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Yersinia enterocolitica

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Yersinia enterocolitica, Yersiniosis

  • See Also
  1. Diarrhea
  2. Infectious Diarrhea
  3. Enterobacteriaceae
  • Pathophysiology
  1. Characteristics
    1. Yersinia enterocolitica is a facultative Anaerobic Gram Negative Rod in Enterobacteriaceae family
      1. Closely related to Yersinia Pestis (Bubonic Plague)
    2. Motile (with flagella)
    3. Grows at refrigerator Temperatures
  2. Exposure sources
    1. Natural Hosts: Wild and domestic mammals, birds
    2. Waterborne Illness source
      1. Natural waters in which E. coli is not present
    3. Foodborne Illness source (esp. children)
      1. Contaminated meat (esp. pork products, as well as poultry and seafood)
      2. Dairy products
      3. Outbreaks have also occurred with fruits, vegetables, stewed and fermented products
    4. Fecal-oral tranmission
      1. Bacterial shedding in stool continues up to 3-4 months after symptom resolution
  3. Pathogenesis of Bacterial Gastroenteritis (Yersiniosis)
    1. Systemic invasion (similar to Salmonella typhi)
      1. Yersinia enterocolitica binds and invades intestinal epithelial cells
      2. May spread to regional Lymph Nodes, and in some cases, cause bacteremia and Sepsis
    2. Enterotoxin
      1. Similar to E. coli Heat Stable Enterotoxin (ST)
      2. Causes Diarrhea
  1. Fever
  2. Nausea and Vomiting
  3. Abdominal Pain (esp. RLQ Abdominal Pain)
  4. Diarrhea
    1. Often prolonged (2-3 weeks)
    2. Bloody Diarrhea may occur (esp. children)
  • Differential Diagnosis
  1. See Acute Diarrhea
  2. Appendicitis
    1. Yersinia causes Mesenteric Lymphadenitis and Mucosal Ulceration of the terminal ileum (pseudo-Appendicitis)
  • Labs
  1. See Acute Diarrhea
  2. Diagnosis
    1. Enteric Pathogens Nucleic Acid Test Panels (preferred) OR
    2. Stool Culture on selective growth medium
  • Management
  • General
  1. See Acute Diarrhea
  2. Severe cases with systemic infection (Yersiniosis) and Sepsis may occur
  3. Supportive Care
    1. Oral Rehydration
  1. Antibiotic Indications
    1. Severe disease
    2. Bacteremia
    3. Antibiotics not needed in mild disease or uncomplicated enteritis
  2. Severe disease - first line regimen (combined Doxycycline with Aminoglycoside)
    1. Doxycycline 100 mg IV twice daily AND
    2. Gentamicin or Tobramycin 5 mg/kg/day every 24 hours
  3. Severe disease - alternative regimens
    1. Trimethoprim-Sulfamethoxazole (TMP-SMZ) DS 160/180 mg twice daily for 5 days
    2. Ciprofloxacin 500 mg orally twice daily for 7-10 days
  4. References
    1. Gilbert (2013) Sanford Guide
  • Complications
  1. Sepsis
  2. Extraintestinal Yersiniosis (post-infectious, primarily in Immunocompromised patients)
    1. Erythema Nodosum
    2. Reactive Arthritis
    3. Glomerulonephritis
  • Prevention
  1. See Prevention of Foodborne Illness
  2. See Prevention of Waterborne Illness
  3. Prevent fecal-oral transmission
    1. Patients, care givers and their close contacts should practice good Hand Hygiene
    2. Bacterial shedding in stool continues up to 3-4 months after symptom resolution
  • Resources
  1. Yersinia enterocolitica (StatPearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK499837/
  • References
  1. Shoaib (2019) RSC Adv 9(70):41010-21 +PMID: 35540058 [PubMed]