Symptoms of yersiniosis

Yersiniosis has an incubation period that lasts from 15 hours to 6 days, usually 2-3 days, after which typical symptoms of yersiniosis appear.

The variety of symptoms of yersiniosis does not allow for the development of a generally accepted classification of this disease. As a rule, the clinical classification of N.D. Yushchuk et al. is used, which is based on the syndromic principle.

Clinical classification of yersiniosis

Form of the disease	Clinical variant	Severity	Nature of the flow
Gastrointestinal	Gastroenteritis, enterocolitis, gastroenterocolitis	Light	Spicy
Abdominal	Mesenteric lymphadenitis, terminal ileitis, acute appendicitis	Average	Protracted
Generalized	Mixed, septic	Heavy	Chronic
Secondary focal	Arthritis(es), erythema nodosum, Reiter's syndrome, etc.,

In most cases, yersiniosis begins with symptoms of acute gastroenteritis, and then proceeds either as an acute intestinal or generalized infection. All forms of yersiniosis are characterized by an acute onset, fever, symptoms of intoxication, abdominal pain, bowel disorder, exanthema, myalgia, arthralgia, lymphadenopathy and a tendency to a wave-like course. In addition to manifest forms, there are erased ones, that is, when the symptoms of yersiniosis are practically absent. The course of the disease can be acute (up to 3 months), protracted (3-6 months) and chronic (over 6 months).

The gastrointestinal form (gastroenteritis, enterocolitis, gastroenterocolitis) is the most common. Most patients develop the gastroenteric variant of yersiniosis. The disease begins acutely, with symptoms of gastrointestinal tract damage and symptoms of intoxication. Patients are concerned about the following symptoms of yersiniosis: abdominal pain of varying intensity, constant or cramping in nature, localized in the epigastrium, around the navel, less often in the right iliac region. Stool is frequent, sometimes with an admixture of mucus and blood. Some patients experience catarrhal and dysuric symptoms, exanthema. Symptoms of "gloves" and "socks" are characteristic. On the 2nd-6th day of the disease, mainly on the hands, palms, feet, chest and thighs, a punctate, maculopapular or urticarial rash is found, after which peeling appears. Hyperemia or pallor of the skin of the face, scleritis, hyperemia of the conjunctiva and oral mucosa, polyadenopathy are noted. The tongue becomes "raspberry" on the 5th-6th day. When palpating the abdomen - local pain in the right iliac region, enlargement of the liver, less often - the spleen. The temperature normalizes on the 4th-5th day. There are no typical changes in the hemogram.

Yersiniosis often occurs in a moderately severe form. Sometimes the only clinical symptom of the disease is diarrhea. Recovery occurs in most cases in 1-2 weeks. A wave-like course, relapses and exacerbations are possible.

The abdominal form of yersiniosis develops in 3.5-10% of patients (mesenteric lymphadenitis, terminal ileitis, acute appendicitis). The most common variant is acute appendicitis. The onset of the disease is similar to the gastrointestinal form. However, after 1-3 days, pain appears (or intensifies) in the right iliac region or around the navel. The disease can begin with intense abdominal pain. Appendicular symptoms of yersiniosis are accompanied by fever and leukocytosis. Forms of appendicitis: catarrhal, phlegmonous or gangrenous.

Mesenteric lymphadenitis can develop with any form of yersiniosis, but its symptoms predominate in the abdominal form. Patients are bothered by mild pain in the right iliac region, occurring on the 2nd-4th day against the background of fever and diarrhea and persisting for up to 2 months. Sometimes painful mesenteric lymph nodes can be palpated to the right of the navel.

Terminal ileitis is characterized by fever, constant aching pain in the right iliac region, and enterocolitis. Laparoscopy reveals an inflamed and edematous distal ileum with mesenteric adenitis in the right lower quadrant of the abdomen. Terminal ileitis usually resolves within 2-6 weeks. The prognosis is favorable.

In patients with the abdominal form, exanthema, arthralgia and myalgia, peeling of the skin of the palms, fingers and toes, polyadenopathy, hepato- and hepatosplenomegaly are possible.

The abdominal form may be complicated by peritonitis, stenosis of the terminal ileum and adhesive disease. It may have a long course (several months and even years) with relapses and exacerbations.

The generalized form of yersiniosis can proceed according to a mixed or septic variant. The most striking symptoms of yersiniosis are observed in the mixed variant. Characteristically, severe damage to various organs and systems. Most often, the disease begins acutely. Fever and symptoms of intoxication develop in combination with catarrhal phenomena. Then dull pain in the epigastrium and around the navel, nausea appear. The stool becomes mushy or liquid, without pathological impurities; vomiting is possible. The febrile period usually lasts no more than 2 weeks. Polymorphic rash appears on the 2-3rd day of the disease and persists for 3-6 days, rashes and itching are possible. From the second week of the pathological process, peeling appears at the site of the rash. Arthralgia usually occurs in the first week, the pain varies in intensity and duration, and is wave-like. Large (knee, shoulder, ankle) and small (wrist, phalangeal) joints are affected. In some patients, the process is accompanied by inflammation of the plantar and/or calcaneal aponeurosis. Arthritis develops rarely. As a rule, there are no changes in the joints on the radiograph. Symptoms of "hood", "gloves" and "socks" are characteristic. tonsillitis, conjunctivitis and scleritis. Mild jaundice is possible. Dry wheezing may be heard in the lungs. Palpation of the abdomen often reveals pain in the right hypochondrium, right iliac region and below the navel. Polyadenopathy, hepatomegaly, and less often splenomegaly are common.

With a long course of the generalized form, stabbing pain in the heart area, palpitations, tachycardia (even at normal temperature) are possible. The pulse and blood pressure are labile. The ECG shows signs of infectious cardiopathy or myocarditis. The development of specific small-focal pneumonia, uveitis, iridocyclitis and an increase in symptoms of CNS damage (dizziness, sleep disturbance, lethargy, adynamia, negativism) are possible. In rare cases, meningeal syndrome is detected. Some patients complain of pain when urinating.

The course of the disease is favorable in most cases. Relapses and exacerbations are observed, which proceed more easily than the first wave of the disease, the symptoms of yersiniosis with local lesions predominate: arthralgia (arthritis) and abdominal pain.

The recovery period is usually long. At first, asthenovegetative disorders increase. In the generalized form, the development of yersiniosis myocarditis, hepatitis, pyelonephritis, meningitis (meningoencephalitis) and damage to the nervous system (vegetative dysfunction syndrome) is possible, characterized by a benign course and a favorable outcome.

The septic variant of the generalized form is rare and, as a rule, occurs in individuals with severe concomitant diseases and immunodeficiency states. The course does not differ from the course of sepsis of other etiologies. Mortality, reaching 60%, is due to ISS, diffuse ileitis with intestinal perforation, peritonitis. The recovery period is long.

The secondary focal form may develop after any other form of yersiniosis. The disease preceding it either proceeds subclinically, or the first manifestations and the focal lesions that arise are separated from each other by a long period (up to several years), during which the patient's health remains satisfactory. In these cases, the first symptoms of yersiniosis are damage to one organ (heart, liver, etc.).

Symptoms of secondary focal yersiniosis include arthritis, Reiter's syndrome, erythema nodosum, protracted or chronic enterocolitis, cervical lymphadenitis, ophthalmitis, conjunctivitis and osteitis. The most common variant is arthritic, which differs from the mixed variant of the generalized form by more intense and prolonged arthralgia (arthritis), which in most cases is preceded by dyspeptic symptoms and symptoms of intoxication. Most patients develop polyarthritis. Most often, the interphalangeal, wrist, intervertebral, scapuloclavicular and hip joints are affected, and in monoarthritis, the knee, ankle or elbow joints. Asymmetrical lesions of the lower limb joints and unilateral sacroiliitis are characteristic. The hemogram shows eosinophilia and an increase in ESR. Yersiniosis arthritis is often combined with carditis.

Most patients with secondary focal yersiniosis develop asthenic and vegetoneurotic reactions that are difficult to relieve.