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Yersinia Enterocolitica Treatment & Management

  • Author: Zartash Zafar Khan, MD, FACP; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Oct 20, 2015
 

Approach Considerations

Care in patients with Y enterocolitica infection is primarily supportive, with good nutrition and hydration being mainstays of treatment.[4]

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.

Surgical therapy

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.

Consultations

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.

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Antibiotic Therapy

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:

  • Elderly patients
  • Patients with diabetes
  • Patients with cirrhosis
  • Immunocompromised patients
  • 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:

  • Cellulitis
  • Ophthalmitis
  • Endocarditis
  • Meningitis
  • Osteomyelitis
  • Pneumonia
  • Focal abscesses
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Inpatient Care

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:

  • Elderly patients
  • 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
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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
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Contributor Information and Disclosures
Author

Zartash Zafar Khan, MD, FACP Infectious Disease Consultant

Zartash Zafar Khan, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, International Society for Infectious Diseases

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel R Bronfin, MD Clinical Professor of Pediatrics, Tulane University School of Medicine; Vice Chairman of Pediatrics, Ochsner Children's Health Center

Daniel R Bronfin, MD is a member of the following medical societies: American Academy of Pediatrics, American Cleft Palate-Craniofacial Association

Disclosure: Nothing to disclose.

Michelle R Salvaggio, MD, FACP Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, Director, Clinical Trials Unit, Director, Ryan White Programs, Department of Medicine, University of Oklahoma Health Sciences Center; Attending Physician, Infectious Diseases Consultation Service, Infectious Diseases Institute, OU Medical Center

Michelle R Salvaggio, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Received honoraria from Merck for speaking and teaching.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

Daniel R Bronfin, MD Head, General Academic Pediatrics, Ochsner Children's Health Center

Daniel R Bronfin, MD is a member of the following medical societies: American Academy of Pediatrics and American Cleft Palate/Craniofacial Association

Disclosure: Nothing to disclose.

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.

Brooks D Cash, MD, FACP Director of Clinical Research, Assistant Professor of Medicine, Gastroenterology, National Naval Medical Center

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, and Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Mark H Johnston, MD Associate Professor of Medicine, Uniformed Services University of the 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.

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

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.

Swetha G Pinninti, MD Fellow in Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham School of Medicine

Swetha G Pinninti, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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