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 and until the first symptoms of yersiniosis appear 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 greater was 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 abdomen.

In the vast majority of cases, yersiniosis begins with symptoms of acute gastroenteritis ( inflammation of the lining of the stomach and small intestine), which is characterized by fever, acute onset, abdominal pain, nausea, vomiting, diarrhea, etc. After the onset of these symptoms, yersiniosis can proceed further 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 an additional lesion of various organs that are not part of the gastrointestinal tract). This stage of yersiniosis is called the peak period of the disease. It is at this stage for yersiniosis, depending on the symptoms, that 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	Pain in the abdomen with yersiniosis is caused by damage to sensitive nerve endings localized in the intestinal wall. The damage itself is caused by an inflammatory process, which is caused by pathogenic bacteria that affect intestinal tissues.	Pain is most often projected in the epigastric region ( anatomical region located just below the xiphoid process of the sternum), the umbilical zone of the abdomen and / or the right iliac region ( lower right corner of the abdomen). The intensity, duration, nature of abdominal pain is always different and depends 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 that die as a result of the immune response. All these products have a harmful effect on various structures of the brain, as a result of which these symptoms occur.	Nausea, vomiting, general weakness, decreased ability to work, muscle pain are symptoms that are not specific to yersiniosis. They usually appear in all its forms, in addition, they can be observed in many other infectious diseases. As a rule, all 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 is always individual. The duration of such symptoms is most often determined by the form of the disease. So, for example, with the gastrointestinal form of yersiniosis, these symptoms begin to disappear by the 5th - 6th day of illness, and with a generalized form, they last more than 1 - 2 weeks.
Vomit
General weakness
Decreased ability to work
Pain in the muscles
Fever	Fever in yersiniosis is a consequence of exposure to inflammatory substances secreted from damaged organs ( small and large intestines, appendix, joints, etc.), to 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 the reflex spasm of peripheral subcutaneous vessels, resulting in 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 onset of chills.	Body temperature most often rises from 2 to 3 days of infection. It fluctuates between 37 and 38 degrees. Slightly less often, fever can reach significant values ​​( 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, a high body temperature can last about 14 days.
Chills (shivering with fever)
Diarrhea	Diarrhea in yersiniosis is caused by inflammatory processes in the wall of the small and large intestines. With inflammation, a large amount of mucus, protein exudate, pus is released into the intestinal lumen, which become part of the feces. In addition, harmful bacteria damage the membranes of the cells of the intestinal epithelium, as a result of which the transmembrane transport of electrolytes is disturbed, which leads to an imbalance in 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 abundant loose stools.	Diarrhea in the gastrointestinal form of yersiniosis occurs along with nausea, vomiting, general weakness, decreased ability to work, pain in the muscles, abdomen, and fever. The stools are mushy, sometimes liquid, have a fetid character, with an admixture of mucus and blood. Purulent secretions are usually not found. The frequency of stool varies from 4 to 20 times a day. The duration of diarrhea on average does not exceed 4 - 5 days. In the abdominal form, diarrhea ends on 3-4 days, and the nature of the bowel movements is exactly the same as in the gastrointestinal form. Diarrhea in generalized and secondary focal forms of yersiniosis is not a dominant symptom and usually occurs at the initial stages of the disease, then yielding to other manifestations of this infection.
Joint pain	The appearance of soreness in the joints and exanthema is associated with the development of delayed-type hypersensitivity reactions to antigens during the course of the disease ( pathogen molecules that the patient's immune system recognizes) yersinium. 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, with the help of which they are sometimes introduced into other organs and tissues ( for example, in the joints, skin, mucous membranes of the respiratory tract, etc.) where they are deposited. The cells of the immune system that live in the places of deposition of such antigens recognize them and trigger inflammatory reactions, resulting in partial damage to their own tissues.	A rash on the skin and pain in the joints with a generalized and gastrointestinal form usually appear on the 2nd - 4th day of the disease. Exanthematous rashes can be of a varied nature ( spotted, punctate, maculopapular, etc.). They are localized on the skin of the palms, chest, feet, back of the hands, thighs. Regression ( reverse development) rash is noted after a few ( 3 - 6 ) days. After itself, the rash leaves peeling on the skin. Pain in the joints in these forms can be of varying intensity and manifest itself at different intervals during the day. Most often, with yersiniosis, small ( phalangeal, wrist) and large ( ankle, scapular-clavicular, 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 joint pain can also occur with the abdominal form of yersiniosis, but they are not the main ones, therefore they are rarely clinically encountered.
Exanthema (rash on the skin)

Diagnosis of yersiniosis

The diagnosis of yersiniosis is made on the basis of 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, the course of the disease, the 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.). For yersiniosis, there are no external specific signs, however, an external examination of the patient can reveal a rash on the skin ( on the 2nd - 6th day of the disease), blanching of the skin, redness of the tongue ( crimson tongue) on the 5th - 6th day of illness ( in gastrointestinal form), lacrimation, hyperemia ( redness) conjunctiva of the eye.

In some cases, patients can detect yellowing of the skin ( jaundice), which may be due to damage to the liver tissue. On palpation ( palpation with fingers) of the abdomen often reveals pain in the epigastric region ( an area on the abdomen just below the sternum), navel and right iliac zone. Sometimes hepatomegaly can be detected ( enlargement of the liver), hepatosplenomegaly ( ), lymphadenopathy ( enlargement of the lymph nodes) cervical nodes.

In the abdominal form, enlarged lymph nodes can be palpated ( feel with fingers) to the right of the navel. Clinical studies are necessary in order for the doctor to fully understand what exactly is happening with the patient, to find out the full clinical picture of the disease and to determine further tactics for managing the patient. After clinical trials, the patient should usually be given laboratory tests ( complete blood count, 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.

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

The main laboratory methods for the diagnosis of yersiniosis

Diagnostic method	Methodology	What signs of the 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 from the cubital vein into a special plastic tube - a vacutainer. Then the blood samples will be placed in special hematological and biochemical analyzers, which determine the main indicators for these types of studies. In a complete blood count, the number of different blood cells is usually calculated ( erythrocytes, leukocytes, platelets, monocytes, lymphocytes, etc.) and some other indicators such as total hemoglobin, hematocrit ( percentage of erythrocytes to whole blood), ESR ( sedimentation rate of erythrocytes). In biochemical analysis, the analyzer determines the concentration in the blood of various enzymes, proteins, minerals and metabolic products.	In a general blood test for yersiniosis, anemia can be detected ( ), leukocytosis ( increased levels of leukocytes in the blood), lymphopenia ( low levels of lymphocytes in the blood), eosinophilia ( an increase in the number of eosinophils in the blood), an increase in ESR ( ), band shift ( an increase in the content of segmented neutrophils and a decrease in the content of stab neutrophils).
Blood chemistry		In a biochemical blood test, an increase in the activity of alanine aminotransferase can be detected ( ALAT), aspartate aminotransferase ( ASAT), alkaline phosphatase, an increase in the concentration of C-reactive protein, total bilirubin, a decrease in the concentration of albumin.
Immunological blood test	In an immunological analysis, a blood sample is taken in the same way as in a general or biochemical study. The essence of this study is to find antigens using certain methods ( particles of yersinia) 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 that are 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) must be sought from the 14th day of illness. At the same time, 10 days after the first immunological blood test for antibodies, it is necessary to appoint a second study to assess the level of antibodies and the dynamics of their growth / decrease.
Genetic analysis	Genetic analysis makes it possible to identify in any pathological material ( blood, vomit, feces, etc.), taken from a patient, the DNA of the causative agent of yersiniosis. This study is highly accurate and 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 DNA molecules contain dead or alive) of yersinia, therefore, if it is established by genetic analysis that it is present in the material, then, therefore, it can be concluded 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 of the posterior pharyngeal wall, etc.) in the pure form of the causative agent of yersiniosis. The essence of this study is as follows. The pathological material taken from the patient will interfere ( sown) on special plant media in which this pathogen can freely grow and multiply. 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 a patient. Samples for microbiological examination are recommended to be sent to a bacteriological laboratory no later than 7 days from the onset of the disease. This analysis can also be applied to study environmental objects ( e.g. water, food) that may have caused the infection.

Differential diagnosis of yersiniosis

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

The stool in dysentery is very scanty with blood and mucus, in PTI and salmonellosis it has a greenish color and a fetid odor. Yersiniosis is characterized by the appearance of liquid fecal masses, in which, in some cases, small streaks of blood and mucus may be present. 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.), an increase in mesenteric lymph nodes, an increase in ESR in the blood ( in the absence of complications), exanthema ( rash on the skin). 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.). In the abdominal form, the opposite is true - first, symptoms of intoxication appear, and then painful sensations in the abdomen join them.

Pain in the abdomen 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. Skin ( hands, neck, face, feet) and mucous membranes ( eye, mouth) in the abdominal form of yersiniosis are often hyperemic ( of red color). In acute appendicitis, they are either unchanged or have a pale color. Differential diagnosis of generalized and secondary focal forms of yersiniosis presents great difficulties, especially if it is done with the same clinical forms of pseudotuberculosis. This is due to the pronounced polymorphic ( diverse) symptoms. The results of laboratory analyzes are of decisive importance here.

Complications of yersiniosis

Serious complications can occur with yersiniosis. Some of these complications can lead to additional complications, which are sometimes even more significant and can lead to death. 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 is hello to peritonitis ( inflammation of the peritoneum) is an additional life-threatening condition.

Most complications of yersiniosis ( peritonitis, appendicitis, intestinal perforation, intestinal obstruction, sepsis) require surgical intervention and cannot be cured by the usual therapeutic agents that are used in its treatment. Many complications of this infectious disease can lead to ( especially if they are not detected in time.) in the future to adverse consequences relating not only to the gastrointestinal tract, but also to other organs and tissues important for 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 only needs to see a doctor when he develops ( in a patient) the first symptoms of yersiniosis. In these cases, you should not try to heal yourself, since the antibacterial drugs that are used to treat this ailment may in certain cases be ineffective.

The most common complications of yersiniosis are:

• 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 impaired. Sepsis develops in response to the release, spread and multiplication of bacteria ( in this case yersinia) 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 is 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 (SIRS). USSR). This syndrome can also develop in other pathological conditions, for example, serious mechanical injuries, burns, intoxications, etc. Sepsis is a 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);
• pallor of the skin;
• anemia ( decrease in the number of red blood cells and hemoglobin);
• leukocytosis ( an 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 parameters of the blood ( increased levels of bilirubin, creatinine, lactate, C-reactive protein, procalcitonin, presepsin in the blood).

Peritonitis

Peritonitis is an inflammation of the sheets ( parietal and / or organ) peritoneum. The peritoneum is a thin sheet that lines the abdominal cavity from the inside ( and abdominal organs from the outside). Normally, this cavity is sterile. Under certain circumstances, infection from the gastrointestinal tract ( e.g. from the small or large intestine) can go to the peritoneum. With yersiniosis, secondary peritonitis usually develops. This means that for the development of inflammation of the sheets of the peritoneum, the presence of an infectious focus in the abdominal organs is necessary, from where the infection can directly move to them. In most cases, peritonitis is observed with abdominal and generalized forms of yersiniosis. This complication is one of the most severe in surgical practice, as it is accompanied by severe 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 there is inflammation of the tissues of the appendix ( appendix) caecum. The appendix is ​​a cavitary elongated anatomical formation located in the right iliac region ( lower right corner of the abdomen). 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 caecum is a frequent manifestation of the abdominal form of yersiniosis. It occurs when Yersinia penetrates from the cavity of the caecum 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 tissues of the appendix swell a little, turn 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 increases significantly in size, pus accumulates in its lumen, numerous hemorrhages occur, numerous erosions and ulcers appear on the walls. In the absence of therapeutic intervention, the organ gradually begins to die ( necrotize). 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), phlegmone ( subcutaneous fat inflammation) 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, a 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, aneurysms of the coronary arteries, 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 a certain contribution to its occurrence is made by autoimmune disorders ( disorders of the functioning of the immune system) and genetic predisposition.

The main symptoms of Kawasaki syndrome are:

• prolonged fever ( up to several weeks);
• chills;
• reddening of the tongue crimson tongue);
• lymphadenitis ( enlargement 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 on the skin of the fingers and toes;
• dryness and cracks on the lips;
• arthralgia ( joint pain);
• rash on the skin of the inguinal zone, trunk and limbs;
• soreness in the region of the heart;
• cough;
• runny nose;
• dyspnea;
• gastrointestinal symptoms ( nausea, vomiting, diarrhea, abdominal pain, etc.).

Bowel perforation

Perforation of the intestine 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 its tissues. This condition is very dangerous for the patient, since, due to perforation, the intestinal contents can enter the sterile environment of the abdominal cavity, resulting in peritonitis ( inflammation in the peritoneum). In addition, perforation may open internal bleeding into the abdominal cavity, which is not so easy to stop. Intestinal perforation in yersiniosis occurs as a result of an excessively violent inflammatory process in its cavity, during which harmful bacteria seriously damage its tissues. First, ulcerations form in the intestinal wall, which are replaced by deep ulcers. The destruction of the bottom of such ulcers leads to perforation of the intestinal wall itself. The formation of pathological holes can take place anywhere - in the large or small intestine and in absolutely any of their departments.

Most often, with yersiniosis, perforation of the ileum and caecum occurs. Symptoms of bowel perforation are similar to those of peritonitis ( fever, chills, cutting pains in the abdomen, shortness of breath, nausea, vomiting, impaired consciousness, lowering 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; therefore, such a complication is diagnosed quite late, which creates prerequisites for an unfavorable prognosis of the clinical course of yersiniosis.

Intestinal obstruction

Intestinal obstruction can be a complication not only of yersiniosis, but also of its other complications ( e.g. peritonitis, sepsis, etc.). With it, the patient is disturbed in the promotion of feces through the gastrointestinal system, which is accompanied by the appearance of serious metabolic disorders, pain shock and autointoxication syndrome ( self-poisoning). Of the metabolic disorders, one can single out a decrease in the intake of protein in the body, the loss of potassium, chlorine, water, a violation of carbohydrate and lipid metabolism. Loss of electrolytes ( potassium, sodium, chloride) and water in intestinal obstruction, mainly due to vomiting and persistent effusion ( going out) into the intestinal lumen of intravascular fluid. Violation of water-electrolyte metabolism leads to detrimental to the body disorders in the cardiovascular system. 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 fecal masses 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 ( pain shock).

The syndrome of autointoxication occurs due to the fact that a prolonged stagnation of feces occurs in the intestinal cavity, which serves as a favorable background for the development of a diverse microflora, which forms a large amount of toxins in the course of its vital activity. These toxic substances freely enter the bloodstream and then, spreading with 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, a decrease in the amount of potassium in the blood, etc.) can negatively affect the neuromuscular apparatus of the intestine and disrupt its normal functioning, which will affect its motility ( contractile movements of the smooth muscles of the intestine, providing 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 ( adhesions). Such adhesions within the intestine can mechanically block the passage ( promotion) intestinal contents. Adhesions can also occur outside the intestine ( between his loops). This is often seen in peritonitis ( inflammation of the peritoneum). Intra-abdominal adhesions can compress the intestine from the outside and block the passage of feces through it and cause acute intestinal obstruction.

The main clinical manifestations of intestinal obstruction are:

• pain in the abdomen of a varied nature and intensity;
• nausea;
• vomit;
• stool retention;
• visible asymmetry ( relief unevenness a) anterior abdominal wall;
• lowering blood pressure;
• tachycardia ( increase in 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. Accompanied by meningoencephalitis, the patient develops fever, nausea, vomiting, headache, dizziness, convulsions, discoordination of movements, motor disorders ( paresis, paralysis) activity and skin sensitivity, impaired consciousness ( agitation, delusions, hallucinations, etc.), photophobia, etc. Late diagnosis of meningoencephalitis can lead to disastrous consequences, since prolonged inflammation of the 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, skin sensitivity.

Treatment of yersiniosis

Treatment of uncomplicated forms of yersiniosis is medical. This infectious disease is treated with the help of various means ( antibiotics, probiotics, eubiotics, enzymes, detoxifiers, anti-inflammatory nonsteroidal drugs). The basic medicines in the treatment of this disease are antibiotics, which are designed to destroy pathogenic bacteria that multiply in the intestines of the patient. Selection of antibiotics should always be carried out in accordance with the results of the antibiogram performed by the microbiological laboratory. An antibiogram is a special bacteriological analysis that establishes 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 the normal intestinal microflora, which is often suppressed during an intestinal infection. In addition, taking antibiotics also inhibits the growth of the patient's own microflora. Enzymes are needed by patients to facilitate the processes of digestion in the small intestine, since during the period of infection they are often seriously disturbed.

Non-steroidal anti-inflammatory drugs reduce the symptoms of intoxication ( reduce temperature, increase performance). Detoxification agents help to remove bacterial toxins from the body. In the treatment of the secondary focal form of yersiniosis, glucocorticoids and immunostimulants are often prescribed. The first have a pronounced anti-inflammatory and immunosuppressive ( lower the immune response) effect. Immunostimulants are needed to increase overall resistance ( resistance) of the body, they stimulate the reproduction 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, some forms of appendicitis ( phlegmonous, gangrenous appendicitis).

Drugs used in the treatment of yersiniosis

The name of the drug group	Name of the drug	How to use 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 use 200 - 400 mg 2 times a day.
	Ciprofloxacin	Most often, it is prescribed at a dose of 500 mg and the 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 weight of the patient. It is recommended to prescribe 70-100 mg per day for each kilogram of body weight.
	Cefotaxime	Assign 2 grams 3 times a day in the form of intravenous or intramuscular injections ( injections).
	Ceftriaxone	Prescribed 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 - 1-3 tablets 2 times a day.
Non-steroidal anti-inflammatory drugs	Ibuprofen	Patients over 12 years of age may take one tablet ( 200 mg) 3-4 times a day. The maximum daily dose for them is 1200 mg ( that is, you can not take more than 6 tablets per day). Children from 6 to 12 years old are allowed to take exactly the same pills no more than 3-4 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, this drug should be taken 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. No more than two capsules may be taken at a time. The maximum daily dose of the drug is 200 mg.
Glucocorticoids	Prednisolone	Dosages of these drugs prednisone, 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 to 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 exceed 1 - 2 grams. Doctors advise taking this drug 3-4 times a day. Each tablet contains 250 mg of the drug.
	Pentoxyl	Pentoxyl is prescribed 200-400 mg 3-4 times a day.
	Imunofan	Prescribed 100 mcg once a day. This drug is used in the form of a spray. One press on the spray is accompanied by a release of 50 micrograms 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 sprayer in each of the nasal passages.
Probiotics and Eubiotics	Linex	1 - 2 capsules 3 times a day.
	Acipol	Patients from 3 months to 3 years, one capsule 2-3 times a day. Patients older than three years are recommended to use 1 capsule 3-4 times a day.
	Bifidumbacterin	Children over 7 years old and adults are prescribed 2 sachets of this drug. Multiplicity of reception - 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	It is sold in the form of a solution for infusion. The drug solution is administered intravenously ( drip). Hemodez-n can be used 1-2 times a 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 of body weight). The maximum single dose depends on the age of the child.
	Neohemodes	It is produced in the same form as Hemodez-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	For adults, pancreatin should be taken one tablet 3 times a day. For children, the dosage is selected individually.
	Pancreoflat	Adults appoint 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?

For the treatment of yersiniosis, in most cases, hospitalization is necessary. Patients are usually hospitalized according to epidemiological and clinical indications. According to epidemiological indications, those persons who have been in contact with the source of the disease are placed in the hospital ( e.g. sick animals, humans) or stayed in those places ( for example, in public catering establishments, vegetable and fruit processing points, 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.

Carriers ( those people who have the causative agent of the disease in the intestines, but do not have symptoms of the disease) are generally treated on an outpatient basis. If the work of these persons is related to cooking, then they are temporarily transferred to another workplace. Clinical indications for hospitalization are the severity of the disease, the presence of complications, 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 the implementation of a single bacteriological study confirming the absence of Yersinia in the patient's intestines.

Can yersiniosis go away without treatment?

Erased forms of yersiniosis can pass in a patient in the form of an ordinary intestinal infection ( as usual gastroenteritis). This happens sometimes. However, the main clinical forms of yersiniosis must necessarily be subject to medical treatment. The fact is that yersiniosis is one of those infections that can give 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 turn into a chronic course, especially often this is observed in people who have either not been treated at all, or in those who have not contacted their doctor in time 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, and also 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 activities. 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 food contamination ( milk, fruits, vegetables, meat, etc.) Yersinia. Important in the prevention of this infectious disease are also anti-epidemic measures used to stop the spread and destruction in the epidemic focus ( ) causative agent of yersiniosis.

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

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

Measures 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 agricultural domestic animals with which a person constantly contacts and uses for the purpose of food enrichment. To prevent infection of animals, farmers must strictly comply with all sanitary and veterinary requirements and rules for caring for animals, which are specified in regulatory documents. These rules contain specific recommendations regarding the necessary conditions for keeping animals, feeding them, timely recognition of yersiniosis, its treatment, isolation of the source of the pathogen. They also specify the requirements for high-quality cleaning and disinfection of places where pets are kept, disinfestation and deratization of the premises where they live, and areas that are located near the farm.

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

Measures related to the prevention of food contamination with Yersinia

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

Of utmost importance in preventing the transmission of yersiniosis is proper storage and distribution ( temperature, humidity, shelf life) food. These conditions are enshrined in special regulatory documents ( GOSTs). To prevent food contamination 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 necessarily be carried out not only in warehouses where primary products are located, but also in the territories of primary processing enterprises, public catering establishments, medical institutions, food industry enterprises, etc. In addition to these measures, bacteriological control of Yersinia rodent contamination is also needed. The same control is used to analyze the presence of harmful bacteria on the surface of fruits, vegetables, dishes, household products, equipment for fruit and vegetable bases.

Anti-epidemic measures

Anti-epidemic measures are a set of measures aimed at identifying and eliminating an 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 among the population are detected. These include active recognition of patients and carriers ( and their isolation) in one or another team ( for example, among food service workers in whose canteens cases of infection have been identified in visitors), taking food products for laboratory examination, washing off surfaces on which products are processed, sanitary inspection of food storage areas. In such cases, close attention is paid to the inspection of the object to maintain its cleanliness and the habitat of rodents. When rodents are detected, appropriate unscheduled deratization activities are carried out. In the process of epidemiological analysis at the facility where cases of yersiniosis have been reported, it is prohibited to sell products that have not undergone heat treatment.

After identification of transmission factors ( that is, elements of the environment through which an infectious agent is transmitted from the source of infection to a susceptible organism) harmful bacteria in all premises of the catering unit, total disinfection is organized with the treatment of all working and non-working surfaces, equipment, food packaging, utensils. Those who have recovered from yersiniosis are discharged from a hospital ( infectious diseases hospital) only after a complete clinical recovery with control bacteriological studies of feces before discharge. Children and adolescents who have had yersiniosis are sent for dispensary observation to the local pediatrician ( family doctor).

If there are no signs of recurrence ( recurrence of symptoms) and complications, the duration of medical 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 contribute to blocking the alimentary route of transmission of the yersiniosis pathogen, which is achieved by excluding food products and ready meals contaminated with the pathogen from the sale. It should be noted that the means of specific prophylaxis ( vaccines) have not been developed against yersiniosis.

Yersiniosis prognosis

The prognosis of yersiniosis, in most cases, is favorable. The disease does not last long and with timely treatment quickly passes. Lethal outcomes are extremely rare. Death from yersiniosis is mainly due to complications ( peritonitis, sepsis, intestinal obstruction, intestinal perforation, meningoencephalitis, etc.) that may develop during the course of the 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 after 3-4 weeks, with the abdominal or generalized form, the cure can take several months. The long period of recovery in 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, in a generalized form of yersiniosis, a patient may often develop myocarditis ( inflammation of the heart muscle), pyelonephritis ( inflammation of the kidney tissue), pneumonia ( pneumonia), hepatitis ( inflammation of the 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, such as peritonitis ( inflammation of the peritoneum), phlegmonous appendicitis ( purulent inflammation of the appendix of the caecum), intestinal obstruction, intestinal perforation. In addition, there are so-called erased forms of yersiniosis, which are clinically almost not manifested in any way or are accompanied by the appearance of an unexpressed and quickly disappearing symptomatology in the patient. The recovery time for such yersiniosis can take even less time than the average period required for a cure in the gastrointestinal form.

The biggest problem of yersiniosis is that even after recovery, the patient remains at risk of a chronic 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, the 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 easily breed in soil and water from surface sources. The soil is their natural habitat. A person is more likely to become infected with Yersinia either by drinking contaminated water or by eating poorly washed vegetables ( such as cabbage, radish, cucumber, tomato, carrot, onion, etc.), fruits ( apples, plums, apricots, strawberries, pears, etc.). Yersiniosis can also develop when eating insufficiently thermally processed meat ( made from meat of rabbit, cattle, pig, poultry, deer), 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 reproduces very well. Therefore, it is necessary not only to wash vegetables well, but also to observe the permissible shelf life of salads ( which is often not followed by catering establishments). In addition, a person consumes many vegetables raw and, in addition, does not always follow the rules of personal hygiene. All this creates additional risks of yersiniosis.

Is yersiniosis contagious?

Transmission of yersiniosis from a person ( source of infection) to a person ( susceptible organism) is possible, but is not the main mechanism for the spread of this infection in nature. In principle, it is quite easy to get infected from a sick person, especially if he does not follow the rules of personal hygiene ( for example, does not wash his hands after going to bed). Transmission from a sick person can be either direct ( for example, through a handshake), or indirectly ( mainly through food).
In the same ways, you can simply get infected from a bacillicarrier. The difference between a sick person and a 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 necessary for the development of the disease. Bacteriocarrier is usually formed 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 bacteriocarrier is due to some individual immunological tolerance ( sustainability) of the organism 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 at discharge of the patient, and the presence of immunodeficiency. Although bacteria carriers release much less of the pathogen into the environment, it is they who 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 ( e.g. daily nutrient content, total dietary energy content, permitted and prohibited foods). The diet should be chosen by the doctor, taking into account the general condition of the patient, the severity of his illness, the presence of complications and the presence of concomitant pathologies of other organs and tissues.

How does yersiniosis progress in children?

In children under 3-4 years of age, the gastrointestinal form of yersiniosis is most common. The disease is accompanied by more pronounced and prolonged symptoms. The clinical picture is dominated by a strong intoxication syndrome with high body temperature, adynamia ( decreased motor activity), vomiting and diarrhea. Quite often, these children experience convulsions, loss of consciousness, and a significant decrease in blood pressure.
Yersiniosis in older children from 4 years) proceeds in exactly the same way 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. They 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 patients are misdiagnosed and inadequately treated.

Yersiniosis - what is it?

The name of the disease is due to the sonorous name of its main pathogen - Yersinia (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. Perhaps its recurrent course.
The causative agent of yersiniosis is a mobile non-capsular bacillus that does not form spores. It is a close relative of Salmonella, Escherichia, cholera, tularemia and Brucella.
The comfort temperature for her life activity is 22 - 28 C, but she feels good even at lower heat values ​​(down to 0 C). Boiling, drying, exposure to ultraviolet radiation or most disinfectants (after 1 to 2 hours) are detrimental to it.
Has a tropism for the intestinal epithelium. The gastrointestinal tract, joints, skin are most often affected, less often other localizations.
Pseudotuberculosis and yersiniosis are similar in clinic. The difference lies in the more erased course of the latter. Its development is also more characteristic of certain working 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)
• protracted (up to 6 months)
• chronic (up to 2 years)
• undulating
• acyclic
• recurrent
• erased
• latent

By severity:

• light
• average
• heavy
• extremely severe

Classification by 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 a temperate climate.
The natural reservoir and main source are wildlife and domestic animals, as well as rodents and birds. Therefore, the infection refers to zoonoses. However, you can get infected from a person not only with an open, but also with a latent (erased) form of the course 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 the 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 infection of vegetables and fruits during their ripening or watering.
In addition, sick rats and mice often have access to vegetable stores, polluting the entire crop with their paws. This contributes to an increase in the incidence of yersiniosis in adults, especially among urban residents who consume such products or use catering services.
There are known cases of infection of both entire families, and the spread of infection within the hospital after hospitalization of the sick person. The sources of such a contact-household transmission route 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 old, usually associated with the start of complementary foods.
The incidence of yersiniosis is somewhat higher in autumn.

Stages of development of the pathological process

This is how a person works, that in his stomach there is hydrochloric acid, one of the functions of which is the disinfection of the food eaten. Upon receipt of Yersinia-infected products, the death of some pathogens is observed.
However, not all microbes die, and the survivors move along the digestive tube into the intestines.
Their main goal is the epithelium of the small intestine, namely, the distal section, where it is populated and colonized by yersiniosis pathogens. The incubation period, lasting all this time, is from 1 to 10 days.
The subsequent process of the development of the disease 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 gastrointestinal lymphatic system with the development of inflammation in the mesenteric lymph nodes. This will manifest as gastrointestinal or abdominal forms of yersiniosis.
If the immune forces of the macroorganism are also reduced, then a 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. At the same time, their long-term presence and accumulation in macrophages with periodic release into the blood during the destruction of the latter and the appearance of repeated foci of infection with the development of chronic yersiniosis is possible.

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, the interstitium of many organs and systems, where it is widely represented, the body begins to produce autoantibodies. They are fixed in the interstitium and form pathological autoimmune complexes. It also damages tissues with the formation of organ dysfunctions and the development of an autoimmune disease clinic 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 direct exposure to yersiniosis endotoxins.
The liver and spleen are enlarged and have direct signs of damage in the form of small foci of necrosis. The lymph nodes of the mesentery and on the periphery are also enlarged.
Characteristic complications are usually characteristic of a severe course of the disease. These include toxic shock, DIC, intestinal perforation in necrotic form of ileitis, peritonitis, adhesive disease, sepsis. Generalization of the process is characterized by high mortality up to 60%.
Aggravating factors are late access to specialists with a belated start of treatment, immunodeficiency and exacerbation of concomitant pathology.

Features of the formation 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, grow. With a favorable outcome, a gradual growth of T cells with their gradual normalization is observed.
If the level of T-lymphocytes does not grow to normal, this indicates the possibility of a relapse of the disease or its chronicity.
The beginning of the immune response with the development 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 there is their maximum value.
Immunity in intestinal yersiniosis is unstable, for a short time. On the contrary, in pseudotuberculosis it persists for a long time, but is type-specific.
It should be noted that healthy people often endure the infectious process without any symptoms. But people with problems in the immune status, as well as weakened children, suffer the disease heavily. Such patients have a tendency to form a recurrence of yersiniosis.

Whom to go to for treatment

Given 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 overall effect of the pathogen on the course of pregnancy is negative. Multiple organ disorders are possible both in the body of the mother and the 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 epidemic work on:

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

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

Symptoms

The symptoms of yersiniosis are:

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

The appearance of certain signs of yersiniosis depends on the severity of the disease and on 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 takes place in a hospital with the use of serious drugs, 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 temperature. It can reach 38-39°C.

Also, a sick person has the following symptoms:

• Strong headache;
• the appearance of weakness;
• pain in the whole body;
• prolonged insomnia;
• chills;
• complete lack of appetite;
• cramping abdominal pain. However, they can be of varying intensity. Most often, discomfort is observed in the right side or near the navel;
• the appearance of diarrhea, while the discharge has a liquid consistency, an unpleasant odor, often with impurities of blood or mucus. In some cases, the chair becomes more frequent up to 10-15 times per day;
• frequent urge to vomit;
• nausea.

Gastroenterocolitic form of yersiniosis sometimes occurs without fever. Often it can be subfebrile. In this case, the chair becomes more frequent up to 3 times a day. Pain in the abdomen is insignificant, and the general condition of the patient can be considered satisfactory.

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

With the progression of the disease, the liver and spleen increase significantly.

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 on the whole 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 bowel dysfunction.

Exanthemic form of yersiniosis - characteristic features

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

The exanthemic 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 - the first symptoms

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

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 so pronounced.

The main signs of the septic form of yersiniosis

The septic form of yersiniosis is not common. It is accompanied by serious violations of the work of many organs and systems. At the same time, it is observed:

• temperature rise. At the same time, during the day, the indicators can fluctuate with an interval of 2 ° C;
• the appearance of chills;
• prostration;
• muscle pain;
• enlargement of the 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

It is characterized by the appearance of chills, intoxication. In this case, the body temperature most often rises, there are violations of the digestive system.

After a few days, other symptoms appear:

• pain in the right side or near the navel, which are characteristic of appendicitis;
• the patient hardly rolls over from the right side to the left;
• discomfort on palpation of the abdominal region. In this case, there is severe pain on the right side;
• in a horizontal position of the body, a person with difficulty raises his right leg.

Generalized form of yersiniosis - the main signs of the disease

This form of yersiniosis is characterized by mixed symptoms. In this case, 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 reappears. After it, dry and flaky areas remain on the skin;
• the appearance of pain in the joints;
• 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 rales 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 is characterized by a pronounced pain syndrome. They become asymmetrical;
• formation of subcutaneous soft plaques and nodes on the thighs, buttocks, legs. They are very painful. Most often reach a significant size. Their number may exceed 10 pieces. After 2-3 weeks, the nodules resolve;
• stitching pains in the chest;
• inflammation of the outer shell of the eye;
• the appearance of pain during urination.

Symptoms of chronic yersiniosis

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

Throughout the time, the patient has the following symptoms:

• rise in temperature to subfebrile levels. This is especially observed in the evening;
• prostration;
• constant discomfort and pain in the joints;
• periodic cramps in the abdomen;
• pain in all muscles;
• a sick person may feel sick, sometimes there is diarrhea, 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 risk of this disease. Yersiniosis in childhood is characterized by:

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

Without timely and proper treatment, complications develop rapidly in children, which are characterized by damage to many internal organs.

Diagnostics

When signs of yersiniosis appear, first of all, it is necessary to contact a gastroenterologist and an infectious disease specialist. It is also important to consult with a cardiologist, neurologist and nephrologist, especially if the treatment of the disease has not yielded results, and some complications have appeared.

Diagnosis of yersiniosis includes the following steps:

• bakposev sputum or smear from the nasopharynx;
• blood test for yersiniosis;
• examination of the cerebrospinal fluid;
• analysis of urine, bile and feces for yersiniosis;
• ECG, echocardiography;
• 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 with damage to bone tissue and joints;
• diagnostic laparoscopy; p
• sigmoidoscopy;
• sonography.

The differential diagnosis of yersiniosis involves separating the symptoms of yersiniosis from signs that may be due to other health problems. It is for this that it is necessary to pass all the tests in order to correctly prescribe a treatment that will be as effective as possible.

Laboratory diagnostics - bacteriological methods

Microbiology plays an important role in the diagnosis of this disease. With yersiniosis, it is necessary to pass several tests that will help determine the patient's condition. The research material is:

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

Also, sowing for yersiniosis is carried out from a material that is in the environment where the patient is. Vegetables, fruits, dairy products, fish meat are used. Also, smears are examined, which are obtained from the surface of dishes and kitchen equipment that the patient used. After all tests, a conclusion is made about the presence or absence of pathogens 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 the development of the disease 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 the biological material, especially in the patient's blood. To increase the probability of identifying the pathogen, the study is carried out using at least four different samples. For example, faeces, blood, sputum, urine.

Also, the bacteriological diagnostic method requires a lot of time. On average, one analysis takes 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 that 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 the exact diagnosis, you need to re-test after about 12-14 days. The antibody titer in yersiniosis begins to rise on the 7-8th day after the onset of the first symptoms, and their maximum is reached already in the second week. Then their concentration begins to decrease and reaches the norm after 4-6 months. Sometimes there are cases when antibodies to yersiniosis are determined for several more years, but this is more an exception 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. Most of all, the analysis is informative after 2-3 weeks. It is carried out several times with a frequency of 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;
• RKA - this analysis is effective in severe 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 RPHA for yersiniosis can be negative if antibodies to this pathogen have not yet been developed in the human body. Therefore, to clarify the diagnosis, a second blood test is performed. If the result is again negative, then the symptoms that are determined in the patient are caused by other reasons.

Additional investigations in the presence of yersiniosis

In the presence of characteristic symptoms in yersiniosis, which indicates damage to the internal organs, it is necessary to undergo additional studies. They are aimed at determining the severity of the disease. With yersiniosis are shown:

• 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 the structures of the heart are visualized using ultrasonic signals from a special device. This allows you to determine the development of problems with this body 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 whole body using a special device that uses x-rays. It is very effective if it is necessary to determine the condition of a person or differentiate yersiniosis from other diseases.

X-ray examination of the intestine

This study reveals pathological changes in the lower intestine, including the rectum, sigmoid colon, descending colon, ascending colon, 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 intestine is exposed to minimal doses of ionizing radiation. This approach allows obtaining high-quality visualization, which greatly simplifies the diagnosis of yersiniosis.

For this purpose, colonoscopy or fluoroscopy has also been successfully used. 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 laparoscopy

Diagnostic laparoscopy is used only as a last resort, when other types of examination of the body with yersiniosis did not give a complete picture of the patient's condition.

This technique involves surgery. In this case, one or two small incisions are made on the abdominal wall, after which the doctor examines the organs. To increase the view, most often a small amount of gas is injected inside.

In this case, a special device is inserted into one incision - a laparoscope. It is a thin tube, at the end of which is placed an optical device that allows for inspection. A manipulator is inserted through another incision, with 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 help the doctor to correctly diagnose and determine the tactics of treatment.

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

With a mild form of the disease, the treatment of yersiniosis is carried out at home. But with pronounced symptoms of moderate and severe forms, the patient is sent to the hospital. Yersiniosis, the treatment of which should be carried out under the supervision of a doctor, occurs in both adults and children. The intake of any drugs should be under the supervision of medical professionals. This will help to avoid adverse consequences.

The main goals of the treatment of yersiniosis are:

• conducting antibiotic therapy;
• body detoxification;
• normalization of the digestive tract;
• restoration of water balance;
• taking drugs whose action is aimed at eliminating symptoms (anti-inflammatory, antihistamine, corticosteroid, and so on);
• restoration of the body's defenses (vitaminization).

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

During treatment, it is important for the patient to follow all the instructions of the doctor and adhere to the diet. Complex therapy is aimed at eliminating the pathogen and reducing symptoms. With a timely visit to the doctor, the prognosis of yersiniosis in most cases is favorable. 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 after an acute period for additional therapy.

Treatment of yersiniosis with antibiotics

Only antibiotic therapy can stop the reproduction of microorganisms. Treatment of yersiniosis with antibiotics is prescribed for all forms of diseases for both adults and children. Most often, the doctor prescribes tetracycline antibiotics, levomecithin or aminoglycoside. In the case of a serious 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 course of the disease. In case of complications during the course of treatment, the types of antibiotics can be changed. These actions help speed up the healing process.

Complementary Therapy

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

• antihistamines;
• corticosteroid;
• non-steroidal anti-inflammatory;
• preparations for the restoration of intestinal biocenosis and so on.

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

To restore the work of the gastrointestinal tract, special preparations are used. One of the goals of treatment is the resumption of intestinal biocenosis, therefore enzymes, preparations 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 medicines.

Restoration of immunity

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

• vitamin complexes;
• immunomodulators;
• folk remedies.

After stopping the acute period of the disease, taking vitamins and special preparations 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 the treatment of yersiniosis directly depends on proper nutrition. A strict diet for yersiniosis helps relieve stress from the gastrointestinal tract and quickly cope with intoxication of the body. In the first days, the patient is recommended to use:

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

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

Over time, with the improvement of well-being, 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 to 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. Small patients are prescribed anti-inflammatory, antihistamine and other drugs. All medicines must be taken only as prescribed by a doctor.

If complications occur, additional treatments and medications may be used. For example, when diarrhea appears, a child must be prescribed a medicine that can stop it. Severe diarrhea increases dehydration and worsens the condition in general.

In children under one year old, yersiniosis due to intoxication of the body can cause an enlarged liver. This complication requires immediate intervention by a doctor, otherwise the work of this important organ may be disrupted in the future.

Prevention of yersiniosis

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

• Always wash your hands before eating.
• Thoroughly wash vegetables, fruits, herbs and so on.
• Eat only sanitary-tested meat.
• Do not give rodents a chance to live in the house.

The main prevention of yersiniosis is clean hands. Also, always keep an eye on the quality of the products you use.

If you are considering whether to treat yersiniosis in adults or not, then remember that the disease can lead to serious complications. In addition, only antibiotics can stop the reproduction and activity of microorganisms. Treatment of yersiniosis requires an integrated approach. Do not self-medicate and do not resort to the help of folk remedies without consulting a doctor.

Medications

What medications to take for yersiniosis depends on the form and severity of the disease. Most often, the infection affects only the organs of the gastrointestinal tract, but there are more complex varieties of this disease. For example, the area affected by generalized yersiniosis can cover any organs. In the worst cases, the infection spreads to the cardiovascular and nervous systems. In addition, as a complication of yersiniosis, autoimmune diseases are often encountered, which also need to be treated at their initial stage.

When the first symptoms of the disease occur, it is necessary to consult a specialist for the appointment of effective treatment. The treatment of yersiniosis is carried out by an infectious disease specialist. Timely treatment will not allow the disease to develop into a more severe form. If you start to treat 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 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 possibility of waiting for the results of such an analysis, any broad-spectrum antibiotic with high rates of effect on the causative agent of yersiniosis must be prescribed. Flemoklav or Zinnat with pseudotuberculosis and yersiniosis have a very high efficiency. Also common drugs for yersiniosis are those that belong to one of 3 groups of antibiotics:

• Tetracycline. They are excellent bacteriostatics, but among the side effects there is a high level of toxicity. Therefore, the drug has a limited level of prescription to cure yersiniosis. Antibiotics of this group should not be used by persons under the age of 18, 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 have a high efficiency of action. At the same time, their level of toxicity is low enough so that it can be used by a wider range of people.
• Fluoroquinolones. By acting on enzymes, they do not allow new bacteria to be synthesized. This type of drug has good spreading properties and affects the entire body at once. This is very important if the disease has affected 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. With yersiniosis, injections will act most effectively, as they are better absorbed and act on bacteria faster. The duration of treatment of yersiniosis with antibiotics is at least 7 days, depending on the chosen drug and the severity of the disease.

In chronic yersiniosis, it should be borne in mind that bacteria can develop resistance to one or another type of drug, therefore, with periodic treatment, it is necessary to replace drugs. With long-term treatment, antibiotic groups can be replaced several times to increase its effectiveness.

With prolonged use of antibiotics, patients often develop dysbacteriosis. Therefore, at the same time with them, you need to prescribe drugs with a high content of beneficial bacteria. The most effective are: Acipol, Linex, Bifiform.

To prevent the disease from becoming more severe, a course of anti-inflammatory drugs is usually prescribed. Most often they do not contain hormones in their composition. 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.

For the treatment of autoimmune diseases that can develop against the background of yersiniosis, it is necessary to take glucocorticoid drugs 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 establishing dehydration, drugs of the rehydroid group are prescribed in order to replenish the lost fluid. This group of drugs is taken until the indicated symptoms disappear and for a short time after that.

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

Folk remedies

When symptoms of yersiniosis appear, do not self-medicate. Consult a 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 in the main drug therapy. Decoctions and tinctures are used for the following purposes:

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

Before you start checking 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 immunity

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, a decoction of wild rose 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 herbal decoctions and other folk remedies that improve metabolic processes and help restore the gastrointestinal tract. Often used medicinal herbs that have anti-inflammatory and analgesic properties. Non-traditional methods help to quickly cleanse the body of toxins and reduce the negative impact of antibiotics, which are required in the treatment of yersiniosis.

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

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

Do not self-medicate and do not try to cure yersiniosis on your own with folk remedies. This will inevitably lead to health complications. Consult your doctor before using any non-traditional treatments. Even harmless methods can complicate the course of the disease. Be aware that some herbs must be used with extreme caution as they are poisonous (such as 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 "yersinia infections" combines 2 acute infectious diseases: extraintestinal yersiniosis (pseudotuberculosis) and enteritis caused by Yersinia enterocolitica(intestinal yersiniosis). 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.

PSEUDOTUBERCULOSIS

(EXTRAINTESTINAL YERSINIASIS)

Pseudotuberculosis (A28.2), or Far East 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- Gram-negative bacillus, located in the culture in the form of long chains, does not form spores, has a capsule. The microorganism is sensitive to drying, exposure to sunlight. When heated to 60 ° C, it dies after 30 minutes, when boiled - after 10 s. Conventional disinfection (2% solution of chloramine, 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 optimum growth temperature is 22-28 °C. According to the surface antigen, 8 serovars are distinguished, each of which can cause a disease in humans, but serovars 1 and 3 are more common. The microorganism actively reproduces in boiled tap, river water, and also reproduces and retains all its properties at low temperatures (2-12 ° FROM). 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 the 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 are wild and domestic animals. The causative agent was 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 mass accumulation of the pathogen occur. It is assumed that its reservoirs can be not only rodents and other animals, but also the 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, found on containers, kitchen utensils, etc. Therefore, the pathogen has saprophytic properties and lives in the body of warm-blooded animals and the environment. This plays an important epidemiological role, as it makes it possible to trace the initial ways of infection of vegetables and root crops during their cultivation in fields and gardens. In the future, during storage, the contamination increases, which is facilitated by the temperature of vegetable stores (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 in the alimentary way when eating infected food (salads, vinaigrettes, fruits, dairy products, etc.) or water that has not been heat-treated. Epidemic outbreaks of varying intensity occur as a result of the spread of the pathogen by 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, at the age of 7 months to 1 year they rarely get sick, which can be explained by the peculiarities of their nutrition.

Diseases are registered throughout the year, the maximum falls on February - March due to the wider consumption of fruits and vegetables coming from vegetable stores. Contagiousness is moderate - 8-20 per 1000 children.

Pathogenesis. The pathogen with infected food or water penetrates through the mouth (infection phase) and, having overcome the gastric barrier, enters the small intestine, where it is introduced into enterocytes or intercellular spaces of the intestinal wall (enteral phase). From the intestine, microorganisms penetrate into the regional mesenteric lymph nodes and cause lymphadenitis (phase of regional infection). The massive intake of the pathogen and its toxins from the primary localization sites into the blood leads to the development of the infection generalization phase (bacteremia and toxemia). It corresponds to the appearance of clinical symptoms of the disease. Further progression of the process is associated with the fixation of the pathogen by the cells of the reticuloendothelial system, mainly in the liver and spleen. Essentially, this is the parenchymal phase. Clinically, it is manifested by an increase in the liver and often the spleen, a violation of their functions. Re-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. There is a clinical recovery.

In the pathogenesis of pseudotuberculosis, the allergic component associated with the re-entry of the pathogen into the circulation or the previous nonspecific sensitization of the body also has a certain significance. 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 allergy in the pathogenesis of the disease. In those who died from pseudotuberculosis, changes in organs resemble a picture of acute generalized infectious reticulosis with a predominant lesion of the lymphatic system of the intestine, spleen and liver. In these organs, pseudotuberculous foci are determined - granulomas, often microabscesses and necrosis. There are also dystrophic changes, hyperemia and plethora of internal organs, hemorrhagic edema is also possible, endo- and perivasculitis, peribronchitis and panbronchitis, interstitial and focal pneumonia, myocarditis and glomerulonephritis occur. Changes in the gut are fairly constant. The greatest changes are found in the terminal section of the intestine, at the place of its confluence with the caecum. Here, a depot of the pathogen 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 is slow. 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 factors of nonspecific protection play an important role in the elimination of the pathogen. However, in some cases, phagocytosis remains incomplete for a long time. In such children, pseudotuberculosis is severe, prolonged, with exacerbations and relapses. Ultimately, the level of specific antibodies begins to gradually increase and nonspecific defense mechanisms increase, the pathogen is completely eliminated and recovery occurs. The duration of immunity has not been precisely established, but there are reasons to consider it persistent. Recurrence, if any, is 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 phenomena 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, abdominal pain, mainly in the right iliac region or in the epigastrium, are noted. In some cases, there is a liquid stool 2-3 times a day by the type of enteritis. Examination of the patient at the very beginning reveals a number of characteristic clinical symptoms (Fig. 1). Attention is drawn to the puffiness and hyperemia of the face and neck, which contrasts with the pale nasolabial triangle. Typical hyperemia of the conjunctiva and injection of the vessels of the sclera, less often there is a herpetic rash on the lips and wings of the nose. 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, enanthema is sometimes observed. The tongue in the initial period is densely coated with a grayish-white coating, from the 3rd day of the disease it begins to clear and becomes crimson, papillary. From the first days of the disease, some patients have pain in the joints, enlargement of the liver, spleen.

Symptoms of the disease progress and reach a 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. Some patients in this period have a symptom of the hood - flushing of the face and neck with a cyanotic tint, a symptom of gloves - a delimited pink-bluish color of the hands, a symptom of socks - a delimited pink-bluish color of the feet. A rash is noted on the skin of the trunk in 70-80% of patients. It can appear from the first days of the disease, but often occurs during the peak, and always at the same time and is either dotted, reminiscent of scarlet fever, or spotted. The color of the rash is from pale pink to bright red. The background of the skin in this case can be both hyperemic and unchanged. Larger rashes are located around large joints, where they form a continuous erythema. The combination of scarlet fever and maculopapular rash occurs in about half of the patients. The rash is large-spotted, in some patients hemorrhagic, sometimes accompanied by itching of the skin. With a long course of the disease or its recurrence, elements of erythema nodosum appear on the legs, less often on the buttocks.

A rash in pseudotuberculosis is usually localized in the lower abdomen, in the axillary regions and on the lateral surfaces of the body. As with scarlet fever, there is white persistent dermographism. Pastia's symptoms (dark red color of skin folds), pinching, burning 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 have arthralgia, but there may be swelling and soreness of the joints. The wrist, interphalangeal, knee, and ankle joints are usually affected. With great constancy in this period of the disease, changes in the digestive organs are noted. Appetite is significantly reduced, nausea, infrequent vomiting, and often abdominal pain and upset stools occur. The abdomen is moderately swollen. Palpation in half of the patients can reveal soreness and rumbling in the right iliac region. In the projection of the caecum, enlarged and painful mesenteric lymph nodes are sometimes determined.

Intestinal disorders occur infrequently, while there is a slight increase and thinning of the stool while maintaining a 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, sometimes there is icterus of the skin and sclera. In the blood serum, the amount of direct bilirubin is increased, the activity of hepatocellular enzymes (AlAT, AsAT, F-1-FA, etc.) is increased, sediment tests are positive. Less often there is a picture of acute cholecystitis or angiocholecystitis.

Changes in the cardiovascular system are manifested by relative bradycardia, rarely tachycardia, muffled heart sounds, sometimes systolic murmur, in severe cases, arrhythmia. Arterial pressure is moderately low. On the ECG, changes in the contractile function of the myocardium, conduction disturbance, extrasystole, tooth reduction are determined T, lengthening of the ventricular complex.

At the height of the disease, pain in the lumbar region, decreased diuresis are possible. In the urine sediment, albuminuria, microhematuria, cylindruria and pyuria are determined. 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 a stab shift, monocytosis, eosinophilia, and elevated ESR.

Classification. There is no single 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 fever, abdominal, generalized, arthralgic, as well as mixed and septic variants.

In clinical practice, forms with an isolated syndrome (scarlet fever-like, icteric, arthralgic, etc.) are rare. 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 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 according to 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 the hemogram are normalized. In some cases, after the disappearance of the rash, lamellar peeling is observed on the hands and feet, pityriasis - on the back, chest and neck. With a smooth course, the total duration of the disease is not more than 1-1.5 months, but exacerbations and relapses are not uncommon. The frequency of relapses in children with all forms of the disease ranges from 16 to 22%. More often there is 1 relapse, less often 2-3 or more. Relapses are easier than the initial episode of the disease, but the disease is delayed, full recovery occurs after 2-3 months from its onset. Chronic forms of pseudotuberculosis are rare.

Diagnostics based on a combination of clinical and laboratory data. It is possible to suspect pseudotuberculosis in a patient when a scarlatiniform rash is combined with symptoms of damage to other organs and systems, especially with prolonged fever and undulating course. Winter-spring seasonality and group morbidity of persons who consumed food or water from one source are of great importance.

A decisive role in the diagnosis is played by bacteriological and serological research methods, especially if the disease is not accompanied by characteristic rashes.

The material for bacteriological examination is blood, sputum, feces, urine and swabs from the oropharynx. Sowing of the material is carried out both on ordinary nutrient media and on enrichment media, while using the ability of Yersinia to multiply well at low temperatures (refrigerator conditions). Cultures of blood and swabs from the pharynx should be carried out in the 1st week of the disease, cultures of feces and urine - throughout the disease. From serological studies, RA, precipitation test (RP), RSK, RPHA, passive hemagglutination inhibition test (RTPGA), ELISA are used. For emergency diagnosis, PCR and the immunofluorescence method are also used. In practice, RA is more often used, while living reference cultures of pseudotuberculous 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 more 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, typhoid-like diseases.

Treatment. Assign bed rest until the body temperature normalizes and the symptoms of intoxication disappear. Nutrition is complete, without significant restrictions. However, when symptoms appear that indicate damage to the gastrointestinal tract or liver, restrictions are introduced according to generally accepted recommendations for these diseases.

As an etiotropic treatment, chloramphenicol is prescribed at an age dose for 7-10 days. In the absence of effect or in case of exacerbation after the abolition of levomycetin, a course of treatment with a 3rd generation cephalosporin antibiotic should be carried out. In severe forms, 2 antibiotics are used, taking into account their compatibility. In mild forms, antibiotics are not required.

For the purpose of detoxification, reopoliglyukin, albumin, 10% glucose solution, as well as enterosorbents (enterosgel, enterodes, etc.) are injected intravenously during 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 in the development of erythema nodosum and polyarthritis. Antihistamines (suprastin, tavegil, diphenhydramine, diprazine, etc.) are prescribed as desensitizing therapy, and Wobenzym is used to normalize the functioning of the immune system.

Since exacerbations and relapses often occur in pseudotuberculosis due to insufficient immunity, drugs that stimulate immunogenesis are indicated: Gepon, Polyoxidonium, Anaferon for children, etc.

Posindromic therapy is important.

Prevention. The first place in the system of preventive measures belongs to the fight against rodents. Of great importance is the proper storage of vegetables, fruits and other food products, excluding the possibility of their infection. There is a need for strict sanitary control over the technology of cooking, especially dishes that are not subjected to heat treatment (salads, vinaigrettes, fruits, etc.), as well as water supply in rural areas.

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

INTESTINAL YERSINIASIS

(ENTERITIS CAUSED BY I. ENTEROCOLITICA)

Intestinal yersiniosis (A04.6) is an acute infectious disease from the group of anthropozoonoses with symptoms of intoxication and a primary lesion of the gastrointestinal tract, liver, joints, less often 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. Undemanding to nutrient media, grows well at low temperatures. According to biochemical properties, strains I. enterocolitica divided into 5 biovars. In humans, biovars III and IV are more often found, less often - II. More than 30 serovars were identified for the O-antigen. The predominance of individual serovars in certain areas was noted. The microorganism is antigenic 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. Especially often the pathogen is found in mouse-like rodents, cattle, pigs, dogs, cats, it is isolated from dairy products, ice cream.

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

In children's organized groups there are outbreaks of diseases caused by a single source of nutrition. Family and nosocomial outbreaks are noted, in which the most likely source of infection is a patient in an acute period 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 clear 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 ingestion of contaminated food, water or contact. Of great importance is the massiveness of the dose of the pathogen. The pathogen passes through the stomach, is localized in the small intestine, where it begins to multiply. A particularly frequent localization is the place where the small intestine passes into the blind (terminal section of the small intestine, appendix). With enterotoxigenic and invasive properties, I. enterocolitica penetrates and destroys the cells of the epithelium of the intestinal mucosa. The inflammatory process can be different - from catarrhal to ulcerative necrotic. The duration of the inflammatory process is also different. The infection spreads to regional lymph nodes, which increase as a result of hyperplasia of the lymphoid tissue. They may form foci of necrosis or microabscesses. The liver and pancreas are sometimes involved in the process.

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

The pathogen is able to persist in the lymph nodes for a long time, 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, tendovaginitis, myositis, heart damage, nodular and other erythema, Reiter's syndrome - some authors explain 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 - in 14%.

Pathomorphology. In intestinal yersiniosis, liver enlargement, gallbladder enlargement, spleen enlargement with multiple microabscesses are determined. In the intestine, a pronounced edema and infiltration are found with a narrowing of the lumen, with fibrinous overlays 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 to central necrosis and purulent fusion are found in the liver and spleen. With erythema nodosum, diffuse panniculitis, sometimes necrotizing vasculitis, is histologically noted.

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 in many respects similar to those in 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 begins more often 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 disease. From the first days, symptoms of intoxication are expressed: lethargy, weakness, loss of appetite, headache, dizziness, often nausea, repeated vomiting, and abdominal pain. Diarrhea is a constant symptom of the disease. The chair becomes more frequent from 2-3 to 15 times a day. The feces are liquefied, often with an admixture of mucus and greenery, sometimes blood. Mucus, polymorphonuclear leukocytes, single erythrocytes, violation of the enzymatic function of the intestine are noted in the coprogram. In the peripheral blood - moderate leukocytosis with a shift of the formula to the left, ESR increased.

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

Clinical symptoms in such patients practically do not differ from those in pseudotuberculosis. However, with yersiniosis, the disease often begins with intestinal disorders, and damage to internal organs occurs, as it were, secondarily, at the height of clinical manifestations and more often in severe cases.

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

Pseudoappendicular form, or syndrome of the right iliac region, occurs mainly in children older than 5 years. 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. A constant and leading symptom of the disease is abdominal pain, which is more often cramping, localized around the navel or in the right iliac region. On palpation, rumbling along the small intestine, diffuse or local soreness in the right iliac region are determined, symptoms of peritoneal irritation are sometimes noted. There may be short-term diarrhea or constipation, flying pains in the joints, 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 found, and more often mesadenitis (increased mesenteric lymph nodes), edema and inflammation of the terminal ileum. In crops from the removed appendix are found I. enterocolitica.

Septic (generalized) form of intestinal yersiniosis is rare. Allocate acute and subacute septicemia. The acute form is accompanied by pronounced and prolonged symptoms of intoxication. Drowsiness, weakness, anorexia, chills are noted. Children complain of headache, their body weight gradually decreases. The body temperature is hectic, with rises up to 40 ° C and above, with a daily range of 2-3 ° C. At the height of the disease, disorders of the cardiovascular and respiratory systems are noted. Often there are mild diarrhea, abdominal pain, enlargement of the liver and spleen. Some patients have skin rashes and arthritis. In the blood, a decrease in the level of hemoglobin, neutrophilic leukocytosis (16-25.10 9 / l), ESR 60-80 mm / h are found. From the blood, feces, urine, mucus from the pharynx in the midst of the disease, they secrete 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, osteomyelitis. From purulent foci is sown 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, not decreasing in the icteric period, elevated ESR. Sometimes there is short-term diarrhea, abdominal pain. In some patients, exanthema of a different nature appears in the early stages from the onset of the disease. On the 3-5th day of illness, dark urine, discolored feces and jaundice are noted. The liver is enlarged, thickened and painful. The edge of the spleen is palpated. The clinical picture is very similar to that of viral hepatitis. Without additional methods of examination, diagnosis is difficult.

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

Nodular (nodous) erythema occurs mainly in children older than 10 years. The disease begins acutely, with symptoms of intoxication, fever. Rashes appear on the shins in the form of painful pink nodes with a cyanotic tint, which disappear after 2-3 weeks, which differs from those with erythema of rheumatic etiology - they last longer. In half of 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 proceeds according to the type of non-purulent polyarthritis and arthralgia. It is rare, mostly in children older than 10 years. 5-20 days before the onset of arthritis in children, intestinal disorders are noted, accompanied by fever. The knee and elbow joints are more often involved in the process, less often the small joints of the hands and feet. The joints are painful, swollen, the skin over them is hyperemic. X-ray examination of the affected joints in the acute phase of the disease does not reveal pathological changes.

Intestinal yersiniosis in young children. At the age of 3 years, the gastrointestinal form of yersiniosis is usually noted by the type of gastroenteritis or gastroenterocolitis. These children have a higher prolonged fever, more pronounced intoxication (adynamia, periodic anxiety, convulsions, loss of consciousness, hemodynamic disorders), more frequent and longer vomiting and upset stool than older children. Symptoms of dehydration are detected almost exclusively in children of the 1st year of life.

Diagnostics. Intestinal yersiniosis is diagnosed on the basis of clinical and laboratory data. Of the clinical symptoms, lesions of the gastrointestinal tract are of the greatest importance, followed by the appearance of a polymorphic rash in the patient, mainly on the hands, feet, around the joints, enlarged 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 method are especially important for laboratory diagnostics. I. enterocolitica can be isolated from feces, blood, urine, pus, mucus from the pharynx, lymph nodes, surgical material, etc. The pathogen is most often isolated in the first 2-3 weeks from the onset of the disease, sometimes within 4 months. In the articular and cutaneous forms, the pathogen is very rarely isolated. In these cases, serological diagnosis is used. RA with a live or killed culture of Yersinia and RNHA are placed in the dynamics of the disease. Diagnostic titers in RA 1:40-1:160, in RNGA - 1:100-1:200. The maximum titers of agglutinins 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 of decisive importance.

Intestinal yersiniosis should be differentiated primarily from scarlet fever, measles, enterovirus infection, rheumatism, sepsis, 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 mild intestinal yersiniosis can be treated at home. In severe cases, hospitalization is required. With 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. With long-term enterosorption therapy, it is advisable to use a selective enterosorbent with pronounced hydrophobic properties. Of the means of etiotropic therapy, preference is given to chloramphenicol succinate and cephalosporins of the 3rd generation.

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

With appendicitis, abscesses, osteomyelitis, surgical intervention is indicated.

Prevention intestinal yersiniosis is the same as intestinal infections of other etiologies. No less important are those preventive measures that are carried out with pseudotuberculosis.

Yersiniosis mainly affects the digestive organs. In some situations, an infectious disease characterized by symptoms of intoxication affects the musculoskeletal system or the 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 extend to many internal organs, but the first symptoms appear when the intestines are affected. Not only adults, but also children, especially at preschool age, suffer from an infectious disease.

Yersiniosis (it is important to follow the doctor's clinical recommendations in order 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, provoking enterocolitis or gastroenterocolitis. In a difficult situation, peptic ulcer develops, pathological processes affect the mesenteric lymph nodes. The causative agent, getting into the blood, provokes bacteremia, against which the inflammatory process affects the internal organs located next to the focus.

Types of yersiniosis

In medicine, there is still no single classification of the disease. There are forms of yersiniosis, degrees and stages of development of pathological changes. They help doctors to diagnose and choose therapy for patients.

Name (type, form)	Description
Gastrointestinal (enterocolitis, gastroenteritis, gastroenterocolitis).	It occurs more often, 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 appendix of the caecum becomes inflamed. Complications include the accumulation of pus in the abdominal cavity, when the patient needs urgent surgery. Clinical signs: pain syndrome in the navel; 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 icteric, and the urine darkens). The abdominal form of yersiniosis proceeds for a long time, for several months.
Generalized (mixed, septic, septic-pyemic yersiniosis).	Pathology is characterized by vomiting, small punctate rashes, itching, pain in small and large joints. The liver is affected, the whites of the eyes become yellow, the urine becomes dark. The work of the cardiovascular system is disrupted, stabbing pain occurs, the heartbeat quickens, the pulse and blood pressure fluctuate. With disturbances in the work of the central nervous system, a person becomes lethargic, depressive and complains of dizziness.
Erased (secondary focal: arthritis, myocarditis, meningitis, Reiter's syndrome).	A form of yersiniosis, which is accompanied by a low body temperature (37 ° C), weakness, malaise 2-3 weeks after infection. More often, patients are diagnosed with reactive polyarthritis against the background of the disease.

All types of yersiniosis are accompanied by a characteristic clinical picture. An accurate diagnosis will be established by the doctor after a complete medical examination.

Stages and degrees of yersiniosis

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

Once in the stomach, some of the microbes die from hydrochloric acid. The rest move into the epithelium of the small intestine (distal), 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 through 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, a generalization of the pathological process is observed, due to which pathogenic microorganisms enter the bloodstream.

From this point 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 a long stay 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 rapidly, clinical signs appear abruptly.

The main symptoms of yersiniosis include:

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

Causes of yersiniosis

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

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

Pets are carriers of yersiniosis

The increase in statistics on patients with yersiniosis is explained by the 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 use active measures against pests, which provoke the appearance of pathogenic bacteria.

In the risk category are people who work in a food unit, poultry or livestock enterprise. There were cases when 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 to determine 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, according to the results, the doctor may assume a bacterial origin of the disease.	from 1500 r.
Isolation of the pathogen.	For research, the patient takes blood and mucus from the nasopharynx in the first 3 days. After a while, the doctor prescribes an analysis of feces and urine. If necessary, cerebrospinal fluid is taken from the patient.	from 900 rubles
Immunological study of blood.	Tests are carried out 2 weeks after the onset of the disease, so that antibodies have time to develop.	from 500 r.
Electrocardiography (ECG).	The examination will show changes in the work of the cardiovascular system.	from 150 rubles
Echocardiography (EchoCG).	Ultrasound signals allow you to examine all the structures of the heart and determine problems with it.	from 320 rubles
Ultrasound examination of internal organs (ultrasound).	Helps to identify pathological processes in yersiniosis, the area of ​​​​damage to internal organs.	from 1600 rubles
Computed tomography (CT).	A special device allows you to comprehensively examine the entire body of the patient using x-rays. The most effective diagnostic method that makes it possible to distinguish yersiniosis from other diseases.	from 1300 r.

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

Comprehensive diagnostics will help the doctor get maximum information for making a diagnosis, determine the degree of the disease and the form of the pathology. Based on the results, the patient is selected drugs 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 an infectious disease consultation. Doctors allow mild form of pathology to be treated at home. In a difficult situation, an additional consultation with a surgeon, rheumatologist and hepatologist will be required.

A doctor should be consulted with severe abdominal pain and prolonged diarrhea, accompanied by fever. Early diagnosis of yersiniosis and its adequate treatment will speed up recovery and prevent complications. Compliance with clinical recommendations will exclude prolonged therapy.

Prevention of yersiniosis

It is possible to prevent an infectious disease, it is enough to 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, treated with special disinfectants. Dry all containers, racks.

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

Methods of treatment of yersiniosis

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

Medications

Patients with severe yersiniosis are hospitalized. Given the form and type of the disease, a gastroenterologist, infectious disease specialist, immunologist or family doctor is involved in the treatment.

Patients are prescribed a complex of drugs:

Group name	Name of drugs	Description, course, effectiveness
Antibacterial agents	"Levomycetin succinate soluble", "Gentamicin", "Metacycline".	Influence 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 for 2-3 doses for 6-7 days.
Immunomodulators	"Pentoxyl", multivitamins, ascorbic acid in large dosages.	They are used for the recurrence of the disease or for the treatment of complicated forms of yersiniosis. Drugs 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 tab. per day during meals, drink plenty of water, do not chew.
Corticosteroids	"Prednisolone".	It is prescribed to patients with severe lesions of the joints, heart, if the selected treatment is ineffective. For 5-7 days, 1-2 mg / kg for 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, it restores water balance. Severe intoxication, frequent vomiting, rare urination and disturbances in the work of the cardiovascular system worsen the condition of a person.

Folk methods

Alternative medicine is used in complex treatment, helps to reduce the 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 efficacy
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 3 to 5 years old. Before cutting the leaves, it is not recommended to water it for 3-5 days. Mix all the components well, leave in a cold place for 7 days, shaking occasionally.	The resulting medicine is taken for yersiniosis 3 r. per day before meals for 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). Boil the resulting 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 p. per day. The medicine improves the condition of the digestive system in infectious diseases and restores stool (eliminates diarrhea).

A proven and effective remedy is juniper. It helps the body recover faster after an 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, reducing each day by 1 pc. The 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

In the process of treating yersiniosis, it is important to eat right so as not to burden the gastrointestinal tract. Drink more pure water to remove toxins from the body. The recommended diet includes boiled rice, liquid cereals, crackers, lean meat steam cutlets.

A weak green tea will help reduce nausea. Dried fruit compote contains minerals needed by the body during the period of illness. If you want to eat a salty dish, doctors recommend drinking boiled water with the addition of salt in a small amount.

Possible complications

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

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

Article formatting: Mila Fridan

Video about yersiniosis

Elena Malysheva will talk about yersiniosis: