Bacteremia and suppurative lymphadenitis due to Yersinia enterocolitica in a neutropenic patient who prepared chitterlings

Chronic Lyme Disease and Co-infections: Differential Diagnosis

In Lyme disease concurrent infections frequently occur. The clinical and pathological impact of co-infections was first recognized in the 1990th, i.e. approximately ten years after the discovery of Lyme disease. Their pathological synergism can exacerbate Lyme disease or induce similar disease manifestations. Co-infecting agents can be transmitted together with Borrelia burgdorferi by tick bite resulting in multiple infections but a fraction of co-infections occur independently of tick bite. Clinically relevant co-infections are caused by Bartonella species, Yersinia enterocolitica, Chlamydophila pneumoniae, Chlamydia trachomatis, and Mycoplasma pneumoniae. In contrast to the USA, human granulocytic anaplasmosis (HGA) and babesiosis are not of major importance in Europe. Infections caused by these pathogens in patients not infected by Borrelia burgdorferi can result in clinical symptoms similar to those occurring in Lyme disease. This applies particularly to infections caused by Bartonella henselae, Yersinia enterocolitica, and Mycoplasma pneumoniae. Chlamydia trachomatis primarily causes polyarthritis. Chlamydophila pneumoniae not only causes arthritis but also affects the nervous system and the heart, which renders the differential diagnosis difficult. The diagnosis is even more complex when co-infections occur in association with Lyme disease. Treatment recommendations are based on individual expert opinions. In antibiotic therapy, the use of third generation cephalosporins should only be considered in cases of Lyme disease. The same applies to carbapenems, which however are used occasionally in infections caused by Yersinia enterocolitica. For the remaining infections predominantly tetracyclines and macrolides are used. Quinolones are for alternative treatment, particularly gemifloxacin. For Bartonella henselae, Chlamydia trachomatis, and Chlamydophila pneumoniae the combination with rifampicin is recommended. Erythromycin is the drug of choice for Campylobacter jejuni.

Axillary abscess due to Yersinia enterocolitica

Yersinia enterocolitica rarely causes extraintestinal disease. A 54-year-old construction worker with chronic hepatitis C developed an axillary abscess following an injury to his finger. An aspirate from the axillary mass grew Y. enterocolitica. Direct inoculation is proposed as the mode of transmission of this classically enteric pathogen.

Detection of chromosomal and plasmid--encoded virulence determinants in Yersinia enterocolitica and other Yersinia spp. isolated from food animals in Greece

The distribution of Yersinia strains in animal reservoirs was examined in 835 food animals (pigs, chickens, sheep, cows) from different Greek departments (Attica, Fthiotida, Viotia and Evia) over a one year period. The isolated strains were characterized with respect to the presence of chromosomal (yst) and plasmid-encoded virulence determinants (virF, yadA) and their antimicrobial susceptibility was tested. In total, Yersiniaspp. were obtained from 9.94% of the 835 food animals at slaughter that were sampled in this study. There was no statistically significant seasonal distribution, nor was any significant departmental distribution observed. From the 83 isolated Yersinia strains, 76 (91,57%) belonged to Y. enterocolitica (58 were of serotype O:3/biotype 4 and 18 strains were non O:3, non O:9), 3 belonged to Y. pseudotuberculosis, 2 to Y. kristensenii and 2 to Y. intermedia. Y. enterocolitica O:3/4 was mainly isolated from the pigs, while Y. enterocolitica non O:3, non O:9 was from the chickens. The strains were grouped into 5 genotypes, with respect to the presence or absence of the virulence genes. A significant predominance of genotype V, the one carrying all the three virulence genes, was observed in the strains isolated from the pigs. Complete susceptibility to most of the 3rd and to the 4th generation cephalosporins and to ciprofloxacin, was observed among the isolates. Remarkable was the association between the presence of each virulence gene separately and resistance to some antimicrobials, a matter of further investigation.

Recognition of Yersinia enterocolitica multiple strain infection in twin infants using PCR-based DNA fingerprinting

AIMS

Yersinia enterocolitica causes several syndromes in humans. The most common presentation is enterocolitis in children, presenting as fever and diarrhoea. A Y. enterocolitica multiple strain infection in twin infants was investigated.

METHODS AND RESULTS

One isolate was recovered from one patient and two morphologically-different isolates were recovered from the other infant. Biochemically, all isolates were identified as Y. enterocolitica group. The genomic DNA from each strain was purified and DNA fingerprinting was performed. The banding patterns observed for Y. enterocolitica isolates 2 and 3, from patients 1 and 2, respectively, were identical when comparing the presence or absence of major bands. However, Y. enterocolitica isolate 1, from patient 1, showed a distinctive banding pattern from isolates 2 and 3.

CONCLUSION

The findings indicate that one infant was colonized by more than one strain of Y. enterocolitica, demonstrating that multiple strains can colonize and invade a patient.

SIGNIFICANCE AND IMPACT OF THE STUDY

Recognition of multiple strain infections can be important in diagnosis, treatment and prognosis of Y. enterocolitica infections, as well as in disease epidemiology. The technique described here offers a straightforward method for strain comparison.

Yersinia enterocolitica: overview and epidemiologic correlates

Yersinia enterocolitica comprises both pathogenic and nonpathogenic members. Distinguished by biogrouping, serogrouping, and ecological distribution, commonly occurring pathogenic serobiogroups, e.g., O:3/4; O:5,27/2; O:8/1b; O:9/2, possess both chromosomal and plasmid-mediated virulence traits. Studies have revealed several (oral, blood transfusion) modes of acquisition, elucidated the putative role of chromosomal and plasmid-encoded virulence factors in the pathogenesis of human infection, and have identified major animal reservoirs, e.g., the pig. Diagnosis has been refined though use of selective media, monoclonal antibodies directed against outer membrane proteins, and of purified yersiniae outer membrane proteins for antibody detection. Epidemiological investigations of foodborne outbreaks have been advanced through the use of molecular biology techniques such as ribotyping and pulsed-field gel electrophoresis.

Yersinia enterocolitica: the charisma continues

Yersinia enterocolitica, a gram-negative coccobacillus, comprises a heterogeneous group of bacterial strains recovered from animal and environmental reservoirs. The majority of human pathogenic strains are found among distinct serogroups (e.g. O:3, O:5,27, O:8, O:9) and contain both chromosome- and plasmid (60 to 75 kb)-mediated virulence factors that are absent in "avirulent" strains. While Y. enterocolitica is primarily a gastrointestinal tract pathogen, it may produce extraintestinal infections in hosts with underlying predisposing factors. Postinfection sequelae include arthritis and erythema nodosum, which are seen mainly in Europe among patients with serogroups O:3 and O:9 infection and HLA-B27 antigen. Y. enterocolitica is acquired through the oral route and is epidemiologically linked to porcine sources. Bacteremia is prominent in the setting of immunosuppression or in patients with iron overload or those being treated with desferrioxamine. metastatic foci following bacteremia are common and often involve the liver and spleen. Of particular concern is blood transfusion-related bacteremia. Evidence has accumulated substantiating the role of Y. enterocolitica as a food-borne pathogen that has caused six major outbreaks in the United States. The diagnosis of Y. enterocolitica gastroenteritis is best achieved through isolation of the bacterium on routine or selective bacteriologic media. When necessary, serogrouping, biogrouping, and assessment for plasmid-encoded virulence traits may aid in distinguishing virulent from "avirulent" strains. Epidemiologically, outside of identified food-borne outbreaks, the source (reservoir) of Y. enterocolitica in sporadic cases is speculative. Therefore, prevention and control measures are difficult to institute.