Although most episodes of yersiniosis remit spontaneously without long-term sequelae, infections with Y. enterocolitica are noteworthy for the large variety of immunological complications, such as reactive arthritis, erythema nodosum, uveitis, glomerulonephritis, carditis, and thyroiditis, which have been reported to follow acute infection (51). Of these, reactive arthritis is the most widely recognized (58-60). This manifestation of infection is infrequent before the age of 10 years and occurs most often in Scandinavian countries where serotype O:3 strains and the human leukocyte antigen, HLA-B27, are especially prevalent. Men and women are effected equally. Arthritis typically follows the onset of diarrhea or the pseudoappendicular syndrome by 1-2 weeks with a range of from 1 to 38 days. The joints most commonly involved are the knees, ankles, toes, tarsal joints, fingers, wrists, and elbows. Synovial fluid from affected joints contains large numbers of inflammatory cells, principally polymorphonuclear leukocytes, and is invariably sterile, although it generally contains bacterial antigens (61). The duration of arthritis is typically less than 3 months, and the long-term prognosis in terms of joint destruction is excellent, although some patients may have symptoms that persist for several years (60,62). Many patients with arthritis also have extra-articular symptoms, including urethritis, uveitis, and erythema nodosum (59).
Y. enterocolitica-induced erythema nodosum occurs predominantly in women and is not associated with HLA-B27. Other autoimmune complications of yersiniosis, including Reiter's syndrome, uveitis, acute proliferative glomerulonephritis, collagenous colitis, and rheumatic-like carditis, have been reported, mostly from Scandinavian countries (63). Yersiniosis has also been linked to various thyroid disorders, including Graves' disease hyperthyroidism, nontoxic goiter, and Hashimoto's thyroiditis, although the causative role of yersiniae in these conditions is uncertain (64). In Japan, Y. pseudotuberculosis has been implicated in the etiology of Kawasaki's disease (65).
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