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218 BACTERIOSESUnited States of America, Department of Health and Human Services, Centers for DiseaseControl and Prevention (CDC). Pneumonic plague—Arizona, 1992. MMWR Morb MortalWkly Rep 41:737–739, 1992.Willeberg, P.W., R. Ruppanner, D.E. Behymer, H.H. Higa, C.E. Franti, R.A. Thomson, etal. Epidemiologic survey of sylvatic plague by serotesting coyote sentinels with enzymeimmunoassay. Am J Epidemiol 110:328–334, 1979.Williams, J.E., L. Arntzen, G.L. Tyndal, M. Isaacson. Application of enzyme immunoassaysfor the confirmation of clinically suspect plague in Namibia, 1982. Bull World HealthOrgan 64:745–752, 1986.World Health Organization (WHO). WHO Expert Committee on Plague. Fourth Report.Geneva: WHO; 1970. (Technical Report Series 447).World Health Organization (WHO). Human plague in 1991. Wkly Epidemiol Rec68(4):21–23, 1993.PSEUDOTUBERCULOUS YERSINIOSISICD-10 A28.2 extraintestinal yersiniosisEtiology: Yersinia pseudotuberculosis is a coccobacillary, gram-negative bacteriathat is motile at 25°C, nonmotile at 37°C, and can live a long time in soil and water.It belongs to the family Enterobacteriaceae. DNA hybridization studies have confirmedthe close relationship between the agent of plague and that of pseudotuberculousyersiniosis.Y. pseudotuberculosis is subdivided on the basis of its biochemical properties intofive biotypes and on the basis of somatic (O) antigens into six serogroups (1–6),types 1, 2, 4, and 5 of which are divided into subgroups (Schiemann, 1989). Morerecently, Tsubokura et al. (1993) expanded the serogroups to 11 and also added asubgroup to O:1 (O:1C).Virulent strains of Y. pseudotuberculosis have a plasmid that determines the virulencefactors, including a kinase that determines the pathogenicity of the strains(Galyov et al., 1993).Geographic Distribution: The distribution of the etiologic agent is probablyworldwide. The greatest concentration of animal and human cases is found inEurope, the Russian Far East, and Japan.Occurrence in Man: For many years, pseudotuberculous yersiniosis was considereda disease that almost exclusively affected animals. However, since the 1950s,cases of lymphadenitis were described in children who had been operated on forappendicitis. In slightly more than three years, 117 cases of the disease werereported in Germany, most of which were diagnosed serologically. Hundreds ofcases were diagnosed in Europe in later years (Schiemann, 1989).Outbreaks occur as well as sporadic cases, which are possibly more numerous. Anepidemic outbreak with 19 cases occurred in Finland (Tertti et al., 1984). In the