[So called "pseudoappendicitis rheumatica"].
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Appendicitis↗
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Yersinia pseudoappendicitis--case report.
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Appendicitis↗
[Appendicitis, pseudoappendicitis and Crohn's disease].
Abdominal pain which is a basic symptom of Crohn's disease was in a group of 53 patients treated in 1981-1982 at the Surgical Clinic of the Third Medical Faculty in Prague 10 the initial symptom in 73.3% of the patients. The inflammation was most frequently in the terminal ileum and in the ileocaecal region, in the authors' group in 49.0% and 30.2% resp. In 18 patients appendectomy was performed, incl. 10 where it was performed a long time before the development of the first complaints caused by Crohn's disease. In these patients the authors do not assume, because of the long symptom-free period, that there existed a direct relationship with Crohn's disease which developed later. In six patients during laparotomy performed on account of pain in the right hypogastrium acute terminal ileitis, the first stage of Crohn's disease, was detected. In two patients the initial finding was granulomatous appendicitis.
Adult↗
Pseudoappendicitis preceding infectious mononucleosis.
In patients with infectious mononucleosis, abdominal pain is usually attributed to visceral enlargement. A teenage girl with symptoms of appendicitis was found at laparotomy to have mesenteric adenitis. Postoperatively, she developed classic features of Epstein-Barr virus (EBV)-induced mononucleosis. The lymphoproliferation characteristic of EBV infection can cause severe localized abdominal pain that predates the onset of mononucleosis.
Abdomen, Acute↗
Epidemiological, clinical and microbiological features of Yersinia enterocolitica infections in a community during a four-year period.
Epidemiological and clinical features of 17 cases (13 children) of yersiniosis treated in a hospital over a four-year period, as well as factors associated with virulence, antibiotic resistance and plasmids in Yersinia enterocolitica strains from these patients were studied. The proportion of Y. enterocolitica was 3.57% of all fecal cultures positive for enteric pathogens, with 13 sporadic episodes and one outbreak. In 11 cases the infection was unimicrobial. The clinical presentation was: gastroenteritis (14 cases), pseudoappendicitis (1 case) and asymptomatic (2 cases). Eight cases needed hospital care, and 8 required antimicrobial treatment. None of the isolated bacterial strains produced pyrazinamidase, hemolysins, elastase, fibrinolysine, colicines or aerobactin. Eight strains showed calcium dependence, 7 of them exhibited autoagglutination, serum resistance, crystal violet binding and carried a 42 MDa plasmid related with virulence. Two strains carried a 3.3 MDa R-plasmid that encoded streptomycin-sulfadiazine resistance. The restriction analysis showed that the virulence plasmids constitute one variety and R-plasmids another.
Adult↗
[Intestinal yersiniosis. Clinical importance, epidemiology, diagnosis, and prevention].
Yersinia enterocolitica and Y. pseudotuberculosis are causative agents of yersiniosis in humans and animals that have to be separated from Y. pestis, the causative agent of plague, representing a separate clinical and epidemiological entity. Intestinal yersiniosis may manifest in humans as (1) enteritis, (2) terminal ileitis, mesenteric lymphadenitis, or pseudoappendicitis, and (3) septicemia leading to focal abscesses in spleen and liver. The intestinal infection may be followed by reactive arthritis in a number of cases. Y. enterocolitica and Y. pseudotuberculosis are distributed worldwide but occur mainly in moderate or subtropical climates. The most important reservoirs are rodents, lagomorphs, and birds for Y. pseudotuberculosis and domestic animals, especially pigs, for Y. enterocolitica. All Y. pseudotuberculosis isolates may be considered as pathogenic whereas Y. enterocolitica strains can be subdivided into pathotypes of different virulence. The differentiation of pathotypes by determination of the biovar and demonstration of the 75-kb virulence plasmid is therefore of diagnostic importance. Preventive measures include avoidance of direct infection by contact with infected reservoir animals and practice of good hygiene during slaughtering as well as in food production and preparation of meals.
Age Distribution↗
Intestinal spirochetosis of the vermiform appendix.
A series of 681 surgically removed appendices were examined for spirochetes. Five hundred seventy-four appendices were removed because of suspected acute appendicitis; the rest were removed per occasionem. One hundred six of the former were histologically normal, whereas 421 showed acute appendicitis. The remaining 47 specimens showed a variety of other pathological conditions, for example, tumors and diverticula. Spirochetes were found in 13 (12.3%) of the appendices removed from patients clinically suspected to suffer from acute appendicitis, but whose appendices were otherwise histologically normal (pseudoappendicitis). Only 3 patients (0.7%) with histologically confirmed acute appendicitis (p less than 0.05) did show spirochetes in their appendices. Of the 107 patients who had their appendices removed per occasionem, 2 patients (1.9%) had spirochetosis (p less than 0.05). The ultrastructure of the spirochetes obtained from appendices with spirochetosis was studied by means of negative staining and ultrathin sectioning. The morphology of these spirochetes was very similar to that of Brachyspira aalborgi, a spirochete recently isolated from rectal biopsy specimens obtained from patients with colorectal spirochetosis.
Appendectomy↗
Yersinia enteritis.
Y. enterocolitica has been shown to be a fairly common human pathogen in many countries. The clinical picture produced by Y. enterocolitica infections is quite variable. An acute abdominal disease (acute gastroenteritis or colitis, or a pseudoappendicitis due to acute terminal ileitis) and, less commonly, erythema nodosum and arthritis are the most important manifestations of the disease. On radiologic examination mucosal lesions of the terminal ileum are found in most patients with gastrointestinal symptoms. The colon is less frequently involved. The most typical lesions consist of shallow, small, round ulcers characteristic of the disease. Microscopic examination may suggest yersiniosis but does not show pathogenic signs. Y. enterocolitica can be detected by stool cultures or by serologic examinations. The disease is usually mild. If specific therapy is indicated the disease usually responds well to antibiotic therapy.
Anti-Bacterial Agents↗
Yersinia enterocolitica infections in children.
Y. enterocolitica has been increasingly associated with a wide range of age-related clinical manifestations in children and adults, including febrile gastroenteritis, pseudoappendicitis, arthritis, sepsis, and focal suppurative disease. Although definite patterns of incidence, prevalence, transmission, and pathophysiology are emerging, much remains to be explained. The alert clinician who notifies his clinical laboratory colleagues that special isolation techniques are required to recover this organism from stool samples, and who submits mesenteric lymph nodes for bacteriologic examination in cases of mesenteric adenitis, will aid attempts to further delineate the significance of this emerging pathogen in the United States. Therapy depends on the form and severity of illness and must be guided by in vitro sensitivity, pending animal and epidemiologic studies.
Animals↗
Severe gastroenteritis associated with Vibrio hollisae infection: report of two cases and review.
Vibrio hollisae, one of the more recently described halophilic Vibrio species, is infrequently associated with gastrointestinal disease and only rarely recovered from individuals presenting with gram-negative sepsis. In this report we describe two cases of severe gastrointestinal disease associated with V. hollisae in otherwise healthy individuals. In one of these individuals, severe epigastric pain was apparently associated with signs of pseudoappendicitis, necessitating exploratory surgery. In both individuals, infection was associated with the ingestion of raw shellfish. These cases are discussed in light of previous reports on the epidemiology, pathogenesis, and spectrum of disease caused by this unusual pathogen.
Adult↗
Yersinia enterocolitica infection in children.
The clinical presentation, course and outcome of Yersinia enterocolitica infection was studied prospectively in 125 children. Enteric forms occurred in 114 children (92 enteritis, 20 pseudoappendicitis, 2 chronic ileitis), of whom 17 also had extramesenteric manifestations; 11 children had one or more extramesenteric forms without enteric disease. Enteritis occurred more frequently in young children whereas serious forms and extramesenteric forms were more common in children older than 6 years of age (P < 0.001). Arthritis was observed in 13 children and extensive lymphadenopathy in 11; 1 child had septicemia with pleurisy, 1 had vasculitis, 1 had cholecystitis and 4 had erythema nodosum. Diagnosis was established by positive culture in 100 (80%) children and by agglutinin test in 11 of 45 (24%), demonstration of circulating specific anti-IgA and anti-IgG to Yersinia outer membrane proteins in 47 of 48 (98%) and detection of antigen in biopsies in 28 of 33 (85%) children. The 2 latter methods were superior to the agglutinin test. Serotype O3 and O9 predominated. The frequency and seriousness of complications may justify the use of antibiotics for Yersinia enteritis in children 6 years of age or older.
Adolescent↗
Plague and other human infections caused by Yersinia species.
With an estimated 100 million victims, pandemically and epidemically occurring plague has been looked upon as a classical scourge of mankind during the last two millenia. Without treatment at least 50% of the affected individuals die from infection with Yersinia pestis, a bacterium belonging to the family of Enterobacteriaceae. The disease takes a fulminant course. After an incubation period of 2-6 days, bubonic plague primarily attacks one group of lymph nodes. The onset of pulmonic plague, transmitted by droplet infection, takes place within several hours and causes bronchopneumonia. Early recognition facilitates a promising antibiotic therapy with tetracycline, streptomycin or chloramphenicol. Human beings acquire the bacteria through bites of fleas from domestic rats in densely populated cities of countries with low hygienic standards, or sporadically in the open country from infected wild rodents. Laboratory procedure includes microscopy supplemented by immunofluorescence and cultivation of the bacterium from clinical material. Direct serology and PCR result in a fast detection of specific antigens or nucleotide sequences. Determination of serum antibodies is principally used for epidemiological investigation. Today, physicians in the civilized western world lack experience for the recognition of plague, and analytical techniques for diagnosis are only available in some specialized laboratories. Yersiniosis becomes primarily manifest as gastroenteritis caused by Yersinia enterocolitica or as pseudoappendicitis caused by Yersinia pseudotuberculosis and requires antibiotics only in severe septic cases. Different extraintestinal symptoms may be observed in dependence on the patient's HLA type and gender. The ubiquitous germ is mainly transmitted by the fecal-oral route via infected domestic or farm animals and contaminated food. The relevant virulence factors are encoded on a 70 kB plasmid common to all Yersinia species and strains that are human pathogens. The most important tools for laboratory diagnosis are culture from suitable body fluids and serological detection of specific antibodies. The infection rate among healthy individuals in Europe in terms of percentage of elevated IgA or IgG titers has been quoted to be 3-40% in different investigations but does not significantly correlate to direct bacteriological detection.
Animals↗
[Human Parvovirus B19--really only fifth disease? Unusual disease course in children and adolescents].
The human parvovirus B19 agent causes infectious erythema (fifth disease). However, a wide range of other pathological manifestations may also be seen: atypical exanthema, ARD (also obstructive forms, e.g. bronchiolitis), acute gastroenteritis, chronic anemia or aplastic crises (in constitutional or malignant hematological diseases or immunological deficiency), arthralgia/arthritis (e.g. rheumatoid arthritis, jcA), diseases of the central nervous systems (e.g. febrile convulsions in young children), lymphadenopathies (e.g. lymphadenitis mesenterialis or pseudoappendicitis); prenatal infection can lead to fetal death (not malformations!). Infection occurring concomitantly with vaccination may suggest complications of the latter. To clarify the true etiological situation, modern laboratory investigations are then required. Vaccination against parvovirus B19 (initially indicated in the case of non-immune girls and women wanting children) is a desirable future development.
Adolescent↗
[Yersiniosis in a general hospital in the Basque country (1984-1989). Clinical and epidemiological aspects].
BACKGROUND: The features of the diseases caused by Yersinia have not been properly evaluated in the Basque Country. The present study was performed to assess the incidence and consequences of this infection. METHODS: 51 cases of Yersinia infection in a general hospital during the period 1984-1989 were reviewed. Clinical, epidemiological, microbiological, and therapeutic data and the hospital stay were evaluated. RESULTS: 62% of patients were males with a mean age of 16 +/- 19.4 years. Most came from urban areas. 40% of cases developed in winter and 32% in summer. The presenting features were: acute gastroenteritis (66%), pseudoappendicitis (10%), sepsis (4%), lymphadenopathy (2%) and others (18%). 40% of the patients had significant underlying diseases, and 16% had complications attributable to the infection. The microbiological diagnosis was made by stool culture in 88%. 96% corresponded to Yersinia enterocolitica (biotype 4), serogroup 0: 3 (93%). Yersinia pseudotuberculosis was isolated from the culture of a cervical lymph node in one patient. In the Yersinia enterocolitica strains the most common antibiotic resistances were to ampicillin (87%), cephalotin (81%), ticarcillin (75%), mezlocillin (43%) and piperacillin (43%). The mean hospital stay was 6.1 +/- 12.2 days and it was significantly shorter in children (3.3 +/- 6.1%) than in the adult population (10.9 +/- 17.4) (p less than 0.05). It was longer in patients with underlying diseases (13.3 +/- 17.8 vs 3.3 +/- 5.6) (p less than 0.005). CONCLUSIONS: Our patient population had male and urban predominance. Most infections were caused by Yersinia enterocolitica and presented as acute gastroenteritis, without differences between winter and summer. We point out to the relationship between Yersinia infection, abnormalities in iron metabolism and immunosuppression. There were few complications of the infection. The mean hospital stay was directly correlated with age and underlying diseases.
Adolescent↗
[Yersinia exanthema].
Yersinia is an enterobacterium that causes acute enterocolitis, pseudoappendicitis and sepsis. Some patients suffer from post-infectious immunopathological complications, such as erythema nodosum and yersinia arthritis, which are well known. Less information exists concerning the erythema multiforme-like yersinia exanthema, which is a distinctive dermatological disorder with target lesions localized predominantly on the neck, shoulders and arms. These lesions, which may be smaller but often are larger than the iris lesions in conventional erythema multiforme, tend to coalesce into plaques and reveal a papulovesicular component at their periphery. In our cases the exanthema was associated with a conjunctivitis, especially of the nasal part of the conjunctiva. This exanthema can be induced by yersinia enterocolitica, serotype O-3 and type O-9, at least in Europe, whereas serotype O-8 prevails in North America. The most helpful diagnostic criteria are serological data. However, it is crucial to remember that Widal's agglutination reaction gives rise to high titres, whereas the results of the complement-fixation test are often not reliable.
Adult↗
[Enteritis due to yersinia enterocolitica in children (author's transl)].
1922 stool specimens of children aged less than 14 years were screened for enteropathogenic bacteria over the past two years. In 24 cases Yersinia enterocolitica serovar 03 and 09, respectively, was identified. 16 of them suffered from acute gastroenteritis, 8 showed symptoms of pseudoappendicitis. All patients exhibited high agglutinin titers against the respective reference strains which were maintained for up to 4 months. All isolated strains had identical sensitivity patterns against the chemotherapeutics tested. Other enteropathogenic bacteria isolated at the same time are mentioned.
Adolescent↗
[Pathogenesis and pathologic anatomy of human Yersinia infections].
Yersinioses are zoonoses inspite of the fact, that the pathogen is rarely transferred directly from the animal to man, but mostly from contaminated food or contaminated surroundings. Enteritis or enterocolitis develop in most cases after infection with Y. enterocolitica (enteritic form), whereas pseudoappendicitis accompanied by massive mesenterial lymphadenitis of the ileocecal lymph nodes with or without the participation of adjacent parts of the intestine develops after infection with Y. pseudotuberculosis (pseudoappendicitic form). Some complications like arthritis and erythema nodosum occur rather frequently and may help to establish the diagnosis; septicemia occurs very rarely and is as yet lethal in 50% of cases. Confirmation of yersiniosis is in general not possible on clinical grounds only. Also microscopic as well as macroscopic morphological findings will allow a tentative diagnosis only. Confirmation must come from bacteriologic or serologic findings.
Appendix↗
A five-year survey of human Yersinia enterocolitica infections in Hungary.
Human infections associated with Yersinia enterocolitica in Hungary in the years 1969-1974 have been surveyed. During this period the public health laboratory network isolated 1355 strains from 1096 persons. The number of isolates according to sero-groups was: 1343 O3, 6 O9, 2 O1, 2a, 3 and 1 strain for O5, O6, O1O and O15 each. (ii) A total of 2192 serum specimens from patients gave positive agglutination reaction with antigen O3 in 26.8%, with antigen O9 in 3.2%. (iii) Fifty-six per cent of bacteriologically positive persons had enteritis. Other clinical forms (pseudoappendicitis and other abdominal complaints, erythema nodosum, rheumatoid arthritis) were encountered in O 1-2.7%. Symptomless excreters of Y. enterocolitica amounted to 23.1% of all positive persons. (iv) Patients with enteritis and symptomless excreters were rather evenly distributed between 10 and 60 years of age; 1--9-year-old children were affected more frequently (47.7% of all positive persons). Six distribution was, males: females = 1.5 : 1. In seasonal incidence yersiniosis differed from other enteric diseases: it showed a peak in the autumn-winter months. Sporadic cases and family outbreaks were the most frequent; epidemic infections in nurseries were also recorded. (v) Out of 59 animal strains 39 group O3 cultures were isolated from pigs, which may be assumed as the most important reservoir of yersinosis in Hungary.
Adolescent↗