Further Inpatient Care
Supportive care for patients with Y pseudotuberculosis sepsis includes general hospital acute-level care (intensive medical/surgical care may be needed, although uncommon unless the patient is severely ill) and intravenous fluids, frequent monitoring, serial examinations, radiographic studies, intravenous antibiotics, and treatment of any complicating host- or disease-related factors.
Inpatient & Outpatient Medications
In outpatient settings or mild inpatient situations, close observation without the use of antibiotics is reasonable.
Deterrence/Prevention
Foodborne epidemics of Y pseudotuberculosis infection can occur. Contact precautions, especially in the inpatient setting, apply to appropriate barriers (eg, gown, gloves) to exposure to enteric secretions, such as with diarrhea. Avoid ingestion of uncooked meat, contaminated water, or unpasteurized milk. Careful handwashing should follow consumption or handling of chitterlings (pork intestines).
Complications
Enteric disease may be complicated by intussusception in children. Postinfectious sequelae may include arthritis and erythema nodosum. Bacteremia and septic arthritis, osteomyelitis, and abscesses have been reported, particularly in the settings of iron overload (eg, hemophilia) and hemochromatosis.
Prognosis
Uncomplicated mesenteric lymphadenitis due to Y pseudotuberculosis infection is generally self-limited and commonly does not require antibiotic therapy. Septic forms of Y pseudotuberculosis infection or those associated with systemic manifestations are serious and carry a high mortality rate (often 75% despite antibiotic therapy).
Patient Education
Patients with Y pseudotuberculosis infection (and their families) should be familiar with forms of exposure, routes of infection, variable manifestations of the disease, difficulties in the diagnostic issues, and the potential for associated complications, including sepsis, reactive arthritis, erythema nodosum, and rare events such as cardiac or renal sequelae.
