Diagnosis of yersiniosis

Diagnosis of yersiniosis is complex in any form and is based on characteristic symptoms and laboratory diagnosis.

In the hemogram, in generalized form, leukocytosis, a stab-shift, eosinophilia (up to 7%), lymphopenia and an increase in ESR; in the biochemical analysis of blood an increase in the activity of enzymes, less often - hyperbilirubinemia. Specific laboratory diagnostics of yersiniosis includes bacteriological, immunological and serological methods. The main method is bacteriological. Material from the patient, received no later than the 7th day of the disease, the material from the external environment and from the animals is first sown on the accumulation media - phosphate buffer solution and medium with bromothymol blue, then onto dense nutrient media (preferably two at a time): on medium Endo and buffer-casein-yeast medium - followed by identification of the culture. At the same time, no less than four substrates are examined (for example, feces, urine, blood, flushing from the posterior pharyngeal wall).

Immunological diagnostics of yersiniosis allows to detect antigens Y. Enterocolitica in clinical material before the 10th day from the onset of the disease (ELISA, RCA, RIF, RNIF, RAL, PCR, immunoblotting).

Serological diagnosis of yersiniosis is used to determine specific antibodies to the antigens Y. Enterocolitica (ELISA, RA, RSK, RPGA). The study is carried out from the second week of the disease in paired sera with an interval of 10-14 days at the same time with 2-3 methods.

The following instrumental methods are recommended for diagnosis and choice of management tactics: chest x-ray, affected joints and sacroiliac joints, ECG, echocardiography, ultrasound of the abdominal cavity, sigmoidoscopy, colonoscopy, CT, diagnostic laparoscopy and sonography.

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

Differential diagnosis of yersiniosis

Differential diagnosis of yersiniosis, salmonellosis and shigellosis.

Clinical signs	Differential diseases
	Yersiniosis	PTI (salmonellosis)	Acute shigellosis
Onset of disease	Acute	Stormy	Acute
Intoxication	Expressed from the first day. Long	Expressive and short-term	Expressive and short-term
Fever	Febrile. Holds 1-2 weeks	Febrile transient (2-3 days)	Febrile or subfebrile, short-term
Cataracts	Often	No	No
Exanthema	Polymorphic, appears at different times	No	No
Symptoms of the "hood". "Gloves", "socks"	Characteristic, but may be absent	Can not be	Can not be
Arthralgia. Arthritis	Characteristic	None	None
Language	Enclosed, since the second week of "crimson"	Lined, dry	Lined, wet
Abdominal pain	Cramp-shaped, more often in the right iliac and peripumpous region	Different intensity, in the upper and middle parts of the abdomen	Cramping, in the lower abdomen, in the region of sigma
Character of the chair	Liquid, sometimes with an admixture of mucus and blood	Copious offensive, greenish color	Lean, with mucus and blood, "rectal spitting"
Dysuric symptoms	Characteristic	In severe current	Can not be
Heart Attack	Rarely - myocarditis	CCS at the peak of intoxication and dehydration	STS in severe course
Hepatospel-nemogalia	Typical	Can not be	Can not be
Jaundice	Rarely, at the height of fever and intoxication	Rarely	Absent
Lymphadenopathy	Typical	Can not be	Can not be
Indicators of the hemogram	Leukocytosis, lymphopenia, increased ESR	Leukocytosis, lymphopenia	Neutrophil shift left
Data of epidemiology	Eating non-processed fresh vegetables; stored for a long time in the refrigerator milk and products from it	Nutritional factor Group diseases	Contact with a sick person, use of non-contaminated water and suspicious foods
Nausea, vomiting	There are	Characteristic	Rarely

Differential diagnosis of yersiniosis, viral hepatitis and rheumatism

Clinical signs	Differential diseases
	Yersiniosis	Viral hepatitis	Rheumatism
Onset of disease	Acute	Gradual	More often gradual, can be violent
Fever	Febrile (1-2 weeks)	Febrile temperature (with HAV and BHD), short-term	Febrile - briefly, subfebrile - for a long time
Cataracts	Often	In the prodromal period of hepatitis A	For 2-4 weeks, an episode of streptococcal angina or exacerbation of chronic tonsillitis
Cutaneous manifestations	Exanthema polymorphic, at different times	Possible exanthema by type of urticaria	Nodular, ring-shaped erythema. Rheumatoid nodules
Hyperemia and puffiness of the palms and feet, "crimson" tongue	Characteristic	None	None
Nausea, vomiting	There are	Possible	Not typical
Abdominal pain	More common in the right iliac region	Not typical. Is possible with VGD, VGE	Not typical
Character of the chair	Liquid, sometimes with an admixture of mucus and blood	Tendency to constipation	Do not change much
Dysuric symptoms	Characteristic	Can not be	Possible jade
Heart Attack	Rarely - myocarditis	Cardiovascular failure in severe (fulminant) course	Carditis and rheumatic heart disease
Hepatospel-nemogalia	Typical	Possible	Can not be
Jaundice	Rarely, at the height of fever and intoxication	Most often bright, prolonged	Absent
Lymphadenopathy	Typical	Absent	Most often submandibular
Neurological symptoms	Vegeto-vascular disorders. Meningeal syndrome	Acute or subacute hepatic encephalopathy	Malignant chorea, meningoencephalitis, serous rheumatic meningitis. Cerebral vasculitis
Laboratory research	Leukocytosis, lymphopenia. Increased ESR	Leukopenia, lymphocytosis, decreased ESR	Leukocytosis with a rightward shift, lymphopenia
	Moderate and unstable increase in enzyme activity, hyperbilirubinemia	Long-term hyperbilirubinemia and increased activity of enzymes. Change in thymol and sulemic samples	Dysproteinemia, sharply elevated titer of antistreptolysin-O, CRP
	Isolation of Yersinia culture. Their antigens and antibodies to them	Detection of markers of viral hepatitis	Detection of streptococcal antigen of antistreptolysin-O, ASA, ASG
Data of epidemiology	The use of thermally unprocessed fresh vegetables, especially cabbage, carrots of milk and products stored in the refrigerator for a long time	The use of products and water, contaminated with HAV and VHE viruses, contact with patients with HAV. Parenteral history (HBV, HCV, VGD)	Without features
Arthralgia, arthritis	Characteristic	Flying Arthralgia (HBV, VGD)	Symmetrical lesion of large joints

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