II. Pathophysiology
- Characteristics
- Yersinia enterocolitica is a facultative Anaerobic Gram Negative Rod in Enterobacteriaceae family
- Closely related to Yersinia Pestis (Bubonic Plague)
- Motile (with flagella)
- Grows at refrigerator Temperatures
- Yersinia enterocolitica is a facultative Anaerobic Gram Negative Rod in Enterobacteriaceae family
- Exposure sources
- Natural Hosts: Wild and domestic mammals, birds
- Waterborne Illness source
- Natural waters in which E. coli is not present
- Foodborne Illness source (esp. children)
- Contaminated meat (esp. pork products, as well as poultry and seafood)
- Dairy products
- Outbreaks have also occurred with fruits, vegetables, stewed and fermented products
- Fecal-oral tranmission
- Bacterial shedding in stool continues up to 3-4 months after symptom resolution
- Pathogenesis of Bacterial Gastroenteritis (Yersiniosis)
- Systemic invasion (similar to Salmonella typhi)
- Yersinia enterocolitica binds and invades intestinal epithelial cells
- May spread to regional Lymph Nodes, and in some cases, cause bacteremia and Sepsis
- Enterotoxin
- Similar to E. coli Heat Stable Enterotoxin (ST)
- Causes Diarrhea
- Systemic invasion (similar to Salmonella typhi)
III. Findings: Bacterial Gastroenteritis
- Fever
- Nausea and Vomiting
- Abdominal Pain (esp. RLQ Abdominal Pain)
-
Diarrhea
- Often prolonged (2-3 weeks)
- Bloody Diarrhea may occur (esp. children)
IV. Differential Diagnosis
- See Acute Diarrhea
-
Appendicitis
- Yersinia causes Mesenteric Lymphadenitis and Mucosal Ulceration of the terminal ileum (pseudo-Appendicitis)
V. Labs
- See Acute Diarrhea
- Diagnosis
- Enteric Pathogens Nucleic Acid Test Panels (preferred) OR
- Stool Culture on selective growth medium
VI. Management: General
- See Acute Diarrhea
- Severe cases with systemic infection (Yersiniosis) and Sepsis may occur
- Supportive Care
- Oral Rehydration
VII. Management: Antibiotics
-
Antibiotic Indications
- Severe disease
- Bacteremia
- Antibiotics not needed in mild disease or uncomplicated enteritis
- Severe disease - first line regimen (combined Doxycycline with Aminoglycoside)
- Doxycycline 100 mg IV twice daily AND
- Gentamicin or Tobramycin 5 mg/kg/day every 24 hours
- Severe disease - alternative regimens
- Trimethoprim-Sulfamethoxazole (TMP-SMZ) DS 160/180 mg twice daily for 5 days
- Ciprofloxacin 500 mg orally twice daily for 7-10 days
- References
- Gilbert (2013) Sanford Guide
VIII. Complications
- Sepsis
- Extraintestinal Yersiniosis (post-infectious, primarily in Immunocompromised patients)
IX. Prevention
- See Prevention of Foodborne Illness
- See Prevention of Waterborne Illness
- Prevent fecal-oral transmission
- Patients, care givers and their close contacts should practice good Hand Hygiene
- Bacterial shedding in stool continues up to 3-4 months after symptom resolution
X. Resources
- Yersinia enterocolitica (StatPearls)