Intestinal yersiniosis and Pseudotuberculosis

at a mesadenitis for man ( the first time )
1959 - in East of Russia there was a flashout of the disease
which had obtained the name FESF- « Far Eastern
scarlatinoform fever »
1965 - В.А. Знаменский and А.К. Вишняков isolated of the pathogen FESF. from the patients. В.А. Знаменский confirmed of an etiology FESF in experience autoinfection as pseudotuberculosis
1939 - Д. Шлейфстен and M. Колеман detected of the new
pathogen Y. under the name Yersinia enterocolitica
Since 1944 – isolated pathogens Y. and PТ. are included in a new genus “Yersinia"

0.6 – 0.8 microns of width, gram-(-), facultative anaerobic,
nonspore-forming bacillus. They are nonmotile at 37dg.C, but usually motile at 22 dg.C. ( have flagella).
When Y. is coccobacillary - it`s virulent and when Y. is bacillary – it`s avirulent.
Grow on simple mediums, but they are better reproduced at +4 - +8 dg.C.
Y. are steady against cycles freezing - defreezing
Y. are longly survived and are multiplied in ground .
They are sensitive to desiccation, UVL, to warming and boiling (survive no more than 30 seconds) to all disinfectant solutions in usual concentrations (survive no more than 5 minutes.)

bacillary – it`s avirulent.

antigene all pathogens are distributed on serotypes:
- 8 serotypes are revealed at PТ. - but for the people more often cause diseases - 1st serotype ( 60 - 90%),
less often - 3rd serotype
and 2,nd 4 th, 5th serotypes are very seldom
- 50 serotypes are revealed at Y. – but for the people more often cause diseases - 03- 08 - 09 serotypes
V and W - antigens of virulance ( located by exterior of memdrane )

Y. - has expressed enteropathogenic effect.
The endotoxin PТ.- has expressed invasion properties and enteropathogenic effect have only some strains 1st and 3rd serotypes.
EPIDEMIOLOGY
Saprozoonosis. Many birds and animal are sick Y. and PТ.
Main source for the man – are variety domestic (dogs), and wild ( rodents ) mammals which by own the excretions infected food and water.
Auxiliary source - ground, water and molluscs

with infected animals ( hands - to -mouth) or contaminated food or water.
The factors of transmission:
- vegetable dishes (salads from fresh vegetables)
- milk (without boiling)
- water (open reservoirs)
- the contact mode of transmission – person-to-person is proved at only at intestinal yersiniosis!!!

closed collectives ( have common public catering organization)
Peak of a case rate:
Y. – October- November ( become more frequent all IIT)
PТ. - March – May ( most activity of the rodents )
The sporadic and group cases rate are recorded
Pathogeny:
1.After infection through a mouth Y. advance on a small intestine up to its terminal portion (place of primary localization pathogens). In a lumen of a small intestine Y., apparently, intensively do not multiply ( confirmation - in seedings of a feces they are found out only in 1- 3 % of
cases!

through an epithelium up to lamina propria and clump of an lymphoid tissue (Peyer’s patches ), where occurs them colony.
Here concentration Y. are in 1000 times more, than in other portions of an intestine!
3. The macrophages capture Y. but killing them more often is not completed.
With a current of a lymph Y. are brought in of lymphoid derivation of an intestine and mesenteric lymph nodes, causing in them an inflammation

by a consequence of activation of the system «adenylcyclase – of cyclic 3,5 adenosinemono-phosphates » of cellilar membrane of enterocytes with the thermostable enterotoxin.
5. At Y the contents of prostaglandin Е (itself is capable to cause a diarrhea) and prostaglandin F 2а (itself is cause allergic reactions) increase in plasma.
6. More often at this stage the infectious process is completed and by 5- 9 days the cellular immunity and by 12th - 15th to days humoral immunity are shaped.

stream and are carried on all organism with a toxico-allergic lesion of many bodies and systems.
The generalizations of the process are promoted by used of iron preparations with the medical purpose (oppress a phagocytosis).
The particular value has a serotype of the Y. e.g.:
03 serotype Y. - more often localized forms of disease are shaped
and 09 serotype Y. - generalized forms of disease are shaped

in various autoimmune processes, frequently with increase of circulating immune complexes
9. The link between Y. and following diseases fixed:
- Reiter’s and Krohn’s Illnesses, reactive arthritises
- erythema nodosum, myocardites, uveites
Is suspected them participation at:
- set of symptoms Gougerot- Sjhogren’s
- thyroid disease, glomerulonephritis
- hemolytic anemia, haemolytico-uremic set of symptoms
- Schonlein’s, Bechterew’s, Behcet’s diseases etc.

The liberation of an organism from Y. occurs slowly, the exacerbations and relapses are often, as the immunity is shaped not so strong
PATHOMORPHOLOGY:
At autopsies or surgical operations find various changes:
- in a small intestine: catarrhal, ulcerative, hemorrhagic,
and necrotic enteritises
- in the lymphatic system: a mesadenitis, appendicitis
terminal ileitis etc.
- in bodies SMP: at PT. find out granulomas reminding
tubercular

Seldom +
- abdominal + +
- scarlatiniform + Seldom
- arthralgial + Seldom
- icteric + Seldom
- catarrhal + Seldom
- mixed + +
- generalized + +

of current and polymorphism of clinical manifestations!
INCUBATION:
At Y. (1- 6 days ) at PТ. (3 - 18 days )
Initial period: (1 - 5 days)
- the disease starts is acute, without a prodrome:
- fever up to 38 - 40 d.C
- nasal cold, tickling in throat or pharyngalgia at a
swallowing, cough
- nausea, vomiting, diarrhea, moderate pains in
mesogastrium

muscle pains,
insomnia,
OBJECTIVE:
- dry and hot skin, swollen the face, conjuctivitis, scleritis
- at PT. - a punctate eruption on hands, stops, neck
(as “gloves“, “socks", "hood") and acyanotic nasolabial
a triangule
- at Y. micropunctate or micromacular an eruption on
extremities or trunk.
HEIGHT of disease (5 - 7 DAYS):
- the fever and the intoxication amplifies
- the liver and lien is enlarged

extremities and side part of a trunk, is especial in skin folds - ( с-м Пастиа ),
(The skin of the face without an eruption )
- the arthralgias (through 7 - 14 days can be transformed to a polyarthritis, around of them occurs macromacular an eruption or nodal erythema
- the anorexia, nausea, vomiting (is sometimes saved),
diarrhea
- coated tongue - « white strawberry tongue », but to the 5th
to day refines - «red strawberry tongue »

mesogastrium and hypogastrium (on the right)
- CVS - tachycardia, moderate lowering BP, dull of cardiac sounds
- on the part of urine - signs of a syndrome “toxic kidney”
- the brain - edema also can be serous a meningitis
- WBC -neutrophilic a leukocytosis 10-30 х 10 in 9th dg.\L
ESR - 20 - 55 mm / h, sometimes eosinophilia
The period convalescence:- is accompanied by lowering temperature and sluggish restoration of the function of the struck bodies.
After 2 - 3 weeks for the majority of the patients have been a desquamation of a skin of a trunk and extremities (palm and sole)

of abdomen
- moderate watery diarrhea up to 5 - 7 times per day with slime, but without admixture of a blood. The duration of a diarrhea is prolonged 2 - 3 weeks without treatment, but sometimes can last by months!!!
The terminal ileitis (intoxication, fever in limits 38 - 39 dg.C is less often taped, the colicy pains on the right in hypogastric region during a defecation, are saved by stationary values after it of the termination. X-ray examination the site of contraction of a small intestine- « a sign of a cord » is taped
Mesadenitis (acute beginning, nausea, vomiting, pain in meso and hypogastrium, diarrhea 3 - 5 times per day, moderate boring of a peritoneum, appearance of an infiltrate on the right in hypogastrium, positive signs Штейберга, Mc Fadden, Падалки

of an acute mesadenitis a little.
Frequently is accompanied by arthralgias, exanthema, conjunctivitis, « by strawberry tongue ». Usually patients are exposed to operating treatment after an advice of the surgeon (clinic of an acute appendicitis + hyperleuko-cytosis).
Scarlеtform: More often at PT
Fever and intoxication, acyanotic a nasolabial triangle, « strawberry tongue », punctate rash on a skin and its an desquamation, absence of a diarrhea. Usually proceeds without relapses!!!

locomotory apparatus ( arthralgia and arthritises ) in a combination to other manifestations Y. prevail
Icteric:
Appears by a reactive hepatitis with increase of a liver, spleen by an icterus, rising ALT and AST in 5- 10 times neutrophilic by a leukocytosis, negative markers VH.
catarrhal
The damage URT (rhinitis, pharyngitis, tracheitis, bronchitis prevail. The exanthema meets seldom. More often diagnosis as acute URTI

with creation of multiple purulent focuses of internal bodies.
A lethality in limits 50 % even for the patients treated by antibiotics!!!
The forecast:
- favourable, except for the septic form.
- without antibiotics the illness stops in 1,5 months, but up
to 3 - 6 months can be prolonged
- relapses and exacerbations – 8 – 55%
subacute and chronic course – 3 - 10%

appendicitis
Mononucleosis
Typhoids
Sepsis
Canicola fever ( leptospirosis )
Brucellosis
Chlamydiosis etc.

Bacteriological method - inoculations of a blood, vomitive masses, feces, operational and biopsied of a material on phosphatno- buffered solution or medium Серова with the subsequent cultivation at low temperature
(Frequency of detection Y. in a feces 1 - 3 %),
(Frequency of detection Y. in biopsied a material 33 %)
- Immunological method – HA test (1:200) and HAP test (1:100) with usage of a method « of the pair serums »
- ELISA.

0,4 gr PO q12h
- doxycycline 0,1 gr PO q12h
- chloramphenicol 0,5 – 1,0gr PO q6h
- trimethaprim - sulphamethoxazole 960mg PO q12h
- Furazolidonum 0,1- 0,15 gr PO q6h
- Gentamicin 80 mg IM IV q8-12h
- Metacyclinum 0,2 gr PO q8h
Duration of treatment - at Y. - 7 - 14 days,
and at PT.-14 days

surgical treatment + antiinfectious drugs
- glucocorticoids ( at TIS, brain edema, rising in a blood circulating immune of complexes)
Prophylaxis:
- Deratization and protection against of the rodents vegetable stores
- Constant sanitary supervision of water supply, preparation and storage of food
- Strict control at processing and storaging of foodstuffs especially made of crude vegetables (salads)