Campylobacteriosis

Differential diagnosis of yersiniosis

When performing a differential diagnosis of acute intestinal infections, it is necessary to keep in mind the specific features of yersiniosis. Unlike other pathogens, enteropathogenic Yersinia are psychrophilic (multiply at low temperatures) and oligotrophic.

Epidemiological history is of key importance: infection often occurs after consuming raw vegetables (carrots, cabbage, onions) stored in a cellar, approximately three days before the onset of the disease.

Features of the clinical picture:

• Pain syndrome: Right-sided abdominal pain predominates, clinical features of acute catarrhal appendicitis and hepatomegaly may develop.
• Generalized form: Characterized by catarrhal changes in the oropharynx, maculopapular rash on a hyperemic background (concentrated in the ankle and wrist joints), icterus of the mucous membranes, and severe joint pain.
• Erythema nodosum: Painful, deep-seated nodules (ranging from a hazelnut to a chicken egg) appear on the shins. The skin over them becomes purple-cyanotic and, as the elements evolve, acquires a yellow-green color (“bruise blossoming”).

Differential diagnosis of botulism

When assessing gastroenteritic syndrome on the first day of the disease, it is important not to miss the initial signs of botulism. The disease begins acutely (nausea, vomiting 3–5 times, loose stools 2–4 times, burning sensation in the epigastrium).

Crucial specifics: diarrhea and vomiting are neither profuse nor prolonged. By the time neurological symptoms appear, diarrhea is replaced by persistent constipation.

Neurological symptoms (the main sign is bilateral symmetrical paresis without sensory impairment):

1. Ophthalmoplegic syndrome: Involvement of cranial nerve III (n. oculomotorius). Patients complain of a "net" or "fog" before the eyes, acute farsightedness, and accommodation paresis. Objectively, mydriasis, anisocoria, ptosis, strabismus, and decreased pupillary light reflex are detected.
2. Bulbar disorders: Involvement of the muscles of the tongue, pharynx, and larynx. There is impaired swallowing (fluid regurgitation through the nose), loss of the pharyngeal reflex, dysarthria, and nasal voice.
3. Acute respiratory failure: In severe cases, a sensation of chest heaviness and air hunger occurs; breathing becomes shallow but not accelerated.

General intestinal and catarrhal symptoms

When assessing the severity of various AII, clinicians take into account the severity of intoxication (weakness, anorexia, fever for 1–3 days) and the degree of dehydration. These two syndromes are not always equivalently expressed. Abdominal pain occurs in 30–40% of cases, is usually diffuse in nature, is localized in the epigastrium, and is accompanied by intense gurgling, while its intensity is lower than in AII with exudative diarrhea.

Catarrhal syndrome:

• Occurs in rotavirus infection (respiratory manifestations in 30–56%, oropharyngeal changes in 64–80% of cases).
• Pharyngoscopy reveals hyperemia and granularity of the soft palate, arches, and posterior pharyngeal wall.
• Symptoms are short-lived (resolve in 3–4 days) and often coincide with the seasonal rise in ARVI incidence.

Doctors often make the mistake of interpreting such catarrhal phenomena without laboratory confirmation as the non-existent diagnosis of "flu with intestinal syndrome".

Patient management tactics

Medical care for AII at the pre-hospital stage generally does not require specific therapy, but proper patient routing is essential.

• Hospitalization: Patients are referred to the intestinal infections department for a full examination, bacteriological culture (stool, urine, throat swab), complete blood count, and urinalysis.
• Monitoring: Dynamic monitoring of the abdominal syndrome is required to rule out acute surgical pathology.
• Prevention: The physician is obliged to instruct close contacts in the family regarding the routes of transmission of the infection through non-heat-treated food and the need to seek medical help immediately upon the appearance of the first symptoms.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Pathomorphological organ changes in localized and generalized forms
• Pathogenetic basis for the development of chronic forms (pathogen persistence and incomplete phagocytosis)
• Molecular-genetic and serological methods of laboratory diagnosis in AII
• The role of macroorganism genotypic features in the development of secondary focal forms
• Indications for surgical treatment in the event of abdominal complications

Other topics in the "Acute Intestinal Infections" section

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