Yersinia pseudotuberculosis bacteraemia with splenic abscesses: a case report

  1. Rahel Tefera Zewude
  2. Aleksandra Stefanovic
  3. Zersenay Alem

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Abstract

Introduction. Yersinia pseudotuberculosis has been known to cause a variety of clinical manifestations ranging from mild enteric illness to bacteraemia with septic shock and extraintestinal abscesses. Patients with liver disease and iron overload are at risk of more severe disease manifestations.

Case Report. A middle-aged male with chronic alcohol use disorder presented with confusion and jaundice, with ascites and asterixis noted on examination. His blood work was remarkable for neutrophilic leukocytosis, elevated liver enzymes and lactate. An abdominal computed tomography scan revealed splenic microabscesses and a cirrhotic liver. Yersinia pseudotuberculosis was recovered from his blood cultures and he was treated with ceftriaxone following susceptibility results.

Conclusion. Y. pseudotuberculosis should be considered in the differential diagnosis of splenic or other extraintestinal microabscesses particularly in patients with chronic liver disease.

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  1. Version published to 10.1099/acmi.0.000525.v3 on Access Microbiology
  3. Access Microbiology

    Please rate the quality of the presentation and structure of the manuscript

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    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

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    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

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  4. Version published to 10.1099/acmi.0.000525.v2 on Access Microbiology
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    Comments to Author

    Zewude et al provide a case report for a pa8ent with bacteremia purported to be Yersinia pseudotuberculosis, hepa8c encephalopathy, and splenic abscesses. While this is an interes8ng and relevant case report if indeed the splenic abscesses were caused by Yersinia, the data showing that the cultured bacteria was indeed Yersinia pseudotuberculosis was not provided. In addi8on, the sequence of events and whether all the symptoms were caused by the Yersinia pseudotuberculos infec8on is not made clear. Major comments: 1) This reviewer is not familiar with enteropathogenic Yersinia being spread by direct contact with animals (lines 53-54). It is known to be spread by ea8ng undercooked pork, but this is dis8nct from "direct contact". Furthermore, references #1 and 2, which are cited in this sentence, do not state that transmission of enteropathogenic Yersinia can occur by direct contact. Rather, reference #1 discusses some mammals as reservoirs. 2) The MALDI-TOF data showing that the bacteria from the blood was iden8fied as Yersinia pseudotuberculosis is not shown. This is the most cri8cal piece of data for this manuscript and must be provided and properly annotated. In addi8on, if possible, ideally sequencing of 16s rRNA and other genes such as invasin and YopJ should be shown as confirma8on. 3) Line 113: If paracentesis showed no bacterial growth then why did peritoneal fluid show bacterial peritoni8s. Was the paracentesis sampled from the peritoneal cavity or another 8ssue? Was paracentesis and peritoneal fluid sampling done on the same day? Please clarify this sec8on. Did this peritoneal infec8on get cleared by the second course of an8bio8cs? 4) It is not clear whether the pa8ent's confusion and elevated liver enzymes resolved. 5) Lines 172-182: Barnes et al (reference #17) showed that Yersinia pseudotuberculosis in mice need not transit through the Peyer's patches to colonize the spleen and liver in mice. In fact, Yersinia found in the Peyer's patches seem not to have the capacity to effec8vely colonize the spleen and liver as shown by Barnes et al. Therefore, the first sentence of this paragraph is inaccurate. Furthermore, because of this, it is not clear whether this paragraph is relevant. 6) Fig 3 needs a scale bar. Minor comments: 1) Line 36: "piperacillin-tazobactam with unknown culprit pathogen" doesn't make sense. Perhaps what is meant is "piperacillin-tazobactam to treat an unknown culprit pathogen"? 2) Line 50: There is more than two species of Yersinia in the family Yersiniacae. Therefore, "similar to the other member of the family" should be changed to "similar to another member of the family". 3) Lines 73-76 should say "two weeks" rather than "2-weeks". 4) Lines 75-67: Rather than "last week" or "last 2-weeks", it should say "the previous week" or "the previous two weeks". The sentence should also be changed to past tense rather than presence perfect tense: for example, "has had" is incorrect. 5) Line 74: The fall from fishing is more appropriate to discuss in lines 82-85 when the trip to Central America is discussed. 6) Line 133: The word "nodes" is missing. 7) Line 141: Did the authors mean "iri8s" rather than "irits"? 8) Is conjunc8vi8s an "immunological" complica8on? Reference #1 lists it simply as a "complica8on". 9) Yersinia pseudotuberculosis was first described in 1883 but the first reported case was in 1911? Please clarify. 10) Since the figure legends for Fig 1 and 2 are very similar, it is recommended for the two figures to be two difference panels of the same figure instead.

    Please rate the quality of the presentation and structure of the manuscript

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    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

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    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

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  7. Access Microbiology

    Comments to Author

    Reviewer comments: 1. Title: Suggestion: A case study of Yersinia pseudotuberculosis Bacteremia with Splenic Abscesses: A Case Report 2. Author names: Kindly provide an Orchid ID. 3. Keywords: I recommend addition of bacteremia to keywords and remove comma. 4. Graphical abstract will illustrate the case study details more easily. It should elaborate case timeline and past medical history. 5. Write methodology as a separate section and use subheadings to demonstrate each step. 6. Use subheading in the results section. 7. Yersinia should be written only when mentioned for the first time in the manuscript then will bw written as Y. . 8. The whole paper needs a careful English grammar and spelling revision: 9. References should be modified according to journal instructions: bold authors names, only first initial should be writtenand journal name should be italic. 10. Patient consent and ethical approval code should be provided. 11. In Results section: antibiogram results should be clearly tabulated for both disc diffusion technique and E- test. 12. In Discussion section: antibiogram susceptibility results should be compared with previously published articles. 13. Was this patient suffering from SARS-CoV-2?. 14. Kindly add table of abbreviations (e.g. lines 95 and 96) and mention the normal ranges 15. Regarding bilirubin, direct, indirect and total values should be provided to determine type of jaundice. 16. Line 106, add year of CLSI edition used. 17. Adding antibiogram in material and methods section is recommended. 18. Antibiogram results for the isolate should be mentioned in details. 19. Lines 117-122: this paragraph is not obvious at all and should be rewritten. 20. Discussion is too long 21. Line 170: bacterial names should be italics 22. Regarding MALDI-TOF system: * Which Scores were considered reliable for species level identification? * Which scores were considered reliable for genus level identification? * Documented figure for MALDI-TOF data should be provided. * What are The Yersinia spp. included in the MALDI Biotyper? 23. conclusion must be rewritten and supported by data 24. Lines 157-160: explain the relation between iron and extraintestinal abscesses 25. Regarding clinical manifestations of patient: a. Was the patient feverish as splenic abscess is usually accompanied by severe fever? b. Was prokinetic drugs administered? c. Procalcitonin test performed? d. Has the patient any previous hepatitis history? Many Thanks

    Please rate the quality of the presentation and structure of the manuscript

    Satisfactory

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

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    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    No: i asked the author to provide ethical approval number

  8. Access Microbiology

    Comments to Author

    1. Description of the case(s): very good 2. Presentation of results: The presentation has details for the patient more than usual; for instance the vacancy time, family visit...I would recommend to only use the important information related to the clinical case including (signs and symptoms) 3. How the style and organization of the paper communicates and represents key findings: Good 4. Literature analysis or discussion Good 5. Any other relevant comments: Its good to add the image for the growth morphology of Yersinia to assist other researchers. Is there any other simple method for the identification of Yersinia rather than using matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry?

    Please rate the quality of the presentation and structure of the manuscript

    Very good

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  9. Version published to 10.1099/acmi.0.000525.v1 on Access Microbiology