Diagnosis of pseudotuberculosis: analyzes, differential diagnosis

Clinical diagnosis of pseudotuberculosis is complex in case of sporadic morbidity and becomes relatively simple in flare. It is based on the characteristic clinical symptoms and laboratory diagnostics.

[1], [2], [3], [4], [5], [6], [7],

Indications for consultation of other specialists

The same as in yersiniosis.

Specific and nonspecific laboratory diagnosis of pseudotuberculosis

In the hemogram, neutrophilic leukocytosis, monocytosis, eosinophilia is detected. Relative lymphopenia and an increase in ESR. In the biochemical analysis of blood, increased activity of enzymes, less often - hyperbilirubinemia. Specific laboratory diagnosis of pseudotuberculosis is the same as in yersiniosis. Promising methods of specific diagnostics are the immunoenzyme test system based on the porin Y. Pseudotuberculosis protein and erythrocyte antigenic diagnosticum for RIGA based on cell wall proteins Y. Pseudotuberculosis.

Instrumental diagnosis of pseudotuberculosis

Additional instrumental diagnosis of pseudotuberculosis does not differ from those described for iersiniosis.

Example of the formulation of the diagnosis

• A28.2. Pseudotuberculosis, abdominal form, terminal ileitis, moderate severity.
• A28.2. Pseudotuberculosis, secondary focal form, erythema nodosum, moderate severity, prolonged course.

[8]

Differential diagnosis of pseudotuberculosis

Differential and diagnostic signs of abdominal pseudotuberculosis and acute appendicitis

Symptoms	Abdominal form of pseudotuberculosis	Acute appendicitis
Epidemiological data	More often in the spring, late winter and early summer. Characteristic of group cases	Sporadic cases, without seasonality
Onset of disease	Acute, feverish chills, severe intoxication and abdominal pain	Stage: first pain in the abdomen, then increasing intoxication and fever
Skin and mucous membranes	Hyperemia of the palms, feet, face, neck of the mucous membrane of the throat and conjunctiva	Most common or pale
Exanthema	Typical	Not visible
Language	"Crimson"	Lined, dry
Abdominal pain	More often, from the 2nd to 4th day of the disease, paroxysmal	From the first hours of illness, constant
Nausea and vomiting	They rarely do not depend on abdominal pain	Often especially in children. Arise after the onset of abdominal pain
Symptoms of irritation of the peritoneum	Rare, pronounced vaguely	Characteristic, expressed
Enlarged mesenteric lymph nodes	Often	Not visible
Symptoms of parenchymal hepatitis	Often	Not typical
Body temperature	Febrile, reaches a maximum in the first day	Increases gradually, more often subfebrile
Increased ESR	Characteristically	Not typical in the absence of complications

Differential diagnosis of pseudotuberculosis, trichinosis and drug dermatitis

Clinical signs	Differential diseases
	Pseudo-tuberculosis	Trichinosis	Drug dermatitis
Start	Acute, can be gradual	Often acute	Acute
Fever	More often febrile, 1-2 weeks	Remittent, permanent or incorrect type. It grows within 1-2 weeks. Reduces gradually, Rarely subfebrile condition up to several months	Subfebrile. Can be a normal temperature
Intoxication	Expressed from the first day, prolonged	Expressive, prolonged	Not expressed
Exanthema	Polymorphic, sometimes with hemorrhages. From the 2nd-4th day of illness, mainly on the trunk of the limbs, palms, feet, against the background of hyperemia, sometimes itchy. Can be nodosum erythema, After the disappearance of the rash - peeling	More often macular, draining, is saved 5-8 days, then a pigmentation and an ecdysis. There is no characteristic localization and staggering of rashes Sometimes itchy. Several waves of rashes are characteristic	More often macular, korepodobnaja, after reception of medicines. Itchy, draining. Disappears after drug discontinuation
Scleritis and conjunctivitis	Characteristic	Conjunctivitis with hemorrhages in the stage of periorbital edema	Often
Hyperemia and puffiness of the face	Characteristic	More often the puffiness of the face (especially with normal skin color	Puffiness, burning sensation of the face without hyperemia
Abdominal pain	Cramping or constant, aching in ileocecal angle and near navel	In severe conditions	Sometimes, spilled
Diarrhea	Typical	In severe conditions	Occurs rarely
Jaundice	With the development of hepatitis, a mild, short-term	Possible	Can not be
Raspberry tongue	Characteristic	Characteristic	Rarely - red, without hypertrophied papillae, "geographic"
Arthralgia	Typical	Can not be	Rarely
Hepato-lienal syndrome, polyadenopathy	Characteristic	Characteristic	Rarely
Renal damage	Sometimes pyelonephritis with scant symptoms	Not typical	Rarely - allergic nephritis
Changes in the hemogram	Moderate neutrophilic leukocytosis, relative lymphocytosis, eosinophilia. Increased ESR	Leukocytosis, eosinophilia (up to 60%) for 2-3 months	Nonspecific. Rarely moderate eosinophilia
Myalgia	Typical	Pronounced, Appears in the extremities then in the muscles of the pharynx and chewing muscles	Rarely

[9], [10], [11], [12], [13]