Far East scarlet-like fever
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.
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. 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. 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.
- erythematous skin rash usually of the face, elbows and knees
- skin desquamation
- hyperaemic tongue
- toxic shock syndrome
Relapses occur in up to 50% of patients.
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