Yersinia Enterocolitica Treatment & Management

Updated: Sep 27, 2018
  • Author: Zartash Zafar Khan, MD, FACP; Chief Editor: John L Brusch, MD, FACP  more...
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Treatment

Approach Considerations

Care in patients with Y enterocolitica infection is primarily supportive, with good nutrition and hydration being mainstays of treatment. [4]

First-line drugs used against the bacterium include aminoglycosides and trimethoprim-sulfamethoxazole (TMP-SMZ). Other effective drugs include third-generation cephalosporins, tetracyclines (not recommended in children < 8 y), and fluoroquinolones (not approved for use in children < 18 y).

In the event of an acute outbreak of Y enterocolitica, attempt to isolate persons who have been in contact with the index patient.

Surgical therapy

Abscesses may require surgical drainage. Surgical exploration may be warranted if appendicitis cannot be safely 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.

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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:

  • Elderly patients

  • Patients with diabetes

  • Patients with cirrhosis

  • Immunocompromised patients

  • Patients with cancer who are receiving chemotherapy

  • Healthcare and childcare workers who are at an increased risk of 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:

  • Cellulitis

  • Ophthalmitis

  • Endocarditis

  • Meningitis

  • Osteomyelitis

  • Pneumonia

  • Focal abscesses

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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:

  • Elderly patients

  • Patients who are immunocompromised

  • Patients who are chronically ill

  • Patients with iron overload

  • Patients with chronic hemolysis

  • Patients with alcoholism

  • Patients with diabetes mellitus

  • Patients on deferoxamine therapy

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Deterrence and Prevention

The following steps can be taken to prevent the spread of Y enterocolitica infection:

  • Instruct patients and at-risk individuals about appropriate hygiene methods and signs and symptoms of infection

  • Encourage public awareness of Y enterocolitica outbreaks and modes of transmission

  • 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

  • In blood banks, donors should be asked about any recent symptoms of gastroenteritis

  • Unwashed raw vegetables, uncooked meats (especially pork), and unpasteurized milk should be avoided [14, 15]

  • Reservoirs should be eliminated

  • The contamination of food products should be minimized

  • Enteric precautions should be instituted in the care of patients who have been hospitalized with infection

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