Yersinia Enterocolitica Workup

  • Author: Zartash Zafar Khan, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 12, 2012
 

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.[17]
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Imaging Studies

  • Ultrasonography or CT scanning may be useful in delineating true appendicitis from pseudoappendicitis.
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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. Yersinia enterocolitis in a 45-year-old white womaYersinia 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 Yersinia enterocolitica.Gram stain of Yersinia enterocolitica.
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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.[18]

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Contributor Information and Disclosures
Author

Zartash Zafar Khan, MD  Infectious Disease Consultant

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

Disclosure: Nothing to disclose.

Coauthor(s)

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 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.

Specialty Editor Board

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.

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

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.

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.

Additional Contributors

This article was reviewed by Michelle R. Salvaggio, MD, FACP, Assistant Professor, Associate Fellowship Director of Infectious Diseases, University of Oklahoma Health Science Center.

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Brooks D Cash, MD, FACP, to the development and writing of this article.

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