Yersiniosis: expanding traditional ideas about diagnosis, treatment and medical examination of patients

Type of infection and route of infection

The causative agent of the disease is intestinal bacteria Enterobacteriaceae from the genus Yersinia. They are gram-negative rods up to 0.9 microns in size, growing on regular and depleted nutrient media. The most favorable temperature for them is in the range from +4 to +8 degrees, at which they are able to survive for a long time and actively reproduce on various foods. The mechanism of transmission of yersioniasis infection is close to pseudotuberculosis.

Some strains of bacteria are resistant to pasteurization, but boiling kills any of them within a few seconds. They are also sensitive to the effects of disinfectants. The peak incidence is usually observed in November and spring. People of any age are susceptible to the disease; yersiniosis is often found in children. Women are more resistant to pathogens than men.

Pathogens enter the human body through the fecal-oral or alimentary route, through a transfusion of contaminated blood, or directly under the skin through injury or injection. Transmission of intestinal yersiniosis infection can occur through contaminated foods that have not undergone heat treatment - meat, vegetables and milk, as well as water from open sources.

Symptoms of yersiniosis

The incubation period of yersiniosis pathogens lasts 1-6 days. Symptoms of yersiniosis are nonspecific. The disease is characterized by polymorphism of clinical manifestations:

begins acutely, with the appearance of chills, headaches, weakness and malaise;
possible pain in muscles and joints, sore throat, loss of appetite and insomnia;
body temperature is subfebrile, can sometimes rise to 38-40 degrees;
symptoms of general intoxication of the body are combined with signs of gastrointestinal damage - abdominal pain, nausea, diarrhea, vomiting;
the skin becomes dry and a scaly, dotted or small-spotted rash may appear on it;
Relative tachycardia and hypotension may occur;
During the course of the disease, symptoms are possible that indicate damage to various internal organs - dark urine, heaviness or pain in the right hypochondrium, etc.;
icteric staining of the sclera and skin indicates an enlarged liver; headaches may intensify over time, and focal and meningeal symptoms of central nervous system damage may appear;
damage to the genitourinary system is accompanied by pain during urination and a decrease in daily diuresis up to complete anuria;
as the disease progresses, pain in the abdominal area intensifies, signs of peritoneal irritation appear;
in the second week, signs of acute arthritis may appear with damage to large joints, swelling of the face and elements of urticaria, hyperemia and pain in the eyes.

Forms of yersiniosis disease and their complications

The clinical classification of yersiniosis has not yet been fully developed. Taking into account the leading syndrome, it is customary to distinguish 2 groups of clinical forms:

localized (gastroenterocolitic):
generalized (icteric, septic, exanthem and arthralgic).

The clinical picture of yersiniosis of the localized form is limited primarily to damage to the gastrointestinal tract; generalized forms are accompanied by damage to other organs and systems.

The gastroenterocolitic form of siniosis is the most common disease, accounting for almost 70% of all cases. The disease begins acutely, with an increase in temperature to 38-39 degrees, accompanied by headaches, anorexia, chills, malaise, abdominal pain and loose stools - up to 15 times a day. The duration of the disease is 2-14 days; severe forms are rare. It can occur in the form of enterocolitis, enteritis and gastroenterocolitis. In most cases, the syndrome of general intoxication is mild, abdominal pain is of low intensity, and the frequency of stools is 2-4 times per bowel movement.
The icteric form is a complication of yersiniosis and can develop simultaneously with the gastroenterocolitic form or 2-4 days after the onset of intestinal dysfunction. Signs of liver damage come to the fore, and toxic hepatitis develops. Patients complain of pain and a feeling of heaviness in the right hypochondrium, sometimes itching of the skin appears. The disease is accompanied by yellowness of the sclera and skin, the size of the liver increases, pain appears on palpation, discoloration of feces and darkening of urine are observed. Hypertransaminasemia and hyperbilirubinemia are determined.
The exanthema variety of the disease is manifested by exanthema and intoxication syndrome. With this form of yersiniosis, a rash appears on the skin on the 1st-6th day of illness; it can be dotted, large or small-spotted, with or without itching. After a few days, the rash usually disappears without a trace, and pityriasis-like peeling appears in its place.
The arthralgic form occurs with intoxication, fever and severe pain in the joints, which, however, do not change externally. Arthralgia can cause immobility and insomnia.
The septic type of the disease is quite rare and is the most dangerous, with mortality accounting for up to 30% of cases. It manifests itself as high fever with a daily range of up to 2 degrees, chills, enlarged liver and spleen. Damage to other organs is possible. The consequences of septic yersiniosis are endocarditis, nephritis with acute renal failure, pneumonia, hepatitis, meningitis, meningoencephalitis. Sometimes the result of a complication of yersiniosis is mocarditis - inflammation of the heart muscle. It is manifested by heart rhythm disturbances and tachycardia.
The secondary focal form can occur independently or as a complication of other forms. In the second case, primary and secondary signs of the disease can be separated by a long period of well-being. Secondary manifestations are signs of damage to individual organs, causing concomitant diseases - the liver, thyroid gland (autoimmune thyroiditis), joints (arthritis), meninges (meningitis).

Complications of yersiniosis most often occur in the second or third week of the disease. Among them: exanthema (erythema nodosum, urticaria), arthritis of the joints (usually large ones), Quincke's edema, myocarditis, urethritis, appendicitis and conjunctivitis.

If you experience similar symptoms, consult your doctor

. It is easier to prevent a disease than to deal with the consequences.

Yersiniosis - what is it?

Yersiniosis is an acute infectious disease that leads to damage to the gastrointestinal tract and negative effects on other human organs and systems.

Type of infection and route of infection

Diagnosis of yersiniosis

Diagnosis of yersiniosis is carried out on the basis of the symptoms of the onset of the disease - fever, intoxication and signs of an acute form of gastroenterocolitis in combination with jaundice, exanthema and arthralgia. The most common are enteritis, terminal ileitis, enterocolitis and mesadenitis. Less common forms are sepsis, tonsillitis and secondary foci of infection.

Enteritis and enterocolitis are the most common, they manifest themselves in inflammation of the large and small intestines, accompanied by loose, foul-smelling stools up to 10-15 times a day, sometimes with mucus and blood. The duration of diarrhea, depending on the severity of the disease, ranges from 1 day to several months. In most cases, the temperature remains low-grade - about 37.5 degrees, sometimes it can rise to 39-40 degrees.

Almost all forms of the disease are accompanied by enlarged lymph nodes. Pathogens are able to concentrate in the lymph nodes with the formation of microabscesses - purulent inflammations. To confirm the diagnosis, tests for yersiniosis are performed.

Tests for yersiniosis

Diagnosis of yersiniosis is based on bacteriological and serological research methods. The culture technique is the same as for pseudotuberculosis. For the purpose of laboratory confirmation of the diagnosis, cultures of feces, cerebrospinal fluid and blood are performed on nutrient media. From a series of serological methods, agglutination reactions, latex agglutination, indirect hemagglutination with erythrocyte diagnostics and enzyme-linked immunosorbent assay are used.

In uncomplicated forms of the disease, laboratory data are not specific. The leukocyte level is normal or slightly increased. ESR in reactive arthritis can reach 100 mm/h, but antinuclear antibodies and rheumatoid factor are usually absent. Blood, lymph node tissue, cerebrospinal fluid, peritoneal fluid, and abscess contents are subjected to standard clinical microbiology techniques.

Differential diagnosis is carried out taking into account the clinical picture of the disease. Its primary goal is to exclude acute intestinal infections, various joint diseases, viral hepatitis, acute appendicitis and sepsis of other etiologies.

When X-ray studies of the intestinal area, a sharp narrowing of the affected part of the ileum is observed, the relief of the mucous membrane is often smoothed (the so-called “cord” symptom). At the following stages, it is possible to develop a granulomatous-ulcerative lesion in the ileum, which is morphologically indistinguishable from Crohn's disease.

The presence of yersiniosis is signaled by the accelerated positive dynamics of clinical signs and morphological changes in the terminal ileum during treatment with antibacterial drugs, while glucocorticoids and mesalazine are effective in Crohn's disease.

Difficulties may arise in the differential diagnosis of hepatitis of viral etiology and yersinia hepatitis. Yersiniosis hepatitis can manifest itself both as an independent variant and in a generalized form of yersiniosis. From the first stages of the disease, an increase in the blood bilirubin content and pronounced signs of intoxication are observed, while the activity of transaminases slightly increases.

Yersiniosis: expanding traditional ideas about diagnosis, treatment and medical examination of patients

Yersiniosis is widespread in the Russian Federation, and the consistently low level of officially registered incidence does not reflect the true state of the problem. Yersiniosis has now gone beyond the scope of a purely infectious pathology, becoming a therapeutic problem due to the “weak” laboratory base used in practical healthcare, problems in choosing treatment tactics and rehabilitation of patients. Clinicians are particularly concerned about the adverse consequences of yersiniosis, in particular, the chronicity of the infectious process and the formation of systemic autoimmune diseases as a result of the disease [1].

Although in recent years the clinical manifestations of the disease, including the chronic course, have been described in sufficient detail, and significant adjustments have been made to the understanding of the links of immunopathogenesis, practicing doctors know how difficult it is to make a diagnosis, and most importantly, to select treatment for patients that is adequate to the stage of the disease.

As our experience shows, patients with yersiniosis, due to the polymorphism of clinical manifestations of different periods of the disease, are often referred not to an infectious disease specialist, but to doctors of other specialties (gastroenterologists, rheumatologists, endocrinologists, hematologists, etc.), each of whom makes a diagnosis, in fact, being syndromic, and, as a result, prescribes only symptomatic treatment. This statement is based on data from long-term monitoring of yersiniosis survivors, according to which recurrent course among hospitalized patients is recorded extremely rarely (1.3%) and does not correspond to real data on the true frequency of relapses (from 15.8% to 44% in different years).

Apparently, such a rare hospitalization of these patients is associated with the lack of long-term outpatient follow-up of patients who have had yersiniosis, as a result of which, after discharge from the hospital, they fall out of the field of view of the infectious disease specialist, and developing relapses are mistakenly interpreted by other specialists. However, it is early diagnosis and timely treatment that is given the leading role in the prevention of post-yersinia immunopathological diseases, leading to a long-term decrease in performance and disability of patients.

Diagnostic drugs and test systems widely used in practical medicine have rather low sensitivity and efficiency [2, 3]. Long-term monitoring of the diagnosis of “yersiniosis” in patients hospitalized at ICH No. 2 in Moscow has shown that over the past ten years the number of erroneous diagnoses of “yersiniosis” has been steadily increasing, which leads to unnecessary antibiotic therapy and long-term disability of patients. Thus, at the prehospital stage, 57.6% (ranges from 50.9% to 66.3% in different years) of patients are mistakenly diagnosed with yersiniosis, and the patients do not receive adequate treatment in specialized departments of general clinical hospitals.

In the infectious diseases hospital, 42% of these patients had other infectious diseases as their final diagnosis (acute intestinal infections, ARVI, enteroviral diseases, infectious mononucleosis, hemorrhagic fever with renal syndrome, viral hepatitis, generalized chlamydia, leptospirosis, HIV, brucellosis, tularemia, etc. .) and 58% had non-infectious pathology. Of particular concern is yersiniosis, which is misdiagnosed at the prehospital stage in 5.7–15.2% of patients with acute surgical pathology requiring emergency surgical intervention [4, 5].

One cannot but agree with the opinion of V. A. Orlov et al. (1991) that “most diagnostic errors are due to an incorrect approach to the diagnostic process.” Apparently, only this can explain the fact that over the course of ten years, 2.9–9.1% of patients with suspected yersiniosis are eventually diagnosed with heart and vascular diseases, and 2.8–6.4% with intestinal tumors , lungs and pelvic organs, in 2.9–7.1% - Hodgkin lymphoma, lympho- and myeloid leukemia, in 2.8–6.1% - diseases of the endocrine system (toxic goiter, thyrotoxicosis, autoimmune thyroiditis), in 2 1–12.1% - inflammatory diseases of the genital organs.

In our opinion, one of the main reasons for diagnostic errors leading to both under- and overdiagnosis of yersiniosis is the low information content of insufficiently specific techniques and diagnostic tools, as well as non-compliance with existing recommendations for the diagnosis of yersiniosis. In the Russian Federation there are modern diagnostic drugs, methods and culture media for the indication and identification of Yersinia enterocolitica and antibodies to them, but the system of their use is not unified, and the assessment of specificity is imperfect.

Laboratory diagnosis of yersiniosis should include bacteriological, immunodiagnostic and serological methods. The main method is bacteriological - seeding the patient’s biological material (feces, urine, washings from the back of the throat, blood clot, sputum, bile, cerebrospinal fluid, surgical material, etc.), material from the external environment and from animals on nutrient media to detect Y growth enterocolitica followed by culture identification. At least four materials must be tested (for example, feces, urine, blood, pharyngeal wash). The optimal time for collecting material is the first 7–10 days of illness. It is extremely rare to obtain a culture of Y. enterocolitica from material from patients with prolonged course and secondary focal forms of yersiniosis.

The main disadvantages of the bacteriological method are the low frequency of obtaining culture growth - on average in the Russian Federation, Y. enterocolitica is isolated in 2-3% of samples, 0.81%, and retrospectiveness (the final result is on the 21-28th day of production) [2]. For more than ten years, in the bacteriological laboratory of the IKB No. 2 in Moscow, it was possible to isolate Y. enterocolitica in only 0.2% of the samples taken (only in the generalized form of yersiniosis), which is consistent with the data of the GSEN center in Moscow and is four times worse, than in the Russian Federation as a whole [2, 3].

Immunodiagnostic methods make it possible to detect Y. enterocolitica antigens in clinical material up to the 10th day from the onset of the disease (enzyme-linked immunosorbent assay (ELISA), coagglutination reaction (ICA), immunofluorescence reaction (RIF), indirect immunofluorescence reaction (IRIF), agglutination and lysis reaction ( RAL)). According to manufacturers, the sensitivity of test systems reaches 104–105 m cells/ml, and the efficiency of testing coprofiltrate and serum in the first five days of illness is 83–85%. Promising methods are methods for indicating and identifying pathogenic Y. enterocolitica by a set of phenotypic characteristics associated with its pathogenicity determinants (API test systems (sensitivity 79%) and genetic methods for diagnosing and typing Yersinia (polymerase chain reaction (PCR), multiprimer PCR) .The advantages of PCR include the speed of analysis (up to 6 hours), information content, high sensitivity and specificity. However, in practical medicine, the specificity of this reaction turned out to be the most vulnerable. The immunoblotting method, which makes it possible to detect and identify proteins (antigens) of Yersinia using antisera, in RF is used unreasonably rarely.

To determine specific antibodies to Y. enterocolitica antigens, serological methods are used. The study must be carried out from the 2nd week of illness in paired sera with an interval of 10–14 days. A 2–4-fold dynamics of antibody titer in paired sera is desirable, which, however, is not always observed in practice. At the onset of the disease, the most informative reaction is ELISA with determination of IgA, IgM and IgG, ELISA; at 3–4 weeks - ELISA, ELISA, agglutination test (RA), RSC, A-BNM. For the qualitative determination of IgA and IgG class antibodies to the virulence factors of pathogenic strains of Y. enterocolitica, you can use the immunoblotting method, which is used for the differential and retrospective diagnosis of yersiniosis. In the chronic course of yersiniosis, ELISA with the determination of IgA and IgG and immunoblotting are informative.

Despite the large number of test systems offered and various companies guaranteeing a high frequency of detection of yersinia antigens or antibodies to them (up to 85%), in practical health care the indirect hemagglutination test (IRHA) and RA are more often used, which actually makes it possible to diagnose yersiniosis only in every fourth patient (25.3%): with the abdominal form - in 41.7% of patients, with the generalized form - in 21.1% of patients, with the secondary focal form - in 30.8% of patients. It is extremely rare that serological methods confirm the gastrointestinal form of yersiniosis (4.5%). There is no reliable relationship between the level of antibodies to Yersinia and the severity of yersiniosis.

Quite often (21.1% of cases), attending physicians interpret a single detection of specific antibodies to Y. enterocolitica in the blood of patients as laboratory confirmation of yersiniosis. However, in the majority of patients (54.1%), the titer does not exceed 1:200, which means it cannot be considered laboratory confirmation of the clinical diagnosis. The explanation for this lies in the intensive circulation of Yersinia in the environment and among the population. According to materials from the GSEN centers in the Russian Federation, when examining healthy individuals, specific antibodies to Y. enterocolitica are detected in 0.4–4.4% of samples [2]. However, the immune layer among the population is much higher - 18.2–19.6% [6, 7].

Antibody titers to Y. enterocolitica in the direct hemagglutination reaction (DHR) and RA above 1:200 are recorded only in 45.9% of patients. However, a one-time blood test using the mentioned methods, even with a high titer, cannot be unambiguously interpreted as yersiniosis. Thus, in our practice there was a patient with severe articular syndrome, during a dynamic blood test of which antibodies to Y. enterocolitica using the RA method were at a constant level of 1:102,400, which only indicated that she had suffered yersiniosis and was not an indication for prescribing antibacterial therapy.

Analyzing the general recommendations for laboratory diagnosis of yersiniosis and the current situation in practice, we can state that laboratory diagnosis of the disease remains at the level of the early 90s. The reasons lie not only in the use of insufficiently effective methods, but also in non-compliance with existing recommendations for diagnosing yersiniosis. Thus, in most cases, when making a diagnosis, practitioners rely on a single examination of material taken from the patient and the titer of antibodies to Y. enterocolitica. However, the serological criterion for the diagnosis of “yersiniosis” should be considered not so much the achievement of the “diagnostic” titer of specific antibodies, but rather its dynamics when studying paired sera with an interval of 10–14 days. To increase the efficiency of diagnosing yersiniosis, we recommend examining the blood serum of patients with yersiniosis using at least three methods (for example, RNGA, RSK and ELISA, etc.).

Pathogenesis of yersiniosis. The choice of management tactics and drug treatment for patients with yersiniosis directly depends on the pathogenesis of different stages of the disease. It is known that the nature of the interaction of Y. enterocolitica with the macroorganism depends on the set of pathogenicity factors of the strain, the dose of the infection, the route of administration and the immunological reactivity of the macroorganism. Taking into account the available experimental data, the pathogenesis of yersiniosis in humans can be presented as follows. Y. enterocolitica enters the human body orally, and the disease develops after a fairly short incubation period - from 15 hours to 6 days (on average 2-3 days). The bulk of Yersinia overcomes the protective barrier of the stomach. In the stomach and duodenum, catarrhal-erosive, less commonly, catarrhal-ulcerative gastroduodenitis develops. Then the development of the pathological process can go in two directions: either local inflammatory changes will occur in the intestine, or a generalized process will develop with lympho- and hematogenous dissemination of Y. enterocolitica.

If the disease is caused by serotypes of Y. enterocolitica, which have pronounced enterotoxigenicity and low invasiveness, then, as a rule, processes localized in the intestine develop, the manifestations of which will be damage to the gastrointestinal tract (catarrhal-desquamative, catarrhal-ulcerative enteritis and enterocolitis) and intoxication.

If Y. enterocolitica penetrates the mesenteric nodes, the abdominal form develops. The pathomorphology of yersinia lymphadenitis is a combination of infectious, inflammatory and immunological processes. In the appendix, the inflammatory process is often catarrhal in nature, but the development of a phlegmonous process with subsequent destruction of the appendix and the development of peritonitis is possible. Gastrointestinal and abdominal forms of yersiniosis can be either independent or one of the phases of the generalized form.

There are two known ways of generalization of the yersinia process - invasive and non-invasive. The invasive route of entry of Y. enterocolitica through the intestinal epithelium is the classic and best studied. If the infection is caused by a highly virulent strain of Y. enterocolitica, then a non-invasive route of penetration through the intestinal mucosa inside the phagocyte is possible.

During the period of convalescence, the body should be freed from yersinia and the impaired functions of organs and systems should be restored, resulting in clinical and laboratory recovery. However, such a favorable development of events is possible only with an adequate immune response and the absence of immunogenetic and epigenetic markers of an unfavorable outcome. Dispensary observation of convalescents for five years after acute yersiniosis showed that the outcomes of yersiniosis can be:

1) clinical and laboratory recovery (55.2%);

2) unfavorable outcomes (29.2%):

a) with the formation of a chronic course (57%);

b) with the formation of pathological conditions and diseases of an autoimmune nature (43%);

3) relatively unfavorable outcomes with a predominance of the infectious and inflammatory component (10.5%):

a) with exacerbation of chronic inflammatory diseases (35.5%);

b) with the formation of new diseases with a predominance of the infectious-inflammatory component (64.5%);

4) residual effects (short-term low-grade fever, periodic myalgia and arthralgia, neurological symptoms involving nerve plexuses and roots, autonomic reactions, asthenic and hypochondriacal syndromes, the phenomenon of interoception, etc.) (5.1%).

The best prognosis is for patients aged 19–25 years. Among them, 71% recover. At the same time, 45% of survivors aged 26–45 years develop pathological conditions of various origins that are included in the category of unfavorable outcomes of yersiniosis.

According to our data, doctors diagnose secondary focal forms of yersiniosis more often than they actually form. This is due to the absence of pathognomonic clinical manifestations of secondary focal forms of yersiniosis and their systemic nature. The group of patients with the so-called secondary focal form of yersiniosis is not homogeneous. This group often unreasonably includes both patients with a pathological process of yersiniosis etiology (for example, the chronic course of yersiniosis), and patients with a chronic course of post-yersiniosis infection, with emerging new acute processes of non-yersinia etiology and patients with autoimmune pathology. This state of affairs requires special attention and analysis of clinical and laboratory parameters from the practicing physician, since further treatment tactics, and therefore the outcome of the entire pathological process, depend on their understanding.

In patients with chronic yersiniosis, Y. enterocolitica continues to circulate in the body for a long time. According to our data, the chronic course of yersiniosis develops in 16.6% of patients and is more often observed in people over 25 years of age. The “shelter” of pathogens is the lymph nodes, small intestine and cells of the macrophage-monocyte series. Activation of foci of infection can clinically manifest itself in the form of urethritis, nephritis, enteritis, meningitis, etc. From the foci, Yersinia antigens enter the blood as part of immune complexes, causing reactive arthritis, damage to the kidneys, intestines, organs of vision, etc. Slowing the speed of blood flow in the tissues - targets creates favorable conditions for the deposition of Y. enterocolitica antigens. A criterion for the persistence of the pathogen can be considered long-term (more than 6 months) circulation of specific IgA to Yersinia lipopolysaccharide.

Among the diseases that are of an autoimmune nature and are the outcome of yersiniosis, seronegative spondyloarthropathy (usually reactive arthritis and Reiter's syndrome), rheumatoid arthritis, autoimmune thyroiditis and Crohn's disease predominate.

Treatment of patients with yersiniosis and pseudotuberculosis should be comprehensive, pathogenetically substantiated and carried out taking into account the clinical form and severity of the disease (

), (

). The most important task is to relieve symptoms of the acute period and prevent adverse outcomes of the disease. Hospitalization of patients with yersiniosis is carried out according to clinical and epidemiological indications. For mild and uncomplicated moderate cases, treatment at home is allowed. According to epidemiological indications, patients belonging to the decreed group (military personnel, workers of water utilities, catering departments, etc.) are hospitalized.

For dietary nutrition, tables No. 4, 2 and 13 are used. Antibacterial therapy is prescribed for 10–14 days (for the gastrointestinal form it can be limited to seven days) to all patients, regardless of the form of the disease, as early as possible (preferably before the third day of illness) [8] .

The choice of drug depends on the antibiotic sensitivity of Yersinia strains circulating in a given area (determined twice a year). Currently, preference is given to fluoroquinolones and third-generation cephalosporins [9, 10].

The main direction of pathogenetic therapy for the gastrointestinal form of yersinia infection is oral (parenteral) rehydration and detoxification with polyionic solutions.

The treatment tactics for patients with the abdominal form are agreed with the surgeon. The surgeon decides whether surgical intervention is necessary. Before and after surgery, etiotropic and pathogenetic treatment is carried out in full.

In the generalized form, etiotropic drugs, in most cases, are prescribed parenterally. In generalized forms with symptoms of pyelonephritis, pefloxacin has proven itself well - 0.8 g/day. Levomycetin succinate is used for the development of meningitis of yersinia etiology (7–100 mg/kg per day). In severe cases of the generalized form, several courses of parenteral antibiotic therapy are carried out. Start with gentamicin - for 2-3 days at 2.4-3.2 mg/kg per day, then 0.8-1.2 mg/kg per day. In the absence of a therapeutic effect or drug intolerance, streptomycin sulfate is used at a dose of 1 g/day. If hepatitis develops, you should avoid prescribing medications that have a hepatotropic effect. For patients with a septic form of the disease, it is advisable to administer two or three antibiotics of different groups (fluoroquinolones, aminoglycosides, cephalosporins) intravenously. If antibacterial therapy is ineffective, L. A. Galkina, L. V. Feklisova (2000) recommend using polyvalent yersinia bacteriophage (50.0–60.0 ml 3 times a day, No. 5–7) as monoetiotherapy or in combination with antibiotics [eleven].

In addition to etiotropic treatment, pathogenetic therapy is indicated (detoxification, restorative, desensitizing drugs, stimulants). In complex therapy, agents for the treatment of dysbiotic disorders must be used.

Most patients with severe asthenic, vegetative and neurotic manifestations require taking nootropic drugs, tranquilizers, bromides, peony infusion, motherwort tincture, valerian root decoction, etc. The selection of therapy in such cases is coordinated with a neuropsychiatrist and a vegetarian.

Treatment of patients with a secondary focal form of yersiniosis is carried out according to an individual scheme for each patient. Antibacterial drugs have no independent significance, but should be prescribed when clinical and laboratory signs of intensification of the infectious process appear and there is no history of taking antibiotics. Treatment of patients is coordinated with a rheumatologist, gastroenterologist, endocrinologist, psychoneurologist and other specialists (as indicated). Immunocorrectors should be prescribed to patients strictly according to indications in the absence of laboratory signs of an autoimmune process based on the results of a study of the immune status and autoantibodies in the patient’s blood.

Dispensary observation of convalescents. There is still no consensus on the duration and tactics of dispensary observation of convalescents of yersiniosis and pseudotuberculosis. In accordance with the orders and guidelines of the Ministry of Health (Order No. 408 of 1989; Appendix 6 to the Order of the Ministry of Health of the Russian Federation of September 17, 1993 No. 220 “Regulations on the office (department) of infectious diseases”, etc.), monitoring of convalescents of yersinia infection is carried out in depending on the nosology and severity of the disease for 1–6 months after discharge from the hospital (for mild forms - one month, for moderate forms - three months, for severe forms - six months).

Some researchers recommend using the following indicators to predict unfavorable outcomes of yersiniosis: unfavorable premorbid background (chronic diseases, grade 3-4 dysbiosis, burdened allergic history, etc.), long-lasting decrease in albumin, alpha proteins, urea-ammonia ratio, dysproteinemia, increased concentration blood ammonia, fibrinogen, neutrophilia, monocytosis, lymphocytosis, eosinophilia, low activity of the complement system, decreased levels of T- and B-lymphocytes in the period of convalescence and nonspecific resistance factors, high levels of circulating immune complexes (CIC), the presence of HLA B7, B18 and B27 , O (I) blood group.

However, dynamic observation of patients who have had yersiniosis and the use of modern methods of statistical processing of clinical and laboratory parameters allow us to express the opinion that the clinical manifestations of yersiniosis and pseudotuberculosis, their severity and duration are not objective criteria for prognosis, and therefore cannot be used for prognosis course and outcome of the disease. The immunoprognostic testing algorithm we created (

) patients in the acute period of the disease and the developed set of criteria for assessing immunograms for yersiniosis enable doctors to predict an unfavorable course and outcome already in the first 2–4 weeks from the onset of the disease [12, 13].

In our opinion, if the patient does not have criteria for adverse outcomes of yersiniosis infection, dispensary observation of convalescents is recommended for one year after discharge from the hospital. If there are indicators of possible adverse outcomes of yersiniosis, dispensary observation should be carried out for five years after discharge from the hospital - the first year every 2-3 months, then once every six months in the absence of complaints and deviations in health. In the presence of clinical and laboratory problems - more often, as necessary. According to indications, patients should undergo clinical, laboratory and instrumental examination by a rheumatologist, endocrinologist, cardiologist, ophthalmologist, dermatologist, etc.

The tactics of medical examination of patients with yersiniosis are not regulated at all by orders of the Ministry of Health of the Russian Federation. Based on our own results of long-term observation of patients with yersiniosis, we recommend the following tactics for their clinical examination. After discharge from the hospital, the duration of clinical observation for survivors of yersiniosis and pseudotuberculosis in the absence of genetic and immunological prognostic criteria for adverse outcomes should be one year, and if they are present, at least three years. To monitor the completeness of recovery, it is recommended to use the following scheme: during the first year after the acute period, patients must be examined comprehensively (clinical, laboratory, immunological methods) every 2–3 months, then once every six months in the absence of complaints and deviations in health. In the presence of clinical and laboratory problems - more often, as necessary. According to indications, during clinical examination, patients should be consulted with other specialists (rheumatologist, gastroenterologist, endocrinologist, cardiologist, ophthalmologist, dermatologist, gynecologist and gynecologist-endocrinologist) with the necessary laboratory and instrumental studies.

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I. V. Shestakova , Doctor of Medical Sciences, Associate Professor N. D. Yushchuk , Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Medical Sciences MGMSU , Moscow

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Treatment of yersiniosis

How to treat yersiniosis is determined for each patient by the doctor individually. Treatment of yersiniosis is prescribed depending on the form of the disease and its clinical picture. Uncomplicated forms of intestinal yersiniosis require treatment with etiotropic drugs and detoxification therapy for 7-10 days, depending on the severity of the patient’s condition, orally or parenterally.

Yersiniosis is also treated with antibiotics. The septic form of yersiniosis, secondary foci of infection and intestinal forms of the disease against a background of weakened immunity are treated with 2-3 types of antibacterial agents for 12-14 days, with detoxification therapy and the prescription of drugs that promote rehydration. If necessary, probiotics and multienzyme preparations can be used.

Prevention of yersiniosis

Specific prevention of yersiniosis has not yet been developed. All preventive measures are based on the epidemiological characteristics of the infection. They come down to the fight against rodents as the main carriers of infectious diseases. In vegetable stores, warehouses and stores, rodents are periodically exterminated. In order to timely identify individuals with yersiniosis among domestic animals and birds, scheduled and extraordinary veterinary examinations are periodically carried out on farms. Dairy plants establish control over the processing of dairy products.

When storing fruits and vegetables, attention is paid to the quality of preventive measures for disinfection and deratization of vegetable stores when a new crop arrives. Current disinfection and deratization is carried out in winter and autumn. Places for storing any products that are not subject to heat treatment are subject to careful control; catering establishments monitor compliance with the technological and sanitary regime during storage and preparation of food. In the event of a separate disease or outbreak, the food enterprise from which the product that caused the infection came is identified.

In medical institutions, the prevention of yersiniosis is based on compliance with the anti-epidemic and sanitary regime adopted for intestinal infections. Along with sanitary measures, timely identification of relatives and medical personnel infected while caring for sick people is important.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.