Yersiniosis: A Clinical Overview for Health Care Providers

A summary of CDC's clinical overview for health care providers.

The organism

Yersinia species are facultatively anaerobic, gram-negative coccobacilli. Yersiniosis is caused most often by Yersinia enterocolitica (serogroups O:3, O:5,27, O:8 and O:9), and also by Y. pseudotuberculosis. The term does not include plague, caused by Y. pestis.

Who is at risk

• Young children, in whom Y. enterocolitica infection is most common.
• People with high iron levels — from diseases such as hemochromatosis or thalassemia, including those on iron chelation therapy — who are at greater risk of infection and of severe disease.

Yersinia can spread from hands to infants and toddlers, so parents should always wash their hands well after preparing food and before touching a child or the child's bottles, pacifiers or toys.

Presentation

The incubation period is typically 4 to 6 days (range 1 to 14), and onset may be more gradual than with other enteric pathogens. Enterocolitis is the most common presentation:

• abdominal pain;
• diarrhoea, which can be bloody and can last several weeks;
• fever;
• sore throat, particularly in children.

Mesenteric adenitis, with pain mimicking appendicitis, is well described.

Diagnosis

The organism is usually isolated from stool, blood, bile, cerebrospinal fluid, mesenteric lymph nodes, peritoneal fluid, a throat swab or wounds. If yersiniosis is suspected, tell the laboratory: cold enrichment, alkali treatment or plating on CIN agar make a positive culture more likely.

Treatment

• Most infections resolve on their own and can be managed symptomatically; rehydrate patients with profuse diarrhoea.
• Consider antibiotics for severe infections. Y. enterocolitica isolates are usually susceptible to aminoglycosides, third-generation cephalosporins, fluoroquinolones, tetracyclines and trimethoprim-sulfamethoxazole, and resistant to first-generation cephalosporins and most penicillins. Antibiotics do not affect post-infectious complications.
• Antimotility agents should be avoided in bloody diarrhoea, and treatment reassessed if symptoms have not improved within 48 hours. No known data show that kaolin-pectin compounds or lactobacillus slow diarrhoea or relieve cramping.

Published clinical practice guidelines for the diagnosis and management of infectious diarrhoea give further guidance.

Complications

• Necrotizing enterocolitis has been described in infants.
• Reactive arthritis of the wrists, knees and ankles, usually about 1 month after the diarrhoea, resolving in 1 to 6 months.
• Erythema nodosum — painful raised red or purple lesions on the trunk and legs — usually resolving on its own within 1 month.

Sources

• Centers for Disease Control and Prevention, "Clinical Overview of Yersiniosis." https://www.cdc.gov/yersinia/hcp/clinical-overview/index.html
• Corrected: "yersinosis" (yersiniosis). The photograph of a Yersinia culture is not reproduced.
• Rewritten in hubnx's own words.