Yersiniosis

Yersiniosis (intestinal yersiniosis) - the acute infectious disease characterised by a primary lesion of a gastrointestinal tract with the tendency to a generalised lesion of various organs and systems.

Aetiology. The originator yersiniosis concerns family of colibacilluses (Enterobacteriaceae to sort Yersinia) to kind Yersinia enterocolitica. Gram-negative rods in the dimension 1,8-2,7o0,7-0,9 a micron. Grow both on usual, and on depauperated nutrient mediums. The originator yersiniosis contains O - and H - antigens, on O - to an antigen is more than 50 serovars yersiniosis. In a pathology of the human serovars O1, O5, O8 and O9 though from sick humans others are excreted also have the greatest value. At temperature +4 - + 8 C° microbes are capable is long to remain and propagate on various foodstuff. On biochemical and cultural properties Y. enterocolitica it is close to Y. pseudotuberculosis.

Epidemiology. Mechanisms of conservation and originator transfer yersiniosis and a pseudotuberculosis are very close.

Pathogenesis. The accessory of originators yersiniosis and a pseudotuberculosis to one sort Yersinia causes resemblance of mechanisms of a pathogenesis.

Symptoms and flow. The incubation interval proceeds from 1 till 6 days. The yersiniosis is characterised by polymorphism of clinical implications. Disease begins acutely without a prodrome. There is a fever, a headache, a malaise, delicacy, pains in muscles and joints, a sleeplessness, a congested pipes, appetite depression. A body temperature subfebrile, sometimes till 38-40 C°. Along with symptoms of the general intoxication it is frequent on the foreground signs of a lesion of a gastrointestinal tract (an abdominal pain, a nausea, vomiting, diarrhoeia) act. The skin dry, sometimes appears finely spotted and punctual eruption with the subsequent ecdysis. The relative tachycardia, bent to a hypotension quite often becomes perceptible. Throughout disease there can be the new symptoms specifying in a lesion of these or those organs. Complaints to pains and gravity in right hypochondrium, dark colour of urine. There is an icteric staining of a skin and scleras. The liver dimensions are enlarged. In dynamics the headache can strengthen, capsulate and focal symptoms of a lesion of the central excitatory system are taped. Urodynias, depression of a daily urine up to an anuria. Abdominal pains strengthen, symptoms of a boring of a peritoneum are taped. On 2nd week there can be signs of an acute arthritis with a primary lesion of large joints, elements of a nodulose eruption or an urticaria, a cutaneous dropsy of the face (Quincke's edema), a smarting in eyes, a hyperemia and an edema of conjunctivas.

Clinical classification yersiniosis is not developed. On a leading syndrome it is possible to secure some the clinical forms, in particular localised (gastroenterocolitis), which clinical picture confines a primary lesion of a gastrointestinal tract and generalised (icteric, exanthem, arthralgic, septic) forms.

The gastroenterocolitis form. It meets more often than others. On its lobe it is necessary about 70 % of diseases. Begins acutely, the body temperature C° raises till 38-39. There is a headache, a malaise, a sleeplessness, an anorexia, a fever. Simultaneously with an intoxication syndrome there is an abdominal pain, diarrhoeia, sometimes vomiting. A chair liquid with a sharp unpleasant odour, occasionally with an admixing of phlegm, blood. Frequency of a chair varies from 2 to 15 times for days. Serious flow meets was rarely. More often a body temperature subfebrile or normal, the syndrome of the general intoxication is expressed weakly, a chair 2-3 times for days, abdominal pains insignificant. Such patients are activly taped at group diseases. This form can proceed in the form of an enteritis, a coloenteritis and a gastroenterocolitis. Duration of this form yersiniosis from 2 days till 2 weeks.

The icteric form educes or simultaneously with gastroenterocolitis, or later 2-3 days after intestine dysfunction. At this form on the foreground symptoms of a lesion of a liver act, the toxic hepatitis educes. Complaints to gravity and a pain in right hypochondrium, sometimes a skin itch. There is a yellowness of a skin and scleras. The liver is enlarged, painful at a palpation. Urine darkening becomes perceptible, the feces is decolorized. The hyperbilirubinemia and a hyper-transaminasemia is defined.

The Exanthematous form is characterised by a syndrome of an intoxication and an exanthema. The eruption appears for 1-6th day of disease. It can be punctual, finely - or largly - spotted skin without an itch. The eruption usually disappears completely in 2-5 days, on a place of the former eruption there is a pityroid ecdysis.

The arthralgic form proceeds with a fever, an intoxication and strong joint pains. The basic complaint to joint pains. Arthralgias sometimes cause immobilisation of patients and a sleeplessness. Joints choronomicly are not variated.

These forms are secured on a predominant syndrome, at them can be and other symptoms, characteristic for yersiniosis, but they are weakly expressed.

The septic form meets was rarely. For it the fever, augmentation of a liver, a lien and a lesion of various organs are characteristic a high fever with daily allowances ranges to 2C°. The endocarditis, a pneumonia, a nephritis with acute renal insufficiency, a meningitis, a meningocephalitis, a hepatitis can educe.

Complications arise more often on 2-3rd week. Them concern an allergic exanthema (an urticaria, a nodulose erythema), a Quincke's edema, an arthritis (mainly large joints), a myocarditis, an urethritis, a conjunctivitis, an appendicitis.

The diagnosis and the differential diagnosis. The yersiniosis can be diagnosed clinically on the basis of the acute beginning, an intoxication, a fever, symptoms of an acute gastroenterocolitis in a combination to an exanthema, an icterus, arthralgias and epidemiological preconditions. For laboratory acknowledgement of the diagnosis effect sowings on nutrient mediums of blood, a feces, the liquor, the inflamed mesenteric lymph nodes and appendicular processes. Procedure of sowing of stuffs same, as at a pseudotuberculosis. From serological procedures use an agglutination test, reaction of an indirect hemagglutination with erythrocyte diagnosticums, latex-agglutination, an enzyme immunoassay.

The differential diagnosis spend with acute gastrointestinal infectious diseases (an acute dysentery, a colibacillosis, a salmonellosis, a pseudotuberculosis, a virus hepatitis, a scarlatina, a rubella, a toxyc-allergic erythema).