Diagnosis of yersiniosis

Diagnosis of yersiniosis is difficult in any form and is based on characteristic symptoms and laboratory diagnostics.

In the generalized form, the hemogram reveals leukocytosis, band shift, eosinophilia (up to 7%), lymphopenia and increased ESR; in the biochemical blood test, increased enzyme activity, less often - hyperbilirubinemia. Specific laboratory diagnostics of yersiniosis includes bacteriological, immunological and serological methods. The main method is bacteriological. Material from the patient, obtained no later than the 7th day of illness, material from the external environment and from animals are first sown on accumulation media - phosphate-buffered solution and medium with bromothymol blue, then on dense nutrient media (preferably on two at the same time): on Endo medium and buffer-casein-yeast medium - with subsequent identification of the culture. At least four substrates are examined simultaneously (for example, feces, urine, blood, washing from the back of the pharynx).

Immunological diagnostics of yersiniosis allows detection of Y. enterocolitica antigens in clinical material up to the 10th day from the onset of the disease (ELISA, RCA, RIF, RNIF, RAL, PCR, immunoblotting).

Serological diagnostics of yersiniosis is used to determine specific antibodies to Y. enterocolitica antigens (ELISA, RA, RSK, RPGA). The study is conducted from the second week of the disease in paired sera with an interval of 10-14 days simultaneously by 2-3 methods.

For diagnosis and selection of patient management tactics, the following instrumental methods are recommended: chest X-ray, affected joints and sacroiliac joints, ECG, echocardiography, abdominal ultrasound, rectoscopy, colonoscopy, CT, diagnostic laparoscopy and sonography.

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Differential diagnosis of yersiniosis

Differential diagnostics of yersiniosis, salmonellosis and shigellosis.

Clinical signs	Differentiable diseases
	Yersiniosis	PTI (salmonellosis)	Acute shigellosis
Onset of the disease	Spicy	Stormy	Spicy
Intoxication	Expressed from the first day. Long-term	Pronounced and short-term	Pronounced and short-term
Fever	Febrile. lasts 1-2 weeks	Febrile short-term (2-3 days)	Febrile or subfebrile, short-term
Catarrhal phenomena	Often	No	No
Exanthema	Polymorphic, appears at different times	No	No
Symptoms of "hood", "gloves", "socks"	Characteristic, but may be absent	It doesn't happen	It doesn't happen
Arthralgia. arthritis	Characteristic	None	None
Language	Coated, from the second week "raspberry"	Coated, dry	Coated, damp
Abdominal pain	Cramp-like, most often in the right iliac and umbilical region	Of varying intensity, in the upper and middle abdomen	Cramping, in the lower abdomen, in the sigmoid region
Character of stool	Liquid, sometimes mixed with mucus and blood	Profuse, foul-smelling, greenish in colour	Scanty, with mucus and blood, "rectal spit"
Dysuric symptoms	Characteristic	In severe cases	It doesn't happen
Heart failure	Rarely - myocarditis	SSN at the peak of intoxication and dehydration	Severe CVD
Hepatosplenomegaly	Characteristic	It doesn't happen	It doesn't happen
Jaundice	Rarely, at the height of fever and intoxication	Very rarely	Absent
Lymphadenopathy	Characteristic	It doesn't happen	It doesn't happen
Hemogram indicators	Leukocytosis, lymphopenia, increased ESR	Leukocytosis, lymphopenia	Neutrophilic left shift
Epidemiological anamnesis data	Eating unprocessed fresh vegetables; milk and milk products that have been stored in the refrigerator for a long time	Food factor Group diseases	Contact with a sick person, consumption of untreated water and suspicious food products
Nausea, vomiting	They happen	Characteristic	Rarely

Differential diagnostics of yersiniosis, viral hepatitis and rheumatism

Clinical signs	Differentiable diseases
	Yersiniosis	Viral hepatitis	Rheumatism
Onset of the disease	Spicy	Gradual	Mostly gradual, can be stormy
Fever	Febrile (1-2 weeks)	Febrile temperature (with VGA and VHD), short-term	Febrile - short-term, subfebrile - long-term
Catarrhal phenomena	Often	In the prodromal period of hepatitis A	2-4 weeks prior to an episode of streptococcal sore throat or exacerbation of chronic tonsillitis
Skin manifestations	Polymorphic exanthema, at different times	An urticaria-like exanthema is possible	Erythema nodosum, annulare. Rheumatoid nodules
Hyperemia and swelling of the palms and feet, "raspberry" tongue	Characteristic	None	None
Nausea, vomiting	They happen	Possible	Not typical
Abdominal pain	Most often in the right iliac region	Not typical. Possible with VHD, VHEV	Not typical
Character of stool	Liquid, sometimes mixed with mucus and blood	Tendency to constipation	Most often it does not change
Dysuric symptoms	Characteristic	It doesn't happen	Nephritis is possible
Heart failure	Rarely - myocarditis	Cardiovascular failure in severe (fulminant) course	Carditis and rheumatic carditis
Hepatosplenomegaly	Characteristic	Possible	It doesn't happen
Jaundice	Rarely, at the height of fever and intoxication	Often bright, long lasting	Absent
Lymphadenopathy	Characteristic	Absent	Most often submandibular
Neurological symptoms	Vegetative-vascular disorders. Meningeal syndrome	Acute or subacute hepatic encephalopathy	Chorea minor, meningoencephalitis, serous rheumatic meningitis, cerebral vasculitis
Laboratory research	Leukocytosis, lymphopenia, increased ESR	Leukopenia, lymphocytosis, decreased ESR	Leukocytosis with a shift to the right, lymphopenia
	Moderate and unstable increase in enzyme activity, hyperbilirubinemia	Long-term hyperbilirubinemia and increased enzyme activity. Changes in thymol and sublimate tests	Dysproteinemia, sharply increased titer of antistreptolysin-O, CRP
	Isolation of Yersinia culture, their antigens and antibodies to them	Detection of markers of viral hepatitis	Detection of streptococcal antigen antistreptolysin-O, ASC, ASG
Epidemiological anamnesis data	Eating unprocessed fresh vegetables, especially cabbage, carrots, milk and milk products that have been stored in the refrigerator for a long time	Consumption of food and water contaminated with HAV and HEV viruses, contact with patients with HAV. parenteral history (HBV, HCV, HDV)	No special features
Arthralgia, arthritis	Characteristic	Volatile arthralgias (VHB, VHD)	Symmetrical lesions of large joints

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