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[Yersinia infections]
1Academisch Ziekenhuis, afd. Medische Microbiologie, Nijmegen.
Abstract:
The genus Yersinia contains three pathogenic species: Y. pestis, Y. enterocolitica and Y. pseudotuberculosis. All pathogenic strains contain a 70 kb plasmid coding for a number of virulence factors, of which outer membrane proteins including an adhesin are the most important. In 65% of the patients the infection is self-limiting, but in the others a chronic local inflammation develops. Persistence of the infection has been associated with the immune status and the HLA-B27 antigen. Y. enterocolitica leads to abdominal complaints in young children that usually subside spontaneously. The infection is more serious with increasing age, and in people older than 30 years may involve a septicaemic form with multiple abscesses in various organs, or a lymphadenopathic form with generalized lymphadenitis mimicking a haematologic malignancy. Yersinia can be easily isolated during the acute phase by culture; during the chronic and persistent phase it is not cultivable anymore. Then serology should be performed, anti-Yop serology being the most reliable. Yersinia is susceptible to most antibiotics, except penicillins. Local penetration of the antibiotic may be a problem, however. First-choice antibiotics are cotrimoxazole, tetracyclines, chloramphenicol and fluoroquinolones. Systemic extra-mesenteric infections should always be treated with antibiotics.
Insights
Yersinia infections are often self-limiting but can become chronic, influenced by immune status and HLA-B27. Diagnosis shifts from culture in acute phases to serology in chronic Yersinia infections.
Area of Science:
- Microbiology
- Immunology
- Infectious Diseases
Background:
- The genus Yersinia includes three main pathogenic species: Y. pestis, Y. enterocolitica, and Y. pseudotuberculosis.
- Pathogenic Yersinia strains possess a 70 kb plasmid encoding crucial virulence factors, notably outer membrane proteins like adhesins.
Purpose of the Study:
- To summarize the clinical manifestations, diagnostic approaches, and treatment strategies for Yersinia infections.
- To highlight the challenges in diagnosing persistent Yersinia infections and the importance of serological testing.
Main Methods:
- Review of clinical presentations of Yersinia infections.
- Discussion of diagnostic methods including bacterial culture and serology (anti-Yop).
- Overview of antibiotic susceptibility and treatment recommendations for Yersinia.
Main Results:
- Yersinia infections present a spectrum from self-limiting to chronic inflammation.
- Persistence is linked to immune status and HLA-B27 antigen.
- Diagnostic methods vary by infection phase: culture for acute, serology for chronic/persistent phases.
- Yersinia is broadly susceptible to antibiotics, excluding penicillins, with specific first-line choices.
Conclusions:
- Effective management of Yersinia infections requires understanding their varied clinical courses and appropriate diagnostic timing.
- Serological testing, particularly anti-Yop, is crucial for diagnosing non-culturable chronic infections.
- Antibiotic selection should consider local penetration and systemic vs. localized infection, avoiding penicillins.