Yersiniosis and campylobacteriosis

Differential Diagnosis of Pain Syndrome

Assessing the nature of abdominal pain is a critically important stage in the diagnosis of infectious and non-infectious bowel diseases. The pain syndrome exhibits strict specificity depending on the nosology:

• Acute shigellosis (colitic variant): Patients complain of cramping pain predominantly localized in the lower half of the abdomen.
• Foodborne toxicoinfections (FTI): Pain of varying intensity is characteristic. Localization is most often noted in the upper half of the abdomen as well as the umbilical region.
• Ulcerative colitis (UC): Pain intensity can vary. Pain is often aching and moderate. In some cases, especially in early stages or outside of exacerbation, pain may be completely absent. Pronounced tenderness appears during the progressive course of the disease.
• Colorectal cancer: The character and intensity of pain directly depend on the localization of the tumor process. In most cases, pain is mild or absent altogether. Acute pain typically occurs only when complications develop, such as intestinal obstruction.

Stool Characteristics and Presence of Tenesmus

Macroscopic assessment of feces and detection of false urges to defecate (tenesmus) allow for a clear distinction between various lesions of the large intestine:

• Acute shigellosis: Stool is liquid with an extremely scant fecal mass. Visual inspection reveals mucus admixtures and characteristic streaks of blood. Tenesmus is very common in this disease and serves as a typical symptom.
• Foodborne toxicoinfections: Feces are abundant, fecal in character, often greenish and foul-smelling. Pathological impurities (blood, pus) are absent. Tenesmus is not characteristic of FTI.
• Ulcerative colitis: Stool is usually mushy, less often liquid. Pus, mucus, and bright red blood are clearly defined in the fecal masses. Tenesmus occurs exclusively in severe forms of the disease.
• Colorectal cancer: Stool is most often formed or semi-formed, rarely liquid. A specific sign is that blood is located on top of the feces without mixing with them. Tenesmus occurs only if the tumor is localized directly in the rectum.

Liver Status and Hemogram

Involvement of the hepatobiliary system and systemic inflammatory responses are reflected in palpation data and the complete blood count:

1. Shigellosis: Hepatomegaly is absent. The complete blood count typically shows no significant changes. Leukocytosis and neutrophilia may be noted only in severe forms.
2. FTI: The liver is unchanged. The hemogram shows leukocytosis, neutrophilia with a band shift to the left. The erythrocyte sedimentation rate (ESR) is slightly elevated.
3. UC: The liver is moderately enlarged and tender on palpation. Blood analysis shows leukocytosis, a band shift to the left, and an elevated ESR. Varying degrees of anemia are also frequently observed.
4. Colorectal cancer: The liver enlarges and becomes nodular in the presence of distant metastases; it is painless on palpation. Blood analysis may show no significant changes, or a band shift and relative neutrophilia may be observed. ESR is elevated, in some cases significantly. Anemia phenomena may be pronounced.

Typhoid Fever: Clinical Presentation and Examination

For differential diagnosis, it is necessary to clearly know the manifestations of typhoid fever.

Leading symptoms of typhoid fever:

• Prolonged high fever;
• Hepatosplenomegaly (enlargement of the liver and spleen);
• Specific "typhoid" tongue;
• Typical roseolous rash;
• Positive Padalka's sign;
• Toxic encephalopathy.

Clinical case: A 43-year-old patient. The disease began a week ago with weakness, malaise, low-grade fever (37.5–38.0°C), poor sleep, and lack of appetite. Initially, an erroneous diagnosis of "influenza" was made, and antipyretic drugs were ineffective. Over time, the temperature rose to 39°C, and intoxication increased (general weakness, headache, insomnia). Dyspeptic syndrome appeared: mushy stool 3–4 times a day, abdominal distension. On the 8th day of the illness, objective examination revealed: temperature 38.9°C, pale face. Single elements of a roseolous rash were found on the skin of the abdomen. The tongue is thickened, has tooth indentations along the edges, and is thickly coated in the center with a characteristic grayish deposit.

Principles of Patient Management

According to diagnostic algorithms, a physician is required to purposefully elicit complaints, collect a detailed medical history and epidemiological history (epidemiological anamnesis). A thorough examination and physical assessment are necessary to identify leading syndromes. The specialist's tasks include assessing the severity of the patient's condition, identifying specific complications, and mastering the algorithm for establishing a clinical diagnosis (including formulating complications from a pathogenetic standpoint). To confirm the diagnosis, it is necessary to substantiate the examination plan, correctly analyze the results of bacteriological and immunological laboratory diagnostic methods, and then prescribe adequate therapy.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• The essence of clinical symptoms and complications of intestinal infections from a pathogenetic perspective.
• Principles of diagnosis, treatment, and prevention of typhoid fever.
• Indications for hospitalization of patients with intestinal infections.
• Rules for discharging convalescents from an infectious diseases hospital.
• Algorithm for establishing and formulating a complete clinical diagnosis.

Other topics in the "Acute Intestinal Infections" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.