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Yersinia pseudotuberculosis

Species of bacterium

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Through Gram-negative bacteria and Bacteria

Typical strains of Y. pseudotuberculosis can be differentiated from the closely related Y. pestis and Y. similis by biochemical tests: this species can ferment both melibiose and rhamnose. It is urease-positive.

Pathogenesis

Y. pseudotuberculosis can affect both mammals and birds. Clinical yersiniosis has high mortality in most animal species (there is a lack of study reporting its presence or absence in asymptomatic animals).

In mammals the symptoms observed before death are usually limited to low appetite, lethargy, and diarrhea. Animals may also die without exhibiting any obvious symptoms beforehand. Some animals live long enough for other symptoms to show up, e.g. necrotic abcesses in organs, abortion, and jaundice.

Non-human primates can, too, die before exhibiting obvious symptoms. Recorded symptoms include diarrhea (sometimes bloody), various sickness behavior (low energy, low appetite, depression), significant weight loss, dehydration, and hypothermia. Occasionally there are rashes, erythema nodosum, and arthritis just like in human "Izumi fever". The ypmA gene may be responsible.

Birds generally die without warning, or after only exhibiting lethargy, diarrhea, and low appetite.

Many white-yellow nodules can be seen in various organs during post-mortem examination. These nodules resembles the tubercles of tuberculosis, hence the name. In non-primate mammals the presentation is mainly gastrointestinal, manifesting as ulcerative enteritis, mesenteric lymphadenomegaly, and hepatitis. In birds it is more commonly lymphoreticular with hepatitis and splenitis. However, lymphoreticular presentation can also appear in birds and vice versa.

Definite diagnosis is by a polymerase chain reaction (PCR) setup that detects the pYV. Identifying by culturing from feces is possible but slow and difficult. Whether the diagnosis can be made antemortem is a different matter.

Humans

Symptoms of infection by non-YPM-carrying Y. pseudotuberculosis are similar to those of infection with Yersinia enterocolitica (fever and right-sided abdominal pain), except that the diarrheal component is often absent, which sometimes makes the resulting condition difficult to diagnose. Y. pseudotuberculosis infections can mimic appendicitis, especially in children and younger adults. In rare cases there may be spread of bacteria to the blood (bacteremia).

East Asian strains of Y. pseudotuberculosis carry a YPM gene that causes overactivation of the immune system, leading to additional skin complaints (erythema nodosum), joint stiffness and pain (reactive arthritis), even Kawasaki disease. This is called "Far East scarlet-like fever" (FESF) or "Izumi fever".

In any case, infection usually becomes apparent five to 10 days after exposure and typically lasts one to three weeks without treatment. In complex cases or those involving immunocompromised patients, antibiotics may be necessary for resolution; ampicillin, aminoglycosides, tetracycline, chloramphenicol, or a cephalosporin may all be effective.

The symptoms of fever and abdominal pain mimicking appendicitis (actually from mesenteric lymphadenitis) associated with Y. pseudotuberculosis infection are not typical of the diarrhea and vomiting from classical food poisoning incidents. Although Y. pseudotuberculosis is usually only able to colonize hosts by peripheral routes and cause serious disease in immunocompromised individuals, if this bacterium gains access to the blood stream, it has an LD50 comparable to Y. pestis at only 10 CFU.

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