Pediatric Yersinia Enterocolitica Clinical Presentation

  • Author: Swetha G Pinninti, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 29, 2012
 

History

Yersinia enterocolitica infection may be asymptomatic; however, several syndromes are associated with this infection in children.

  • Enterocolitis
    • Enterocolitis, the most common presentation, occurs primarily in young children, with a mean age of 24 months.
    • The incubation period is 4-6 days, typically with a range of 1-14 days.
    • Prodromal symptoms of listlessness, anorexia, and headache may be present. Such symptoms are followed by watery, mucoid diarrhea (78-96%); fever (43-47%); colicky abdominal pain (22-84%); bloody stools (< 10%); and WBCs in the stool (25%).
    • Duration of diarrhea is generally 1 day to 3 weeks.
    • Concomitant bacteremia may occur in 20-30% of infants younger than 3 months.
    • Most cases are self-limited.
    • Complications include appendicitis,[9] diffuse ulceration and inflammation of the small intestine and colon, peritonitis,[10, 11] meningitis, intussusception,[12] and cholangitis.
  • Pseudoappendicitis syndrome
    • Characteristics include fever, abdominal pain, tenderness in the right lower quadrant, and leukocytosis.
    • This condition is predominantly reported in patients with Y pseudotuberculosis infection.
    • Infection causes mesenteric lymphadenitis with terminal ileitis.
    • Pseudoappendicitis syndrome is more common in older children and young adults.[13]
  • Bacteremia: Bacteremia is seen most frequently in very young infants and patients with iron-overload syndromes receiving frequent transfusion for sickle cell anemia,[14] thalassemia,[3] and hemochromatosis[4] , as well as those receiving oral iron supplementation and those who experienced an unintentional iron overload. Both iron overload and treatment with desferrioxamine are predisposing factors.[14] Treatment with desferrioxamine increases bioavailability of iron to Y enterocolitica.
  • Postinfectious, nonsuppurative sequelae: Such sequelae, which are uncommon, include reactive polyarthritis[15] , erythema nodosum, and proliferative glomerulonephritis. These sequelae are most often seen in individuals with human leukocyte antigen (HLA)-B27.[16] Long-term prognosis for this form of arthritis is good. Chronic inflammatory bowel disease has also been associated with Y enterocolitica infections.[17]
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Physical

  • Clinically, suspect Y enterocolitica infection in children with watery, bloody, mucoid diarrhea; a positive stain for WBCs; and exposure to uncooked meat products, particularly pork.
  • Physical findings mimicking appendicitis may be noted.
  • Less commonly, pharyngitis, cellulitis, meningitis, conjunctivitis, pneumonia, arthritis, and erythema nodosum are observed.
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Causes

  • Animal reservoirs
    • Swine (principle reservoir)
    • Cattle
    • Dogs
    • Rodents
    • Sheep
    • Cats
  • Transmission
    • Transmission is primarily via ingestion of contaminated foods, especially people who handle/eat pork. Chitterlings have been documented as a source of infection.[18] Guidelines for the diagnosis and management of foodborne illnesses have been established.[19]
    • Pasteurized milk and dairy products can also cause outbreaks because Yersinia can proliferate at refrigerated temperatures.[20, 21]
    • Fecal-oral transmission among humans has not been proven.[22]
    • Transmission via blood products has occurred.[23]
    • Infection can be transmitted from mother to newborn infant.
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Contributor Information and Disclosures
Author

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.

Coauthor(s)

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

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.

Specialty Editor Board

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

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.

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.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

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.

References

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  16. Ström H, Johansson C. Appendicitis followed by reactive arthritis in an HLA B27-positive man after infection with Yersinia enterocolitica, diagnosed by serotype specific antibodies and antibodies to Yersinia outer membrane proteins. Infection. Sep-Oct 1997;25(5):317-9. [Medline].

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Gram stain of Yersinia enterocolitica.
 
 
 
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