Yersinia

Yersinia Enterocolitica.

Yersinia (a coliform & fecal coliform) is one of the Enterobacteriaceae. Infections include, aneurysms,
endocarditis, severe abscess of the lung, diarrhea, hepatic and splenic, Focal (oral) infections,
bacteremia, pharyngitis, meningitis, osteomyelitis, pyomyositis, conjunctivitis, pneumonia, acute
proliferative glomerulonephritis, peritonitis, and primary cutaneous, necrotizlng "flesh eating"
enterocolitis, pseudotuberculosis, acute gastroenteritis and mesenteric lymphadenitis, arthritis,
septicemia, and erythema nodosum, Reiter's syndrome. It is antibiotic resistant and now produces
poisonous Hydrogen Sulfide (H2S) gas.
Yersinia is a thermotolerant bacteria that has become very deadly since 1976.

According to the 1976 study, “
Lung abscess and osteomyelitis of rib due to Yersinia enterocolitica,”
by J. I. Sebes, et al., “Yersinia enterocolitica is a gram-negative organism that only recently has
become known to infect man. Although the number of infections with Yersinia entercolitica has
increased during the last few years, most reports came from Europe, Africa, Australia, and Japan.
During the past year, Yersinia infections have been discovered in Canada and in the United States. –
Most diseases caused by  Yersinia entercolitica are relatively benign; however, we have recently
observed one case that presented as a severe abscess of the lung. This case is unique in that it is
not only the first report of pulmonary disease with this organism, but also demonstrates the potential
aggressiveness of this organism in areas outside the gastrointestinal tract. Our purpose is to report
this unusual occurrence and to acquaint the physician with this organism and some of its
manifestations.”
http://chestjournal.chestpubs.org/content/69/4/546.full.pdf

In the 1993 study, “
Case report: Yersinia enterocolitica necrotizing pneumonia in an
immunocompromised patient
,” J.N. Greene, et al., said, “The authors report a rare case of Yersinia
enterocolitica necrotizing pneumonia in an immunocompromised patient, who responded with
resolution of the infection after 6 weeks of therapy with a third-generation cephalosporin but
subsequently expired from the underlying lymphoma. In the few cases of Y. enterocolitica pulmonary
infections that have been reported, the prognosis for cure of the infection is excellent with appropriate
antibiotic therapy. Y. enterocolitica is likely to be recognized more frequently as a cause of serious
infection in the growing immunosuppressed population. Early recognition and appropriate therapy can
improve survival significantly.” http://www.ncbi.nlm.nih.gov/sites/entrez?
cmd=Retrieve&db=PubMed&list_uids=8447337&dopt=Abstract

According to the 2006 study, “
Molecular Biogrouping of Pathogenic Yersinia enterocolitica -
Development of a Diagnostic PCR Assay With Histologic Correlation
,” Laura W. Lamps, MD, et al.,
reported, “Previous serologic, microbiologic, and molecular studies have implicated pathogenic
strains of Y. enterocolitica as causative agents in numerous gastrointestinal inflammatory diseases,
including appendicitis (granulomatous and suppurative), gastroenteritis, ileitis, colitis, and mesenteric
lymphadenitis.[4,8,11,13-18] The spectrum of illness caused by Y. enterocolitica is extremely variable,
ranging from acute self-limited gastroenteritis to fatal dissemination and sepsis. Food-borne
outbreaks have been associated with virtually all pathogenic serovars. Serovar O:8 has
characteristically been associated with more catastrophic human infection, whereas O:3 and O:9
have been linked to milder cases. – Six archival, formalin-fixed, paraffin-embedded patient specimens
that had tested positive for pathogenic Y. enterocolitica chromosomal DNA using PCR analysis (see
"Initial PCR Assay for the Y. enterocolitica ail Gene")[15,20,21] also were retrieved. Of the 6 cases, 3
were granulomatous appendicitis, 1 was malacoplakia of the appendix and right colon, 1 was a colon
resection from a patient with acute Y. enterocolitica enterocolitis with perforation and sepsis, and 1
was a Y. enterocolitica soft tissue abscess.”
http://www.medscape.com/viewarticle/530612_2 `

According to the 2009 American Academy of Pediatrics (AAP) Committee on Infectious Diseases Red
Book Online, “Yersinia enterocolitica causes several age-specific syndromes and a variety of other
less common presentations. Infection with Y. enterocolitica typically manifests as fever and diarrhea in
young children; stool often contains leukocytes, blood, and mucus. Relapsing disease and, rarely,
necrotizing enterocolitis also have been described. In older children and adults, a pseudoappendicitis
syndrome (fever, abdominal pain, tenderness in the right lower quadrant of the abdomen, and
leukocytosis) predominates. Bacteremia with Y. enterocolitica most often occurs in children younger
than 1 year of age and in older children with predisposing conditions, such as excessive iron storage
(e.g., desferrioxamine use, sickle cell disease, beta-thalassemia) and immunosuppressive states.
Focal manifestations of Y. enterocolitica are uncommon and include pharyngitis, meningitis,
osteomyelitis, pyomyositis, conjunctivitis, pneumonia, empyema, endocarditis, acute peritonitis,
abscesses of the liver and spleen, and primary cutaneous infection. Post infectious sequelae with Y.
enterocolitica infection include erythema nodosum, proliferative glomerulonephritis, and reactive
arthritis; these sequelae occur most often in older children and adults, particularly people with HLA-
B27 antigen.”
http://aapredbook.aappublications.org/cgi/content/extract/2009/1/3.153

Yersinia enterocolitia in Animals

“Yersinia enterocolitica, is often carried by many animal species, especially pigs, and associated with
sporadic diarrhea in humans and animals. Farmed deer are highly susceptible.” Saunders
Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved

Yersinia (Pasteurella) pestis,

Black Death -- Yersinia pestis causes the bubonic, pneumonic, and septicemic plagues . Human
contraction of bubonic plague is usually through flea bites. Once inside the body, Y. pestis
releases a toxin which inhibits electron transport chain function. Swelling of the lymph nodes, skin
blotches, and dilerium are sometimes observed within a few days of infection. Untreated infections
usually result in death within a week of initial infection.
http://www.boisestate.edu/courses/westciv/plague/02.shtml

“Etymology: Alexandre E.J. Yersin; L, pestis, plague a species of small gram-negative bacteria that
causes plague. The primary host is the rat, but other small rodents also harbor the organism. A
person without symptoms may be a carrier, but this happens rarely. Yersinia pestis is hardy, living for
long periods in infected carcasses, the soil of the host's habitat, or sputum. Also called Pasteurella
pestis. See also plague.” Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

In a 2007 study, “Multiple Antimicrobial Resistance in Plague: An Emerging Public Health Risk,”
Timothy J. Welch, et al., United States Department of Agriculture (USDA), reported, “Antimicrobial
resistance in Yersinia pestis is rare, yet constitutes a significant international public health and
biodefense threat. In 1995, the first multidrug resistant (MDR) isolate of Y. pestis (strain IP275) was
identified, and was shown to contain a self-transmissible plasmid (pIP1202) that conferred resistance
to many of the antimicrobials recommended for plague treatment and prophylaxis. Comparative
analysis of the DNA sequence of Y. pestis plasmid pIP1202 revealed a near identical IncA/C plasmid
backbone that is shared by MDR plasmids isolated from Salmonella enterica serotype Newport
SL254 and the fish pathogen Yersinia ruckeri YR71. The high degree of sequence identity and gene
synteny between the plasmid backbones suggests recent acquisition of these plasmids from a
common ancestor. In addition, the Y. pestis pIP1202-like plasmid backbone was detected in
numerous MDR enterobacterial pathogens isolated from retail meat samples collected between 2002
and 2005 in the United States. Plasmid-positive strains were isolated from beef, chicken, turkey and
pork, and were found in samples from the following states: California, Colorado, Connecticut,
Georgia, Maryland, Minnesota, New Mexico, New York and Oregon. Our studies reveal that this
common plasmid backbone is broadly disseminated among MDR zoonotic pathogens associated with
agriculture. This reservoir of mobile resistance determinants has the potential to disseminate to Y.
pestis and other human and zoonotic bacterial pathogens and therefore represents a significant
public health concern.”
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000309

Plague is an endemic disease of rodents in the western United States, with occasional spread into
human and non-rodent populations via enzootic or amplification hosts.

Contributor’s comment about the plague in mule deer and blacktailed deer states: “The mule deer
had bilateral ocular infection due to Yersinia pestis. In addition to these changes there were acute
necrotizing inflammatory lesions in lung, adrenals, lymph node, and liver with intralesional bacteria,
and disseminated intravascular coagulation. – Plague is unusual in big game animals and ungulates
are generally considered resistant to the disease. There is a published report of plague in a free-
ranging mule deer in Wyoming,1 an unpublished, laboratory-confirmed case in a mule deer in
Montana, 2 and bilateral plague- associated necrotizing panophthalmitis in a blacktailed deer in
California.3 Ocular plague has been seen in Colorado (Dr. M. Miller, Colorado Division of Wildlife,
unpublished observations).”
http://www.jwildlifedis.org/cgi/content/full/44/4/983
http://www.cwd.cc/Mule-deer_plagued_by_blindness.htm

Yersinia was reported in an EPA sewage sludge compost study in 1988

Black Plague -- Yersinia pestis causes the bubonic, pneumonic, and septicemic plagues . Human
contraction of bubonic plague is usually through flea bites. Once inside the body, Y. pestis releases
a toxin which inhibits electron transport chain function. Swelling of the lymph nodes, skin blotches,
and dilerium are sometimes observed within a few days of infection. Untreated infections usually
result in death within a week of initial infection.

Plague is an endemic disease of rodents in the western United States, with occasional spread into
human and non-rodent populations via enzootic or amplification hosts.

Yersinia enterocolitica (1976) is a gram-negative organism that only recently has become known
to infect man. Although the number of infections with Yersiniia entercolitica has increased during the
last few years, most  reports came from Europe, Africa, Australia, and Japan. During the past year,
Yersinia infections have been discovered in Canada  and in the United States.

Most diseases caused by Yersinia entercolitica are relatively benign; however, we have recently
observed one case that presented as a severe abscess of the lung. This case is unique in that it is
not only the first report of pulmonary disease with this organism, but also demonstrates the potential
aggressiveness of this organism in areas outside the gastrointestinal tract. Our purpose is to report
this unusual occurrence and to acquaint the physician with this organism and some of its
manifestations.

CLINICAL MANIFESTATIONS: Yersinia enterocolitica and Yersinia pseudotuberculosis cause
several age-specific syndromes and a variety of uncommon presentations. The most common
manifestation of infection with Y enterocolitica is enterocolitis with fever and diarrhea; stool often
contains leukocytes, blood, and mucus. This syndrome occurs most often in young children. A
pseudoappendicitis syndrome (fever, abdominal pain, tenderness in the right lower quadrant of the
abdomen, and leukocytosis) occurs primarily in older children and young adults. Focal infections,
abscess formation (such as hepatic and splenic), and bacteremia occur most often in patients with
predisposing conditions, such as excessive iron storage. Other manifestations of infection are
uncommon and include pharyngitis, meningitis, osteomyelitis, pyomyositis, conjunctivitis, pneumonia,
acute proliferative glomerulonephritis, peritonitis, and primary cutaneous

Of 187 newborns admitted to a 33-bed, level III neonatal intensive care unit between January 1,
1985 and June 23, 1985, 33 developed necrotlzlng enterocolitis during their hospital stay. Twenty of
the 33 newborns (61%) had onset of symptoms between April 1 and June 23, suggesting clustering
during this period. A case-control study, with matching on birth weIght class, approximate date of
admission to the unit and approximate duration of stay, failed to reveal any association of the
syndrome with type or timing of feeding, perinatal hypoxic events, as determined by apgar scores
and labor history, or specific microbial organisms. By contrast, however, transfusion of packed red
blood cells was highly and significantly associated with the syndrome (odds ratio = 15.1, 95%
confidence interval = 2.59–92.51). In addition, therapy with caffeine, with theoph ylline, and with
furosemide were moderately associated with the syndrome, although not significantly so. During this
outbreak period, the Incidence of necrotizing enterocolitis by birth weight was 30.6% in infants less
than 1,500 gm, 10.8% in infants 1,500–2,500 gm, and 11.9% in infants 2,500 gm or more. These
findings confirm the importance of low birth weight as a risk factor for development of the syndrome
and suggest that Insults to volume homeostasis, such as transfusion and use of diuretics, need to be
considered as possible mechanisms whereby necrotizing enterocolitis is Initiated.

The authors report (1993) a rare case of Yersinia enterocolitica necrotizing pneumonia in an
immunocompromised patient, who responded with resolution of the infection after 6 weeks of therapy
with a third-generation cephalosporin but subsequently expired from the underlying lymphoma. In the
few cases of Y. enterocolitica pulmonary infections that have been reported, the prognosis for cure
of the infection is excellent with appropriate antibiotic therapy. Y. enterocolitica is likely to be
recognized more frequently as a cause of serious infection in the growing immunosuppressed
population. Early recognition and appropriate therapy can improve survival significantly.

The Cytotoxic Necrotizing Factors (2007)  from Yersinia pseudotuberculosis and from
Escherichia coli Bind to Different Cellular Receptors but Take the Same Route to the Cytosol

Eight pathogenic strains (O:1, O:2, O:4, O:13, O:15, O:20, O:21, and O:34) of Y enterocolitica
were obtained from the Centers for Disease Control and Prevention (CDC), Atlanta, GA. These
specimens were received as
freeze-dried organisms, which subsequently were rehydrated with
phosphate-buffered saline (PBS) before culture.

Yer·sin·ia/ (yer-sin´e-ah) a genus of nonmotile, ovoid or rod-shaped, nonencapsulated, gram-
negative bacteria (family Enterobacteriaceae); Y. enterocoli´tica is a ubiquitous species that causes
acute gastroenteritis and mesenteric lymphadenitis in children and arthritis, septicemia, and
erythema nodosum in adults; Y. pes´tis causes plague in humans and rodents, transmitted from rats
to humans by the rat flea, and from person to person by the human body louse; Y.
pseudotuberculo´sis causes disease in rodents and mesenteric lymphadenitis in humans.
http://medical-dictionary.thefreedictionary.com/YERSINIA

Yersinia genus: Y. enterocolitica and Y. pestis. Y. enterocolitica is the most often encountered
species of Yersinia in the lab. This bacterium is an invasive pathogen which can penetrate the gut
lining and enter the lymphatic system and the blood. Infection, which is usually through ingestion of
contaminated foods, can cause a severe intestinal inflammation called yersiniosis. Release of its
enterotoxin can cause severe pain similar to that found in patients with appendicitis.

Yersinia enterocolitica (1984) Now that its role as a human pathogen is firmly established, reports
documenting Yersinia enterocolitica infections are increasing worldwide. The organism has been
encountered both sporadically and epidemically (3). Y. enterocolitica causes a diarrheal illness in
children (10), and its association with Reiter's syndrome in adults is well known (6, 13), but only a
handful of cases of primary soft tissue infection have been described.

Contributor’s Comment: The mule deer had bilateral ocular infection due to Yersinia pestis. In
addition to these changes there were acute necrotizing inflammatory lesions in lung, adrenals, lymph
node, and liver with intralesional bacteria, and disseminated intravascular coagulation

Plague is unusual in big game animals and ungulates are generally considered resistant to the
disease. There is a published report of plague in a free-ranging mule deer in Wyoming,1 an
unpublished, laboratory-confirmed case in a mule deer in Montana,2 and bilateral plague-associated
necrotizing panophthalmitis in a blacktailed deer in California.3 Ocular plague has been seen in
Colorado (Dr. M. Miller, Colorado Division of Wildlife, unpublished observations).