Far East scarlet-like fever

Far East scarlet-like fever
Other names: FESLF[1],Scarlatinoid fever
Top: Mesenteric adipose tissue days after Yersinia pseudotuberculosis infection Bottom:Colonies of Y. pseudotuberculosis grown on CIN agar and mVYE agar
Specialty	Infectious disease
Symptoms	Fever,rash[2]
Complications	Reactive arthritis, erythema nodosum, iritis[2]
Causes	Yersinia pseudotuberculosis[2]
Diagnostic method	Blood or stool cultures and serological tests[2]
Differential diagnosis	Scarlet fever[2] Toxic shock syndrome Pancreatitis Inflammatory bowel disease
Treatment	Doxycycline[2]
Frequency	Sporadic(Rusia,Japan)[3]

Far East scarlet-like fever is an infectious disease caused by the gram negative bacillus Yersinia pseudotuberculosis. In Japan it is called Izumi fever.^[4][5]

The disease is primarily transmitted through the consumption of contaminated food(vegetables). It is important to note that this disease is different from scarlet fever, which is caused by Streptococcus pyogenes.^[2][6]

Treatment of this disease, we find that ampicillin, ceftriaxone, and doxycycline^[2]

Signs and symptoms

Among the symptoms demonstrated are the following which include^[8][9]

• Red skin rash of face, elbows, and knees
• Skin desquamation
• Exanthema
• Red tongue

Complications

In terms of complications we find the affected individual may have:^[2]

• Intestinal obstruction
• Septic arthritis
• Uveitis
• Acute tubulointerstitial nephritis
• Severe GI bleeding
• Intestinal abscess

Cause

The cause of this disease is Yersinia pseudotuberculosis serotype O1. A very high percentage of Far East scarlet-like fever infections are subtype O1b.^[10][6]

Yersinia pseudotuberculosis has been divided into 6 genetic groups: group 1 has only been isolated from the Far East.^[11]

Molecular mechanism

Y. pseudotuberculosis has a single circular chromosome and carries two plasmids. The chromosome size is 4.7 Mb, and the plasmids are 59 kb and 153 kb.It harbors a 70-kb virulence plasmid called pYV, which encodes a type III secretion system important for its pathogenicity.Several strains of Y. pseudotuberculosis have been sequenced, including IP2666pIB1, IP31758, and MD672. ^[13][14][15]

The clinical features of this disease appear to be due—at least in part—to the production of a superantigen—YpM (Yersinia pseudotuberculosis-derived mitogen). This is present in almost all strains from the Far East but only 20% of European isolates.^[16]

The antigen was discovered in 1993 and is encoded by a 456-base gene. The protein has 151 amino acids, with a signal sequence of 20 amino acids.^[17]

The mitogenic antigens are scattered across the protein but two cysteine residues (residues 32 and 129) which form a disulfide bridge are critical.^[3]

The G+C content of this gene is 35%—lower than the genomic average (47%) suggesting that this gene has been acquired from some other organism.^[16]

The organism from which this gene originated has not yet been identified. This gene seems likely to have been introduced into the genome by a bacteriophage, given the nearby presence of a phage integration site, but the mechanism of entry into the genome is not currently known.^[12][3]

Diagnosis

In terms of the diagnosis of East scarlet-like fever, we find evaluation is on basis on the following:^[18][2]

• Blood

• Stool

• Synovial fluids

• Peritoneal fluid

• Other organ-based biopsy

Differential diagnosis

In terms of the differential diagnosis we find the following:^[19][2]

• Gastroenteritis

• Scarlet fever

• Toxic shock syndrome

• Pancreatitis

• Inflammatory bowel disease

Treatment

In terms of the treatment of Far East scarlet-like fever this disease is managed via:^[2]

• Ampicillin
• Ceftriaxone
• Doxycycline
• Gentamycin

Prognosis

We find that most cases are mild and self-limited; however in those who are immunocompromised or have chronic liver disease, the prognosis can be very poor.^[2]

Epidemiology

In terms of the epidemiology we find that Yersinia pseudotuberculosis infection occurs worldwide and cases happen more in winter time.^[2]

Y. pseudotuberculosis outbreaks have happened in Russian Far East, and Japan; while only sporadically in Europe.^[2]The disease is often seen in clusters within specific geographic regions with higher incidences in areas like the Russian Far East, with lower case numbers reported in central Russia and other regions with milder climates^[3][2]

History

The first outbreak of this disease was reported from the Pacific coastal areas (Primorsky Krai) of Russia in the 1950s.^[6]

The disease was first described in 1959 during an outbreak in Vladivostok, Russia ^[6]

References