eMedicine Specialties > Infectious Diseases > Bacterial Infections

Yersinia Enterocolitica: Differential Diagnoses & Workup

Author: Zartash Zafar Khan, MD, Fellow in Infectious Diseases, University of Oklahoma Health Science Center
Coauthor(s): Michelle R Salvaggio, MD, Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, University of Oklahoma Health Sciences Center; Mark H Johnston, MD, Associate Professor of Medicine, Uniformed Services University of Health Sciences; Consulting Staff, Lancaster Gastroenterology Inc; Gregory J Martin, MD, Director, Infectious Diseases Clinical Research Program (IDCRP) Associate Professor of Medicine, Uniformed Services University, Bethesda, MD
Contributor Information and Disclosures

Updated: Apr 9, 2009

Differential Diagnoses

Amebiasis
Pseudomembranous Colitis
Appendicitis
Pseudotuberculosis (Yersinia)
Campylobacter Infections
Salmonellosis
Clostridium Difficile Colitis
Shigellosis
Crohn Disease
Ulcerative Colitis
Diverticulitis
Vibrio Infections
Inflammatory Bowel Disease

Other Problems to Be Considered

Ischemic bowel disease
Inflammatory bowel disease

Workup

Laboratory Studies

  • Stool samples tested for leukocytes usually produce positive results, but Y enterocolitica is difficult to distinguish from other invasive pathogens.
  • When Y enterocolitica infection is suspected, instruct the microbiology laboratory to use CIN agar, which is a differential selective medium with increased yield for Y enterocolitica. When using conventional enteric media, MacConkey agar incubated at 25°C for 48 hours produces the best results.
  • Recovery of organisms from otherwise sterile samples, such as blood, CSF, and lymph node tissue, is usually faster than recovery from stool samples. Isolation of Y enterocolitica from stool is hampered by slow growth and overgrowth of normal flora.
  • Serodiagnosis is possible with various methods; however, carefully interpret the serodiagnosis of Y enterocolitica infection without a positive stool culture result. Cross-reactions with other organisms can occur, and a background seroprevalence rate among different populations may confound the diagnosis by acting as a false-positive result. Methods available include tube agglutination, enzyme-linked immunosorbent assays, and radioimmunoassays. Agglutinin titers typically increase 1-2 weeks after infection and peak at 1:200. Antibodies persist for several years.
  • Advanced experimental techniques for diagnosis of Y enterocolitica infection include polymerase chain reaction (PCR), DNA microarray, and immunohistochemical staining. Diagnostic DNA microarray for pathogenetic organisms is a new technique that is used to determine multiple genes from different kinds of pathogens, allowing it to be used to detect different species, biotypes, and/or toxins of pathogenic organisms in the same specimens, which is the major advantage over the conventional PCR technique, which is used to determine only one gene from a hybridization. DNA microarray is also more sensitive and accurate than the multiplex PCR.15

Imaging Studies

  • Ultrasonography or CT scanning may be useful in delineating true appendicitis from pseudoappendicitis.

Procedures

  • Colonoscopy: Findings may vary and are relatively nonspecific. Typically, the cecum contains aphthoid lesions and the terminal ileum has small round elevations and ulcers (as seen in the image below). An exudate may be present. The left side of the colon is typically unaffected, but case reports have described left-sided colitis with serotype O:8.

  • <EM>Yersinia</EM> enterocolitis in a 45-year-old ...

    Yersinia enterocolitis in a 45-year-old white woman who presented with chronic diarrhea.

    [ CLOSE WINDOW ]
    <EM>Yersinia</EM> enterocolitis in a 45-year-old ...

    Yersinia enterocolitis in a 45-year-old white woman who presented with chronic diarrhea.

  • Joint aspiration: Synovial fluid contains 500-60,000 WBCs/µL, with a predominance of polymorphonuclear cells. Cultures are sterile. Testing synovial fluid for bacterial antigens may be of some use in difficult cases. Image showing Gram stain of Yersinia enterocolitica is seen below.

  • Gram stain of <EM>Yersinia enterocolitica.</EM>

    Gram stain of Yersinia enterocolitica.

    [ CLOSE WINDOW ]
    Gram stain of <EM>Yersinia enterocolitica.</EM>

    Gram stain of Yersinia enterocolitica.

Histologic Findings

Histologic findings in Y enterocolitica infection are consistent with acute and chronic inflammation. Yersiniosis does not produce unique histologic findings. Epithelial cell granulomas with suppuration of the centers of the granulomas (central microabscesses) have been reported. These granulomas were composed of numerous histiocytes with or without epithelioid cell features, along with scattered small T-lymphocytes and plasmacytoid monocytes.16

More on Yersinia Enterocolitica

Overview: Yersinia Enterocolitica
Differential Diagnoses & Workup: Yersinia Enterocolitica
Treatment & Medication: Yersinia Enterocolitica
Follow-up: Yersinia Enterocolitica
Multimedia: Yersinia Enterocolitica
References
[ CLOSE WINDOW ]

References

  1. Bercovier H, Brenner DJ, Ursing J, Steigerwalt AG, Fanning GR, Alonso JM, et al. Characterization of Yersinia enterocolitica sensu stricto. Current Microbiology. 1980;4:201-6.

  2. Bottone EJ. Yersinia enterocolitica: a panoramic view of a charismatic microorganism. CRC Crit Rev Microbiol. 1977;5(2):211-41. [Medline].

  3. Schleifstein J, Coleman, MB. An unidentified microorganism resembling B. lignieresi and Pasteurella pseudotuberculosis, pathogenic for man. New York State Journal of Medicine. 1939;39:1749-53.

  4. Zheng H, Sun Y, Lin S, Mao Z, Jiang B. Yersinia enterocolitica infection in diarrheal patients. Eur J Clin Microbiol Infect Dis. Aug 2008;27(8):741-52. [Medline].

  5. Young VB, Falkow S, Schoolnik GK. The invasin protein of Yersinia enterocolitica: internalization of invasin-bearing bacteria by eukaryotic cells is associated with reorganization of the cytoskeleton. J Cell Biol. Jan 1992;116(1):197-207. [Medline].

  6. Handley SA, Newberry RD, Miller VL. Yersinia enterocolitica invasin-dependent and invasin-independent mechanisms of systemic dissemination. Infect Immun. Dec 2005;73(12):8453-5. [Medline].

  7. Bradford WD, Noce PS, Gutman LT. Pathologic features of enteric infection with Yersinia enterocolitica. Arch Pathol. Jul 1974;98(1):17-22. [Medline].

  8. Aho K, Ahvonen P, Lassus A, Sievers K, Tiilikainen A. HL-A 27 in reactive arthritis. A study of Yersinia arthritis and Reiter's disease. Arthritis Rheum. Sep-Oct 1974;17(5):521-6. [Medline].

  9. Yersinia enterocolitica. Available at http://www.foodsafety.gov/~mow/chap5.html.

  10. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 states, 2007. MMWR Morb Mortal Wkly Rep. Apr 11 2008;57(14):366-70. [Medline].

  11. Jacobs J, Jamaer D, Vandeven J, Wouters M, Vermylen C, Vandepitte J. Yersinia enterocolitica in donor blood: a case report and review. J Clin Microbiol. May 1989;27(5):1119-21. [Medline].

  12. Bottone EJ. Yersinia enterocolitica: the charisma continues. Clin Microbiol Rev. Apr 1997;10(2):257-76. [Medline].

  13. Helms M, Simonsen J, Mølbak K. Foodborne bacterial infection and hospitalization: a registry-based study. Clin Infect Dis. Feb 15 2006;42(4):498-506. [Medline].

  14. Metchock B, Lonsway DR, Carter GP, Lee LA, McGowan JE Jr. Yersinia enterocolitica: a frequent seasonal stool isolate from children at an urban hospital in the southeast United States. J Clin Microbiol. Dec 1991;29(12):2868-9. [Medline].

  15. You Y, Fu C, Zeng X, Fang D, Yan X, Sun B, et al. A novel DNA microarray for rapid diagnosis of enteropathogenic bacteria in stool specimens of patients with diarrhea. J Microbiol Methods. Dec 2008;75(3):566-71. [Medline].

  16. Kojima M, Morita Y, Shimizu K, Yoshida T, Yamada I, Togo T, et al. Immunohistological findings of suppurative granulomas of Yersinia enterocolitica appendicitis: a report of two cases. Pathol Res Pract. 2007;203(2):115-9. [Medline].

  17. Noble RC. Failure of cefotaxime in the treatment of Yersinia enterocolitica sepsis despite in vitro susceptibility. Current Therapeutic Research, Clinical and Experimental. 1989;46(4):692-4.

  18. Lal M, Kaur H, Gupta LK. Y.enterocolitica gastroenteritis - A prospective study. Indian J Med Microbiol. Jul-Sep 2003;21(3):186-8. [Medline].

  19. Black RE, Slome S. Yersinia enterocolitica. Infect Dis Clin North Am. Sep 1988;2(3):625-41. [Medline].

  20. Caplan LM, Dobson ML, Dorkin H. Yersinia enterocolitica septicemia. Am J Clin Pathol. Feb 1978;69(2):189-92. [Medline].

  21. Chatzipanagiotou S, Kyriazi Z, Ioannidis A, et al. Detection of chromosomal- and plasmid-encoded virulence-associated epidemiological markers in Yersinia enterocolitica strains isolated from clinical cases: a comparative study. Mol Diagn. 2004;8(2):131-2. [Medline].

  22. Cover TL, Aber RC. Yersinia enterocolitica. N Engl J Med. Jul 6 1989;321(1):16-24. [Medline].

  23. Cunha BA. Pseudoappendicitis. Infectious Disease Practice. 1995;19:56.

  24. Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. Feb 1 2001;32(3):331-51. [Medline].

  25. Lian CJ, Hwang WS, Kelly JK, Pai CH. Invasiveness of Yersinia enterocolitica lacking the virulence plasmid: an in-vivo study. J Med Microbiol. Nov 1987;24(3):219-26. [Medline].

  26. Lian CJ, Pai CH. Inhibition of human neutrophil chemiluminescence by plasmid-mediated outer membrane proteins of Yersinia enterocolitica. Infect Immun. Jul 1985;49(1):145-51. [Medline].

  27. Makinen M, Niemela S, Lehtola J, Karttunen TJ. Collagenous colitis and Yersinia enterocolitica infection. Dig Dis Sci. Jun 1998;43(6):1341-6. [Medline].

  28. Matsumoto T, Iida M, Matsui T, et al. Endoscopic findings in Yersinia enterocolitica enterocolitis. Gastrointest Endosc. Nov-Dec 1990;36(6):583-7. [Medline].

  29. O'Loughlin EV, Gall DG, Pai CH. Yersinia enterocolitica: mechanisms of microbial pathogenesis and pathophysiology of diarrhoea. J Gastroenterol Hepatol. Mar-Apr 1990;5(2):173-9. [Medline].

  30. Papaioannou CA, Varvarigos N, Karatsolis G, Papaioannou N, Draganigos A, Katsantouris C, et al. Yersinia Enterocolitica Endocarditis. Hellenic J Cardiol [serial online]. 2003;44:Available at http://www.hellenicjcardiol.com/archive/full_text/2003/6/2003_6_427.pdf.

  31. Portnoy DA, Moseley SL, Falkow S. Characterization of plasmids and plasmid-associated determinants of Yersinia enterocolitica pathogenesis. Infect Immun. Feb 1981;31(2):775-82. [Medline].

  32. Rose FB, Camp CJ, Antes EJ. Family outbreak of fatal Yersinia enterocolitica pharyngitis. Am J Med. Mar 23 1987;82(3 Spec No):636-7. [Medline].

  33. Stuart RC, Leahy AL, Cafferkey MT, Stephens RB. Yersinia enterocolitica infection and toxic megacolon. Br J Surg. Jul 1986;73(7):590. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Yersinia enterocolitica, Y enterocolitica, Yersinia enterocolitis, yersiniosis, acute bacterial gastroenteritis, bacterial gastroenteritis, gastroenteritis, food poisoning, food contamination, water contamination, mesenteric adenitis, enterocolitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Zartash Zafar Khan, MD, Fellow in Infectious Diseases, University of Oklahoma Health Science Center
Zartash Zafar Khan, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and International Society for Infectious Diseases
Disclosure: Nothing to disclose.

Coauthor(s)

Michelle R Salvaggio, MD, Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, University of Oklahoma Health Sciences Center
Michelle R Salvaggio, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Merck Honoraria Speaking and teaching

Mark H Johnston, MD, Associate Professor of Medicine, Uniformed Services University of Health Sciences; Consulting Staff, Lancaster Gastroenterology Inc
Mark H Johnston, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Gregory J Martin, MD, Director, Infectious Diseases Clinical Research Program (IDCRP) Associate Professor of Medicine, Uniformed Services University, Bethesda, MD
Gregory J Martin, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Thomas Herchline, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.