Approach Considerations
Care in patients with Y enterocolitica infection primarily is supportive, with good nutrition and hydration being mainstays of treatment. [5]
Reduced osmolarity oral rehydration solution (ORS) is recommended as the first-line therapy of mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause, and in people with mild to moderate dehydration associated with vomiting or severe diarrhea. Isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered when there is severe dehydration, shock, or altered mental status and failure of ORS therapy or ileus. Anti-motility drugs generally should be avoided in the setting of acute diarrhea. Antiemetic may be considered if needed.
Most infections are self-limiting. Antibiotics should be given for severe cases. Y enterocolitica isolates usually are susceptible to trimethoprim-sulfamethoxazole, aminoglycosides, third-generation cephalosporins, fluoroquinolones, and tetracyclines; they typically are resistant to first-generation cephalosporins and most penicillins. Trimethoprim-Sulfamethoxazole is the preferred antibiotic. Cefotaxime and ciprofloxacin are preferred alternatives. Antimicrobial therapy has no effect on postinfectious sequelae. [6]
In the event of an acute outbreak of Y enterocolitica, attempt to isolate persons who have been in contact with the index patient. Public health should be notified in case of foodborne disease outbreak.
Surgical therapy
Abscesses may require surgical drainage. Surgical exploration may be warranted if appendicitis cannot safely be ruled out.
Laparotomy findings in Y enterocolitica infection usually include mesenteric lymphadenitis and terminal ileitis, with a healthy appendix.
Consultations
The diagnosis and management of yersiniosis do not require specific consultations. However, consultation with an infectious diseases specialist or gastroenterologist may be useful. Consultation with a rheumatologist may be helpful in cases of erythema nodosum or reactive arthritis.
Antibiotic Therapy
The value of antibiotic therapy in uncomplicated acute diarrhea has not been established. Diarrhea should be managed with fluid and electrolyte replacement. Avoid antimotility medications, which could lead to bacteremia.
In cases of severe enterocolitis, antibiotics have shown some benefit in terms of shortening the duration of illness. Patient populations who should be considered for empiric antibiotic therapy include the following:
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Elderly patients
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Patients with diabetes
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Patients with cirrhosis
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Immunocompromised patients
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Patients with cancer who are receiving chemotherapy
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Healthcare and childcare workers who are at an increased risk for person-to-person spread
Antibiotic treatment should be used in patients with bacteremia with extraintestinal manifestations. They should be used in cases of primary extraintestinal disorders, such as the following:
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Cellulitis
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Ophthalmitis
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Endocarditis
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Meningitis
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Osteomyelitis
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Pneumonia
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Focal abscesses
Inpatient Care
Admit patients with Y enterocolitica infection who have evidence of severe dehydration, malnourishment, or septicemia.
Patients with conditions that place them at risk for Y enterocolitica septicemia, including the following, should be monitored closely and admitted for supportive measures and antibiotic therapy at the first sign of disseminated disease:
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Elderly patients
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Patients who are immunocompromised
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Patients who are chronically ill
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Patients with iron overload
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Patients with chronic hemolysis
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Patients with alcoholism
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Patients with diabetes mellitus
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Patients on deferoxamine therapy
Deterrence and Prevention
The following steps can be taken to prevent the spread of Y enterocolitica infection:
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Instruct patients and at-risk individuals about appropriate hygiene methods and signs and symptoms of infection
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Encourage public awareness of Y enterocolitica outbreaks and modes of transmission
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Hand washing and control of environmental cross-contamination are principal measures in reducing the spread of enteric pathogens in daycare centers, healthcare settings, and pet-care facilities, as well as within households
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In blood banks, donors should be asked about any recent symptoms of gastroenteritis
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Reservoirs should be eliminated
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The contamination of food products should be minimized
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Enteric precautions should be instituted in the care of patients who have been hospitalized with infection
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Yersinia enterocolitis in a 45-year-old white woman who presented with chronic diarrhea.
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Gram stain of Yersinia enterocolitica.
