Diagnosis of pseudotuberculosis: tests, differential diagnosis

Clinical diagnostics of pseudotuberculosis is complicated in sporadic cases and becomes comparatively simple in outbreak cases. It is based on characteristic clinical symptoms and laboratory diagnostics.

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Indications for consultation with other specialists

The same as for yersiniosis.

Specific and non-specific laboratory diagnostics of pseudo-tuberculosis

The hemogram reveals neutrophilic leukocytosis, monocytosis, eosinophilia, relative lymphopenia and increased ESR. The biochemical blood test reveals increased enzyme activity, less commonly hyperbilirubinemia. Specific laboratory diagnostics of pseudotuberculosis is the same as for yersiniosis. Promising methods of specific diagnostics include an enzyme immunoassay system based on the Y. pseudotuberculosis porin protein and an erythrocyte antigen diagnosticum for RIGA based on Y. pseudotuberculosis cell wall proteins.

Instrumental diagnostics of pseudotuberculosis

Additional instrumental diagnostics of pseudotuberculosis is no different from those described for yersiniosis.

Example of diagnosis formulation

• A28.2. Pseudotuberculosis, abdominal form, terminal ileitis, moderate severity.
• A28.2. Pseudotuberculosis, secondary focal form, erythema nodosum, moderate severity, protracted course.

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Differential diagnostics of pseudotuberculosis

Differential diagnostic signs of abdominal pseudotuberculosis and acute appendicitis

Signs	Abdominal form of pseudotuberculosis	Acute appendicitis
Epidemiological data	Most often in spring, late winter and early summer. Group cases are typical	Sporadic cases, no seasonality
Onset of the disease	Acute, with chills, fever, severe intoxication and abdominal pain	Stages: first abdominal pain, then increasing intoxication and fever
Skin and mucous membrane coloration	Hyperemia of the palms, feet, face, neck, mucous membrane of the pharynx and conjunctiva	Most often normal or pale
Exanthema	Characteristic	Not observed
Language	"Crimson"	Coated, dry
Abdominal pain	Most often, from the 2nd to the 4th day of illness, paroxysmal	From the first hours of the disease, constant
Nausea and vomiting	They are rarely independent of abdominal pain	Often, especially in children. Occurs after the onset of abdominal pain.
Symptoms of peritoneal irritation	Rare, not clearly expressed	Characteristic, expressed
Enlarged mesenteric lymph nodes	Often	Not observed
Symptoms of parenchymatous hepatitis	Often	Not typical
Body temperature	Febrile, reaches a maximum in the first day	Increases gradually, usually subfebrile
Increased ESR	Typical	Not typical in the absence of complications

Differential diagnostics of pseudotuberculosis, trichinosis and drug dermatitis

Clinical signs	Differentiable diseases
	Pseudo-tuberculosis	Trichinosis	Drug dermatitis
Start	Acute, may be gradual	Often spicy	Spicy
Fever	Most often febrile, 1-2 weeks	Remittent, constant or irregular type. Increases over 1-2 weeks. Decreases gradually, Rarely subfebrile for up to several months	Subfebrile. May have normal temperature.
Intoxication	Expressed from the first day, long-term	Pronounced, long-lasting	Not expressed
Exanthema	Polymorphic, sometimes with hemorrhages. From the 2nd to 4th day of illness, mainly on the trunk, limbs, palms, feet, against the background of hyperemia, sometimes itchy. There may be nodular erythema, After the disappearance of the rash - peeling	Most often macular, confluent, persists for 5-8 days, then pigmentation and peeling. No characteristic localization and stages of rashes Sometimes itchy. Several waves of rashes are characteristic	Most often macular, morbilliform, after taking medications. Itchy, confluent. Disappears after discontinuing the drug.
Scleritis and conjunctivitis	Characteristic	Conjunctivitis with hemorrhages in the stage of periorbital edema	Often
Hyperemia and puffiness of the face	Characteristic	More often, puffiness of the face (especially with normal skin color)	Puffiness, burning sensation of the face without hyperemia
Abdominal pain	Cramping or constant, aching in the ileocecal angle and near the navel	In severe cases	Sometimes, spilled
Diarrhea	Characteristic	In severe cases	Rarely encountered
Jaundice	When hepatitis develops, it is dim and short-lived.	Possible	It doesn't happen
"Raspberry" language	Characteristic	Characteristic	Rarely - red, without hypertrophied papillae, "geographical"
Arthralgia	Characteristic	It doesn't happen	Rarely
Hepatolienal syndrome, polyadenopathy	Characteristic	Characteristic	Extremely rare
Kidney damage	Sometimes pyelonephritis with scanty symptoms	Not typical	Rarely - allergic nephritis
Changes in the hemogram	Moderate neutrophilic leukocytosis, relative lymphocytosis, eosinophilia. increased ESR	Leukocytosis, eosinophilia (up to 60%) for 2-3 months	Non-specific. Rarely moderate eosinophilia
Myalgia	Characteristic	Sharply expressed, appears in the extremities, then in the muscles of the tongue, pharynx and chewing muscles	Extremely rare

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