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

ENTEROCOLITIC YERSINIOSIS 125Although extraintestinal complications are rare, they can be fatal (mortality isestimated at 34% to 50%) (Marasco et al., 1993). Complications, such as hepatic orsplenic abscesses, occur in adults and generally in immunodeficient patients.Mortality is very high in septicemia caused by transfusion of red blood cells contaminatedby Y. enterocolitica. Of 35 cases counted, 23 were fatal. Fever andhypotension are the principal symptoms and appear in less than one hour (see thesection on source of infection and mode of transmission).In Norway during the period 1974–1983, 458 cases of yersiniosis were diagnosedand patients were followed up for 10 years. Upon admission to the hospital, 184patients had abdominal pain, 200 had diarrhea, 45 experienced vomiting, and 36experienced weight loss. Mesenteric lymphadenitis or ileitis was found in 43 of 56who underwent laparotomy. Four to 14 years after discharge, 38 were readmittedwith abdominal pain, and 28 with diarrhea. High mortality was confirmed in 16 of22 patients who suffered from chronic hepatitis as a result of the infection (Saeboand Lassen, 1992a and 1992b).Treatment may be useful in the case of gastrointestinal symptoms and is highlyrecommended for septicemia and complications from the disease (Benenson, 1992).Y. enterocolitica is susceptible to commonly used antimicrobials, except for ampicillinand cephalothin. There are indications that there is no good correlationbetween in vitro assays and clinical efficacy (Lee et al., 1991). Aminoglycosides arethe antibiotics recommended most often in cases of septicemia. Other indicatedantimicrobials are cotrimoxazole and ciprofloxacin.The Disease in Animals: In the 1960s, several epizootics in chinchillas occurredin Europe, the United States, and Mexico, with many cases of septicemia and highmortality. These outbreaks were originally attributed to Y. pseudotuberculosis, butthe agent was later determined to be Y. enterocolitica serotype 1 (biotype 3), whichhad never been isolated from man. The principal clinical symptoms consisted ofsialorrhea, diarrhea, and weight loss. In the same period, cases of septicemia weredescribed in hares, from which serotype 2 (biotype 5) was isolated; this serotypealso does not affect man. Y. enterocolitica has been isolated from several species ofwild animals, in some of which intestinal lesions or hepatic abscesses were found.In the former Czechoslovakia and the Scandinavian countries, Y. enterocolitica wasisolated from 3% to 26% of wild rodents, but necropsy of these animals revealed nolesions. Similar results were obtained in southern Chile, where the agent was isolatedfrom 4% of 305 rodents of different species and from different habitats(Zamora et al., 1979). Serotypes isolated from rodents are generally not those pathogenicfor man. Among wild animals in New York State, serotype O:8 has been isolatedfrom a gray fox (Urocyon cinereoargenteus) and from a porcupine (Erethizondorsatum); serotype O:3 has been isolated from another gray fox. Both serotypes arepathogenic for man (Shayegani et al., 1986).Studies carried out on swine, dogs, and cats are of particular interest, since theseanimals harbor serotypes that infect man. The agent has been isolated from clinicallyhealthy swine and from animals destined for human consumption. In onestudy, a much higher rate of isolations was obtained from swine with diarrhea thanfrom apparently healthy animals. In another study, however, the agent was isolatedfrom 17% of healthy swine and from 5.4% of swine tested because of various symptoms(Hurvell, 1981). Y. enterocolitica has been isolated from swine during out-