Yersinia

Yersinias are pathogenic to humans. Yersinia pestis and Yersinia pseudotuberculosis have ecological and genetic similarities, but epidemiological differences. Yersinia enterocolitica is found mainly in water, soil and the digestive tract of vertebrates.

Yersinia pestis
Yersinia pestis is a major pathogen causing plague pandemics. It was first isolated by Alexander Yersin in 1894 in Hong Kong. Plague is associated with high mortality without antibacterial therapy. In the wild, Yersinia pestis has been found in several rodent species. However, Yersinia pestis circulates through flea bites, in humans it is a  rat flea bite. Bacteria get into the wound.Human-to-human transmission can occur via aerosol particles, droplet infection and a primary plague infection. Plague is rare, at this time, occurring in Africa, India, Southeast Asia, Mexico, and the western United States.

Morphology
Yersinia pestis is a rod-shaped pleomorphic bacterium with a capsule. It is a stationary stick. Other yersinias are mobile. A common feature of Y. pseudotuberculosis and Y. enterocolitica is that it stains polar. This gender, like all Enterobacteriaceae is characterized by the ability to grow on simple laboratory soils. Their undemanding growth ranges from 0–40 °C with a temperature optimum around 30  °C.

Antigenic structure
On its surface is a localized F1 protein complex, which is a protective antigen. O-specific side chains are not present. Virulent strains form V and W proteins, the production of which is linked to plasmids.

Pathogenicity
The pathogenicity of Yersinia pestis is determined by a complex of chromosome and plasmid-linked factors. Surface factors that block phagocytosis are important. Virulent strains of this bacterium are facultatively intracellular parasites, that multiply in macrophages. During infection,Yersinia pestis, an facultative intracellular bacterium, exhibits the ability to first invade cells and then thwart phagocytosis of the host cell. During these two distinct phases, the invasion phase and the anti-phagocytic factor phase, the bacteria in manipulating the host cell help to complete each of these functions, but the mechanism by which Yersinia regulates these functions during each step remains unclear. In addition to macrophages, the bacterium is also able to penetrate epithelial cells. During the invasion at the site of injury, a hemorrhagic pustule, is formed, from where the infection is further distributed to the descending lymphatic nodes, in which the subsequent enlargement produces bubonic form of the plague. Later, bacteremia and sepsis and sepsis develop. A secondary disease, Pneumonia, may develop, causing Yersinia pestis to spread to the surrounding area by coughing up, and the infected person will develop primary pneumonia – a pulmonary form of the plague. When a patient manages to overcome the disease, he develops good immunity.

Diagnosis and therapy
Bacteria are diagnosed from the contents of the pustules, lymphatic nodes, blood culture, bone marrow and sputum. Cultivation is possible on blood agar. Bacteria stain according to Gram. When testing Yersinia pestis for antibiotic susceptibility, the bacteria were found to susceptible to (chloramphenicol, streptomycin, kanamycin, tetracycline, quinolones. However, plague vaccines produced by Yersinia pestis, are in clinical development. Streptomycin is given in endemic areas to prevent it. We can induce short-term immunity when a dead vaccine with a protective antigen is given. A live vaccine, with live attenuated strains is more effective, but the use of this vaccine is only approved in some parts of the world. There is currently no licensed vaccine to prevent plague in Western Europe.

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Yersinia enterocolitica
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Yersinia enterocolitica is a non-sporulating, facultatively anaerobic straight rod. It is pathogenic to humans and is the cause of human yersiniosis. The disease is transmitted alimentary through infected raw pork. It is widespread cosmopolitanly. The prevention is to avoid consuming badly roasted pork, or to observe hygiene after contact with the meat. The disease can be treated with antibiotics.

Morphology
Yersinia enterocolitica is a gram-negative straight rod, but it is only mobile at lower temperatures. Its size is 0,3–1,0 μm and 1,0–6,0  μm. It can be grown on conventional cultivation soils because it is easy to grow. It has no problem growing in a low glucose environment at 28 °C. It is recommended to use selective soils for culturing bacteria from faeces. The ideal pH for growth is in a wide range of 4,6–9 with an optimal pH 7–8.

Epidemiology
Yersinia enterocolitica was discovered by Schleifstein and Coleman in 1939 in the USA. It has been a well-known pathogen in the last four decades. It occurs mainly in food, especially in raw pork, but has no problem surviving on fruits and vegetables in the refrigerator at lower temperatures. Most Y. enterocolitica isolates recovered from natural samples, including houses where animals are slaughtered or in butchers. They were non-pathogenic in nature and in water. Bio serotypes 4/O:3 are the most common cause of human yersiniosis, food poisoning caused by Y. enterocolitica, is known cosmopolitanly.

Pathogenicity and virulence
Virulence is bound to the chromosome and to the plasmid. It is given by the invasiveness and penetration of the microbe into the cell. Food can enter the terminal ileum and appendix, where it penetrates cells and lymphatic tissues, to which it has a particularly high affinity. Virulent strains multiply in macrophages and induce granuloma formation. Non-virulent strains are eliminated without penetrating the cells.

Clinical picture
Clinical signs are observed from mild diarrhoea to serious complications such as liver abscesses and post-infectious extraintestinal sequelae. The main reservoir is pigs, which are asymptomatic carriers.

Disease
Manifestations of the disease in humans are different in children and adults. Children develop fever and diarrhoea, where blood may appear. Abdominal pain is also typical in the right lumbar pit. In adults, we observe gastrointestinal infections and diarrhoea. With long-term illness, secondary complications can occur and these are inflammations of the joints. An unusual case of infection manifesting as perianal ulcers and colon ulcers has also been observed. An individual can become infected from infected pork. Toxic bacteria produce a thermostable toxin at 25 °C in milk. However, at 4 °C they will not produce significant amounts of this toxin.

Therapy
Bacteremia requires antibiotic treatment. Tetracycline is used. Tests have shown that bacteria have a high degree of resistance to ampicilin and cephalothin. In the diagnostic laboratory, examinations of the stool, nodes, and appendix are performed. Immunochromatic test for the quantitative determination of serotypes O3 and O9 in a stool sample with a result within 1 hour. The test is highly sensitive and specific.

Prevention
Prevention against Yersinia enterocolitica and Yersinia pseudotuberculosis is to avoid eating undercooked pork or unpasteurized milk. After contact with raw pork, it is recommended to wash your hands thoroughly with soap.

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Yersinia pseudotuberculosis
Yersinia pseudotuberculosis je G−, fakultativně anaerobní, pleomorfní tyčinka schopná pohybu při nižších teplotách. Je rozšířená kosmopolitně. Přenos alimentárně, orofekálně z nakažených zvířat či potravin. Onemocnění jsou spojena s gastrointestinálními problémy, horečkou, průjmem. Nejlepší prevencí je osobní hygiena a vyhnutí se kontaktu s nakaženými zvířaty.

Morfologie
Yersinia pseudotuberculosis je G−, pleomorfní tyčinka. Při nižších teplotách je schopna pohybu. Tento organismus byl popsán v roce 1889 jako choroba guinejských vepřů. Avšak Yersinia pseudotuberculosis se ukázala jako předek Yersinia pestis, která byla příčinou pandemického moru během let 541−767.

Epidemiologie
Na kultivaci je nenáročná, kultivuje se na běžných půdách. Je rozšířená kosmopolitně a byla izolovaná z několika druhů zvířat jako jsou kočky, psi, prasata, opice a další. Y. pseudotuberculosis je široce rozšířená v životním prostředí (fekálie, voda), kde může přežít po dlouhou dobu. Samotné prostředí je kontaminované z výkalů nakažených zvířat, především hlodavců a ptáků. Kromě zvířat byla nalezena i ve vodě, a to jak v řekách, tak i ve vysokohorských potůčcích.

Antigenní struktura
Můžeme rozlišit 5 sérotypů podle somatického antigenu.

Patogenita a virulence
Toxin vázaný v buňce je však odlišný od morového toxinu. Virulentní kmeny mohou vyvolat septikemickou formu podobnou moru zejména u jedinců s oslabenou imunitou. O mnoho častěji se vyskytují postižení gastrointestinálního traktu jako jsou akutní a chronické apendicitis, postižení mezenteriálních lymfatických uzlin, gastroenteritidy. Infekce Y. pseudotuberculosis byly zaznamenány po celém světě. Tyto infekce se vyskytují méně často než infekce Yersinia enterocolitica. Většina infekcí je sporadických a vyskytuje se vzácně, příkladem může být výskyt ve Finsku a Japonsku.

Klinické projevy
Onemocnění se u člověka projevuje horečkou, vyrážkami, bolestmi břicha a průjmy. Yersinia pseudotuberculosis byla asociována s Kawasakiho chorobou.

Diagnostika
Laboratorní testy se získávají ze vzorků stolice, moči nebo testů krve na protilátky bakterie. Sérotypizace izolovaného kmene. K léčbě se používají antibiotika. Nesmíme zapomenout, že pacient může být dehydratovaný z důvodu zvýšené teploty a průjmů. Je nutná rehydratace pacienta.

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