Yersiniosis

Infectious Agent

Facultative anaerobic gram-negative coccobacilli in the genus Yersinia (most commonly Yersinia enterocolitica serogroups O:3; O:5,27; O:8; and O:9).

Transmission

Consuming or handling contaminated food, most commonly raw or undercooked pork products; milk that was not pasteurized, inadequately pasteurized, or contaminated after pasteurization; or untreated water. Also transmitted by direct or indirect contact with animals.

Epidemiology

Most common in northern Europe (particularly Scandinavia), Japan, and Canada. In temperate climates, risk is higher in cooler months. The incidence among travelers to developing countries is generally low. A US study found that approximately 6% of Y. enterocolitica infections were travel associated. People with high iron levels are at higher risk of infection and severe disease.

Clinical Presentation

Incubation period is 4–6 days (range, 1–14 days). Symptoms include fever, abdominal pain (may mimic appendicitis), and diarrhea (may be bloody and can persist for several weeks). Necrotizing enterocolitis has been described in young infants. Reactive arthritis affecting the wrists, knees, and ankles can occur, usually 1 month after the initial diarrhea episode, resolving after 1–6 months. Erythema nodosum can also occur, manifesting as painful, raised red or purple lesions along the trunk and legs, usually resolving spontaneously within 1 month.

Diagnosis

Isolation of the organism from stool, blood, bile, wound, throat swab, mesenteric lymph node, cerebrospinal fluid, or peritoneal fluid. If yersiniosis is suspected, the clinical laboratory should be notified and instructed to culture on CIN agar.

Treatment

Most infections are self-limited. Antibiotics should be given for moderate to severe cases. Y. enterocolitica isolates are usually susceptible to trimethoprim-sulfamethoxazole, aminoglycosides, third-generation cephalosporins, fluoroquinolones, and tetracyclines; they are typically resistant to first-generation cephalosporins and most penicillins. Antimicrobial therapy has no effect on postinfectious sequelae.

Prevention

Avoid eating raw or undercooked pork products, unpasteurized milk products, and untreated water (see Chapter 2, Food & Water Precautions). Wash hands with soap and water before eating and preparing food, after contact with animals, and after handling raw meat.

CDC website: www.cdc.gov/yersinia

Bibliography

  1. Cover TL, Aber RC.Yersinia enterocolitica . N Engl J Med. 1989 Jul 6;321(1):16–24.  [PMID:2659991]
  2. Kendall ME, Crim S, Fullerton K, Han PV, Cronquist AB, Shiferaw B, et al. Travel-associated enteric infections diagnosed after return to the United States, Foodborne Diseases Active Surveillance Network (FoodNet), 2004–2009. Clin Infect Dis. 2012 Jun;54 Suppl 5:S480–7.  [PMID:22572673]
  3. Mead PS.Yersinia species, including plague. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia: Saunders Elsevier; 2015. pp. 2615–7.
  4. Perdikogianni C, Galanakis E, Michalakis M, Giannoussi E, Maraki S, Tselentis Y, et al. Yersinia enterocolitica infection mimicking surgical conditions. Pediatr Surg Int. 2006 Jul;22(7):589–92.  [PMID:16770604]

Authors

L. Hannah Gould, Cindy R Friedman