Yersiniosis( intestinal yersiniosis) - Causes, symptoms and treatment. MF.

Yersiniosis( intestinal yersiniosis, entereritis caused by Yersinia enterocolitica) belongs to the group of yersiniosis, it is an acute zoophilic sapronotic bacterial infection with a fecal-oral transmission mechanism, with primary lesion of the gastrointestinal tract( but polyorganous lesions are possible) taking place against a background of febrile-inoxication syndrome.

The causative agent of iersiniasis

The causative agent and its pathogenicity factors( ability to cause morbidity):

Gram negative stick( when colored in grams turns pink), the color of which indicates the presence of a capsule;

• There are also flagella that cause active movement after introduction into the body;
• There is also an adhesive that binds to collagen, resulting in arthritis;
• The ability to synthesize a serine protease that breaks the secretory IgA of mucous membranes and facilitates penetration through the protective barrier, because IgA is the first line of defense on the mucous membranes( and not only the intestines).

• As with pseudotuberculosis, the causative agent of intestinal yersiniosis has outer membrane proteins that provide penetration through the mucous membrane of the intestine by a non-invasive route( i.e. without disrupting the integrity of the intestinal wall);

The last two factors explain the unimpeded penetration through the mucous barrier and further into the gliding tissues.

The causative agent of the group of iersiniosis( pseudotuberculosis and yersiniosis of the intestinal)

Yersinia enterocolitica perishes when it dries, boils, exposed to direct UV and various chemicals( eg, thleema, chlorine, alcohol).Pasteurization and short-term exposure to temperatures up to 80 ° C do not always lead to death.

Susceptibility to the disease is high. The risk group includes people working in animal husbandry, poultry farming, and also on the kitchen. Children 4-6 times more likely to suffer from 3-6 years of age, possibly because local immunization is not developed, and the mother's IgA is already exhausted from the last feeding.

Prevalence: endangered countries in Western and Northern Europe, United Kingdom, USA, Canada, Japan and Russia, Africa, Asia, South America, Eastern Europe.

There is no specific seasonality, registered disease throughout the year, but recently epidemic outbreaks and / or sporadic incidences have been noted from March to July and at the end of the year.

Causes of yersiniosis

Reservoir( keepers) - soil, rodents, pigs, cattle, rabbits, birds, cats and dogs. Sources: animal reservoirs and patients with various forms, as well as bacterial carriers. The mechanism of transmission: fecal-oral( through food, that is, alimentary), infections have also been recorded after a blood transfusion from an infected person.

Symptoms of iersiniosis

The incubation period is the time from the onset of the introduction of the pathogen into the body prior to the first clinical manifestations, with yersiniosis can last from 15 hours to 6 days, but more often 2-3 days. During this period, through the gastrointestinal tract the pathogen penetrates into the intestine, where it is fixed and multiplies. There, it is captured by tissue macrovagi, part of it is killed, secreting endotoxin, and some are carried by the same macrophages( due to incomplete phagocytosis) through the lymphoid system, and then through the bloodstream - causing dissemination, which is the trigger mechanism for the onset of the period of clinical manifestations.

The duration of the incubation period and the course of all other processes will depend on the following factors: immunological reactivity of the organism, from the strain and the infectious dose of the pathogen, from the path of penetration.

Period of clinical manifestations - the symptoms are very diverse, because the same clinical manifestation can be both isolated and the beginning of the next form. And because of this there is still no generally accepted classification, and at the moment for the separation and simplification of the understanding of yersiniosis, the syndromic principle is laid( as in pseudotuberculosis, the division of clinical forms is identical):

• gastrointestinal( characterized by the manifestation of gastroenteritis, enteritis, enterocolitis);
• abdominal form( presence of mesenteric lymphadenitis, terminal ileitis, acute appendicitis);
• generalized form( can be mixed and septic);
• secondary focal manifestations( arthritis, erythema, Reitra syndrome).

In any form, the disease begins with acute gastroenteritis on the background of intoxication, on 4-5 days the temperature normalizes, and by the end of the second week there comes a complete recovery.

Additional symptoms may also be present: catarrhal;dysuretic;exanthema;scarlet fever-like symptoms( "gloves, sock and hood", "crimson tongue");hepatosplenomegaly.

With , the gastrointestinal form of has abdominal pain of varying intensity, constant or cramping. Localization often in the right iliac region or in the navel region, can also be in epigastrium. Also.as with pseudotuberculosis, there is an increase in stool, but unlike it, with iersiniosis in the stool, an admixture of mucus and blood is found. Let me remind you that the gastrointestinal form can be both separately flowing, and testify to the onset of a generalized form, combining all the symptoms listed below - that's why one should always be on the alert.

Abdominal form of iersiniosis : the onset of the disease is identical to the gastrointestinal infection, and after 1-3 days, the symptoms of appendicitis appear and grow( pain in the right iliac region and / or around the navel, tenderness in palpation of this area, positive and diagnostic symptoms -from the right side to the left, increasing soreness when raising the right leg in a supine position, etc., symptoms of irritation of the peritoneum may join these symptoms).

Mesenteric lymphadenitis : against a background of a febrile-intoxication syndrome for 2-4 days there are blurred, often diffuse pains in the abdomen, lasting for 2 months.

Generalized form : flows through a mixed or septic variant. This form is characterized by "composite symptomatology" from each different form:

• acute on the background of the same symptoms as the gastrointestinal form;
• catarrhal phenomena appearing against the background of febrile-intoxication syndrome, lasting for 2 months;
• Scaralatino-like rash appears on day 2-3 and lasts for a week, with possible itching and podsypaniyami;
• Arthralgia of varying intensity and duration, with damage to various joints, with inflammation of plantar aponeurosis;
• Hepatosplenomegaly with the following consequences - icteric( icteric) sclera and skin, there is soreness in palpation in the right and left hypochondrium.
• Dry rattles in the lungs, which may indicate small focal pneumonia.
• With prolonged course, signs of infectious cardiomyopathy or myocarditis, manifested by stabbing pain in the heart, a feeling of intense heartbeat, tachycardia not associated with fever.

Septic form of iersiniasis: is also characterized by a sharp onset, but in addition to gastroenteritis, symptoms of ITH( infectious-toxic shock) and DIC-syndrome( disseminated intravascular coagulation) come to the fore.

Secondary focal form of : can develop after any other form and in the foreground in this case is the defeat of any organ, so the symptoms are extremely diverse, but the most frequent are the following manifestations:

• polyarthritis( interphalangeal joints, wrist, intervertebral,shovel-clavicular, hip);
• monoarthritis( knee, ankle, elbow joints are affected in combination or isolated from each other).In this case, joint damage is often asymmetric.
• Developing difficult-to-maintain astheno-vegetoneurotic reactions.

Immunity is weak and intraspecific, that is for a certain strain, that is, after the disease has been transferred it is possible to catch again.

Diagnosis of yersiniosis

Diagnosis is carried out taking into account epidemiological, clinical and specific laboratory data. Clinical data are often based on differential diagnosis, taking into account the comparison of a number of data( the onset of the disease, the severity of intoxication-febrile symptoms, the presence of catarrhal phenomena, the presence of exanthema and its characteristics, dyspeptic symptoms) and require specialized training of infectious diseases.

Laboratory analysis:
• Hemogram( ↑ Lc and Nf with left shift, ↑ E and ESR, ↓ LF)
• Biochemical blood test: ↑ ALT, AST and APF, as well as bilirubin
• Specific laboratory diagnostics:
- bacteriologicalthe method is basic, but it is not very convenient, because the final diagnosis becomes known after 10 days. This method is based on the collection of biological material and preferably a different substrate( feces, blood, urine and flushing from the posterior pharyngeal wall)
- immunological method: RA, RIGA is aimed at determining specific antibodies on day 6-10, ELISA specifies specific antibodies as early as 3day - that's why it is an express method.
• Instrumental methods: chest x-ray and joints, ECG, echocardiography, visceral ultrasound of the abdominal cavity and retroperitoneal space where kidneys, sigmoidoscopy, colonoscopy, CT, laparoscopy, sonography are localized.

Treatment, complications and prevention are similar to those for pseudotuberculosis.

Doctor therapist Shabanova IE