Management of Yersinia enterocolitica Infections
Clinical Presentation
- Y. enterocolitica typically causes watery, mucoid or bloody diarrhea, abdominal tenderness, fever, and nausea 1
- Abdominal pain can be particularly severe and may mimic appendicitis, especially in school-aged children who may present with mesenteric adenitis 3, 4
Diagnostic Approach
- Test for Y. enterocolitica in people with persistent abdominal pain and in those with fever who have epidemiologic risk for yersiniosis 3, 4
- Stool culture remains the primary diagnostic method 5
- Blood cultures should be obtained in infants <3 months of age 4, patients with signs of septicemia 5, immunocompromised individuals 2, and those with high-risk conditions like hemolytic anemia 4, 5
Treatment Recommendations
- For mild to moderate disease, treatment options include fluoroquinolones, trimethoprim-sulfamethoxazole, or doxycycline 1, 2
- For severe infections or in immunocompromised patients, the preferred regimen is a third-generation cephalosporin combined with gentamicin 1, 2
- Immunocompromised patients and those with bacteremia should always receive systemic antibiotic treatment 1
- Cancer patients with Y. enterocolitica infections should receive systemic antibiotics due to higher risk of complications 1, 6
Complications and Follow-up
- Gastrointestinal infections with Y. enterocolitica may be followed by reactive arthritis 1
- Rare but serious complications include bacteremia, rectal prolapse, ileus, toxic megacolon, and perforation 1, 2
- Monitoring for these complications with appropriate imaging may be necessary in cases of clinical deterioration 1
Antimicrobial Susceptibility
- Most Y. enterocolitica isolates are susceptible to trimethoprim-sulfamethoxazole, fluoroquinolones, gentamicin, and third-generation cephalosporins like cefotaxime 1, 6