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[Clinical aspects, diagnosis and therapy of Yersinia enterocolitica infections]
J A Hoogkamp-Korstanje1, J de Koning
1Laboratory for Public Health, Leeuwarden/Niederlande.
Abstract:
The predominant form (65% of all patients) of yersiniosis is mesenteric adenitis, resulting in enteritis, pseudo-appendicular syndromes, ileitis or colitis. The severity of this form depends to some degree on the age. Extra-mesenteric forms (in 20-25%), focal infections by dissemination, the septic form and the lymphadenopathy syndrome may occur after or without previous enteritis. Persistence of Y. enterocolitica in lymphnodes and the GALT is responsible for chronic and recurrent forms. Secondary immunological complications (25%) are arthritis and Erythema nodosum. Diagnosis is made by culture, serology, of which demonstration of specific antibodies against released proteins is more reliable than demonstration of agglutinins and antigen detection by indirect immunofluorescence in biopsies. Antibiotic treatment of mild enteric forms is questionable, extra-mesenteric forms should be treated. Appropriate antibiotics are trimethoprim, chloramphenicol, tetracycline and the new fluoroquinolones. Studies are in progress (Leeuwarden and Hanover, MHH) to elucidate the indication of antibiotic treatment of Yersinia-arthritis patients.
Insights
Yersiniosis, primarily mesenteric adenitis, can lead to various gastrointestinal and extra-intestinal conditions. Diagnosis involves culture and serology, with specific antibody detection being more reliable for Yersinia enterocolitica infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Immunology
Background:
- Yersiniosis is a bacterial infection caused by Yersinia species.
- The predominant form is mesenteric adenitis, presenting as enteritis, ileitis, or colitis.
- Extra-mesenteric and chronic forms can arise from dissemination or persistent infection.
Purpose of the Study:
- To describe the clinical spectrum of yersiniosis.
- To evaluate diagnostic methods for Yersinia enterocolitica.
- To discuss antibiotic treatment strategies and ongoing research for Yersinia-induced arthritis.
Main Methods:
- Review of clinical presentations and diagnostic techniques for yersiniosis.
- Analysis of serological markers, including specific antibodies and agglutinins.
- Assessment of diagnostic accuracy using indirect immunofluorescence in biopsies.
Main Results:
- Mesenteric adenitis accounts for 65% of yersiniosis cases, with severity varying by age.
- Extra-mesenteric forms occur in 20-25% of patients, potentially leading to sepsis or lymphadenopathy.
- Secondary immunological complications like arthritis and Erythema nodosum affect 25% of patients.
Conclusions:
- Diagnosis relies on culture, serology (specific antibodies preferred), and antigen detection.
- Antibiotic treatment is recommended for extra-mesenteric yersiniosis; its role in mild enteric forms is debated.
- Further research is needed to determine antibiotic indications for Yersinia-associated arthritis.