zoonoses and communicable diseases common to ... - PAHO/WHO

124 BACTERIOSESrecorded during the period 1984–1989 found that most of the patients were urban,62% were male, their average age was 16–19 years, and the hospital stay was 6 to12 days for adults and less for children (Franco-Vicario et al., 1991). However, thisscenario varies from country to country. In many industrialized countries, Y. enterocoliticais one of the principal causes of gastroenteritis in children and sometimes issecond to Salmonella in isolates taken from the pediatric population (Cover andAber, 1989). In late 1989 and early 1990, an outbreak occurred in Atlanta, Georgia(USA) among black children. Y. enterocolitica serotype 3 was isolated from 38(0.78%) of 4,841 fecal samples from seven hospitals in different American cities.Twenty of the 38 children had eaten pig intestines (“chitterlings”), which were probablyundercooked. Other intestinal pathogens isolated were Shigella (1.01%),Campylobacter (1.24%), and Salmonella (2.02%) (Lee et al., 1991). An outbreakaffecting 80 children was recorded in Rumania (Constantiniu et al., 1992).Most cases occur in fall and winter in Europe and from December to May inSouth Africa.Occurrence in Animals: Y. enterocolitica has been isolated from many domesticand wild mammals, as well as from some birds and cold-blooded animals. Theserotypes isolated from most animal species differ from those in man. Importantexceptions are swine, dogs, and cats, from which serotypes 3 and 9, the most prevalentcauses of human infection in many countries, have been isolated. In addition,serotype 5 was found in swine and is common in people in Japan (Hurvell, 1981).In some countries, the rate of isolations from animals is very high. In Belgium,serotypes that affect man were isolated from 62.5% of pork tongues collected frombutchers (de Groote et al., 1982). Studies done in Belgium and Denmark revealedthat 3% to 5% of swine carry the agent in their intestines.The Disease in Man: Y. enterocolitica is mainly a human pathogen that usuallyaffects children. The predominant symptom in small children is an acute enteritiswith watery diarrhea lasting 3 to 14 days; blood is present in the stool in 5% of cases.In older children and adolescents, pseudoappendicitis syndrome predominates, withpain in the right iliac fossa, fever, moderate leukocytosis, and a high rate of erythrosedimentation.The syndrome’s great similarity to acute appendicitis has frequentlyled to surgery. In adults, especially in those over 40 years of age, an erythemanodosum may develop one to two weeks after enteritis. The prognosis is favorable foralmost all those affected, 80% of whom are women. Reactive arthritis of one or morejoints is a more serious complication. About 100 cases of septicemia have beendescribed, mainly in Europe. Other complications may be present, but are much rarer.Of 1,700 patients with Y. enterocolitica infection in Belgium, 86% had gastroenteritis,nearly 10% had the pseudoappendicitis syndrome, and less than 1% had septicemiaand hepatic abscesses (Swaminathan et al., 1982).An epidemic with 172 cases occurred in the United States in 1982 and was attributedto pasteurized milk: 86% had enteritis and 14% had extraintestinal infectionslocalized in the throat, blood, urinary tract, peritoneum, central nervous system, andwounds. Extraintestinal infections were more common in adults. In patients withenteritis (mostly children), the disease caused fever (92.7%), abdominal pain(86.3%), diarrhea (82.7%), vomiting (41.4%), sore throat (22.2%), cutaneous eruptions(22.2%), bloody stool (19.7%), and joint pain (15.1%). The last symptom wasseen only in patients 3 years of age or older (Tacket et al., 1984).