To the differential diagnosis of arthritides of pseudotuberculous and chlamydial etiology
- Authors: Burgasova O.A.1, Yushchuk N.D.1, Pogorel'skaya L.V.1, Tseneva G.Y.1, Kulyashova L.B.1, Voskresenskaya E.A.1, Fedunyak I.P.1, Burgasova OA2, Yushchuk ND2, Pogorelskaya LV3, Tseneva GY.4, Kulyashova LB4, Voskresenskaya Y.A4, Fedunyak IP5
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Affiliations:
- Moscow State University of Medicine and Dentistry, Russian Agency for Health Care
- Russian Medical Academy of Postgraduate Education
- Pasteur Saint Petersburg Research Institute of Epidemiology and Microbiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare
- S. P. Botkin Clinical Infectious Diseases Hospital
- Issue: Vol 82, No 11 (2010)
- Pages: 53-57
- Section: Editorial
- Submitted: 09.04.2020
- Published: 15.11.2010
- URL: https://ter-arkhiv.ru/0040-3660/article/view/30747
- ID: 30747
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Abstract
Subjects and methods. Forty-six patients with pseudotuberculosis and 41 patients with chronic urogenital chlamydial infection with articular involvement were examined. A bacteriological method of polymerase chain reaction (PCR), agglutination test, enzyme immunoassay (EIA) (IgA, IgG, IgM), indirect hemagglutination (IHA) test were used to diagnose pseudotuberculosis. Diagnostic techniques for chlamydiasis involved cultural, direct immunofluorescence (DIF), real-time PCR, and EIA (IgM, IgG, IgA).
Results. Patients with pseudotuberculosis developed polyarthritis and oligoarthritis in 56 and 39%, respectively. The development of arthritides was accompanied by fever in 89%, exanthema in 57%, gastrointestinal lesion in 56%, hepatomegalia in 78%. The pseudotuberculous etiology of the disease was confirmed by the agglutination test in 71% of the patients and by IHA in 7%. EIA revealed IgG in 78% of the patients, IgA in 11%, and IgM in 29%. PCR of synovial fluid (SF), synovial shell, and other biological substrates revealed Yersinia pseudotuberculosis DNA in 43%. Chlamydiasis and polyarthritis developed in 71 and 19%, respectively. The diagnosis of chlamydiasis was verified by EIA detection of IgG and IgA in 76 and 27% of cases, respectively. DIF, PCR, and culture studies of urethral scrapes found Chlamydia in 9, 32, and 29% of cases, respectively. Examination of SF and synovial shells revealed Chlamydia trachomatis in 24% of the patients and culture studies detected the pathogen in 21%.
Conclusion. Asymmetrical polyarthritides mainly involving the knee joints are the most common arthritides of pseudotuberculous etiology. EIA detection of serum IgG and IgA and PCR study of SF are optimal diagnostic tools. Artritides of chlamydial etiology are asymmetrical oligoarthritides predominantly involving the knee and ankle joints. Examination of urethral and cervical canal scrapes, SF by culture and PCR studies and that of serum IgA and IgG by EIA are optimal diagnostic tests.
About the authors
Ol'ga Aleksandrovna Burgasova
Email: medichope@mail.ru
Nikolay Dmitrievich Yushchuk
Email: medichope@mail.ru
Lidiya Vasil'evna Pogorel'skaya
Galina Yakovlevna Tseneva
Lidiya Borisovna Kulyashova
Ekaterina Aleksandrovna Voskresenskaya
Email: tsenevapasteur@yandex.ru
Ivan Pavlovich Fedunyak
O A Burgasova
Moscow State University of Medicine and Dentistry, Russian Agency for Health CareMoscow State University of Medicine and Dentistry, Russian Agency for Health Care
N D Yushchuk
Moscow State University of Medicine and Dentistry, Russian Agency for Health CareMoscow State University of Medicine and Dentistry, Russian Agency for Health Care
L V Pogorelskaya
Russian Medical Academy of Postgraduate EducationRussian Medical Academy of Postgraduate Education
G Ya Tseneva
Pasteur Saint Petersburg Research Institute of Epidemiology and Microbiology, Russian Inspectorate for the Protection of Consumer Rights and Human WelfarePasteur Saint Petersburg Research Institute of Epidemiology and Microbiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare
L B Kulyashova
Pasteur Saint Petersburg Research Institute of Epidemiology and Microbiology, Russian Inspectorate for the Protection of Consumer Rights and Human WelfarePasteur Saint Petersburg Research Institute of Epidemiology and Microbiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare
Ye A Voskresenskaya
Pasteur Saint Petersburg Research Institute of Epidemiology and Microbiology, Russian Inspectorate for the Protection of Consumer Rights and Human WelfarePasteur Saint Petersburg Research Institute of Epidemiology and Microbiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare
I P Fedunyak
S. P. Botkin Clinical Infectious Diseases HospitalS. P. Botkin Clinical Infectious Diseases Hospital
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