Far East scarlet-like fever is an infectious disease caused by the

gram negative The gram (originally gramme; SI unit symbol g) is a unit of mass in the International System of Units (SI) equal to one one thousandth of a kilogram. Originally defined as of 1795 as "the absolute weight of a volume of pure water equal to th ...

bacillus ''Bacillus'' (Latin "stick") is a genus of Gram-positive, rod-shaped bacteria, a member of the phylum '' Bacillota'', with 266 named species. The term is also used to describe the shape (rod) of other so-shaped bacteria; and the plural ''Bacill ...

Yersinia pseudotuberculosis ''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. pseudotuber ...

''. In Japan it is called Izumi fever.Sato K, Ouchi K, Taki M (1983) ''Yersinia pseudotuberculosis'' infection in children, resembling Izumi fever and

Kawasaki syndrome Kawasaki disease is a syndrome of unknown cause that results in a fever and mainly affects children under 5 years of age. It is a form of vasculitis, where blood vessels become inflamed throughout the body. The fever typically lasts for more tha ...

. Pediatr Infect Dis 2: 123–126

Signs and symptoms

These includeZalmover IIu, Znamenskiĭ VA, Ignatovich VO, Vishniakov AK, Serov GD (1969) Clinical aspects of Far Eastern scarlatina-like fever. Voen Med Zh 1:47–51Solozhenkin VG (1978) Scarlet fever-like disease in children. Pediatriia (1):27–28 * red skin rash usually of the face, elbows, and knees * skin desquamation * exanthema * red tongue *

toxic shock syndrome 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, osteomyeli ...

Other features include mesenteric lymphadenitis and arthritis.

Kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...

failure rarely occurs. Relapses occur in up to 50% of patients.

Enterocolitis Enterocolitis is an inflammation of the digestive tract, involving enteritis of the small intestine and colitis of the colon. It may be caused by various infections, with bacteria, viruses, fungi, parasites, or other causes. Common clinical manif ...

is common in children.

Sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

occasionally occurs; it primarily occurs in patients with preexisting comorbidities such as diabetes mellitus, liver cirrhosis, or

hemochromatosis Iron overload or hemochromatosis (also spelled ''haemochromatosis'' in British English) indicates increased total accumulation of iron in the body from any cause and resulting organ damage. The most important causes are hereditary haemochromatos ...

. Postinfective complications include reactive arthritis,

erythema nodosum Erythema nodosum (EN) is an inflammatory condition characterized by inflammation of the fat cells under the skin, resulting in tender red nodules or lumps that are usually seen on both shins. It can be caused by a variety of conditions, and typi ...

iritis Uveitis () is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and ...

, and

glomerulonephritis Glomerulonephritis (GN) is a term used to refer to several kidney diseases (usually affecting both kidneys). Many of the diseases are characterised by inflammation either of the glomeruli or of the small blood vessels in the kidneys, hence the ...

Cause

The cause of this disease is ''

'' 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.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

Pathophysiology

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.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 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. 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.

Diagnosis

Differential diagnosis

The main differential diagnosis is scarlet fever.Antonov VS (1978) Differential diagnosis of scarlet fever-like forms of pseudotuberculosis and scarlet fever in children. Pediatriia 52(1):6–9

Treatment

History

The first outbreak of this disease was reported from the

Pacific The Pacific Ocean is the largest and deepest of Earth's five oceanic divisions. It extends from the Arctic Ocean in the north to the Southern Ocean (or, depending on definition, to Antarctica) in the south, and is bounded by the contine ...

coastal areas (

Primorsky Krai Primorsky Krai (russian: Приморский край, r=Primorsky kray, p=prʲɪˈmorskʲɪj kraj), informally known as Primorye (, ), is a federal subject (a krai) of Russia, located in the Far East region of the country and is a part of t ...

) of

Russia Russia (, , ), or the Russian Federation, is a transcontinental country spanning Eastern Europe and Northern Asia. It is the largest country in the world, with its internationally recognised territory covering , and encompassing one-eig ...

in the 1950s.

References

{{reflist, 2 Bacterial diseases Scarlet fever