Symptoms of yersiniosis

Yersiniosis has an incubation period that lasts from 15 hours to 6 days, usually 2-3 days, after which typical symptoms of iersiniosis appear.

The various symptoms of iersiniosis do not allow the development of a generally accepted classification of the disease. As a rule, the clinical classification of ND is used. Yuschuk et al., Which is based on the syndromic principle.

Clinical classification of iersiniosis

Form of the disease	Clinical variant	Degree of severity	Flow pattern
Gastrointestinal	Gastroenteritis, enterocolitis, gastroenterocolitis	Light	Acute
Abdominal	Mesenteric lymphadenitis, terminal ileitis, acute appendicitis	Average	Protracted
Generalized	Mixed, septic	Heavy	Chronic
Secondary focal	Arthritis (s), nodal erythema, Reiter's syndrome, and others,

In most cases, yersiniosis begins with the symptoms of acute gastroenteritis, and then proceeds either as an acute intestinal infection or as a generalized infection. All forms of yersiniosis are characterized by acute onset, fever, symptoms of intoxication, abdominal pain, stool, exanthema, myalgia, arthralgia, lymphadenopathy and tendency to wave-like flow. In addition to manifest forms, there are erased, that is, when symptoms of yersiniosis are practically absent. The course of the disease can be acute (up to 3 months), protracted (3-6 months) and chronic (over 6 months).

The gastrointestinal form (gastroenteritis, enterocolitis, gastroenterocolitis) is most common. The majority of patients develop a gastro-enteric variant of yersiniosis. The disease begins acutely, with symptoms of gastrointestinal disease and symptoms of intoxication. Patients are concerned about the following symptoms of yersiniosis: abdominal pain of varying intensity, constant or cramping, localized in epigastrium, around the navel, less frequently in the right ileal region. The chair is quickened, sometimes with an admixture of mucus and blood. In some patients, catarrhal and dysuric symptoms, exanthema, are observed. Symptoms of "gloves" and "socks" are characteristic. On the 2nd-6th day of the disease, a spot, spotted-papular or urticar rash is found mainly on the hands, palms, feet, chest and hips, after which peeling appears. They note congestion or pallor of the skin of the face, scleritis, hyperemia of the conjunctiva and mucous membrane of the oral cavity, polyadenopathy. Language on the 5th-6th day becomes "crimson". With palpation of the abdomen - local soreness in the right iliac region, enlarged liver, less often - spleen. The temperature is normalized on the 4th-5th day. There are no typical hemogram changes.

Yersiniosis often occurs in a moderate form. Sometimes the only clinical symptom of the disease is diarrhea. Recovery occurs in most cases in 1-2 weeks. Wave-like flow, relapses and exacerbations are possible.

The abdominal form of iersiniosis develops in 3.5-10% of patients (mesenteric lymphadenitis, terminal ileitis, acute appendicitis). The most frequent option is acute appendicitis. The onset of the disease is similar to the gastrointestinal form. However, after 1-3 days, pain (in the right iliac region or around the navel) appears (or worsens). The disease can begin with intense pain in the abdomen. Appendicular symptoms of yersiniosis are accompanied by fever and leukocytosis. Forms of appendicitis: catarrhal, phlegmonous or gangrenous.

Mesenteric lymphadenitis can develop with any form of yersiniosis, but its symptoms predominate in the abdominal form. Patients are concerned about unsharp pains in the right ileal region that occur on the 2nd-4th day against a background of fever and diarrhea and persist up to 2 months. Sometimes painful mesenteric lymph nodes can be palpated to the right of the navel.

For terminal ileitis, fever, constant aching pain in the right iliac region and enterocolitis are characteristic. With laparoscopy in the right lower quadrant of the abdomen, an inflamed and edematic distal ileum with mesenteric adenitis is found. Usually the phenomena of terminal ileitis disappear in 2-6 weeks. The forecast is favorable.

Patients with abdominal form may have exanthema, arthralgia and myalgia, peeling of the skin of the palms, fingers and feet, polyadenopathy, hepato- and hepatosplenomegaly.

The abdominal form may be complicated by peritonitis, terminal stenosis of the ileum and adhesions. Perhaps a prolonged course (several months and even years) with relapses and exacerbations.

The generalized form of yersiniosis can occur in a mixed or septic variant. The most striking symptoms of iersiniosis are observed in a mixed version. Characteristically pronounced lesion of various organs and systems. Most often the disease begins acutely. Develop fever and symptoms of intoxication in combination with catarrhal phenomena. Then there are dull pains in the epigastrium and around the navel, nausea. The stool becomes mushy or liquid, without pathological impurities; possible vomiting. Feverish period usually lasts no more than 2 weeks. Polymorphic rash appears on the 2-3rd day of the disease and persists for 3-6 days, it is possible to puff up and itch. From the second week of the course of the pathological process on the place of the rash appears peeling. Arthralgia occurs usually in the first week, pains of varying intensity and duration, are wavy in nature. Large (knee, shoulder, ankle) and small (wrist, phalangeal) joints are affected. In some patients, the process is accompanied by inflammation of the plantar and / or subclavian aponeurosis. Arthritis develops rarely. On the roentgenogram of changes in joints, as a rule, no. Characteristic of the "hood", "gloves" and "socks". Tonsillitis, conjunctivitis and scleritis. A slight jaundice is possible. In the lungs dry rales can be heard. When palpation of the abdomen is often determined by soreness in the right upper quadrant, right iliac region and down from the navel. Often there are polyadenopathy, hepatomegaly, rarely - splenomegaly.

With prolonged course of generalized form, stabbing pain in the heart, palpitation, tachycardia (even at normal temperature) is possible. Pulse and arterial pressure are labile. On ECG - signs of infectious cardiopathy or myocarditis. It is possible to develop specific small-focal pneumonia, uveitis, iridocyclitis and increased symptoms of CNS damage (dizziness, sleep disturbance, lethargy, adynamia, negativism). In rare cases, meningeal syndrome is found. Some patients complain of urinating when urinating.

The course of the disease is favorable in most cases. Observe relapses and exacerbations that proceed more easily than the first wave of the disease, the symptoms of iersiniosis with local lesions predominate: arthralgia (arthritis) and abdominal pain.

The period of convalescence is usually long. Initially, asthenovegetative disorders increase. In the generalized form, the development of yersiniosis myocarditis, hepatitis, pyelonephritis, meningitis (meningoencephalitis) and nervous system damage (vegetative dysfunction syndrome) are possible, characterized by benign course and favorable outcome.

The septic variant of the generalized form is rare and, as a rule, in people with severe concomitant diseases and immunodeficiency conditions. The course does not differ from the course of the sepsis of another etiology. Mortality, reaching 60%, is due to ITH, diffuse ileitis with perforation of the intestine, peritonitis. The period of convalescence is long.

The secondary focal form can develop after any other form of iersiniosis. The disease that precedes it either proceeds subclinically, or the first manifestations and subsequent focal lesions are separated from each other by a long period (up to several years) during which the patient's state of health remains satisfactory. In these cases, the first symptoms of iersiniosis - the defeat of any one organ (heart, liver, etc.).

Symptoms of yersiniosis of the secondary focal form - arthritis, Reiter's syndrome, erythema nodosum, protracted or chronic enterocolitis, cervical lymphadenitis, ophthalmitis. Conjunctivitis and osteitis. The most frequent variant is arthritic, which differs from the mixed version of the generalized form with more intense and prolonged arthralgia (arthritis), which in most cases is preceded by dyspeptic phenomena and symptoms of intoxication. Most patients develop polyarthritis. Most often affected interphalangeal, radiocarpal, intervertebral, scapula-clavicular and hip, with monoarthritis - knee, ankle or elbow joints. Characteristic asymmetric lesion of the joints of the lower limbs and unilateral sakroileitis. In the hemogram - eosinophilia and an increase in ESR. Yersiniosis arthritis is often combined with carditis.

In the majority of patients with a secondary focal form of yersiniosis, asthenic and vegetoneurotic reactions, which are difficult to cope, develop.