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[Intestinal yersiniosis: 25 cases of infections with Yersinia pseudotuberculosis and Yersinia enterocolitica (author's transl)].

Yersinia infections in 16 adults and 9 children are reported. 15 cases were caused by Yersinia pseudotuberculosis, 8 of them were proved by serological findings. In 4 cases the infection by Yersinia pseudotuberculosis was likely, in 3 other cases possible only. Real infections caused by serotype IV are demonstrated too. Furthermore there were 10 cases caused by Yersinia enterocolitica, 3 of them were proved by bacterial, the other ones by serological findings. Both germs caused identical symptoms: fever (80%), abdominal pains (56%), diarrhoea (52%), erythema nodosum (44%), arthritis (40%), vomiting (16%), weight loss (16%), lymphoma (12%) and others. In children 50% of erythema nodosum was produced by intestinal yersiniosis. The beginning with gastroenteritis and fever mostly was followed by a second phase with returning fever, abdominal pains, erythema nodosum and/or arthritis. Antibiotic therapy had a definite effect only in the first phase of gastroenteritis and in the two possibly relapsing cases. In two of 5 patients with long standing arthritis the HL-AB 27 was present.

Adolescent

[Allergic reactions in guinea pigs infected with Yersinia enterocolitica type 9 relative to homologous (Yersinia) and heterologous (Brucella) allergens].

Obtained were allergens from Brucella abortus 99 and Yersinia enterocolitica Type 9 through hydrolysis with hydrochloric acid after M. M. Ivanov and with acetic acid after Kirzhaev. They were tested on guinea pigs that were infected with Yersinia enterocolitica Type 9 through different ways. To M. M. Ivanov's allergens all infected animals responded pronouncedly in the case of the homologous allergen, and half of them only and to a lower degree in the case of the heterologous Brucella allergen. To Kirzhaev's allergens the infected guinea pigs showed more strongly expressed skin reactions. In this case, too, the response was stronger to the homologous Yersinai allergen. The diameters of skin swelling were more than twice greater than with the use of the heterologous Brucella allergen, and the sum of the reacting skin sites was five times greater in the case of the homologous Yersinia allergen. No essential differences were observed between the oral and the plantar route of infection combined with the subcutaneous injection of carboneum tetrachloratum and the morphine preparation Omnopon.

Allergens

Isolation of Yersinia enterocolitica and Yersinia pseudotuberculosis from human specimens and their drug-resistance in the Niigata District of Japan.

A total number of 60 Yersina strains (Yersinia enterocolitica 58; Yersinia pseudotuberculosis 2) were isolated from 58 patients who were more or less doubtful to yersinia infection in the Niigata district. An etiologic significance with respect to serogroup and biovar was investigated from the following viewpoints, (1) serum agglutinin titer; (2) positive recovery in the follow-up; (3) relation of positive specimen to the inflammatory lesion, (4) comparison with the isolates from a healthy group. Thus, etiologic significance was highly susceptible in the cases with 03 (4), 03 (3), and 05B (2) of Y. enterocolitica and Y. pseudotuberculosis, less susceptible in those with 05A (1) and 015 (1) of Y. enterocolitica and not susceptible in those with 06 (1), 07,8 (1), and 012 (1) or Y. enterocolitica. Among the isolates, drug-resistant strains--some of them involved with R plasmid--were demonstrated.

Anti-Bacterial Agents

Cultural characteristics of Yersinia enterocolitica and Yersinia pseudotuberculosis on differential media.

A study was made of the cultural characteristics of 43 strains of Yersinia enterocolitica and 49 strains of Yersinia pseudotuberculosis on media commonly used for the isolation and differentiation of enteric bacteria. Best growth of the yersinia occurred on MacConkey agar, followed by growth on SS agar; none of the strains of either species developed colonies on brilliant green agar. The Y. pseudotuberculosis strains developed only one type of colony on MacConkey, SS, EMB, Hektoen, and XLD media whereas Y. enterocolitica exhibited more than one type of colony on all of the media except MacConkey and SS agar. The 'lactose-positive' colonies of Y. enterocolitica were especially distinctive on EMB. These were quite dark, with or without a metallic sheen, and closely resembled the colonies of lactose fermenting Escherichia coli on EMB agar. Strains of both Y. enterocolitica and Y. pseudotuberculosis grew better on the differential media at 35 degrees C than at 22 degrees C but the growth of Y. pseudotuberculosis was considerably slower than that of the other species.

Agar

Cell-mediated immunity of Yersinia enterocolitica serotype 3 in patients with thyroid diseases.

The cellular immunity to Yersinia enterocolitica serotype 3 and crude human thyroid extract in 64 patients with thyroid diseases and 25 controls was studied by the leucocyte migration test. In the patient group as a whole and in patients with Graves' disease and nontoxic diffuse goitre a significantly reduced leucocyte migration towards Yersinia was found when compared with the controls. In controls the migration index was not related to the presence or titre of circulating yersinia antibodies, whereas the migration index of patients with yersinia antibodies was lower than the migration index of patients without yersinia antibodies as well as that of the controls. The leucocyte migration inhibition in two patients with recent yersinosis was normal during the recovery phase. In the presence of thyroid extract leucocyte migration inhibition differed only significantly in Graves' disease. However, a significantly positive correlation between inhibition of migration by thyroid extract and by Yersinia was found, while no correlation could be demonstrated in the controls. The cell-mediated immunity towards Yersinia in thyroid diseases thus demonstrated adds further evidence to the association between Yersinia and thyroid disease.

Adolescent

Experimental studies on the serological relationships between Yersinia enterocolitica and Brucella abortus.

Yersinia enterocolitica O9 was shown to provoke O, OH and H antibody response in calves. Brucella abortus failed to generate Yersinia H antibody response and generated Brucella O antibodies that cross-reacted with Yersinia O and OH antigens. The presence of Yersinia H agglutinins along with a higher titre of Yersinia OH antibody than Brucella O antibody is suggestive of subclinical infection with yersiniosis rather than brucellosis. Cross-absorption of sera from calves with established Yersinia infections indicated that absorption of sera with Brucella O antigens, although completely removing Brucella O antibodies, failed to remove completely Yersinia O, OH and H antibodies, and thus provides an additional method of distinguishing between the two infections.

Agglutination Tests

[Acute enteritis with "new" pathogens. Yersinia infections (author's transl)].

Infections of the intestinal tract with Yersinia enterocolitica and Yersinia pseudotuberculosis are known the world over. Post-infection reactions like arthritis, erythema nodosum, erythema multiforme, scarlatiniform exanthemata and septicemic types deserve particular clinical attention. The clinical importance of enteric yersinioses has been shown in studies with the identification of significant antibody titers against Yersinia enterocolitis and Yersinia pseudotuberculosis in 6.71 and 4.58% respectively of 4411 patients examined for the first time. It was possible to isolate Yersinia enterocolitica from 5.05% of 616 samples of stool and Yersinia pseudotubercolosis from 0.66% of 136 lymph nodes taken from 751 patients.

Abdomen, Acute

Yersinia enterocolitica and pseudotuberculosis infection in children.

The clinical symptoms of infections with Y. ent. and pseudotub. are of a different nature. Whether the infection becomes apparent in form of a pseudo-appendicitis, enterocolitis or a typho-septic disease does apparently not only depend on the type of pathogens but also on the children's condition with regard to their resistance. All forms mentioned are observed in case of infections with Yersinia pseudotuberculosis as well as in case of infections with Yersinia pseudotuberculosis as well as in case of infections with Yersinia enterocolitica. However, infections with Yersinia enterocolitica seem to have more frequently a chronic course and to be accompanied by conjunctivitis, arthritis and skin diseases. For the subacute and the chronic forms of the disease, a specific treatment is not necessary in most cases. Severe enterocolitis and septicemia, however, need an antibiotic therapy besides the symptomatic therapy. The best antibiotics for an infection with Yersinia enterocolitica still seem to be the tetracyclines and leucomycine, for an infection with Yersinia pseudotuberculosis also the cephalosporines, ampicilline and carbenicilline.

Anti-Bacterial Agents

Enzymatic degradation of polygalacturonic acid by Yersinia and Klebsiella species in relation to clinical laboratory procedures.

As scored by several specified plating procedures, clinical and environmental strains of Yersinia enterocolitica, Yersinia pseudotuberculosis, and Klebsiella pneumoniae "Oxytocum" showed detectable, albeit generally weak, ability to digest polygalacturonic (pectic) acid. None of these bacterial strains had the vigorous and rapid pectolytic activity on these polygalacturonic acid-containing media that is typical of soft-rot Erwinia species, although some of the Oxytocum strains came fairly close. Analyses of the pectolytic enzyme contents of the cells and culture supernatants of the Yersinia and Klebsiella species revealed that readily detectable quantities of cell-bound polygalacturonic acid trans-eliminase and hydrolytic polygalacturonase were formed by the Yersinia and Klebsiella species; however, the total units of enzyme activity produced by these bacteria were, in general, lower than were produced by soft-rot Erwinia species. Furthermore, unlike the situation in soft-rot Erwinia cultures, these pectolytic enzymes of Yersinia and Klebsiella species were not excreted rapidly and massively into the growth medium. Cultures of other enterobacteria (Citrobacter species, Enterobacter species, Erwinia amylovora, Erwinia herbicola, Escherichia coli, Proteus species, Salmonella typhimurium, and Serratia marcescens) showed no pectolytic ability whatsoever by any of the plating procedures used and (to the extent they were so examined) produced no pectolytic enzymes detectable either in their cells or culture supernatants. This slow or weak release of pectolytic enzymes by Yersinia and Klebsiella species has a bearing on clinical laboratory procedures suitable for detecting their pectolytic activity; methods adequate for this purpose are detailed.

Bacteriological Techniques

Speciation in Yersinia.

Deoxyribonucleic acid (DNA) relatedness among members of the genus Yersinia and the biochemical reactions of these organisms were compared. These data were used to reassess speciation within the genus Yersinia, and three new species were proposed. These are Yersinia ruckeri sp. n., formerly called the redmouth bacterium; Yersinia intermedia, sp. n., formerly a rhamnose-positive, raffinose-positive, melibiose-positive biogroup within Yersinia enterocolitica; and Yersinia frederiksenii sp. n., formerly a rhamnose-positive, raffinose-negative, melibiose-negative biogroup within Y. enterocolitica.

DNA, Bacterial

Evaluation of some cold enrichment and isolation media for the recovery of Yersinia enterocolitica.

An evaluation of several cold enrichment media for Yersinia enterocolitica showed that the enrichment quotient achieved after 3 weeks at 4 degrees C was highly dependent on the initial cell concentration and the medium used. The latter should be of high nutritional value, in order to allow sufficient growth of Yersinia enterocolitica at a low temperature. Enrichment in typtone--soya broth yielded better results than in--frequently used--phosphate buffer, pH 7.6. While comparing isolation media for Yersinia enterocoliica to be used after cold enrichment, DHL agar was most satisfactory: after 20 h incubation at 29 degrees C, colonies of Yersinia enterocolitica are easily distinguishable and the organisms fully recovered. An urea medium, containing novobiocin as selective agent, also yielded good results. It must be stressed that only human strains of serotypes 0:3 and 0:9 of Yersinia enterocolitica were studied.

Bacteriological Techniques

Accumulation of iron by yersiniae.

Escherichia coli, Bacillus megaterium, and three species of yersiniae grew rapidly without significant production of soluble siderophores in a defined iron-sufficient medium (20 microM Fe3+). In iron-deficient medium (0.1 to 0.3 microM Fe3+) all organisms showed reduced growth, and there was extensive production of siderophores by E. coli and B. megaterium. Release of soluble siderophores by Yersinia pestis, Y. pseudotuberculosis, or Y. enterocolitica in this medium was not detected. Citrate (1 mM) inhibited growth of yersiniae in iron-deficient medium, indicating that the organisms lack an inducible Fe3+-citrate transport mechanism. Uptake of 59Fe3+ by all yersiniae was an energy-dependent saturable process, showing increased accumulation after adaptation to iron-deficient medium. Growth of Y. pseudotuberculosis and Y. enterocolitica but not Y. pestis on iron-limited solid medium was enhanced to varying degrees by exogenous siderophores (desferal, schizokinen, aerobactin, and enterochelin). Only hemin (0.1 pmol) or a combination of inorganic iron plus protoporphyrin IX promoted growth of Y. pestis on agar rendered highly iron deficient with egg white conalbumin (10 microM). Growth of Y. pseudotuberculosis and Y. enterocolitica was stimulated on this medium by Fe3+ or hemin. These results indicate that hemin can serve as a sole source of iron for yersiniae and that the organisms possess an efficient cell-bound transport system for Fe3+.

Bacillus megaterium