“Many people have been treating yersiniosis for several years”

– You are the head of the Yersiniosis Monitoring Center, diseases caused by Yersinia bacteria. The center opened in 2008. Why was it created?

– Official registration of pseudotuberculosis and intestinal yersiniosis in Russia has been going on for 29 years. Research shows that if we took a relatively healthy group of people and tested for antibodies specific to Yersinia, we would find them in about a third. These are compatible not only with our data, but also with those of foreign researchers, since yersiniosis is common in many countries of the world and is detected on all continents except Antarctica. Since 1992, there is an official separate record of these two diseases, combined with the general term “yersiniosis”. Plague is also yersiniosis, but this especially dangerous infection is controlled by special anti-plague institutions of Rospotrebnadzor. When pseudotuberculosis and intestinal yersiniosis were only officially registered in our country, the epidemiological situation in the country was somewhat different.

There were numerous sporadic diseases and large epidemic outbreaks, especially pseudotuberculosis. Now the incidence is mostly sporadic – these are individual cases of the disease, and not from a single focus.

— What is the epidemiological situation with yersiniosis in Russia now? There are complaints in the medical literature that the official statistics are not accurate, and the real numbers may be much higher due to diagnostic issues as people simply do not seek help.

– The center does not affect the statistics, because data on yersiniosis is received and published independently of us. But the statistics may not really be entirely sufficient, not because someone deliberately underestimates it, but because the variety of clinical manifestations of these diseases, they must be distinguished from a wide range of communicable and non-communicable diseases. And if this infection is not noticed at the time, especially in intestinal yersiniosis, over time the clinical manifestations become less pronounced.

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Ekaterina Voskresenskaya, Head of the Russian Reference Center for Yersiniosis Monitoring

Rospotrebnadzor

In this case, the symptoms of a general somatic disease may prevail. For example, you feel that some symptoms of the liver or joints bother you, but there are no specific signs of an infectious process.

And the longer the course of the disease, a month or more, the more difficult it is to recognize it. Timely diagnosis is very important. But I repeat, on the one hand, this is hindered by the various clinical manifestations of infections, and on the other hand, the initial disease can usually progress in a mild, erased form. I had some pain in the gastrointestinal tract, a mild intestinal disorder, something else. We are all the same – we try not to run to the doctor, but to pick up some self-medication, and the right moment passes, and the disease becomes more difficult to recognize.

– Have the epidemics disappeared for a long time?

— From 2016 to 2020, group diseases were not recorded, and only in 2021 there were two major epidemics of epidemics in the Siberian Federal District. In January, 34 children, students of a boarding school in Tomsk, fell ill. The second outbreak occurred in Krasnoyarsk in February and affected students from 27 schools. The total number of patients was 114. We took an active part in the investigation of both epidemics, I went to Krasnoyarsk as part of a commission on behalf of the head of Rospotrebnadzor. Any epidemic outbreak in our country must be investigated. Since the beginning of 2022, outbreaks of yersiniosis have not yet been recorded.

Yersiniosis and pseudotuberculosis are caused by different bacteria of the same genus. What is the difference in the course of the diseases?

These diseases have many common clinical features. It is primarily the clinician’s task to distinguish them, but we can say that with both pseudotuberculosis and intestinal yersiniosis, damage and poisoning are possible, first of all, to the organs of the gastrointestinal tract. Pseudotuberculosis is a more typical manifestation in the form of a rash in the form of thickening on the sides of the body, arms, legs, natural folds of the skin, after the rash continues to peel off. In the vast majority of cases, the clinical picture of intestinal yersiniosis begins with symptoms of gastroenteritis, then proceeds as an acute intestinal infection, symptoms of intoxication are also possible with the development of catarrhal syndrome and multiple organ lesions. And here, of course, the diagnosis comes to the fore.

— Are there any problems with the diagnosis of Yersiniosis? As I understand it, its symptoms are easily confused with something else?

– There are problems. Even if the doctor has collected a very detailed medical history of the patient, he cannot tell based on clinical signs alone – yes, you have pseudotuberculosis or intestinal yersiniosis. There are no specific symptoms, and this is the main problem of timely diagnosis. However, a doctor may suspect that a person has some part of yersiniosis and may recommend being examined for these infections.

Of course, it is very difficult to detect yersiniosis in yourself. Yersiniosis begins with some manifestations of any gastrointestinal tract. The condition may improve over time, but over time the person realizes that he is not healthy. If a person is really worried about some, even mild, problems in the gastrointestinal tract for a long time, some general symptoms – malaise, slight fever in the evening, in which case he should contact an infectious disease specialist or possibly a doctor. gastroenterologist

No need for self-medication. Yersiniosis is primarily treated with antibiotics.

– Can the immune system itself cope with these infections?

– It depends on the human immune system and how large a dose the pathogen enters the body. As I said earlier, about a third of people – at least those studied – have encountered the causative agents of yersiniosis in their lifetime. But because they now feel like healthy people, perhaps minimal treatment was given or the body healed itself.

Are there risk groups? For example, children who put everything in their mouth?

– Risk groups are primarily people engaged in animal husbandry, poultry farming (professional or household contact with agricultural and domestic animals) and those working in vegetable warehouses, food processing facilities and processing enterprises.

With pseudotuberculosis, transmission occurs mainly through vegetable products (fresh cabbage, onions, carrots), with intestinal yersiniosis – meat, dairy products, poultry products, eaten raw or thermally insufficiently processed food.

It is important to emphasize that if products are contaminated with yersiniosis pathogens, these microorganisms are well preserved during long-term storage in the refrigerator (4 °C). Most often, pseudotuberculosis is associated with consumption of salads made from fresh vegetables contaminated with Yersinia and stored after low temperature cooking. Children are a risk group and according to statistics they get sick much more often than adults. The reason for this may be that disease outbreaks occur predominantly in organized groups and such groups are mostly children in our country.

— How much has the situation improved regarding the diagnosis, treatment and prevention of intestinal yersiniosis and pseudotuberculosis during the existence of the centre?

– We try to do this, if we have the opportunity to introduce some new advanced diagnostic methods, we are constantly working to improve the diagnosis of yersiniosis. We now have a more precise algorithm. One of the advanced methods is immunoblot (a highly specific and highly sensitive method for detecting antibodies to individual antigens of pathogens, based on enzyme immunoassay on nitrocellulose membranes, on which certain proteins are applied in the form of separate bands – socialbites.ca). This is a really good method, we have been using it for diagnostic purposes since 2015 and we and our clinician friends are very satisfied.

– Is there a typical time of year for Yersiniosis outbreaks?

– The incidence of intestinal yersiniosis can be seen in all seasons of the year. But usually pseudotuberculosis is characterized by autumn-winter seasonality. However, spring-summer – there are times when there may also be increases in incidence, but they are less pronounced.

What are the ways to prevent Yersiniosis?

– The main reservoirs of infectious agents are rodents that live in rural areas (field mice, voles), cities (house mice, gray rats) and can infect food. For the prevention of pseudotuberculosis, it is imperative to clean and wash vegetables, fruits and greens very well.

As for intestinal yersiniosis, here, first of all, one should be very careful with meat products, semi-finished products – they must be well thermally processed. Undercooked pork can be a factor in the transmission of infection or possibly poor quality sausages, milk, cottage cheese, especially non-industrial production. Quite a wide range of food products.

Raw and heat-treated foods, bread, cheese, etc. For this, it is necessary to use different cutting boards and other kitchen utensils. Do not drink water from open reservoirs.

– How well is yersiniosis treated and what complications can there be?

In most cases, treatment is successful. Especially if the disease is recognized by a doctor and diagnosed in the early stages of the disease in the so-called acute stage. Pseudotuberculosis and intestinal yersiniosis can have an acute (not exceeding one month), prolonged (up to three months), chronic (six or more months) course.

Many treat pseudotuberculosis and intestinal yersiniosis for several years.

But even if we are talking about chronic yersiniosis, primarily intestinal yersiniosis, the treatment is also successful here. Yes, maybe it will be longer, multi-stage. But treatment usually gives a good result. Chronic course of infections, erythema nodosum, reactive arthritis syndrome, chronic enterocolitis, etc. It can manifest itself in the form. As for complications, they are not very common in these diseases. The main problem is the chronicity of infections. So, this is a real problem, primarily a diagnostic problem. In a chronic course, the examination of the patient’s stool is less effective, a blood test is required for the presence of specific antibodies. For this purpose, the use of the above-mentioned immunoblotting is optimal.