Imaging studies e. Diagnosis may also be obtained from positive cultures obtained from mesenteric lymph nodes, pharyngeal exudates, peritoneal fluid, or blood. Polymerase chain reaction and immunofluorescence assays have been developed but not widely used.
Colonoscopy is not usually done but when performed, it may reveal aphthoid lesions and ulcers in the terminal ileum. In most cases, the right side of the bowel is involved. The treatment of Yersinia is supportive care with hydration and nutritional support. The drugs of choice are the aminoglycosides or trimethoprim-sulfamethoxazole. Other effective agents include tetracycline not in children , quinolones and cephalosporins.
Sometimes surgery is required to drain an abdominal abscess, and surgical exploration is warranted if appendicitis cannot be ruled out. It is important to note that in many cases, pseudoappendicitis and appendicitis cannot be differentiated on a clinical exam or even with imaging. Thus, some patients undergo surgery for removal of an appendix.
In such scenarios, the appendix is found to be normal, but there is localized mesenteric adenitis, which is confirmed by the pathologist. Antimotility agents should be avoided in patients with diarrhea, as they may worsen the infection. Antibiotics should be used only in selected patients such as the elderly, immunocompromised individuals or patients with diabetes. Children may need admission for dehydration or sepsis. Most patients are anorexic and may require an overnight admission for intravenous IV hydration.
In some cases, patients are admitted because it is not possible to rule out appendicitis. The preventive measures include handwashing after exposure to an exposed animal, safe food processing, avoiding raw consumption of pork and products, routine water treatment and disinfection, and screening for the pathogen in blood and blood products. Diagnosis depends on a detailed history, detailed physical examination and supportive laboratory and radiological findings.
Diseases that can present in a similar include:. Yersiniosis generally has a favorable outcome. A study from the United States reported only 1. In another study from Norway, only 2 deaths were reported from patient diagnosed with yersiniosis. Conditions that cause hemolysis and release iron increase the risk of systemic infection. In addition, use of deferoxamine also enhances the risk of Yersinia enterocolitis. Patients presenting with appendicitis needs evaluation by general surgery for surgical exploration to evaluate the etiology.
Patients should be counseled regarding hydration and electrolyte intake if they have uncomplicated diarrhea that can be observed. Education including proper food processing, handwashing, and avoidance of raw pork products should be done to prevent infection. Over the past few decades, yersinia infections have become very common with epidemics reported in many parts of the globe.
Since the majority of patients with yersinia infection present to the emergency department, nurses and emergency dept physicians should be aware of the presentation, diagnosis, and management. While most patients do improve with hydration, some may require antibiotics. The public health nurse should be involved when there is an epidemic because education of the public is vital.
The key to prevention is to educate the patients on the importance of handwashing and maintenance of personal hygiene. Travelers to endemic areas should be told to wash all fruit and vegetables and avoid consuming unpasteurized milk. For those patients who are hospitalized, nurses should ensure that enteric precautions are in place.
This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 University of Toledo Medical Center.
Continuing Education Activity In order to improve health outcomes for patients, practitioners should recognize that yersinia enterocolitica has an acute diarrheal form of infection as well as pseudoappendicitis which mimics appendicitis both requiring different treatment strategies. Introduction Yersinia enterocolitica is a gram-negative bacillus shaped bacterium that causes a zoonotic disease called yersiniosis.
Etiology The genus Yersinia includes 11 species, of which 3 are notable for causing human diseases: Yersinia pestis, Yersinia enterocolitica, and Yersinia pseudotuberculosis. Epidemiology Y. Pathophysiology Infection is transferred predominantly through the fecal-oral route. History and Physical Yersinia infections can present with enterocolitis, pseudoappendicitis, reactive arthritis, sepsis, pharyngitis, myocarditis, mesenteric adenitis or dermatitis.
Clinically the infection can manifest in 2 ways: Acute Yersiniosis This condition manifests as diarrhea, abdominal pain, nausea, vomiting, and fever. Pseudoappendicitis Acute yersiniosis can mimic appendicitis and present with right lower quadrant abdominal pain, fever, vomiting, elevated white blood count, and diarrhea.
Evaluation The blood work is usually unremarkable, but in severe cases of diarrhea, one may observe hypernatremia and hypokalemia. Differential Diagnosis Diagnosis depends on a detailed history, detailed physical examination and supportive laboratory and radiological findings.
Diseases that can present in a similar include: Acute diarrhea secondary viral, bacterial, protozoal, fungal organisms. Prognosis Yersiniosis generally has a favorable outcome.
However, yersinia does have other morbidity that includes: Pseudoappendicitis. Complications Complications related to Yersiniosis include: Gastrointestinal Bowel perforation.
Consultations Patients presenting with appendicitis needs evaluation by general surgery for surgical exploration to evaluate the etiology. Deterrence and Patient Education Patients should be counseled regarding hydration and electrolyte intake if they have uncomplicated diarrhea that can be observed. The prevalence of ail, ystA and ystB genes in Yersinia enterocolitica biotype 1B, 2—4 isolates from game animals. Most controlled hunting zones in Poland are situated in large forests which occupy vast parts of the country, except central Poland.
Free-living animals seem to play an important role in the epidemiology of yersiniosis. It should be noted that the consumption of game meat increases the risk of foodborne diseases [14,17,22]. There is a general scarcity of published data on the prevalence of foodborne infec- tions caused by the consumption of game meat contaminated with Y. However, the pathogen can contaminate the carcasses of infected game animals when the intestines are damaged by shot pellets or during evisceration.
The contamination of game meat with Y. Bucher et al. Avagnina et al. In Poland, Bancerz-Kisiel et al. Relatively little is known about the occurrence of Y. According to some studies, wild boars are a significant reservoir of strains patho- genic to humans [14,22,26—28]. Serological investigations in northeastern Germany and Swit- zerland demonstrated the presence of antibodies against Yersinia spp. Bacteriological analyses conducted by von Altrock [28] revealed the presence of Y.
Our study demonstrated that other species of game animals, including red deer, roe deer and fallow deer, can also be a source of infections of Y. The highest number of positive samples was found in wild boars Pigs are the natural hosts and reservoirs of the discussed pathogen.
However, signifi- cant percentages of Y. These findings provide evi- dence that wild boars are not the only species of game animals that play a role in dissemination of Y. Most isolates were classified as BT1A Similar results were observed by other researchers [17,27,28] and in our previous study into Y. However, we also detected 18 isolates 0. In Europe, the most common pathogenic bio-serotypes isolated in clinical cases of yersiniosis are serotypes O:9 and O The pathogenic characteristics of 3 isolates were confirmed by molecular analysis which revealed the presence of ail and ystA genes Table 4.
In , cases of yersiniosis were recorded in Poland. The incidence rate was 0. The clinical significance of Y.
Until recently, BT1A strains were defined as non-pathogenic. In recent years, they have been increasingly isolated from clinical cases of yersiniosis, although in some cases, the symptoms of yersiniosis were not specific and could be caused by another pathogen [7—9]. However, there is clinical evidence that selected BT1A strains of Y.
Little is known about the pathogenic mechanisms of disease caused by Y. This bio-serotype is rare, and it is isolated mainly in North America. In Poland, the prevalence of yersiniosis has increased gradually since , and in O:8 strains of Y. The res- ervoir of Y.
However, our isolate harbored only the ystB gene Table 4. In some cases, the results were ambiguous and required replication. Virulence markers were quickly and reliably identi- fied by PCR, but the results were difficult to interpret when ail and ystB were detected simulta- neously. Therefore, both methods should be used to Y. The isolation and characterization of Y. The method applied in the present study is useful for isolating Y. In this study, virulence markers ail, ystA and ystB were amplified in a molecular analysis to determine the pathogenicity of isolates.
More importantly, this procedure was applied to con- firm and verify the results of the bacteriological methods. The amplification of the ail gene is particularly useful for determining the virulence properties of Y.
Our results confirm the high prevalence of Y. Red deer appear to be more susceptible to Y. The prevalence of the identified virulence factors and the bio-serotype affilia- tion of the isolates from game animals inhabiting different Polish regions clearly indicate that Y. Supporting information S1 Table. Primer sequences for amplifying the ail, yst A and yst B genes.
Biochemical tests used for biotyping Yersinia enterocolitica isolates. Funding acquisition: Gulzhan Chuzhebayeva. Resources: Joanna Pajdak-Czaus. Software: Anna Szczerba-Turek. References 1. Bottone EJ. Yersinia enterocolitica: the charisma continues. Clin Microbiol Rev. PMID: 2. Yersinia enterocolitica monographic study. J Anim Sci Biotechnol.
Wren BW. The Yersiniae—a model genus to study the rapid evolution of bacterial pathogens. Nat Rev Microbiol. Revised biogrouping scheme of Yersinia enterocolitica. Contrib Microbiol Immunol. PMID: 6. Wauters G. Antigens of Yersinia enterocolitica. In: Yersinia enterocolitica. Bottone E. Symptoms and sources of Yer- sinia enterocolitica-infection: a case-control study.
BMC Infect Dis. Pathogenicity of Yersinia enterocolitica biotype 1A. Facebook Twitter LinkedIn Syndicate. Yersinia enterocolitica Yersiniosis Minus Related Pages. For Healthcare Professionals. Making Chitlins? Links with this icon indicate that you are leaving the CDC website.
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