Yersinia enterocolitica and the chronic fatigue syndrome.

OBJECTIVES: To investigate the potential role of Yersinia enterocolitica in patients with chronic fatigue syndrome (CFS). METHODS: An immunoblot technique was used to detect antibodies to various Yersinia outer membrane proteins (YOPs) in serum samples from 88 patients with CFS and 77 healthy neighbourhood controls, matched for gender and age. RESULTS: The prevalence of IgG and IgA antibodies to various Yersinia outer membrane proteins (YOPs) did not differ between patients with CFS and healthy controls. Twenty-four patients (27%) and nineteen controls (25%) had IgG antibodies to one or more YOPs. Four patients and two controls had both serum IgG and IgA antibodies to at least two different YOPs, compatible with a recent or persistent infection. Although all patients with positive IgG and IgA reactions to two or more YOPs had symptoms that could point to persistent Yersinia infection, these symptoms were also found frequently in patients without antibodies to YOPs. CONCLUSIONS: We conclude that Y. enterocolitica is unlikely to play a major role in the aetiology of CFS.

Clinical presentation and diagnosis of gastrointestinal infections by Yersinia enterocolitica in 261 Dutch patients.

A surveillance of the clinical manifestations, course and outcome of 261 patients with gastrointestinal infection by Yersinia enterocolitica between 1982 and 1991 was carried out. Acute uncomplicated enteritis was diagnosed in 169 patients, complicated enteritis in 37, appendicular syndrome in 33, ileitis in 8 and colitis in 14. Children (age < 16 years, n = 105) presented most often with mild enteritis, young adults (age 16-25 years, n = 47) with enteritis or appendicular syndrome, adults (age > 25 years, n = 109) had significant risk for developing serious enteritis, ileitis and colitis. Complications included reactive arthritis, septicaemia, lymphadenitis, disturbed liver functions and erythema nodosum. Four patients died of generalized peritonitis. Diagnosis was established by positive culture in 207 patients. Another 54 patients were diagnosed by having at least two other positive tests: serum agglutinins, specific IgA and IgG antibodies to Yersinia outer membrane proteins (Yops) or antigen detection in biopsies. Culture alone was sufficient to diagnose uncomplicated enteritis, antiYops serology appeared to be very useful in diagnosing patients with other manifestations of yersiniosis. The majority of the infections were caused by serotypes O3 and O9 while unusual serotypes were associated with advancing age and colitis.

In-vitro antimicrobial susceptibility of Yersinia enterocolitica isolates from stools of patients in The Netherlands from 1982-1991.

The MICs of 24 antimicrobial agents were determined for 335 strains of Yersinia enterocolitica isolated from faeces in the Netherlands during 1982-1991. The isolates belonged to biotypes 1A, 1B, 2, 3, 4 and to serotypes O3, O5.27, O6.3, O7.8, O8, O9. Almost all strains were susceptible to piperacillin, piperacillin/tazobactam, imipenem, all cephalosporins except cefazolin, the aminoglycosides, quinolones, co-trimoxazole, doxycycline and chloramphenicol but resistant to amoxycillin, co-amoxiclav and macrolides. No association was observed between susceptibility patterns, biotype or serotype nor were there marked changes in the susceptibility during the last decade. The agents traditionally used to treat human infection, including co-trimoxazole, doxycycline and chloramphenicol may remain drugs of first choice.

Yersinia enterocolitica infection in children.

The clinical presentation, course and outcome of Yersinia enterocolitica infection was studied prospectively in 125 children. Enteric forms occurred in 114 children (92 enteritis, 20 pseudoappendicitis, 2 chronic ileitis), of whom 17 also had extramesenteric manifestations; 11 children had one or more extramesenteric forms without enteric disease. Enteritis occurred more frequently in young children whereas serious forms and extramesenteric forms were more common in children older than 6 years of age (P < 0.001). Arthritis was observed in 13 children and extensive lymphadenopathy in 11; 1 child had septicemia with pleurisy, 1 had vasculitis, 1 had cholecystitis and 4 had erythema nodosum. Diagnosis was established by positive culture in 100 (80%) children and by agglutinin test in 11 of 45 (24%), demonstration of circulating specific anti-IgA and anti-IgG to Yersinia outer membrane proteins in 47 of 48 (98%) and detection of antigen in biopsies in 28 of 33 (85%) children. The 2 latter methods were superior to the agglutinin test. Serotype O3 and O9 predominated. The frequency and seriousness of complications may justify the use of antibiotics for Yersinia enteritis in children 6 years of age or older.