Orthopedics - Oleksa A.P. 2006

Joint Diseases
Infectious Arthritis of Known Etiology
Yersinial Arthritis

Intestinal yersiniosis is an infectious disease belonging to the zoonosis group (Studenikin M.Ya., Yakovleva A.A., 1987). The causative agent is Yersinia enterocolitica from the family Enterobacteriaceae. This group also includes Y. pseudotuberculosis (the CAUSATIVE AGENT OF scarlatiniform fever).

Given the epidemiological and clinical similarities between these pathogens, the common term "yersiniosis" accompanied by the identification of the specific causative agent is considered justified. However, Dmitrovskaya T.I. et al. (1979) do not specify the exact pathogen, taking into account the "almost identical" clinical manifestations of the disease.

The aforementioned pathogens can trigger The Development of yersinial Arthritis.

Transmission occurs through food products (such as milk, butter, cheese, and fresh raw fruits and vegetables) contaminated with the excrement of rodents and domestic animals (cats, dogs, cows, etc.). Infection can happen even when these foods are stored in household refrigerators, as the pathogen is capable of multiplying at a Temperature of 4’ C. The incubation period of the disease ranges from 4–5 to 18–19 days.

In his Analysis of the Pathogenesis of yersiniosis, Yushchenko G.V. (1977) identifies four phases: 1) enteric; 2) regional; 3) generalized; and 4) the phase of secondary focal and allergic manifestations.

The first two phases encompass The entry of the pathogen into The Human Body along with the associated primary, regional-focal, and inflammatory reactions. The subsequent phases are driven by bacteremia, hematogenous dissemination, and septicemia.

Upon entering the digestive tract, the pathogen causes gastritis and enteritis, with the inflammation predominantly localized in the ileocecal region. This leads to regional mesenteric lymphadenitis accompanied by The formation of abscesses within the Lymph Nodes. During this period, Internal Organs (such as the Liver, Spleen, and Lungs) as well as The Musculoskeletal System become affected.

Patients experience Muscle and joint pain, and during the peak of the disease, yersinial arthritis develops, occurring in 12–18% of patients. The knee and ankle joints are most frequently affected, while the interphalangeal JOINTS OF THE fingers and the elbows are involved less often. The joints become swollen and painful, local temperature is elevated, Skin hyperemia may occur over the affected areas, and joint mobility is restricted. Radiological examination reveals no pathological Changes in the joint. The duration of arthritis varies and depends on the Treatment administered.

These signs of inflammation may disappear within a few days or weeks, or in severe cases, even after a month or more.

Following joint puncture, synovial fluid analysis reveals an elevated Cell count with a predominance of neutrophils. The causative agent is not detected in the fluid.

Blood laboratory parameters provide higher diagnostic value. The acute period of the disease is characterized by leukocytosis with neutrophil predominance, elevated ESR, anemia, a positive C-reactive protein test, and dysproteinemia.

Unlike other enterocolitis cases, 74–86% of patients exhibit various circulating tissue Antibodies and immune complexes. Specific antibodies against the pathogen can be detected in blood serum as early as the end of the first week of the disease, though their titers peak by the third week, which is crucial for Diagnosis.

Bacteriological examinations conducted during the second and third weeks from the onset of the disease successfully isolate the pathogen from feces, urine, blood, as well as nasopharyngeal mucus and sputum.

Among diagnostic tools, the in vitro leukocyte lysis test deserves attention, as it is performed for Differential diagnosis between yersiniosis and brucellosis during their chronic courses.

A relatively short duration (rarely exceeding two years) points to a yersinial process, whereas a rheumatoid process is progressive and persists for many years.

The diagnosis of yersiniosis is established by detecting the pathogen in feces, whereas other intestinal infections are diagnosed through specific tests.

Treatment. Antibiotic therapy is considered etiotropic treatment. For this purpose, patients are prescribed levomycetin, tetracycline, gentamicin, and Other Antibiotics to which yersinia species show the highest sensitivity. In severe cases, the combination of gentamicin with Cephalosporins or The Use of osteotropic lincomycin is highly effective. Infusion and anti-inflammatory therapy are mandatory. Additionally, desensitizing agents, Vitamins, and general supportive treatments are administered. Corticosteroids are occasionally used in severe forms of the disease.