Yersiniosis in children

Is metabolic stress a common denominator in inflammatory bowel disease?

The enteric epithelium represents the major boundary between the outside world and the body, and in the colon it is the interface between the host and a vast and diverse microbiota. A common feature of inflammatory bowel disease (IBD) is decreased epithelial barrier function, and while a cause-and-effect relationship can be debated, prolonged loss of epithelial barrier function (whether this means the ability to sense bacteria or exclude them) would contribute to inflammation. While there are undoubtedly individual nuances in IBD, we review data in support of metabolic stress--that is, perturbed mitochondrial function--in the enterocyte as a contributing factor to the initiation of inflammation and relapses in IBD. The postulate is presented that metabolic stress, which can arise as a consequence of a variety of stimuli (e.g., infection, bacterial dysbiosis, and inflammation also), will reduce epithelial barrier function and perturb the enterocyte-commensal flora relationship and suggest that means to negate enterocytic metabolic stress should be considered as a prophylactic or adjuvant therapy in IBD.

Age-dependent expression of abdominal symptoms in patients with Yersinia enterocolitica infection

BACKGROUND

The aim of the present study was to determine the relationship between the expression of abdominal symptoms and the age of patients with Yersinia enterocolitica infections.

METHODS

Twenty-four patients with positive fecal cultures of Yersinia enterocolitica participated in the present study. The abdominal symptoms were taken from medical records. Statistical analysis was performed by Mann-Whitney U-test.

RESULTS

Patients with diarrhea were younger than those without diarrhea (P = 0.014). Older children had abdominal pain or irritability more frequently than younger children (P = 0.004).

CONCLUSIONS

In Yersinia enterocolitica infections, younger children are predisposed to diarrhea and older children are predisposed to abdominal pain.

Chronic intussusception associated with Yersinia enterocolitica mesenteric adenitis

An unusual case of chronic intussusception, without any digestive sign, secondary to mesenteric lymphadenitis caused by Yersinia enterocolitica is reported. Operative reduction by taxis was performed but ileopexy and antibiotic treatment were also carried out to reduce chances of recurrent intussusception.

Acute and chronic gastrointestinal manifestations associated with Yersinia enterocolitica infection. A Norwegian 10-year follow-up study on 458 hospitalized patients

The aim of the present study was to elucidate the gastrointestinal manifestations of yersiniosis. During the period 1974 to 1983, Yersinia enterocolitica infection was diagnosed in 458 patients, by isolation from fecal samples or by antibody response. At first admission, 184 patients had abdominal pain; 200, diarrhea; 45, vomiting; and 36, weight loss. Ulcerative colitis was diagnosed in 7 patients, Crohn's disease in 2, and unspecific colitis in 11. Mesenteric lymphadenitis or ileitis were found in 43 of 56 patients at laparotomy. The patients were followed for 4 to 14 years (1987). Thirty-eight patients were readmitted with abdominal pain and 28 with diarrhea; these symptoms were significantly correlated with the corresponding symptoms at first admission. Chronic colitis was diagnosed in 4 patients, chronic weight loss in 12. A follow-up inquiry (380 patients) indicated that patients with right iliac fossa pain during the acute infection less frequently developed chronic abdominal complaints. Gastrointestinal symptoms are common in both the acute and chronic states of yersiniosis. The correlations between acute and chronic symptoms indicate that yersiniosis is a chronic disease. Immunologically competent individuals may profit by fighting the infection in the right iliac fossa. The relationship between yersiniosis and inflammatory bowel diseases may still not be settled.

Haemolytic uraemic syndrome associated with Yersinia enterocolitica infection

Haemolytic uraemic syndrome (HUS) associated with Yersinia enterocolitica gastroenteritis is reported in a 6-year-old girl. Y. enterocolitica of biotype 03 was isolated from the patient's initial stool sample and was subsequently identified as serotype 03 based on the rising agglutinin titres. This paper shows that yersiniosis should be suspected as a possible cause of HUS, and investigations should include the measurement of serum agglutinin titres against antigen preparations of the genus Yersinia.

Acute anterior uveitis and conjunctivitis following Yersinia infection in children

We studied characteristics of ocular inflammation associated with yersinia infection in six children, three boys and three girls, ranging in age between 4 and 14 years. Four patients developed acute anterior uveitis with aqueous flare and cells, small keratic precipitates, cells in the vitreous, and occasionally with fibrinous exudates, posterior synechiae and macular edema. The uveitis was unilateral in two patients and bilateral in two. In three 10- to 14-year-old patients the uveitis resolved during corticosteroid treatment in 3 to 8 (mean 6) weeks. In a 4-year-old girl with positive antinuclear antibody titers bilateral uveitis lasted for 17 weeks. Two uveitis patients had recurrent episodes. Two patients had mucopurulent bilateral mild conjunctivitis which resolved in 3 to 5 days. All patients had symptoms of reactive arthritis and one had sacroiliitis. All tested patients were HLA-B27 positive. Our results indicate that in HLA-B27 positive children, especially after the age of 10 years, yersinia infection may occasionally trigger reactive iritis or conjunctivitis which often occur together with other HLA-B27 associated rheumatic diseases.

Pathogenicity of 42-44 Mdal plasmid positive and negative Yersinia pseudotuberculosis I and Yersinia enterocolitica 0:8 and 0:9 studied in the guinea pig eye model (Serény test)

When virulence plasmid (42-44 Mdal) positive and negative Yersinia pseudotuberculosis I and Yersinia enterocolitica 0:8 and 0:9 were tested in the guinea pig eye model the following order of pathogenicity was observed: Plasmid-positive Y. pseudotuberculosis I (death of the animal) greater than plasmid-negative Y. pseudotuberculosis I approximately equal to plasmid-positive Y. enterocolitica 0:8 (severe conjunctivitis) greater than plasmid-positive Y. enterocolitica 0:9 (mild conjunctivitis) greater than plasmid-negative Y. enterocolitica 0:8 and 0:9 (no effect).

Enhancement of invasiveness of Yersinia enterocolitica and Escherichia coli in HEp-2 cells by centrifugation

Centrifugation enhanced the infectivity of invasive Escherichia coli and Yersinia enterocolitica for HEp-2 cells. Noninvasive bacteria were not endocytosed after centrifugation. The centrifugation procedure may increase the sensitivity of testing for bacterial invasiveness in cell culture without causing false-positive results.

Plasmids in Yersinia enterocolitica serotypes O:3 and O:9: correlation with epithelial cell adherence in vitro

Human isolates of Yersinia enterocolitica serotypes O:3 (biotype 4) and O:9 (biotype 3) harbored plasmids sized approximately 47 and 44 megadaltons, respectively. No such plasmids were found in "apathogenic" strains of Y. enterocolitica belonging to biotype 1. There was a positive correlation among the presence of plasmid, autoagglutination, and adherence to and toxicity for HEp-2 cell cultures; all of these properties were lost by culturing at 37 degrees C in the absence of calcium. Strains of Y. enterocolitica O:3 and O:9 cured of the plasmids showed increased invasiveness in the HEp-2 cell culture model, but no invasiveness in guinea pig eye. It is suggested that the plasmids of Y. enterocolitica primarily determine epithelial cell adherence, but may also be associated with other pathogenic properties.