Updated: 11/13/2019

Yersinia enterocolitica

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Snapshot
  • A 2-year-old girl presents to her pediatrician with 1 week of low-grade fevers, initially watery diarrhea which became bloody today, and abdominal pain. Her parents report that when they saw some blood in the diarrhea, they were alarmed and decided to bring her in. On physical exam, the girl has sunken eyes and dry mucous membranes. Her belly is tender to palpation in the right lower quadrant. A bedside abdominal ultrasound shows a normal appendix. A stool sample is sent for studies. Meanwhile, she is given supportive care for treatment.
Introduction
  • Classification
    • Yersinia enterocolitica 
      • a nonmotile, gram-negative, facultative intracellular bacillus
        • non-lactose fermenting, oxidase negative, and does not produce H2S
      • requires iron as an essential growth factor
      • transmitted via ingestion of contaminated foods
        • unpasteurized milk
        • raw pork or seafood
      • causes gastroenteritis and pseudoappendicitis
  • Epidemiology
    • demographics
      • more common in infants and children
    • risk factors
      • day-care centers
      • drinking or eating unpasteurized milk products
      • iron overload
        • chronic hemolysis
        • hereditary hemochromatosis
  • Pathogenesis
    • the bacteria invade tissue
      • proliferates in Peyer patches
    • produces enterotoxin similar to E. coli heat-stable toxin
  • Associated conditions
    • erythema nodosum
    • reactive arthritis
  • Prognosis
    • typically self-limited
Presentation
  • Symptoms 
    • acute diarrhea
      • may be bloody
    • abdominal pain
      • may be in the right lower quadrant
    • vomiting
  • Physical exam
    • low-grade fever
    • tenderness to palpation of the abdomen
Imaging
  • Abdominal computed tomography (CT)
    • indication
      • suspected appendicitis
    • findings
      • normal appendix
Studies
  • Labs
    • stool studies
      • white blood cells
      • culture
  • Making the diagnosis
    • based on clinical presentation
Differential
  • Acute appendicitis
    • distinguishing factor
      • ultrasound or CT shows enlarged appendix
Treatment
  • Management approach
    • mainstay of treatment is supportive care
    • antibiotics can be used in severe cases or immunocompromised patients
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • hydration
  • Medical
    • aminoglycosides
      • indication
        • first-line for those who need treatment
    • cephalosporins
      • indication
        • second-line
    • trimethoprim-sulfamethoxazole
      • indication
        • second-line
Complications
  • Mesenteric vessel thrombosis and necrotic bowel
  • Intussusception
 

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Questions (2)
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(M1.MC.15.6001) A 4-year-old male presents to the pediatrician with a one week history of fever, several days of bloody diarrhea, and right-sided abdominal pain. The mother explains that several other children at his son's pre-K have been having similar symptoms. She heard the daycare owner had similar symptoms and may have her appendix removed, but the mother claims this may just have been a rumor. Based on the history, the pediatrician sends for an abdominal ultrasound, which shows a normal vermiform appendix. She then sends a stool sample for culturing. The cultures demonstrate a Gram-negative bacteria that is motile at 25 C but not at 37 C, non-lactose fermenter, and non-hydrogen sulfide producer. What is the most likely causative agent? Tested Concept

QID: 106942
1

Yersinia enterocolitica

69%

(45/65)

2

Enterotoxigenic E. coli

12%

(8/65)

3

Vibrio cholerae

12%

(8/65)

4

Clostridium perfringens

5%

(3/65)

5

Rotavirus

2%

(1/65)

L 2 E

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