Far East scarlet-like fever

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Far East scarlet-like fever
Specialty Infectious disease

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]

<i>Bacillus</i> genus of bacteria

Bacillus is a genus of Gram-positive, rod-shaped bacteria, a member of the phylum Firmicutes, with 266 named species. The term is also used to describe the shape (rod) of certain bacteria; and the plural Bacilli is the name of the class of bacteria to which this genus belongs. Bacillus species can be either obligate aerobes: oxygen dependent; or facultative anaerobes: having the ability to be anaerobic in the absence of oxygen. Cultured Bacillus species test positive for the enzyme catalase if oxygen has been used or is present.

<i>Yersinia pseudotuberculosis</i> species of bacterium

Yersinia pseudotuberculosis is a Gram-negative bacterium that causes Far East scarlet-like fever in humans, who occasionally get infected zoonotically, most often through the food-borne route. Animals are also infected by Y. pseudotuberculosis. The bacterium is urease positive.


Signs and symptoms

These include [2] [3]

Toxic shock syndrome condition caused by bacterial toxins

Toxic shock syndrome (TSS) is a condition caused by bacterial toxins. Symptoms may include fever, rash, skin peeling, and low blood pressure. There may also be symptoms related to the specific underlying infection such as mastitis, osteomyelitis, necrotising fasciitis, or pneumonia.

Other features include mesenteric lymphadenitis and arthritis. Kidney failure rarely occurs.

Arthritis form of joint disorder that involves inflammation of one or more joints

Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types other organs are also affected. Onset can be gradual or sudden.

Kidney internal organ in most animals, including vertebrates and some invertebrates

The kidneys are two bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about 11 centimetres (4.3 in) in length. They receive blood from the paired renal arteries; blood exits into the paired renal veins. Each kidney is attached to a ureter, a tube that carries excreted urine to the bladder.

Relapses occur in up to 50% of patients.


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. [4]


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. [5] 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 disulfide bridge are critical.

Cysteine chemical compound

Cysteine (symbol Cys or C; ) is a semiessential proteinogenic amino acid with the formula HO2CCH(NH2)CH2SH. The thiol side chain in cysteine often participates in enzymatic reactions, as a nucleophile. The thiol is susceptible to oxidation to give the disulfide derivative cystine, which serves an important structural role in many proteins. When used as a food additive, it has the E number E920. It is encoded by the codons UGU and UGC.

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. [5] 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.


Differential diagnosis

The main differential diagnosis is scarlet fever. [6]


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

Related Research Articles

<i>Yersinia pestis</i> species of bacteria, cause of plague

Yersinia pestis is a gram-negative, nonmotile, rod-shaped coccobacillus bacteria, with no spores. It is a facultative anaerobic organism that can infect humans via the Oriental rat flea. It causes the disease plague, which takes three main forms: pneumonic, septicemic and bubonic plagues. All three forms were responsible for a number of high-mortality epidemics throughout human history, including: the sixth century's Plague of Justinian; the Black Death, which accounted for the death of at least one-third of the European population between 1347 and 1353; and the Third Pandemic, sometimes referred to as the Modern Plague, which began in the late nineteenth century in China and spread by rats on steamboats claiming close to 10,000,000 lives. These plagues likely originated in China and were transmitted west via trade routes. Recent research indicates that the pathogen may have been the cause of what is described as the Neolithic Decline, when European populations declined significantly. This would push the date to much earlier and might be indicative of an origin in Europe rather than Eurasia.

<i>Clostridium botulinum</i> species of bacterium

Clostridium botulinum is a Gram-positive, rod-shaped, anaerobic, spore-forming, motile bacterium with the ability to produce the neurotoxin botulinum.

<i>Streptococcus pyogenes</i> Species of bacterium

Streptococcus pyogenes is a species of Gram-positive bacterium in the genus Streptococcus. These bacteria are aerotolerant and an extracellular bacterium, made up of non-motile and non-sporing cocci. It is clinically important for humans. It is an infrequent, but usually pathogenic, part of the skin microbiota. It is the predominant species harboring the Lancefield group A antigen, and is often called group A streptococcus (GAS). However, both Streptococcus dysgalactiae and the Streptococcus anginosus group can possess group A antigen. Group A streptococci when grown on blood agar typically produces small zones of beta-hemolysis, a complete destruction of red blood cells. It is thus also called group A (beta-hemolytic) streptococcus (GABHS), and can make colonies greater than 5 mm in size.

Scarlet fever infectious disease

Scarlet fever is a disease which can occur as a result of a group A Streptococcus infection. The signs and symptoms include a sore throat, fever, headaches, swollen lymph nodes, and a characteristic rash. The rash is red and feels like sandpaper and the tongue may be red and bumpy. It most commonly affects children between five and 15 years of age.

Scrub typhus form of typhus caused by the intracellular parasite Orientia tsutsugamushi

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<i>Yersinia enterocolitica</i> species of bacterium

Yersinia enterocolitica is a Gram-negative bacillus-shaped bacterium, belonging to the family Enterobacteriaceae. It is motile at temperatures of 22–29 C (72-84°F), but becomes nonmotile at normal human body temperature.Y. enterocolitica infection causes the disease yersiniosis, which is an animal-borne disease occurring in humans, as well as in a wide array of animals such as cattle, deer, pigs, and birds. Many of these animals recover from the disease and become carriers; these are potential sources of contagion despite showing no signs of disease. The bacterium infects the host by sticking to its cells using trimeric autotransporter adhesins.

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Malaria antigen detection tests

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<i>Orientia tsutsugamushi</i> species of bacterium

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Erythrogenic toxin

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  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. 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
  3. Solozhenkin VG (1978) Scarlet fever-like disease in children. Pediatriia (1):27–28
  4. 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
  5. 1 2 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 the ypm gene encoding the novel superantigen among Yersinia pseudotuberculosis strains. J Clin Microbiol 33(12) 3356–3358
  6. Antonov VS (1978) Differential diagnosis of scarlet fever-like forms of pseudotuberculosis and scarlet fever in children. Pediatriia 52(1):6–9