Symptoms of periods of pseudotuberculosis: clinical classification

Pseudotuberculosis has an incubation period that lasts from 3 to 19 days (on average 5-10 days), sometimes reduced to 1-3 days, after which typical symptoms of pseudotuberculosis appear.

Pseudotuberculosis does not have a single clinical classification. It is recommended to use the classification (with minor changes) of N.D. Yushchuk et al.

Clinical classification of pseudotuberculosis

Clinical form	Option	Severity	Flow
Mixed	Scarlatiniform Septic	Moderate severity	Prolonged (up to 6 months)
Secondary focal	Arthritis(s) Erythema nodosum Reiter's syndrome, etc.	Heavy	Chronic (over 6 months)
Abdominal	Mesenteric lymphadenitis Terminal ileitis Acute appendicitis	Easy	Acute (up to 3 months)

The following periods of pseudo-tuberculosis are distinguished: incubation, initial, peak, convalescence or remission.

The initial period of pseudo-tuberculosis lasts from 6-8 hours to 2-5 days. The symptoms of pseudo-tuberculosis in the initial period are similar in all forms of the disease: severe intoxication and polymorphism of symptoms. The peculiarity of each form is revealed only during the peak period. In most patients, the disease begins acutely, sometimes violently. General health deteriorates sharply. Body temperature quickly rises to 38-40 ° C, may be with chills. Severe headache, dizziness, severe weakness, insomnia, arthralgia, myalgia, back pain, sweating, apathy, anorexia are disturbing. Sometimes fainting. Patients are irritable, adynamic. Signs of acute catarrh of the upper respiratory tract, burning on the palms and soles often appear. During examination, symptoms of "hood", "gloves", "socks" and injection of scleral vessels are detected. The mucous membrane of the oropharynx is hyperemic, in some patients - "flaming" pharynx, enanthem on the soft palate, catarrhal tonsillitis. The tongue becomes "raspberry" from the 3rd-5th day of the disease. Some patients have abdominal pain, nausea, vomiting and loose stools.

The peak period is 3-10 days (maximum - a month) and is characterized by the severity of symptoms of a specific clinical form and intoxication.

Symptoms of pseudo-tuberculosis of mixed form are characterized by a rash that appears in most patients on the 2nd-7th days of the disease. Most often, the rash is scarlet fever-like, but it can be polymorphic, ephemeral, petechial, small- and large-spotted, urticarial, erythematous, vesicular and in the form of erythema nodosum, sometimes itching. Scarlet fever-like rash is abundant, located on the chest, back, abdomen, limbs and face, thickening in natural folds. Spotted-papular and urticarial rash is often grouped around large joints (knees, elbows, ankles). The rash can appear on the first day of the disease, and all other symptoms will join later. In these cases, slightly itchy, spotted-papular exanthema is usually localized on the soles, hands, feet. As a rule, it persists for 3-6 days, erythema nodosum - for several weeks. Rashes are possible. From the second week of the disease, large- or small-plate peeling of the skin begins. Arthralgia and myalgia often become unbearable. Most often, the knee, ankle, elbow, interphalangeal and wrist joints are affected, less often - the shoulder, hip, intervertebral and temporomandibular joints. The duration of arthralgia is from 4-5 days to 2-3 weeks. Pain syndrome and hyperesthesia of the skin are generally characteristic of pseudo-tuberculosis. Suddenly, for no apparent reason, the pains suddenly stop. Dyspeptic and catarrhal phenomena persist or intensify during the peak period.

From the 2nd to the 4th day of illness, the face is pale, especially in the area of the nasolabial triangle; there is often subicteric skin and sclera and polyadenopathy.

During the peak period, abdominal pain persists or appears for the first time. Palpation of most patients reveals pain in the right iliac region, below and to the right of the navel, in the right hypochondrium and above the pubis. Almost all patients have an enlarged liver, sometimes the spleen. Diarrhea is rare. Stool is normal or constipated. Changes in the central nervous system, cardiovascular and urinary systems in the mixed variant of pseudo-tuberculosis do not differ from changes in yersiniosis. During the peak period, the temperature reaches its maximum; it is constant, undulating or irregular. The duration of the febrile period is from 2-4 days to several weeks.

The onset of the convalescence period is indicated by an improvement in the patient's well-being, gradual normalization of temperature, restoration of appetite, disappearance of rash, abdominal and joint pain. Subfebrile temperature often persists. In the 2nd-3rd week of the convalescence period, vegetative disorders appear, which intensify with a protracted course and the formation of secondary focal forms.

In all clinical forms of the disease, exacerbations and relapses more often occur in patients who have not received antibacterial therapy.

The septic variant of the mixed form of pseudo-tuberculosis is rare. The symptoms of pseudo-tuberculosis of this form do not differ from sepsis in yersiniosis. The mortality rate reaches 30-40%.

The scarlet fever-like variant of pseudo tuberculosis is the most common. It is characterized by severe intoxication, fever, and abundant pinpoint rash that thickens in skin folds and around large joints. In most patients, the rash is not itchy and appears on the 1st to 4th (less often on the 5th to 6th) day of illness. The exanthema is most often pinpoint on a hyperemic or normal skin background, sometimes erythematous and spotty (measles- or rubella-like). It is localized on the chest, abdomen, lateral surfaces of the body, arms, and lower extremities, often with hemorrhages. The "tourniquet" symptom is positive. Most patients also have "glove", "socks", and "hood" symptoms. Characteristic features include a pale nasolabial triangle, "raspberry" tongue, bright hyperemia of the face, tonsils, arches, and persistent white dermographism. Joint pain, abdominal pain and dyspeptic symptoms are not typical.

The abdominal form of pseudo-tuberculosis is more common in children. The main symptoms of pseudo-tuberculosis of this form are severe, constant or paroxysmal pain in the right iliac region or around the navel, which may be preceded by an episode of acute enterocolitis with fever. In some patients, the disease immediately begins with sharp pain in the ileocecal region, as a result of which they are hospitalized in the surgical department with suspected acute appendicitis.

Mesenteric lymphadenitis of pseudo-tuberculous etiology is characterized by an acute onset (with high temperature, chills) and increasing abdominal pain. Patients complain of nausea, vomiting, loose stools without pathological impurities, weakness, headache, muscle and joint pain. Some of them have hyperemia of the skin of the face, neck and chest, a pinpoint rash on the skin of the chest, abdomen, limbs and inguinal folds. In severe cases, muscle tension in the right iliac region and peritoneal symptoms appear. During laparotomy, enlarged mesenteric lymph nodes up to 3 cm in diameter, injection and hyperemia of the ileum with fibrinous plaque on the serous membrane are visible. False-appendicular syndrome is characteristic, allowing to differentiate mesenteric lymphadenitis from acute appendicitis.

Acute appendicitis may manifest itself with symptoms that are the first clinical manifestations of pseudo-tuberculosis or appear several days (weeks) after the onset of the disease. The pain, which is localized mainly in the right iliac region, is cramping, less often constant. Patients are bothered by nausea and vomiting. Fever of the wrong type. The tongue is "raspberry".

Terminal ileitis is the first manifestation of pseudo-tuberculosis, but it often develops during relapses or remission. Characteristic symptoms include abdominal pain, muscle tension in the right iliac region, symptoms of peritoneal irritation, nausea, repeated vomiting, loose stools 2-3 times a day. Sometimes moderate liver enlargement. Chronic ileitis may develop, clinically manifested during relapses and exacerbations. Relapses in the abdominal form are more common than in other forms of pseudo-tuberculosis. Clinical and laboratory signs of pseudo-tuberculous hepatitis are similar to those in yersiniosis. Some patients develop pancreatitis, manifested by a violation of the exocrine function of the pancreas.

Myocarditis is practically no different in its course and outcome from myocarditis in yersiniosis. However, cases of severe infectious-toxic myocarditis and damage to the cardiac conduction system have been described. Endo-, peri- and panvasculitis, as well as circulatory disorders are possible.

Most patients develop pyelonephritis, less commonly glomerulonephritis, tubulointerstitial nephritis and acute renal failure. Changes in the urinary system are transient.

Pneumonia develops more frequently than with yersiniosis. It is registered in almost all patients with a fatal outcome.

The course and outcome of meningitis in pseudo-tuberculosis do not differ from meningitis in yersiniosis. In the secondary focal form, meningoencephalitis may develop.

Symptoms of pseudo-tuberculosis are characterized by damage to the somatic (polyneuritis and meningoradiculoneuritis) and autonomic nervous systems (irritability, sleep disturbance, paleness or hyperemia of the skin, sweating, dissociation of blood pressure, paresthesia, etc.).

The secondary focal form of pseudotuberculosis most often manifests itself as erythema nodosum, Reiter's syndrome and chronic enterocolitis.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Complications of pseudo tuberculosis

Complications of pseudo-tuberculosis: ISS, adhesive and paralytic obstruction, intussusception, necrosis and perforation of the intestine with the development of peritonitis, meningoencephalitis, acute renal failure, Kawasaki syndrome - develop rarely and can cause death.

[ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ]