Acute kidney injury associated with Yersinia pseudotuberculosis infection: Forgotten but not gone

BACKGROUND: Yersinia pseudotuberculosis is known to cause fever, gastroenteritis, or acute kidney injury (AKI). There have been several Y. pseudotuberculosis infection outbreaks to date associated with ingestion of contaminated food or unsterile water. While this disease was considered to have practically been eradicated with the improvement in public health, we encountered several cases of AKI associated with Yersinia infection. METHODS: We retrospectively collected data from medical records of patients with suspected Y. pseudotuberculosis infection who visited Seoul National University Children’s Hospital in 2017. RESULTS: There were nine suspected cases of Yersinia infection (six males and three females; age range 2.99–12.18 years). Among them, five cases occurred in May, and seven patients were residing in the metropolitan Seoul area. Three patients had history of drinking mountain water. Every patient first presented with fever for a median of 13 days, followed by gastrointestinal symptoms and oliguria. Imaging studies revealed mesenteric lymphadenitis, terminal ileum wall thickening, and increased renal parenchymal echogenicity. Creatinine levels increased to 5.72 ± 2.18 mg/dL. Urinalysis revealed sterile pyuria, proteinuria, and glycosuria. Oliguria continued for 4 to 17 days, and two patients required dialysis; however, all of them recovered from AKI. Mucocutaneous manifestations developed later. In the diagnostic work-up, Yersinia was isolated from the stool culture in one patient. Anti-Yersinia immunoglobulin (Ig) A and IgG were positive in 6 patients. CONCLUSION: Y. pseudotuberculosis infection is an infrequent cause of interstitial nephritis presenting with AKI. When a patient presents with fever, gastroenteritis, and AKI not resolving despite hydration, the clinician should suspect Y. pseudotuberculosis infection.

Enhanced protective immune response to PCV2 adenovirus vaccine by fusion expression of Cap protein with InvC in pigs

The major immunogenic protein capsid (Cap) of porcine circovirus type 2 (PCV2) is critical to induce neutralizing antibodies and protective immune response against PCV2 infection. This study was conducted to investigate the immune response of recombinant adenovirus expressing PCV2b Cap and C-terminal domain of Yersinia pseudotuberculosis invasin (Cap-InvC) fusion protein in pigs. The recombinant adenovirus rAd-Cap-InvC, rAd-Cap and rAd were generated and used to immunize pigs. The phosphate-buffered saline was used as negative control. The specific antibodies levels in rAd-Cap-InvC and ZJ/C-strain vaccine groups were higher than that of rAd-Cap group (p < 0.05), and the neutralization antibody titer in rAd-Cap-InvC group was significantly higher than those of other groups during 21–42 days post-immunization (DPI). Moreover, lymphocyte proliferative level, interferon-γ and interleukin-13 levels in rAd-Cap-InvC group were increased compared to rAd-Cap group (p < 0.05). After virulent challenge, viruses were not detected from the blood samples in rAd-Cap-InvC and ZJ/C-strain vaccine groups after 49 DPI. And the respiratory symptom, rectal temperature, lung lesion and lymph node lesion were minimal and similar in the ZJ/C-strain and rAd-Cap-InVC groups. In conclusion, our results demonstrated that rAd-Cap-InvC was more efficiently to stimulate the production of antibody and protect pigs from PCV2 infection. We inferred that InvC is a good candidate gene for further development and application of PCV2 genetic engineering vaccine.

Establishment and evaluation of identification method for Yersinia pestis and Yersinia pseudotuberculosis / 中华流行病学杂志

<p><b>OBJECTIVE</b>To establish a gene identification method of Yersinia pestis and Yersinia pseudotuberculosis for plague surveillance.</p><p><b>METHODS</b>According to the specific genomic sequences of Y. pestis and Y. pseudotuberculosis, i.e. "pestis Island (PeI)" and "pseudotuberculosis Island (PsI)" and the published genomic sequences of 12 strains of Y. pestis and 4 strains of Y. pseudotuberculosis, the specific identification primers of these sequences were designed.</p><p><b>RESULTS</b>A total of 52 strains of Y. pestis and 57 strains of Y. pseudotuberculosis and other intestinal bacteria strains were tested with PCR. Of the 5 pairs of Y. pestis identification primers, PeI2 and PeI11 were specific for Y. pestis. Besides Y. pestis, the primers PeI1, PeI3 and PeI12 could detect part of 57 Y. pseudotuberculosis strains. Of the 5 pairs of Y. pseudotuberculosis identification primers, PsI1 could detect all the 52 strains of Y. pestis and 57 strains of Y. pseudotuberculosis. PsI7, PsI16, PsI18 and PsI19 were specific for Y. pseudotuberculosis.</p><p><b>CONCLUSION</b>The primers PsI1, PeI 2 and PeI11, PsI7, PsI16, PsI18 and PsI19 can be used in the rapid identification of Y. pestis and Y. pseudotuberculosis, which can be also used to explore the circulation of atypical Y. pestis in quiescent plague foci.</p>

Infecciones por Yersinia / Yersinia infections

La Yersinia enterocolitica o la Yersinia pseudotuberculosis pueden tener diferentes formas de presentación entre las que están la enteritis o enterocolitis, la adenitis mesentérica asociada a ileitis distal, la septicemia, infecciones localizadas o manifestaciones extraintestinales. Es responsable de hasta 7 por ciento de los cuadros de gastroenteritis infecciosas y se asocia a una elevada mortalidad post-infección a corto y largo plazo, de 2 a 3 veces mayor. Esta infección bacteriana se adquiere mediante la ingesta oral de productos contaminados y/o inadecuadamente preparados. El aislamiento de Yersinia en las deposiciones es el examen más específico y siempre debe ser solicitado. Debido a su baja sensibilidad los estudios serológicos pueden ser útiles para el diagnóstico, y la reacción de polimerasa en cadena (PCR) puede constituirse próximamente en el examen de elección para el diagnóstico de esta infección. Los antibióticos útiles para su tratamiento son los aminoglicósidos, cefalosporinas de tercera generación, cloranfenicol, quinolonas, tetraciclinas y trimetoprim-sulfametoxazol.

Yersinia enterocolitica or yersinia pseudotuberculosis may have different presentation forms: among those are enteritis or enterocholitis, mesenteric adenitis associated with distal ileitis, septicemia, localized infections or extra-intestinal manifestations. It is responsible for up to 7 percent of infectious gastroenteritis and is associated with high post-infection mortality in the short and long term, which is 2 to 3 times higher. This bacterial infection is acquired through oral consumption of contaminated and/or inappropriately prepared products. Isolation of Yersinia in stool samples is the more specific exam and it should always be performed. Due to its low sensibility, serological studies may be useful for the diagnosis, and the polymerase chain reaction (PCR) may become the elective exam for the diagnosis of this infection in the future. Antibiotics that are useful for its treatment are aminoglycoside, third-generation cephalosporins, chloramphenicol, quinolones, tetracyclines, and Trimetoprim-sulfametoxasol.

Annual Report on External Quality Assessment in Clinical Microbiology Laboratory in Korea (2008) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2008. A total of 16 specimens were distributed. Eight specimens were distributed to 330 laboratories with 319 (96.7%) returns in Trial I, and 8 specimens to 335 laboratories with 319 returns (95.2%) in Trial II. Two slide specimens for mycobacterium stain (AFB) were distributed in Trial I and II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology except for Acinetobacter baumannii. The acceptable percentages of bacterial identification (correct answers to species level) on Klebsiella pneumoniae, Staphylococcus aureus, Neisseria meningitidis, Serratia marcescens, Erysipelothrix rhusiopathiae and Candida albicans (Trial I) were 97.4%, 99.2%, 55.6%, 97.0%, 79.2%, and 92.0%, respectively. The acceptable percentages of bacterial identification on A. baumannii, Enterococcus faecalis, Streptococcus pyogenes, Haemophilus parainfluenzae, Elizabethkingia meningoseptica, and Yersinia pseudotuberculosis (Trial II) were 92.0%, 90.8%, 4.5%, 53.1%, 74.8% and 94.3%, respectively. The acceptable percentages for antimicrobial susceptibility tests on K. pneumoniae and S. aureus (Trial I), and A. baumannii and E. faecalis, (Trial II) were relatively good compared to data of the last year. The acceptable percentages for AFB stain in Trial I and II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good except some cases with poor specimen quality. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Panoramic view of the occurrence of Yersinia species other than Y. pestis in Brazil

Data on the occurrence of Yersinia species. other than Y. pestis in Brazil are presented. Over the past 40 years, 767 Yersinia strains have been identified and typed by the National Reference Center on Yersinia spp. other than Y. pestis, using the classical biochemical tests for species characterization. The strains were further classified into biotypes, serotypes and phagetypes when pertinent. These tests led to the identification of Yersinia cultures belonging to the species Y. enterocolitica, Y.pseudotuberculosis, Y. intermedia, Y. frederiksenii and Y. kristensenii. Six isolates could not be classified in any of the known Yersinia species and for this reason were defined as Non-typable (NT). The bio-sero-phagetypes of these strains were diverse. The following species of Yersinia were not identified among the Brazilian strains by the classical phenotypic or biochemical tests: Y. aldovae, Y. rhodei, Y. mollaretti, Y. bercovieri and Y.ruckeri. The Yersinia strains were isolated from clinical material taken from sick and/or healthy humans and animals, from various types of food and from the environment, by investigators of various Institutions localized in different cities and regions of Brazil.

Ribotyping and virulence markers of Yersinia pseudotuberculosis strains isolated from animals in Brazil

Ribotyping and virulence markers has been used to investigate 68 Yersinia pseudotuberculosis strains of serogroups O:1a and O:3. The strains were isolated from clinical material obtained from healthy and sick animals in the Southern region of Brazil. Ribotypes were identified by double digestion of extracted DNA with the restriction endonucleases SmaI and PstI, separation by electrophoresis and hybridization with a digoxigenin-labeled cDNA probe. The presence of the chromosomal virulence marker genes inv, irp1, irp2, psn, ybtE, ybtP-ybtQ, and ybtX-ybtS, of the IS100 insertion sequence, and of the plasmid gene lcrF was detected by polymerase chain reaction. The strains were grouped into four distinct ribotypes, all of them comprising several strains. Ribotypes 1 and 4 presented distinct profiles, with 57.3 percent genetic similarity, ribotypes 2 and 3 presented 52.5 percent genetic similarity, and genetic similarity was 45 percent between these two groups (1/4 and 2/3). All strains possessed the inv, irp1, and irp2 genes. Additionally, strains of serogroup O:1a carried psn, ybtE, ybtP-ybtQ, ybtX-ybtS, and IS100. As expected lcrF was only detected in strains harboring the virulence plasmid. These data demonstrate the presence of Y. pseudotuberculosis strains harboring genotypic virulence markers in the livestock from Southern Brazil and that the dissemination of these bacteria may occur between herds.

Invasin of Yersinia pseudotuberculosis is not a polyclonal activator of mouse B lymphocytes

It is known that the invasin molecule of Yersinia pseudotuberculosis stimulates human peripheral B cells in vitro. In this work we evaluated the in vivo role ofinvasin as polyclonal activator of B lymphocytes in the mouse experimental model, by comparing strains of Y.pseudotuberculosis expressing invasin and isogenic inv mutants. Swiss mice were infected intravenously with two strains expressing invasin (YpIII pIB1 and an isogenic virulence plasmid-cured strain, YpIII) and with two invasin mutant strains (Yp100 pIB1 and Yp100, plasmid-cured). Spleen cells were sampled on days 7, 14, 21 and 28 after infection. Immunoglobulin (Ig)-secreting spleen cells were detected by protein A plaque assay and specific antibodies were detected in sera by ELISA. The virulent strain YPIII pIB1 (wild type) did not provoke polyclonal activation of B lymphocytes in vivo. In general, fewer Ig-secreting spleen cells of all isotypes were foundin the infected animals than in the control animals. Specific IgG antibodies were detected in the sera of animals infected with all strains. The peak response occurred on the 21st day post-infection, and the Yp100 strain provoked the highest level of these antibodies. We concluded that invasin is not a polyclonal activator of murine B cells.

Epidemiological study on yersiniosis in pediatric acute diarrhea [with 5 tables and 5 figures]

Yersiniosis is considered one of the most important bacterial foodborne infections as their incidence among humans had increased dramatically. A total of one hundred and fifty random samples were collected from children with acute diarrhea. 50 of them had blood in stools and 100 had no blood in their stools. Samples were collected from the gastroenterology unit of Assiut University Children Hospital during the period from January to December 2005. The present study was designed to estimate the incidence of Yersinia enterocolitica and Yersinia pseudotuberculosis among diarrheal children with and without blood in stools. Moreover, demographic and clinical characteristics of the Yersinia infected children were investigated. Yersinia enterocolitica and Yersinia pseudotuberculosis could be detected in 17.33% and 13.33% of the examined children, respectively. Ecological distribution of the examined children revealed that the rate of infection was higher in rural areas [52.9%] than in urban areas [11.25%]. The majority of cases in the present study were in the age group of [> 24-60months] with a rate of [87.5%], followed by those in age group of [7 -24 months] with a rate of 18.33%. It has been determined that incidence of Yersinia species was higher among females [33.33%] than males [29.52%]. Seasonal incidence of the infection by Yersinia enterocolitica and Yersinia pseudotuberculosis was studied. Public health hazard and preventive measures to control infection were discussed

Comparative study for Isolation of Yersinia pseudotuberculosis from Water / 대한임상미생물학회지

BACKGROUND: Yersinia pseudotuberculosis is recognized throughout the world as a cause of water-or food born infections in human and animals. Although many attempts have been made to define optimal conditions for the isolation of the organism from water, their isolation yields remain low; therefore, we tried to find an effective method for the recovery of Y. pseudotuberculosis from water. METHODS: Water samples were deliberately contaminated with Y. pseudotuberculosis at various levels and then processed by the following three isolation METHODS: centrifugation, direct filtration, and intracellular culture. For the centrifugation method, the water samples were centrifuged at 5000 rpm for 1 hr and the final precipitates were inoculated in cefsulodin-irgasan-novobiocin(CIN) media. For the filtration method, the water samples were filtered by negative pressure and the filter papers were put directly on CIN media. For the intracellular culture method, the organisms were extracted from the HeLa cells that had been infected with Y. pseudotuberculosis and inoculated on CIN media. We also examined the efficacy of the filtration method after cold enrichment with a mixture of Y. pseudotuberculosis, Escherichia coli, and Citrobacter freundii. RESULTS: With the concentration of 3x10(2)/100 mL, Y. pseudotuberculosis was isolated only by the filtration method; however, none of the culture methods were good enough to recover the organism from the water sample when the concentration was 3x10/100 mL. With cold enrichment, however, the recovery was much more efficient; the organism grew after direct inoculation or after filter inoculation when the starting concentrations were 3x10(2)/100 mL or 3x10/100 mL, respectively. CONCLUSION: A combined use of direct filtration and filter inoculation after cold enrichment is the most effective method to yield Y. pseudotuberculosis isolation. The introduction of effective methods for the isolation of Y. pseudotuberculosis from untreated drinking water would increase the awareness by the public of the health hazard of spring water.

Experimental kinetics of infection induced by Yersinia pseudotuberculosis isolated from stock animals

The course of in vivo infection of five isolates of Yersinia pseudotuberculosis was followed for three weeks in Swiss mice. The strains were isolated from diarrheic and normal feces and mesenteric lymph nodes of healthy and sick stock animals. Four strains of serogroup O:3 and one of serogroup O:1a, with and without the virulence plasmid, were inoculated intragastrically and intravenously in the mice. Groups of five animals were sacrificed at 6 h and 3, 6, 10, 15, and 21 days after inoculation, and organs and tissues were checked for possible macroscopic alterations. Development of infection was monitored at these times by performing viable bacterial counts in homogenates of selected tissues. The animals were cheked daily for clinical alterations. The results of the study showed that strains with the virulence plasmid infected organs and tissues at various times and at varying intensity by both routes of infection, the strain of type O:1a being the most invasive. Moreover, clinical and pathological alterations occurred only in animals inoculated with bacteria carrying the virulence plasmid, regardless of the route of infection.

Characterization of outer membrane proteins of Yersinia pestis and Yersinia pseudotuberculosis strains isolated from India.

The majority of virulence factors including the 12 Yersinia outer membrane proteins (Yops), 29 Yop secretion proteins (Ysc) and few specific Yop chaperone (Syc) are contributed by the 70 kb LCR middle plasmid of Yersinia pestis. Yersinia pestis isolates recovered during 1994 plague outbreak and rodent surveillance samples of Southern states of India were studied for the presence of important Yops by the conventional procedure of partially purifying outer membrane proteins (Omps) after cultivation in calcium deficient media. Prominent bands numbering 4-5 between 34-42 kDa region corresponding to important Yops were seen in all the isolates as well as in other Yersinia and non-Yersinia species by SDS-PAGE. Western blotting with the polyclonal antisera raised against these Omp preparations revealed few immuno-reactive bands that appeared to be shared among Y. pestis, Y. pseudotruberculosis, Y. enterocolitica, Y. fredrocksenii, Y. intermedia, Y. kristensenii and E. coli. Three recombinant Yop proteins namely, YopM, YopB and LcrV were produced and antisera to these proteins could reveal presence of these Yops in the Y. pestis Omp preparations. In order to further characterize the important Yops among Omps, attempts were made to generate monoclonal antibodies against Omp preparation. Three of the 4 stable reactive clones that were obtained, when tested, had extensive cross-reactions among pathogenic Yersinia species, Y. pestis and Y. pseudotuberculosis isolates, other Yersinia species and the members of Enterobacteriaceae in dot-ELISA and Western blotting. One of the monoclonal antibodies, YP1, exhibited reaction to all the pathogenic Yersinia species and the isolates, with restricted cross-reactivity to Y. intermedia, Y. kristensenii, K. pneumoniae. None of the 4 monoclonal antibodies had reactions with the 3 recombinant Yop proteins. It appears that under low calcium response, the Y. pestis not only activates secretion of Yops but also a large number of other proteins, which as per the present observations are cross-reactive within the family Enterobacteriaceae.

Distribution of Pathogenic Genes and Molecular Typing of Yersinia pseudotuberculosis Isolated from Spring Water in Seoul

In order to investigate pathogenic genes and genetic relationships of Y. pseudotuberculosis strains, We isolated 9 strains of Y. pseudotuberculosis from 380 spring water sites in Seoul from 2000 to 2003. All isolates were distributed to the northeast area in Seoul. The isloates were analyzed for chromosomal virulence gene (inv) and plasmid-borne genes (yadA and lcrF) using PCR to assume pathogenicity. As a result, all isolates were positive for the inv gene, but only five isolates (55.6%) were positive for the yadA and lcrF genes. RAPD and PCR-ribotyping were tested and all isolates were grouped with 90% similarity. RAPD revealed 4 clusters and PCR-ribotyping revealed 2 clusters. The result of this experiments confirmed the view that RAPD had better powerful discrimination than PCR-ribotyping and RAPD typing was effective to distinguish between various strains of Y. pseudotuberculosis from spring water.

Characterization and utilization of monoclonal antibodies reactive to Yersinia pseudotuberculosis.

The 3 murine monoclonal antibodies, Yps1, Yps2 and Yps3 reactive to Y. pseudotuberculosis can be stabilized and all were found to be of IgG type. Monoclonal antibody, Yps1, recognized a glycoprotein antigen of the organism with reactivity at the 55-75 kDa region, while Yps2 and Yps3 recognized protein antigens of Y. pseudotuberculosis 65 kDa and 26-28 kDa molecular weight regions, respectively. The specificity of monoclonal antibodies was tested using dot ELISA and Western blotting with whole cell organisms or whole cell sonicated soluble antigens of different Yersinia species, Salmonella typhi, Klebsiella pnemoniae, Streptococcus abortus-equi and Escherichia coli. Monoclonal antibody, Yps1 exhibited cross-reactivity with soluble antigens and whole cell preparations of Y. pestis. Yps2 cross-reacted to soluble antigens of all the tested bacteria. Reactivity of monoclonal antibody, Yps3 was restricted to Y. pseudotuberculosis and Y. pestis with soluble antigen preparations. No reaction was observed with Yps2 and Yps3 to whole cell organism preparations from tested bacteria including Y. pseudotuberculosis. The co-agglutination reagent prepared by sensitizing staphylococcal cells with Yps1 monoclonal antibody produced a positive agglutination with all the 4 Y. pseudotuberculosis isolates and the 3 Y. pestis strains tested. Sandwich dot ELISA using monospecific antisera as a capture antibody and a monoclonal antibody, and Yps3 as a revealing antibody had a high level of specificity in detecting Y. pseudotuberculosis antigens.

Papel das proteínas "Yops" de Yersinia pseudotuberculosis na ativação do linfócitos B / Role of Yops of Yersinia pseudotuberculosis in B lymphocyte activation

O plasmídeo de virulência, comum às espécies patogênicas de Yersinia codifica um conjunto de proteínas secretadas denominadas Yops ("Yersinia outer proteins"). As "Yops" efetoras têm sido relacionadas e uma série de propriedades biológicas, incluindo resitência à fagocitose, citotoxicidade e desfosforilação de proteínas do hospedeiro. Porém, a associação das "Yops" de Yersinia com a resposta imune adaptativa do hospedeiro não está bem esclarecida. Yops secretadas por Yersinia enterocolitica O:3 provocam ativação policlonal de linfócitos B, quando inoculadas em camundongos. Neste trabalho, Yops secretadas po Y. pseudotuberculosis foram inoculadas por via intravenosa em camundongos Swiss livres de patógenos específicos (SPF), com objetivo de se verificar o papel in vivo destas proteínas sobre a ativação de linfócitos B esplênicos. Para tanto, foi determinada a cinética de células secretoras de imunoglobulinas inespecíficas e específicas dos diferentes isotipos (IgG, IgM e IgA), pela técnica de ELISPOT e pesquisada a presença de anticorpos específicos anti-Yersinia nos soros dos animais inoculados, através de ELISA. Foi verificado que ocorreu um aumento significativo apenas no número de linfócitos secretores de Igs inespecíficas do isotipo IgG no 21º dia poó-inoculação (aumento de 2,5 vezes em relação aos controles). O número de linfócitos secretores dos outros isotipos foi semelhante aos controles, com exceção de IgA, que sofreu uma diminuição de 3,1 vezes no 7º dia pós-inoculação. Quanto às células secretoras de imunoglobulinas específicas, a resposta dos animais inoculados foi muito individual. Em alguns camundongos inoculados, foram detectadas células secretoras de Igs anti-Yersinia do isotipo IgG, no 7º e 14º dia pós-inoculação e do isotipo IgM, no 7º e 28º dia pós-inoculação. Por outro lado, foram detectados anticorpos séricos anti-Yersinia foram detectados apenas no 7º dia pós-inoculação. Estes resultados demonstram que existe uma diferença na capacidade imunomoduladora das Yops secretadas por Y.pseudotuberculosis e Y.enterocolitica.

Molecular Relatedness between Isolates Yersinia pseudotuberculosis from a Patient and an Isolate from Mountain Spring Water

A 40-yr-old buddhist monk was admitted to the hospital with abdominal pain, fever, and confusion. He had a history of drinking untreated mountain spring water in his temple, and experienced the above symptoms for several days before admission. In past medical history, he had suffered from hepatic cirrhosis. Yersinia pseudotuberculosis was isolated from his blood and ascitic fluid. The mountain spring water that he had ingested was cultivated and Y. pseudotuberculosis was also isolated. For identification of pathogenic Y. pseudotuberculosis, each isolate from the three sources (blood, ascitic fluid, and drinking water) was also analysed for the inv gene for Y. pseudotuberculosis and the virF gene for virulent plasmid by PCR. All strains were positive for both the virF and the inv genes and also positive for autoagglutination test. For relationship study, each isolate from the three sources was also analysed with serotyping and restriction endonuclease analysis of virulence plasmid DNA (REAP) using BamHI. All belonged to the serotype 4b and REAP pattern D. Thus, all these findings supported that the mountain spring water was the source of the Y. pseudotuberculosis infection in this case.

A Case of Septicemia Caused by Yersinia pseudotuberculosis / 대한임상미생물학회지

Yersinia pseudotuberculosis is a relatively infrequent cause of human infections, mostly as intestinal yersinosis. A septicemic form of Y. pseudotuberculosis infection has been reported only rarely. It is usually seen in patients with underlying disorders such as diabetes, hepatic cirrhosis or iron overload. A 63-year-old man with diabetes mellitus and liver fibrosis was admitted to Asan Medical Center via emergency department because of epigastric pain, fever and watery diarrhea; he was septic. The stool culture did not grow Salmonella, Shigella, or Yersinia. But, in the blood culture Y. pseudotuberculosis grew from one anaerobic vial among two sets of aerobic and anaerobic blood cultures. Serotype of Y. pseudotuberculosis strain was could not be determined because it was a rough type. The isolate was positive in the autoagglutination test and polymerase chain reaction for the virF gene. The serum levels of iron, TIBC and ferritin were within normal range. The patient received ceftriaxone therapy for 3 days and was discharged with a clinical improvement.

Epidemiologia da Yersinia pseudotuberculosis no Brasil / Epidemiology of the Yersinia pseudotuberculosis in Brazil

O Laboratório de Referência em Yersinia no Brasil, responsável pela identificaçäo e biossorofagotipagem de bactérias isoladas no país, caracterizou, durante os anos de 1982 a 1990, 105 cepas de Yersinia pseudotuberculosis, isoladas de animais sadios ou doentes, nos Estados do Paraná e do Rio Grande do Sul. Cepas adicionais näo foram recebidas pelo Laboratório após aquele período, bem como näo foram caracterizadas amostras de Y. pseudotuberculosis isoladas do homem. As bactérias foram isoladas de diferentes materiais clínicos de bubalinos, bovinos e de um suíno. Após a biossorotipagem, a grande maioria (97,14 por cento) dos isolados foi classificada no biotipo 2 e sorogrupo O3, ao passo que 2,8 por cento deles no biotipo 1 e sorogrupo 1b.

Comparison of serotypes, restriction enzyme analysis of plasmid DNA pattern and PFGE(pulsed-field gel electrophoresis) patterns of Yersinia pseudotuberculosis isolates in Korea / 대한임상병리학회지

BACKGROUND: Yersinia pseudotuberculosis, a member of genus Enterobactericeae, is a main etiologic organism of diarrhea in childhood. Because a mouse and a unchlorinated spring water are main reservoirs of Y. pseudotuberculosis, the strains from a contaminated spring water and mouse could be involved in human epidemic. The purpose of this study was to investigate a clonality between the strains from patients and those from an unchlorinated spring water and a mouse by restriction enzyme analysis of plasmid DNA and pulsed-field gel electrophoresis (PFGE). METHOD: We isolated 15 Y. pseudotuberculosis strains including 8 isolates from patients (S1-S8), 6 isolates from mountain water (W1-W6), 1 isolate from a mouse (M1) in northeast area of Seoul. Plasmid and chromosomal DNA of all strains were analyzed by REAP with Bam H1 restriction and by PFGE with Xba I restriction , respectively. RESULTS: Restriction enzyme analysis of plasmid DNA was classified into type B and type D. All 7 strains of serotype 15 were classified as type B and 8 strains of serotype 4b were classified as type D. PFGE were classified into 6 different types. Among them, strains of PFGE type I, II, III, IV belong to Y. pseudotuberculosis serotype 15 and Y. pseudotuberculosis 4b strains were classified into PFGE type V, VI. S1 and W1 were classified into PFGE type I . S8, W6 and M1 were classfied into PFGE type VI. CONCLUSIONS: PFGE revealed clonality among strains from patients, a water and a mouse. PFGE was more discriminative than REAP to characterize the Y. pseudotuberculosis outbreaks in Korea.

A Case of yersinia pseudotuberculosis sepsis presenting as multiple liver abscesser in systemic lupus erythematosus / 대한내과학회지

A 40-year-old man with systemic lupus erythematosus (SLE) and diabetes was found to have sepsis with multiple small hepatic abscesses secondary to Yersinia pseudotuberculosis which were detected by computed tomography (CT) scan and blood cultures. Sepsis with Y. pseudotuberculosis is uncommon but usually seen in patients with underlying liver diseases or diabetes. A few of those patients are accompanied by liver abscesses. Those patients with liver abscesses invariably have multiple small abscesses. CT scan of the liver was important in demonstrating the multiple small liver abscesses. Identification of the pathogen on blaod culture and elevated serum antibody titer to Y. pseudotu-berculosis are useful for diagnosis. Although rare, Y. pseudotuberculosis should be also considered as a possible cause in febrile patient with immunocompromised state such as SLE, diabetes or hemochromatosis.