Yersiniosis is an ailment characterized by a predominant lesion of the gastrointestinal tract, as well as a generalized lesion of the skin, joints, other systems and organs.
Yersiniosis (intestinal yersiniosis) is an infectious disease that is transmitted alimentarily. It is characterized by severe intoxication, significant damage to the digestive system, musculoskeletal system.
The causative agent of intestinal yersiniosis
The causative agent is a member of the family of intestinal bacteria of the species Yersinia enterocolitica. These microorganisms exhibit extreme resistance to low temperatures, including freezing, however, they quickly die at a temperature exceeding 60 degrees, especially when boiling. In addition, yersinia feel excellent at temperatures from +4 to +8 degrees, reproducing on food products, which is why yersiniosis is often called "refrigerator disease".
The causative agents of this infection are very widespread in nature. The fact is that they strongly contaminated the soil of the fields; fish, animals and birds get sick. They can be found on the surfaces of root crops, vegetables, in dust, in the water of water bodies and so on. The main causative agents of intestinal yersiniosis for humans are rodents along with dogs, cats, pigs, cattle, birds, rabbits and other animals. People are infected from animals not only by contact in a domestic way, but also by food, that is, against the background of the use of food and water, which was contaminated by excreta of animals. This type of infection in most cases is considered the most common.
Among this category of pathogenic microorganisms, several different strains are distinguished, which can differ in aggressiveness, which determines the difference in the course of the disease. With an unfavorable development of the disease, the causative agent of intestinal yersiniosis and pseudotuberculosis can penetrate into the blood and lymph vessels, thereby causing disturbances in the functioning of various organs and systems. So, then we move on to the symptoms of this ailment.
Symptomatology
With the development of yersiniosis (intestinal yersiniosis), as a rule, the following symptoms are noted in patients:
- The presence of high body temperature up to thirty-nine degrees.
- Catarrhal manifestations in the form of a runny nose, lacrimation, sore throat.
- The occurrence of abdominal pain (we are talking about constant or cramping sensations, mainly in the navel or on the right).
- The appearance of a disorder of the stool (sometimes this is accompanied by an admixture of mucus and blood).
- The occurrence of muscle pain.
- The presence of dry skin. Usually on the second - sixth day on the hands, and, in addition, on the palms and feet there are edematous areas of the skin, there is a small-spotted and pinpoint rash, itching is likely. Subsequently, peeling forms on the areas of rashes.
- Symptoms of intestinal yersiniosis include the appearance of redness or pallor of the skin of the face.
- On the fifth or sixth day, the tongue may acquire a raspberry color.
- During palpation of the abdomen, pain is observed, usually on the right.
- The presence of pain in the right hypochondrium.
- The spleen (much less often the liver) is enlarged.
The incubation period, as a rule, ranges from fifteen hours to six days (mainly two to three days).
Forms of pathology: gastrointestinal
This form is more common than others, while the following is noted:
- The disease develops acutely, with an increase in temperature up to thirty-eight - thirty-nine degrees with chills.
- The occurrence of headache and malaise.
- Abdominal pain can be accompanied by diarrhea, and sometimes vomiting.
- The appearance of loose stools, sometimes with impurities of mucus and blood. The frequency of the stool in this case is from two to fifteen times a day.
Abdominal form
This type of yersiniosis (intestinal yersiniosis) is formed against the background of the penetration of the pathogen from the digestive system into the mesenteric lymph nodes. This type is often accompanied by the occurrence of acute appendicitis, that is, inflammation of the appendix of the cecum, which is extremely dangerous by the occurrence of purulent inflammation of the abdominal region and requires surgical treatment:
- Typical are abdominal pain (mainly in the navel).
- The occurrence of heat.
- As part of palpation (that is, with palpation), the increase in lymph nodes to the right of the navel is determined.
- The appearance of peeling hands and skin of the feet.
- Enlarged spleen and liver.
- Damage to the liver can sometimes be manifested by icteric staining of the skin, eye proteins, and at the same time, darkening of the urine.
- This form is characterized by a protracted course (in complex examples up to several months).
Generalized form
This type of pathology proceeds, accompanied by the following symptoms:
- The presence of profuse vomiting in the patient.
- Rashes are characteristic (the occurrence of a small spotted and spotted rash with subsequent peeling), which is accompanied by itching.
- The patient may complain of intense joint pain in large (knee, shoulder) and small joints.
- Damage to the liver is possible, which can be expressed by yellowness of the proteins of the eyes, skin and darkening of the urine.
- The development of damage to the cardiovascular system, which is usually accompanied by stitching pains in the region of the heart along with the occurrence of heart palpitations, fluctuations in heart rate and blood pressure.
- The appearance of symptoms of damage to the nervous system in the form of lethargy, dizziness, depression.
- The occurrence of pain during urination.
Worn out form
In the presence of an erased form, the disease can proceed easily, with an increase in temperature up to thirty-seven degrees, along with weakness and malaise. The last symptoms are usually mild, stool two to three times a day. By duration, there are:
- The acute course of the disease, which lasts up to three months.
- A protracted process that usually lasts from three to six months.
- Chronic course, when the disease torments for more than six months.
Causes
The following causes of intestinal yersiniosis and pseudotuberculosis are distinguished:
- The causative agent, as noted earlier, usually lives in nature in the soil. But also with water and food, it can enter the body to animals. A key role in the spread of this pathogen is given to rodents, and, in addition, farm animals like pigs, cattle, rabbits and pets (that is, cats, dogs).
- The main method of transmitting the pathogen to humans is the consumption of contaminated water and products that differ in animal origin (vegetables, unpasteurized milk, dairy products).
- Risk category includes people working on food units, in livestock and poultry complexes.
- Mostly sick are residents of cities where the population very often uses public catering (for example: canteens, cafes and the like).
- Cases of yersiniosis immediately after transfusion of infected blood are not excluded.
- The peak incidence, as a rule, occurs in the period from October to November.
Diagnosis of intestinal yersiniosis
As part of the diagnosis of this disease, patients need to undergo the following examination:
- Submitting an analysis of the epidemiological history (while establishing the fact of eating unwashed foods), identify cases of the disease among the environment, whether it is family members, a kindergarten, and more.
- The clinical picture is being studied (attention is drawn to whether there is abdominal pain along with diarrhea, palpation of enlarged mesenteric lymph nodes, and more).
- Performing the bacteriological method (blood, vomit and stool samples taken no later than the seventh day from the onset of the first symptomatology) on special nutrient media. In the event that a characteristic colony of bacteria grows on such media, this confirms the diagnosis of the disease. Additionally, the sensitivity of microorganisms to antibiotics is determined (by performing an antibioticogram). It is worth noting that determining the degree of sensitivity to antibiotics is extremely important in order to determine adequate therapy.
- Serological diagnosis is the determination of antibodies to pathogens in the patient’s blood. Antibodies act as specific proteins of the immune system, whose main function is the recognition of the pathogen (viruses or bacteria) along with its further elimination.
- Consultation from an infectious disease specialist is also possible.
Therapy
Treatment of intestinal yersiniosis should be carried out exclusively in a hospital under the supervision of a doctor. Additionally, antibiotic therapy is carried out taking into account the established sensitivity of the pathogen to various categories of antibiotics. To restore patients, saline or glucose injections are also used to make up for lost fluid.
Patients are administered drugs containing ready-made donor antibodies (we are talking about polyglobulin, immunoglobulin, plasma), in order to increase the resistance of the human body. In the case of the development of yersiniosis appendicitis (that is, against the background of an abdominal form), patients are shown surgical treatment. Now let's talk about the complications and consequences of this pathology.
Complications and consequences
Over the course of five years, some of the patients with yersiniosis (intestinal yersiniosis) develop the following phenomena:
- The development of chronic inflammation of the thyroid gland.
- The occurrence of Crohn's disease (chronic inflammation of all parts of the digestive system with the formation of scars and ulcers on the walls of the intestine).
- The appearance of Reiter's syndrome, a condition that is accompanied by a triad of symptoms in the form of urethritis (inflammation of the urethra), conjunctivitis (a disease of the mucosa that covers the eyes and surface of the eyelids), arthritis (changes in the joints).
The abdominal form of intestinal infection of yersiniosis is dangerous by the formation of the following processes:
- The development of stenosis (i.e. narrowing) of the terminal ileum, and, as a result, obstruction.
- The occurrence of adhesive disease of the abdominal region - a defect in which adhesions form between the organs of this cavity (intestinal loop, pelvis, liver, and so on).
- Perforation of the intestine (in this case, we mean a violation of integrity along with a rupture of the walls of this organ of the appendix). Perhaps the development of peritonitis (purulent inflammation of the abdominal cavity).
Against the background of a generalized type, the following may develop:
- The appearance of myocarditis (inflammation of the middle muscle layers of the heart).
- The development of hepatitis (inflammatory changes in the liver).
- The presence of pyelonephritis (an inflammatory process with the development of damage to the renal pelvis, renal parenchyma and calyx).
- The appearance of minengitis (inflammation of the membranes of the spinal cord and brain).
- The presence of sepsis (this rarely develops, is observed in individuals who have a suppressed immune system). Sepsis is an inflammatory systemic process that occurs as a result of the ingress of infectious agents into the blood (bacteria, unicellular, viruses or their toxins), a disease can be accompanied by the formation of a secondary infectious focus in the internal organs and, as a result, a malfunction of their normal functioning.
Next, we learn about the methods of preventing this infectious disease.
Intestinal yersiniosis and its prevention
As part of the prevention of intestinal yersiniosis, the following measures must be taken:
- Prevention on livestock farms (we are talking about the timely identification and isolation of infected individuals).
- Conducting regular water monitoring on plumbing and sewer systems.
- Execution of the destruction of rodents in warehouses, fields, farms, in canteens and shops, at least twice.
- Good hygiene when working with animals (requires frequent hand washing with soap).
- Thorough processing of vegetables along with pasteurization of milk.
- Timely detection of patients and carriers of yersiniosis, especially workers related to the food industry.
Pseudotuberculosis
We found that yersinia are the causative agents of intestinal yersiniosis and pseudotuberculosis. These are two independent pathologies that have many common features, with fecal and oral transmission mechanisms. The clinical manifestation of these two diseases is polymorphic and includes symptoms of a lesion of the digestive system. In a number of situations, there is a tendency to generalization of infection along with the development of exanthema, in some examples subsequent damage to the musculoskeletal system is possible.
The epidemiological feature of these diseases is their frequent connection with the consumption of vegetable products, which are stored in storages and contaminated by rodent excrement. Examples of extremely severe sepsis associated with the use of donated blood taken from donors suffering from subclinical bacteremia, in which there was a selective accumulation of pathogenic pathogens due to improper storage of samples without freezing at low temperature, are described. In rare situations, yersiniosis is caused by other types of yersinia. It is worth noting that they are often detected among patients with symptoms of acute appendicitis who are hospitalized in surgical hospitals.
Despite a significant decrease in the incidence of intestinal yersiniosis and pseudotuberculosis, sites with fairly high rates of such incidence have been preserved in recent years. In addition, such diseases continue to pose a very big problem for citizens in isolated separate groups (for example, in military units and so on).
Comparative characteristics of laboratory diagnostic techniques
The most informative method for laboratory diagnosis of intestinal yersiniosis, as well as pseudotuberculosis, is cultural in combination with adequate methods of species identification of the pathogen. A mandatory step, in the framework of the study against the background of the identification of such diseases, is to determine the virulent properties of the isolated isolate. The presence of the antigenic characteristics of the isolate cannot serve as direct evidence of the occurrence of virulent properties in it, and, in addition, the etiological connection with the picture of pathology.
We examined an infectious disease - intestinal yersiniosis.