Yerseniosis

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THEME OF THE LESSON:

YERSINIOSISES.
DIFFERENTIAL DIAGNOSTICS OF ACUTE INTESTINAL INFECTIONS.
Activators: Y. еnterocolitica and Y. pseudotuberculosis. They are close on

biochemical and cultural properties. They contain O- and H-antigens; on O-antigen it is
allocated more than 50 serovars of intestinal yersinias and 8 serovars of activators of
pseudo-tuberculosis. They are capable to be kept long and reproduce at temperature +4 -
+8°С, are steady against repeated freezing. An optimum of growth in thermostate is at
temperature +25°С. Yersinias are trigger microorganisms: they can provoke serious
autoimmune reactions resulting in formation of chronic nonspecific diseases
(collagenosises).
Source of an infection: synantropic and other rodents (are also the basic
reservoir, alongside with ground), many kinds of animals and birds. Rodents infect with
excrements food stuffs, water and ground. Infection usually occurs at the use in food
thermally not processed vegetables (cabbage, salad etc.), stored is long - within several
months - in conditions of a vegetable storehouse. Both diseases are distributed, mainly,
in northern areas of the European part of Russia (Leningrad, Pskov, Novgorod etc.) and
on the Far East. The person, as a rule, a source of infection is not. However, sporadic
cases and even flashes of yersiniosises in children's hospitals (mainly - in
rheumatological) are described.
Pseudo-tuberculosis and intestinal yersiniosis (owing to a generality of etiology,
pathogenesis and clinics of them designate the general term “yersiniosises”) can proceed
with aggravations and relapses, with connection of new organic lesions. Duration of
disease makes from 2-3 weeks about several months. At 5-18 % of patients it is
observed long yersiniosis (duration is over 3-6 months, from the point of view of
classifications of infectious diseases would be more correct to name its chronic),
finishing in most cases by formation of chronic autoimmune diseases: reactive
polyarthritis, myocarditis, glomerulonephritis, nodular erythema, Rejter’s syndrome,
uveitis, iridocyclitis.
INTESTINAL YERSINIOSIS
Clinic. The incubatory period is from 1 up to 6 days. The beginning of disease is
from fever, muscular and articulate pains, rise in temperature up to 38-40°С, symptoms
of gastroenteritis - nausea, vomiting, pains in an abdomen (especially - in the right
ileocecal area; will carry out differential diagnostics with appendicitis), liquid stool.
Disease can be finished within several days without involving in process of other organs.
However, during the disease there can be the new symptoms indicating lesion of other
organs - a liver (hepatitises unicteric and icteric), large joints (arthritises), a skin
(nodular erythema, various rash, including - allergic character) and a conjunctive. The
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septic form meets seldom, is accompanied by lesion of several organs and can be
finished by lethal outcome.
Complications: allergic reactions, myocarditis, appendicitis.
PSEUDO-TUBERCULOSIS
Clinic. The incubatory period is from 3 about 18 days. Disease begins, as well as
intestinal yersiniosis, from the expressed intoxication and feverish reaction. The clinic of
gastroenteritis meets rather seldom, however pains in an abdomen are one of
characteristic signs (are caused by lesion of mesenterial and retroperitoneal lymphatic
nodes in which the inflammation with caseous-liked disintegration a little bit similar
with tubercular develops is it was reflected in the name of the disease). A skin is dry and
hot, frequently puffiness and hyperemia of a face and a neck – “symptom of a hood”,
pale nasolabial triangle, limited hyperemia and both puffiness of hands and feet -
symptoms of “gloves” and “socks” are observed; in late terms of disease on the
mentioned sites of hyperemia desqamation is marked. Within the first week of the
disease hyperemia of a fauces, sometimes - with enantema, a dot rash on type of
scarlatinous or micromacular is appeared. Eruptions are kept from several hours about 8
days and disappear completely. In connection with character of a rash, paleness of
nasolabial triangle, changes in a fauces such form of the disease name Far East
scarlatinoliked fever.
During a period of heat at the majority of patients are marked expressed
arthralgias, on occasion - up to full impossibility of movement. Quite often conducting
complaint of the patient are pains in an abdomen (in an ileocecal area), in the same place
is observed shortening of percutory sound and tension of muscles of a forward
abdominal wall. This symptomocomplex is caused by development of mesadenitis,
terminal ileitis or appendicitis as at intestinal yersiniosis. In the acute period the
phenomena of hepatitis, toxic lesion of kidneys, hemopoietic organs are also possible; at
polyorganic pathology it is possible to suspect the generalized form of pseudo-
tuberculosis (sepsis).
Complications: allergic reactions - urticaria, Quincke’s edema, reactive arthritises,
nodular erythema; less often - meningitis, meningoencephalitis, nephritis, acute renal
insufficiency, myocarditis, pneumonia.
Laboratory diagnostics
1. Bacteriological research. Yersinias is possible to separate from blood,
excrements or urine (depending on clinic of the disease). Seeding make on a nutrient
medium, from which during 15 - 20 day periodically (1 time in 5 days) make seedings
on dense nutrient mediums. The negative result does not exclude the disease (yersinias
grow badly).
2. Serological research. Antibodies to yersinias appear not earlier than 3 weeks of
the disease. Reaction of agglutination or RNHA in dynamics with an interval in 1-2
weeks are used. The diagnostic titer is 1:160 and is higher.
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Treatment. Antibacterial treatment is applied in all cases of diagnosed
yersiniosis, including - and at long current (the activator at half of patients can be kept in
intestines about several months and even about one year). A preparation of a choice is
Laevomycetinum (on 2,0 g per day within 14 days), it is possible to apply Tetracyclins,
streptomycin, Ftorchinolons, at generalised forms (sepsis) - cefalosporins and
carbapenems (imipenem / tienam) parenterally.
Hospitalization. On clinical and epidemiological indications.
The order of an extract of patients from a hospital. After clinical recovery and
negative result of the bacteriological research which has been carried out in 2 days after
the termination of reception of antibiotics.
Specific prophylaxis is not developed.
The characteristic of intestinal infections.
Dysentery FTI, Cholera

salmonellosis
The incubatory period 1-7 days 12-24 hours hours – 5 days
(2-3 дн)
Temperature subfebrile Up to 38° N or subfebrile
Characteristic of stool Rectal spittle, Liquid, plentiful, Plentiful,
without feces, fetid, dark green, without feces,
slime, blood “marsh” “rice broth”,
without a smell
Pains In the left ileocecal In an No

area (tenesmus, epigastrium near
false desires) a navel
(gastroenteritis)
Vomiting - Vomiting from Plentiful
the beginning of vomiting after
the disease diarrhea
Hepatosplenomegalia - + -
Dehydration - + +
RRS Erosive
proctosigmoiditis,
sphincteritis
Coprogram Slime, leukocytes Leukocytes -
(neutrophils),
erythrocytes,
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epithelial cells
Special laboratory Searation of Separation of Separation of
diagnostics Shigella, Salmonellas, vibrio cholera,
bacteriological bacterial seeding bacterial
research, RNHA seeding,
serodiagnostics
(RN, IFA)
accelerated
bacterial
diagnostics
Treatment Intestinal antibiotics Rehydration, Rehydration
8-oxichinolon, desintoxication after vomiting,
desintoxicayion desintoxication
REALIZATION OF THE LESSON
The purpose is to learn to diagnose yersiniosises and other AII (dysentery,

cholera, FTI, salmonellosis) according to clinic, the epidemiological anamnesis and also
to make the plan of inspection and treatment of the patient.
Control questions to the beginning of the lesson

1. Etiology of yersiniosises.
2. Name a source of infection.
3. Enumerate ways of transmission at yersiniosises.
4. Name clinical forms of yersiniosises.
5. Name complications, characteristic for intestinal yersiniosis.
6. What methods of laboratory diagnostics are used at yersiniosises?
7. With what diseases is it necessary to differentiate yersiniosises?
8. What are principles of treatment of yersiniosises?
9. Order of an extract of patients with yersiniosis from a hospital.
The test
1. The basic pathogenetic mechanisms of gastrointestinal form of yersiniosises are:
1. Secretory diarrhea
2. Inflammatory process in an intestine
3. Toxic-allergic reactions
4. Endotoxemia
5. Development of mesenterial lymphadenitis
2. Toxic-allergic reactions to antigens of the activator are shown by:

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1. Exanthema
2. Hyperemia of skin of a face, a neck
3. Arthralgias
4. Enlargement of a liver
5. Enlargement of a spleen
3. The generality of antigens of yersinias and antigens of the person results in:
1. Accumulation of autoantibobies
2. Formation of autoimmune complexes
3. Formation of secondary – focal organic disturbances
4. Transition of infectious process in the chronic form
5. Long endocellular parasitisation of the activator
4. Variants of gastrointestinal form are:
1. Gastroenteritis
2. Terminal ileitis
3. Acute appendicitis
4. Colitis
5. Polyarthritis
5. Variants of generalized form are:
1. Mixed
2. Septic
3. Hepatitis
4. Meningitis
5. Pyelonephritis
6. At thegeneralized form of yersiniosises observes:
1. Long fever
2. Expressed intoxication
3. Myalgias ang arthralgias
4. Hepatolienal syndrome
5. Exanthema
7. Yersinious gastroenteritis can be accompanied by:
1. Catarrhal changes of a mucous membrane of an oropharynx
2. Arthralgias
3. Exanthema
4. The disuric phenomena.
5. Jaundice
8. Clinical manifestations of terminal ileitis:
1. Manifestations of dehydration
2. Intensive pains in the right ileocecal area.
3. Arthralgias and myalgias
4. Fever
5. Exanthema
9. The rash at yersiniosis can be:
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1. Vesicular
2. Micropointed
3. Maculo-papular
4. Urticar.
5. Pustulous
10. The secondary - focal form can be shown by:
1. Development of arthritises.
2. Lesion of eyes, urethras and joints (Rejter’s syndrome).
3. Thyroiditis
4. Nodular erythema
5. Myocarditis
11. Methods of laboratory diagnostics of yersiniosises:
1. Bacterioscopy
2. Bacteriological research of excrements.
3. RNHA, RA.
4. IFA, complement fixation test
5. Dermal-allergic test.
12. For eriological therapy of yersiniosises are used:
1. Ftorchinolons
2. Hemisynthetic tetracyclins
3. Combined sulfanilamides
4. Aminoglucosides
5. Cefalosporins of the 3rd generation.
For studying a theme of the lesson students study a clinical problem. At the
decision of problems students write in writing-books the clinical diagnosis in view of the
form and severity of the disease, the plan of laboratory-instrumental inspection.
PROBLEM
In a reception of hospital of the first help patient K., 34 years, with complaints to
constants and colicky pains in the right ileocecal area, vomiting, pains in joints and
muscles has entered. He was ill on the eve, with fever, the temperature has raised up to
38,5°, pains in joints have appeared. At temperature 39,5° there was disposable vomiting.
In the anamnesis: the patient is in holiday, some days he lived and worked on a
summer residence, ate many crude vegetables and fruit, including a strawberry, a
raspberry.
Objectively: temperature is 39°. In a fauces there is hyperemia of the soft palate.
A tongue is “crimson”. A face and a neck are hyperemic. On a skin of a trunk,
extremities, more in axillary and inguinal plicae there is plentiful fine maculo-papular
rash. Joints externally are not changed. Pulse is 80 in one minute, the arterial pressure is
110/70. Tones of heart are muffled. An abdomen is soft, painful at palpation in the right
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ileocecal area. Blumberg’s symptom is poorly positive.
In the analysis of blood: erythrocytes 4,9•1012/l, Hb - 145 g/l, leukocytes -
20,0•109/l, eosinophiles - 5 %, rodonuclear-5 %, segmented - 72 %, lymphocytes - 15 %,
monocytes - 3 %, RSE - 43 mm / h.
In an accident ward of hospital the on duty surgeon has diagnosed “acute
appendicitis? Food allergy”. The patient is left under supervision.
1. Diagnosis.
2. Estimate tactics of the surgeon.
3. Plan of inspection.
4. Treatment.

Yerseniosis

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1

THEME OF THE LESSON:

Activators: Y. еnterocolitica and Y. pseudotuberculosis. They are close on

The characteristic of intestinal infections.

Dysentery FTI, Cholera

Pains In the left ileocecal In an No

REALIZATION OF THE LESSON

The purpose is to learn to diagnose yersiniosises and other AII (dysentery,

Control questions to the beginning of the lesson

2. Toxic-allergic reactions to antigens of the activator are shown by:

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