Yersinia Enterocolitica Treatment & Management
- Author: Zartash Zafar Khan, MD, FACP; Chief Editor: Mark R Wallace, MD, FACP, FIDSA more...
Care in patients with Y enterocolitica infection is primarily supportive, with good nutrition and hydration being mainstays of treatment.
First-line drugs used against the bacterium include aminoglycosides and trimethoprim-sulfamethoxazole (TMP-SMZ). Other effective drugs include third-generation cephalosporins, tetracyclines (not recommended in children < 8 y), and fluoroquinolones (not approved for use in children < 18 y).
In the event of an acute outbreak of Y enterocolitica, attempt to isolate persons who have been in contact with the index patient.
Abscesses may require surgical drainage. Surgical exploration may be warranted if appendicitis cannot be safely ruled out.
Laparotomy findings in Y enterocolitica infection usually include mesenteric lymphadenitis and terminal ileitis, with a healthy appendix.
The diagnosis and management of yersiniosis do not require specific consultations. However, consultation with an infectious diseases specialist or gastroenterologist may be useful. Consultation with a rheumatologist may be helpful in cases of erythema nodosum or reactive arthritis.
The value of antibiotic therapy in uncomplicated acute diarrhea has not been established. Diarrhea should be managed with fluid and electrolyte replacement. Avoid antimotility medications, which could lead to bacteremia.
In cases of severe enterocolitis, antibiotics have shown some benefit in terms of shortening the duration of illness. Patient populations who should be considered for empiric antibiotic therapy include the following:
Patients with diabetes
Patients with cirrhosis
Patients with cancer who are receiving chemotherapy
Healthcare and childcare workers who are at an increased risk of person-to-person spread
Antibiotic treatment should be used in patients with bacteremia with extraintestinal manifestations. They should be used in cases of primary extraintestinal disorders, such as the following:
Admit patients with Y enterocolitica infection who have evidence of severe dehydration, malnourishment, or septicemia.
Patients with conditions that place them at risk for Y enterocolitica septicemia, including the following, should be monitored closely and admitted for supportive measures and antibiotic therapy at the first sign of disseminated disease:
Patients who are immunocompromised
Patients who are chronically ill
Patients with iron overload
Patients with chronic hemolysis
Patients with alcoholism
Patients with diabetes mellitus
Patients on deferoxamine therapy
Deterrence and Prevention
The following steps can be taken to prevent the spread of Y enterocolitica infection:
Instruct patients and at-risk individuals about appropriate hygiene methods and signs and symptoms of infection
Encourage public awareness of Y enterocolitica outbreaks and modes of transmission
Hand washing and control of environmental cross-contamination are principal measures in reducing the spread of enteric pathogens in daycare centers, healthcare settings, and pet-care facilities, as well as within households
In blood banks, donors should be asked about any recent symptoms of gastroenteritis
Unwashed raw vegetables, uncooked meats (especially pork), and unpasteurized milk should be avoided [14, 15]
Reservoirs should be eliminated
The contamination of food products should be minimized
Enteric precautions should be instituted in the care of patients who have been hospitalized with infection
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.
Zheng H, Wang J, Sun Y, Jiang B. Clinical isolation and characterization of Yersinia enterocolitica in China using real-time PCR and culture method. Digestion. 2007. 75(4):199-204. [Medline].
Zheng HX, Sun Y, Jiang B. [Evaluation of 4 culture methods of Yersinia enterocolitica]. Nan Fang Yi Ke Da Xue Xue Bao. 2007 Sep. 27(9):1438-40. [Medline].
Centers for Disease Control and Prevention. Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. 2004 Apr 16. 53:1-33. [Medline].
Bottone EJ. Yersinia enterocolitica: a panoramic view of a charismatic microorganism. CRC Crit Rev Microbiol. 1977. 5(2):211-41. [Medline].
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.
Zheng H, Sun Y, Lin S, Mao Z, Jiang B. Yersinia enterocolitica infection in diarrheal patients. Eur J Clin Microbiol Infect Dis. 2008 Aug. 27(8):741-52. [Medline].
Huovinen E, Sihvonen LM, Virtanen MJ, Haukka K, Siitonen A, Kuusi M. Symptoms and sources of Yersinia enterocolitica-infection: a case-control study. BMC Infect Dis. 2010 May 20. 10:122. [Medline]. [Full Text].
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. 1992 Jan. 116(1):197-207. [Medline].
Handley SA, Newberry RD, Miller VL. Yersinia enterocolitica invasin-dependent and invasin-independent mechanisms of systemic dissemination. Infect Immun. 2005 Dec. 73(12):8453-5. [Medline].
Bradford WD, Noce PS, Gutman LT. Pathologic features of enteric infection with Yersinia enterocolitica. Arch Pathol. 1974 Jul. 98(1):17-22. [Medline].
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. 1974 Sep-Oct. 17(5):521-6. [Medline].
Välimäki E, Aittomäki S, Karenko L, Kantonen J, Pettersson T, Turunen U, et al. Normal inflammasome activation and low production of IL-23 by monocyte-derived macrophages from subjects with a history of reactive arthritis. Scand J Rheumatol. 2013 Feb 20. [Medline].
Stoddard JJ, Wechsler DS, Nataro JP, Casella JF. Yersinia enterocolitica infection in a patient with sickle cell disease after exposure to chitterlings. Am J Pediatr Hematol Oncol. 1994 May. 16(2):153-5. [Medline].
Centers for Disease Control and Prevention. Yersinia enterocolitica gastroenteritis among infants exposed to chitterlings--Chicago, Illinois, 2002. MMWR Morb Mortal Wkly Rep. 2003 Oct 10. 52(40):956-8. [Medline].
Notes from the field: Yersinia enterocolitica infections associated with pasteurized milk --- southwestern Pennsylvania, March-August, 2011. MMWR Morb Mortal Wkly Rep. 2011 Oct 21. 60(41):1428. [Medline].
Tacket CO, Narain JP, Sattin R, Lofgren JP, Konigsberg C Jr, Rendtorff RC, et al. A multistate outbreak of infections caused by Yersinia enterocolitica transmitted by pasteurized milk. JAMA. 1984 Jan 27. 251(4):483-6. [Medline].
Cortes PR, Contreras Funes V, Huerta VG, Dichiara DM. [Yersinia enterocolitica in the fecal material from 6 pediatric patients in the city of Córdoba]. Rev Argent Microbiol. 2010 Jan-Feb. 42(1):79. [Medline].
Leclercq A, Martin L, Vergnes ML, Ounnoughene N, Laran JF, Giraud P, et al. Fatal Yersinia enterocolitica biotype 4 serovar O:3 sepsis after red blood cell transfusion. Transfusion. 2005 May. 45(5):814-8. [Medline].
Centers for Disease Control and Prevention. Yersinia enterocolitica. CDC. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/yersinia_g.htm. Accessed: Feb 22 2013.
Centers for Disease Control and Prevention. Vital signs: incidence and trends of infection with pathogens transmitted commonly through food--foodborne diseases active surveillance network, 10 U.S. sites, 1996-2010. MMWR Morb Mortal Wkly Rep. 2011 Jun 10. 60(22):749-55. [Medline]. [Full Text].
Scallan E, Mahon BE, Hoekstra RM, Griffin PM. Estimates of Illnesses, Hospitalizations, and Deaths Caused By Major Bacterial Enteric Pathogens in Young Children in the United States. Pediatr Infect Dis J. 2012 Dec 17. [Medline].
Abdel-Haq NM, Asmar BI, Abuhammour WM, Brown WJ. Yersinia enterocolitica infection in children. Pediatr Infect Dis J. 2000 Oct. 19(10):954-8. [Medline].
Saebo A, Vik E, Lange OJ, Matuszkiewicz L. Inflammatory bowel disease associated with Yersinia enterocolitica O:3 infection. Eur J Intern Med. 2005 Jun. 16(3):176-182. [Medline].
Ray SM, Ahuja SD, Blake PA, Farley MM, Samuel M, Fiorentino T, et al. Population-based surveillance for Yersinia enterocolitica infections in FoodNet sites, 1996-1999: higher risk of disease in infants and minority populations. Clin Infect Dis. 2004 Apr 15. 38 Suppl 3:S181-9. [Medline].
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. 1991 Dec. 29(12):2868-9. [Medline].
Koehler KM, Lasky T, Fein SB, Delong SM, Hawkins MA, Rabatsky-Ehr T, et al. Population-based incidence of infection with selected bacterial enteric pathogens in children younger than five years of age, 1996-1998. Pediatr Infect Dis J. 2006 Feb. 25(2):129-34. [Medline].
Helms M, Simonsen J, Mølbak K. Foodborne bacterial infection and hospitalization: a registry-based study. Clin Infect Dis. 2006 Feb 15. 42(4):498-506. [Medline].
Girszyn N, Kerleau JM, Robaday S, Lefebvre S, Marie I, Levesque H. [Pneumonia with bacteremia due to Yersinia enterocolitica in a diabetic patient carrying HLA-B27]. Rev Med Interne. 2007 Dec. 28(12):882-4. [Medline].
Hoelen DW, Tjan DH, Schouten MA, Dujardin BC, van Zanten AR. Severe Yersinia enterocolitica sepsis after blood transfusion. Neth J Med. 2007 Sep. 65(8):301-3. [Medline].
Pulvirenti D, Aikaterini T, Neri S. Septicemia, hepatic abscess, and encephalitis due to Yersinia enterocolitica. J Clin Gastroenterol. 2007 Mar. 41(3):333-4. [Medline].
Jess T, Jess P. Acute terminal ileitis, yersiniosis, and Crohn's disease: a long-term follow-up study of the relationships. Eur J Intern Med. 2001 Apr. 12(2):98-100. [Medline].
Navarro-Llavat M, Domènech E, Masnou H, Ojanguren I, Mañosa M, Lorenzo-Zúñiga V, et al. Collagenous duodeno-ileo-colitis with transient IgG deficiency preceded by Yersinia enterocolitica intestinal infection: case report and review of literature. Gastroenterol Hepatol. 2007 Apr. 30(4):219-21. [Medline].
Berner R, Kist M, Sauer M. Encephalopathy associated with Yersinia enterocolitica O:3. Lancet. 1998 Feb 7. 351(9100):418. [Medline].
von Eckardstein K, Spuler A, Brauer C, Mehl M, Kiwit J. Spontaneous cervical osteomyelitis due to Yersinia enterocolitica in a non-immunocompromised host. Eur J Clin Microbiol Infect Dis. 2004 Jan. 23(1):66-8. [Medline].
Krajinovic V, Tambic Andrasevic A, Barsic B. Tricuspidal valve endocarditis due to Yersinia enterocolitica. Infection. 2007 Jun. 35(3):203-5. [Medline].
Kelesidis T, Balba G, Worthington M. Axillary abscess in a patient with Yersinia enterocolitica infection as a result of exposure to pork. Am J Med. 2008 Mar. 121(3):e1. [Medline].
Mills DM, Meyer DR. Posttraumatic cellulitis and ulcerative conjunctivitis caused by Yersinia enterocolitica O:8. Ophthal Plast Reconstr Surg. 2008 Sep-Oct. 24(5):425-6. [Medline].
Tennant SM, Hartland EL, Phumoonna T, Lyras D, Rood JI, Robins-Browne RM, et al. Influence of gastric acid on susceptibility to infection with ingested bacterial pathogens. Infect Immun. 2008 Feb. 76(2):639-45. [Medline]. [Full Text].
Lamps LW, Madhusudhan KT, Greenson JK, Pierce RH, Massoll NA, Chiles MC, et al. The role of Yersinia enterocolitica and Yersinia pseudotuberculosis in granulomatous appendicitis: a histologic and molecular study. Am J Surg Pathol. 2001 Apr. 25(4):508-15. [Medline].
Taccetti G, Trapani S, Ermini M, Falcini F. Reactive arthritis triggered by Yersinia enterocolitica: a review of 18 pediatric cases. Clin Exp Rheumatol. 1994 Nov-Dec. 12(6):681-4. [Medline].
De Berardis B, Torresini G, Brucchi M, Marinelli S, Mattucci S, Schietroma M, et al. Yersinia enterocolitica intestinal infection with ileum perforation: report of a clinical observation. Acta Biomed. 2004 Apr. 75(1):77-81. [Medline].
Reed RP, Robins-Browne RM, Williams ML. Yersinia enterocolitica peritonitis. Clin Infect Dis. 1997 Dec. 25(6):1468-9. [Medline].
Hervás JA, Albertí P, Bregante JI, Boya E, Reina J, Gil J. Chronic intussusception associated with Yersinia enterocolitica mesenteric adenitis. J Pediatr Surg. 1992 Dec. 27(12):1591-2. [Medline].
Chandler ND, Parisi MT. Radiological case of the month. Yersinia enterocolitica masquerading as appendicitis. Arch Pediatr Adolesc Med. 1994 May. 148(5):527-8. [Medline].
Bottone EJ. Yersinia enterocolitica: the charisma continues. Clin Microbiol Rev. 1997 Apr. 10(2):257-76. [Medline].
Vento S, Cainelli F, Cesario F. Infections and thalassaemia. Lancet Infect Dis. 2006 Apr. 6(4):226-33. [Medline].
Bergmann TK, Vinding K, Hey H. Multiple hepatic abscesses due to Yersinia enterocolitica infection secondary to primary haemochromatosis. Scand J Gastroenterol. 2001 Aug. 36(8):891-5. [Medline].
Antonopoulos P, Constantinidis F, Charalampopoulos G, Dalamarinis K, Karanicas I, Kokkini G. An emergency diagnostic dilemma: a case of Yersinia enterocolitica colitis mimicking acute appendicitis in a beta-thalassemia major patient: the role of CT and literature review. Emerg Radiol. 2008 Mar. 15(2):123-6. [Medline].
Renaud N, Lecci L, Courcol RJ, Simonet M, Gaillot O. CHROMagar Yersinia: a new chromogenic agar for the screening of potentially pathogenic Yersinia enterocolitica in stools. J Clin Microbiol. 2013 Jan 30. [Medline].
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. 2008 Dec. 75(3):566-71. [Medline].
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].
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.
Lal M, Kaur H, Gupta LK. Y.enterocolitica gastroenteritis - A prospective study. Indian J Med Microbiol. 2003 Jul-Sep. 21(3):186-8. [Medline].
Chan J, Gandhi RT. A Case of Septic Arthritis of the Shoulder Due to Yersinia enterocolitica with Review of the Literature. Open Forum Infect Dis. 2014 Sep. 1 (2):ofu054. [Medline].