eMedicine Specialties > Infectious Diseases > Bacterial Infections

Pseudotuberculosis (Yersinia): Follow-up

Author: Asim A Jani, MD, MPH, FACP, Clinician-Educator and Epidemiologist, Consultant and Senior Physician, Florida Department of Health; Assistant Professor, University of Central Florida College of Medicine
Coauthor(s): Paul Chen, Public Health Intern, American Public Health Association
Contributor Information and Disclosures

Updated: Sep 8, 2008

Follow-up

Further Inpatient Care

Supportive care for patients with Y pseudotuberculosis sepsis includes general hospital acute-level care (intensive medical/surgical care may be needed, although uncommon unless the patient is severely ill) and intravenous fluids, frequent monitoring, serial examinations, radiographic studies, intravenous antibiotics, and treatment of any complicating host- or disease-related factors.

Inpatient & Outpatient Medications

In outpatient settings or mild inpatient situations, vigilant observation without the use of antibiotics is reasonable. (See Complications, Prognosis.) Y pseudotuberculosis infection is often benign and self-limited.

Deterrence/Prevention

Food-borne epidemics of Y pseudotuberculosis infection can occur. Contact precautions, especially in the inpatient setting, apply to appropriate barriers (eg, gown, gloves) to exposure to enteric secretions, such as with diarrhea. Avoid ingestion of uncooked meat, contaminated water, or unpasteurized milk. Careful handwashing should follow consumption or handling of chitterlings (pork intestines).

Complications

Postinfectious sequelae may include arthritis and erythema nodosum. Additionally, severe Y pseudotuberculosis infection may be complicated by formation of coronary aneurysms, septic features associated with iron-overload states, and renal involvement with tubulointerstitial nephritis. Intussusception has also been reported in children.

Prognosis

Uncomplicated mesenteric lymphadenitis due to Y pseudotuberculosis infection is generally self-limited and commonly does not require antibiotic therapy. Septic forms of Y pseudotuberculosis infection or those associated with systemic manifestations are serious and carry a high mortality rate (often 75% despite antibiotic therapy).

Patient Education

Patients with Y pseudotuberculosis infection (and their families) should be familiar with forms of exposure, routes of infection, variable manifestations of the disease, difficulties in the diagnostic issues, and the potential for associated complications, including sepsis, reactive arthritis, erythema nodosum, and rare events such as cardiac or renal sequelae.

Miscellaneous

Medicolegal Pitfalls

  • Y pseudotuberculosis infection is an unusual infection, meaning that its diagnosis may be missed or delayed because of its variable presentation. In addition, because this infection has a wide variety of differential diagnoses based on which features predominate in a given patient (intestinal vs extra-intestinal), documentation and communication with the patient, family, and colleagues should be realistic and comprehensive.
  • Patients with sepsis and those with complicated mesenteric adenitis syndromes should be treated promptly, and consultation with infectious diseases specialist and gastroenterologist (adult or pediatric, as indicated) is recommended.
  • Because of the uncertainties involved in predicting the extent of disease and/or potential postinfectious sequelae, practitioners may opt for empirical antimicrobial therapy in patients with uncomplicated presentations. However, no significant data have shown that antibiotic therapy directly reduces the likelihood of postinfectious sequelae.
 


More on Pseudotuberculosis (Yersinia)

Overview: Pseudotuberculosis (Yersinia)
Differential Diagnoses & Workup: Pseudotuberculosis (Yersinia)
Treatment & Medication: Pseudotuberculosis (Yersinia)
Follow-up: Pseudotuberculosis (Yersinia)
References
Further Reading
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Further Reading

The reader may find the following texts useful:

The Genus Yersinia:  From Genomics to Function
Series: Advances in Experimental Medicine and Biology, Vol. 603
Perry, Robert D.; Fetherston, Jacqueline D. (Eds.)
2007, XXIV, 432 p. 242 illus., 2 in color., Hardcover
ISBN: 978-0-387-72123-1

Yersinia enterocolitica and Yersinia pseudotuberculosis Infections (Enteritis and Other Illnesses) In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:[732-4]

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Keywords

Yersinia pseudotuberculosis, Y pseudotuberculosis, Y pseudotuberculosis gastroenteritis, Far East scarlet-like fever, FESLF, scarlatinoid fever, scarlet fever, Izumi fever, YPM, YPMa, YPMb, YPMc, Kawasaki disease, Pasteurella pseudotuberculosis, P pseudotuberculosis, Shigella pseudotuberculosis, S pseudotuberculosis, Bacillus pseudotuberculosis, B pseudotuberculosis, Yersinia infections, Yersinia mesenteric adenitis

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Contributor Information and Disclosures

Author

Asim A Jani, MD, MPH, FACP, Clinician-Educator and Epidemiologist, Consultant and Senior Physician, Florida Department of Health; Assistant Professor, University of Central Florida College of Medicine
Asim A Jani, MD, MPH, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Public Health Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Paul Chen, Public Health Intern, American Public Health Association
Disclosure: Nothing to disclose.

Medical Editor

Douglas A Drevets, MD, Assistant Professor, Department of Medicine, Section of Infectious Disease, Oklahoma University Health Sciences Center
Douglas A Drevets, MD is a member of the following medical societies: American Association of Immunologists, American Society for Microbiology, Central Society for Clinical Research, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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