Symptoms of pseudotuberculosis in children: description of periods

The incubation period of pseudo-tuberculosis lasts from 3 to 18 days. The disease begins acutely, with a rise in body temperature to 38-40 °C, and only in isolated cases - gradually or subacutely. From the first days of the disease, children complain of general weakness, headache, insomnia, poor appetite, sometimes chills, muscle and joint pain. Some children at the beginning of the disease have mild catarrhal symptoms in the form of nasal congestion and cough. Pain when swallowing, a feeling of irritation and sore throat are also possible. Patients with pronounced initial symptoms of intoxication experience dizziness, nausea, vomiting, abdominal pain, mainly in the right iliac region or in the epigastrium. In some cases, there is loose stool 2-3 times a day of the enteritis type.

Characteristic features are puffiness and hyperemia of the face and neck, which contrasts with the pale nasolabial triangle. Conjunctival hyperemia and scleral vascular injection are typical, less common is herpetic rash on the lips and wings of the nose. Most patients have hyperemia of the mucous membranes of the tonsils, sometimes very bright and often delimited from the hard palate. The mucous membrane is edematous, sometimes enanthem is observed. The tongue in the initial period is densely coated with a grayish-white coating, from the 3rd day of the disease it begins to clear and becomes crimson, papillary. From the first days of the disease, some patients experience joint pain, enlarged liver and spleen.

The height of pseudotuberculosis

Symptoms of pseudo-tuberculosis progress and reach their maximum on the 3rd-4th day. In some patients, the hood symptom is detected during this period - hyperemia of the face and neck with a cyanotic tint, the glove symptom - a delimited pink-blue coloration of the hands, the socks symptom - a delimited pink-blue coloration of the feet.

A rash is observed on the skin of the trunk in 70-80% of patients. It can appear from the first days of the disease, but most often occurs during the peak period. The rash appears at one time, and can be either pinpoint, reminiscent of scarlet fever, or spotty. The color of the rash ranges from pale pink to bright red. The background of the skin can be either hyperemic or unchanged. Larger rashes are located around large joints, where they form continuous erythema. A combination of scarlet fever-like and maculopapular rash is observed in about half of the patients. The rash is large-spotted, in some patients hemorrhagic, sometimes accompanied by itching of the skin. With a long course of the disease or its relapses, elements of nodular erythema appear on the shins, less often on the buttocks.

The rash in pseudo tuberculosis is usually localized in the lower abdomen, in the armpits and on the lateral surfaces of the body. As in scarlet fever, there is white persistent dermographism. Pastia symptoms (dark red color of skin folds), pinching symptoms, tourniquet are usually positive. The rash lasts no more than 3-7 days, but sometimes with weak expression - only a few hours.

At the height of the disease, more than half of patients experience arthralgia, but there may be swelling and pain in the joints. The wrist, interphalangeal, knee and ankle joints are usually affected. Intestinal disorders occur infrequently, with a slight increase in the frequency and loosening of stools, while maintaining a fecal character. Changes in the gastrointestinal tract in some patients can be pronounced with the development of symptoms of terminal ileitis or acute appendicitis.

In pseudo-tuberculosis, the liver and spleen are often enlarged, sometimes there is icterus of the skin and sclera. The amount of direct bilirubin in the blood serum is increased, the activity of hepatocellular enzymes (ALT, AST, etc.) is increased, sediment tests are positive. Less often, a picture of acute cholecystitis or angiocholecystitis develops.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]