Yersinia pseudotuberculosis

In contrast to Yersinia enterocolitica, rather rare yersiniosis. Yersinia pseudotuberculosis causes lymphadenitis mesenterialis, which is usually blanched in Central Europe. Since such a finding also occurred in intestinal tuberculosis, the name pseudotuberculosis was given. This infection is of particular importance because immunopathological complications can occur weeks after an acute infection, preferably in women, such as reactive arthritides and erythema nodosum.

Oral transmission through contaminated, insufficiently heated meat, via contaminated water and animal contacts. Zoonosis (indirectly from animals via food, dairy products, raw pork) (Tauxe RV 2004). The pathogens can also multiply at low ambient temperatures (refrigerator temperature) and under microaerophilic conditions.

For the human pathogenic Y. enterocolitica strains, pigs (domestic swine and wild boar) are the most important animal reservoir. The infection is asymptomatic here. Therefore, contamination of carcasses may occur during the slaughter process (Drummond N et al. 2012).

Y. pseudotuberculosis occur widely in the environment and are mainly isolated from various birds and wild animals, e.g. rodents and other small mammals.

Infectivity persists as long as symptoms persist, usually 2-3 weeks. A longer period of shedding is possible in both children and adults.

The level of infection in the population is very low. The same applies to the number of cases detected.

Pseudoappendicitis course is observed in 75-90% of cases. (older children, adolescents): Appendicitis-like symptomatology with mesenteric lymphadenitis (Maßhoff's disease, Maßhoff's lymphadenitis, pseudoappendicitis). More rarely, ileus symptomatology.

Pathogen detection: Culturally from mesenteric lymph nodes (after surgery); possibly also detection of Yersinia DNA. Yersinia can still multiply on meat and sausage at + 4°C in the refrigerator.

Serology: Double titre determination for antibodies against Y. pseudotuberculosis.

In cases of reactive arthritis, serological detection of Yop (yersinia outer proteins) antibodies is used for diagnosis. Yop-positive diagnoses are only meaningful if a titer increase can be detected between two samples taken several days apart.

Far East scarlet fever (FESLF) is a severe inflammatory disease that occurs sporadically and in outbreaks in Russia and Japan. The disease is caused Yersinia pseudotubuclosis. There appears to be geographic heterogeneity between virulence factors produced by European and Far Eastern Y pseudotuberculosis strains. Superantigen Y pseudotuberculosis-derived mitogen A (YPMa) triggered by the virulence plasmid pYV is thought to play an essential role in the pathogenesis of FESLF (Amphlett A 2015; Timchenko NF et al. 2016).

For the duration of the illness, patients should stay at home and follow the listed hygiene measures. For infections in hospitals, other medical facilities, in homes, care facilities and other community facilities, special hygiene measures apply.

In the case of a mild course: In the case of an acute Yersinia infection without a severe course of the disease, antimicrobial therapy should generally not be administered according to the S2k guideline "Gastrointestinal infections and Whipple's disease" (Hagel et al., 2015), as the course cannot be significantly influenced. Oral fluid and electrolyte replacement are sufficient.

In severe cases: antibiotic therapy with fluoroquinolones (e.g. ciprofloxacin) or 3rd generation cephalosporins (e.g. ceftriaxone).

Mostly healing without consequences

Yersinia pseudotuberculosis, a gastrointestinal bacterium, produces three closely related T-cell superantigens, YPMa, YPMb and YPMc, which do not share significant sequence similarity to other bacterial superantigens. YPMa has pathogenetic significance in causing Far East scarlet fever (FESLF) (Donadini R et al. 2007).

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