Increased susceptibility to Yersinia enterocolitica Infection of Tff2 deficient mice.

TFF2 is one of the members of the trefoil factor family, known for its role in protection of gastrointestinal epithelia upon injury; however, recent studies suggest that TFF2 could also play an important role in the immune system. In the present study Tff2 deficient and wild type mice were infected by Y. enterocolitica which resulted in a lethal outcome in all Tff2 deficient mice, but not in WT animals. Yersinia invaded Peyer's patches more efficiently as shown by high bacterial titers in the KO mice while wild type mice displayed lower titers and a visible bacterial accumulation in the intestine. Bacterial accumulation in Peyer's patches of Tff2 deficient mice was accompanied by increased recruitment of macrophages. While an increased level of MAC-1 positive cells was observed in the spleens of both Tff2 deficient and WT mice at third day post infection, bacterial dissemination to liver, lung and kidneys was observed only in Tff2 knock-out mice. Analysis of the cellular composition of spleen did not reveal any substantial alteration to WT animals, suggesting possible disregulation of hemopoietic cells involved in immune response to Y. enterocolitica. These new data indicate that Tff2 plays an important role in immune response by protecting the organism from consequences of infection and that Tff2 knock-out mice react adversely to bacterial infections, in this case specifically to Y. enterocolitica.

Yersinia enterocolitica in sheep--a high frequency of biotype 1A.

BACKGROUND: Pigs are regarded as the main reservoir for human pathogenic Yersinia enterocolitica, which is dominated by bioserotype 4/O:3. Other animals, including sheep, have occasionally been reported as carriers of pathogenic strains of Y. enterocolitica. To our knowledge, this is the first study performed in the Nordic countries in which the presence of Y. enterocolitica in sheep is investigated. METHODS: Tonsils and faecal samples collected from sheep slaughtered on the island Gotland (Sweden) from September 2010 through January 2011 were analysed for presence of Y. enterocolitica. In an attempt to maximize recovery, several cultural strategies were applied. Various non-selective media were used and different temperatures and durations of the enrichment were applied before subculturing on Cefsulodin Irgasan Novobiocin (CIN) agar. Presumptive Y. enterocolitica colonies were subjected to urease, API 20E and agglutination test. Yersinia enterocolitica isolates were biotyped, serotyped, and tested for pathogenicity using a TaqMan PCR directed towards the ail-gene that is associated with human pathogenic strains of Y. enterocolitica. RESULTS: The samples collected from 99 sheep yielded 567 presumptive Y. enterocolitica colonies. Eighty urease positive isolates, from 35 sheep, were identified as Y. enterocolitica by API 20E. Thirty-four of 35 further subtyped Y. enterocolitica isolates, all from faecal samples, belonged to biotype 1A serotype O:5, O:6. O:13,7 and O:10. One strain was Yersinia mollaretii serotype O:62. No human pathogenic strains of Y. enterocolitica were found in the investigated sheep. Other species identified were Y. kristensenii (n = 4), Y. frederiksenii/intermedia (n = 3), Providencia rettgeri (n = 2), Serratia marcescens (n = 1) and Raoultella ornithinolytica (n = 1). CONCLUSIONS: This study does not support the hypothesis that sheep play an important role in transmission of the known human pathogenic Y. enterocolitica in the studied geographical region. However, because there are studies indicating that some strains of Y. enterocolitica biotype 1A may cause disease in humans, the relative importance of sheep as carriers of human pathogenic strains of Y. enterocolitica remains unclear. Tonsils do not appear to be favourable sites for Y. enterocolitica biotype 1A in sheep.

Prevalence of Yersinia enterocolitica in market weight hogs in the United States.

Pigs are the major animal reservoir for Yersinia enterocolitica strains, which are potentially pathogenic for humans. The goals of this study were (i) to estimate the individual animal and on-farm prevalences of Y. enterocolitica in hogs based on tonsil samples collected during National Animal Health Monitoring System Swine 2002 study and (ii) to use these data with data previously published for fecal samples to determine on-farm risk factors for Y. enterocolitica. Tonsil swabs (1,218) and fecal samples (2,847) were collected on 124 farms located in the top 17 pork-producing states. Ten percent of tonsils (122 of 1,218 samples) were positive in irgasan-tiracillin-chlorate (ITC) enrichment broth by real-time PCR, but only 5.6% of samples (68 of 1,218) were positive after subculture on the more selective cefsulodin-irgasan-novobiocin (CIN) agar. For tonsils, the on-farm prevalence based on real-time PCR detection of the ail gene in ITC enrichment broth cultures was 32% (32 of 100 premises sampled); the prevalence based on subculture in CIN agar was 19.6% (20 of 102 premises). Results of bacteriological isolation and real-time PCR analysis of tonsils and feces were combined to estimate prevalence (individual animal and farm), which was subsequently correlated with 40 farm management practices. Four factors and their accompanying odds ratios (ORs) were identified in the final regression model: location in a central state (OR = 0.3), vaccination for Escherichia coli (OR = 3.0), percentage of deaths due to scours (OR = 3.5), and presence of meat or bone meal in grower-finisher diet (OR = 4.1).

Yersinia septic shock following an autologous transfusion in a pediatric patient.

Although the literature on infections transmitted via transfused blood focuses on viruses, Yersinia enterocolitica can also cause severe infections in patients receiving transfusions. A 13-year-old patient developed severe sepsis after an autologous blood transfusion contaminated with Y. enterocolitica. The patient was an otherwise healthy female undergoing posterior spinal fusion for congenital scoliosis. Prior to surgery, the patient donated blood for perioperative and postoperative use. A few days before the donation, she had complained of abdominal pain and was experiencing mild diarrhea. The patient received four units of packed red blood cells (PRBCs) during the surgery. Intraoperatively, the patient developed fever up to 103.6 degrees F, became hypotensive requiring epinephrine and dopamine, and developed metabolic acidosis with serum bicarbonate concentration dropping to 16 mmol/l. The surgery team believed the patient was experiencing malignant hyperthermia and attempted to cool patient during the procedure. Postoperatively, the patient was transferred to the pediatric intensive care unit and treated for severe shock of unknown etiology. The patient further developed disseminated intravascular coagulation. The patient received supportive care and was started on ampicillin/sulbactam on postoperative day (POD) one which was changed to clindamycin, ciprofloxacin and tobramycin on POD two when blood cultures grew gram-negative bacilli. On POD three, cultures were identified as Y. enterocolitica and antibiotics were changed to tobramycin and cefotaxime based on susceptibility data. Sequelae of the shock included adult respiratory distress syndrome requiring intubation and a tracheostomy and multiple intracranial hemorrhagic infarcts with subsequent seizure disorder. Due to severe lower extremity ischemia, she required a bilateral below the knee amputation. The cultures of the snippets from the bags of blood transfused to the patient also grew Y. enterocolitica. This case illustrates the importance of considering transfusion related bacterial infections in patients receiving PRBCs. All patients in shock following any type of transfusion may require aggressive antibiotic therapy, until the diagnosis and etiology are known.

Evaluation of culture methods for rapid screening of swine faecal samples for Yersinia enterocolitica O:3/biotype 4.

In two studies, seven different culture protocols were compared to test naturally contaminated faecal samples from pigs for isolation of Y. enterocolitica serotype O:3/biotype 4 (n = 70 and n = 79). Four of the protocols were based on the Nordic Committee on Food Analysis (NMKL, protocols), while three protocols were based on a rapid and selective method (here called ITC protocols). The protocols differed mainly in time of pre-enrichment (1, 10 and 24 d) and enrichment (2, 10, 24 d) and the type of selective enrichment media (ITC vs. MRB). The sensitivity of the rapid ITC protocol (24% and 9%) was comparable with the lengthy NMKL-protocols (16% and 11%), while the results of direct plating after 3 h (4%) and the extended enrichment in ITC-broth (4%) were very low. In addition, there was a marked reduction in the number of false positive plates in the short selective protocol (62% vs. 12%). The results indicate possibilities of shortening the culture methods by replacing most of the biochemical tests with an agglutination test based on a monoclonal antibody.

[Fatal Yersinia infection after intraoperative transfusion]. / Letale Yersiniensepsis nach intraoperativer Transfusion.

A 47-year old man was operated for a malignant tumour of the bladder. During cystectomia packed red cells had to be transfused. Minutes after the rapid transfusion the oxygen saturation dropped. In the following hours his circulation became unstable and the pulmonary function deteriorated. Signs of disseminated intravascular coagulation occurred, making more transfusions necessary. Inspite of all intensive-care efforts the patient died with a multiorgan failure caused by endotoxin shock 66 hours after having received the first transfusions. In the blood cultures of the patient and in the cultures of the first transfused unit of packed red cells Yersinia enterocolitica was isolated.

Yersinia enterocolitica transmission from a red cell unit 34 days old.

In 1993 the North London Blood Transfusion Centre received its first report of Yersinia enterocolitica transmission from a unit of red cells supplied to a local hospital. The recipient was a 23-year-old male who was neutropenic following a third cycle of chemotherapy for treatment of acute myeloblastic leukaemia (FAB type M6) and received a 34-day-old red cell unit. During transfusion the patient developed septicaemia and endotoxin-mediated shock. The transfusion was stopped immediately and broad spectrum antibiotics administered immediately on suspicion of bacteraemia from the transfused unit. This prompt action undoubtedly prevented a fatal outcome. Y. enterocolitica was isolated from the blood bag. Antibody was also detected in the bag and in a sample taken from the donor 39 days post-donation. Antibody to serotype 03 was identified, the commonest serotype reported in transfusion-transmitted Y. enterocolitica. The donor reported no gastrointestinal upset or illness prior to donation. This transfusion reaction might not have occurred had the red cells been transfused earlier in their storage period, but would not have been prevented by the exclusion of donors with a history of gastrointestinal illness as the donor was asymptomatic. Nor would it have been prevented by inspecting the blood for a change in colour, as no such change was observed. Y. enterocolitica is a significant problem in transfusion medicine and transmission is generally associated with a high mortality rate. Hospitals should be urged to investigate bacteriologically all appropriate transfusion reactions so that the true extent of the problem in the United Kingdom can be assessed.

Transfusion-transmitted bacterial infection.

Transfusion-transmitted bacterial infection is a persistent but often underemphasized problem facing transfusion medicine today. The present status of bacterial contamination of red cells, platelet products and plasma, frequency of contamination, and types of organisms implicated is reviewed. Current methods of prevention and detection are discussed, as well as typical clinical presentations and therapy.

[Leukocyte depletion of blood products and post-transfusion infections]. / Déleucocytation des produits sanguins et infections post-transfusionnelles.

The transmission of unwanted infection agents to patients, through white blood cells, in blood products is now well established. Therefore the leukodepletion procedure undertaken in blood banks is justified. Leukodepletion prior to transfusion prevents the transmission of leukocyte-associated viruses such as CMV, EBV and HTLV 1 and 2 of viruses present both in plasma and inside leukocytes such as HTLV 1 and 2 viruses and B 19 parvovirus. The mechanism of the immunosuppressive effect of transfusion is still uncertain. The risks of transmitting bacterial diseases through blood transfusions is also a well-known source of concern, particularly the transmission of Yersinia Enterocolitica. However such an event seems to be prevented through leukocyte depletion by filtration when these procedures are performed after a hold of whole blood at 22 degrees C for 6 to no longer than 24 hours. Leukocyte-free blood components prepared by filtration may have a sufficiently reduced rate of infection to provide adequate prophylaxis. In any case the final number of leukocytes should be < or = 10(6) per unit of blood product. Leukocyte filtration must be performed before the onset of a disintegration process of granulocytes.

Possible confounders of the relationship between occupational swine contact and Yersinia enterocolitica 0:3 and 0:9 antibodies.

Increased risk of high Yersinia enterocolitica 0:3 and 0:9 antibody content has been previously reported in occupations with swine contact. In this study several possible confounders of this elevated risk among pig farmers and abattoir workers were considered. Only in three instances the standardized risk ratio was decreased close to unity, namely after the standardization of Y. enterocolitica 0:3 IgG antibody positivity for age among abattoir workers, after the standardization of Y. enterocolitica 0:9 IgG antibody positivity for farm butchering among pig farmers and for smoking among abattoir workers. As the decrease did not apply for both pig farmers and abattoir workers and for both 0:3 and 0:9 serotypes considered, it seems reasonable to assume that the three decreases represent products of multiple testing inherent in this kind of search of confounders rather than any true effects. In view of the present knowledge on the determinants of yersinia antibodies in populations, the crude risk ratios for elevated yersinia antibodies can be held to be reasonably unconfounded.

Yersinia enterocolitica in donor blood: a case report and review.

Routine sterility control of a unit of leukocyte-depleted erythrocyte concentrate yielded growth of Yersinia enterocolitica serotype O:3. Plasma of the donor showed a high titer of agglutinins against the homologous organism. Although the donor was apparently well at the time of donation, he had a history of protracted terminal ileitis treated by surgery. The recipient of the contaminated blood was taking broad-spectrum antibiotics and did not experience any adverse effect. Fourteen other cases of transfusion-associated yersiniosis have been reported.

Significance of milk as a possible source of infection for human yersiniosis. I. Incidence of Yersinia organisms in raw milk in Shimane Prefecture, Japan.

Twelve strains of Yersinia enterocolitica and 4 strains of a Y. enterocolitica-like organism (Y. intermedia) were isolated from 374 pooled raw milk samples. Growth occurred in a cold enrichment system using phosphate buffer solution (7 strains), peptone solution (5 strains) and yeast extract-casein-cystine broth (5 strains). Serovar 13,7 was most frequently isolated (8 strains) followed by serovars 5,27 (2 strains), 6,31, 7,8, 14 and 22 (each one strain). Two strains were untypable, serologically. Seasonal variation was of little consequence, but the regional incidence was an important feature of the bacteriological findings. Autoagglutination tests gave negative results with all isolates. Although so-called "clinical strains" were not identified, the relationship of the strains of Yersinia to milk-borne infections in humans cannot be excluded.

[Intestinal yersinia infection: pathogenesis, clinical course, epidemiology and diagnosis]. / Die enteralen Yersiniosen: Pathogenese, klinischer Verlauf, Epidemiologie und Diagnose.

Human abdominal yersiniosis is caused by Yersinia enterocolitica and Yersinia pseudotuberculosis. The organisms invade the intestinal wall and produce an inflammation of the gut and the mesenteric lymph nodes. Their virulence appears to be determined by a group of plasmids of 40-48 megadaltons molecular size, which stimulate the production of V and W virulence antigens and mediate the capacity of Y. enterocolitica to adhere to, and invade into, epithelial cells.

Pseudotuberculosis in man: possible epidemiological role of the cats.

Human infection by Malassez and Vignal's bacillus (Yersinia pseudotuberculosis) can take many clinical aspects, the most frequent of which is mesenteric adenitis with pseudoappendicular syndrome, but occasionally also appearing as a tumor of the right lower abdominal quadrant. In a subsequent stage this mesenteric adenitis is often accompanied by erythema nodosum. There also exist some septicemia-like forms, which have become more and more frequent of late, always appearing on a particular terrain (predisposed persons). These various forms all correspond to contamination via the digestive route. Other, more exceptional modes of contamination may result in much rarer forms, such as ocular or pulmonary forms. Diagnosis is based on: (a) demonstrating the presence of Yersinia pseudotuberculosis, (b) serodiagnosis, (c) a positive intradermal reaction, (d) the characteristic aspect of lymph node lesions. Pseudotuberculosis is extremely frequent in animals. Many species, most of them rodents or birds, can serve as healthy carriers. This is how cats, through their access to this natural "reservoir", get contaminated and thus act as a "conveyor belt" in transmitting the disease to man.