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Pseudotuberculosis and yersiniosis. Differential diagnosis

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Content

  1. Definition of the concepts of yersiniosis and pseudotuberculosis
  2. The reasons for the development of yersiniosis and pseudotuberculosis
  3. Pathogenesis of diseases
  4. Typical symptoms of yersiniosis and pseudotuberculosis
  5. Clinical features of pseudotuberculosis
  6. Clinical features of yersiniosis
  7. Diagnosis of yersiniosis and pseudotuberculosis
  8. Bacteriological analysis
  9. Serological analysis
  10. RNGA with immunoglobulin diagnostics
  11. IPA
  12. Histological examination of a biopsy of lymph nodes and other organs
  13. Differentiation of yersiniosis and pseudotuberculosis from other diseases
  14. Acute intestinal infections
  15. Appendicitis
  16. Diseases of the joints
  17. Viral hepatitis
  18. Sepsis
  19. Treatment of yersiniosis and pseudotuberculosis
  20. Video about pseudotuberculosis

Pseudotuberculosis and yersiniosis is an acute infectious bowel disease. Violations have similar symptoms with other pathologies and require differential diagnosis.

Definition of the concepts of yersiniosis and pseudotuberculosis

Both pathologies have the same nature of origin and represent scarlet fever, with which is observed toxic damage to the body - liver, intestines and other internal organs and systems.

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The reasons for the development of yersiniosis and pseudotuberculosis

The causative agents of diseases are intestinal bacteria (Yersiniae pseudotuberculosis), which are present in various systems of the outside world - soil, earth, water. However, rodents are believed to be the main vectors of microorganisms.

The route of infection is food. Disorders result from inadequate food processing. Most small rodents secrete an internal secret in fields, vegetable gardens with plants or vegetables that are sold or stored in a warehouse.

Also, the pathogen is found in dairy products that have undergone insufficient or no heat treatment at all.

The life span of microbacteria is from 2 to 8 months. In the soil, the pathogen can persist for 1 year. In rare cases, the pathogen is transmitted by the contact-household route (typical for pseudotuberculosis) through dust and air.

Pathogenesis of diseases

Since the pathogen enters the body with food, the gastrointestinal tract is primarily negatively affected. In this case, damage to the mucous membrane of the ileum, as well as its lymph nodes, occurs.Pseudotuberculosis and yersiniosis. Differential diagnosis

As a result, an inflammatory process (terminal ileitis) or acute appendicitis occurs. A small part of the pathogen remains on the surface of the intestine and leads to the development of diarrheal syndrome.

A minimal amount of bacteria enter the colon and cause irritable bowel syndrome.

With further spread, the microorganism will enter the solitary follicles and mesenteric lymph nodes, which leads to the development of the disease.

When bacteria are destroyed, a specific toxin is released, which enters the bloodstream and causes negative symptoms on the part of the central and autonomic nervous system.

Further spread of the pathogen leads to damage to the liver and spleen. In some cases, septic manifestations may occur. Various reactive states and collagenoses can also develop.

During this period, the body begins to produce antibodies (approximately, on the 6-8th day of the disease). The immune response develops slowly and lasts for 1 year.

Typical symptoms of yersiniosis and pseudotuberculosis

Pseudotuberculosis and yersiniosis (differential diagnosis is prescribed and performed without fail) are similar in symptomatology, pathogenesis and reasons that lead to their development. However, each disease has its own characteristics of the course, the incubation period and the nature of the course.

Clinical features of pseudotuberculosis

For pseudotuberculosis, the incubation period can range from 2 days to 18 days. However, in most cases, this indicator remains at the level of 1-1.5 weeks.

The clinic of the disease is distinguished by a variety of symptoms. In most cases, toxic-allergic reactions develop in the gastrointestinal tract. In this case, the condition is accompanied by fever, intoxication, exanthema and other focal signs in the internal organs.Pseudotuberculosis and yersiniosis. Differential diagnosis

The pathology is characterized by acute development and course, which is observed in more than 81% of patients. In the first week, patients have acute and pronounced signs of the disease.

Symptoms:

  • general weakness of the body;
  • headache;
  • muscle pain;
  • feverish condition;
  • joint pain;
  • an increase in temperature to febrile values;
  • chills.

At the beginning of the 2nd week, the temperature drops. Only in 10-15% of patients the temperature can persist for a month.

In this case, the following signs are observed:

  • weakness and malaise;
  • catarrhal syndrome;
  • cough;
  • runny nose;
  • redness of the mucous membranes around the mouth and pharynx.

The first 3 days there are rashes and redness in the area of ​​the skin of the face and neck, edema is formed on the feet and palms. The rash can be of a different nature.

Pseudotuberculosis and yersiniosis. Differential diagnosis
A rash on the body is characteristic of pseudotuberculosis and yersiniosis

With a mild course of pathology, the symptoms are less pronounced and are observed during the first 1-3 days. The body temperature does not exceed 380C. All signs point to a common intestinal infection.

The moderate course of the disease is accompanied by a febrile condition, pronounced toxic damage to the body, severe pain attacks (in the abdomen). This also develops loose stools and multiple vomiting occurs. The condition can lead to the development of exanthema, arthralgic disorders, the appearance of signs of hepatitis.

In severe cases, vomiting may develop, the spleen may enlarge, and signs of hepatitis may appear (in more rare cases, meningitis). The prognosis is favorable in most cases.

Clinical features of yersiniosis

With yersiniosis, the incubation period varies from 2 to 6 days. In some cases, this indicator can increase up to 2 weeks. In most cases, the disorder is acute in the first week. About 30% of patients report a gradual and progressive development of the disease.

Symptoms:

  • fever;
  • an increase in body temperature (in the first days of illness);
  • toxic damage to the stomach;
  • general malaise;
  • decreased appetite;
  • chills;
  • headache.Pseudotuberculosis and yersiniosis. Differential diagnosis

60-90% of patients develop abdominal pain of varying intensity and localization (around the navel and the right iliac region). In some cases, there is a change in the appendix. Yersiniosis is characterized by the development of negative signs from the gastrointestinal tract. In this case, enteritis, enterocolitis, gastroenterocolitis often occur. Stool frequency increases up to 10 times a day. At the same time, diarrheal syndrome develops in younger patients.

Also, rashes (exanthema) are formed, the pancreas is damaged (in rare cases), the articular system is affected. The pathology is characterized by the development of disorders from the cardiovascular system - tachycardia, noises, changes in tones, arrhythmia, an increase in blood pressure.Pseudotuberculosis and yersiniosis. Differential diagnosis

Damage to the nervous system is observed 2 times more often than with the development of pseudotuberculosis. In this case, the course of meningococcal infection is more complex and severe.

The prognosis for the disease is favorable. In extremely rare cases, surgery may be required.

Diagnosis of yersiniosis and pseudotuberculosis

Pseudotuberculosis and yersiniosis (differential diagnosis will help distinguish pathologies from other similar diseases) require mandatory examinations, which will help you choose the most suitable option treatment.

It is possible to diagnose the presence of a disease only with a comprehensive study, since it is not always possible to accurately diagnose on the basis of exclusively external manifestations.

Bacteriological analysis

A bacteriological study is carried out to determine the presence of pathogenic microorganisms. In the course of the study, the properties and other characteristics of urine and feces are studied. Also, cerebrospinal fluid is diagnosed, lymph nodes are examined, and the condition of the appendix is ​​assessed.

Serological analysis

Serological diagnostic methods include ELISA and RPGA. Both methods allow you to determine the presence of antibodies to Yersenia. For the analysis, venous blood is taken, taken at the onset of the disease and at the 3rd week. The study of the material also makes it possible to determine the nature of the origin of microorganisms. It is necessary to take an analysis every 2 weeks. An enzyme-linked immunosorbent assay can detect colonies of parasites in feces or urine.

RNGA with immunoglobulin diagnostics

For the study, blood is taken, which is studied by standard erythrocyte diagnostics. During the study, erythrocytes are studied, on the surface of which antigens have formed.

The study is carried out using a microscope. For an accurate diagnosis, additional diagnostics are required.

IPA

Differential diagnosis by the MFA method is also a mandatory study to separate pseudotuberculosis and yersiniosis from other intestinal infections.Pseudotuberculosis and yersiniosis. Differential diagnosis

The fluorescent antibody method is used to detect antigens in microorganisms or liquids. In this case, antibodies are used, marked with special luminous dyes.

To carry out diagnostics, a material that contains an antigen is placed on the glass. Then a fluorescent serum is applied. After that, the sample is placed in a humid environment, the temperature of which should be +370C.

Finally, the sample is removed and the excess dye is removed. The results are determined by the brightness of the coloring element and are marked with crosses.

Meaning Description Output
++++ Intense, bright, sparkling color The presence of infection (100% confirmation)
+++ Pronounced clearly, bright color Acute or moderate course of the disease
++ Glow is weak, but morphological signs are pronounced The onset of the disease, more research is required
+ Weakly expressed color, signs of morphology are barely distinguishable Possible infection. Additional comprehensive research is required
No glow No disease identified

Histological examination of a biopsy of lymph nodes and other organs

Histological diagnosis is prescribed if the patient has complaints - pain or palpation of the lymph nodes.

The study is a collection of biological material from the lymph nodes. For this, surgery is performed, during which a biopsy is performed.

At the same time, during the operation, the state of the lymph nodes is assessed - the structure is studied, the presence of inflammatory processes is determined, which would indicate the presence of an infection.

Based on the results of the study, a diagnosis is made. To determine the deviations, the number of determined cells is counted. At the same time, at least 500 cells are differentiated.

Differentiation of yersiniosis and pseudotuberculosis from other diseases

Differential diagnosis helps distinguish pseudotuberculosis and yersiniosis from other similar disorders. Each disease has its own distinctive features and clinical manifestations, which may be absent in other pathologies.

Acute intestinal infections

Pseudotuberculosis and yersiniosis (differential diagnosis is the main way to determine infectious diseases) is accompanied by less pronounced manifestations of intoxication and diarrhea. In this case, the large intestine is less often involved in the pathological process.Pseudotuberculosis and yersiniosis. Differential diagnosis

There is also a symptomatology uncharacteristic for AEI:

  • rashes;
  • an increase in the volume of the liver;
  • catarrhal syndrome;
  • arthralgia.

For intestinal infections, the development of signs of exicosis is characteristic.

Appendicitis

In contrast to both disorders, appendicitis develops more slowly. At the same time, during the study, pathological changes in the adnexal organ are found more often than with standard appendicitis.

Yersiniosis and pseudotuberculosis are characterized by an enlarged liver, the development of fever, the formation of exanthema, which is not observed with appendicitis.

Diseases of the joints

In diseases of the joints, in most cases, the articular system is affected, and signs of arthritis develop. Erythema nodosum may also occur, and heart damage is observed. At the same time, liver enlargement does not occur, exanthema and diarrhea are absent.Pseudotuberculosis and yersiniosis. Differential diagnosis

With rheumatism, an increase in the concentration of antistreptolysin is noted.

Viral hepatitis

In viral hepatitis, the fever is shorter, which goes away after jaundice develops. In this case, exanthema and arthralgia occur immediately before jaundice, and not simultaneously with it.

With yersiniosis, there is a longer diarrhea, abdominal pain, the formation of rashes of a different nature. Also, with pathology, scleritis, arthritis, conjunctivitis develops.

Sepsis

It is extremely difficult to distinguish both pathologies from septic lesions. For pathology, an outbreak is characteristic, while the disease itself does not develop cyclically.

Body temperature with sepsis can fluctuate during the day with alternating chills or sweat.

For the differentiation of both diseases, a mandatory study of feces is necessary.

Treatment of yersiniosis and pseudotuberculosis

Pseudotuberculosis and yersiniosis (differential diagnosis is necessary for any intestinal infectious diseases, since each disease their methods of treatment) requires compulsory therapy, since pathologies can lead to the development of various consequences and complications.

Treatment of diseases should be comprehensive and only after all the necessary research has been carried out.

Patients with moderate or severe forms of the disease are subject to hospitalization. For mild types of disorders, outpatient treatment is indicated.

As methods of therapy, both drugs and surgical intervention (with severe pathologies) can be used.

First of all, antibacterial drugs are prescribed. Moreover, only those agents are used to which the microorganism turned out to be sensitive.Pseudotuberculosis and yersiniosis. Differential diagnosis

The most commonly prescribed is Levomycetin.

Also used are funds belonging to the group of 3rd generation cephalosporins:

  • Ceftriaxone.
  • Cefoperazone.
  • Ceftazidime.
  • Cefotaxime.

Some varieties of bacterial strains have shown high sensitivity to fluorinated quinolones:

  • Ciprofloxacin.
  • Norfloxacin.
  • Pefloxacin.

Aminoglycosides of the 2nd generation (Gentamicin, Amikacin) are also highly therapeutic.

Various drugs of the penicillin series (Amoxiclav, Augmentin) can also be prescribed.

In the case of the development of gastrointestinal types of diseases, the most suitable drugs are Ersefuril, Biseptol, Intetrix.

Other auxiliary drugs (in case of damage to other organs and systems):

  • Membrane stabilizing agents - Aevit, Essentiale.
  • Medicines to maintain the work of the cardiovascular system - Riboxin, Cocarboxylase.
  • Antihistamines (with the development of allergic reactions) - Claritin, Suprastin, Tavegil, Zodak.
  • Hepatoprotective medicines (for liver damage) - Karsil, Heptral, Hofitol.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) - Diclofenac, Ibuprofen, Indomethacin.

Etiotropic therapy is carried out for 1-1.5 weeks. With focal lesions, the duration of treatment should be 12-14 days.

As a rule, therapy is carried out in a complex manner using 2-3 drugs (antibiotics) at once.

As a local therapy, the use of an alcoholic or brilliant green solution is indicated. For this purpose, the indicated means are applied to the skin surface. Apply according to the testimony of a doctor or as needed.

In case of damage to the oropharynx (anginal form of disorders), it is recommended to rinse with antiseptic or disinfectant solutions (Chlorhexidine, Miramistin).

Surgical intervention is prescribed only in case of severe infection with damage to other organs and systems. Most often it is performed with appendicitis or the development of abscesses.

If there are signs of intestinal infections (pseudotuberculosis or yersiniosis), immediate referral to a specialist, since diseases can progress and lead to the development of additional violations. To clarify and make a diagnosis, it is necessary to undergo research from other specialists in order to differentiate pathologies from other diseases.

Video about pseudotuberculosis

Pseudotuberculosis:

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