Foberg U, Frydén A, Kihlström E, Persson K, Weiland O
Scand J Infect Dis. 1986;18(4):269-79. doi: 10.3109/00365548609032337.
Septicemia is a rare but serious complication of infection with Yersinia enterocolitica (Y.e.). Seven cases of Y.e. septicemia are presented. Five of the patients had no underlying disease predisposing to septicemia. Five patients displayed recurrent episodes of septicemia, despite treatment with recommended doses of antibiotics to which the isolates were sensitive in vitro. One patient developed endocarditis which required surgical replacement of the aortic valve. Other clinical manifestations were arthritis, diverticulitis and pulmonary abscesses. The outcome was fatal to 3 elderly patients. The serological response to Y.e. was followed by tube agglutination and a diffusion-in-gel enzyme-linked immunosorbent assay. One patient, with a benign course of illness, had transient elevated Y.e. antibody titres, while the 3 cases with a protracted disease showed sustained antibody responses for 6-18 months. Blood isolates of Y.e. had ordinary virulence characteristics identical to fecal isolates and produced extracellular beta-lactamase. All isolates were sensitive in vitro to trimethoprim-sulfamethoxazole, mecillinam, piperacillin, cefotaxime, ceftazidime, chloramphenicol and gentamicin. The lowest MIC values were recorded for mecillinam. Full synergistic activity was demonstrated when mecillinam was combined with trimethoprim-sulfamethoxazole, cefuroxime or rifampicin.
败血症是小肠结肠炎耶尔森菌（Y.e.）感染的一种罕见但严重的并发症。本文报告了7例Y.e.败血症病例。其中5例患者没有易患败血症的基础疾病。尽管使用了推荐剂量的对体外分离菌株敏感的抗生素进行治疗，但仍有5例患者出现败血症复发。1例患者发生心内膜炎，需要手术置换主动脉瓣。其他临床表现包括关节炎、憩室炎和肺脓肿。3例老年患者预后不佳。通过试管凝集试验和凝胶扩散酶联免疫吸附测定对Y.e.的血清学反应进行了跟踪。1例病情呈良性经过的患者Y.e.抗体滴度短暂升高，而3例病程迁延的患者抗体反应持续6至18个月。Y.e.的血液分离菌株具有与粪便分离菌株相同的普通毒力特征，并产生细胞外β-内酰胺酶。所有分离菌株在体外对甲氧苄啶-磺胺甲恶唑、美西林、哌拉西林、头孢噻肟、头孢他啶、氯霉素和庆大霉素敏感。美西林的最低抑菌浓度值最低。美西林与甲氧苄啶-磺胺甲恶唑、头孢呋辛或利福平联合使用时显示出完全的协同活性。
