Far East scarlet-like fever

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Far East scarlet-like fever or scarlatinoid fever is an infectious disease caused by the gram negative bacillus Yersinia pseudotuberculosis. In Japan it is called Izumi fever.[1]

History[edit]

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

Aetiology[edit]

The cause of this disease is Yersinia pseudotuberculosis serotype O1. 95% are subtype O1b.

Yersinia pseudotuberculosis has been divided into 6 genetic groups: group 1 has only been isolated from the Far East.[2]

Pathophysiology[edit]

The clinical features of this disease appear to be due—at least in part—to the production of a superantigen—YpM (yersina pseudotuberculosis-derived mitogen). This is present in almost all strains from the Far East but only 20% of European isolates.[3] 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. The mitogenic antigens are scattered across the protein but two cysteine residues (residues 32 and 129) which form a disulphide bridge are critical.

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.[3] 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.

Clinical features[edit]

These include[4][5]

  • erythematous skin rash usually of the face, elbows and knees
  • skin desquamation
  • exanthema
  • hyperaemic tongue
  • toxic shock syndrome

Other features include mesenteric lymphadenitis and arthritis. Renal failure while rare may occur.

Relapses occur in up to 50% of patients.

Diferential diagnosis[edit]

The main differential diagnosis is scarlet fever.[6]

References[edit]

  1. ^ Sato K, Ouchi K, Taki M (1983) Yersinia pseudotuberculosis infection in children, resembling Izumi fever and Kawasaki syndrome. Pediatr Infect Dis 2: 123–126
  2. ^ Fukushima H Matsuda Y, Seki R, Tsubokura M, Takeda N, Shubin FN, Paik IK, Zheng XB (2001) Geographical heterogeneity between Far Eastern and Western countries in prevalence of the virulence plasmid, the superantigen Yersinia pseudotuberculosis-derived mitogen, and the high-pathogenicity island among Yersinia pseudotuberculosis strains. J Clin Microbiol 39:3541–3547
  3. ^ a b Yoshino K, Ramamurthy T, Nair GB, Fukushima H, Ohtomo Y, Takeda N, Kaneko S, Takeda T (1995) Geographical heterogeneity between Far East and Europe in prevalence of ypm gene encoding the novel superantigen among Yersinia pseudotuberculosis strains. J Clin Microbiol 33(12) 3356–3358
  4. ^ Zalmover IIu, Znamenskiĭ VA, Ignatovich VO, Vishniakov AK, Serov GD (1969) Clinical aspects of Far Eastern scarlatina-like fever. Voen Med Zh 1:47–51
  5. ^ Solozhenkin VG (1978) Scarlet fever-like disease in children. Pediatriia (1):27–28
  6. ^ Antonov VS (1978) Differential diagnosis of scarlet fever-like forms of pseudotuberculosis and scarlet fever in children. Pediatriia 52(1):6–9