Yersiniosis is a recurrent disease. Yersiniosis. Causes, symptoms, treatment and prevention

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

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

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

Diagnosis of yersiniosis

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

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

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

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

Basic laboratory methods for diagnosing yersiniosis

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

Differential diagnosis of yersiniosis

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

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

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

Complications of yersiniosis

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

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

The most common complications of yersiniosis are the following pathologies:

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

Sepsis

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

The main symptoms of yersinia sepsis are:

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

Peritonitis

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

Appendicitis

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

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

Kawasaki syndrome

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

The main symptoms of Kawasaki syndrome are:

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

Intestinal perforation

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

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

Intestinal obstruction

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

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

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

The main clinical manifestations of intestinal obstruction are:

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

Meningoencephalitis

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

Treatment of yersiniosis

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

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

Medicines used in the treatment of yersiniosis

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

When is hospitalization necessary for yersiniosis?

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

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

Can yersiniosis go away without treatment?

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

Yersinia infection can progress to chronic course, this is especially often observed in people who either were not treated at all, or in those who untimely turned to their doctor for qualified help. In addition, it is also worth remembering that a wait-and-see attitude towards infectious diseases often seriously increases the patient’s risk of developing various complications, 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 measures. In most cases, they are aimed at preventing the spread of infection among farm animals, which are the main carriers of yersiniosis in nature, and preventing contamination of food products ( milk, fruits, vegetables, meat, etc.) Yersinia. Anti-epidemic measures taken to stop the spread and destruction in the epidemic focus are also important in the prevention of this infectious disease ( ) the causative agent of yersiniosis.

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

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

Activities related to the prevention of infection of animals with Yersinia

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

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

Activities related to the prevention of food contamination with Yersinia

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

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

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

Anti-epidemic measures

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

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

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

Forecast of yersiniosis

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

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

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

What foods can cause yersiniosis?

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

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

Is yersiniosis contagious?

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

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

How does yersiniosis occur in children?

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

Yersiniosis is an intestinal infection caused by the bacterium Yersinia enterocolitica.

Intestinal yersiniosis is spread by the fecal-oral route.

The disease is manifested by intoxication and allergic reactions.

Both adults and children are susceptible to this infection. Men have a greater predisposition than women.

Yersiniosis is characterized by damage to the intestines, musculoskeletal system, liver and other organs.

The disease has different symptoms, which makes timely diagnosis difficult. As a result, there arise various kinds complications that can pose a serious threat to human health and even life.

Causes

The bacterium that causes intestinal yersiniosis is quite viable in environmental conditions. Yersinia is resistant to cold, can easily withstand freezing and subsequent thawing, for a long time live in water and soil. But sunlight, boiling, drying and chemical disinfectants are destructive to bacteria of this kind.

During their life, bacteria release 3 types of toxins: enterotoxin, cytotoxins and endotoxin.

Yersinia infection spreads mostly from animals: rodents, domestic animals (mainly pigs), dogs. Infection from an infected person is extremely rare.

The method of infection is fecal-oral through food and water. The main causes of the disease include:

• livestock food products that have undergone insufficient heat treatment;
• water that has been contaminated with feces from sick animals;
• poor hygiene, which can lead to household infection.

Factors contributing to the disease

There are a number of factors that contribute to the occurrence of the disease:

• Yersiniosis occurs more often in children. In childhood, the disease is much more severe;
• weakened immune system;
• various chronic diseases.

Symptoms

Intestinal yersiniosis has different symptoms depending on the form of its occurrence (see photo). Incubation period, as a rule, ranges from 1 to 6 days.

Experts identify several symptoms inherent in almost all forms of yersiniosis:

• general intoxication of the body;
• high temperatures, reaching up to 40 degrees;
• chills;
• general weakness;
• severe headaches;
• muscle and joint pain;
• decreased appetite;
• disorders of the nervous system in severe forms of the disease;
• , which subsequently leaves flaky spots. This symptom is rare.

These symptoms are present for 3-10 days.

Symptoms in children

Symptoms in children are expressed quite clearly. Parents note the presence of such signs of the disease as:

• severe intoxication of the body;
• heat;
• chills;
• disorders of the gastrointestinal tract, manifested in the form of nausea and vomiting;
• sore throat, cough and nasal congestion;
• enlarged lymph nodes;
• rashes on various parts of the body;
• bowel disorders.

Almost every child reports pain in the abdominal area. The pain is similar to appendicitis. This similarity leads to erroneous primary diagnosis.

Types and forms of the disease

Experts classify yersiniosis according to various forms, depending on the symptoms of the disease:

• Gastrointestinal form. With this course of the disease, the stomach is affected, which leads to the development, and the colon and appendix are also damaged. In this case, pain in the abdominal area of ​​various etiologies is pronounced. Noted frequent urge to defecation. This form of yersiniosis can occur as separate form, so be a sign of initial stage generalized form of the disease.
• Abdominal form characterized by similar symptoms to the gastrointestinal form at the initial stage, then symptoms of appendicitis appear.
• Generalized form characterized by damage to all organs of the body with development. The kidneys, membranes of the brain and lungs are mainly affected. This form of the disease occurs in a mixed type and has symptoms inherent different forms yersiniosis. These symptoms include:
  • a sharp, pronounced onset of the disease with symptoms of the gastrointestinal form;
  • a rash similar to a rash that causes itching and the appearance of new rashes;
  • arthralgia;
  • wheezing in the lungs;
  • manifestations are possible that occur during a long course of the disease;
  • catarrhal phenomena that last up to 2 months.
• Septic form It also has a pronounced onset, but the difference between this form of the disease is the occurrence of infectious-toxic shock and disseminated intravascular coagulation syndrome.
• Secondary – focal form characterized by damage to the joints, intestines, skin, and heart muscles. Develops as a consequence of some other form of disease. Due to damage to certain organs, it has different symptoms, but several common signs stand out:
  • polyarthritis;
  • monoarthritis;
  • a difficult-to-treat astheno-vegetative neurotic syndrome appears.

Mild, moderate, and severe degrees of the disease are also distinguished.

According to the course, yersiniosis can occur in acute, chronic and recurrent stages.

Diagnostics

Since yersiniosis has various symptoms, similar to other diseases, for differentiation the following diagnostics are carried out:

• blood biochemistry;
• immunological analysis;
• bacterial culture is the most informative method, but this is a rather long analysis. To carry it out, such biomaterial is used as: feces, urine, sputum, washing from the back wall of the pharynx;
• instrumental methods: X-ray, ECG, abdominal ultrasound, CT, laparoscopy.

Treatment of yersiniosis

Yersiniosis is a disease that requires hospital treatment in any form.

Since the infection can progress to chronic form, the impact on the source is carried out over a fairly long period of time.

Treatment of yersiniosis in both adults and children consists of: complex therapy. Bed rest is prescribed.

The diet is provided only for the gastrointestinal form.

Drug treatment

Treatment of yersiniosis involves taking the following medications:

• antibacterial and antimicrobial, therapy is carried out during hyperthermia and in the next 10-15 days. At the same time, it is customary to change antibiotic drugs to avoid addiction;
• antiallergic drugs;
• non-hormonal anti-inflammatory drugs;
• drugs to strengthen the immune system;
• probiotics;
• lowering agents.

Also, therapy is carried out to remove toxins from the body, and treatment of yersiniosis in children involves taking vitamins.

Surgery

Treatment for yersiniosis does not involve surgery. It is performed only in cases of complications that require surgery.

Additional treatments at home

Yersiniosis is an infection that requires immediate treatment in a hospital setting. It is possible to use alternative medicine, but only as an auxiliary therapy.

Self-medication threatens the occurrence of complications that threaten not only health, but also life.

Folk remedies (pharmaceutical herbs)

Folk remedies can be used as aids for:

• increasing and strengthening immunity;
• improving the functioning of organs and systems;
• quick and easy removal of toxins from the body.

To strengthen the immune system and tone the body, you can use: rose hips, aloe, echinacea, ginseng and other herbs.

After the acute form of the disease has been stopped, the doctor may allow, and in some cases, prescribe herbs or infusions traditional medicine to restore the functions of individual organs or systems. Also, some alternative medicine recipes help remove toxins and have anti-inflammatory properties.

Traditional medicine suggests using the following plants that have various properties and action: chamomile, chicory, celandine, cinquefoil, calendula, yarrow.

Before using any remedy not prescribed by a doctor, you should consult about the possibility of using this or that remedy. Since any remedy not provided for in therapy for the treatment of yersiniosis may not only fail to produce results, but also lead to worsening of the disease.

Complications

Yersiniosis is a disease that causes a large number of complications. Some of them can lead to very sad consequences.

One of the complications that occurs is that it can rupture and, as a result, cause peritonitis, and this complication threatens the patient’s life.

Most complications will require surgery. In addition, some complications of this intestinal infection lead to serious consequences for human organs.

Experts identify the following most common complications of this disease:

• peritonitis;
• inflammation of the appendix;
• Kawasaki syndrome;
• meningitis encephalitis;

To prevent complications, it is necessary to seek medical help in a timely manner. Because early stage the disease can be cured without consequences.

Prevention

To prevent infection with yersiniosis, a number of preventive measures are necessary.

The first and most important thing that is required is the fight against rodents, as they pose the greatest danger. You should also follow all food storage measures to avoid infection.

Verification is very important sanitary standards preparing dishes from raw products, as well as checking water quality.

If one person becomes ill, disinfection is carried out in any group.

It is very important to maintain personal hygiene and keep the refrigerator and food storage areas clean.

Forecast

Yersiniosis is a disease that has a large number of complications, but despite this the prognosis is favorable. Deaths are quite rare.

An unfavorable outcome of the disease occurs in the septic form of the disease, where mortality occurs in 50% of cases.

Yersiniosis – enough insidious disease which requires immediate medical care. Children deserve special attention. In childhood, in most cases the disease is severe.

The disease has different symptoms and treatment in adults and children, depending on the form and severity of the disease.

To avoid infection, all disease prevention measures should be followed. And if symptoms appear that indicate the presence of the disease, you should immediately consult a doctor. It is important to remember that timely medical care is the key to recovery without complications.

It is very important not to self-medicate; the disease cannot be cured without medical help. Before taking any medication, consult a specialist.

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Acute anthropozoonotic intestinal infection, accompanied by a toxic-allergic reaction, characterized by multifocality. Yersiniosis is characterized by a fecal-oral route of transmission. The reservoir of infection is livestock, rodents and dogs. The incubation period of yersiniosis lasts no more than a week. The clinical picture consists of a general toxic syndrome, maculopapular rashes, and dyspeptic disorders; hepatosplenomegaly, arthropathic syndrome, development of acute appendicitis, and a generalized form of yersiniosis are possible. The diagnosis is established on the basis of the isolation of Yersinia in various biological environments of the patient.

General information

Acute anthropozoonotic intestinal infection, accompanied by a toxic-allergic reaction, characterized by multifocality.

Characteristics of the pathogen

Yersiniosis is caused by the bacterium Yersinia enterocolitica, a motile gram-negative facultative anaerobic bacillus. Yersinia is well tolerated low temperatures, in the refrigerator at 4-6 °C they can not only survive, but also multiply on food. (Yersiniosis is often called “refrigerator disease”). Bacteria easily tolerate freezing and subsequent thawing, persist for a long time in water and soil, but are sensitive to sunlight, drying, boiling and chemical disinfectants. Yersinia produces enterotoxin, cytotoxins and endotoxin.

The reservoir and source of yersiniosis are mainly animals: various rodents, livestock (mainly pigs), dogs. People can spread the infection, but transmission from humans is quite rare. In cities, the infection is mainly spread by rodents; it is their clusters that form epidemic foci of infection during outbreak periods. Yersiniosis is transmitted through the fecal-oral mechanism through food and water. Food products of animal origin that are insufficiently thermally processed, water sources contaminated with the excrement of sick animals, contribute to the implementation of infection routes. In rare cases, contact-household transmission occurs (as a rule, it is associated with poor hygienic culture).

The natural susceptibility of humans to yersiniosis is low. Healthy people practically do not develop clinical forms of infection. Severe and manifest course is typical for children, people suffering from immunodeficiency conditions, chronic diseases, contributing to a pronounced weakening of the body’s protective properties. Epidemic outbreaks of yersiniosis are quite rare and most often occur with the massive consumption of vegetables contaminated with microbes.

Classification of yersiniosis

Yersiniosis is divided into gastrointestinal, generalized and secondary focal forms. The gastrointestinal form includes gastroenteritis, thermal ileitis and acute yersinia appendicitis. The generalized form can occur in the form of sepsis, hepatitis, meningitis, pyelonephritis, pneumonia, as well as in a mixed form.

The secondary focal form is subdivided into yersinia arthritis, myocarditis, enterocolitis, erythema nodosum and Reiter's syndrome. Yersiniosis can occur in mild, moderate and severe forms, acquiring an acute cyclic, chronic and recurrent course.

Symptoms of yersiniosis

The incubation period of intestinal yersiniosis is 1-6 days, clinical picture usually represented by several syndromes. Most often, a general toxic syndrome is observed, manifested in the form of fever reaching 38-40 ° C, chills, headaches, general weakness, aches in the muscles and joints. Appetite is reduced, and in severe cases, central nervous system disorders may occur. The febrile period usually lasts 7-10 days (significantly lengthening in the case of generalized yersiniosis). The gastrointestinal form of general intoxication is usually accompanied by dyspepsia (nausea, vomiting, diarrhea, abdominal pain).

In rare cases, exanthema appears with yersiniosis. Rashes are maculopapular, pinpoint or large-spotted (sometimes ring-shaped), appear on various areas of the skin, most often in the lower part of the extremities (symptom of “socks” and “gloves”). The rash may be accompanied by a burning sensation in the palms and leaves behind areas of peeling. In some forms of yersiniosis, arthropathic syndrome (arthralgia) is observed. The joints of the limbs (hands, feet, elbows and knees) are painful, swollen, and movement in the affected joints is limited. With generalized yersiniosis, hepatolienal syndrome (enlarged liver and spleen) may be observed.

In clinical practice, the gastrointestinal form of yersiniosis is most common. The disease proceeds like other infectious-toxic intestinal lesions and is characterized mainly by manifestations of intoxication and (in half of the cases) dyspeptic disorders. Intoxication usually precedes, but can develop simultaneously with dyspepsia. Sometimes this form of infection is accompanied by rashes, catarrhal or arthropathic syndrome. Severe intoxication may contribute to the development of hepatosplenomegaly, and sometimes moderate polylymphadenopathy is observed (lymph nodes are enlarged, but painless and do not lose mobility).

Depending on the severity of the disease, the duration of the disease ranges from 2-3 days to two or more weeks. Long-term intestinal yersiniosis acquires a wave-like character, and signs of dehydration appear. Acute appendicitis or terminal ileitis when affected by Yersinia do not differ in course from those pathologies caused by nonspecific flora. These conditions can either develop independently or be secondary, resulting from the progression of gastrointestinal or other forms of infection.

In the generalized form, a variety of symptoms are noted. The general toxic syndrome is intense, the fever reaches critical levels. In the vast majority of cases (80%), arthralgic syndrome is expressed, catarrhal symptoms are noted (sore throat, rhinitis, cough), and on the 2-3rd day a rash may be noted on the palms and soles (less often in other locations). Dyspeptic symptoms may occur during initial stage and rarely persist at the height of the disease. Half of the patients report abdominal pain (mainly on the lower right), a quarter – nausea, vomiting and diarrhea.

As the infection progresses, the liver and spleen enlarge, and the course can become undulating and recurrent. Similar symptoms may accompany the mixed form of yersiniosis. In the case of prolonged bacteremia and contamination of various organs and systems by microorganisms, signs of secondary hepatitis, pneumonia, pyelonephritis, serous meningitis and (extremely rarely) sepsis may appear. In this case, the initial symptoms may subside or persist and progress.

The secondary focal form can result from any of the above-described forms of infection; it usually develops 2-3 weeks after the onset of the disease or at a later date. This form is associated with the formation of pathological reactivity and autoimmune damage to organs and tissues. IN rare cases proceeds without pronounced clinical symptoms. The most common is yersiniosa reactive polyarthritis. The joints of the extremities (feet, hands) are usually affected, often asymmetrically. Monoarthritis is rare (no more than a quarter of cases). The joints are swollen, there is no hyperemia of the skin over them. The course of polyarthritis can become protracted or chronic, with an average duration of 2-3 months.

In 10-20% of cases, yersiniosis occurs in the form of erythema nodosum. Subcutaneous nodules form on the legs, thighs and buttocks, they are painful and large. The quantity can vary from a few pieces to two or more dozen. After 2-3 weeks, the nodules resolve. Reiter's syndrome is a combination of conjunctivitis, urethritis and arthritis. Yersinia myocarditis often lasts for several months, but usually in a mild benign form, cardiovascular failure does not develop.

The secondary focal form can occur in the form of enterocolitis (usually develops in individuals with a history of intestinal infections). The lesion is localized mainly in the upper parts of the intestine, often combined with other types of infection (arthritis, exanthema, catarrhal syndrome), and may be accompanied by asthenic symptoms (asthenia) and an increase in body temperature to subfebrile levels. TO rare symptoms Yersiniosis may include a variety of lymphadenopathy, pyoderma, and osteomyelitis. A common feature of reactive multiorgan pathologies in yersiniosis is an undulating course and a tendency to vegetative-vascular disorders.

Complications of yersiniosis

Complications of yersiniosis due to the polymorphism of manifestations and the tendency to form autoimmune reactions are quite diverse. It can be inflammatory diseases organs (myocarditis, hepatitis, cholecystitis, pancreatitis), surgical pathologies(adhesive disease, intestinal obstruction, appendicitis, perforation of the intestinal wall and peritonitis), diseases of the nervous system (meningoencephalitis), urinary (glomerulonephritis) and musculoskeletal (arthritis, osteomyelitis) apparatus.

Diagnosis of yersiniosis

Isolation of the pathogen is possible from feces, blood, bile, urine, and cerebrospinal fluid of patients; in addition, bacterial culture of swabs from the mucous membrane of the pharynx and sputum can be carried out. The pathogen is detected in swabs from environmental objects, objects, and food products. However, bacteriological diagnosis requires considerable time (often up to 30 days). As a rapid analysis, reactions are used to determine pathogen antigens in biological fluids (using RCA, RLA, RNIF, ELISA).

The sensitivity of RCA increases with severe and chronic process. From 6-7 days of the disease, RA and RIGA become positive, after 5-7 days the antibody titer is re-measured. A patient with yersiniosis may require consultation with a gastroenterologist, cardiologist, nephrologist, or neurologist. If a complication develops, ECG, Echo-CG, ultrasound of the abdominal organs, etc. are indicated.

Treatment of yersiniosis

In modern clinical practice, yersiniosis is treated inpatiently, prescribing long-acting etiotropic drugs even for mild forms of the disease. This tactic is determined by the frequency of chronic infection and the development of a relapsing nature of the course. Etiotropic therapy includes a course of antibiotics and fluoroquinolones, lasting for the entire febrile period and 10-12 days after. Late administration of drugs (after 3 days clinical symptoms) does not guarantee the prevention of complications and chronic infection. The generalized form is treated comprehensively (drugs are prescribed various groups antibacterial agents parenterally), to prevent relapses, antibiotics are changed throughout the course.

A set of nonspecific therapeutic measures is selected depending on the patient’s condition and the course of the disease. According to indications, detoxification solutions (dextran, colloid and crystalloid mixtures), antihistamines, anti-inflammatory groups are prescribed non-steroidal drugs, and, if necessary, prednisolone (hormonal anti-inflammatory drugs for topical use are often used). Patients may be prescribed vitamin therapy, digestive enzymes, probiotics to correct intestinal biocenosis, as well as means to increase immune defense (immunomodulators, human immunoglobulin).

Forecast and prevention of yersiniosis

Despite the variety of complications and forms of the disease, the course of yersiniosis is usually benign, and deaths are extremely rare. Yersinia sepsis has an unfavorable prognosis, ending in death in half of the cases.

Prevention of yersiniosis involves maintaining personal hygiene, including food hygiene, as well as sanitary and epidemiological control of medical institutions and catering establishments and the food industry. A significant measure is control over the condition of water sources. One of the preventive measures is deratization settlements and agricultural land.

Yersiniosis is an infectious disease characterized by predominant damage to the gastrointestinal tract, as well as generalized damage to the skin, joints, and other systems and organs.

Since this disease primarily affects the digestive canal, it is also called intestinal yersiniosis.

The causative agent of the disease is a member of the family of intestinal bacteria of the species Yersinia enterocolitica. These microorganisms exhibit extreme resistance to low temperatures, including freezing, but they quickly die at temperatures exceeding 60 0 C, especially when boiled.

In addition, Yersinia feels excellent at temperatures from +4 to +8 0 C, multiplying on food products, which is why yersiniosis is often called “refrigerator disease.”

The carriers of the infection in the wild are small rodents, but small cattle and cows, which are capable of excreting the pathogen, pose a greater danger to humans. Most often, Yersinia enters the human body through food, especially fresh vegetables. However, in addition to food and water, the source of infection is also an already infected person, since yersiniosis is also transmitted by contact (fecal-oral mechanism).

Everyone is at risk of contracting this infection. age groups However, yersiniosis can most often be observed in children aged 1 to 3 years. This disease is characterized by autumn-spring seasonality.

Symptoms of yersiniosis

The incubation period usually lasts 1-2 days, but in some cases it can last up to 10 days. Symptoms of yersiniosis are largely reminiscent of gastroenteritis, gastroenterocolitis, enterocolitis, and terminal ileitis.

Intestinal yersiniosis is characterized by abdominal pain, which can be constant or cramping, vomiting, nausea, and foul-smelling diarrhea. During illness, stool can be from 2 to 15 times a day, mixed with pus, mucus, and sometimes blood.

Symptoms of yersiniosis, in addition to intestinal damage, also indicate general intoxication of the body - an increase or decrease in temperature, dehydration, toxicosis. The onset of the disease in some cases is characterized by the appearance of a small-spotted or pinpoint rash on the limbs and torso; also during this period of yersiniosis, meningeal syndrome and liver damage can be observed.

The later period of this infection is characterized by the development of diseases such as erythema nodosum, mono- or polyarthritis, iritis, conjunctivitis, myocarditis, and Reiter's syndrome.

Intestinal yersiniosis can last from one week to several months.

Diagnosis and treatment of yersiniosis

Yersinia can be detected using laboratory equipment in the feces and urine of a sick person, and in special cases- in blood, cerebrospinal fluid, bile, sputum, pus from abscesses. Intestinal yersiniosis can also be diagnosed by detecting antibodies to the pathogen, which usually appear on the 7th day after infection. However, it is possible that the immune response may be weak or completely absent, as a result of which antibodies will not be detected. You can confidently talk about infection with yersiniosis if antigens of the pathogen or its DNA are detected in the blood or stool.

Treatment of yersiniosis, like other intestinal infections, involves detoxification therapy, as well as replenishment of lost fluid. Antibacterial therapy is also mandatory in the treatment of yersiniosis. The causative agents of this disease are usually sensitive to chloramphenicol, tetracyclines, and biseptol. If these drugs are ineffective, fluoroquinols (ofloxacin, ciprofloxacin) are prescribed, as well as intramuscular injections gentamicin.

After the body temperature returns to normal, treatment of yersiniosis with anibiotics is carried out for another 10 days.

In a situation where the symptoms of the disease persist, but the pathogens are no longer in the body, corticosteroids are used, the action of which is aimed at suppressing the immune response. When arthritis develops due to Yersinia infection, nonsteroidal anti-inflammatory drugs such as aspirin, voltaren, diclofenac, and ibuprofen are prescribed.

Intestinal yersiniosis in children

Despite the fact that in most cases yersiniosis in children has symptoms typical of this infection, there are some features of the clinical picture of the disease in this age category. Firstly, signs of infection such as intoxication, elevated temperature, and fever are more pronounced than in adults. Secondly, during illness, children become adynamic, restless, loss of consciousness, convulsions, and hemodynamic disorders are possible. Yersiniosis is especially severe in children in the first year of life: dehydration is observed, the lymph nodes and spleen are enlarged, and respiratory syndrome appears.

Prevention of yersiniosis

It is possible to prevent the disease yerosiniosis if you adhere to the rules of food storage and processing:

• raw vegetables and fruits must be washed well before consumption warm water, remove rotten areas, then scald with boiling water;
• do not store or consume products whose expiration date has already expired;
• Only freshly prepared salads should be eaten;
• meat, especially pork, should be subjected to long-term heat treatment;
• Do not store peeled vegetables in water, including in the refrigerator.

Prevention of intestinal yersiniosis involves timely identification of infected people and their isolation, as well as disinfection of premises.

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Yersiniosis is an infectious disease caused by the bacterium Yersinia enterocolitica and occurs primarily in the intestinal tract. Yersiniosis affects people at any age, but children are most vulnerable. An increase in the incidence of this infection is observed in the autumn-winter period.

Routes of transmission

Yersiniosis is caused by the bacterium Yersinia enterocolitica, which belongs to the family Enterobacteriaceae, genus Yersinia. The pathogen, Yersinia pseudotuberculosis, also belongs to the same genus. Therefore, yersiniosis and pseudotuberculosis have much in common, in particular, the clinical picture of these infections is very similar.

The sources of yersiniosis are rodents, livestock, and dogs. Rodents play the main role. Sick rats and mice run around in cellars, warehouses and defecate on vegetables and other food products. Feces can also end up in water tanks. The mechanism of transmission of yersiniosis is fecal-oral. That is, a person becomes infected with the disease by consuming contaminated food or water. Bacteria, entering the body, settle in the intestines, after which the clinical picture of the disease begins to unfold.

Symptoms of yersiniosis

Yersiniosis is an infection that can take many forms. Yersiniosis almost always occurs with intestinal damage. But it is very difficult to predict how the infection will develop further. Depending on the clinical picture, infectious disease specialists distinguish the following forms of yersiniosis:

1. Gastrointestinal (occurs with intestinal damage);
2. Generalized (proceeds like sepsis);
3. Secondary focal (occurs with damage to various organs).

The illness begins suddenly. A person’s temperature rises, he begins to feel weak, weak, and vague pain in the muscles and joints. These are manifestations of general intoxication. Soon a person begins to worry about gastrointestinal disorders.

Gastrointestinal form

Yersiniosis at the initial stage always manifests itself with symptoms of damage digestive tract . So, against the background of weakness and elevated body temperature, a person begins to feel. May also occur. Then comes the abdominal pain. The pain may be vague, throughout the abdomen. But in most cases, painful sensations are concentrated in the right lower abdomen.

Then diarrhea appears. The frequency of stool can vary from 1-3 to 15 times per day. The stool is liquid, and sometimes mucus and blood are detected in the stool. Heavy diarrhea can lead to dehydration.

In most cases, yersiniosis occurs in the gastrointestinal form. However, in weakened people suffering from chronic diseases, yersiniosis can occur in a generalized form.

Generalized form

This form of the disease is characterized by an acute onset and severe intoxication with high body temperature and chills. The general condition of the patient is serious. In addition, there are lesions of various organs (and not just the digestive tract), which is why the clinical picture becomes very vivid. The generalized form can manifest itself with symptoms such as:

• peripheral lymph nodes;
• Increase in liver size;
• The appearance of a hemorrhagic rash.

Secondary focal form

The secondary focal form of yersiniosis develops after the gastrointestinal or generalized form after two to three weeks of illness. This form can occur in the form of erythema nodosum. Thus, the secondary focal form of yersiniosis can manifest itself with symptoms such as:

• Dotted or small-spotted rash on the torso and limbs. The rash is especially pronounced on the hands and feet (gloves and socks symptom).
• Joint damage - arthritis. It manifests itself as joint pain, swelling, and limited mobility.
• The appearance of painful subcutaneous nodules on the legs, which is a sign of erythema nodosum. There can be from several pieces to several dozen nodules.
• Reiter's syndrome manifests itself as a combination of signs of conjunctivitis, urethritis and arthritis.
• The development of myocarditis, which manifests itself in the heart area, a violation of the heart rhythm.

Diagnostics

To confirm or refute yersiniosis, a bacteriological study is first carried out. To do this, material is taken from the patient (urine, feces, sputum, throat swab) and inoculated on special nutrient media. Colony growth occurs over several days and the study itself takes more than a week. Therefore, patients are simultaneously prescribed other research methods, for example, immunodiagnostic ones.

Using immunodiagnostic research methods ( linked immunosorbent assay, immunofluorescence reaction, agglutination reaction) laboratory assistants manage to detect Y. Enterocolitica antigens in the selected material. These research methods make it possible to confirm the diagnosis of yersiniosis in a shorter time.

Treatment of yersniosis

Treatment of yersniosis is primarily aimed at combating the pathogen. To do this, the doctor prescribes to the patient