pseudotuberculosis Septicemia and HIV

Two cases of community-acquired septicemia caused by serotype-O1 Yersinia pseudotuberculosis were diag-nosed in middle-aged, HIV-positive, immunodeficient patients during an 8-month period. Bacterial isolates were genetically indistinguishable, but no epidemiologic link between the 2 patients was established. HIV-related immunosuppression should be regarded as a risk factor for Y. pseudotuberculosis septicemia. Yersinia pseudotuberculosis is a rare cause of disease inhumans. Animals, food, and the abiotic environment are Y. pseudotuberculosis reservoirs from which epizootic and human infection may arise (1). A geographic gradient of Y. pseudotuberculosis isolation rates has been reported in Europe (1,2), with a 0.05 % recovery rate from stools of patients with acute enteritis in Italy (3). The organism can also cause mesenteric lymphadenitis, which mimics appendicitis, or infection at other body sites that occasion-ally leads to postinfectious sequelae such as reactive arthri-tis and erythema nodosum (1). About 60 cases of Y. pseudotuberculosis septicemia have been reported thus far, mainly in patients with underlying conditions such as hepatic cirrhosis, malignancy, diabetes, aplastic anemia, thalassemia, and iron overload (1,4,5). We recently report-ed the first case of Y. pseudotuberculosis septicemia in a severely immunocompromised, HIV-positive patient (6). Here, a second case of Y. pseudotuberculosis septicemia in an HIV-infected outpatient attending the same hospital is described. The unique molecular type of both Y. pseudotu-berculosis isolates and the atypical clinical course of infec-tion will be comparatively discussed. The Study The first case has recently been reported (6) and is briefly reviewed here. Patient 1 was a 42-year-old woman with HIV infection since 1987 (Centers for Disease Contro