Hoogkamp-Korstanje J A
Academisch Ziekenhuis, afd. Medische Microbiologie, Nijmegen.
Ned Tijdschr Geneeskd. 1996 Jan 20;140(3):128-30.
The genus Yersinia contains three pathogenic species: Y. pestis, Y. enterocolitica and Y. pseudotuberculosis. All pathogenic strains contain a 70 kb plasmid coding for a number of virulence factors, of which outer membrane proteins including an adhesin are the most important. In 65% of the patients the infection is self-limiting, but in the others a chronic local inflammation develops. Persistence of the infection has been associated with the immune status and the HLA-B27 antigen. Y. enterocolitica leads to abdominal complaints in young children that usually subside spontaneously. The infection is more serious with increasing age, and in people older than 30 years may involve a septicaemic form with multiple abscesses in various organs, or a lymphadenopathic form with generalized lymphadenitis mimicking a haematologic malignancy. Yersinia can be easily isolated during the acute phase by culture; during the chronic and persistent phase it is not cultivable anymore. Then serology should be performed, anti-Yop serology being the most reliable. Yersinia is susceptible to most antibiotics, except penicillins. Local penetration of the antibiotic may be a problem, however. First-choice antibiotics are cotrimoxazole, tetracyclines, chloramphenicol and fluoroquinolones. Systemic extra-mesenteric infections should always be treated with antibiotics.
鼠疫耶尔森菌、小肠结肠炎耶尔森菌和假结核耶尔森菌。所有致病菌株都含有一个70 kb的质粒，该质粒编码多种毒力因子，其中包括粘附素在内的外膜蛋白最为重要。65%的患者感染是自限性的，但其他患者会发展为慢性局部炎症。感染的持续存在与免疫状态和HLA - B27抗原有关。小肠结肠炎耶尔森菌会导致幼儿出现腹部不适，通常会自行缓解。随着年龄增长，感染会更严重，30岁以上的人可能会出现败血症形式，在各个器官有多个脓肿，或者出现淋巴结病形式，伴有全身性淋巴结炎，类似血液系统恶性肿瘤。耶尔森菌在急性期通过培养很容易分离出来；在慢性和持续期则不再可培养。此时应进行血清学检测，抗Yop血清学检测最为可靠。耶尔森菌对大多数抗生素敏感，但对青霉素不敏感。然而，抗生素的局部渗透可能是个问题。首选抗生素是复方新诺明、四环素、氯霉素和氟喹诺酮类。全身性肠系膜外感染始终应使用抗生素治疗。
