Influence of antibiotics on IgA and IgG response and persistence of Yersinia enterocolitica in patients with Yersinia-associated spondylarthropathy

Terminal Ileitis due to Yersinia Infection: An Underdiagnosed Situation

Endoscopy is currently the gold standard for the diagnosis of inflammatory bowel disease (IBD). The presence of macroscopic lesions along with the microscopic detection of inflammatory infiltration in the terminal ileum often leads the gastroenterologist to the diagnosis of Crohn's disease (CD). However, some of these cases could be, in fact, an infection caused by Yersinia spp., accompanied or not with CD, which could be easily diagnosed with the identification of serum antibodies against Yersinia outer protein antigens (YOP antigens). Since Yersiniosis is considered to be an uncommon situation, food and water are not usually checked for the possibility of contamination by Yersinia. Therefore, it is reasonable to assume that the true prevalence of Yersinia infection in patients with terminal ileitis is probably underestimated. In this article, we review the most important data regarding the various aspects of Yersinia infection with special focus on its pathophysiology and diagnosis. We recommend testing for serum antibodies against YOP antigens in all patients with an endoscopic and histological image of terminal ileitis in order to identify Yersiniosis in conjunction or not with terminal ileum CD.

Phytosterols improve immunity and exert anti-inflammatory activity in weaned piglets

BACKGROUND

Phytosterols (PS), plant-derived natural steroid compounds, are novel feed additives to regulate immune function and promote pig growth. This study was conducted to determine the effects of PS on the immune response of weaned piglets.

RESULTS

One hundred and twenty crossbred (Duroc × Landrace × Yorkshire) piglets with an average initial weight of 9.58 ± 0.26 kg were randomly allotted to three treatments. Treatments consisted of a control, PS (0.2 g kg^-1 ) and polymyxin E (0.04 g kg^-1 , antibiotic control) treatment. The results showed that PS or polymyxin E supplementation remarkably decreased diarrhea rate and elevated CD3⁺ CD4⁺ /CD3⁺ CD8⁺ ratio in piglets compared with the control (P < 0.05). PS increased basophil and serum interleukin-4, and caused a shift towards Th2 profile by decreasing Th1/Th2 ratios in piglets compared with control (P < 0.05). Polymyxin E contributed to an increase in interleukin-10 compared with the control (P < 0.05). No significant difference was observed in the amount of Lactobacillus, Bifidobacterium or Escherichia coli of jejunum among the three treatments (P > 0.05).

CONCLUSION

These results suggest that PS supplementation has no significant effect on growth but could remarkably decrease diarrhea rate, and improve immunity and anti-inflammatory activity in weaned piglets. In addition, PS supplementation had similar effects on growth, anti-inflammation and intestinal microorganisms as supplementation with polymyxin E in piglets. © 2017 Society of Chemical Industry.

Anti-Yersinia antibodies are not associated with microscopic colitis in an American case-control study

BACKGROUND

Microscopic colitis (MC), which consists of lymphocytic colitis and collagenous colitis, may be triggered by gastrointestinal infections. Studies have suggested a relationship between MC and Yersinia enterocolitica infection. We tested this hypothesis in a case-control study of American patients with MC.

METHODS

Serum was collected from 47 patients with MC and 44 age- and gender-matched healthy controls at a large referral center in the mid-western United States. Anti-IgA and IgG antibodies to Y. enterocolitica were measured using an enzyme-linked immunosorbent assay (ELISA). Fisher's exact test was used to assess statistical significance.

RESULTS

There were no differences between the two groups for seroprevalence of anti-Yersinia IgA (cases 2.1%, controls 2.3%, p = 1.00) or IgG antibodies (cases 4.3%, controls 6.8%, p = 0.67). There was no correlation between antibody titers and duration of MC diagnosis.

CONCLUSION

Our data do not support the role of exposure to Y. enterocolitica in an American group of patients with MC.

Reactive arthritis or post-infectious arthritis?

The term 'reactive arthritis' was first used in 1969 to describe the development of sterile inflammatory arthritis as a sequel to remote infection, often in the gastrointestinal or urogenital tract. The demonstration of antigenic material (e.g. Salmonella and Yersinia lipopolysaccharide), DNA and RNA, and, in occasional cases, evidence of metabolically active Chlamydia spp. in the joints has blurred the boundary between reactive and post-infectious forms of arthritis. No validated and generally agreed diagnostic criteria exist, but the diagnosis of reactive arthritis is mainly clinical based on acute oligoarticular arthritis of larger joints that develops within 2-4 weeks of the preceding infection. In about 25% of patients, the infection can be asymptomatic. Diagnosis of the triggering infection is very helpful for the diagnosis of reactive arthritis. This is mainly achieved by isolating the triggering infection (stools, urogenital tract) by cultures (stool cultures for enteric microbes) or ligase reaction (Chlamydia trachomatis). However, after the onset of arthritis, this is less likely to be possible. Therefore, the diagnosis must rely on various serological tests to demonstrate evidence of previous infection, but, these serological tests are unfortunately not standardized. Treatment with antibiotics to cure Chlamydia infection is important, but the use of either short or prolonged courses of antibiotics in established arthritis has not been found to be effective for the cure of arthritis. The long-term outcome of reactive arthritis is usually good; however, about 25-50% of patients, depending on the triggering infections and possible new infections, subsequently develop acute arthritis. About 25% of patients proceed to chronic spondyloarthritis of varying activity.

Increased prevalence of antibodies to enteropathogenic Yersinia enterocolitica virulence proteins in relatives of patients with autoimmune thyroid disease

Infections have been implicated in the pathogenesis of a number of autoimmune diseases, and Yersinia enterocolitica (YE) might play a role in the development of autoimmune thyroid disease (AITD). Clinical evidence in support of this hypothesis has been inconclusive. We reasoned that looking earlier in the natural course of AITD might enhance chances of finding evidence for YE infection. Consequently, we determined seroreactivity against YE in subjects at risk of developing AITD, i.e. in 803 female relatives of AITD patients in self-proclaimed good health. As a comparison group we used 100 healthy women who participated in a program for reference values. IgG and IgA antibodies to virulence-associated outer membrane proteins (YOPs) of YE were measured by a specific assay. Serum thyroid peroxidase antibodies (TPO-Ab) as indicators of AITD were considered to be positive at levels of> 100 kU/l. The prevalence of YOP IgG-Ab was higher in AITD relatives than in controls (40.1% vs. 24%, P = 0.002), and the same was true for YOP IgA-Ab (22% vs. 13%, P < 0.05). Of the 803 AITD relatives, 44 had an increased or decreased plasma TSH, and 759 were euthyroid as evident from a normal TSH; the prevalence of YOP-Ab did not differ between these three subgroups. TPO-Ab were present in 10% of controls and in 27% of the AITD relatives (P < 0.001). The prevalence of TPO-Ab in the euthyroid AITD relatives was not different between YOP IgG-Ab positive and negative subjects (23.3% vs. 24.7%, NS), nor between YOP IgA-Ab positive and negative subjects (21.2% vs. 24.9%, NS). In conclusion, healthy female relatives of AITD patients have an increased prevalence of YOP antibodies, which, however, is not related to the higher prevalence of TPO antibodies in these subjects. The findings suggest a higher rate of persistent YE infection in AITD relatives. Susceptibility genes for AITD may also confer a risk for YE infection.

Bacteria-Triggered reactive arthritis: implications for antibacterial treatment

Reactive arthritis (ReA) is definitely caused by an infection. Several observations suggest that the triggering microbe may persist in the tissues of the patient for a prolonged time. The obvious conclusion is to consider antibacterial treatment. In two instances antibacterial agents are of definite value: in the primary and secondary prevention of rheumatic fever and for early eradication of Borrelia burgdorferi in order to prevent development of the arthritis associated with Lyme disease. Altogether, clinical and experimental data exist to indicate that if antibacterial treatment of ReA can be started very early during the pathogenetic process, the disease can be prevented or the prognosis improved. In fully developed ReA, the value of antibacterial agents is less certain. All available evidence indicates that short term antibacterial treatment has no effect on the prognosis and final outcome of ReA, and the results with long term administration of antibacterials are also overall poor. In some instances sulfasalazine appears useful, rather as a result of its antirheumatic effect or influence on an underlying inflammatory bowel disease than its action as an antibacterial agent. Tetracyclines have also been found to have an effect on ReA, but again, this is probably due to their anti-inflammatory action rather than any antibacterial effect.

Bacterial antigens in reactive arthritis and spondarthritis. Rational use of laboratory testing in diagnosis and follow-up

An aetiological diagnosis of reactive arthritis is based on the demonstration of recent or ongoing infection with the causative bacterium. This may be done by serological demonstration of antibacterial antibodies, demonstration of the causative microorganism at an extra-articular site or by identification of bacterial nucleic acids or antigens in joint material from patients with aseptic arthritis. The finding of elevated titres of bacteria-specific IgG- and IgA-class antibodies may indicate recent or persistent infection, but has some limitations due to the prevalence of such antibodies among apparently healthy individuals and the persistence of such antibodies after the infection. While Chlamydia can be demonstrated in urogenital specimens in at least one-third of patients with Chlamydia-induced arthritis, the triggering microorganisms are usually no longer detectable in post-dysenteric reactive arthritides. Assays involving molecular amplifications have been successfully used to demonstrate bacterial nucleic acids in joint specimens from patients with reactive arthritis. In addition, bacterial antigens have been detected by immunofluorescence tests. Even though examination of synovial fluid and synovial membrane specimens for bacterial DNA by the polymerase chain reaction is increasingly used to diagnose reactive arthritis, such assays have not been standardized and are not generally available. While some problems remain, these techniques will facilitate the exact diagnosis of reactive arthritides in the near future.

Prognosis, course of disease, and treatment of the spondyloarthropathies

Prognosis in the majority of patients with acute reactive arthritis is usually good, with most patients recovering in a few months. In about 15% to 30% of such patients, the disease progresses, and spondyloarthropathy and even ankylosing spondylitis develop in the following 10 to 20 years. A recurrent attack of reactive arthritis is common in patients with chlamydia-triggered arthritis, but it is rare in patients who have had enteroarthritis. In patients with chronic spondyloarthropathy without evidence of preceding infection, the disease can progress slowly into ankylosing spondylitis. When reactive chlamydia arthritis is indicated, a prolonged course of antibiotics is needed. For other forms of reactive arthritis, solid evidence in favor of antibiotic therapy is still lacking. Presence of hip pain, decreased mobility of thoracic cervical or thoracic spine, heel pain, inflammatory gut lesions, high erythrocyte sedimentation rate, positive family history, and presence of human leukocyte antigen B27 are indicators for chronicity. Sulfasalazine might be of use in chronic arthritis and ankylosing spondylitis, especially if the patient has peripheral arthritis.

Yersinia enterocolitica and the chronic fatigue syndrome

OBJECTIVES

To investigate the potential role of Yersinia enterocolitica in patients with chronic fatigue syndrome (CFS).

METHODS

An immunoblot technique was used to detect antibodies to various Yersinia outer membrane proteins (YOPs) in serum samples from 88 patients with CFS and 77 healthy neighbourhood controls, matched for gender and age.

RESULTS

The prevalence of IgG and IgA antibodies to various Yersinia outer membrane proteins (YOPs) did not differ between patients with CFS and healthy controls. Twenty-four patients (27%) and nineteen controls (25%) had IgG antibodies to one or more YOPs. Four patients and two controls had both serum IgG and IgA antibodies to at least two different YOPs, compatible with a recent or persistent infection. Although all patients with positive IgG and IgA reactions to two or more YOPs had symptoms that could point to persistent Yersinia infection, these symptoms were also found frequently in patients without antibodies to YOPs.

CONCLUSIONS

We conclude that Y. enterocolitica is unlikely to play a major role in the aetiology of CFS.

Clinical presentation and diagnosis of gastrointestinal infections by Yersinia enterocolitica in 261 Dutch patients

A surveillance of the clinical manifestations, course and outcome of 261 patients with gastrointestinal infection by Yersinia enterocolitica between 1982 and 1991 was carried out. Acute uncomplicated enteritis was diagnosed in 169 patients, complicated enteritis in 37, appendicular syndrome in 33, ileitis in 8 and colitis in 14. Children (age < 16 years, n = 105) presented most often with mild enteritis, young adults (age 16-25 years, n = 47) with enteritis or appendicular syndrome, adults (age > 25 years, n = 109) had significant risk for developing serious enteritis, ileitis and colitis. Complications included reactive arthritis, septicaemia, lymphadenitis, disturbed liver functions and erythema nodosum. Four patients died of generalized peritonitis. Diagnosis was established by positive culture in 207 patients. Another 54 patients were diagnosed by having at least two other positive tests: serum agglutinins, specific IgA and IgG antibodies to Yersinia outer membrane proteins (Yops) or antigen detection in biopsies. Culture alone was sufficient to diagnose uncomplicated enteritis, antiYops serology appeared to be very useful in diagnosing patients with other manifestations of yersiniosis. The majority of the infections were caused by serotypes O3 and O9 while unusual serotypes were associated with advancing age and colitis.

PCR-based characterization of Yersinia enterocolitica: comparison with biotyping and serotyping

PCR-based DNA fingerprinting was used to characterize 48 clinical isolates of Yersinia enterocolitica. The samples were examined by random amplified polymorphic DNA (RAPD-PCR) and inter-repeat PCR (IR-PCR). IR-PCR with two enterobacterial repetitive intergenic consensus primers resulted in patterns which were poorly discriminated; 2 of 11 arbitrary primers (RAPD-PCR) provided sufficient discriminatory power. In comparisons with serotyping and biotyping, RAPD-fingerprinting was the most discriminatory technique and may therefore be a valuable epidemiological tool for the study of Y. enterocolitica infections.

Reactive arthritis

Reactive arthritis (ReA) develops after an infection elsewhere in the body, generally in the genitourinary or intestinal tract. Chlamydia trachomatis, Yersinia enterocolitica, salmonella, shigella, and campylobacter are frequent triggering agents. Between 60% and 90% of patients are positive for HLA-B27. The arthritis occurs within 4 weeks of the primary infection and is oligoarticular and asymmetric. Extra-articular manifestations include mucocutaneous symptoms, ocular inflammation, and urethritis. The average duration of arthritis is 4 to 5 months but two-thirds of patients have symptoms for more than a year. Bacterial antigens have been found in synovial specimens from patients with ReA, but cultures are sterile. The treatment of ReA comprises non-steroidal anti-inflammatory drugs, intra-articular steroid injections, and physical treatment. Short-term antibiotic treatment has no effect in manifest ReA, whereas a tendency to improvement has been seen with treatment over months, at least after chlamydia infection.

Are antibiotics of any use in reactive arthritis?

In the pathogenesis of reactive arthritis, infection through the mucosal route and genetic susceptibility (HLA-B27) are the most important contributing factors. With regard to non-specific urethritis, most probably caused by Chlamydia trachomatis infection, the use of early antimicrobial therapy has been shown to be effective in preventing arthritic recurrences. When the arthritis has been initiated, short-term conventional antimicrobial therapy seems unable to modify the course of the ongoing disease. In patients with acute reactive arthritis, a prolonged (3-month) treatment with tetracycline shortens the duration of arthritis when triggered by Chlamydia trachomatis, while such treatment has not proved effective in enteroarthritis. In patients with chronic reactive enteroarthritis, a prolonged course of quinolones, such as ciprofloxacin, might be of benefit. Sulfasalazine, which has an effect in the acute exacerbations of ankylosing spondylitis, is probably also effective in chronic reactive arthritis. An antimicrobial effect can be one of the mechanisms by which sulfasalazine exerts its therapeutic effect. Follow-up studies are necessary to assess the influence of antibiotic therapy on the late prognosis of patients with reactive arthritis.