Iyersinioz (intestinal iyersinioz) — the acute zoonotic disease which is shown defeat of the digestive channel and a toksiko-allergic syndrome.
Etiology. The activator belongs to family of enterobakteriya, a sort of iyersiniya. There are about 30 various serovars. The infection in the person is caused by the 3, 5, 8 and 9 serovars. Iyersiny remain and breed on vegetables, root crops and other foodstuff, are not resistant to drying and high temperature, are highly sensitive to action of usual disinfectants.
Epidemiology. The activator reservoir in the nature are small rodents. They plant various objects of external environment, the soil, foodstuff, water, promoting distribution of an infection among wild domestic animals and small songbirds. An infection source for the person are generally domestic animals and small rodents. The leading way of transfer — alimentary. The main factors of infection are meat products, vegetables, root crops, milk, water. Seasonal rise in incidence of winter is characteristic. Sporadic cases of diseases meet more often, but family group diseases and epidemics in collectives with the centralized food are possible.
Pathogeny. The microbes which broke a gastric barrier get and breed in the lymphoid office of distal department of an ileal gut, causing inflammatory process in the form of a terminal ileitis, a mesadenitis, it is possible also appendicitis. The endotoxemia arising at the same time causes development of toksiko-allergic reactions. Also bacteremia is possible.
Clinic. The incubation interval of 1 — 2 day, can reach 10 days. Symptoms of damage of intestines in the form of a gastroenteritis, a coloenteritis, a gastroenterocolitis, mezenterialny lymphadenitis, a terminal ileitis, an acute appendicitis are most constantly shown. An abdominal pain of constant or skhvatkoobrazny character, various localization, nausea, vomiting, a diarrhea, a chair with slime and pus, sometimes with blood, from 2 — 3 to 15 times a day. Along with damage of intestines symptoms of the general intoxication are expressed, temperature can be high, in hard cases — toxicosis, dehydration, fall of temperature of a body. In an onset of the illness emergence of dot or melkopyatnisty rash on a trunk and extremities, damage of a liver, a meningeal syndrome is possible. During later period — mono - or polyarthritis, a knotty erythema, myocarditis, conjunctivitis, an iritis, sometimes a syndrome of Reuters (a purulent urethritis, polyarthritis and conjunctivitis). This syndrome is regarded as allergic reaction. In peripheral blood — a neutrophylic leukocytosis, the raised SOE (20 — 70 mm/h). The disease lasts from a week to several months. In the epidemic centers the erased and subclinical forms of an illness come to light.
Differential diagnosis. Clinical diagnosis is possible at the relevant epidemiological data and existence of clinical syndromes, characteristic of this infection: acute or subacute enteritis or gastroenteritis, feverish reaction, dieback, terminal ileitis, mesadenitis, appendicitis.
Intestinal iyersinioz often it is possible to distinguish from an abdominal form of a pseudotuberculosisonly by means of laboratory methods. The expressed syndrome of enteritis or a gastroenteritis is more characteristic of an intestinal iyersinioz.
Intestinal iyersinioz it is difficult to distinguish also from a gastroenteritichesky form of a salmonellosis, an esherikhioz, proteose of intestines, an intestinal stafiglokokkoz, and also from a gastroenterokolitachesky form of dysenteryas the called infections have no specific symptoms. However at an iyersinioza connection of a disease with the use of vegetable dishes is more often established, at a salmonellosis — meat products; though for staphylococcal food bakteriotoksikoz communication with the use of vegetable dishes is also possible. All this gives the grounds to suspect iyersinioz, confirmed laboratory.
The Rotavirusny gastroenteritis differs from an iyersinioz in a hyperemia of a mucous membrane of a pharynx, granularity of a soft palate and a picture of blood (a leukopenia, normal SOE).
Intestinal iyersinioz differs from cholerain the temperature reaction expressed by an abdominal pain, moderate disturbance of water and electrolytic balance, character of a chair, and also epidemiological yielded and results of bacteriological and serological researches. The easy and erased forms of an iyersinioz need to be differentiated from helminthoses (an ascaridosis, a trichuriasis, an enterobiosis), protozoan (an amebiasis, a balanthidiasis, a lambliasis), toxic (in particular, medicamentous) and allergic (a food idiosyncrasy) coloenterites. Data of the epidemiological anamnesis and laboratory inspection are decisive in diagnosis of these forms of diseases.
In differential diagnosis of a yersinia terminal ileitis and mezenteriit from an acute appendicitis it is necessary to consider a megalgia combination, not inherent for the last, in the right ileal area with the expressed syndrome of the general intoxication and a dieback in the absence of indicators or very scanty indicators of irritation of a peritoneum. At the same time sometimes diagnostic doubts are resolved only at an operative measure using laboratory methods of research of fabric of a worm-shaped shoot or a mezenterialny lymph node. The combination of an arthritic syndrome to diarrhea distinguishes iyersinioz from rheumatismand polyarthritises of other etiology.
Septic form of an iyersinioz difficult an otlichima from sepsis of other etiology. In favor of the last detection of the septic center testifies. At sepsis of the obscure origin the diagnosis is established on the basis of repeated crops of blood on sterility and serological methods of identification of antibodies to the activator of an iyersinioz.
In final diagnosis of an iyersinioz crucial importance belongs to bacteriological research of excrements and serological tests with a specific diagnosticum in pair serums. As a diagnostic caption for RA consider 1: 80 and above, for THRESHING BARN — 1: 160 and above.