Liver Abscess and Splenic Infarction Due to Yersinia pseudotuberculosis bloodstream infection : A case report

Liver Abscess and Splenic Infarction Due to Yersinia pseudotuberculosis bloodstream infection : A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Liver Abscess and Splenic Infarction Due to Yersinia pseudotuberculosis bloodstream infection : A case report Yixun Wang, Yanni Xiang, Chao Lei, Xiaxia Zheng, Wen Wu, ZhaoHui Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5107965/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Dec, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Yersinia pseudotuberculosis is an emerging zoonotic intestinal pathogen that is transmitted primarily through contaminated food and water. Yersinia pseudotuberculosis infection is usually self-limited and usually manifests as gastroenteritis or "pseudoappendicitis", characterized by fever and abdominal pain; Bloodstream infection with Yersinia pseudotuberculosis is uncommon but can result in Multiple distant sites of infection, including liver, splenic and kidney abscesses , even hip and knee jiont , often with underlying immunodeficiency. Case presentation : We present the case of a 40-year-old man who was admitted to the intensive care unit (ICU) with intermittent fever for five days followed by worsening abdominal pain and distension one day after consuming contaminated food. Upon admission, the patient developed severe hypotension, quickly followed by signs of liver and kidney failure, progressing to multiple organ dysfunction syndrome (MODS). In particular, the patient's abdominal CT showed signs of liver abscess and splenic infarction. He was treated with fluid resuscitation, broad-spectrum antibiotics, vasopressors, continuous renal replacement therapy (CRRT), and plasma exchange. Blood cultures and metagenomic next-generation sequencing (mNGS) confirmed Yersinia pseudotuberculosis infection. After 17 days of ICU treatment, the patient was transferred to the infectious disease department for further treatment for 14 days and was discharged. Three months after discharge, the patient had two follow-up visits and was in good condition. Conclusions: To our knowledge, this is the rare reported case of MODS, liver abscess, and splenic infarction caused by Y. pseudotuberculosis infection.Timely use of broad-spectrum antibiotics and active organ function support are the keys to treatment. The lack of further progression of the liver abscess may indicate that the bacteria are not very virulent. Fortunately, the patient eventually recovered, and follow-up observation of the liver and spleen after discharge became important. Yersinia pseudotuberculosis Bloodstream infection Septic shock Liver abscess Splenic infection Figures Figure 1 BACKGROUND Yersinia pseudotuberculosis ( Y. pseudotuberculosis ) is a Gram-negative, facultatively anaerobic coccobacillus with a wide range of animal hosts, including both domestic and wild mammals and birds[ 1 ]. It is an emerging zoonotic enteric pathogen that is transmitted primarily through contaminated food and water. Notably, this bacterium can survive in contaminated refrigeration environments, leading to its colloquial designation as “refrigerator disease”[ 2 ]. Y. pseudotuberculosis infections are typically self-limiting and often present as gastroenteritis or “pseudoappendicitis” characterized by fever and abdominal pain. Systemic infections, including sepsis caused by Y. pseudotuberculosis , are rare and generally occur in individuals with underlying conditions such as cirrhosis, diabetes mellitus, organ transplants, severe anemia, malignancies, or HIV. Bloodstream infection with Yersinia pseudotuberculosis is uncommon but can result in Multiple distant sites of infection, such as abscesses of the liver, splenic, or kidney, often with underlying immunodeficiency. Case Presentation A 40-year-old man was admitted with a 5-day history of intermittent fever, followed by the onset of abdominal pain and distension for 1 day. According to his family, the patient had consumed food from the refrigerator approximately a week before the symptoms began. He did not exhibit any overt signs of vomiting or diarrhea; Despite receiving 2 days of intravenous treatment with levofloxacin at a local clinic, the patient's condition progressively worsened, characterized by persistent high fever, abdominal pain, and lethargy, prompting his family to bring him to the emergency department (ED) of our hospital. The patient denied recent travel, contact with sick individuals, animal exposure, or water-related activities. He worked in waste recycling and had no known history of diabetes, hepatitis, tuberculosis, or other immunocompromising conditions. Upon arrival at the ED, the patient appeared lethargic, with an axillary temperature of 38.5°C, heart rate of 120 beats per minute with no murmurs, blood pressure of 80/50 mmHg, respiratory rate of 28 breaths per minute, and a Glasgow Coma Scale (GCS) score of 13. Abdominal examination revealed generalized muscle rigidity, tenderness in the left upper quadrant without rebound tenderness, mild tenderness at McBurney's point, no hepatosplenomegaly, and slightly hyperactive bowel sounds. Laboratory results revealed a white blood cell (WBC) count of 16.34 × 10⁹/L (normal range: 3–10×10⁹), with 87.7% neutrophils and 4.2% lymphocytes. Hemoglobin was 61 g/L (normal range: 120–160 g/L), platelet count (PLT) was 152 × 10⁹/L (normal range: 150–450×10⁹), procalcitonin (PCT) was elevated at 9.6 ng/ml (normal: 0–0.046 ng/ml), interleukin-6 was markedly elevated at 3918 pg/ml (normal range: 0–7 pg/ml), C-reactive protein (CRP) was 325 mg/L (normal: 0–10 mg/L), serum lactate was 6.8 mmol/L (normal: 0–3 mmol/L), alanine aminotransferase (ALT) was 156 U/L (normal: 0–45 U/L), and aspartate aminotransferase (AST) was 177 U/L (normal: 0–45 U/L). Both total and direct bilirubin levels were mildly elevated. Serum creatinine (Scr) was 101 mmol/L, random blood glucose was 19.6 mmol/L, and glycated hemoglobin (HbA1c) was 8.43% (normal: ≤7.0%). The patient was admitted to the intensive care unit (ICU) with a preliminary diagnosis of septic shock secondary to abdominal infection. According to the Surviving Sepsis Campaign (SSC) guidelines, the patient underwent the 3-hour sepsis bundle, including fluid resuscitation (30 ml/kg within 3 hours), central venous catheter placement, central venous oxygen saturation (ScvO2) monitoring, and blood cultures (aerobic and anaerobic) collected prior to the initiation of empirical antibiotic therapy with piperacillin-tazobactam (4.5 g every 8 hours). Intravenous insulin was administered to control blood glucose. Due to persistent hypotension despite fluid resuscitation, norepinephrine and vasopressin were administered to maintain a mean arterial pressure (MAP) of ≥ 65 mmHg, with the maximum norepinephrine dose reaching 0.9 µg/(kg·min). Surgical diseases such as acute appendicitis, acute cholecystitis, or gastrointestinal perforation were excluded after surgeon consultation. Post-ICU admission, the patient’s renal function rapidly deteriorated, with a marked reduction in urine output and a rise in Scr (Day 4: SCr max 560 mmol/L), consistent with septic acute kidney injury (AKI). Continuous venovenous hemodiafiltration (CVVHDF) with citrate anticoagulation was initiated on ICU day 2. Given the severity of septic shock, a multidisciplinary team escalated antibiotics to meropenem (1.0 g every 8 hours). Brain, chest, and contrast-enhanced abdominal CT scans (Fig. 1 : A, B) revealed no brain abnormalities, bilateral lung infiltrates with mild pleural effusion, multiple hypodense liver lesions suggestive of infection, splenic infarction, retroperitoneal lymphadenopathy, and a small amount of pelvic fluid. To identify potential pathogens as quickly as possible, blood samples were sent for next-generation metagenomic sequencing (mNGS). On ICU day 3, liver enzymes ALT and AST peaked at 3169 IU/L and 1112 IU/L, respectively, accompanied by jaundice involving the skin and sclera. Total and direct bilirubin levels continued to rise, peaking on day 6 at 286.7 µmol/L and 134.7 µmol/L, respectively. Coagulation abnormalities and elevated blood ammonia levels indicated acute liver injury. Plasma exchange therapy (2000 ml of fresh frozen plasma, daily for 7 consecutive days) was initiated on ICU day 5. On ICU day 4, mNGS identified Yersinia pseudotuberculosis , with a sequence count of 7 and relative abundance of 17.08%. Based on the Sanford Guide to Antimicrobial Therapy and the patient’s glomerular filtration rate, antibiotics were adjusted to gentamicin (160,000 U QD) and levofloxacin in sodium chloride (100 ml QD). Because of the ongoing need for high doses of norepinephrine and vasopressin, we were concerned about the efficacy of antibiotics and decided to continue meropenem. Concurrent blood cultures confirmed Y. pseudotuberculosis , which was sensitive to all tested antibiotics. Testing for hepatitis A, B, C, E, and autoimmune hepatitis was negative, ruling out liver disease as a cause of acute liver injury. Point-of-care abdominal ultrasound revealed no evidence of intrahepatic bile duct dilatation. Lymphocyte subset analysis on ICU day 3 indicated immunosuppression. HIV, anti-neutrophil cytoplasmic antibodies (ANCA), and extractable nuclear antigen (ENA) tests were negative, and stool examination for parasites was unremarkable. Following combined antibiotic therapy, shock management, glycemic control, intermittent red blood cell transfusions, and organ support, the patient's temperature normalized on day 8. Blood pressure stabilized, with vasopressin discontinued on day 6 and norepinephrine on day 12. Urine output progressively increased, reaching 3540 ml by day 10, at which point continuous renal replacement therapy (CRRT) was discontinued. After 7 plasma exchanges, liver function normalized. Blood cultures were negative on days 7, 12, and 18. Meropenem was used for 6 days, while gentamicin and levofloxacin were continued for 8 days. Abdominal CT scans on days 12, 19, and 27 revealed significant resolution of hepatic lesions, with no further progression of splenic infarction (Fig. 1 : C, D, E). After 17 days in the ICU, the patient’s vital signs stabilized, and he was transferred to the infectious disease department for an additional 13 days of treatment. At the 3-month outpatient follow-up, the patient reported no significant discomfort. A follow-up abdominal CT scan (Fig. 1 : F) showed a marked reduction in the liver lesions, while the splenic infarction remained stable without further enlargement. Regular telephone follow-up revealed no signs of recurrence. The imaging and laboratory findings during treatment are presented in Table 1 and Fig. 1 . Table 1. Laboratory investigation results of patients in two weeks in the ICU Abbreviations : ALT: alanine aminotransferase; AST: aspartate aminotransferase; CRP: C-reactive protein;T, temperature; WBC,white blood cell; PLT ,platelet count; IL-6, interleukin 6; PCT, procalcitonin; PCT: procalcitonin; TBil: total bilirubin; DBil: direct bilirubin; Scr: serum creatinine; Lac: lactic acid; LYMPH, Lymphocyte count;UO,urine output; Hb,hemoglobin. Discussion and Conclusions We report a case of an adult patient who developed septic shock, acute kidney injury, acute liver injury, liver abscess, and splenic infarction due to Y. pseudotuberculosis bacteremia. A literature review by Kaasch et al. identified 72 cases of Yersinia bacteraemia between 1911 and 2012, of which only 7 cases involved liver abscesses or Splenic abscesses [18].Another literature review by Yun Jeong Lee et al. reported only 1 of 78 patients with Yersinia infection involved a splenic abscess from 2000 to 2021[14] . None of them mentioned the occurrence of splenic infarction cases. To the best of our knowledge, this is the first reported case of MODS, splenic infarction，liver abscess,and caused by this bacterium. Generally, Y. pseudotuberculosis infection is a self-limiting disease that often does not require antimicrobial treatment. The most common manifestations are gastroenteritis and “pseudoappendicitis,” characterized by fever and abdominal pain[3,4]. Severe cases usually occur in patients with underlying conditions, including liver cirrhosis, diabetes, organ transplantation, severe anemia, malignancy, and HIV[5,6]. Additionally, some patients may develop infections in joints such as the knee, hip, or even the cervical spine[7-9]. Notably, in 2021, Hashimoto et al.[10] reported the first severe case of septic shock caused by Y. pseudotuberculosis in an immunocompetent adult, which might suggest increased virulence of the pathogen. Upon admission, our patient developed severe septic shock requiring high doses of vasopressors to maintain blood pressure, accompanied by progressive deterioration of liver and kidney function. These manifestations have not been previously described in other case reports. The patient's primary risk factor was undiagnosed diabetes before admission. Regarding the route of infection, upon careful inquiry, the patient’s family mentioned a habit of using the microwave to heat food stored in the refrigerator, leading us to suspect undercooked food might be the source of infection. In terms of treatment, the patient received multiple antibiotics and timely interventions with plasma exchange and CRRT. Without a doubt, plasma exchange is the first-line treatment for acute liver failure[11]. After seven plasma exchange sessions, the patient’s liver function returned to normal. Moreover, plasma exchange plays an essential role in treating severe sepsis by clearing inflammatory mediators, correcting coagulopathy, and restoring internal environment stability[12]. The patient’s renal failure was primarily attributed to septic shock, and after nine days of bedside CRRT, her urine output and serum creatinine levels returned to normal. In most clinical cases of pseudotuberculosis infection, hepatic involvement is uncommon. Potentially due to limitations in imaging techniques, most cases of liver abscess reported in early literature were diagnosed postmortem during autopsy [18]. In 2020, a case report by Martyn E et al.[13], liver dysfunction manifested only as mildly elevated liver enzymes and bilirubin, likely due to sepsis or the use of ceftriaxone. Abdominal CT and liver ultrasound revealed no abnormal liver findings. In 2021, Lee, Y.J. et al.[14] reported a case of Y. pseudotuberculosis bacteremia presenting with acute hepatitis-like symptoms, characterized by elevated liver enzymes and markedly increased liver echogenicity with a mildly enlarged spleen on ultrasound. Contrast-enhanced abdominal CT ruled out hepatocellular carcinoma and hepatic hemangioma, leading to the consideration of a hepatic abscess due to bacteremia. Y. pseudotuberculosis is not a common pathogen for hepatic abscess, but diabetes is an independent risk factor for liver abscess. Fortunately, Y. pseudotuberculosis generally has low virulence and is sensitive to antibiotics. Antibiotic use is based on the recommendations from Up To Date [15,16]. For severe adult cases of Y. pseudotuberculosis infection, a combination of ceftriaxone (2 g, once daily) and gentamicin (5 mg/kg) is recommended for at least three weeks. In our case, due to severe septic shock early on, after consulting with infectious disease experts (microbiologists), we primarily used gentamicin, levofloxacin, and meropenem. Although gentamicin has potential nephrotoxicity, we adjusted the dosage on the basis of the patient's glomerular filtration rate. Multiple follow-up abdominal CT scans revealed that the hepatic infection focus was controlled without liquefaction or abscess formation, avoiding the need for drainage or surgical intervention. In 2017, Kimura J et al.[17] reported a case where surgery was necessary due to uncontrolled intra-abdominal infection despite antibiotic treatment, and Yersinia pseudotuberculosis was isolated from the abdominal fluid. To date, there have been no clinical case reports of splenic infarction caused by Y. pseudotuberculosis infection. The patient’s ECG, echocardiography, and laboratory tests excluded embolic splenic infarction caused by infective endocarditis and atrial fibrillation. We speculate that splenic infarction is related to postinfection shock, hypotension, decreased splenic artery blood flow, and coagulopathy. Currently, it is believed that there is no specific treatment for splenic infarction, and most cases resolve spontaneously or fibrose. Our patient had a large splenic infarction, raising concerns about the risk of splenic rupture, but fortunately, it did not occur. Mortality from bloodstream infections Y. pseudotuberculosis infection rates as high as 75% have been reported [18]. With respect to the reported mortality of severe cases of Y. pseudotuberculosis infection, from 1991--1994, 6 out of 9 reported cases died, resulting in a mortality rate of 66%[19]. However, from 1995--2021, all 5 reported cases survived [10] owing to advancements in diagnostic techniques and timely antibiotic application. Y. pseudotuberculosis infection is usually confirmed in the laboratory through serological tests, blood cultures, stool cultures, polymerase chain reaction (PCR), metagenomic next-generation sequencing (mNGS), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF-MS) and histopathology[ 20 ]. Owing to the critical condition of our patient, we performed mNGS of blood samples alongside blood cultures, which quickly confirmed the diagnosis of Y. pseudotuberculosis infection. Hashimoto, T.et al . [ 10 ] achieved accurate and rapid diagnosis of Y. pseudotuberculosis infection via blood cultures and MALDI-TOF mass spectrometry in their case report. Heuvelmans M. et al . [ 21 ] noted that PCR testing of stool samples for intestinal infection has limitations, and commercial PCR kits for Y. pseudotuberculosis are not widely used, making blood culture the preferred method for diagnosing invasive Y. pseudotuberculosis infection[ 14 ]. In addition to blood cultures, there have been reports of Y. pseudotuberculosis being isolated from abdominal fluid [ 19 ], and if the pathogen disseminates to the bones and joints, surgical biopsy of bone tissue is essential[ 22 ]. There have also been reports of inguinal lymph node biopsy confirming Yersinia pseudotuberculosis infection[ 23 ]. Additionally, there are cases where both blood and stool cultures are negative, and the diagnosis was finally confirmed by detecting Y. pseudotuberculosis antibodies in the serum via enzyme-linked immunosorbent assays (ELISAs)[ 24 ]. In conclusion, we herein report a case of septic shock, liver abscess, splenic infarction and MODS caused by Y. pseudotuberculosis infection. Although the mortality rate of Y. pseudotuberculosis infection has significantly decreased, the severity of this patient's condition suggests that the virulence of this pathogen may be increasing, alerting clinicians to the need for heightened vigilance and awareness. Further observations and research are needed to understand the virulence, clinical manifestations, and complications of this pathogen. The patient fully recovered, and we conducted regular follow-ups. Abbreviations Y. pseudotuberculosis : Yersinia pseudotuberculosis ; ICU: intensive care unit; MODS: multiple organ dysfunction syndrome; CRRT: continuous renal replacement therapy; mNGS: metagenomic next-generation sequencing; ED: emergency department; GCS: Glasgow Coma Scale; WBC: white cell count; PLT: platelet count; CRP: C-reactive protein; PCT: procalcitonin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; TBil: total bilirubin; DBil: direct bilirubin; Scr: serum creatinine; Lac: lactic acid; CT: computed tomography; PCR: polymerase chain reaction; MALDI-TOF MS: matrix-assisted laser desorption ionization-time-of-flight mass spectrometry; ELISA: enzyme-linked immunosorbent assay; MAP: mean arterial pressure; CVVHDF: continuous venovenous hemodiafiltration Declarations Ethics approval and consent to participate Our hospital's ethics review board approved this study. Written informed consent from the patient's family was also obtained for publication of this case report. Ethical Review Approval Number:2024-302-01. Consent for publication Written informed consent was obtained from the patient upon publication, including personal or clinical details, along with any identifying images of this case report. Competing interests The authors declare that they have no competing interests. Funding None. Author Contribution YW and YX were involved in patient management and data collection. XZ, CL, WW, and ZZ contributed to patient management, t prepared table 1 ,figure 1, and manuscript refinement. XQ was responsible for the study design and drafted the manuscript." Acknowledgments We would like to thank the intensive care unit and infectious disease department staff for their excellent teamwork. Data Availability Data is provided within the manuscript or supplementary information files. References Fukushima H, Gomyoda M, Ishikura S, Nishio T, Moriki S, Endo J, Kaneko S, Tsubokura M. Cat-contaminated environmental substances lead to Yersinia pseudotuberculosis infection in children. J Clin Microbiol. 1989;27:2706–9. Wang X, Chen Z, Ran L et al. Interpretation for diagnosis of Yersiniosis. [J].Zhonghua liu xing bing xue za zhi, 2019, 40(9):1048–51. 10.3760/cma.j.issn.0254-6450.2019.09.005 Naktin J, Beavis KG. Yersinia enterocolitica and Yersinia pseudotuberculosis . Clin Lab Med. 1999;19:523–36. Weber J, Finlayson NB, Mark JB. Mesenteric lymphadenitis and terminal ileitis due to Yersinia pseudotuberculosis . N Engl J Med. 1970;283:172–4. Renvoise A, Lemaitre N, Saintenoy G, Benosman H, Geffrier C, Epelboin L, Jarlier V, Poynard T, Thabut D. Spontaneous ascitic fluid infection and bacteremia due to Yersinia pseudotuberculosis in a liver transplant patient. Int J Infect Dis. 2015;34:122–5. Paglia MG, D’Arezzo S, Festa A, Del Borgo C, LoIacono L, Antinori A, Antonucci G, Visca P. Yersinia pseudotuberculosisSepticemia and HIV. Emerg Infect Dis. 2005;11:112–1130. Cormier G, Lucas V, Varin S, et al. Yersinia pseudotuberculosis infection of a lumbar facet joint. Joint Bone Spine. 2007;74:110–1. Kaasch AJ, Dinter J, Goeser T, Plum G, Seifert H. Yersinia pseudotuberculosis bloodstream infection and septic arthritis: case report and review of the literature. Infection. 2012;40(2):185–90. Ishihara T, et al. Pyogenic vertebral osteomyelitis caused by Yersinia pseudotuberculosis . Joint Bone Spine. 2016. http://dx.doi.org/10.1016/j.jbspin.2016.01.009 . Hashimoto T, Takenaka R, Fukuda H, et al. Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review. BMC Infect Dis. 2021;21:36. https://doi.org/10.1186/s12879-020-05733-w . Tan EX, Wang MX, Pang J, Lee GH. Plasma exchange in patients with acute and acute-on-chronic liver failure: A systematic review. World J Gastroenterol. 2020;26(2):219–45. 10.3748/wjg.v26.i2.219 . PMID: 31988586; PMCID: PMC6962432. Kuklin V, Sovershaev M, Bjerner J, et al. Influence of therapeutic plasma exchange treatment on short-term mortality of critically ill adult patients with sepsis-induced organ dysfunction: a systematic review and meta-analysis[J]. Crit Care. 2024;28(1). 10.1186/s13054-023-04795-x . Martyn E, Heward J, Herbert R. Yersinia pseudotuberculosis : an unexpected cause of fever and a hot joint. BMJ Case Rep. 2020;13(2):e233125. 10.1136/bcr-2019-233125 . PMID: 32060113; PMCID: PMC7046400. Lee YJ, Kim J, Jeon JH, Seok H, Choi WS, Chang E-A, Yim HJ, Park DW. Extraintestinal Manifestation of Yersinia pseudotuberculosis Bacteremia as Acute Hepatitis: Case Report and Review of the Literature. Pathogens. 2021;10:1255. https://doi.org/10.3390/pathogens10101255 . Tauxe RV. In: Calderwood SBKS, editor. Treatment and Prevention of Yersinia enterocolitica and Yersinia pseudotuberculosis infection. Waltham, MA: Up To Date; 2019. p. 18. Morris J. Yersinia pseudotuberculosis . secondary Yersinia pseudotuberculosis , 2017. Available: https://www.infectiousdiseaseadvisor.com/home/decision-support-inmedicine/infectious-diseases/yersinia-pseudotuberculosis/ Kimura J, Sasaki K. .case report -open access yersinia pseudotuberculosis infection intractable by antibiotics: a rare case report[J]. 2017. 10.1016/j.ijscr.2016.02.039 Mandell GL, Bennet JE, Dolin R, Mandell. Douglas, and Bennett’s principles and practice of infectious diseases. 7th ed. New York: Churchill Livingstone; 2009. Kaasch AJ, Dinter J, Goeser T, Plum G, Seifert H. Yersinia pseudotuberculosis bloodstream infection and septic arthritis: case report and review of the literature. Infection. 2012;40(2):185–90. Srinivasa KG, Vidhya JV, Manohar TM, Naik M. Right hemicolectomy for intestinal obstruction due toYersinia pseudotuberculosis: a histopathological surprise, Indian J. Surg. 75 (Suppl. 1) (2013) 214–216. https://doi.org/10.1186/s12879-020-05733-w Heuvelmans M, Lammertink MHA, Kusters JG, Bruns AHW, Monkelbaan JF. Yersinia pseudotuberculosis infection with severe localized inflammation and ulceration of the ileum in a heart transplant patient. BMJ Case Rep. 2020;13(12):e236343. 10.1136/bcr-2020-236343 . PMID: 33318266; PMCID: PMC7737070. Ishihara T, Miyazaki M, Yoshiiwa T, et al. Pyogenic vertebral osteomyelitis caused by Yersinia pseudotuberculosis [J]. Joint Bone Spine. 2016;727–9. 10.1016/j.jbspin.2016.01.009 . Iwata K, Morishita N, Masuda Y, et al. Unilateral inguinal lymphadenitis caused by Yersinia pseudotuberculosis . A case report[J]. J Infect Chemother. 2020;26(7). 10.1016/j.jiac.2020.04.017 . Ohnishi T, Nakazawa M, Wada N. ,et al. Yersinia pseudotuberculosis Infection Accompanied by Intussusception and Incomplete Kawasaki Disease in a 7-year-old Girl[J]. Keio J Med. 2021. 10.2302/kjm.2021-0002-CR . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Dec, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 24 Sep, 2024 Editor assigned by journal 22 Sep, 2024 Submission checks completed at journal 22 Sep, 2024 First submitted to journal 18 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5107965","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":358322738,"identity":"90871668-2397-453e-96ac-b09eeeb9d05a","order_by":0,"name":"Yixun Wang","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Yixun","middleName":"","lastName":"Wang","suffix":""},{"id":358322739,"identity":"03410cf3-eb0a-43f9-8552-69b302845749","order_by":1,"name":"Yanni Xiang","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Yanni","middleName":"","lastName":"Xiang","suffix":""},{"id":358322740,"identity":"a8d17561-8b88-44ba-85e6-df6157a24a30","order_by":2,"name":"Chao Lei","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Lei","suffix":""},{"id":358322741,"identity":"fd705047-fec0-487e-81b2-4918df730812","order_by":3,"name":"Xiaxia Zheng","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Xiaxia","middleName":"","lastName":"Zheng","suffix":""},{"id":358322742,"identity":"ed6ecfca-11e3-41a0-b474-9fc27687c677","order_by":4,"name":"Wen Wu","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Wu","suffix":""},{"id":358322743,"identity":"e48b47c8-2e76-471e-ae8f-720bccf321dd","order_by":5,"name":"ZhaoHui Zhang","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"ZhaoHui","middleName":"","lastName":"Zhang","suffix":""},{"id":358322744,"identity":"cd781811-b713-4a00-b541-4f93c687b02f","order_by":6,"name":"xingguang qu","email":"data:image/png;base64,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","orcid":"","institution":"China Three Gorges University","correspondingAuthor":true,"prefix":"","firstName":"xingguang","middleName":"","lastName":"qu","suffix":""}],"badges":[],"createdAt":"2024-09-18 07:51:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5107965/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5107965/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-024-10325-z","type":"published","date":"2024-12-18T15:58:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70946140,"identity":"c3607b26-3ab0-4231-9344-e5f559ee69b0","added_by":"auto","created_at":"2024-12-09 13:03:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":265132,"visible":true,"origin":"","legend":"\u003cp\u003eComputed tomography of the patient during hospitalization and follow-up after discharge. (A) Day 2 in the ICU,Contrast-enhanced abdominal CT (Arterial phase) multiple hypodense lesionsof the liver;The possibility of splenic infarction was considered by the low-density lesion of spleen ; (B) On the same day, CT images of the venous phase of the abdomen.（C）Day 12 in the ICU,the multiple low-density shadows in the liver seemed to be slightly reduced. The boundary of splenic infarction was more definite than before. (D) Day 19 in the hosipital,multiple hypodense lesions in the liver, some with ill-defined borders. there was no significant change in splenic infarct size. (E) Day 27 in the hosipital，the number of multiple hypodense lesions in the liver was significantly reduced. There was still a large area of infarction in the spleen. (F) Three months after discharge,the multiple low-density lesions in the liver basically disappeared, and the low-density infarct lesions in the spleen had blurred boundaries.（\u003cem\u003eStraight arrows point to splenic infarction; Curved arrows point to hypodense lesions in the liver.\u003c/em\u003e)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5107965/v1/6876a3838df726a096f07a2b.png"},{"id":72203076,"identity":"d80be7ee-3d89-4bd1-8d96-a94849a63a0b","added_by":"auto","created_at":"2024-12-23 16:16:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":791724,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5107965/v1/38f71d89-ab60-493e-a2f8-103da197414a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Liver Abscess and Splenic Infarction Due to Yersinia pseudotuberculosis bloodstream infection : A case report","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003e \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e (\u003cem\u003eY. pseudotuberculosis\u003c/em\u003e) is a Gram-negative, facultatively anaerobic coccobacillus with a wide range of animal hosts, including both domestic and wild mammals and birds[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is an emerging zoonotic enteric pathogen that is transmitted primarily through contaminated food and water. Notably, this bacterium can survive in contaminated refrigeration environments, leading to its colloquial designation as \u0026ldquo;refrigerator disease\u0026rdquo;[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e infections are typically self-limiting and often present as gastroenteritis or \u0026ldquo;pseudoappendicitis\u0026rdquo; characterized by fever and abdominal pain. Systemic infections, including sepsis caused by \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e, are rare and generally occur in individuals with underlying conditions such as cirrhosis, diabetes mellitus, organ transplants, severe anemia, malignancies, or HIV. Bloodstream infection with Yersinia pseudotuberculosis is uncommon but can result in Multiple distant sites of infection, such as abscesses of the liver, splenic, or kidney, often with underlying immunodeficiency.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 40-year-old man was admitted with a 5-day history of intermittent fever, followed by the onset of abdominal pain and distension for 1 day. According to his family, the patient had consumed food from the refrigerator approximately a week before the symptoms began. He did not exhibit any overt signs of vomiting or diarrhea; Despite receiving 2 days of intravenous treatment with levofloxacin at a local clinic, the patient's condition progressively worsened, characterized by persistent high fever, abdominal pain, and lethargy, prompting his family to bring him to the emergency department (ED) of our hospital. The patient denied recent travel, contact with sick individuals, animal exposure, or water-related activities. He worked in waste recycling and had no known history of diabetes, hepatitis, tuberculosis, or other immunocompromising conditions.\u003c/p\u003e \u003cp\u003eUpon arrival at the ED, the patient appeared lethargic, with an axillary temperature of 38.5\u0026deg;C, heart rate of 120 beats per minute with no murmurs, blood pressure of 80/50 mmHg, respiratory rate of 28 breaths per minute, and a Glasgow Coma Scale (GCS) score of 13. Abdominal examination revealed generalized muscle rigidity, tenderness in the left upper quadrant without rebound tenderness, mild tenderness at McBurney's point, no hepatosplenomegaly, and slightly hyperactive bowel sounds.\u003c/p\u003e \u003cp\u003eLaboratory results revealed a white blood cell (WBC) count of 16.34 \u0026times; 10⁹/L (normal range: 3\u0026ndash;10\u0026times;10⁹), with 87.7% neutrophils and 4.2% lymphocytes. Hemoglobin was 61 g/L (normal range: 120\u0026ndash;160 g/L), platelet count (PLT) was 152 \u0026times; 10⁹/L (normal range: 150\u0026ndash;450\u0026times;10⁹), procalcitonin (PCT) was elevated at 9.6 ng/ml (normal: 0\u0026ndash;0.046 ng/ml), interleukin-6 was markedly elevated at 3918 pg/ml (normal range: 0\u0026ndash;7 pg/ml), C-reactive protein (CRP) was 325 mg/L (normal: 0\u0026ndash;10 mg/L), serum lactate was 6.8 mmol/L (normal: 0\u0026ndash;3 mmol/L), alanine aminotransferase (ALT) was 156 U/L (normal: 0\u0026ndash;45 U/L), and aspartate aminotransferase (AST) was 177 U/L (normal: 0\u0026ndash;45 U/L). Both total and direct bilirubin levels were mildly elevated. Serum creatinine (Scr) was 101 mmol/L, random blood glucose was 19.6 mmol/L, and glycated hemoglobin (HbA1c) was 8.43% (normal: \u0026le;7.0%).\u003c/p\u003e \u003cp\u003eThe patient was admitted to the intensive care unit (ICU) with a preliminary diagnosis of septic shock secondary to abdominal infection. According to the Surviving Sepsis Campaign (SSC) guidelines, the patient underwent the 3-hour sepsis bundle, including fluid resuscitation (30 ml/kg within 3 hours), central venous catheter placement, central venous oxygen saturation (ScvO2) monitoring, and blood cultures (aerobic and anaerobic) collected prior to the initiation of empirical antibiotic therapy with piperacillin-tazobactam (4.5 g every 8 hours). Intravenous insulin was administered to control blood glucose. Due to persistent hypotension despite fluid resuscitation, norepinephrine and vasopressin were administered to maintain a mean arterial pressure (MAP) of \u0026ge;\u0026thinsp;65 mmHg, with the maximum norepinephrine dose reaching 0.9 \u0026micro;g/(kg\u0026middot;min). Surgical diseases such as acute appendicitis, acute cholecystitis, or gastrointestinal perforation were excluded after surgeon consultation.\u003c/p\u003e \u003cp\u003ePost-ICU admission, the patient\u0026rsquo;s renal function rapidly deteriorated, with a marked reduction in urine output and a rise in Scr (Day 4: SCr\u003csub\u003emax\u003c/sub\u003e 560 mmol/L), consistent with septic acute kidney injury (AKI). Continuous venovenous hemodiafiltration (CVVHDF) with citrate anticoagulation was initiated on ICU day 2. Given the severity of septic shock, a multidisciplinary team escalated antibiotics to meropenem (1.0 g every 8 hours). Brain, chest, and contrast-enhanced abdominal CT scans (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: A, B) revealed no brain abnormalities, bilateral lung infiltrates with mild pleural effusion, multiple hypodense liver lesions suggestive of infection, splenic infarction, retroperitoneal lymphadenopathy, and a small amount of pelvic fluid. To identify potential pathogens as quickly as possible, blood samples were sent for next-generation metagenomic sequencing (mNGS).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOn ICU day 3, liver enzymes ALT and AST peaked at 3169 IU/L and 1112 IU/L, respectively, accompanied by jaundice involving the skin and sclera. Total and direct bilirubin levels continued to rise, peaking on day 6 at 286.7 \u0026micro;mol/L and 134.7 \u0026micro;mol/L, respectively. Coagulation abnormalities and elevated blood ammonia levels indicated acute liver injury. Plasma exchange therapy (2000 ml of fresh frozen plasma, daily for 7 consecutive days) was initiated on ICU day 5.\u003c/p\u003e \u003cp\u003eOn ICU day 4, mNGS identified \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e, with a sequence count of 7 and relative abundance of 17.08%. Based on the Sanford Guide to Antimicrobial Therapy and the patient\u0026rsquo;s glomerular filtration rate, antibiotics were adjusted to gentamicin (160,000 U QD) and levofloxacin in sodium chloride (100 ml QD). Because of the ongoing need for high doses of norepinephrine and vasopressin, we were concerned about the efficacy of antibiotics and decided to continue meropenem. Concurrent blood cultures confirmed \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e, which was sensitive to all tested antibiotics. Testing for hepatitis A, B, C, E, and autoimmune hepatitis was negative, ruling out liver disease as a cause of acute liver injury. Point-of-care abdominal ultrasound revealed no evidence of intrahepatic bile duct dilatation. Lymphocyte subset analysis on ICU day 3 indicated immunosuppression. HIV, anti-neutrophil cytoplasmic antibodies (ANCA), and extractable nuclear antigen (ENA) tests were negative, and stool examination for parasites was unremarkable.\u003c/p\u003e \u003cp\u003eFollowing combined antibiotic therapy, shock management, glycemic control, intermittent red blood cell transfusions, and organ support, the patient's temperature normalized on day 8. Blood pressure stabilized, with vasopressin discontinued on day 6 and norepinephrine on day 12. Urine output progressively increased, reaching 3540 ml by day 10, at which point continuous renal replacement therapy (CRRT) was discontinued. After 7 plasma exchanges, liver function normalized. Blood cultures were negative on days 7, 12, and 18. Meropenem was used for 6 days, while gentamicin and levofloxacin were continued for 8 days. Abdominal CT scans on days 12, 19, and 27 revealed significant resolution of hepatic lesions, with no further progression of splenic infarction (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: C, D, E).\u003c/p\u003e \u003cp\u003eAfter 17 days in the ICU, the patient\u0026rsquo;s vital signs stabilized, and he was transferred to the infectious disease department for an additional 13 days of treatment. At the 3-month outpatient follow-up, the patient reported no significant discomfort. A follow-up abdominal CT scan (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: F) showed a marked reduction in the liver lesions, while the splenic infarction remained stable without further enlargement. Regular telephone follow-up revealed no signs of recurrence. The imaging and laboratory findings during treatment are presented in \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e .\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;1.\u003c/b\u003e Laboratory investigation results of patients in two weeks in the ICU\u003c/p\u003e\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: ALT: alanine aminotransferase; AST: aspartate aminotransferase; CRP: C-reactive protein;T, temperature; WBC,white blood cell; PLT ,platelet count; IL-6, interleukin 6; PCT, procalcitonin; PCT: procalcitonin; TBil: total bilirubin; DBil: direct bilirubin; Scr: serum creatinine; Lac: lactic acid; LYMPH, Lymphocyte count;UO,urine output; Hb,hemoglobin.\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eWe report a case of an adult patient who developed septic shock, acute kidney injury, acute liver injury, liver abscess, and splenic infarction due to Y. pseudotuberculosis bacteremia.\u0026nbsp;A literature review by Kaasch et al. identified 72 cases of Yersinia bacteraemia between 1911 and 2012, of which only 7 cases involved liver abscesses or Splenic abscesses [18].Another literature review by Yun Jeong Lee et al. reported \u0026nbsp;only 1 of 78 patients with Yersinia infection involved a splenic abscess from 2000 to 2021[14] . None of them mentioned the occurrence of splenic infarction cases. To the best of our knowledge, this is the first reported case of MODS, \u0026nbsp;splenic infarction，liver abscess,and caused by this bacterium. Generally, Y. pseudotuberculosis infection is a self-limiting disease that often does not require antimicrobial treatment. The most common manifestations are gastroenteritis and \u0026ldquo;pseudoappendicitis,\u0026rdquo; characterized by fever and abdominal pain[3,4]. Severe cases usually occur in patients with underlying conditions, including liver cirrhosis, diabetes, organ transplantation, severe anemia, malignancy, and HIV[5,6]. Additionally, some patients may develop infections in joints such as the knee, hip, or even the cervical spine[7-9]. Notably, in 2021, Hashimoto et al.[10] reported the first severe case of septic shock caused by \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e in an immunocompetent adult, which might suggest increased virulence of the pathogen.\u003c/p\u003e\n\u003cp\u003eUpon admission, our patient developed severe septic shock requiring high doses of vasopressors to maintain blood pressure, accompanied by progressive deterioration of liver and kidney function. These manifestations have not been previously described in other case reports. The patient\u0026apos;s primary risk factor was undiagnosed diabetes before admission. Regarding the route of infection, upon careful inquiry, the patient\u0026rsquo;s family mentioned a habit of using the microwave to heat food stored in the refrigerator, leading us to suspect undercooked food might be the source of infection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of treatment, the patient received multiple antibiotics and timely interventions with plasma exchange and CRRT. Without a doubt, plasma exchange is the first-line treatment for acute liver failure[11]. After seven plasma exchange sessions, the patient\u0026rsquo;s liver function returned to normal. Moreover, plasma exchange plays an essential role in treating severe sepsis by clearing inflammatory mediators, correcting coagulopathy, and restoring internal environment stability[12]. The patient\u0026rsquo;s renal failure was primarily attributed to septic shock, and after nine days of bedside CRRT, her urine output and serum creatinine levels returned to normal.\u003c/p\u003e\n\u003cp\u003eIn most clinical cases of pseudotuberculosis infection, hepatic involvement is uncommon. Potentially due to limitations in imaging techniques, most cases of liver abscess reported in early literature were diagnosed postmortem during autopsy\u0026nbsp;[18]. In 2020, a case report by Martyn E et al.[13], liver dysfunction manifested only as mildly elevated liver enzymes and bilirubin, likely due to sepsis or the use of ceftriaxone. Abdominal CT and liver ultrasound revealed no abnormal liver findings. In 2021, Lee, Y.J. et al.[14] reported a case of Y. pseudotuberculosis bacteremia presenting with acute hepatitis-like symptoms, characterized by elevated liver enzymes and markedly increased liver echogenicity with a mildly enlarged spleen on ultrasound. Contrast-enhanced abdominal CT ruled out hepatocellular carcinoma and hepatic hemangioma, leading to the consideration of a hepatic abscess due to bacteremia. Y. pseudotuberculosis is not a common pathogen for hepatic abscess, but diabetes is an independent risk factor for liver\u0026nbsp;abscess. Fortunately, Y. pseudotuberculosis generally has low virulence and is sensitive to antibiotics. Antibiotic use is based on the recommendations from Up To Date\u0026nbsp;[15,16]. For severe adult cases of Y. pseudotuberculosis infection, a combination of ceftriaxone (2 g, once daily) and gentamicin (5 mg/kg) is recommended for at least three weeks. In our case, due to severe septic shock early on, after consulting with infectious disease experts (microbiologists), we primarily used gentamicin, levofloxacin, and meropenem. Although gentamicin has potential nephrotoxicity, we adjusted the dosage on the basis of the patient\u0026apos;s glomerular filtration rate. Multiple follow-up abdominal CT scans revealed that the hepatic infection focus was controlled without liquefaction or abscess formation, avoiding the need for drainage or surgical intervention. In 2017, Kimura J et al.[17] reported a case where surgery was necessary due to uncontrolled intra-abdominal infection despite antibiotic treatment, and Yersinia pseudotuberculosis was isolated from the abdominal fluid.\u003c/p\u003e\n\u003cp\u003eTo date, there have been no clinical case reports of splenic infarction caused by \u003cem\u003eY. pseudotuberculosis\u0026nbsp;\u003c/em\u003einfection. The patient\u0026rsquo;s ECG, echocardiography, and laboratory tests excluded embolic splenic infarction caused by infective endocarditis and atrial fibrillation. We speculate that splenic infarction is related to postinfection shock, hypotension, decreased splenic artery blood flow, and coagulopathy. Currently, it is believed that there is no specific treatment for splenic infarction, and most cases resolve spontaneously or fibrose. Our patient had a large splenic infarction, raising concerns about the risk of splenic rupture, but fortunately, it did not occur.\u003c/p\u003e\n\u003cp\u003eMortality from bloodstream infections \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e infection rates as high as 75% have been reported [18]. With respect to the reported mortality of severe cases of \u003cem\u003eY. pseudotuberculosis\u0026nbsp;\u003c/em\u003einfection, from 1991--1994, 6 out of 9 reported cases died, resulting in a mortality rate of 66%[19]. However, from 1995--2021, all 5 reported cases survived [10] owing to advancements in diagnostic techniques and timely antibiotic application. \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e infection is usually confirmed in the laboratory through serological tests, blood cultures, stool cultures, polymerase chain reaction (PCR), metagenomic next-generation sequencing (mNGS), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF-MS)\u0026nbsp;and histopathology[\u003cstrong\u003e20\u003c/strong\u003e]. Owing to the critical condition of our patient, we performed mNGS of blood samples alongside blood cultures, which quickly confirmed the diagnosis of \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e infection. Hashimoto, T.et al\u003cem\u003e.\u003c/em\u003e[\u003cstrong\u003e10\u003c/strong\u003e] achieved accurate and rapid diagnosis of \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e infection via blood cultures and MALDI-TOF mass spectrometry in their case report. Heuvelmans M. et al\u003cem\u003e.\u003c/em\u003e[\u003cstrong\u003e21\u003c/strong\u003e] noted that PCR testing of stool samples for intestinal infection has limitations, and commercial PCR kits for \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e are not widely used, making blood culture the preferred method for diagnosing invasive \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e infection[\u003cstrong\u003e14\u003c/strong\u003e]. In addition to blood cultures, there have been reports of \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e being isolated from abdominal fluid\u0026nbsp;[\u003cstrong\u003e19\u003c/strong\u003e], and if the pathogen disseminates to the bones and joints, surgical biopsy of bone tissue is essential[\u003cstrong\u003e22\u003c/strong\u003e]. There have also been reports of inguinal lymph node biopsy confirming \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e infection[\u003cstrong\u003e23\u003c/strong\u003e]. Additionally, there are cases where both blood and stool cultures are negative, and the diagnosis was finally confirmed by detecting \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e antibodies in the serum via enzyme-linked immunosorbent assays (ELISAs)[\u003cstrong\u003e24\u003c/strong\u003e].\u003c/p\u003e\n\u003cp\u003eIn conclusion, we herein report a case of septic shock, liver abscess, splenic infarction and MODS caused by \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e infection. Although the mortality rate of \u003cem\u003eY. pseudotuberculosis\u003c/em\u003e infection has significantly decreased, the severity of this patient\u0026apos;s condition suggests that the virulence of this pathogen may be increasing, alerting clinicians to the need for heightened vigilance and awareness. Further observations and research are needed to understand the virulence, clinical manifestations, and complications of this pathogen. The patient fully recovered, and we conducted regular follow-ups.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cem\u003eY. pseudotuberculosis\u003c/em\u003e: \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e;\u003c/p\u003e\n\u003cp\u003eICU: intensive care unit;\u003c/p\u003e\n\u003cp\u003eMODS: multiple organ dysfunction syndrome;\u003c/p\u003e\n\u003cp\u003eCRRT: continuous renal replacement therapy;\u003c/p\u003e\n\u003cp\u003emNGS: metagenomic next-generation sequencing;\u003c/p\u003e\n\u003cp\u003eED: emergency department;\u003c/p\u003e\n\u003cp\u003eGCS: Glasgow Coma Scale;\u003c/p\u003e\n\u003cp\u003eWBC: white cell count;\u003c/p\u003e\n\u003cp\u003ePLT: platelet count;\u003c/p\u003e\n\u003cp\u003eCRP: C-reactive protein;\u003c/p\u003e\n\u003cp\u003ePCT: procalcitonin;\u003c/p\u003e\n\u003cp\u003eALT: alanine aminotransferase;\u003c/p\u003e\n\u003cp\u003eAST: aspartate aminotransferase;\u003c/p\u003e\n\u003cp\u003eTBil: total bilirubin;\u003c/p\u003e\n\u003cp\u003eDBil: direct bilirubin;\u003c/p\u003e\n\u003cp\u003eScr: serum creatinine;\u003c/p\u003e\n\u003cp\u003eLac: lactic acid;\u003c/p\u003e\n\u003cp\u003eCT: computed tomography;\u003c/p\u003e\n\u003cp\u003ePCR: polymerase chain reaction;\u003c/p\u003e\n\u003cp\u003eMALDI-TOF MS: matrix-assisted laser desorption ionization-time-of-flight mass spectrometry;\u003c/p\u003e\n\u003cp\u003eELISA: enzyme-linked immunosorbent assay;\u003c/p\u003e\n\u003cp\u003eMAP: mean arterial pressure;\u003c/p\u003e\n\u003cp\u003eCVVHDF: continuous venovenous hemodiafiltration\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eOur hospital's ethics review board approved this study. Written informed consent from the patient's family was also obtained for publication of this case report. Ethical Review Approval Number:2024-302-01.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e Written informed consent was obtained from the patient upon publication, including personal or clinical details, along with any identifying images of this case report.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYW and YX were involved in patient management and data collection. XZ, CL, WW, and ZZ contributed to patient management, t prepared table 1 ,figure 1, and manuscript refinement. XQ was responsible for the study design and drafted the manuscript.\"\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe would like to thank the intensive care unit and infectious disease department staff for their excellent teamwork.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFukushima H, Gomyoda M, Ishikura S, Nishio T, Moriki S, Endo J, Kaneko S, Tsubokura M. Cat-contaminated environmental substances lead to \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e infection in children. J Clin Microbiol. 1989;27:2706\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Chen Z, Ran L et al. Interpretation for diagnosis of Yersiniosis. [J].Zhonghua liu xing bing xue za zhi, 2019, 40(9):1048\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.issn.0254-6450.2019.09.005\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.issn.0254-6450.2019.09.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaktin J, Beavis KG. \u003cem\u003eYersinia enterocolitica\u003c/em\u003e and \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e. Clin Lab Med. 1999;19:523\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeber J, Finlayson NB, Mark JB. Mesenteric lymphadenitis and terminal ileitis due to \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e. N Engl J Med. 1970;283:172\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenvoise A, Lemaitre N, Saintenoy G, Benosman H, Geffrier C, Epelboin L, Jarlier V, Poynard T, Thabut D. Spontaneous ascitic fluid infection and bacteremia due to \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e in a liver transplant patient. Int J Infect Dis. 2015;34:122\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaglia MG, D\u0026rsquo;Arezzo S, Festa A, Del Borgo C, LoIacono L, Antinori A, Antonucci G, Visca P. Yersinia pseudotuberculosisSepticemia and HIV. Emerg Infect Dis. 2005;11:112\u0026ndash;1130.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCormier G, Lucas V, Varin S, et al. \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e infection of a lumbar facet joint. Joint Bone Spine. 2007;74:110\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaasch AJ, Dinter J, Goeser T, Plum G, Seifert H. \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e bloodstream infection and septic arthritis: case report and review of the literature. Infection. 2012;40(2):185\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshihara T, et al. Pyogenic vertebral osteomyelitis caused by \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e. Joint Bone Spine. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.jbspin.2016.01.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jbspin.2016.01.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashimoto T, Takenaka R, Fukuda H, et al. Septic shock due to \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e infection in an adult immunocompetent patient: a case report and literature review. BMC Infect Dis. 2021;21:36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12879-020-05733-w\u003c/span\u003e\u003cspan address=\"10.1186/s12879-020-05733-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan EX, Wang MX, Pang J, Lee GH. Plasma exchange in patients with acute and acute-on-chronic liver failure: A systematic review. World J Gastroenterol. 2020;26(2):219\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3748/wjg.v26.i2.219\u003c/span\u003e\u003cspan address=\"10.3748/wjg.v26.i2.219\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 31988586; PMCID: PMC6962432.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuklin V, Sovershaev M, Bjerner J, et al. Influence of therapeutic plasma exchange treatment on short-term mortality of critically ill adult patients with sepsis-induced organ dysfunction: a systematic review and meta-analysis[J]. Crit Care. 2024;28(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13054-023-04795-x\u003c/span\u003e\u003cspan address=\"10.1186/s13054-023-04795-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartyn E, Heward J, Herbert R. \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e: an unexpected cause of fever and a hot joint. BMJ Case Rep. 2020;13(2):e233125. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bcr-2019-233125\u003c/span\u003e\u003cspan address=\"10.1136/bcr-2019-233125\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 32060113; PMCID: PMC7046400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YJ, Kim J, Jeon JH, Seok H, Choi WS, Chang E-A, Yim HJ, Park DW. Extraintestinal Manifestation of \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e Bacteremia as Acute Hepatitis: Case Report and Review of the Literature. Pathogens. 2021;10:1255. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/pathogens10101255\u003c/span\u003e\u003cspan address=\"10.3390/pathogens10101255\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTauxe RV. In: Calderwood SBKS, editor. Treatment and Prevention of \u003cem\u003eYersinia enterocolitica\u003c/em\u003e and \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e infection. Waltham, MA: Up To Date; 2019. p. 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorris J. \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e. secondary \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e, 2017. Available:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.infectiousdiseaseadvisor.com/home/decision-support-inmedicine/infectious-diseases/yersinia-pseudotuberculosis/\u003c/span\u003e\u003cspan address=\"https://www.infectiousdiseaseadvisor.com/home/decision-support-inmedicine/infectious-diseases/yersinia-pseudotuberculosis/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKimura J, Sasaki K. .case report -open access yersinia pseudotuberculosis infection intractable by antibiotics: a rare case report[J]. 2017.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijscr.2016.02.039\u003c/span\u003e\u003cspan address=\"10.1016/j.ijscr.2016.02.039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMandell GL, Bennet JE, Dolin R, Mandell. Douglas, and Bennett\u0026rsquo;s principles and practice of infectious diseases. 7th ed. New York: Churchill Livingstone; 2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaasch AJ, Dinter J, Goeser T, Plum G, Seifert H. \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e bloodstream infection and septic arthritis: case report and review of the literature. Infection. 2012;40(2):185\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrinivasa KG, Vidhya JV, Manohar TM, Naik M. Right hemicolectomy for intestinal obstruction due toYersinia pseudotuberculosis: a histopathological surprise, Indian J. Surg. 75 (Suppl. 1) (2013) 214\u0026ndash;216. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12879-020-05733-w\u003c/span\u003e\u003cspan address=\"10.1186/s12879-020-05733-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeuvelmans M, Lammertink MHA, Kusters JG, Bruns AHW, Monkelbaan JF. \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e infection with severe localized inflammation and ulceration of the ileum in a heart transplant patient. BMJ Case Rep. 2020;13(12):e236343. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bcr-2020-236343\u003c/span\u003e\u003cspan address=\"10.1136/bcr-2020-236343\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 33318266; PMCID: PMC7737070.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshihara T, Miyazaki M, Yoshiiwa T, et al. Pyogenic vertebral osteomyelitis caused by \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e[J]. Joint Bone Spine. 2016;727\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jbspin.2016.01.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jbspin.2016.01.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIwata K, Morishita N, Masuda Y, et al. Unilateral inguinal lymphadenitis caused by \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e. A case report[J]. J Infect Chemother. 2020;26(7). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jiac.2020.04.017\u003c/span\u003e\u003cspan address=\"10.1016/j.jiac.2020.04.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOhnishi T, Nakazawa M, Wada N. ,et al.\u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e Infection Accompanied by Intussusception and Incomplete Kawasaki Disease in a 7-year-old Girl[J]. Keio J Med. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2302/kjm.2021-0002-CR\u003c/span\u003e\u003cspan address=\"10.2302/kjm.2021-0002-CR\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Yersinia pseudotuberculosis, Bloodstream infection, Septic shock, Liver abscess, Splenic infection","lastPublishedDoi":"10.21203/rs.3.rs-5107965/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5107965/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003e\u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e is an emerging zoonotic intestinal pathogen that is transmitted primarily through contaminated food and water. \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003e infection is usually self-limited and usually manifests as gastroenteritis or \"pseudoappendicitis\", characterized by fever and abdominal pain; Bloodstream infection with Yersinia pseudotuberculosis is uncommon but can result in Multiple distant sites of infection, including liver, splenic and kidney abscesses , even hip and knee jiont , often with underlying immunodeficiency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e: We present the case of a 40-year-old man who was admitted to the intensive care unit (ICU) with intermittent fever for five days followed by worsening abdominal pain and distension one day after consuming contaminated food. Upon admission, the patient developed severe hypotension, quickly followed by signs of liver and kidney failure, progressing to multiple organ dysfunction syndrome (MODS). In particular, the patient's abdominal CT showed signs of liver abscess and splenic infarction. He was treated with fluid resuscitation, broad-spectrum antibiotics, vasopressors, continuous renal replacement therapy (CRRT), and plasma exchange. Blood cultures and metagenomic next-generation sequencing (mNGS) confirmed \u003cem\u003eYersinia pseudotuberculosis\u003c/em\u003einfection. After 17 days of ICU treatment, the patient was transferred to the infectious disease department for further treatment for 14 days and was discharged. Three months after discharge, the patient had two follow-up visits and was in good condition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eTo our knowledge, this is the rare reported case of MODS, liver abscess, and splenic infarction caused by \u003cem\u003eY. pseudotuberculosis\u003c/em\u003einfection.Timely use of broad-spectrum antibiotics and active organ function support are the keys to treatment. The lack of further progression of the liver abscess may indicate that the bacteria are not very virulent. Fortunately, the patient eventually recovered, and follow-up observation of the liver and spleen after discharge became important.\u003c/p\u003e","manuscriptTitle":"Liver Abscess and Splenic Infarction Due to Yersinia pseudotuberculosis bloodstream infection : A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 13:03:37","doi":"10.21203/rs.3.rs-5107965/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-24T07:55:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-23T02:35:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-23T02:34:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-09-18T07:48:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8151d815-7a08-4724-83b4-aa6a74807694","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T16:13:39+00:00","versionOfRecord":{"articleIdentity":"rs-5107965","link":"https://doi.org/10.1186/s12879-024-10325-z","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2024-12-18 15:58:34","publishedOnDateReadable":"December 18th, 2024"},"versionCreatedAt":"2024-12-09 13:03:37","video":"","vorDoi":"10.1186/s12879-024-10325-z","vorDoiUrl":"https://doi.org/10.1186/s12879-024-10325-z","workflowStages":[]},"version":"v1","identity":"rs-5107965","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5107965","identity":"rs-5107965","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}