Humans ; Yersinia Infections/diagnosis* ; Yersinia enterocolitica

A 40-yr-old buddhist monk was admitted to the hospital with abdominal pain, fever, and confusion. He had a history of drinking untreated mountain spring water in his temple, and experienced the above symptoms for several days before admission. In past medical history, he had suffered from hepatic cirrhosis. Yersinia pseudotuberculosis was isolated from his blood and ascitic fluid. The mountain spring water that he had ingested was cultivated and Y. pseudotuberculosis was also isolated. For identification of pathogenic Y. pseudotuberculosis, each isolate from the three sources (blood, ascitic fluid, and drinking water) was also analysed for the inv gene for Y. pseudotuberculosis and the virF gene for virulent plasmid by PCR. All strains were positive for both the virF and the inv genes and also positive for autoagglutination test. For relationship study, each isolate from the three sources was also analysed with serotyping and restriction endonuclease analysis of virulence plasmid DNA (REAP) using BamHI. All belonged to the serotype 4b and REAP pattern D. Thus, all these findings supported that the mountain spring water was the source of the Y. pseudotuberculosis infection in this case.
Adhesins, Bacterial/genetics ; Adult ; Agglutination Tests ; Bacterial Proteins/genetics ; DNA, Bacterial/analysis ; Feces/microbiology ; Food ; Human ; Male ; Plasmids ; Restriction Mapping ; Septicemia/diagnosis/microbiology ; Serotyping ; Virulence Factors/genetics ; *Water Supply ; Yersinia pseudotuberculosis/classification/*genetics/isolation & purification ; Yersinia pseudotuberculosis Infections/*diagnosis/*transmission

Bacterial cold water disease, enteric red mouth disease and frunculosis are the common bacterial diseases of fish worldwide. The etiologic agents of these diseases are Flavobacterium (F.) psychrophilum, Yersinia (Y.) ruckeri and Aeromonas (A.) salmonicida subsp. salmonicida, respectively. In this study, a multiplex polymerase chain reaction (m-PCR) method with YER8/10-Fer3/4-FP1/3 primer pairs which can identify these fish pathogens simultaneously was developed and optimized. In optimized conditions, neither false specific nor nonspecific amplification occurred. The detection limits of the m-PCR method using DNA extracts from dilutions of pure cultures of bacteria were 35 pg for Y. ruckeri and F. psychrophilum and 70 pg for A. salmonicida subsp. salmonicida. It was determined that 15 CFU Y. ruckeri and F. psychrophilum and 30 CFU A. salmonicida subsp. salmonicida could be detected by m-PCR developed using genomic DNA extracted from dilutions of the suspensions. The detection limits in the presence of tissue debris were 125 CFU for Y. ruckeri and F. psychrophilum and 250 CFU for A. salmonicida subsp. salmonicida. In conclusion, we submit that the m-PCR method developed and optimized in this study can be used for accurate and rapid identification of these bacteria.
Aeromonas salmonicida/*genetics ; Animals ; DNA Primers/genetics ; Fish Diseases/*diagnosis/*microbiology ; Fishes ; Flavobacterium/*genetics ; Gram-Negative Bacterial Infections/diagnosis/*veterinary ; Polymerase Chain Reaction/methods/*veterinary ; Yersinia rucker/*genetics

BACKGROUND/AIMS: Clinical manifestations of intestinal yersiniosis include enterocolitis, mesenteric adenitis, and terminal ileitis presenting with fever, right lower quadrant pain, and leukocytosis. According to a previous Korean study in 1997, Yersinia was revealed in two among 15 adult patients with mesenteric adenitis (13%). However, recent reports on the prevalence of Yersinia infection in adult patients are few. The aim of this study was to investigate the prevalence of Yersinia infection in adult patients with acute right lower quadrant pain. METHODS: Adult patients (>18 years) who visited Eulji medical center, due to acute right lower quadrant pain were enrolled prospectively from December 2007 to July 2009. Abdominal CT, stool culture, serologic test for Yersinia, and Widal test were performed. RESULTS: Among 115 patients, 5 patients were excluded due to positive Widal test or salmonella culture. In 110 patients, abdominal CT showed right colitis in 20 (18.2%), terminal ileitis in 16 (14.5%), mesenteric adenitis in 13 (11.8%), acute appendicitis in 10 (9.1%), acute diverticulitis in 7 (6.4%), non specific mucosal edema in 36 (32.7%) and no specific lesion in 8 (7.3%). Two (1.8%) of the 110 patients had antibodies to Yersinia. One patient showed acute enteritis and the other patient was diagnosed with acute appendicitis and underwent appendectomy. No Yersinia species were grown on stool or tissue culture. CONCLUSIONS: Nowadays, among adult Korean patients presenting with acute right lower quadrant pain, there have been few incidences of Yersinia infection.
Abdominal Pain/*microbiology ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Antibodies/blood/immunology ; Appendicitis/epidemiology ; Colitis/epidemiology ; Diverticulitis/epidemiology ; Edema/epidemiology ; Female ; Humans ; Ileitis/epidemiology ; Lymphadenitis/epidemiology ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Tomography, X-Ray Computed ; Yersinia/*isolation & purification ; Yersinia Infections/*diagnosis/*epidemiology

Kikuchi-Fujimoto disease is known as a benign disorder, affecting predilection for cervical lymphadenopathy. The disease is now recognized that can affect patients of any age, gender and can involve any anatomic sites. But, few cases presenting as an acute abdomen have been reported. In a university hospital, three patients of Kikuchi- Fujimoto disease presented as acute abdomen and diagnosed by surgically during the period from April 1998 to February 2004. All three patients, two man and one woman, aged 12 to 27 years, complained abdominal pain for 4 to 20 days. They had fever (in three patients), right lower quadrant tenderness (three), decreased bowel sound (three), anorexia (two), abdominal indirect tenderness (one), but there was no cervical or axillary lymphadenopathy. Abdomino-pelvic computed tomography showed multiple lymphadenopathy in peritoneum (three), periappendiceal fat infiltrations with small amount of ascites (one). Laboratory data showed no markedly increased leukocyte (3,400-6,400 mm(-3)), serum amylase level (47-98 U/L) or serum C-reactive protein concentration (0.8-2.03 mg/dL). Other specific studies revealed negative including tuberculosis infection, lymphoma, Yersinia infection. Laparoscopic operation (two) and open laparotomy (one) were performed. The size of excised lymph nodes in greatest dimension ranged from 1.0 to 7 cm. Histologic features was the presence of pale nodular lymphohistiocytic foci with coagulation necrosis and absence of granulocytic infiltration. All the patients discharged without any surgical complication and no recurrent abdominal symptom. Our study emphasizes that Kikuchi-Fujimoto disease could be considered as one of the differential diagnoses in patients with prolonged fever and suspicious acute abdomen.
Abdomen, Acute* ; Abdominal Pain ; Amylases ; Anorexia ; Ascites ; C-Reactive Protein ; Diagnosis, Differential ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Laparotomy ; Leukocytes ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Necrosis ; Peritoneum ; Tuberculosis ; Yersinia Infections