Yersiniosis Hepatitis

Ierisiniozy are found everywhere and registered in all countries of the world. For example, in Belarus the incidence varies between 3.6-4.2 cases per 100 thousand of the population.

In Russia, according to statistics, there are very monotonous incidence rates of iersiniosis. Thus, pseudotuberculosis was registered in 2006 with a frequency of 3.14 cases, and in 2008 - 2.63 cases per 100 thousand of the population, with a very high incidence of children, which in 2006 was 11.49, and in 2008 - 12.55 cases per 100 thousand of the Russian children's population.

According to research, the incidence of intestinal yersiniosis at the end of the XX century. In Russia was slightly lower than pseudotuberculosis, and by country's regions the frequency of intestinal yersiniosis varied significantly - from 1.5 to 15.5%.

Stably low level of officially registered incidence of iersiniosis does not reflect the true state of it.

There is a sporadic incidence of iersiniosis, and in the form of epidemic outbreaks.

In all countries of the world, pseudotuberculosis is mainly affected by children; intestinal yersiniosis affects children and adults.

How does Yersinia Hepatitis develop?

Defeat of the liver, most likely, arises not so much due to the penetration of iersinia into the parenchyma of the liver, but in connection with the action of toxins on the diaper cells. It is impossible to exclude and immunological mechanisms aimed at elimination of toxin-containing hepatocytes. At present, a large number of studies have been conducted, indicating the involvement of T- and B-systems of immunity in yersiniosis infection. According to L.I. Vasyakina (2001), the acute phase of yersiniosis hepatitis, suppression of both parts of the immune response occurs, with Th1 and Th2 variants of immunological response weakly expressed.

Morphology

Morphological changes in the liver with both iersiniosis are similar. Dyscomplexation of hepatic beams, lymphocytic infiltration with a large number of plasma cells, the presence of eosinophils, dystrophic changes in hepatocytes, focal necrosis of liver cells against a background of moderate granulocyte reaction, and small abscesses are possible. On the outer side of the granule, fibroblasts accumulate and a connective tissue capsule is formed. Destruction and inflammatory infiltration of the bile ducts are observed.

Symptoms of Yersinia Hepatitis

For yersiniosis hepatitis is characterized by an acute onset of the disease with an increase in body temperature, mainly up to 38-39 ° C, symptoms of intoxication in the form of lethargy, weakness, impaired appetite, abdominal pain. The appearance of jaundice is observed on the 4-6th day of the disease, less often - at the 2 nd week from the onset of the disease, against the background of persistent fever. When palpating the abdomen, pains in the right hypochondrium and epigastric region are noted. In all patients, according to our observations and according to other authors, the liver grows in size, while it is palpated 1.5-4 cm below the rib margin, sensitive and even painful, of a compacted consistency. A concomitant increase in the spleen is observed in 20-50% of cases.

In some patients, iersiniosis hepatitis [according to studies, in 6 out of 15, and according to D.I. Shakhgildyapa et al. (1995) - most] simultaneously recorded a scarlatina-like rash on the skin followed by desquamation.

Practically in all patients several groups of lymph nodes are palpable, mainly the anterior and posterior cervical, submaxillary, axillary, inguinal; These lymph nodes are 5-10 mm in diameter, painless, mobile. Changes in the oropharynx are meager. In all patients, mild or moderate hyperemia of palatine tonsils and arches is recorded. Palatine tonsils moderately hypertrophied, clean. The tongue is covered with a whitish bloom, papillary language is rarely observed. Jaundice with yersiniosis hepatitis varies from mild to moderate, in some cases it is intense.

Changes in the biochemical analysis of blood are typical and are expressed in an increase in the level of total bilirubin with a predominance of the conjugated fraction of the pigment, an increase in the activity of aminotransferases, sometimes GTTP and APF, in cases with distinct signs of cholestasis.

According to the research, there is a very wide range of bilirubin indices - from 30 to 205 μmol / l, with the mandatory excess of the level of the conjugated fraction above the level of free bilirubin.

Hyperfermentemia fluctuates within a 3-10-fold increase in ALT and ACT, but in some patients, the increase in transaminase activity exceeds the norm by 40-50 times.

In the clinical analysis of blood, there are no significant changes, with the exception of individual cases. So, according to research, in 13 of 15 children with yersinioznym hepatitis the level of leukocytes was normal, without shifts in the formula of neutrophils. Only in 2 patients the leukocyte count was elevated to 10.0 × ^{10 9} with a moderate left-handed stab-shift; they had the same ESR increased to 20-24 mm / h.

Variants of flow

Iersiniosis hepatitis is characterized by benign flow. Formation of a chronic process is not observed. At the same time for iersiniozov the current with exacerbations and relapses of disease are characteristic. It is noted that with the group morbidity of iersiniosis, the frequency of the wave-like and recurrent course of the disease is higher than in sporadic, with sporadic pseudotuberculosis being 19.3%, and intestinal yersiniosis 16.4%.

Diagnosis of Yersinia Hepatitis

Diagnosis of yersiniosis, especially at the prehospital stage, is always difficult, both in adults and children. According to N.P. Kuprinoy et al. (2002). Only in 1/3 of the sick children, the diagnosis of yersiniosis was made and the onset of the disease. In adult patients, the diagnosis of iersiniosis, delivered at the prehospital stage, coincides with the final only in 26.4% of cases.

Difficulties in the diagnosis of yersiniosis arise due to the clinical diversity of the disease pattern. In cases of hepatitis syndrome, it is extremely rare to prescribe a diagnosis of yersiniosis.

Laboratory diagnosis in the form of bacteriological and serological examination is of great importance for the diagnosis of yersiniosis. Bacteriological study of feces, urine, blood and other biological substrates is currently not sufficiently informative.

According to G.Ya. Censewo et al. (1997), the effectiveness of bacteriological study in case of outbreak morbidity on the 5th day after the onset of the disease does not exceed 67%, on the 10th day - 36.7, on the 15th day - 45, and for sporadic cases - 3-25% .

Serological methods are divided into two groups; methods based on the determination of antibodies to the pathogen in the serum, and methods for detecting directly bacterial antigens in various biological substrates (blood, urine, coprophiltrate, saliva).

To determine antibodies to Yersinia, the agglutination reaction and RIGA are performed with commercial erythrocyte diagnosticums.

In pseudotuberculosis, specific agglutinins appear at week 1 of the disease, but increase with the period of convalescence. For example, at the first week of the disease, antibodies are detected only in 30% of patients in titres 1: 100, and at the 2nd, 3rd, 4th and 5th week they are found in 65.7; 65.9; 70 and 69.8%, respectively, with an increase in titres of 2 times or more, compared with the original ones.

According to NP, Kuprina with co-workers. (2000), a distinct increase in the titer of specific antibodies in yersiniosis is observed at the 3rd-4th week of the disease, with antibody titers reaching 1: 800-1: 1200. However, in 30% of patients, the diagnosis of yersiniosis was made only on the basis of clinical and epidemiological data, as the results of serological studies were negative and.

Among the 5 patients of Yersinia hepatitis observed by us, specific antibodies were detected in 10 in titres from 1: 100 to 1: 800, usually on the 3-5th week of the disease

In adults with intestinal yersiniosis in generalized forms of the disease, specific antibodies in high titres are detected - up to 1: 6400.

Detection of Yersinia antigens is most effective in coprofilters at week 1 of the disease. For example, antigens to Yersinia are found in this period in coprofilteres in 40-80% of cases, and with intestinal yersiniosis, the frequency of antigen detection of the pathogen is 31-51.6%.

Iersiniosis, due to their clinical polymorphism, has to be differentiated with many infectious diseases. For example, differential diagnosis with acute respiratory viral infection, acute intestinal infections, infectious mononucleosis, scarlet fever, rubella, cytomegalovirus, septic and typhoid-like infections. With the manifestation of predominantly hepatitis syndrome, there is a need to eliminate viral hepatitis. Crucial importance is given to negative serological test results for markers of hepatitis viruses.

At the same time, it is known that iersiniosis can be combined, as a mix infection, with viral hepatitis A, B, C, including chronic viral hepatitis. When distinguishing yersiniosis hepatitis and viral hepatitis, the long period of subfebrile condition and febrility in yersiniosis, the presence of catarrhal phenomena in the oropharynx, the increase in several groups of lymph nodes, the appearance of a small-spot or patchy-papular rash in the skin with subsequent desquamation, which is not is observed in viral hepatitis. Of definite importance is the epidemiological anamnesis concerning the consumption of raw vegetables, milk and other dairy products, especially in cases of group illness.

[1], [2], [3], [4]

Treatment of Yersinia Hepatitis

In etiotropic therapy with yersiniosis, metronidazole (trichopolum), rifampicin, chloramphenicol (levomycetin) are used, and in children of early age - with restriction. In adults, tetracycline drugs are widely used, primarily doxycycline. Assign for iersiniozah adults fluoroquinolones III generation (ciprofloxacin). If necessary, parenteral administration appoint cephalosporins of the third generation, as well as aminoglycosides (amikacin, sisomycin), chloramphenicol (levomycetin succinate).

Antibiotics are given for 10 days, with severe forms of the disease - 2-3 weeks.

One of the important criteria for the abolition of antibacterial therapy is the normalization of body temperature; the regress of pathological clinical manifestations is also taken into account.

Prevention of Yersinia Hepatitis

To prevent infection with iersinia, it is necessary to observe sanitary and hygienic standards for storage, processing and sale of food products, especially vegetables. Specific prophylaxis is not developed.