Far East Scarlet-Like Fever Caused by a Few Related Genotypes ofYersinia pseudotuberculosis, Russia

We used multivirulence locus sequence typing to analyze 68 Yersinia pseudotuberculosis isolated in Russia during 1973-2014, including 41 isolates from patients with Far East scarlet-like fever.Four genotypes were found responsible, with 1 being especially prevalent.Evolutionary analysis suggests that epidemiologic advantages could cause this genotype's dominance.F ar East scarlet-like fever (FESLF), a rare and poorly studied disease caused by Yersinia pseudotuberculosis, was first described in 1959, when an outbreak involving >300 hospitalized patients occurred in the city of Vladivostok, Russia, on the coast of the Pacific Ocean (1).Since the 1960s, multiple outbreaks and sporadic cases of FESLF, mainly associated with consumption of contaminated vegetables, have been reported from far eastern and northern parts of Russia and other countries in Eurasia (2-4).Comparing clinical patterns of FESLF and pseudotuberculosis showed that FESLF is not just a form of pseudotuberculosis but is an independent infectious disease that was unknown until the 1960s (4).FESLF is an acute disease with a cyclic course that includes severe fever and early signs such as rash that covers the body, particularly the face, neck, toes, and hands; these signs have become known as "hood," "gloves," and "socks" (online Technical Appendix Figure 1, http://wwwnc.cdc.gov/EID/article/22/3/15-0552-Techapp1.pdf).Typical features of FESLF include a "raspberry tongue" and well-defined nipples.Erythema nodosum can occur with relapse; lamellar or defurfuration on earlobes, hands, palms, feet, and trunk appears during the recovery period.