Symptoms of intestinal yersiniosis

In the gastrointestinal form, clinical manifestations are similar to intestinal infections of other etiologies. The disease often begins acutely, with a rise in body temperature to 38-39 °C, symptoms of intoxication are expressed: lethargy, weakness, loss of appetite, headache, dizziness, nausea, repeated vomiting, abdominal pain are common. A constant symptom of the disease is diarrhea. Stool frequency increases from 2-3 to 15 times a day. Stool is loose, often with an admixture of mucus and greenery, sometimes blood. The coprogram shows mucus, polymorphonuclear leukocytes, single erythrocytes, and a violation of the enzymatic function of the intestine. In the peripheral blood, moderate leukocytosis with a shift in the leukocyte formula to the left, an increase in ESR.

In severe cases, young children may develop a picture of intestinal toxicosis and exsicosis, symptoms of irritation of the meninges. At the height of clinical manifestations, the abdomen is moderately distended. When palpated, pain and rumbling along the intestines are noted, mainly in the area of the cecum and ileum. Sometimes the liver and spleen are enlarged. Some patients develop a polymorphic rash on the skin (spotted, maculopapular, hemorrhagic) with a favorite localization around the joints, on the hands, feet (symptoms of gloves, socks). In some cases, inflammatory changes in the joints (swelling, redness, pain and limitation of movement), myocarditis phenomena occur.

The pseudoappendicular form, or right iliac region syndrome, occurs mainly in children over 5 years of age. The constant and leading symptom of the disease is abdominal pain, which is often cramping, localized around the navel or in the right iliac region. Palpation reveals rumbling along the small intestine, diffuse or localized pain in the right iliac region, and sometimes symptoms of peritoneal irritation. There may be short-term diarrhea or constipation, fleeting joint pain, and mild catarrh of the upper respiratory tract. Blood shows leukocytosis (8-25x10 ⁹ /l) with a shift in the leukocyte formula to the left, increased ESR (10-40 mm/h). During surgery for acute abdomen, catarrhal or gangrenous appendicitis is sometimes detected, and more often mesadenitis (enlargement of the mesenteric lymph nodes), edema and inflammation of the terminal ileum. Y. enterocolitica is detected in cultures from the removed appendix.

Septic (generalized) form of intestinal yersiniosis is rare. Acute and subacute septicemia are distinguished.

Yersiniosis hepatitis begins acutely, with pronounced signs of intoxication, high body temperature that does not decrease during the icteric period, and increased ESR. Sometimes short-term diarrhea and abdominal pain occur. Some patients develop exanthema of various types early in the disease. On the 3rd to 5th day of the disease, dark urine, discolored feces, and jaundice are noted. The liver is enlarged, compacted, and painful. The edge of the spleen is palpated. The clinical picture is very similar to viral hepatitis. Without additional examination methods, diagnosis is difficult. It is necessary to take into account that with yersiniosis hepatitis, the activity of liver enzymes is low or even normal.

Erythema nodosum occurs mainly in children over 10 years of age. A rash appears on the shins in the form of painful pink nodes with a cyanotic tint, which disappear after 2-3 weeks, which is different from erythema of rheumatic etiology, which lasts longer. In half of patients with erythema nodosum, it is possible to establish previous gastroenteritis, abdominal pain, and sometimes changes in the upper respiratory tract are detected.

The articular form of intestinal yersiniosis occurs as non-purulent polyarthritis and arthralgia. It is observed rarely, mainly in children over 10 years old. 5-20 days before the onset of arthritis, children experience intestinal disorders accompanied by fever. The knee and elbow joints are most often involved in the process, and less often - small joints of the hands and feet. The joints are painful, swollen, the skin above them is hyperemic. X-ray examination of the affected joints in the acute phase of the disease does not reveal pathological changes.

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