Extraintestinal yersiniosis (pseudotuberculosis) in children

Pseudotuberculosis (Far Eastern scarlet fever-like fever, pasteurellosis, acute mesenteric lymphadenitis, etc.) is an acute infectious disease from the group of zoonoses with general intoxication, fever, scarlet fever-like rash, as well as damage to other organs and systems.

ICD-10 code

A28.2 Extraintestinal yersiniosis.

Epidemiology of pseudo tuberculosis

Extraintestinal yersiniosis (pseudo tuberculosis) is registered in almost all administrative territories of our country. The disease is classified as a zoonotic infection. The source of infection is wild and domestic animals. The pathogen has been found in 60 species of mammals and 29 species of birds. The main reservoir of infection is mouse-like rodents. They infect food products with secretions, in which, when stored in refrigerators and vegetable stores, the pathogen reproduces and accumulates en masse. It is assumed that its reservoirs may be not only rodents and other animals, but also soil, where the microorganism is able to reproduce and survive for a long time. It is also isolated from water, air, fodder, root crops, vegetables, milk, dairy products, containers, kitchen utensils, etc.

Causes of pseudo tuberculosis

The causative agent of pseudotuberculosis is a gram-negative rod, in culture it is located in the form of long chains, does not form spores, has a capsule. A distinctive feature of the pathogen is the ability to grow at low temperatures (1-4 ° C), the optimal growth temperature is 22-28 ° C. According to the surface antigen, 8 serovars are distinguished, each of which can cause disease in humans, but serovars 1 and 3 are more common. It has high invasive qualities, due to which it is able to penetrate the natural barriers of humans and animals, contains endotoxin. It is assumed that endotoxin is represented by a soluble fraction of O-antigen. The possibility of exotoxin formation has been proven.

Pathogenesis of pseudotuberculosis

The pathogen enters the body through the mouth with contaminated food or water (infection phase) and, having overcome the gastric barrier, enters the small intestine, where it penetrates into the enterocytes or intercellular spaces of the intestinal wall ( enteric phase). From the intestine, the microorganisms penetrate into the regional mesenteric lymph nodes and cause lymphadenitis (regional infection phase). Massive influx of the pathogen and its toxins from the primary localization sites into the blood leads to the generalization phase of the infection (bacteremia and toxemia). It corresponds to the appearance of clinical symptoms of the disease. Further progression of the process is associated with the fixation of the pathogen by the cells of the reticuloendothelial system mainly in the liver and spleen. In essence, this is the parenchymatous phase.

What causes pseudo tuberculosis?

Classification of pseudo tuberculosis

In pediatric clinics, pseudotuberculosis is classified by type, severity and course.

Typical pseudo-tuberculosis includes forms with a complete or partial combination of clinical symptoms characteristic of this disease: scarlet fever-like, abdominal, generalized, arthralgic, as well as mixed and septic variants.

Forms with isolated syndrome (scarlatiniform, icteric, arthralgic, etc.) are rarely observed. Usually, the same patient may have a wide variety of manifestations of the disease, and sometimes they occur simultaneously, but more often sequentially.

Atypical forms include latent, subclinical and catarrhal forms.

Symptoms of pseudo tuberculosis

The incubation period lasts from 3 to 18 days. The disease begins acutely, with a rise in body temperature to 38-40 ° C, and only in isolated cases - gradually or subacutely. From the first days of the disease, children complain of general weakness, headache, insomnia, poor appetite, sometimes chills, muscle and joint pain. Some children at the beginning of the disease have mild catarrhal symptoms in the form of nasal congestion and cough. Pain when swallowing, a feeling of irritation and sore throat are also possible. Patients with pronounced initial symptoms of intoxication experience dizziness, nausea, vomiting, abdominal pain, mainly in the right iliac region or in the epigastrium. In some cases, there is loose stool 2-3 times a day of the enteritis type.

Symptoms of pseudo tuberculosis

Diagnosis of pseudo tuberculosis

Pseudo-tuberculosis can be suspected in a patient with a combination of scarlet fever-like rash with symptoms of damage to other organs and systems (liver, joints, gastrointestinal tract), especially with prolonged fever and an undulating course. Winter-spring seasonality and group morbidity of people who consumed food or water from the same source are important.

Bacteriological and serological research methods are of decisive importance in diagnostics, especially if the disease is not accompanied by characteristic rashes.

Diagnosis of pseudo tuberculosis

Treatment of pseudo tuberculosis

As an etiotropic treatment for pseudo-tuberculosis, levomycetin is prescribed in an age-appropriate dose for 7-10 days. If there is no effect or if there is an exacerbation after discontinuing levomycetin, a course of treatment with a cephalosporin antibiotic of the third and fourth generation should be administered. In severe forms, two antibiotics can be prescribed, taking into account their compatibility. In mild forms, antibiotics may not be used. There is data on the effectiveness of using children's anaferon.

Treatment of pseudo tuberculosis

Prevention of pseudo tuberculosis

Proper storage of vegetables, fruits and other food products is of great importance, eliminating the possibility of their infection by rodents. Strict sanitary control of food preparation technology is necessary, especially dishes that are not subjected to heat treatment (salads, vinaigrettes, fruits, etc.), as well as water supply in rural areas.

Anti-epidemic measures at the site of infection are generally the same as for intestinal infections. After hospitalization of the patient, final disinfection is carried out. Specific prevention has not been developed.

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