Yersiniosis

Clinical and epidemiological features and diagnosis

The diagnosis is based on an acute onset with fever and polysymptomatic manifestations. A characteristic feature is the prolonged persistence of fever and intoxication (over one week).

Main syndromes:

• Gastrointestinal: moderate gastroenterocolitis, dyspepsia, specific right-sided localization of abdominal pain.
• Extraintestinal: catarrhal phenomena, arthralgic syndrome, appearance of enanthema and exanthema, as well as hepatomegaly.

The epidemiological anamnesis often indicates a group character of the morbidity and an association with the consumption of thermally unprocessed vegetables (e.g., green onions). Based on these data, a clinical diagnosis is formulated, for example: "Yersiniosis, gastrointestinal form, gastroenterocolitic variant. Moderate severity".

Neurological manifestations

Various pairs of cranial nerves (CN) can be involved in the pathological process, leading to pronounced oculomotor, bulbar, and facial disorders.

Oculomotor disorders: Caused by damage to the III (n. oculomotorius), IV (n. trochlearis), and VI (n. abducens) pairs of cranial nerves. This leads to dysfunction of the internal muscles of the eye (m. ciliaris, m. dilatator pupillae), the superior oblique and abducens muscles. Clinically, this manifests as mydriasis, anisocoria, ptosis, strabismus, as well as impaired accommodation, convergence, and eyeball movements.

Bulbar and facial disorders:

• IX and X pairs (glossopharyngeal and vagus nerves): paralysis of the muscles of the soft palate, pharynx, and larynx causes dysphagia (swallowing disorder), choking, and phonation disorders (nasal speech, aphonia).
• XII pair (n. hypoglossus): bilateral paralysis leads to complete immobility of the tongue and dysarthria.
• VII pair (n. facialis): peripheral-type paresis makes the face amimic and mask-like. Smoothing of the nasolabial folds, inability to wrinkle the forehead or bare teeth are noted.

Respiratory failure (acute respiratory failure)

Severe forms of the infection may be accompanied by sharp depression of the innervation of respiratory muscles (diaphragm and intercostal muscles). The pathogenesis is associated with damage to motor neurons of the anterior horns of the cervical and upper thoracic spinal cord.

Clinical picture of acute respiratory failure:

• Disappearance of the cough reflex and absence of diaphragmatic breathing.
• Sharp limitation of the mobility of intercostal muscles. Important: in this case, retraction of the intercostal spaces is not observed during the development of acute respiratory failure.
• Breathing becomes frequent and shallow, and an early objective sign is a decrease in vital capacity (VC).
• The patient is frightened, restless, and seeks a comfortable position to engage accessory muscles. The face is hyperemic, the skin is moist, cyanosis, tachycardia, and tachypnea (up to 30–35 breaths per minute) are increasing.

Complaints of air hunger and chest tightness constitute an urgent indication for hospitalization.

Diagnostics and treatment

Laboratory confirmation includes several methods:

1. Bacteriological method: stool culture on elective media with preliminary cold enrichment (the main method).
2. Serological method: assessment of rising antibody titers in paired sera at weeks 1–2 and 3–4.
3. Early diagnostic methods: ELISA (blood serum) and co-agglutination reaction (coprofiltrates, saliva) for antigen detection.

Management tactics (in moderate severity without pronounced dehydration):

• Dietary regimen: Diet No. 13.
• Pathogenetic therapy: oral rehydration with electrolyte solutions (ores).
• Etiotropic therapy: ciprofloxacin (0.5 g 2 times a day) until the 10th day of sustained normal temperature.
• Dynamic monitoring: complete blood count (CBC) monitoring and physical findings. According to indications, abdominal ultrasound or diagnostic laparoscopy is used to rule out acute surgical pathology.

Features of viral diarrhea (RV infection)

In the differential diagnosis of intestinal infections in children, it is important to consider viral lesions. The peak incidence occurs at the age of 6–24 months. The main risk group consists of children from 3 months to 3 years old (children under 3 months are protected by maternal antibodies).

The development of diarrhea begins upon replication of the pathogen in epithelial cells. The clinical picture is nonspecific; a tetrad is characteristic: vomiting, diarrhea, fever, abdominal pain. Termination of the infection is ensured by the production of secretory and serum antibodies, which form short-lived type-specific immunity.

Class and exam questions

What else to study on this topic

• Mechanisms of formation of arthralgic syndrome in yersiniosis
• Differential diagnosis of right-sided abdominal pain
• Pathogenesis of cranial nerve damage in acute infections
• Features of the immune response in intestinal infections of viral and bacterial etiology

Other topics in the "Acute Intestinal Infections" section

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