Medical Care
Y pseudotuberculosis infection is often self-limited. However, more toxic presentations, including septic syndromes, severe dehydration, or other obscured diagnostic issues, may warrant hospitalization and empiric antibiotic therapy and supportive medical care.
Because of the rare nature of the disease, antibiotic management has not been standardized, nor has ampicillin been found effective for mild cases. [19] There has been concern about acquisition of resistance in Y pseudotuberculosis, and Y enterocolitica has been reported as resistant to ampicillin due to beta-lactamase production. Antimicrobial agents generally are not used for the treatment of enteritis or pseudoappendicitis in immunocompetent patients and do not decrease the risk for postinfectious complications. [20] Extraintestinal manifestations of infection by Y. pseudotuberculosis are susceptible to antibiotics against gram-negative bacteria [20] , such as aminoglycosides, tetracycline, cephalosporin, and ciprofloxacin [2, 20] . Antibiotic treatment typically is reserved for moderate to severe infection; however, the mortality rate for Y. pseudotuberculosis septicemia is still as high as 75%. [2]
For moderately severe Y pseudotuberculosis disease, trimethoprim-sulfamethoxazole (TMP 8 mg/kg and SMX 40 mg/kg per day in 2 divided doses) has been recommended in children, and ciprofloxacin 500 mg twice daily in adults as a 2C grade recommendation. The same author recommends ceftriaxone (2 g daily in adults, 100 mg/kg in children in 1 or 2 divided doses daily) plus gentamicin (5 mg/kg/day in 3 divided doses daily) for septicemia or severe disease. [20] Iron is an essential element to bacterial survival and in conditions in which iron is increased, there is a predisposition to bacterial infectious diseases through both the propagation of bacteria and the modification of the immune host response. [21, 22] Given that Yersinia pseudotuberculosis is a siderophilic bacteria [23, 24] , it probably would be prudent to discontinue iron-releasing drugs such as deferoxamine, to control hemolytic anemia, to reduce immunosuppression, and to avoid over transfusion in severely ill patients. [20]
A Y pseudotuberculosis epidemic among cattle in Australia in 1985-86 was controlled by administering tetracyclines. [25]
Surgical Care
Exploratory laparotomy may be warranted in patients with complications, such as severe abdominal pain, including acute abdominal presentations, peritoneal findings, or, uncommonly, intussusception.
Consultations
Consultation with an infectious disease specialist may be helpful. Gastroenterologists or surgeons may be required if invasive diagnostic or therapeutic interventions are warranted. For unusual Y pseudotuberculosis presentations, such as rheumatologic, dermatologic, or ocular complications, the respective consultations may be helpful.
Diet
No special diet is recommended; however, given the enteric nature of the symptoms and associated abdominal pain, diarrhea, fever, and anorexia that accompany such illness, it may be prudent to maintain the patient on nothing-by-mouth (NPO) status through the diagnostic phase of the disease and to administer intravenous fluids to prevent dehydration, as needed.
Activity
Bedrest through the acute illness is recommended. Activity as tolerated can be resumed once the enteric and systemic symptoms resolve.
Prevention
Prevention of Y pseudotuberculosis infection is best accomplished by appropriate handling of pork and wild animal intestines, particularly during preparation of food that might be stored in cold temperatures.
