersiniosis involves separating the symptoms of this disease from signs that may appear due to other health problems. This is why it is necessary to undergo all tests in order to correctly prescribe treatment that will be as effective as possible.

Laboratory diagnostics - bacteriological methods

Microbiology plays an important role in the diagnosis of this disease. For yersiniosis, it is necessary to undergo several tests that will help determine the patient’s condition. In this case, the research material is:

• blood;
• urine;
• washings from the throat;
• sputum;
• cerebrospinal fluid;
• bile;
• blood clots;
• tissue samples that remain after surgery;
• intestinal contents.

Also, culture for yersiniosis is carried out from material that is in the environment where the patient is. Vegetables, fruits, dairy products, fish meat are used. A study of smears obtained from the surface of dishes and kitchen equipment used by the patient is also carried out. After all the tests, a conclusion is made about the presence or absence of the causative agents of this disease.

Despite the prevalence of this method of diagnosing yersiniosis, it is quite ineffective. A positive result can be obtained only in 10-13% of all cases of disease development in the presence of one or more signs, in 30-50% - with an outbreak of characteristic symptoms in several directions. This is due to the low concentration of pathogens in biological material, especially in the patient’s blood. To increase the likelihood of identifying the pathogen, the test is carried out using at least four different samples. For example, feces, blood, sputum, urine.

Also, the bacteriological diagnostic method requires a lot of time. On average, one analysis requires from one week to a month, which will significantly slow down the treatment process. Therefore, this type of diagnosis is often neglected by specialists or used in combination with other faster and more reliable methods.

Serological and immunological research methods

A more reliable diagnostic method for suspected yersiniosis is a blood test, which detects the presence and amount of antibodies to this disease. The efficiency of this method is much higher. It is possible to determine the presence or absence of the disease in up to 90% of all cases in the presence of gastrointestinal yersiniosis.

This study is carried out from the second week after the onset of the disease and the appearance of the first symptoms. To determine an accurate diagnosis, a repeat test should be performed approximately 12-14 days later. The antibody titer for yersiniosis begins to increase 7-8 days after the first symptoms appear, and their maximum is reached already in the second week. Then their concentration begins to decrease and reaches normal after 4-6 months. Sometimes there are cases when antibodies to yersiniosis are detected for several years, but this is an exception rather than a pattern.

Serological and immunological blood tests for the presence of antibodies to yersiniosis include:

• ELISA will not determine the presence of the disease in the first weeks after infection. The analysis is most informative after 2-3 weeks. It is carried out several times every 14-20 days to see the dynamics of the main indicators. Based on the results obtained, the effectiveness of treatment and the development of the disease are judged;
• RCA - this analysis is effective in severe forms of yersiniosis or in the presence of a chronic process;
• RIGA and RA are used 7 days after the onset of the disease.

The result of RPGA for yersiniosis can be negative if the human body has not yet developed antibodies to this pathogen. Therefore, to clarify the diagnosis, a repeat blood test is performed. If the result is negative again, then the symptoms that are detected in the patient are caused by other reasons.

Additional studies in the presence of yersiniosis

If there are characteristic symptoms of yersiniosis, which indicate damage to internal organs, it is necessary to undergo additional research. They are aimed at determining the severity of the disease. For yersiniosis the following are indicated:

• electrocardiography (ECG) – allows you to analyze the activity of the myocardium and the presence of pathological changes in the heart;
• echocardiography (EchoCG) is a technique in which all structures of the heart are visualized using ultrasound signals from a special device. This allows you to determine the development of problems with this organ in the initial stages;
• Ultrasound of the abdominal organs - determines pathological changes in the liver, pancreas and other organs. These data help determine the treatment method that will be most effective;
• computed tomography (CT) - helps to conduct a comprehensive study of the entire body using a special device that uses x-rays. It is very effective if it is necessary to determine a person’s condition or differentiate yersiniosis from other diseases.

X-ray examination of the intestines

This study can identify pathological changes in the lower intestine, including the rectum, sigmoid, descending, ascending, sigmoid colon, transverse colon, and in some cases even the appendix. Based on the results of this diagnosis, one can judge the degree of damage to the digestive system and differentiate yersiniosis from other diseases.

A feature of x-ray examination is that the intestines are exposed to minimal doses of ionizing radiation. This approach allows for high-quality visualization, which greatly simplifies the diagnosis of yersiniosis.

Colonoscopy or fluoroscopy is also successfully used for this purpose. These research methods allow you to see the picture in real time. In the second case, in addition to an auxiliary device (endoscope), the doctor uses a contrast agent - barium or others.

Diagnostic laporoscopy

Diagnostic laporoscopy is used only as a last resort, when other types of examination of the body for yersiniosis did not provide a complete picture of the patient’s condition.

This technique involves surgery. This involves making one or two small incisions in the abdominal wall, after which the doctor examines the organs. To increase visibility, most often a small amount of gas is pumped inside.

In this case, a special device, a laparoscope, is inserted into one incision. It is a thin tube, at the end of which there is an optical device that allows inspection. Through another incision, a manipulator is inserted, with the help of which the organs are displaced. These manipulations make it possible to make an accurate diagnosis, which was not possible with another type of diagnosis.

Sonography is one of the methods for diagnosing yersiniosis

Sonography is one of the types of ultrasound diagnostics of the body, which is indicated for yersiniosis. Using this method, you can examine the larynx, thyroid gland, kidneys and other organs. The data obtained helps the doctor make a correct diagnosis and determine treatment tactics.

Also, using sonography, you can determine the presence or absence of various changes in the joints that often accompany yersiniosis. The advantage of this technique is its complete safety.

Treatment

In mild cases of the disease, yersiniosis is treated at home. But with pronounced symptoms of moderate and severe form, the patient is sent to the hospital. Yersiniosis, the treatment of which should be carried out under the supervision of a physician, occurs in both adults and children. Taking any medications should be under the supervision of medical professionals. This will help avoid adverse consequences.

The main goals of treatment for yersiniosis are:

• carrying out antibacterial therapy;
• detoxification of the body;
• normalization of the gastrointestinal tract;
• restoration of water balance;
• taking medications whose action is aimed at eliminating symptoms (anti-inflammatory, antihistamines, corticosteroids, etc.);
• restoration of the body's defenses (vitaminization).

When a disease occurs in children, treatment is aimed not only at eliminating the pathogen, but also treating complications (the appearance of diarrhea, an increase in liver size, respiratory syndrome, and so on).

During treatment, it is important for the patient to follow all the doctor’s instructions and adhere to the diet. Complex therapy is aimed at eliminating the pathogen and reducing symptoms. If you consult a doctor in a timely manner, the prognosis for yersiniosis is favorable in most cases. It is not worth self-medicating yersiniosis with folk remedies, since decoctions of medicinal herbs are powerless in the fight against microorganisms. They can be used for additional therapy after the acute period.

Treatment of yersiniosis with antibiotics

Only antibacterial therapy can stop the proliferation of microorganisms. Treatment of yersiniosis with antibiotics is prescribed for all forms of disease for both adults and children. Most often, the doctor prescribes tetracycline antibiotics, levomecithin or an aminoglycoside. In case of a severe condition of the patient, third generation cephalosporins are prescribed. A prominent representative of these drugs is ceftriaxone.

Antibacterial therapy lasts from 7 to 20 days, depending on the patient’s condition and the characteristics of the disease. If complications arise during the course of treatment, the types of antibiotics may be changed. Such actions can speed up the healing process.

Adjuvant therapy

The main goal of adjuvant therapy is to reduce symptoms. Since the disease affects not only the gastrointestinal tract, but also other organs, the doctor often prescribes the following types of medications:

• antihistamines;
• corticosteroids;
• non-steroidal anti-inflammatory drugs;
• drugs for restoring intestinal biocenosis and so on.

Antihistamines help get rid of allergic reactions (redness, itching, etc.). Depending on the course, form of the disease and the individual characteristics of the patient, the doctor may prescribe non-steroidal anti-inflammatory drugs or corticosteroids (hormonal medications).

Special medications are used to restore the functioning of the gastrointestinal tract. One of the goals of treatment is to restore the intestinal biocenosis, so enzymes, drugs containing lactobacilli, and so on can be prescribed. Taking antibiotics is often accompanied by dysbacteriosis, so it is necessary to use drugs with live bacteria that help restore the intestinal microflora.

If you are interested in how to cure chronic yersiniosis, then the principles of treating the chronic form of the disease do not differ from the acute form. The patient must undergo a course of treatment with antibacterial drugs, as well as take anti-inflammatory, antihistamine and other medications.

Immunity restoration

An important role in the treatment of yersiniosis is given to the restoration of the body's defenses. For these purposes the following are used:

• vitamin complexes;
• immunomodulators;
• folk remedies.

After stopping the acute period of the disease, taking vitamins and special medications to strengthen the immune system helps to quickly cope with the consequences of exposure to microorganisms and avoid complications.

Diet for yersiniosis

The effectiveness of treatment for yersiniosis directly depends on proper nutrition. A strict diet for yersiniosis helps relieve the burden on the gastrointestinal tract and quickly cope with intoxication of the body. In the first days the patient is recommended to consume:

• boiled rice;
• liquid porridge;
• steamed lean meat cutlets;
• dried fruits;
• crackers.

The patient needs to drink a lot. Weak black tea with a little added sugar or dried fruit compote are good options. Dried fruits contain a large amount of minerals necessary for the body during intoxication. Unsweetened green tea with mint helps cope with nausea. If you really want something salty, then add a little table salt to the boiled water.

Over time, as health improves, vegetable and cereal soups, oatmeal, and so on can be introduced into the patient’s diet.

Treatment of yersiniosis in children

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

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 needed.

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. If the form is so severe that urgent treatment is required, and there is no way to wait for the results of such an analysis, it is necessary to prescribe any broad-spectrum antibiotic with a high rate of impact on the causative agent of yersiniosis. Flemoklav or Zinnat for pseudotuberculosis and yersiniosis are very effective. 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

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 using 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.

The term “yersiniosis infections” combines 2 acute infectious diseases: extraintestinal yersiniosis (pseudotuberculosis) and enteritis caused by Iersinia enterocolitica(intestinal yersiniosis). The diseases are manifested by general intoxication, often exanthema, damage to the liver, spleen, gastrointestinal tract, joints and other organs and systems.

There are many similarities between pseudotuberculosis and intestinal yersiniosis. However, there are also differences, which gives reason to consider pseudotuberculosis and intestinal yersiniosis as independent nosological forms.

PSEUDO-TUBERCULOSIS

(EXTRAINTESTINAL YERSINIOSIS)

Pseudotuberculosis (A28.2), or Far Eastern scarlet-like fever, pasteurellosis, acute mesenteric lymphadenitis, extraintestinal yersiniosis, is an acute infectious disease from the group of zoonoses with general intoxication, fever, scarlet-like rash, as well as damage to various organs and systems.

Etiology. The causative agent of pseudotuberculosis I. pseudotuberculosis- a gram-negative rod, in culture it is located in the form of long chains, does not form spores, has a capsule. The microorganism is sensitive to drying and exposure to sunlight. When heated to 60 °C it dies after 30 minutes, when boiled - after 10 s. Conventional disinfection (2% chloramine solution, solutions of Lysol, sublimate, etc.) kills the pathogen within 1 minute.

A distinctive feature of the causative agent of pseudotuberculosis is the ability to grow at low temperatures (1-4 °C), the optimal growth temperature is 22-28 °C. Based on the surface antigen, 8 serovars are distinguished, each of which can cause disease in humans, but serovars 1 and 3 are more common. The microorganism actively multiplies in boiled tap and river water, and also multiplies and retains all its properties at low temperatures (2-12 ° WITH). It has high invasive qualities, due to which it is able to penetrate the natural barriers of humans and animals, and contains endotoxin. It is assumed that endotoxin is a soluble fraction of O-antigen. The possibility of exotoxin formation has been proven.

Epidemiology. Extraintestinal yersiniosis (pseudotuberculosis) is registered in almost all administrative territories of our country. The disease belongs to the group of zoonotic infections. The source of infection is wild and domestic animals. The pathogen has been found in 60 species of mammals and 29 species of birds. The main reservoir of infection is mouse-like rodents. They infect food products with secretions, in which, when stored in refrigerators and vegetable stores, reproduction and massive accumulation of the pathogen occur. It is assumed that its reservoirs can be not only rodents and other animals, but also soil, where the microorganism is able to multiply and persist for a long time. It is also isolated from water, air, fodder, root crops, vegetables, milk, dairy products, and is found on containers, kitchen utensils, etc. Consequently, the pathogen has saprophytic properties and lives in the body of warm-blooded animals and the external environment. This plays an important epidemiological role, as it allows us to trace the initial routes of infection of vegetables and root crops during their cultivation in fields and vegetable gardens. Subsequently, during storage, the contamination increases, which is facilitated by the temperature of vegetable storage (5-7 ° C).

Microorganisms persist in water for 2-8 months, in oil - 5 months, sugar - up to 3 weeks, bread - up to 150 days, milk - 30 days, in soil under favorable conditions - about a year.

The role of humans as a source of infection remains unproven. Infection occurs through the nutritional route by consuming contaminated food (salads, vinaigrettes, fruits, dairy products, etc.) or water that has not been heat-treated. Epidemic outbreaks of varying intensity arise as a result of the spread of the pathogen through food and waterways, and sporadic cases also occur.

Both children and adults are susceptible to pseudotuberculosis. Children under 6 months of age practically do not get sick; children aged from 7 months to 1 year rarely get sick, which can be explained by the peculiarities of their diet.

Diseases are recorded throughout the year, the maximum occurs in February - March due to the increased consumption of vegetables and fruits coming from vegetable stores. Infectivity is moderate - 8-20 per 1000 children.

Pathogenesis. The pathogen enters through the mouth with infected food or water (infection phase) and, having overcome the gastric barrier, enters the small intestine, where it penetrates into the enterocytes or intercellular spaces of the intestinal wall (enteral phase). From the intestine, microorganisms penetrate the regional mesenteric lymph nodes and cause lymphadenitis (phase of regional infection). The massive entry of the pathogen and its toxins from the sites of primary localization into the blood leads to the development of the generalization phase of the infection (bacteremia and toxemia). It corresponds to the appearance of clinical symptoms of the disease. Further progression of the process is associated with fixation of the pathogen by cells of the reticuloendothelial system, mainly in the liver and spleen. This is essentially the parenchymal phase. Clinically, it is manifested by an enlargement of the liver and often the spleen, and disruption of their functions. Repeated generalization of infection, exacerbations and relapses are possible. Ultimately, persistent fixation and elimination of the pathogen occurs due to both the activation of cellular immune defense factors and the production of specific antibodies. Clinical recovery occurs.

In the pathogenesis of pseudotuberculosis, the allergic component associated with the re-entry of the pathogen into the circulation or previous nonspecific sensitization of the body is also of certain importance. This is evidenced by the high content of histamine and serotonin in the blood of patients. Allergic rash, arthralgia, erythema nodosum and other manifestations confirm the role of allergies in the pathogenesis of the disease. In those who died from pseudotuberculosis, changes in organs resemble the picture of acute generalized infectious reticulosis with predominant damage to the lymphatic system of the intestine, spleen and liver. In these organs, pseudotuberculosis foci are identified - granulomas, often microabscesses and necrosis. Dystrophic changes, hyperemia and plethora of internal organs are also noted, hemorrhagic edema is also possible, endo- and perivasculitis, peribronchitis and panbronchitis, interstitial and focal pneumonia, myocarditis and glomerulonephritis are found. Changes in the intestines are fairly constant. The greatest changes are found in the terminal part of the intestine, at the point where it flows into the cecum. Here a pathogen depot is formed and a picture of terminal, sometimes erosive-ulcerative ileitis, acute appendicitis, lymphangitis and mesenteric adenitis is observed.

Immunity. The accumulation of specific humoral antibodies occurs slowly. In some cases, specific antibodies appear only after relapses of the disease. Weak production of specific antibodies is probably due to insufficient antigenic stimulation. Phagocytosis and other nonspecific defense factors play a major role in the elimination of the pathogen. However, in some cases, phagocytosis remains incomplete for a long time. In such children, pseudotuberculosis has a severe, long-term course, with exacerbations and relapses. Ultimately, the level of specific antibodies begins to gradually increase and nonspecific defense mechanisms become stronger, the pathogen is completely eliminated and recovery occurs. The duration of immunity has not been precisely established, but there is reason to consider it durable. Recurrent diseases, if they occur, are probably rare.

Clinical picture. The incubation period lasts from 3 to 18 days. The clinical picture of the disease is polymorphic. The disease begins acutely, with a rise in body temperature to 38-40 ° C, and only in isolated cases - gradually or subacutely. From the first days of illness, children complain of general weakness, headache, insomnia, poor appetite, sometimes chills, muscle and joint pain. Some children at the beginning of the disease have mild catarrhal symptoms in the form of nasal congestion and cough. There may also be pain when swallowing, a feeling of soreness and soreness in the throat. In patients with pronounced initial symptoms of intoxication, dizziness, nausea, vomiting, and abdominal pain, mainly in the right iliac region or epigastrium, are noted. In some cases, there is loose stool 2-3 times a day, like enteritis. Examination of the patient at the very beginning reveals a number of characteristic clinical symptoms (Fig. 1). Noteworthy is the puffiness and hyperemia of the face and neck, which contrasts with the pale nasolabial triangle. Conjunctival hyperemia and scleral vascular injection are typical; herpetic rash on the lips and wings of the nose is less common. In most patients, hyperemia of the mucous membranes of the tonsils is found, sometimes very bright and often delimited from the hard palate. The mucous membrane is edematous, and enanthema is sometimes observed. The tongue in the initial period is thickly covered with a grayish-white coating; from the 3rd day of illness it begins to clear and becomes crimson and papillary. From the first days of the disease, some patients experience pain in the joints, enlargement of the liver and spleen.

Symptoms of the disease progress and reach their maximum on the 3-4th day. The period of the height of the disease begins with a deterioration in the condition, severe symptoms of intoxication, higher body temperature, damage to internal organs and changes in the skin. In some patients during this period, the hood symptom is revealed - hyperemia of the face and neck with a cyanotic tint, the gloves symptom is a limited pink-bluish coloring of the hands, the socks symptom is a limited pink-bluish coloring of the feet. A rash is observed on the skin of the body in 70-80% of patients. It can appear from the first days of the disease, but often occurs during the height of the disease, and always at once and can be either pinpoint, reminiscent of scarlet fever, or spotty. The color of the rash ranges from pale pink to bright red. In this case, the skin background can be either hyperemic or unchanged. Larger rashes are located around large joints, where they form a continuous erythema. A combination of scarlatiniform and maculopapular rash occurs in approximately half of patients. The rash is large-spotted, hemorrhagic in some patients, and is sometimes accompanied by itchy skin. With a long course of the disease or its relapses on the legs, less often on the buttocks, elements of erythema nodosum appear.

The rash with pseudotuberculosis is usually localized in the lower abdomen, in the axillary areas and on the lateral surfaces of the body. As with scarlet fever, there is a white, persistent dermographism. Pastia symptoms (dark red color of skin folds), pinch symptoms, tourniquet symptoms are usually positive. The rash lasts no more than 3-7 days, but sometimes with mild severity - only a few hours.

At the height of the disease, more than half of the patients experience arthralgia, but there may be swelling and tenderness of the joints. The wrist, interphalangeal, knee and ankle joints are usually affected. Changes in the digestive organs are observed with great consistency during this period of the disease. Appetite is significantly reduced, nausea, infrequent vomiting, and often abdominal pain and upset bowel movements occur. The abdomen is moderately distended. On palpation, in half of the patients, pain and rumbling can be detected in the right iliac region. In the projection of the cecum, enlarged and painful mesenteric lymph nodes are sometimes detected.

Intestinal disorders occur infrequently, with a slight increase and dilution of stools with preservation of the fecal character. Changes in the gastrointestinal tract in some patients are pronounced, with the development of symptoms of terminal ileitis or acute appendicitis.

With pseudotuberculosis, the liver and spleen are often enlarged, and sometimes there is icterus of the skin and sclera. The amount of direct bilirubin in the blood serum is increased, the activity of hepatocellular enzymes (AlAT, AST, F-1-FA, etc.) is increased, sediment tests are positive. Less commonly observed is a picture of acute cholecystitis or angiocholecystitis.

Changes in the cardiovascular system are manifested by relative bradycardia, less often tachycardia, muffled heart sounds, sometimes systolic murmur, and in severe cases arrhythmia. Blood pressure is moderately reduced. The ECG reveals changes in the contractile function of the myocardium, conduction disturbances, extrasystole, reduction of the wave T, lengthening of the ventricular complex.

At the height of the disease, pain in the lumbar region and decreased diuresis are possible. Urine sediment reveals albuminuria, microhematuria, cylindruria and pyuria. These changes are interpreted as an infectious-toxic kidney. In rare cases, a picture of diffuse glomerulonephritis may develop.

Pseudotuberculosis is characterized by leukocytosis, neutrophilia with band shift, monocytosis, eosinophilia, and increased ESR.

Classification. There is no uniform clinical classification of pseudotuberculosis. For pediatricians, the most convenient and acceptable classification is by type, severity and course.

Typical pseudotuberculosis includes forms with a complete or partial combination of clinical symptoms characteristic of this disease: scarlet-like, abdominal, generalized, arthralgic, as well as mixed and septic variants.

In clinical practice, forms with an isolated syndrome (scarlet-like, icteric, arthralgic, etc.) are rarely encountered. Usually the same patient has a wide variety of manifestations of the disease, and sometimes they occur simultaneously, but more often sequentially. The most common clinical variant should be considered combined. Atypical forms include erased, subclinical and catarrhal forms.

Typical pseudotuberculosis can be mild, moderate or severe. The severity should be assessed at the height of the disease by the severity of symptoms of intoxication and the degree of involvement of internal organs and systems in the pathological process.

The course of pseudotuberculosis in most patients is smooth. The fracture occurs on the 5-7th day from the onset of the disease. The body temperature gradually decreases to normal, the symptoms of intoxication disappear, the functions of the internal organs and hemogram are normalized. In some cases, after the rash disappears, lamellar peeling is observed on the hands and feet, and pityriasis-like peeling is observed on the back, chest and neck. With a smooth course, the total duration of the disease is no more than 1-1.5 months, but exacerbations and relapses are common. The relapse rate in children for all forms of the disease ranges from 16 to 22%. More often there is 1 relapse, less often 2-3 or more. Relapses are milder than the initial episode of the disease, but the disease drags on, and complete recovery occurs 2-3 months after its onset. Chronic forms of pseudotuberculosis are rare.

Diagnostics is based on a combination of clinical and laboratory data. Pseudotuberculosis can be suspected in a patient when a scarlet-like rash is combined with symptoms of damage to other organs and systems, especially with prolonged fever and an undulating course. Winter-spring seasonality and group morbidity among individuals who consumed food or water from the same source are important.

Bacteriological and serological research methods play a decisive role in diagnosis, especially if the disease is not accompanied by characteristic rashes.

The material for bacteriological research is blood, sputum, feces, urine and swabs from the oropharynx. The material is inoculated both on ordinary nutrient media and on enrichment media, using the ability of Yersinia to reproduce well at low temperatures (refrigerator conditions). Cultures of blood and throat swabs should be carried out in the 1st week of illness, cultures of feces and urine - throughout the entire disease. From serological studies, RA, precipitation reaction (RP), RSK, RPHA, passive hemagglutination inhibition reaction (RPHA), ELISA are used. For emergency diagnosis, PCR and immunofluorescence are also used. In practice, RA is more often used, while living reference cultures of pseudotuberculosis strains are used as an antigen, and if an autostrain is present, it is introduced into the reaction as an additional antigen. A titer of 1:80 or higher is considered diagnostic. Blood is taken at the beginning of the disease and at the end of the 2-3rd week from the onset of the disease.

Pseudotuberculosis must be differentiated from scarlet fever, measles, enterovirus infection, rheumatism, viral hepatitis, sepsis, and typhoid-like diseases.

Treatment. Bed rest is prescribed until body temperature normalizes and symptoms of intoxication disappear. The food is complete, without significant restrictions. However, if symptoms indicating damage to the gastrointestinal tract or liver appear, restrictions are introduced in accordance with generally accepted recommendations for these diseases.

As etiotropic treatment, chloramphenicol is prescribed in an age-appropriate dose for 7-10 days. If there is no effect or if there is an exacerbation after discontinuation of chloramphenicol, a course of treatment with a 3rd generation cephalosporin antibiotic should be administered. For severe forms, 2 antibiotics are used, taking into account their compatibility. For mild forms, antibiotics are not necessary.

For the purpose of detoxification, rheopolyglucin, albumin, 10% glucose solution, as well as enterosorbents (enterosgel, enterodes, etc.) are infused intravenously throughout the entire period of the disease. In severe cases, corticosteroids are recommended at the rate of 1-2 mg of prednisolone per 1 kg of body weight per day in 3 divided doses for 5-7 days. They are especially indicated for the development of erythema nodosum and polyarthritis. Antihistamines (suprastin, tavegil, diphenhydramine, diprazine, etc.) are prescribed as desensitizing therapy, and Wobenzym is prescribed to normalize the functioning of the immune system.

Since exacerbations and relapses often occur with pseudotuberculosis due to insufficient development of immunity, drugs that stimulate immunogenesis are indicated: Gepon, polyoxidonium, anaferon for children, etc.

Syndromic therapy is important.

Prevention. The first place in the system of preventive measures belongs to rodent control. Proper storage of vegetables, fruits and other food products is of great importance, eliminating the possibility of their infection. Strict sanitary control over food preparation technology is necessary, especially for dishes that are not subject to heat treatment (salads, vinaigrettes, fruits, etc.), as well as over water supply in rural areas.

Anti-epidemic measures at the source of infection are generally the same as for intestinal infections. After hospitalization of the patient, final disinfection is carried out. Specific prevention has not been developed.

INTESTINAL YERSINIOSIS

(ENTERITIS CAUSED I. ENTEROCOLITICA)

Intestinal yersiniosis (A04.6) is an acute infectious disease from the group of anthropozoonoses with symptoms of intoxication and primary damage to the gastrointestinal tract, liver, joints, and less commonly other organs.

Etiology. The causative agent of intestinal yersiniosis is a short gram-negative rod, mobile at a temperature of +4 - -28 °C, immobile at 37 °C. Facultative aerobe, not encapsulated, does not form spores. It is unpretentious to nutrient media and grows well at low temperatures. According to the biochemical properties of the strains I. enterocolitica are divided into 5 biovars. In humans, biovars III and IV are more often found, and II is less common. More than 30 serovars have been identified for O-antigen. The predominance of individual serovars in certain areas has been noted. The microorganism is antigenically related to Salmonella, and serovar O9 strains are related to Brucella.

I. enterocolitica sensitive to the action of physical and chemical factors, but tolerates low temperatures well, while maintaining the ability to reproduce.

Epidemiology.I. enterocolitica widespread in nature. Infected animals are healthy carriers. Strains isolated from pigs, cows, dogs, cats, synanthropic rodents are similar in biochemical and serological properties to strains isolated from humans. The pathogen is especially often found in mouse-like rodents, cattle, pigs, dogs, cats, and is isolated from dairy products and ice cream.

The source of infection is humans and animals, patients or carriers. Human infection occurs mainly through contaminated food, as well as through contact. The pathogen is transmitted from person to person through hands, dishes, and care items. An aerogenic route of infection spread is also possible.

In children's organized groups, outbreaks of diseases caused by a single food source occur. There are familial and nosocomial outbreaks, in which the most likely source of infection is an acute patient or a convalescent. The interval between individual diseases during such outbreaks ranges from several days to 3 weeks.

Diseases are recorded all year round, but a distinct increase in incidence (outbreaks) is observed from October to May, with a peak in November and a decline in July - August. Yersiniosis mainly affects children aged 3 to 5 years.

Pathogenesis. Infection occurs through consumption of contaminated food, water, or contact. The massive dose of the pathogen is of great importance. The pathogen passes through the stomach and is localized in the small intestine, where it begins to multiply. A particularly common location is the junction of the small intestine with the cecum (terminal small intestine, appendix). Possessing enterotoxigenic and invasive properties, I. enterocolitica penetrates and destroys epithelial cells of the intestinal mucosa. The inflammatory process can be different - from catarrhal to ulcerative-necrotic. The length of the inflammatory process also varies. The infection spreads to regional lymph nodes, which become enlarged as a result of hyperplasia of lymphoid tissue. Foci of necrosis or microabscesses may form in them. The liver and pancreas are sometimes involved in the process.

At this enteral or regional stage the disease sometimes ends. In more severe cases, microorganisms may break through into the bloodstream, which leads to generalization of the infection and the occurrence of abscesses of the liver, spleen, lungs, and bones.

The pathogen is capable of persisting for a long time in the lymph nodes, causing repeated waves of the disease or its transition to a chronic form. A variety of infectious and allergic manifestations in yersiniosis - exanthema, poly- and monoarthritis, arthralgia, myalgia, tenosynovitis, myositis, heart damage, erythema nodosum and other erythemas, Reiter's syndrome - some authors explain by the similarity of the structure of the antigen I. enterocolitica and the histocompatibility antigen HLA B-27, which is found in 90% of such patients in the general population - 14%.

Pathomorphology. With intestinal yersiniosis, an enlarged liver, an enlarged gallbladder, an enlarged spleen with multiple microabscesses are determined. In the intestine, pronounced swelling and infiltration are found with narrowing of the lumen, with fibrinous deposits and hemorrhages. Pathologically, they can be regarded as catarrhal-desquamative, catarrhal-ulcerative gastroenteritis, enteritis and enterocolitis. Necrosis of the lymph nodes and the development of peritonitis are also possible.

Histologically, necrotic nodules (yersinia granulomas) with a tendency toward central necrosis and purulent melting are found in the liver and spleen. With erythema nodosum, diffuse panniculitis and sometimes necrotizing vasculitis are histologically observed.

Clinical picture. The incubation period for intestinal yersiniosis is 5-19 days, with an average of 7-10 days. Clinical manifestations are very polymorphic and are in many ways similar to those of pseudotuberculosis. Most authors, based on the predominance of any symptom or syndrome in the clinical picture of the disease, distinguish the gastrointestinal, abdominal form (pseudoappendicular, or right iliac region syndrome, hepatitis), as well as septic, articular forms, erythema nodosum.

Gastrointestinal form. The clinical manifestations of this form are very similar to those of intestinal infections of other etiologies. The disease often begins acutely, with a rise in body temperature to 38-39 °C. Sometimes the temperature rises from the 2-3rd day from the onset of the illness. From the first days, symptoms of intoxication are pronounced: lethargy, weakness, loss of appetite, headache, dizziness, often nausea, repeated vomiting, abdominal pain. A constant symptom of the disease is diarrhea. The bowel movements become more frequent from 2-3 to 15 times a day. The stool is liquefied, often mixed with mucus and greens, and sometimes blood. The coprogram contains mucus, polymorphonuclear leukocytes, single erythrocytes, and impaired intestinal enzymatic function. In the peripheral blood - moderate leukocytosis with a shift to the left, ESR is increased.

The duration of the disease is 3-15 days. Sometimes the disease begins with catarrhal symptoms in the form of a slight cough, runny nose, and nasal congestion. From the first days, chills, muscle pain, and arthralgia are possible. From the first signs of the disease to their maximum development, it takes from 1 to 5 days. In severe cases, young children may develop a picture of intestinal toxicosis and exicosis, symptoms of irritation of the meninges. At the height of clinical manifestations, the abdomen is moderately distended. On palpation, pain and rumbling along the intestine are noted, mainly in the area of ​​the cecum and ileum. Sometimes the liver and spleen are enlarged. In some patients, a polymorphic rash appears on the skin (punctate, maculopapular, hemorrhagic) with a favorite localization around the joints, on the hands, feet (symptoms of gloves, socks). In some cases, inflammatory changes occur in the joints (swelling, redness, pain and limitation of movement), and the phenomenon of myocarditis.

Clinical symptoms in such patients are practically no different from those with pseudotuberculosis. However, with yersiniosis, the disease often begins with intestinal disorders, and damage to internal organs occurs as if secondary, at the height of clinical manifestations and more often in severe cases.

Intestinal yersiniosis in most children occurs in a moderate to mild form. For some, the disease immediately begins as a generalized form. From the first days, high body temperature, chills, headache, muscle and joint pain, weakness, pain when swallowing, nausea, vomiting and loose stools are noted. On the 2-3rd day, some patients develop a rash similar to that of rubella or scarlet fever. The rash is more often and thicker around the joints, where it is usually maculopapular in nature. In such patients, the liver and spleen quickly enlarge, and sometimes jaundice appears as a result of an increase in exclusively conjugated bilirubin in the blood serum. Changes appear in the urine: albuminuria, cylindruria, pyuria. In the blood there is a pronounced leukocytosis, neutrophilia with a band shift; ESR increased to 50-70 mm/h. The course of the disease in such cases is longer, exacerbations and relapses are possible. During the period of decline in clinical manifestations, peeling appears on the skin: large-plate on the palms and feet, pityriasis-like on the torso and limbs.

The pseudoappendicular form, or right iliac region syndrome, occurs mainly in children over 5 years of age. The onset of the disease is acute. Body temperature rises to 38-40 °C. Children complain of headache, nausea, vomiting 1-2 times a day, anorexia. The constant and leading sign of the disease is abdominal pain, which is often cramping and localized around the navel or in the right iliac region. Palpation reveals rumbling along the small intestine, diffuse or local tenderness in the right iliac region, and sometimes symptoms of peritoneal irritation are noted. There may be short-term diarrhea or constipation, intermittent joint pain, and mild catarrh of the upper respiratory tract. In the blood, leukocytosis (8-25-10 9 /l) with a shift of the formula to the left, increased ESR (10-40 mm/h). During surgery for an acute abdomen, catarrhal or gangrenous appendicitis is sometimes discovered, and more often mesadenitis (enlarged mesenteric lymph nodes), edema and inflammation of the terminal ileum. In cultures from the removed vermiform appendix they find I. enterocolitica.

The septic (generalized) form of intestinal yersiniosis is rare. There are acute and subacute septicemia. The acute form is accompanied by pronounced and prolonged symptoms of intoxication. Drowsiness, adynamia, anorexia, and chills are noted. Children complain of headaches and their body weight gradually decreases. Body temperature is hectic, with rises to 40 °C and higher, with daily variations of 2-3 °C. At the height of the disease, disorders of the cardiovascular and respiratory systems are observed. Mild diarrhea, abdominal pain, and enlarged liver and spleen are common. Some patients experience skin rashes and arthritis. A decrease in hemoglobin level, neutrophilic leukocytosis (16-25.109/l), ESR 60-80 mm/h are detected in the blood. From blood, feces, urine, mucus from the throat at the height of the disease, I. enterocolitica. Timely treatment leads to recovery in 3-5 weeks.

In the subacute form, the period of bacteremia may go unnoticed. Clinical symptoms include local lesions in the form of liver abscess, peritonitis, and osteomyelitis. It is sown from purulent foci I. enterocolitica. The prognosis for this form of generalized yersiniosis is often unfavorable.

Yersinia hepatitis begins acutely, with pronounced signs of intoxication, high body temperature that does not decrease during the icteric period, and increased ESR. Sometimes short-term diarrhea and abdominal pain occur. In some patients, exanthema of various types appears in the early stages of the onset of the disease. On the 3-5th day of illness, dark urine, discolored feces and jaundice are noted. The liver is enlarged, hardened and painful. The edge of the spleen is palpated. The clinical picture is very similar to that of viral hepatitis. Without additional examination methods, diagnosis is difficult.

It is important to consider that with yersinia hepatitis, the activity of hecatocellular enzymes can be low or even normal.

Erythema nodosum occurs mainly in children over 10 years of age. The disease begins acutely, with symptoms of intoxication and increased body temperature. Rashes appear on the legs in the form of painful pink nodules with a cyanotic tint, which disappear after 2-3 weeks, which is different from those with erythema of rheumatic etiology - they last longer. In half of the patients with erythema nodosum, it is possible to establish previous gastroenteritis, abdominal pain, and sometimes changes in the upper respiratory tract are detected.

The articular form of intestinal yersiniosis occurs as non-purulent polyarthritis and arthralgia. It is rare, mainly in children over 10 years of age. 5-20 days before the onset of arthritis, children experience intestinal disorders accompanied by fever. The process often involves the knee and elbow joints, less often the small joints of the hands and feet. The joints are painful, swollen, the skin over them is hyperemic. An X-ray examination of the affected joints in the acute phase of the disease does not reveal any pathological changes.

Intestinal yersiniosis in young children. Before the age of 3 years, a gastrointestinal form of yersiniosis, such as gastroenteritis or gastroenterocolitis, is usually observed. Such children experience higher prolonged fever, more severe intoxication (adynamia, periodic restlessness, convulsions, loss of consciousness, hemodynamic disorders), more frequent and prolonged vomiting and stool disorders than older children. Symptoms of dehydration are detected almost exclusively in children of the 1st year of life.

Diagnostics. Intestinal yersiniosis is diagnosed based on clinical and laboratory data. Of the clinical symptoms, the most important are damage to the gastrointestinal tract followed by the appearance of a polymorphic rash in the patient, mainly on the hands, feet, around the joints, enlargement of the liver, spleen; arthralgia; nodular rashes and other characteristic signs of the disease (prolonged fever, changes in the kidneys, heart, peripheral blood, etc.).

PCR and bacteriological methods are especially important for laboratory diagnostics. I. enterocolitica can be isolated from feces, blood, urine, pus, mucus from the throat, lymph nodes, surgical material, etc. Most often, the pathogen is isolated in the first 2-3 weeks from the onset of the disease, sometimes within 4 months. In articular and cutaneous forms, the pathogen is isolated very rarely. In these cases, serological diagnosis is used. RA is performed with a live or killed culture of Yersinia and RNGA in the dynamics of the disease. Diagnostic titers in RA are 1:40-1:160, in RNGA - 1:100-1:200. Maximum agglutinin titers decrease within 2 months. In young children, even with manifest forms of the disease, antibody titers are lower than in older children, so their increase in the dynamics of the disease is crucial.

Intestinal yersiniosis should be differentiated primarily from scarlet fever, measles, enterovirus infection, rheumatism, sepsis, and typhoid-like diseases.

In most cases, it is not possible to clinically differentiate intestinal yersiniosis from pseudotuberculosis, and only the use of laboratory methods (isolation of the pathogen, immunological reactions) makes it possible to clarify the diagnosis of the disease.

Treatment. Patients with a mild form of intestinal yersiniosis can be treated at home. In severe forms, hospitalization is required. For gastrointestinal, abdominal and hepatic forms of the disease, an appropriate diet is prescribed.

Regardless of the severity of the disease, enterosorption therapy (enterosgel, enterodesis, etc.) is prescribed for the entire duration of treatment. For long-term enterosorption therapy, it is advisable to use a selective enterosorbent with pronounced hydrophobic properties. Among the means of etiotropic therapy, preference is given to chloramphenicol succinate and 3rd generation cephalosporins.

For moderate and severe forms, in addition to antibiotic therapy, symptomatic therapy is prescribed, including detoxification and rehydration measures, antihistamines, vitamins, and diet. For septic form, 2 antibiotics are usually prescribed (orally and parenterally), as well as corticosteroids. For arthritis and erythema nodosum, antibiotics are ineffective; the process can only be stopped by adding antirheumatic drugs and corticosteroids, Wobenzym, etc.

For appendicitis, abscesses, and osteomyelitis, surgical intervention is indicated.

Prevention intestinal yersiniosis is the same as intestinal infections of other etiologies. Of no less importance are the preventive measures that are carried out for pseudotuberculosis.

Yersiniosis primarily affects the digestive organs. In some situations, an infectious disease characterized by symptoms of intoxication affects the musculoskeletal system or skin. Clinical recommendations for yersiniosis are prescribed by a doctor after a complete medical examination.

A disease caused by pathogenic microorganisms of the genus Yersinia is called yersiniosis. Pathological processes spread to many internal organs, but the first symptoms appear when the intestines are affected. The infectious disease affects not only adults, but also children, especially in preschool age.

Yersiniosis (it is important to follow the doctor’s clinical recommendations to prevent serious complications) is provoked by the enterobacterium Yersinia Enterocolitica, a gram-negative bacillus. It develops at low temperatures (refrigerator, cellar, vegetable store), and boiling and disinfectants contribute to its death.

More often, the pathogen affects the small intestine, causing enterocolitis or gastroenterocolitis. In a severe situation, peptic ulcer disease develops, pathological processes affect the mesenteric lymph nodes. The pathogen, entering the blood, provokes bacteremia, against the background of which the inflammatory process affects the internal organs located near the lesion.

Types of yersiniosis

In medicine there is still no unified classification of the disease. There are forms of yersiniosis, degrees and stages of development of pathological changes. They help doctors establish a diagnosis and select therapy for patients.

Name (type, form)	Description
Gastrointestinal (enterocolitis, gastroenteritis, gastroenterocolitis).	It occurs more often and is accompanied by high body temperature, headache and malaise. Causes a person to vomit, loose stools (with impurities of blood or mucus up to 15 rubles per day).
Abdominal (terminal ileitis, acute appendicitis, mesenteric lymphadenitis).	Occurs when pathogenic bacteria infect the mesenteric lymph nodes. The vermiform appendix of the cecum becomes inflamed. Complications include the accumulation of pus in the abdominal cavity, when the patient requires urgent surgical intervention. Clinical signs: pain in the navel area; swollen lymph nodes; increase in body temperature; peeling of the skin on the feet and hands; the liver and spleen enlarge (the whites of the eyes become jaundiced and the urine darkens). The abdominal form of yersiniosis lasts a long time, over several months.
Generalized (mixed, septic, septicopyemic yersiniosis).	The pathology is characterized by vomiting, small pinpoint rashes, itching, pain in small and large joints. The liver is affected, the whites of the eyes become yellow, and the urine becomes dark. The functioning of the cardiovascular system is disrupted, stabbing pain occurs, the heartbeat quickens, pulse and blood pressure fluctuate. If there are disturbances in the functioning of the central nervous system, a person becomes lethargic, depressed and complains of dizziness.
Erased (secondary focal: arthritis, myocarditis, meningitis, Reiter's syndrome).	A form of yersiniosis, which is accompanied by low body temperature (37°C), weakness, and malaise 2-3 weeks after infection. More often, patients are diagnosed with reactive polyarthritis due to illness.

All types of yersiniosis are accompanied by a characteristic clinical picture. The doctor will make an accurate diagnosis after a complete medical examination.

Stages and degrees of yersiniosis

Many diseases have similar clinical manifestations, which makes diagnosis difficult and makes it impossible to choose the right therapy without additional diagnostics. At an early stage, yersiniosis is difficult to distinguish from other infectious pathologies. The incubation period ranges from 1 to 10 days.

Once in the stomach, some of the microbes are killed by hydrochloric acid. The remaining ones move into the epithelium of the small intestine (distal section), where they will multiply and develop. How quickly pathological changes will appear depends on the state of the human body and the strain of yersiniosis.

A large number of bacteria, their ability to spread throughout the lymphatic system and digestive organs will lead to the occurrence of inflammatory processes.

This is how the abdominal and gastrointestinal form of yersiniosis begins to develop. Against the background of reduced immunity, generalization of the pathological process is observed, due to which pathogenic microorganisms enter the blood.

From this moment on, Yersinia can penetrate into any internal organ where there is lymphoid tissue (liver, spleen, lymph nodes). The chronic stage of yersiniosis begins with the appearance of repeated foci of the disease against the background of long-term presence and accumulation of bacteria in macrophages.

The severity of the disease can be mild, moderate or severe. Clinical symptoms, their duration and totality, as well as the nature of changes in the composition of blood and urine help determine the severity of the disease.

Symptoms of yersiniosis

The disease develops quickly, clinical signs appear abruptly.

The main symptoms of yersiniosis include:

A small or pinpoint rash appears on the skin, which after a while begins to peel off.

Causes of yersiniosis

The causative agents of the disease (Yersinia) live not only in soil or water. Bacteria live in the body of animals, on the surface of fruits and vegetables. They can withstand low temperatures, due to which they can multiply on foods that are in the refrigerator.

Infection also occurs by eating contaminated food (meat, milk, root vegetables, vegetables, water). In some situations, pathogens enter the human body from a bacterial carrier, but this is a rare case.

Pets are carriers of yersiniosis

The increase in statistics on patients with yersiniosis is explained by a violation of the ecological balance. In big cities there are more warehouses with vegetables and fruits. The number of rodents is increasing, but entrepreneurs do not always take active measures against pests, which provokes the appearance of pathogenic bacteria.

The risk category includes people who work in a food processing unit, poultry or livestock enterprise. There have been cases where yersiniosis developed in a person after a blood transfusion.

Diagnosis of yersiniosis

The doctor will be able to make an accurate diagnosis and select the most effective treatment after a comprehensive medical examination, which allows you to identify the pathogen.

Name of the survey	Description	Price
General blood analysis.	The number of leukocytes in the blood increases, indicating the development of an inflammatory process, and the erythrocyte sedimentation rate changes. The method is ineffective; based on the results, the doctor can assume the bacterial origin of the disease.	from 1500 rub.
Isolation of the pathogen.	For research, blood and mucus from the nasopharynx are taken from the patient in the first 3 days. After a while, the doctor prescribes a stool and urine test. If necessary, cerebrospinal fluid is taken from the patient.	from 900 rub.
Immunological blood test.	Tests are carried out 2 weeks after the onset of the disease so that antibodies have time to develop.	from 500 rub.
Electrocardiography (ECG).	The examination will show changes in the functioning of the cardiovascular system.	from 150 rub.
Echocardiography (EchoCG).	Ultrasound signals allow you to examine all the structures of the heart and identify problems with it.	from 320 rub.
Ultrasound examination of internal organs (ultrasound).	Helps identify pathological processes in yersiniosis, the area of ​​damage to internal organs.	from 1600 rub.
Computed tomography (CT).	A special device allows for a comprehensive examination of the patient’s entire body using X-rays. The most effective diagnostic method, which makes it possible to distinguish yersiniosis from other diseases.	from 1300 rub.

When internal organs are damaged by pathological processes, the patient experiences characteristic symptoms. To confirm yersiniosis, doctors prescribe additional tests for patients to determine the severity of the disease.

A comprehensive diagnosis will help the doctor obtain maximum information to make a diagnosis, determine the extent of the disease and the form of the pathology. Based on the results, medications are selected for the patient to combat yersiniosis.

When to see a doctor

If signs of yersiniosis appear, patients are advised to contact a pediatrician or therapist, who, if necessary, will prescribe a consultation with an infectious disease specialist. Doctors allow mild forms of pathology to be treated at home. In a severe situation, additional consultation with a surgeon, rheumatologist and hepatologist will be required.

You should consult a doctor if you have severe abdominal pain and prolonged diarrhea accompanied by elevated body temperature. Early diagnosis of yersiniosis and its adequate treatment will speed up recovery and prevent complications. Compliance with clinical recommendations will eliminate prolonged therapy.

Prevention of yersiniosis

It is possible to prevent an infectious disease, just remember the useful recommendations of specialists:

Long-term storage of vegetables and fruits requires the preparation of a special room. It is freed from old products and treated with special disinfectants. Dry all containers and shelves.

Important! The food storage room must be carefully protected from the entry of birds, rodents and other pests and vectors of infection.

Treatment methods for yersiniosis

To combat yersiniosis, medications and folk remedies (infusions, decoctions) are used. Treatment should be comprehensive and carried out under the supervision of a doctor.

Medications

Patients with severe yersiniosis are hospitalized. Taking into account the form and type of the disease, treatment is carried out by a gastroenterologist, infectious disease specialist, immunologist or family doctor.

Patients are prescribed a complex of drugs:

Group name	Name of drugs	Description, course, effectiveness
Antibacterial agents	“Levomycetin succinate soluble”, “Gentamicin”, “Metacycline”.	Affect pathogens. The course of therapy depends on the severity of the pathology, but not less than 1-2 weeks. Levomycetin is prescribed at 50 mg/kg in 2-3 doses over 6-7 days.
Immunomodulators	"Pentoxyl", multivitamins, ascorbic acid in large dosages.	They are used when the disease reoccurs or to treat complicated forms of yersiniosis. Medicines stimulate immunogenesis. 200-400 mg per day 3-4 r. after meal.
Intestinal sorbents	Ringer's solution or glucose (10%).	Eliminate intestinal upset in the first days of illness. Intravenously 1-2 liters per day.
Antihistamines	"Suprastin", "Tavegil".	Reduce the manifestations of the inflammatory process. 3-4 tablets each. per day during meals, drink plenty of water, do not chew.
Corticosteroids	"Prednisolone."	It is prescribed to patients with severe damage to the joints and heart, if the selected treatment is ineffective. For 5-7 days, 1-2 mg/kg in 4 doses daily.

Yersiniosis (it is important to strictly follow clinical recommendations in order to speed up recovery and prevent complications) is treated with infusion therapy, which restores water balance. Severe intoxication, frequent vomiting, rare urination and disturbances in the functioning of the cardiovascular system worsen a person’s condition.

Traditional methods

Alternative medicine is used in complex treatment, helps reduce unpleasant symptoms of intoxication and improve the patient’s condition. It is important to carry out therapy under the strict supervision of a physician.

Recipe	Treatment and effectiveness
Mix May honey (250 g) with Cahors (350 g). Add 150 g of juice obtained from aloe leaves. It is important that the plant is between 3 and 5 years old. Before cutting the leaves, it is not recommended to water it for 3-5 days. Mix all components well, leave in a cool place for 7 days, shaking occasionally.	The resulting medicine is taken for yersiniosis 3 times. per day before meals 30 minutes, 1 tbsp. for 2 weeks.
Mix honey and elecampane root in equal proportions (1 tbsp each). Add “Port” or “Cahors” (0.7 l). Cook the mixture over medium heat for 10 minutes. Cool, strain well and take according to the indicated scheme.	The medicine is drunk 50 ml after meals 2-3 r. per day for 14 days.
Pour blackberry leaves (2 tbsp) and calendula flowers (1 tbsp) with hot water (1 l), leave for 2 hours.	Take 2/3 tbsp. 3 r. per day. The medicine improves the condition of the digestive system in case of infectious diseases and restores stool (eliminates diarrhea).

A proven and effective remedy is juniper. It helps the body recover faster after illness.
Doctors recommend chewing fresh berries of the plant every day on an empty stomach. On the first day - 1 berry, on the second day - 2. Gradually increasing their number to 12 pcs. Then chew the berries in the reverse order, decreasing them by 1 piece each day. Treatment will take 24 days.

Juniper improves the general well-being of the patient, increases the tone of the body and strengthens its defenses.

Other methods

During the treatment of yersiniosis, it is important to eat properly so as not to burden the gastrointestinal tract. Drink more clean water to remove toxins from the body. The recommended diet includes boiled rice, liquid porridge, crackers, and steamed lean meat cutlets.

Mild green tea can help reduce nausea. Dried fruit compote contains minerals necessary for the body during illness. If you want to eat a salty dish, doctors recommend drinking boiled water with the addition of table salt in a small amount.

Possible complications

More often, complications of yersiniosis appear if the patient is hospitalized late or the disease is severe. Existing chronic pathologies, immunodeficiency, and incorrectly selected treatment also provoke serious consequences.

There are serious mortality statistics (60%). It is important to consult a doctor (family specialist, infectious disease specialist or immunologist) in a timely manner to prevent immunodeficiency and exacerbation of pathological processes. Yersiniosis can be successfully treated if the patient follows clinical recommendations and is under the supervision of a physician.

Article format: Mila Friedan

Video about yersiniosis

Elena Malysheva will talk about yersiniosis: