Symptoms of pseudotuberculosis in children: description of periods

The incubation period of pseudotuberculosis 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.

Characterized by the puffiness and hyperemia of the face, neck, which contrasts with the pale nasolabial triangle. Typical congestion hyperemia and injection of scleral vessels, rarely there is a herpetic rash on the lips and wings of the nose. Most patients find hyperemia of the mucous membranes of the tonsils, sometimes very bright and often delimited from a solid palate. The mucous membrane is edematic, sometimes the enanthem is observed. Language in the initial period is densely covered with a greyish-white coating, from the 3rd day of the disease it begins to clear and becomes crimson, papillary. From the first days of the disease in individual patients, pain in the joints, enlargement of the liver, spleen.

The period of the height of pseudotuberculosis

Symptoms of pseudotuberculosis progress and on the 3-4th day reach a maximum. Individual patients in this period reveal a hood symptom - hyperemia of the face and neck with a cyanotic shade, a symptom of gloves is a delicate pink-cyanotic color of the brushes, a symptom of the socks is a delimited pink-cyanotic color of the feet.

On the skin of the body, 70-80% of patients have a rash. It can appear from the first days of illness, but more often occurs during the height of the disease. The rash pours at the same time, it can be either pinpoint, reminiscent of scarlet fever, or spotty. Color of the rash from pale pink to bright red. The skin background can be either hyperemic or unchanged. The larger rashes are located around the large joints, where they form a solid erythema. A combination of scarlet fever and spotted-papular rash is observed in about half of the patients. Rash large-puffed, in some patients hemorrhagic, sometimes accompanied by pruritus of the skin. With prolonged course of the disease or its recurrence on the legs, less often on the buttocks appear elements of erythema nodosum.

A rash with pseudotuberculosis is usually located in the lower abdomen, in the axillary regions and on the lateral surfaces of the trunk. Just like with scarlet fever, there is white persistent dermographism. Symptoms of Pastia (dark red color of skin folds), symptoms of pinch, tourniquet usually positive. The rash lasts no more than 3-7 days, but sometimes with mild severity - only a few hours.

At the height of the disease, more than half of the patients notice arthralgia, but there may be swelling and tenderness of the joints. Usually affected are the wrist, interphalangeal, knee and ankle joints. Intestinal disorders occur infrequently, with a slight increase in the frequency and dilution of the stool, while retaining a fecal character. Changes in the gastrointestinal tract in some patients are pronounced with the development of symptoms of terminal ileitis or acute appendicitis.

With pseudotuberculosis, the liver and spleen are often enlarged, sometimes there is skin ichthyosis and sclera. Serum increased the amount of direct bilirubin, increased activity of hepatocellular enzymes (ALT, ACT, etc.), sediment assays positive. Less common is the development of acute cholecystitis or angiocholecystitis.

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