Summary
Ten patients with chronicYersinia enterocolitica infections are described. The initial diagnosis was made by culture, significant agglutinin titres and indirect immunofluorescence (IF) on biopsies. During the chronic phase, culture and agglutinin titres were negative, but specific serum IgA and IgG antibodies reactive with at least two, i.e. the 36 kDa and the 46 kDa, virulence-associated released proteins were demonstrated in nine patients by immunoblot techniques. One patient had only IgG antibodies. The chronically elevated IgA production was the result of chronic stimulation of the gut-associated lymphoid tissue by virulent persistentYersinia antigen, which was identified by IF with O-specific antiserum and monospecific antiserum to the 46 kDa released protein in biopsies. VirulentYersinia bacilli were demonstrated in the intestinal mucosa and in the lymphoid tissue of the submucosa associated with macrophages in patients with chronic ileitis and arthritis, in granulomatous centres of lymph nodes in patients with chronic lymphadenopathy and in portal infiltrates in a patient with chronic hepatitis. Recognition of persistentYersinia infections may have therapeutic implications.
Zusammenfassung
Zehn Patienten mit chronischerYersinia enterocolitica-Infektion werden beschrieben. Die Anfangsdiagnose war mittels positiver Kulturen, signifikanter Agglutinationstiter und immunhistologischem (IF) Yersinia-Nachweis in menschlichem Biopsiematerial gestellt worden. Während der chronischen Phase waren Kultur und Agglutinationstiter negativ, aber im Serum von neun Patienten waren mit Immunoblot spezifische IgA- und IgG-Antikörper gegen mindestens zwei, d. h. die 36 kDa und 46 kDa Virulenz-assoziierten Proteine nachzuweisen. Ein Patient hatte nur IgG-Antikörper. Die chronisch erhöhte IgA-Produktion war verursacht durch chronische Stimulierung des intestinalen lymphatischen Gewebes durch virulente, persistierendeYersinia-Antigene, die mittels IF mit O-spezifischem Antiserum und monospezifischem Antiserum gegen das 46 kDa Virulenz-Protein in Biopsiematerial identifiziert werden konnten. VirulenteYersinia-Bazillen lagen in Biopsien von Patienten mit chronischer Ileitis und Arthritis tief in der Darmmukosa und im lymphoiden Gewebe der Submukosa, assoziiert mit Makrophagen. Sie wurden auch in Lymphknoten von Patienten mit chronischer Lymph-adenopathie nachgewiesen und in portalen Infiltraten eines Patienten mit chronischer Hepatitis. Der Nachweis persistierenderYersinia-Infektionen kann therapeutische Konsequenzen haben.
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Hoogkamp-Korstanje, J.A.A., de Koning, J. & Heesemann, J. Persistence of Yersinia enterocolitica in man. Infection 16, 81–85 (1988). https://doi.org/10.1007/BF01644307
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DOI: https://doi.org/10.1007/BF01644307