Yersiniosis

An infection that is caused by Yersinia enterocolitica or Yersinia pseudotuberculosis, and that is usually acquired by consumption of contaminated meat, water, or unpasteurized milk. It can also be transmitted vertically, pre- or perinatally, from mother to infant. Manifestation of symptoms depends on the infecting species and mode of acquisition, and can range from gastrointestinal syndromes to septicemia

Yersinia enterocolitica

Incidence

• Yersinia enterocolitica causes almost 117,000 illnesses, 640 hospitalizations, and 35 deaths in the United States every year and millions worldwide.
• Children are infected more often than adults, and the infection is more common in the winter.

Cause

Yersiniosis is caused by a facultative anaerobic gram-negative coccobacilli in the genus Yersinia (most commonly Yersinia enterocolitica serogroups O:3; O:5,27; O:8; and O:9).

Symptoms

Symptoms of yersiniosis can vary depending on the age of the person infected.

In young children, common symptoms are

• fever,
• abdominal pain, and
• diarrhea, which is often bloody.

Symptoms in older children and adults may include:

fever and pain on the right side of the abdomen, and may be confused with appendicitis.

Yersinia enterocolitica gram stain

Symptom onset

Symptoms typically develop 4 to 7 days after exposure and may last 1 to 3 weeks or longer.

Clinical features

Incubation period is typically 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 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

Diagnosis is made by isolating the organism from stool, blood, bile, wound, throat swab, mesenteric lymph node, cerebrospinal fluid, or peritoneal fluid. If Yersinia infection is suspected, the clinical laboratory should be notified and instructed to culture on cefsulodin-irgasan-novobiocin (CIN) or other specific for growing it.

Epidemiology

Y. enterocolitica is a relatively infrequent cause of diarrhea and abdominal pain. Infection is more common in winter.

Yersinia enterocolitica colonies on Hektoen enteric (HE) agar

Transmission

Yersinia bacteria can be transmitted by consuming or handling contaminated food, most commonly raw or undercooked pork products; milk or milk products that were not pasteurized, inadequately pasteurized, or contaminated after pasteurization; or untreated water. They can also be transmitted by direct or indirect contact with animals.

Risk groups

Infection with Y. enterocolitica occurs most often in young children.

Laboratory Guidance

• Colonial growth pattern displayed by Yersinia enterocolitica bacteria growing on a blood agar plate (BAP) medium.
• Colonial growth pattern displayed by Yersinia enterocolitica bacteria growing on a blood agar plate (BAP) medium.
• Use of cefsulodin-irgasan-novobiocin (CIN) agar for isolation of Yersinia spp. from nonsterile sites.
• Incubation at 25° C is recommended to prevent loss of the virulence plasmid in Y. enterocolitica.
• In addition, the lower temperature favors the growth of Yersinia over some other members of the Enterobacteriaceae family that can grow on CIN agar.
• Biochemical or molecular tests should be performed on a pure culture for complete identification.

Treatment

• Most infections are self-limited. Antibiotics should be given for severe cases.
• Yersinia 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.
• They are typically resistant to first-generation cephalosporins and most penicillins.
• Antimicrobial therapy has no effect on post infectious sequelae.

Complications

Complications are rare and can include skin rash, joint pains, or spread of bacteria to the bloodstream.

Wash your hands

Prevention

The following tips can help protect you and your family from yersiniosis.

• Avoid eating raw or undercooked pork
• Sliced pork
• Maintain safe minimum cooking temperature for pork
• Drink only pasteurized milk
• Boy drinking milk
• Consume only pasteurized milk and milk products, such as soft cheese, ice cream, and yogurt.

Washing

• Wash hands with soap and water
• washing hands
• Wash hands with soap and water before eating and preparing food, after contact with animals, and after handling raw meat.
• After handling raw chitlins, clean hands and fingernails thoroughly with soap and water before touching infants or their toys, bottles, or pacifiers.

Kitchen practices

• Use separate cutting boards for meat and other foods and carefully clean all cutting boards, countertops, and utensils with soap and hot water after preparing raw meat.

Pets

• Clean up after animals
• Be sure to wash your hands with soap and running water contact with pets and other animals, their poop, or their belongings.

Yersiniosis Resources
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