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. 1885

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History of studies of Yersinia
For the first time pseudotuberculosis pathogens were discovered in 1883 by scientists and
Malassa Vinem. In 1885, Enberg, analyzing morfoligicheskie changes that evolved in the
diseased tissue, noted the similarities with tuberculosis (although, unlike them, granulomas are
not specific obyzvestlyalis their caseous degeneration occurs quickly and is surrounded by
granulomas was no giant cells). Therefore, this bacterium was named pseudotuberculosis. Its
morphology was described in detail in three years. Later, the researcher Zlatogor identified
cultural, and biohomicheskie imunologicheskie similarity with the agent of plague. 1923
psevdotuberuklez was discovered in the U.S. and its designated as an atypical strain Posterella
pseidotuberculosis. In 1959 in Vladivostok pseudotuberculosis fell ill more than 300 people.
Illness accompanied by fever, rash, lesions of the joints and held in a similar manner with scarlet
fever. However, this diagnosis was not confirmed, and the disease has been conventionally called
Far skarlatinopodobnoy fever. Such a fever were also found in the Khabarovsk Territory, Amur
region, Sakhalin. To date, we know that this disease is widespread. In 1966, Professor VMA
Znamenskii establish the etiology of fever with experience in self-infection. In 1972 an
international committee on taxonomy of the bacteria identified a new generic name of Yersinia.
To it were added agents of plague, as well as yersiniosis pseudotuberculosis (yersinia
pseudotuberculosis).
Etiology
Yersiniosis - infectious diseases related to zoonoses. There are 7 species of Yersinia. Of those
pathogenic to humans are the three types. This agent of plague (Yersinia pestis), the agent of
pseudotuberculosis (Yersinia pseudotuberculosis), the agent of intestinal yersiniosis (Y.
Enterocolitica).
By biochemical and cultural properties Y. Y. enterocolitica is close to pseudotuberculosis.
Yersinia have the antigenic relationship of Salmonella, Shigella, Escherichia, Proteus, as well as
V. cholerae, pathogens of tularemia and brucellosis.
Infectious disease yersiniosis is named in honor of Yersena.
The disease can occur under the guise of dysentery, hepatitis, scarlet fever, appendicitis, catarrh
of the upper respiratory tract.
Biochemical activity is much higher in Yersinia enterocolitica than Yersinia pseudotberculosis.
Distinguish five biochemical variants Yersinia enterocolitica, the disease occurs when infected
with 2, 3, 4 biovar. With the destruction of microbial cells secrete endotoxin. 1 and 3 serovars
Yersinia pseudotberculosis produce exotoxin. Yersinia pathogenicity factors have a set that is
capable of adhesion, invasion and intracellular parasitism. These properties are expressed to a
greater extent in Yersinia pseudotberculosis. Yersinia pseudotberculosis more virulent than
Yersinia enterocolitica. Pathogen different polymorphism of bipolar coloring gramotritsatvlen,
capsules and spores are not formed.
Very resistant to low temperature. In the water at a temperature of 18-20 degrees to survive more
than 40 days if the temperature drops to 4 degrees - live 250 days. May persist in food products
(milk, bread). Particularly well preserved in fresh vegetables (carrots, apples) - up to 2 months.
In the faeces of frozen stored up to 3 months and at room temperature for 7 days. Not tolerate
drying and heating. At temperatures above 60 degrees are killed in 30 minutes, up to 100 degrees
- are killed immediately.
Sensitive to the disinfectant in the working concentration.
Have 2 antigen - 0 (somatic) and N. Yersinia pseudotberculosis have 2 antigen: S and R.
By S-antigen, they are divided by 6 and the latest data on 8 serovars. In 90% of the strains
isolated from human belong to the first serovar, and 9% for the third serovar.
R-antigen is shared with Yersinia pestis.
Yersinia enterocolitica has 50 serovars. In human pathology are important serovars O3, O5, O8,
O9.
These pathogens are sensitive to antibiotics of the group chloramphenicol, aminoglycosides,
tetracycline, cephalosporin. To penicillin and erythromycin are not sensitive
Symptoms of yersiniosis
Form of the disease:
icteric (dif. diagnosed with hepatitis)
meningeal
catarrhal
Gastrointestinal
Abdominal (appendicular, psevdoappendikulyarnaya)
Septic or generalized
Secondary focal
arthritic
Artralgicheskaya
Gastroenterokoliticheskaya
exanthematous
Skarlatinopodobnaya
All forms share some common features: acute onset, the temperature rises to 38-40 Tepa oz.
fever, intoxication, abdominal pain, upset his chair, skin rash, pain in joints and muscles, an
increase of peripheral lymph nodes and liver, a tendency to undulating course of exacerbations
and relapses. The disease can be acute (up to 3 months.) Prolonged (up to 6 months.) And
chronic (6 months ago., 1,5 - 2 years).
There may be nausea and vomiting, foul-smelling liquid stools up to 10 times a day. May be an
admixture of mucus, blood usually does not happen. In contrast, no dysentery and tenesmus,
false desires, spasm and pain cribriform cancer. When appendicular form, in addition, symptoms
of appendicitis (and sometimes pus). Leukocytosis, ESR increased.
The leading symptom is abdominal pain. She is so strong that some patients diagnosed "acute
abdomen" and they fall under the supervision of a surgeon.
Yersiniosis must be differentiated from other etiologies gastroenterocolitis (dysentery,
salmonellosis, esherihiozy) pseudotuberculosis appendicitis.
Icteric or developed in conjunction with gastroenterokoliticheskoy or after 2-3 days after bowel
dysfunction. In this form to the foreground the symptoms of liver damage, toxic hepatitis
develops. Complaints of heaviness and pain in the right upper quadrant, sometimes itchy skin.
Appears yellowness of skin and sclera. Liver was enlarged, painful on palpation. Noted dark
urine, discolored stool. Hyperbilirubinemia is defined and hyper-transaminazemiya.
Diff. diagnosed with hepatitis:
Jaundice is moderate, bilirubin (direct) increased 3-fold
ALT levels increased moderately (10 times)
sublimate and thymol in normal
Blood - netstrofillez, left shift, increased sedimentation rate
The fever is not reduced, after the onset of jaundice
Your urine is dark, and feces - normal (since no strong liver)
Pain in the projection of the lymph nodes
If the form is mixed (often icteric + abdominal) - the relevant symptoms (enteritis).
Catarrhal form
The diagnosis is very rare (for example - in the family yersiniosis (intestinal), and one - the flu,
so that's probably - it's not the flu, but simply a catarrhal form of yersiniosis (fever of more than
5 days)). Specific symptoms, NO.
Gastrointestinal form is predominant in adults. The beginning is usually acute, in some cases,
sub-acute or gradual. Symptoms of lesions of the gastrointestinal tract and symptoms of
intoxication. Patients concerned about abdominal pain of varying intensity, periodic or cramping,
localized in the epigastric region or around the navel, marked nausea, repeated vomiting,
abdominal distension. Chair from 4-5 to 15-20 times a day, feces, liquid, fetid, sometimes mixed
with mucus and blood. Possible tenesmus, false desires. Can develop dehydration. Intoxication,
manifested by chills, fever, headache, dizziness, weakness, sweating, decreased appetite, aching
muscles and bones, is preceded by symptoms of gastro-intestinal tract, or joins a few hours after
onset of illness. In some cases, there are easy catarrhal phenomena (slight pain or sore throat,
runny nose, a rare dry cough, hoarseness), which is preceded by gastro-intestinal disorders, and
sometimes saved and on their background. On examination often reveals local tenderness in the
right iliac region, almost half of the patients from the first days of illness revealed enlargement of
the liver. Observed redness or paleness of skin, injection, sometimes subikterichnost sclera,
conjunctival hyperemia, and in some cases - congestion of the mucous membranes of the mouth
and throat, patchy enanthema on the soft palate, seldom poliadenopatiya. Language in the early
days is imposed, the 5-6-th day is clean, with a "raspberry" tip. Pulse rate corresponds to an
increase in body temperature, blood pressure decreased only when the dehydration or severe
intoxication.
During this form of yersiniosis are usually mild or moderate severity. The temperature is
normalized to the 4-5-th day of illness, clinical improvement occurs in most cases by the end of
the 1 st week of a rare disease occurs in waves and the duration increases up to 3-4 weeks.
Exacerbations and recurrences are rare. Possibly blurred over without intoxication with normal
or subfebrile temperature, with minor, transient abdominal pain or without pain, stool 2-3 times a
day, feces can be mushy. Very severe course with severe intoxication, the temperature to 40 , a
sharp dehydration is rare.
Abdominal shape (appendicular, psevdoappendikulyarnaya) form is more common in children.
Initial manifestations may be the same as in the gastrointestinal form of: fever, intoxication, mild
abdominal pain, nausea, vomiting, frequent loose stools, sometimes catarrhal phenomena. 1-3
days vomiting and diarrhea stopped, but there are (or worse) pain in the right podvozdoshnoy
area or around the navel. The disease can begin with the occurrence of severe abdominal pain
with no specific localization, which in time from several hours to 1-2 days, are localized in the
right iliac region. On palpation the abdomen except for a sharp pain in ileocecal angle revealed
the muscle tension and other symptoms of irritation of the peritoneum. Children can sometimes
be painful to palpate enlarged mesenteric lymph nodes. At a blood analysis reveal leukocytosis.
When described the clinical picture is often diagnosed acute appendicitis. Half of the patients
with abdominal form of notes a rash, sometimes increasing the peripheral lymph nodes, aching
muscles and joints, increases the liver.
The duration of this form are usually 3-4 weeks. The disease usually finished, complete
recovery. Abdominal and gastrointestinal form of yersiniosis may become generalized.
Septic or generalized form begins sharply, in some cases gradually. The most common early
manifestations of the disease are chilling or chills, headache, dizziness, pain during movement of
the eyeballs, weakness, loss of appetite, muscle aches, fever combined with catarrhal symptoms
(sore throat, nasal congestion, dry cough). After a few days (sometimes with a 1-day), there are
pains in the epigastric region or around the navel, sometimes in the right upper quadrant and
nausea. Half of the patients becomes more frequent stools 2-3 times a day, feces pasty or liquid,
without impurities, rarely seen vomiting (1-2 times a day). Characterized by an aversion to food,
bad taste, bitterness and dryness in the mouth, loss of taste sensation. Height of disease in this
form usually occurs in 3-4-th day of illness, sometimes later. The temperature may rise to 39-40
, repeated chills, worse headache and other symptoms of intoxication. Temperature curve often
has a wavy character, rarely persistent or remitting.
The duration of febrile period varies widely: from 2 days to 7 months., The majority of patients
is less than 2 weeks. One of the most frequent symptoms in generalized form of yersiniosis is
rash. Most often, skin rashes appear on the 2-3rd day from the onset of the disease, but there may
be in a period of several hours before the end of 2 weeks. They are located on the chest,
abdomen, back, arms and legs, characteristic of localization of the rash on the palms and soles,
and the patient feels a burning sensation (sometimes regardless of the presence of rash), when
swelling and redness of skin. Often localized lesions on the face can be grouped around the knee,
elbow, ankle, shoulder joints. Almost half the patients noted slight itching of the skin. By the
nature of the rash is most often melkotochechnoy, rarely small and krupnopyatnistoy, sometimes
papular, petechial, urticaria, erythema nodosum type, polymorphic. Individual elements of the
rash may merge into a continuous erythema. Duration of the rash usually is 1-4 days, but the rash
may be ephemeral or persist for 1-2 weeks. Podsypaniya possible at various times of illness, and
the character and localization of the rash each time may be different. From 12 to 15-day illness
usually begins large and melkoplastinchatoe peeling fingers and toes or defurfuration skin, hips,
shoulders.
Second in frequency is a symptom of the affected joint. Typically, arthralgia developed a 3-day 4
he started the disease, sometimes after 2-4 weeks. Affects the knee, shoulder, ankle, wrist,
interphalangeal joints. Pain occur in several joints at once. The intensity of the arthralgia mild to
moderate, the duration from several days to 1-2 months. Are characterized by their waviness.
Possible arthritis, especially in small joints, there are different intensities of pain in the muscles
of the back, legs, neck, heels and soles when walking.
On examination of patients in the initial period reveal flushing face and neck skin, scleral
injection, conjunctival hyperemia, sometimes spotted enantio on the soft palate, with a 3-4-day
illness - "raspberry" tongue.
Some patients are increasing and become painful peripheral lymph nodes, usually front-and
zadnesheynye, submandibular, at least - the axillary and inguinal may increase the tonsils. In the
lungs, often dry rales auscultated.
There are stitching pains in the heart, tachycardia (even at normal temperature), ECG - changes,
showing degenerative changes of the myocardium, an infectious cardiomyopathy, in rare cases,
myocarditis.
The vast majority of patients with 3-6-day illness increases the liver, spleen, less frequently. On
palpation the abdomen in 1 / 3 of patients reveal the pain and rumbling in the ileocecal region.
Sometimes patients notice cramps and pain when urinating, which is becoming more frequent.
At the height of the disease possible deterioration of vision due to the development of uveitis,
iridocyclitis. Characterized by a variety of autonomic disorders: sweating, hot flashes, cold hands
and feet, paresthesia, labile blood pressure and heart rate, dizziness, and they usually occur in
early convalescence. Some patients lose weight by 5-10 kg, even after brief course of the disease.
Long period of convalescence, long stored asthenia, fatigue, decreased performance, vegetative
dystonia, sleep disturbances, pain in joints, muscles, the heart.
In some cases, there is a septic variant of the generalized form of yersiniosis. It usually develops
in patients with different concomitant diseases (diabetes, cirrhosis, tuberculosis, chronic
alcoholism, blood diseases, endocrinopathy) and immunodeficiency (congenital or acquired).
Characterized by heavy, prolonged acyclic (21/2-6 months. And more) for high (40 and above),
fever, hectic type, marked intoxication, fantastic chills, profuse sweats, hepatosplenomegaly,
jaundice, severe abdominal pain, profuse (often hemorrhagic), rash, arthritis, myocarditis,
pneumonia, pyelonephritis. Usually detected meningeal syndrome, and in some cases and focal
symptoms of p. Mr. with. that evidence of the development of meningoencephalitis. Hemogram
is characterized by neutrophilic leukocytosis with a shift to the left of leukocyte formula, up to
myelocytes, a significant increase in sedimentation rate are often anemic. Mortality in these
variants, the flow reaches yersiniosis, despite treatment with antibiotics, 30-60%. In favorable
cases recovery will be very slow.
The total duration of illness of 2 months. to 11/2-2 years.
Secondary-focal form is not independent, and can develop after either of these forms of
yersiniosis. The disease may be subclinical or the first manifestation of yersiniosis (eg,
gastroenteritis), and then caused focal lesions are separated by a long period during which health
remains good. In these cases, the first expression of clinical illness is the failure of any organ
(heart, liver, joints, meninges). The most common variant of this form - polyarthritis with
involvement of the joints, or 2.3 monoartrit, arthralgia in 50-80% of cases, preceded by
dyspepsia (abdominal pain, nausea, vomiting, diarrhea) and symptoms of intoxication. Especially
characteristic of the asymmetric lesion leg joints. Usually affects the 2.3 series of the joint at
intervals of several days to 2-3 weeks. The intensity of the arthralgia usually very large, up to an
intolerable at the slightest of passive or active movement. Arthritis in yersiniosis are reactive and
are often combined with lesions of the heart, which does not give marked changes in the ECG
and has a favorable outcome. In this variant of the disease in the blood frequently (up to 30% of
cases) are marked eosinophilia and an increase in ESR. Arthralgia and arthritis can be combined
with erythema nodosum, which is more common in women older than 20 years. Elements of the
rash in half the patients appear after 2-3 weeks. after acute gastroenteritis.
During this version of yersiniosis favorable, recovery usually occurs without sequelae, and
recurrences usually does not happen. Myocarditis manifests subfebrile fever, weakness, fatigue,
discomfort or pain in the heart, palpitation, dyspnea, tachycardia, a weakening of sonority heart
sounds, systolic murmur over the appearance of the tip, extending the boundaries of the heart,
ECG changes, similar to those in myocarditis other etiologies. During benign, circulatory failure
does not develop, but the duration may be several months.
Yersinia hepatitis can be not only a manifestation of a generalized form, but also the option of
secondary focal forms of yersiniosis. At the last jaundice appears at the outset of the disease.
Bilirubin in the blood is moderately enhanced by the bound fraction, liver function tests are
usually within normal limits, the activity of transaminases slightly increased. Jaundice is usually
brief and non-intensive, and fever and intoxication, which begins with a disease can be severe
and prolonged. Meningitis may also be a variant of the secondary focal form, it usually is serous,
during the usually mild, rarely seen. The rare variants of the secondary focal forms of yersiniosis
include Reiter's syndrome, cervical lymphadenitis, ophthalmia, urethritis, osteitis.
Arthritic form
Characterized the development of polyarthritis and the appearance of erythema nodosum and
symptoms of myocarditis. In the blood leukocytosis with a shift in the direction of band forms,
eosinophilia and increased sedimentation rate up to 30-80 mm / h. Usually these symptoms
appear after 1-2 weeks after the onset of the disease and are regarded as a manifestation of an
allergic reaction. The disease usually lasts from several days to 3 months.
Artralgicheskaya form occurs with fever, intoxication, and severe pains in the joints. The main
complaint of pain in the joints. However, no full-fledged arthritis (it occurs only as a
complication (fever joint, redness, pain, swelling), and only 1 joint (often - ankle). Arthralgia
sometimes cause immobilisation of patients, and insomnia. Joints apparently not changed.
Gastroenterokoliticheskaya form
It occurs more frequently than others. It accounts for about 70% of diseases. Begins acutely,
body temperature rises to 38-39o S. headache, malaise, insomnia, anorexia, chills. Along with
the intoxication syndrome arise abdominal pain, diarrhea and sometimes vomiting. Chair liquid
with a sharp odor, occasionally mixed with mucus and blood. Stool frequency varies from 2 to
15 times per day. During the heavy rare. Body temperature is often low-grade or normal, the
syndrome of intoxication is weak, a chair 2-3 times per day, abdominal pain, slight. Such
patients are actively identified with the group diseases. This form may occur in the form of
enteritis, enterocolitis and gastroenterocolitis. The duration of this form of yersiniosis from 2
days to 2 weeks.
Exanthematous form is characterized by a syndrome of intoxication and exanthema. The rash
appears on the 1 day 6 of illness. It may be a point, fine or krupnopyatnistoy without itching. The
rash usually disappears completely after 2-5 days, the former site of the rash is defurfuration.
Skarlatinopodobnaya form
Rash - roseolous, copious (thickened near the large joints), melkotochechnaya. Appears for 1-6
days and lasts "less than a week. Passes without a trace, he begins to peel off. Peeling, where
there is no rash (palms and iambic surface), after the previous flare. Hyperemia of the pharynx.
Raspberry tongue (bright red, and hypertrophy of papillae). Hypertrophy of the lateral buds even
think scalloped edge.
Pathological anatomy. Who died of yersiniosis in the gastrointestinal tract to detect signs of
catarrhal or catarrhal-desquamative and ulcerative lesions, the increase in liver and spleen, which
often reveal small necrotic nodules. Mesenteric and peripheral lymph nodes are enlarged.
Pathogenesis (mechanism of initiation and development of the disease)
Disease begins acutely: body temperature rises, there are abdominal pain, diarrhea mixed with
blood and mucus. In therapeutic branch fall mainly patients with a gastrointestinal form of
yersiniosis. The clinical picture in these patients is characterized by abdominal pain and more or
less severe diarrhea. Along with possible gastro-intestinal and other forms of clinical course:
appendicular, arthritic, septic and subclinical.
Caught in the human body with food or water Yersinia partially killed in the acidic environment
of the stomach and the rest penetrate further into the intestines. The main pathological process
develops in the distal small intestine. With sufficient virulence and sufficient quantities of
pathogens possibly their penetration through the lymph vessels in the mesenteric lymph nodes
and the development of mesenteric lymphadenitis. In these cases, yersiniosis occurs in the
gastrointestinal or abdominal form with high virulence of Yersinia and reduced immunological
reactivity develops bacteremia, clinically manifested by generalization of infection. Pathogen
and into the organs and tissues rich in lymphoid elements and fixed macrophages (liver, spleen,
lymph nodes). In the case of incomplete phagocytosis of Yersinia long persist in the body,
causing new inflammation from which they re-enter the blood. As a consequence, may develop a
secondary form of focal lesions of any organ (heart, liver, joints, lungs) or experience relapse and
recurrence. In the pathogenesis of yersiniosis (especially the secondary forms of focal, acute and
recurrent) are crucial components of allergic, autoimmune processes, which clinically manifested
exanthema, eosinophilia, arthralgia and arthritis.
Immunity is insufficiently studied. It is known that acute phase is characterized by a decrease in
the absolute number of T lymphocytes and increased B-lymphocytes. With the full immune
response occurs postelennoe increase the number of T lymphocytes with normalization of them
in the recovery period. Low levels of T-lymphocytes is a poor prognostic sign, indicating the
possibility of relapse or the transition process in the chronic form. In patients with a prolonged
course of yersiniosis showed a reduction in the number of T-suppressors. At 1-2-week illness
appear specific antibodies, the maximum level which is observed at 3-4-week illness.
Laboratory diagnosis of yersiniosis
Detection of the pathogen genome fragments by PCR in feces or blood. Detection of antibodies
by ELISA, or RSK. For bacteriological examination in all patients taking a bowel movement (3-
5g) and urine (50-100ml), on the testimony - the cerebrospinal fluid, sputum, bile, pus from
abscesses, etc., and for serological studies (RA TPHA) - blood ( 1-2ml). Taken on material prior
to the laboratory stored in the refrigerator, as a medium for storage use buffered or 0.85%
isotonic sodium chloride solution slightly alkaline reaction. After one day incubation in the
refrigerator tube material is placed in a refrigerated chamber at a temperature of 12-18C for 18-
20 hours or at a temperature of-24-30C for 2-3 hours ("cold shock"). After rearing in a thermal
conducting seeding on solid medium (agar or Endo Wednesday Serov) and grown in an
incubator at 22-25C. Identification is carried out on standard media Hiss, strains possessing the
properties of Y. enterocolitica, the determination of biovars with RA on the glass with the serum
against different serovars of this species. Antibody titers taken into account in the serological
diagnosis of TPHA, equal to 1:100 - 1:200, grow over time.
X-ray and endoscopic examination of ileum can detect so-called follicular ileitis: multiple
nodules of lymphoid hyperplasia in the ileum. In the study of blood in some patients reveal
leukocytosis (especially in the beginning of the disease and during exacerbations) and an
increase in ESR to 35-60 mm / h. The urine revealed protein (0,03-0,24 g / L), and the height of
the disease - leucocyturia, microhematuria, cylindruria. The biochemical blood analysis but
increase free bilirubin rarely define and bound bilirubin, as well as a moderate increase in
activity of alanine aminotransferase and aspartate aminotransferase. Polymorphism of clinical
manifestations in yersiniosis makes it necessary to conduct a differential diagnosis with a range
of infectious and noncommunicable diseases. One should pay attention to the epidemiological
history, the dynamics of clinical disease, the severity of some symptoms, the results of
bacteriological and serological (in dynamics) studies, as well as the effectiveness of causal
treatment.
In everyday practice, most often the differential diagnosis is carried out with salmonella, food
poisoning, dysentery, viral hepatitis, tifo-paratyphoid diseases (see Typhoid fever, paratyphoid
fever), brucellosis, septicemia, rheumatic fever, acute appendicitis, arthritis.
Distribution of yersiniosis
More often carriers of infection are rodents. Large outbreaks have suggested that infected rodents
contaminate food by their droppings.
At a temperature of the refrigerator (4-8 degrees) long Yersinia can persist and multiply in the
vegetables, roots and other food products. Mode of pasteurization is not terrible. But when boiled
all strains of Yersinia die after a few seconds. Pseudotuberculosis microbe is stored in sterile soil
at a temperature of 18-20 degrees about 200 days, and in the refrigerator - 10 years!
Of all products most often are infected with Yersinia vegetables and root vegetables: cabbage,
carrots and green onions. In addition to fresh vegetables, factors of transmission may be different
pickles: pickled cabbage, tomatoes, cucumbers. In the salted vegetables microbes persist from 3
to 15 days. Sometimes amazed agent dairy products: cottage cheese, and cheese. Germs multiply
and persist in them for 20 days. Even water can be contaminated with Yersinia. Housewives
need to know what kitchen equipment, in some cases, too, can be transmitted through the link of
the pathogen which, in turn, contaminate food.
TANK AND Source of agent: various species of animals, mainly pigs and cattle, dogs, cats,
rodents, birds, and sometimes people - the patient or carrier.
The main way of infection of human alimentary. Sick man of danger to others is not.
PERIOD contagious SOURCE: depends on the duration of symptoms: usually lasts 2-3 weeks.
Sometimes delayed up to 2-3 months.
Mechanism of transmission by fecal-oral: the main route of transmission - the food, but not
eliminated, and household water.
NATURAL susceptible people, apparently, not very loud. In healthy individuals infection
process is often asymptomatic, causing an immune response. Manifest and severe disease occurs
mainly in children with premorbid background, weakened, with signs of immunodeficiency.
But despite some progress in studying the problem of intestinal yersiniosis, especially in the
medical aspect, there are still many unexplored issues, such as regarding the role of meat and
meat products as factors in the transmission of this infection. Analyzing the current literature, we
can conclude that research on the detection of Yersinia in meat and meat products are held
constant. Also published data on the effect of different factors: pH, packaging, lactic acid
bacteria, the microwave energy on the survival of Yersinia in meat and meat products. But these
details are not systematized, fragmented and does not create a coherent presentation of all
aspects of the problem. In connection with property psychrophilic, standard conditions of storage
of meat products at low positive temperatures contribute to proliferation and accumulation of Y.
enterocolitica. Therefore, the actual development of storage conditions for meat products,
preventing the accumulation of these pathogen. As mentioned above, yersiniosis was listed
officially registered only in 1996 (SP 3.1.094-96, VP 13.3.1318-96). In this regard, employees of
livestock and meat processing plants are not well informed about the intestinal yersiniosis and
how it spreads. In the main risk groups get health workers (farm workers for the care and
maintenance of livestock, livestock breeders, livestock) and workers of meat-packing plants,
poultry farms, poultry plants, meat processing plants. For example, in the Saratov region study
for the detection of Yersinia in meat and meat products were not made. In addition, not explored
the mechanisms of Yersinia contamination of meat products and the development of methods
that prevent this process. Clarification of these issues is of great scientific and practical interest.

legal address | Chertanovo Clinic Medical Center, counseling clinic Chertanovo
Prevention of yersiniosis
In the prevention of Yersinia infections play an important role of sanitary-hygienic measures:
cleaning area, garbage and sewage, control of drinking water quality, compliance with the rules
of food storage, cooking.
When used in food raw vegetables and root vegetables need a good rinse in warm water to clean
the knife all the rotten parts, and then again rinsed and scalded with boiling water. Such
treatment reduces the amount of bacteria on the surface of the fruit. It is worth repeating that are
served only fresh salads!
At the first sign of disease should consult a doctor to review the menu for the last few days and
report on the alleged source of infection
Treatment of yersiniosis
Patients hospitalized for clinical indications. In uncomplicated gastrointestinal form sufficient
diet and pathogenetic therapy of similar treatment for other acute intestinal infections
(detoxification, oral or parenteral rehydration, depending on the degree of dehydration).
When moderate and severe, as well as a protracted, undulating course of this form appoint, in
addition, antibiotics - chloramphenicol (10 mg / kg body weight) or tetracycline in the medium
therapeutic doses for 10-12 days.
Good therapeutic effect is achieved if applied Biseptol-480 2 tablets 2 times a day for 10 days.
In severe cases, corticosteroids are prescribed.
For all other forms of yersiniosis (abdominal, generalized, second-focal) causal treatment is
mandatory.
In case of failure listed antibiotics prescribed gentamicin (40-60 mg 2-3 times a day,
intramuscularly) and doxycycline hydrochloride (0.1 g 1 per day.
Antibacterial therapy not only affects the duration of the febrile period and severity of
intoxication, but also significantly reduces the relapse rate and warns, in some cases the
transition of localized forms of yersiniosis in generalized. In the complex treatment of patients
with yersiniosis is also disintoxication and desensitization therapy (antihistamines).
When the abdominal form, in some cases (Yersinia appendicitis) should prompt treatment
(appendectomy). In the postoperative period must be a course of antibiotics.
In a generalized form of antibiotics prescribed parenteral (eg, chloramphenicol succinate),
usually spend several treatments consistently different drugs (preferably taking into account the
sensitivity of Yersinia isolated from a patient). In order to improve immunogenesis used
preparations containing ready-made antibodies (poliglobulin, immunoglobulin, a plasma).
In arthritis treatment is carried out non-steroidal anti-inflammatory drugs (indomethacin,
hlotazolom, ibuprofen, voltarenom, naproxen, acetylsalicylic acid, phenylbutazone, delagilom,
etc.) in an individually selected doses for several months (the duration of treatment depends on
the clinical effects and indicators ESR).
In cases of persistent monoartrita shown intraarticular corticosteroids (hydrocortisone
suspension, kenaloga, etc.).
When erythema nodosum and myocarditis using the same drugs as for treatment of arthritis, with
a protracted and severe appoint, in addition, prednisolone (30-40 mg / day orally).
When Yersinia hepatitis in addition to causal treatment is important to your diet. In meningitis
preference should be given chloramphenicol succinate in a daily dose of 50-100 mg / kg body
weight, the introduction of intervals for 8 h, while simultaneously conducting detoxication and
dehydration therapy.
Prognosis.
In most cases the disease ends with recovery. In persons with reduced resistance developed
septic conditions, in some patients the disease takes a protracted or chronic course.
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