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Updated: Nov 13 2019

Yersinia enterocolitica

  • 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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