32株小肠结肠炎耶尔森菌病原学特征

目的了解徐州地区小肠结肠炎耶尔森菌的分布及病原学特征。方法常规方法在腹泻患者粪便、家禽家畜粪便、苍蝇、肉食品中分离小肠结肠炎耶尔森菌，用血清学、生物学方法分型及抗菌耐药性分型。并通过PCR技术进行毒力基因检测，同时对检出的国内主要流行血清型O：3和O：9菌株进行脉冲场凝胶电泳分析。结果2014份标本中共检出32株（分为17个血清型）小肠结肠炎耶尔森菌，总检出率为1．59％，其中O：3和O：9血清型的检出率分别为9．4％，且耐药模式相同。32株小肠结肠炎耶尔森菌分别携带ail、ystA、yadA、virF和all、ystA毒力基因的各占9．4％，只携带ystB基因的占21．8％，不携带以上任何基因的占59．4％。32株小肠结肠炎耶尔森菌分为3个生物型别，其中1A型为78．1％，3型为18．8％，2型为3．1％。本地区分离的2株O：3血清型小肠结肠炎耶尔森菌的脉冲场凝胶电泳带型相同，是我国O：3血清型小肠结肠炎耶尔森菌的主要克隆系。结论徐州地区存在致病性小肠结肠炎耶尔森菌O：3和O：9血清型及由此引起的腹泻疾病，应引起高度重视。     

163株小肠结肠炎耶尔森菌的抗菌药物敏感性分析

目的 了解高密市动物宿主中小肠结肠炎耶尔森菌分离株的抗菌药物敏感情况。方法 采用VITEK 2 COMPACT 系统和AST-GN16药敏卡检测高密市2006-2011年分离到的163株小肠结肠炎耶尔森菌的抗菌药物敏感性。抗菌药物敏感率变化趋势采用直线回归法检验,不同宿主间抗菌药物敏感率检验采用非参数检验的Kruskal-Wallis法,两两比较采用Nemenyi法。结果 哌拉西林-他唑巴坦、头孢曲松、头孢吡肟、氨曲南、厄他培南、亚胺培南、阿米卡星、庆大霉素、妥布霉素、左氧氟沙星和替加环素的敏感率均达到或接近100%,氨苄西林和头孢唑林的耐药率超过90%;94.5%（154/163）的菌株对2种及2种以上的抗菌药物耐药,且对4种及4种以上的抗菌药物耐药的菌株达到71.2%（116/163）;抗菌药物敏感率不存在线性变化趋势（P＞0.05）;不同宿主间菌株的抗菌药物敏感性仅环丙沙星和复方新诺明的差异有统计学意义,P值介于0.04-0.05之间,但经两两比较后差异亦无统计学意义。结论 高密市小肠结肠炎耶尔森菌在不同年份、不同宿主间的抗菌药物敏感性变化不大,但耐受多种抗菌药物的现象严重。     

Persistence of Yersinia enterocolitica in man

Summary Ten patients with chronicYersinia enterocolitica infections are described. The initial diagnosis was made by culture, significant agglutinin titres and indirect immunofluorescence (IF) on biopsies. During the chronic phase, culture and agglutinin titres were negative, but specific serum IgA and IgG antibodies reactive with at least two, i.e. the 36 kDa and the 46 kDa, virulence-associated released proteins were demonstrated in nine patients by immunoblot techniques. One patient had only IgG antibodies. The chronically elevated IgA production was the result of chronic stimulation of the gut-associated lymphoid tissue by virulent persistentYersinia antigen, which was identified by IF with O-specific antiserum and monospecific antiserum to the 46 kDa released protein in biopsies. VirulentYersinia bacilli were demonstrated in the intestinal mucosa and in the lymphoid tissue of the submucosa associated with macrophages in patients with chronic ileitis and arthritis, in granulomatous centres of lymph nodes in patients with chronic lymphadenopathy and in portal infiltrates in a patient with chronic hepatitis. Recognition of persistentYersinia infections may have therapeutic implications.

---

Persistenz von Yersinia enterocolitica bei Menschen

Zusammenfassung Zehn Patienten mit chronischerYersinia enterocolitica-Infektion werden beschrieben. Die Anfangsdiagnose war mittels positiver Kulturen, signifikanter Agglutinationstiter und immunhistologischem (IF) Yersinia-Nachweis in menschlichem Biopsiematerial gestellt worden. Während der chronischen Phase waren Kultur und Agglutinationstiter negativ, aber im Serum von neun Patienten waren mit Immunoblot spezifische IgA- und IgG-Antikörper gegen mindestens zwei, d. h. die 36 kDa und 46 kDa Virulenz-assoziierten Proteine nachzuweisen. Ein Patient hatte nur IgG-Antikörper. Die chronisch erhöhte IgA-Produktion war verursacht durch chronische Stimulierung des intestinalen lymphatischen Gewebes durch virulente, persistierendeYersinia-Antigene, die mittels IF mit O-spezifischem Antiserum und monospezifischem Antiserum gegen das 46 kDa Virulenz-Protein in Biopsiematerial identifiziert werden konnten. VirulenteYersinia-Bazillen lagen in Biopsien von Patienten mit chronischer Ileitis und Arthritis tief in der Darmmukosa und im lymphoiden Gewebe der Submukosa, assoziiert mit Makrophagen. Sie wurden auch in Lymphknoten von Patienten mit chronischer Lymph-adenopathie nachgewiesen und in portalen Infiltraten eines Patienten mit chronischer Hepatitis. Der Nachweis persistierenderYersinia-Infektionen kann therapeutische Konsequenzen haben.

     

Antimicrobial resistance and plasmid replicons in Yersinia enterocolitica strains isolated in Brazil in 30 years

Some studies evaluated the resistance profile of the Y. enterocolitica strains isolated in diverse countries. However, in Brazil the isolation and the study of Y. enterocolitica are not common and therefore information about the antimicrobial resistance profile of this species in this country is scarce. Therefore, the aim of this study was to evaluate the antimicrobial resistance of Y. enterocolitica of biotypes 1A, 2 and 4 isolated from clinical and non-clinical sources between 1979 and 2012, in Brazil. This study showed that some Yersinia enterocolitica of different biotypes remain susceptible to antimicrobials used for gastroenteritis treatment. Moreover, neither acquired resistance genes nor diversity of plasmids replicons were found; however, variation in the in vitro intrinsic resistant pattern was detected, except the non-resistance to cefoxitin in all strains. Notwithstanding, due to epidemiological link between Y. enterocolitica and the pork production chain, monitoring plasmid acquired resistance in Y. enterocolitica could also be considered for antimicrobial resistance control purposes and food safety measures.     

Spontaneous Yersinia enterocolitica septicemia in a patient with iron overload

Yersinia enterocolitica septicemia is described in a patient with transfusional iron overload and a myelodysplastic syndrome. The organism was biotype 1 serotype 0:5,27 and carried a virulence-encoding plasmid. It was calcium-dependent, autoagglutinating and virulent to orally challenged mice, but not resistant to the bacteriocidal activity of serum. The patient had depressed neutrophil chemotaxis and bactericidal activity. In this case, both host and microbial factors were present to select out this particular bacteremic disease. Patients with iron overload states should be recognized as compromised hosts and potentially susceptible to spontaneous sepsis due to Y enterocolitica.     

Plasmids of human strains of Yersinia enterocolitica: molecular relatedness and possible importance for pathogenesis

One-hundred fifteen strain of Yersinia enterocolitica were examined for plasmids and plasmid-mediated pathogenic properties. Human strains of serotypes O:3 and O:9 harbored plasmids of 46 and 44 megadaltons, respectively, with 90% homology of DNA sequences. The plasmid-mediated properties were calcium dependence, survival in human serum, conjunctivitis provocation in guinea pigs, and O agglutinogens. One strains of serotype O:8 harbored a 42-megadalton plasmid with 75% sequence homology with plasmids of serotypes O:3 and O:9. An additional plasmid-mediated property was lethality for white mice. Filter hybridization of restriction endonuclease-digested plasmid DNA indicated that a 5.6-megadalton fragment of the plasmid of serotype O:8 had virtually no sequence homology with plasmid DNA of serotypes O:3 and O:9 and therefore may be associated with the lethal factor for mice.     

Liver abscesses due to Yersinia enterocolitica in patients with haemochromatosis

Liver abscesses due to Yersinia enterocolitica usually occur in patients with a pathological iron overload. A case of multiple liver abscesses in a patient with haemochromatosis is reported and the literature is reviewed.     

Yersinia enterocolitica in the synovial membrane of patients with Yersinia-induced arthritis

Using a monospecific rabbit antibody against Yersinia enterocolitica outer membrane protein 1, we examined synovial biopsy specimens from 7 patients with Yersinia-induced arthritis. Yersinia were demonstrated in the synovial membrane by indirect immunofluorescence in 4 patients with Yersinia-induced arthritis, but not in 6 control patients with Salmonella-induced arthritis or with rheumatoid arthritis. These findings suggest the persistence of Yersinia in the joints of patients with Yersinia-induced arthritis.     

Perforation of the Ileum in Yersinia enterocolitica Infection

A 69-year-old woman with a 5-wk history of diarrhea and abdominal pain was found to have multiple perforations of the terminal ileum. Blood cultures and cultures of the fistulae and mesenteric lymph nodes were positive for Yersinia enterocolitica infection. This is believed to be the first documented case of perforation of the intestinal tract with this disease.     

Transfusion-mediated Yersinia enterocolitica septicemia in an adult patient with beta-thalassemia.

We report a case of transfusion-mediated Yersinia enterocolitica septicemia in a 43-y-old woman with homozygous beta-thalassemia. Two h after transfusion of 3 units of red blood cells the patient suffered high-grade fever and shaking chills. Y. enterocolitica serotype O3 grew in blood cultures. Prolonged treatment with i.v. ceftriaxone plus ciprofloxacin led to a favorable outcome. Transfusion-associated Y. enterocolitica septicemia has not previously been reported in an adult beta-thalassemic patient from the Mediterranean area. Our report is particularly important, because of the high incidence of chronically transfused thalassemic patients in Mediterranean countries.     

Lactobacillus fermentum attenuates the proinflammatory effect of Yersinia enterocolitica on human epithelial cells

BACKGROUND: Lactobacilli represent a major component of the human microbiota. In this study we investigated whether and how Lactobacillus fermentum inhibits the proinflammatory responses of human epithelial cells on Yersinia enterocolitica infection. METHODS: Human epithelial cells were exposed to Y. enterocolitica pYV(-) or L. fermentum or to both strains, combinations of heat-killed L. fermentum or supernatant of L. fermentum cultures and Y. enterocolitica. The modulation of Y. enterocolitica induced IL-8 levels in the culture supernatants was determined and activation of Rac, p38, and NF-kappaB was investigated. RESULTS: Exposure of human epithelial cells to L. fermentum does not induce NF-kappaB activation and subsequent IL-8 secretion in HeLa cells, whereas Y. enterocolitica induces NF-kappaB activation and high levels of IL-8. Viable L. fermentum, supernatant of L. fermentum cultures, but not heat-killed L. fermentum, inhibited IL-8 secretion of HeLa cells triggered by Y. enterocolitica. Lactobacillus fermentum-exposed HeLa cells showed decreased Rac, p38, and NF-kappaB activation after Y. enterocolitica infection. Treatment of L. fermentum supernatants with phospholipase C abolished the inhibitory effect, indicating that a secreted phospholipid mediates the antiinflammatory properties of L. fermentum. Adhesion to or invasion of Y. enterocolitica into epithelial cells was not altered by coincubation with L. fermentum. CONCLUSION: Our results lead to the conclusion that L. fermentum inhibits the Y. enterocolitica-induced IL-8 production by a possibly secreted phospholipid of <10 kDa molecular weight. These data suggest that L. fermentum may have probiotic properties modulating intestinal inflammatory responses and might offer new therapeutic strategies in the treatment of intestinal inflammatory diseases.     

Yersinia enterocolitica infection and sarcoidosis. A report of seven cases

Sarcoidosis of recent onset was diagnosed during a Yersinia enterocolitica infection in seven patients at the Copenhagen County Hospitals during a 3 1/2 year period. In all cases the diagnosis was made from clinical symptoms and confirmed by chest X-ray and biopsy. In five of the patients a fourfold rise or decrease was measured in the antibody titre against Yersinia enterocolitica, serotype 3, confirming an acute infection. In another two patients this titre remained significantly elevated greater than or equal to 80, indicating chronic infection. Five patients experienced joint symptoms and four erythema nodosum, symptoms common to both yersiniosis and sarcoidosis. A follow-up examination 14 to 41 months after the debut of sarcoidosis showed total remission (including chest X-ray and respiratory function) in five of the seven patients. Recent research has shown that Yersinia enterocolitica following the early stage of the infection causes granulomatous lesions in lymph follicles, and this aetiology should thus be considered as a differential diagnosis to sarcoidosis.