Pseudotuberculosis (Yersinia pseudotuberculosis Infection) Treatment & Management

Updated: Oct 11, 2017
  • Author: David R Haburchak, MD, FACP; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Treatment

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. [17] 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.

For moderately severe Y pseudotuberculosis disease, trimethoprim-sulfamethoxazole (TMP 8 mg/kg and SMX 40 mg/kg per day in two divided doses) has been recommended in children, and ciprofloxacin 500 mg twice daily in adults as a 2C grade recommendation. [18] The same author recommends ceftriaxone (2 g daily in adults, 100 mg/kg in children in one or 2 divided doses daily) plus gentamicin (5 mg/kg/day in 3 divided doses daily) for septicemia or severe disease. It would probably 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.

Other authorities have recommended older, potentially more toxic drugs. [19]

A Y pseudotuberculosis epidemic among cattle in Australia in 1985-86 was controlled by administering tetracyclines. [20]

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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.

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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.

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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.

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Activity

Bedrest through the acute illness is recommended. Activity as tolerated can be resumed once the enteric and systemic symptoms resolve.

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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.

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