Extraintestinal yersiniosis (pseudotuberculosis) in children

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

ICD-10 code

A28.2 Extraintestinal yersiniosis.

Epidemiology of pseudotuberculosis

Extraintestinal yersiniosis (pseudotuberculosis) is registered in virtually all administrative territories of our country. The disease is classified as a group of zoonotic infections. Wild and domestic animals serve as a source of infection. The causative agent was found in 60 species of mammals and in 29 species of birds. The main reservoir of infection is the mouse rodent. They infect with food products, in which, during storage in refrigerators and vegetable stores, reproduction and mass accumulation of the pathogen occur. It is assumed that its reservoirs can be not only rodents and other animals, but also soil where the microorganism is able to reproduce and persist for a long time. It is isolated from water, air, forage, root crops, vegetables, milk. Dairy products, containers, kitchen utensils, etc.

Causes of pseudotuberculosis

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

Pathogenesis of pseudotuberculosis

The causative agent with infected food or water penetrates the mouth (infection phase) and, breaking the gastric barrier, enters the small intestine, where it enters the enterocytes or intracellular spaces of the intestinal wall ( enteral phase). From the intestine microorganisms penetrate into the regional mesenteric lymph nodes and cause lymphadenitis (phase of regional infection). Massive entry of the pathogen and its toxins from the primary localization into the blood leads to the emergence of a phase of generalization 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 parenchymal phase.

What causes pseudotuberculosis?

Classification of pseudotuberculosis

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

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

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

Atypical include erased, subclinical and catarrhal forms.

Symptoms of pseudotuberculosis

The incubation period lasts from 3 to 18 days. The disease begins sharply, with the rise in body temperature to 38-40 ° C, and only in isolated cases - gradually or subacute. From the first days of illness, 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 congestion of the nose and cough. There is also pain when swallowing, a feeling of perspiration and sore throat. In patients with pronounced initial symptoms of intoxication, dizziness, nausea, vomiting, abdominal pain, mainly in the right iliac region or in epigastrium, are noted. In some cases, there is a loose stool 2-3 times a day as an enteritis.

Symptoms of pseudotuberculosis

Diagnosis of pseudotuberculosis

It is possible to suspect pseudotuberculosis in patients with a combination of scarlet fever-like rash with symptoms of damage to other organs and systems (liver, joints, digestive tract), especially with prolonged fever and undulating course. Winter-spring seasonality and group morbidity of people who eat food or water from a single source is important.

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

Diagnosis of pseudotuberculosis

Treatment of pseudotuberculosis

As etiotropic treatment of pseudotuberculosis, levomycetin is prescribed in the age-related dose for 7-10 days. If there is no effect or if there is an exacerbation after the withdrawal of levomycetin, a course of treatment with cephalosporin antibiotic of III and IV generation should be conducted. In severe forms, you can prescribe two antibiotics, taking into account their compatibility. In mild forms, antibiotics can be avoided. There are data on the effectiveness of anaferon use in children.

Treatment of pseudotuberculosis

Prevention of pseudotuberculosis

Of great importance is the proper storage of vegetables, fruits and other food products, excluding the possibility of their infection with rodents. Strict sanitary control of cooking technology is needed, especially dishes that are not heat treated (salads, vinaigrettes, fruits, etc.), as well as water supply in rural areas.

Anti-epidemic measures in the outbreak are generally the same as in intestinal infections. After hospitalization, the patient is disinfected. Specific prophylaxis is not developed.

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