Yersinia Enterocolitica 

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

Overview

Practice Essentials

Yersinia enterocolitica (see the image below) is a bacterial species in the family Enterobacteriaceae that most often causes enterocolitis, acute diarrhea, terminal ileitis, mesenteric lymphadenitis, and pseudoappendicitis but, if it spreads systemically, can also result in fatal sepsis.[1]

Gram stain of Yersinia enterocolitica.
Gram stain of Yersinia enterocolitica.

Signs and symptoms

Symptoms of Y enterocolitica infection typically include the following:

  • Diarrhea - The most common clinical manifestation of this infection; diarrhea may be bloody in severe cases

  • Low-grade fever

  • Abdominal pain - May localize to the right lower quadrant

  • Vomiting - Present in approximately 15-40% of cases

The patient may also develop erythema nodosum, which manifests as painful, raised red or purple lesions, mainly on the patient’s legs and trunk. Lesions appear 2-20 days after the onset of fever and abdominal pain and resolve spontaneously in most cases in about a month.

See Clinical Presentation for more detail.

Diagnosis

The following tests can be used in the diagnosis of Y enterocolitica infection:

  • Stool culture - This is the best way to confirm a diagnosis of Y enterocolitica[2, 3] ; the culture result is usually positive within 2 weeks of onset of disease

  • Tube agglutination

  • Enzyme-linked immunosorbent assays

  • Radioimmunoassays

  • Imaging studies - Ultrasonography or computed tomography (CT) scanning may be useful in delineating true appendicitis from pseudoappendicitis

  • Colonoscopy - Findings may vary and are relatively nonspecific

  • Joint aspiration in cases of Yersinia- associated reactive arthropathy

See Workup for more detail.

Management

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 the following agents:

  • Third-generation cephalosporins

  • Trimethoprim-sulfamethoxazole (TMP-SMZ)

  • Tetracyclines

  • Fluoroquinolones - not approved for use in children under 18 years

  • Aminoglycosides

See Treatment and Medication for more detail.

Background

Yersinia enterocolitica is a pleomorphic, gram-negative bacillus that belongs to the family Enterobacteriaceae. As a human pathogen, Y enterocolitica is most frequently associated with enterocolitis, acute diarrhea, terminal ileitis, mesenteric lymphadenitis, and pseudoappendicitis,[1] with the spectrum of disease ranging from asymptomatic to life-threatening sepsis, especially in infants. The bacterium was first reported by Mclver and Picke, in 1934.[5] Schleifstein and Coleman provided the first recognized description of 5 human isolates of Y enterocolitica, in 1939. (See Prognosis and Clinical Presentation.)[6]

In several countries, Y enterocolitica has eclipsed Shigella species and approaches Salmonella and Campylobacter species as the predominant cause of acute bacterial gastroenteritis. Y enterocolitica most commonly affects young individuals (approximately 75% of patients with Y enterocolitica infection are aged 5-15 years), but whether this represents an increased susceptibility or a greater likelihood of developing symptomatic illness is unclear. Most cases of Y enterocolitica infection are sporadic, but reports have documented large outbreaks centered on a single contaminated source. (See Epidemiology.)

Human yersiniosis is attributed to contaminated pork, milk, water, and tofu consumption, as well as to blood transfusion. Infected individuals may shed Y enterocolitica in stools for 90 days after the symptom resolution, suggesting that early detection of Y enterocolitica from diarrheal stool samples is critical in preventing its transmission and an eventual outbreak. (See Pathophysiology, Etiology, Clinical Presentation, and Workup.)[7, 8]

Classification

Y enterocolitica is classified according to various distinct biochemical and serologic reactions. Based on biochemical characteristics, 6 biotypes of the bacterium have been described. Biotypes 2, 3, and 4 are most common in humans. The serotyping is based on O and H antigens. More than 60 serotypes of Y enterocolitica have been described. The serotypes most clearly pathogenic to humans include O:3, O:5,27, O:8, O:9, and O:13.

H-antigen typing can be a valuable supplement to O-antigen typing and biochemical characterization in epidemiologic investigations. Accurate identification of pathogenic strains requires consideration of both the biotype and the serotype because some strains can contain multiple cross-reacting O antigens.

Metabolism

Y enterocolitica is non–lactose-fermenting, glucose-fermenting, and oxidase-negative facultative anaerobe that is motile at 25°C and nonmotile at 37°C. Most, but not all, Y enterocolitica isolates reduce nitrates. The presence of bile salts in the medium prevents the organism from fermenting lactose. Colonies of Y enterocolitica do not produce hydrogen sulfide in triple sugar iron medium, but the organism is urease positive.

Patient education

Educate patients and individuals at risk for infection about appropriate hygiene methods and signs or symptoms of infection. Encourage public awareness of outbreaks, modes of transmission, and ways to prevent transmission.

Pathophysiology

As with other members of the genus Yersinia, Y enterocolitica is an invasive organism that appears to cause disease by tissue destruction. Researchers have elucidated several potential pathogenic properties, including chromosomally mediated effects (eg, attachment to tissue culture, production of enterotoxin) and plasmid-mediated mechanisms (eg, production of Vw antigens, calcium dependency for growth, autoagglutination).

Invasion and colonization

Invasion of human epithelial cells and penetration of the mucosa occurs in the ileum, followed by multiplication in Peyer patches. A 103-kd protein, known as invasin and determined by the INV gene, mediates bacterial invasion. The best-defined pathway is through the action of invasin.[9]

As a foodborne pathogen, Y enterocolitica can efficiently colonize and induce disease in the small intestine. Following ingestion, the bacteria colonize the lumen and invade the epithelial lining of the small intestine, resulting in the colonization of the underlying lymphoid tissues known as Peyer patches. A direct lymphatic link between the Peyer patches and mesenteric lymph nodes may result in bacterial dissemination to these sites, resulting in mesenteric lymphadenitis or systemic infection.

Dissemination to extraintestinal sites, such as the spleen, is hypothesized to occur via 2 main mechanisms: (1) colonization of the Peyer patches, which can then be used as a staging ground for spread into the blood and/or lymph, ultimately resulting in the appearance of bacteria in other tissues, and (2) bypass of the Peyer patches, with Y enterocolitica going straight to systemic colonization. The possibilities of additional avenues for dissemination have yet to be excluded.

Y enterocolitica colonization of the intestinal lymphoid tissues requires transmigration of the bacteria from the intestinal lumen across an epithelial tissue barrier. Antigen-sampling intestinal epithelial cells known as M cells are thought to be critical for this transmigratory process. The epithelium overlying the Peyer patches has a high concentration of M cells (although these cells have also been identified throughout the non–Peyer patch areas of the small intestine).

Y enterocolitica and the related pathogen Y pseudotuberculosis produce at least 3 invasion proteins, Ail, YadA, and the aforementioned invasin, which could potentially promote adherence to and invasion of M cells. Invasin, the principle invasion factor of Y enterocolitica and Y pseudotuberculosis, binds to ß1 -chain integrin receptors with high affinity, promoting internalization. These receptors are found at high levels on the luminal side of M cells but not on the luminal side of enterocytes.[10]

Enterotoxicity

The enterotoxin produced by Y enterocolitica is similar to that produced by the heat-stable Escherichia coli; however, it likely plays a minor role in causing disease, as diarrheal syndromes have been observed in the absence of enterotoxin production. In addition, the toxin does not appear to be produced at temperatures higher than 30°C. The plasmid-mediated outer membrane antigens are associated with bacterial resistance to opsonization and neutrophil phagocytosis.

Iron and pathogenicity

One unique property of Y enterocolitica is its inability to chelate iron, which is an essential growth factor for most bacteria and is obtained through the production of chelators known as siderophores. Y enterocolitica does not produce siderophores but can utilize siderophores produced by other bacteria (eg, desferrioxamine E produced by Streptomyces pilosus).

Iron overload substantially increases the pathogenicity of Y enterocolitica, perhaps through attenuation of the bactericidal activity of the serum. Researchers observe differences in the iron requirements of different serotypes of the organism; such differences may explain, in part, the varying degrees of virulence among serotypes.

Complications

After an incubation period of 4-7 days, infection may result in mucosal ulceration (usually in the terminal ileum and rarely in the ascending colon), necrotic lesions in Peyer patches, and mesenteric lymph node enlargement. See the image below.


Yersinia enterocolitis in a 45-year-old white wom Yersinia enterocolitis in a 45-year-old white woman who presented with chronic diarrhea.

In severe cases, bowel necrosis may occur, as a result of mesenteric vessel thrombosis.[11] Focal abscesses may occur. In persons with human leukocyte antigen (HLA)–B27, reactive arthritis is not uncommon, possibly because of the molecular similarity between HLA-B27 antigen and Yersinia antigens. The pathogenesis of Yersinia -associated erythema nodosum is unknown.[12, 13]

Etiology

Human clinical Y enterocolitica infections ensue after ingestion of the microorganisms in contaminated food or water or by direct inoculation through blood transfusion.

Y enterocolitica is potentially transmitted by contaminated unpasteurized milk and milk products, raw pork, tofu, meats, oysters, and fish.[14, 15] Outbreaks have been associated with raw vegetables; the surface of vegetables can become contaminated with pathogenic microorganisms through contact with soil, irrigation water, fertilizers, equipment, humans, and animals.

Pasteurized milk and dairy products can also cause outbreaks because Yersinia can proliferate at refrigerated temperatures.[16, 17]

Animal reservoirs of Y enterocolitica include swine (principle reservoir), dogs, cats, cows, sheep, goats, rodents, foxes, porcupines, and birds.

Reports of person-to-person spread are conflicting and are generally not observed in large outbreaks. Transmission via blood products has occurred, however, and infection can be transmitted from mother to newborn infant. Fecal-oral transmission among humans has not been proven.[18, 19] .

Epidemiology

Occurrence in the United States

Yersiniosis is rare in the absence of a breakdown in food-processing techniques. The Centers for Disease Control and Prevention (CDC) estimates that 1 culture-confirmed Y enterocolitica infection per 100,000 persons is found annually.[20] The bacterium has been isolated in 1.4-2.8% of stools of children with diarrhea.

For 2010, the CDC’s Foodborne Diseases Active Surveillance Network (FoodNet), using surveillance data from 10 US sites, preliminarily identified a total of 19,089 laboratory-confirmed cases of infection caused by bacterial pathogens that are commonly transmitted through food. The number of cases and incidence per 100,000 population were reported as follows[21] :

  • Salmonella (8256; 17.6)

  • Campylobacter (6365; 13.6)

  • Shigella (1780; 3.8)

  • Shiga toxin-producing E coli (STEC) non-O157 (451; 1.0)

  • STEC O157 (442; 0.9)

  • Vibrio (193; 0.4)

  • Yersinia (159; 0.3)

  • Listeria (125; 0.3)

In the United States, Yersinia enterocolitica accounts for approximately 5% of bacterial enteric infections among children younger than 5 years, according to a 2012 study by Scallan et al. The investigators found this to be a greater incidence than that for the enterohemorrhagic E coli strain O157 (3%), but a lower incidence than those for nontyphoidal Salmonella (42%), Campylobacter (28%), and Shigella (21%).[22]

Scallan et al estimated that the 5 pathogens together cause more than 290,000 illnesses annually in children under 5 years.

Y enterocolitica infection is more common in cooler climates, and its prevalence peaks from November to January.[23]

International statistics

Y enterocolitica has been isolated in patients in many countries worldwide, but the infection appears to occur predominantly in cooler climates, being much more common in northern Europe, Scandinavia, and Japan. Most isolates reported from Canada and Europe are O:3 and O:9 serotypes.[24] The O:3 serotype is also common in Japan. Isolation of Y enterocolitica in developing countries is uncommon.[25]

Race- and age-related demographics

Higher incidence of Y enterocolitica infection has been observed among black infants in the United States.[26]

Reports document symptomatic Y enterocolitica infection most commonly in younger age groups. A sample collection from 1988-1991 showed that 77.6% of infections occurred in children aged 12 months and younger, making Y enterocolitica the second most common cause of bacterial gastrointestinal infection in children.[22, 27, 28]

Clinical manifestations of Y enterocolitica infection exhibit some age-dependent predilections, with reactive arthritis and erythema nodosum being more common in older patients. Older patients with more debility are more likely to develop bacteremia than are younger, healthier patients.

Prognosis

Yersiniosis is usually either self-limited or is responsive to therapy; however, reinfection is possible. Most patients with Y enterocolitica infection are symptomatic; however, asymptomatic carriage may occur. Death is uncommon, but patients with significant comorbidities are at risk for Y enterocolitica bacteremia, which carries a case fatality rate of 34-50%.

A national, registry-based study of 52,121 patients in Denmark reported estimates for the risk of developing severe, hospitalization-requiring complications and long-term sequelae up to 1 year after infection with 5 common bacterial gastrointestinal pathogens. Of the 3922 cases of Y enterocolitica infection reported, 368 required hospitalization.[29]

A report from the CDC stated that in 2010 (preliminary data), of 159 Yersinia infections in the United States, 52 required hospitalization and 1 resulted in death.[21]

Various manifestations of Y enterocolitica infection have been reported, including the following[30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42] :

  • Enterocolitis

  • Pseudoappendicitis

  • Mesenteric adenitis

  • Reactive arthritis - Can last 1-4 months

  • Erythema nodosum

  • Septicemia

  • Pharyngitis

  • Dermatitis

  • Myocarditis

  • Glomerulonephritis

Iron is an essential growth factor for the organism, and iron overload (eg, chronic hemolysis, hereditary hemochromatosis) is associated with an increased risk of systemic disease. Deferoxamine therapy also increases susceptibility to Y enterocolitica disease.

 

Presentation

History and Physical Examination

The usual presentation of Y enterocolitica infection includes diarrhea (the most common clinical manifestation of this infection), low-grade fever, and abdominal pain lasting 1-3 weeks. Diarrhea may be bloody in severe cases. Vomiting is present in approximately 15-40% of cases.

The existence of extraintestinal symptoms after a gastrointestinal illness may also indicate the possibility of yersiniosis.

Enterocolitis

Enterocolitis, the most common presentation of Y enterocolitica, occurs primarily in young children, with a mean age of 24 months. The incubation period is 4-6 days, typically with a range of 1-14 days.

Prodromal symptoms of listlessness, anorexia, and headache may be present. Such symptoms are followed by watery, mucoid diarrhea (78-96%); fever (43-47%); colicky abdominal pain (22-84%); bloody stools (< 10%); and white blood cells (WBCs) in the stool (25%). The diarrhea generally has a duration of 1 day to 3 weeks.

Most cases are self-limited. However, concomitant bacteremia may occur in 20-30% of infants younger than 3 months.

Complications of enterocolitis include appendicitis,[41] diffuse ulceration and inflammation of the small intestine and colon, peritonitis,[43, 44] meningitis, intussusception,[45] and cholangitis.

Mesenteric adenitis, mesenteric ileitis, and acute pseudoappendicitis

These manifestations are characterized by the following symptoms (although nausea, vomiting, diarrhea, and aphthous ulcers of the mouth can also occur):

  • Fever

  • Abdominal pain

  • Tenderness of the right lower quadrant

  • Leukocytosis

Pseudoappendicitis syndrome is more common in older children and young adults.[46] Patients with Y enterocolitica infection often undergo appendectomy; several Scandinavian studies suggested a prevalence rate of 3.8-5.6% for infection with Y enterocolitica in patients with suspected appendicitis.

Analysis of several common-source outbreaks in the United States found that 10% of 444 patients with symptomatic, undiagnosed Y enterocolitica infection underwent laparotomy for suspected appendicitis.

Reactive arthritis

This is associated with HLA-B27 (found in approximately 80% of affected patients). Most commonly reported in Scandinavia, polyarticular arthritis can occur after Y enterocolitica infection. Joint symptoms, which occur in approximately 2% of patients, typically arise 1-2 weeks after gastrointestinal illness.[13]

The large joints of the lower extremities are involved most commonly, and symptoms usually persist for 1-4 months, although reports document prolonged syndromes.

Myocarditis and glomerulonephritis

These are other postinfection sequelae associated with the HLA-B27.[47]

Erythema nodosum

This manifests as painful, raised red or purple lesions, mainly on the patient’s legs and trunk. Lesions appear 2-20 days after the onset of fever and abdominal pain and resolve spontaneously in most cases in about a month. The female-to-male ratio of erythema nodosum is 2:1, and it is more common in adults than in children.

Septicemia

In this, a bacteremic spread to extraintestinal sites occurs, resulting in critical illness. Y enterocolitica septicemia is reported most commonly in patients who have predisposing conditions, including alcoholism, diabetes mellitus, or an underlying immune defect.

Patients with iron overload conditions and those who are undergoing treatment with deferoxamine are also at an increased risk for septicemia, secondary to the effect of iron on the virulence of the bacteria.[14]

In addition, Y enterocolitica septicemia is usually reported in patients with a hematologic disease, such as thalassemia, sickle cell disease, or hemochromatosis.[14, 48, 49, 50] Elderly patients and those who are malnourished are also at increased risk of developing septicemia.

Metastatic infections following Y enterocolitica septicemia include focal abscesses in the liver, kidneys, spleen, and lungs. Cutaneous manifestations include cellulitis, pyomyositis, pustules, and bullous lesions. Pneumonia, meningitis, panophthalmitis, endocarditis, infected mycotic aneurysm, and osteomyelitis may also occur.[47]

 

DDx

Diagnostic Considerations

Exercise caution in differentiating yersiniosis from inflammatory bowel disease, specifically Crohn disease. Performing stool cultures and ruling out infectious etiologies prior to initiating immunomodulatory therapy for inflammatory bowel disease should be a general practice.[4]

Other conditions to be considered in the differential diagnosis of Y enterocolitica infection, in addition to those in the next section, include the following:

  • Ascariasis

  • Cryptosporidiosis

  • Cyclospora

  • Cytomegalovirus colitis

  • E coli infections

  • Food poisoning

  • Bacterial gastroenteritis

  • Viral gastroenteritis

  • Giardiasis

  • Intestinal flukes

  • Irritable bowel syndrome

  • Ischemic bowel disease

  • Isosporiasis

  • Lactose intolerance

  • Mesenteric lymphadenitis

  • Microsporidiosis

  • Shigellosis

  • Strongyloidiasis

  • Trichinosis

  • Typhoid fever

  • Ulcerative colitis

  • Vibrio infections

Differential Diagnoses

 

Workup

Approach Considerations

The following tests can be used in the diagnosis of Y enterocolitica infection (see the image below):

  • Stool culture - This is the best way to confirm a diagnosis of Y enterocolitica[2, 3] ; the culture result is usually positive within 2 weeks of onset of disease

  • Tube agglutination

  • Enzyme-linked immunosorbent assays

  • Radioimmunoassays

  • Imaging studies - Ultrasonography or computed tomography (CT) scanning may be useful in delineating true appendicitis from pseudoappendicitis

  • Colonoscopy - Findings may vary and are relatively nonspecific

  • Joint aspiration - Synovial fluid contains 500-60,000 WBCs/µL, with a predominance of polymorphonuclear cell; cultures are sterile; testing synovial fluid for bacterial antigens may be of some use in difficult cases

    Gram stain of Yersinia enterocolitica.
Gram stain of Yersinia enterocolitica.

Stool Culture

Stool samples tested for leukocytes usually produce positive results, but Y enterocolitica is difficult to distinguish from other invasive pathogens. Stool samples from infected patients should be handled carefully to avoid infecting others.

When Y enterocolitica infection is suspected, instruct the microbiology laboratory to use cefsulodin-Irgasan-novobiocin (CIN) agar, which is a differential selective medium with increased yield for Y enterocolitica. It requires 18-20 hours of incubation at 25°C to create unique colony morphology, representing 0.5- to 1-mm colonies with a red "bull's-eye" and a clear border. Use of this media allows differentiation between Y enterocolitica and Y enterocolitica– like isolates.

When using conventional enteric media, MacConkey agar incubated at 25°C for 48 hours produces the best results.[51]

Recovery of organisms from otherwise sterile samples, such as blood, cerebrospinal fluid (CSF), and lymph node tissue, is usually faster than recovery from stool samples. Isolation of Y enterocolitica from stool is hampered by slow growth and overgrowth of normal flora.

Serodiagnosis

Serodiagnosis is possible with various methods, including tube agglutination, enzyme-linked immunosorbent assays, and radioimmunoassays. However, carefully interpret the serotest results for Y enterocolitica infection if a positive stool culture result is absent. Cross-reactions with other organisms can occur—including with Brucella, Morganella, and Salmonella —and a background seroprevalence rate among different populations may confound the diagnosis by acting as a false-positive result.

Agglutinin titers typically increase 1-2 weeks after infection and peak at 1:200. However, elevated levels can be found for years after infection, which also limits the usefulness of serodiagnosis.

DNA Microarray

Advanced experimental techniques for diagnosis of Y enterocolitica infection include polymerase chain reaction (PCR) assay, immunohistochemical staining, and DNA microarray. Diagnostic DNA microarray for pathogenetic organisms is a comparatively new technique that is used to identify multiple genes from different kinds of pathogens, allowing it to be used to detect different species, biotypes, and/or toxins of pathogenic organisms in the same specimens. This is the major advantage over the conventional PCR assay technique, which is used to identify only 1 gene from a hybridization. DNA microarray is also more sensitive and accurate than the multiplex PCR.[52]

Colonoscopy

Typically, in patients with Y enterocolitica infection, the cecum contains aphthoid lesions and the terminal ileum has small, round elevations and ulcers (as seen in the image below). An exudate may be present. The left side of the colon is typically unaffected, but case reports have described left-sided colitis with serotype O:8.


Yersinia enterocolitis in a 45-year-old white wom Yersinia enterocolitis in a 45-year-old white woman who presented with chronic diarrhea.

Histologic Findings

Histologic findings in Y enterocolitica infection are consistent with acute and chronic inflammation. Yersiniosis does not produce unique histologic findings. Epithelial cell granulomas with suppuration of the centers of the granulomas (central microabscesses) have been reported. These granulomas were composed of numerous histiocytes with or without epithelioid cell features, along with scattered small T-lymphocytes and plasmacytoid monocytes.[53]

 

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.

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

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

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

 

Medication

Medication Summary

Treatment of Y enterocolitica infection is usually supportive and directed at maintaining euvolemia. Antibiotics may be used in some cases. Septicemia carries a high mortality rate and should therefore be treated with antibiotics. Uncomplicated cases Y enterocolitica diarrhea usually resolve on their own without antibiotic treatment. However, in more severe or complicated infections, antibiotics may be useful.

Y enterocolitica is usually susceptible in vitro to aminoglycosides, chloramphenicol, tetracycline, trimethoprim-sulfamethoxazole (TMP-SMZ), piperacillin, ciprofloxacin, and third-generation cephalosporins. Isolates are often resistant to penicillin, ampicillin, and first-generation cephalosporins, as the organism often produces beta-lactamase. Clinical failure with cefotaxime has been reported.[54] Resistance to macrolides and fluoroquinolones is also sporadically reported.[55]

Clinically, Y enterocolitica infection responds well to aminoglycosides, TMP-SMZ, ciprofloxacin, and doxycycline.

Antimotility agents are contraindicated in the treatment of Y enterocolitica infection because of the increased risk of invasion.

Antibiotics, Other

Class Summary

The value of antibiotic therapy in uncomplicated acute colitis and mesenteric adenitis is not established. Antibiotic treatment may be required in patients with septicemia, with focal extraintestinal manifestations, and in immunocompromised patients with enterocolitis.

Ciprofloxacin (Cipro)

The bactericidal agent ciprofloxacin is a second-generation quinolone. It acts by interfering with DNA gyrase, by inhibiting the relaxation of supercoiled DNA, and by promoting the breakage of double-stranded DNA. Ciprofloxacin is highly active against gram-negative and gram-positive organisms.

Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra DS)

Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra DS)

The combination antibiotic TMP-SMZ inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. It is not helpful in cases of uncomplicated gastroenteritis.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with gram-negative activity.

Gentamicin

Gentamicin is an aminoglycoside that is bactericidal for susceptible gram-negative organisms. This agent is not helpful for uncomplicated gastroenteritis.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with a gram-negative spectrum. It has lower efficacy against gram-positive organisms. This agent is not helpful for uncomplicated gastroenteritis.

Tetracycline

Tetracycline treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with the 30S and possibly 50S ribosomal subunit(s).

Chloramphenicol

Chloramphenicol binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. It is effective against gram-negative and gram-positive bacteria.

Piperacillin and tazobactam sodium (Zosyn)

This drug combination consists of an antipseudomonal penicillin plus a beta-lactamase inhibitor. It inhibits the biosynthesis of cell wall mucopeptide and is effective during the active multiplication stage.

Carbapenems

Imipenem/cilastatin (Primaxin)

In vitro susceptibility to imipenem has been reported.