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
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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 Type & Select Correct Answer 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 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept