Classification and leading syndromes
The disease always starts acutely. Febrile fever often comes to the fore. In clinical practice, yersiniosis is generally divided into two large groups depending on the predominant manifestations:
- Localized forms. These include the gastrointestinal, abdominal, and catarrhal forms, as well as yersinial hepatitis. The intoxication syndrome here is moderately expressed: general weakness, cephalalgia, sleep disorders, and fever are observed.
- Generalized forms. The severity of the patient's condition is entirely dictated by pronounced systemic intoxication. It prevails over local symptoms of gastrointestinal tract involvement. The generalized course can be subdivided into typhoid-like, septic, and mononucleosis-like forms.
The total duration of the disease usually does not exceed two weeks.
Gastrointestinal tract involvement
Gastrointestinal manifestations largely depend on the patient's age. In infants under one year of age, the infection more frequently presents as gastroenterocolitis, whereas in children over one year old, it presents as gastroenteritis or isolated enteritis. The vast majority of patients experience recurrent vomiting.
Characteristics of stool in yersiniosis:
- Copious and foamy.
- Pungent, foul-smelling odor.
- Specific brownish-green color.
- Frequency of defecation reaches up to 10 times per day.
- Streaks of blood may be found in the feces.
Special attention should be paid to the abdominal form. It is characterized by pronounced intoxication and febrile fever combined with pain syndrome. A distinctive feature is very intense pain in the umbilical region. This pain syndrome is caused by the involvement of lymphoid tissue and the intestinal wall, leading to the development of mesenteric lymphadenitis, terminal ileitis, appendicitis, and reactive pancreatitis.
Exanthem and associated lesions
The appearance of a rash (exanthem) is a pathognomonic (specific) sign of yersiniosis.
Dynamics and morphology of the rash:
- Timing: elements appear on days 2–4 of the illness, peak within 1–2 days, and completely resolve in 2–5 days.
- Appearance: the rash is predominantly maculopapular (less commonly fine-petechial), prone to confluence (festooned, annular). In severe cases, hemorrhagic elements may develop.
- Localization: the rash covers the torso and limbs; the face is rarely affected.
- Specific marker: involvement of the distal extremities (hands and feet) is characteristic. Diffuse hyperemia develops, known as the "sock and glove" sign.
In addition to the rash and GI involvement, yersiniosis may be accompanied by associated syndromes: erythema nodosum, arthritis, and anicteric yersinial hepatitis.
It is easy to remember the characteristic localization of the rash: in winter and spring (the seasonality of the infection), children put on "gloves and socks" (hyperemia of the hands and feet).
Class and exam questions
At what age do children most commonly contract yersiniosis?
The risk group includes preschool and early school-age children, predominantly from 2 to 7 years old.
What causes severe abdominal pain in the abdominal form?
The pain syndrome is associated with the involvement of lymphoid tissue and GI organs: mesenteric lymphadenitis, terminal ileitis, appendicitis, and pancreatitis develop.
On what day does the rash appear and what does it look like?
The rash appears on days 2–4. Most often it is maculopapular, festooned, confluent, and localized on the torso, hands, and feet.
What else to study on this topic
- Typhoid-like form of generalized yersiniosis
- Septic form of generalized yersiniosis
- Mononucleosis-like form
- Differential diagnosis of yersinial appendicitis and classic acute appendicitis
- Pathogenesis of the development of yersinial anicteric hepatitis
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