Symptoms of the periods of pseudotuberculosis: clinical classification

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

Pseudotuberculosis does not have a single clinical classification. Recommended use of classification (with minor changes). Yuschuk et al.

Clinical classification of pseudotuberculosis

Clinical form	Option	Degree of severity	Flow
Mixed	Scarlatiniform Septic	Moderate Gravity	Prolonged (up to 6 months)
Secondary focal	Arthritis (s) Nodal erythema Reiter's syndrome, etc.	Heavy	Chronic (over 6 months)
Abdominal	Mesenteric lymphadenitis Terminal Ileitis Acute appendicitis	Lightweight	Acute (up to 3 months)

The following periods of pseudotuberculosis are distinguished: incubation, initial, high, reconvalescence or remission.

The initial period of pseudotuberculosis lasts from 6-8 hours to 2-5 days. Symptoms of pseudotuberculosis in the initial period in all forms of the disease are similar: pronounced intoxication and polymorphism of symptoms. The originality of each form is revealed only during the height of the swell. In most patients, the disease begins acutely, sometimes violently. The general state of health sharply worsens. The body temperature rises rapidly to 38-40 ° C, possibly with a chill. Disturbing severe headache, dizziness, severe weakness, insomnia, arthralgia, myalgia, back pain, sweating, apathy, anorexia. Sometimes fainting. Patients are irritable, adynamic. Often there are signs of acute catarrh of the upper respiratory tract, burning on the palms and soles. On examination, the symptoms of the "hood", "gloves", "socks" and the injection of vessels of the sclera are detected. Mucous membrane of the oropharynx is hyperemic, in some patients - "glowing" pharynx, enanthem on the soft palate, catarrhal tonsillitis. Language with 3-5 days of illness becomes "crimson". 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 pseudotuberculosis of mixed form are characterized by a rash that appears in most patients on days 2-7 of the disease. More often the rash is scarlet-like, but it can be polymorphous, ephemeral, petechial, small and coarse-grained, urticaria, erythematous, vesicular and in the form of erythema nodosum, sometimes itch. A scarlatina-like rash is abundant, located on the chest, back, stomach, limbs and face, thickens in natural folds. Spotted-papular and urticaria rash is often grouped around large joints (knee, elbow, ankle). The rash may appear on the first day of the illness, and all other symptoms will join later. In these cases, a slightly itchy, patchy-papular exanthema is usually localized on the soles, hands, and feet. As a rule, it persists for 3-6 days, erythema nodosum - several weeks. Possible podsypaniya. From the second week of the disease begins large or small-flake skin peeling. Arthralgia and myalgia often become intolerable. Knee, ankle, elbow, interphalangeal and radiocarpal, more rarely shoulder, hip, intervertebral and maxillofacial joints are more often affected. Duration of arthralgia from 4-5 days to 2-3 weeks. Pain syndrome and hyperesthesia of the skin are generally characteristic of pseudotuberculosis. Suddenly, without apparent causes, the pain suddenly stops. Dyspeptic and catarrhal phenomena persist or intensify during the peak period.

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

During the heat period, abdominal pains persist or appear for the first time. At palpation in the majority of patients define morbidity in the right ileal region, down and to the right of the navel, in the right hypochondrium and above the pubis. Almost all patients have enlarged liver, sometimes - spleen. Diarrhea is rare. Stool is normal or constipated. Changes in the central nervous system, cardiovascular and urinary system with a mixed version of pseudotuberculosis do not differ from changes in iersiniosis. In the peak period, the temperature reaches a maximum; it is constant, wavy or of an irregular type. Duration of febrile period from 2-4 days to several weeks.

The beginning of the period of convalescence is indicated by improvement in the well-being of patients, gradual normalization of temperature, restoration of appetite, disappearance of rash, abdominal pain and joint pain. Quite often low-grade fever. In the 2-3th week of the period of convalescence, vegetative disorders appear, which are intensified with prolonged flow and the formation of secondary focal forms.

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

The septic version of the mixed form of pseudotuberculosis is rare. Symptoms of pseudotuberculosis of this form do not differ from sepsis in yersiniosis. The lethality reaches 30-40%.

Scarlet-like variant of pseudotuberculosis is most common. It is characterized by severe intoxication, fever and abundant acne, accumulating in the skin folds and around large joints. In all patients, the rash in most cases is not itchy, appears on the 1-4-th (less often on the 5th-6th) day of the disease. Exanthema is often dotted on a hyperemic or normal skin background, sometimes erythematous and spotted (crusty or rubella-like). Localized in the chest, abdomen, lateral surfaces of the body, arms and lower limbs, often with hemorrhages. The symptom of the "tourniquet" is positive. In most patients, the symptoms of "gloves", "socks" and "hood" are also observed. Characteristic pale nasolabial triangle, "crimson" language, bright hyperemia of the face, tonsils, arches and persistent white dermographism. Pain in the joints, abdomen and dyspeptic phenomena are not typical.

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

Mesenteric lymphadenitis of pseudotuberculous etiology is characterized by acute onset (with high fever, chills) and increasing pains in the abdomen. 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 course, muscle tension appears in the right iliac region and peritoneal symptoms. With laparotomy, enlarged lymph nodes of the mesentery with a diameter of up to 3 cm, injection and hyperemia of the ileum with a fibrinous plaque on the serous membrane are seen. A false-pendicular syndrome is characteristic, which makes it possible to differentiate mesenteric lymphadenitis from acute appendicitis.

Acute appendicitis may be manifested by symptoms that are the first clinical manifestations of pseudotuberculosis or appearing in a few days (weeks) after the onset of the disease. Pain, which is localized mainly in the right ileal region, cramping, rarely permanent. Patients are concerned about nausea and vomiting. Fever of the wrong type. The language is crimson.

Terminal Ileitis is the first manifestation of pseudotuberculosis, but more often develops during a period of relapse or remission. Characterized by abdominal pain, muscle tension of the right iliac region, symptoms of irritation of the peritoneum, nausea, repeated vomiting, loose stool 2-3 times a day. Sometimes a moderate increase in the liver. It can form a chronic ileitis, clinically manifested during relapses and exacerbations. Relapses with abdominal form are more common than with other forms of pseudotuberculosis. Clinico-laboratory signs of pseudotuberculous hepatitis are similar to those of yersiniosis. Some patients develop pancreatitis, which is manifested by a violation of the exocrine function of the pancreas.

Myocarditis practically does not differ with the course and outcome of myocarditis with yersiniosis. However, cases of severe infectious-toxic myocarditis and damage to the conduction system of the heart are described. Endo-, peri- and panvasculitis, as well as circulatory disorders are possible.

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

Pneumonia develops more often than with yersiniosis. They are registered in almost all patients with a fatal outcome.

The course and outcome of meningitis with pseudotuberculosis do not differ from meningitis in yersiniosis. With a secondary focal form, meningoencephalitis can develop.

Symptoms of pseudotuberculosis are characterized by the defeat of somatic (polyneuritis and meningoradiculoneuritis) and autonomic nervous system (irritability, sleep disturbance, pallor or hyperemia of the skin, sweating, blood pressure dissociation, paresthesia, etc.).

The secondary focal form of pseudotuberculosis is most often manifested by erythema nodosum, Reiter's syndrome and chronic enterocolitis.

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

Complications of pseudotuberculosis

Complications of pseudotuberculosis: ITSH, adhesive and paralytic obstruction, intussusception, necrosis and perforation of the gut with the development of peritonitis, meningoencephalitis, acute renal failure, Kawasaki syndrome - are rare and can cause death.

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