Isolation of Yersinia Pseudotuberculosis Serotype V from The Blood of a Patient with Sickle-Cell Anaemia

Abstract

H u M A N infection with Yersinia pseudotuberculosis (Pasteurella pseudotuberculosis) occurs in two main forms, namely, a benign and not uncommon mesenteric adenitis in children and young adults (Knapp, 1958;Mair et al., 1960) and a septicaemic form that is rare and tends to occur in older patients. One previous septicaemic infection has been recorded in Great Britain (Macaulay et al., 1967). This paper describes the second such case in this country and the first proven instance in the world literature of human infection with serotype V. Case ReportA 25-year-old male student from Sierra Leone, who had been in this country for eighteen months, was admitted to hospital on 25 Dec., 1971, complaining of severe limb and back pains of four days' duration. Transient peri-umbilical pain had also been present at the outset. There was no known family history of sickle-cell anaemia.Although his temperature was normal on admission, it had risen by the following day, at times reaching 40°C. Splinter haemorrhages were present in the fingers of both hands, there was a systolic cardiac murmur, and the edge of the liver was just palpable. There was no abdominal tenderness.The haemoglobin value on admission was 9.5 g per 100 ml, there were 6500 WBC per mm3, with a normal differential count, but there were 72 nucleated RBC per 100 WBC and the ESR was 56 mm in one hour. Sickle cells were seen in blood films and the sickle-cell test was positive; haemoglobin electrophoresis showed Hb S only, and foetal haemoglobin was 1.6% of the total. Thus the diagnosis of sickle-cell anaemia was established.Biochemical investigations revealed the following values : serum bilirubin 1.2 mg per 100 ml; alkaline phosphatase 30 KA units per 100 ml; cholesterol 100 mg per 100 ml; total protein 8.2 g per 100 ml; albumin 4.5 g per 100 ml; y-globulin 1.8 g per 100 ml.A skull X-radiograph showed no change suggestive of chronic haemolytic anaemia. Three sets of blood cultures taken on 28-29 Dec. yielded, from all bottles after 24 hours' incubation, an organism with the characteristics of Y. pseudotuberculosis. Each set of blood cultures consisted of two bottles of Castaneda's medium (25 ml) and one of Brain Heart Infusion Broth (50 ml), each inoculated with 2-3 ml blood. The organism was found by Dr N. S. Mair to belong to serotype V. Serum taken on 1 Jan. agglutinated a stock strain of type V to a titre of 320, and the patient's own organism to 640. Agglutinating antibody titres, measured at intervals during the following eleven months, showed no significant change. Yersinia spp. were not recovered from any of several faecal specimens cultured on a 4% aesculin bile medium.Treatment was started with 120 mg gentamicin per day in divided doses, by intramuscular injection. All subsequent blood cultures were sterile but by 3 Jan. the patient's haemoglobin had fallen to 6.2 g per 100 ml; there were 5920 nucleated RBC per p1 and many target cells were present. He remained pyrexial. Ampicillin in a dose of 1 g per day was then given by intravenous infusion and gen...

Iron and infection.

“…however, neither the appearance, maintenance, (31,97,128,163,208) Neonatal stage (0-30 days) (12,20,57,175,191) Parenteral iron (8, 65) Increased release of iron from stores Hepatitis (59,85,169) Refeeding starvees (141, 143, (58) cytes Malaria (12,20,126,184) Sickling (7,12,20,27,176) (12,20,57,175,191) metabolism, surface properties, nor permeability functions of the macrophages were altered by the metal. The authors concluded that iron simply was required as a bacterial nutrilite and that "seclusion within tissue cells does not isolate microbes from external nutrients" (206).…”

Y. enterocolitica and Y. pseudotuberculosis

“…Systemic Disease Septicemia As for Y. enterocolitica, Y. pseudotuberculosis septicemia often affects patients with a pre-existing condition such as diabetes or a condition involving iron overload and/or liver disease (Mollaret et al, 1964;Marlon et al, 1971) including hemochromatosis (Conway et al, 1989), sickle cell disease (Bradley and Skinner, 1974), thalassemia (Gordts et al, 1984) or chronic hemodialysis (Boelaert et al, 1987). Unlike mesenteric aden- In spite of thorough epidemiological investigations, no common factors other than the water was found among patients in this outbreak which occurred in a remote mountain area where the residents drank unchlorinated well water and mountain stream water.…”