Yersinia enterocolitica: Difference between revisions

Latest revision as of 17:51, 9 August 2023

Background

Microbiology

Gram-negative bacillus
Serogroup O:3 and O:9 have a less effective siderophore that requires presence of iron overload or iron chelation to be invasive

Epidemiology

Acquired from unpasteurized milk, undercooked meat (especially pork), contaminated water
- Classic association with chitterlings

Risk Factors

Iron overload
Treatment with iron chelators, including deferoxamine
Can be acquired from blood transfusion

Clinical Manifestations

Incubation period of 1 to 14 days
Classically causes gastroenteritis
- Fever with blood diarrhea, vomiting
- May cause terminal ileitis, which causes right lower quadrant pain mimicking appendicitis (pseudoappendicitis)
Concurrent pharyngitis in 20%, can can be isolated from throat swabs
Complications include bacteremia, with hematogenous dissemination with metastatic abscesses in the liver and spleen and mesenteric adenitis
Can also cause pneumonia, septic arthritis, meningitis, panophthalmitis, cellulitis, empyema, osteomyelitis, and infective endocarditis or mycotic aneurysm
- More common in immunodeficiency or iron overload
Can lead to post-infectious reactive arthritis, erythema nodosum, and glomerulonephritis

Management

Stop deferoxamine, if taking
Unclear if antimicrobial treatment is beneficial unless severe
Antibiotics are generally indicated in:
- Severe disease
- Extraintestinal disease, including meningitis, cellulitis, pneumonia, osteomyelitis, and endocarditis
- High risk populations, including the elderly, people with diabetes, people with cirrhosis, and immunocompromised patients
Options include ciprofloxacin, ceftriaxone, TMP-SMX, doxycycline, and aminoglycosides
- Duration typically 7 to 14 days

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 ==Background==
+=== Microbiology ===
-*[[Stain::Gram-negative]] [[Cellular shape::bacillus]]
+*[[Stain::Gram-negative]] [[Shape::bacillus]]
+*Serogroup O:3 and O:9 have a less effective siderophore that requires presence of iron overload or iron chelation to be invasive
+=== Epidemiology ===
 *Acquired from unpasteurized milk, undercooked meat (especially pork), contaminated water
 **Classic association with chitterlings
+=== Risk Factors ===
+* Iron overload
+* Treatment with iron chelators, including [[deferoxamine]]
+* Can be acquired from blood transfusion
 ==Clinical Manifestations==
-*Incubation period of [[Usual incubation period:1 to 14 days]]
+*Incubation period of [[Usual incubation period::1 to 14 days]]
+*Classically causes [[Causes::gastroenteritis]]
-*[[Causes::Gastroenteritis]], often with pain isolated to right lower quadrant mimicking appendicitis
+**Fever with blood diarrhea, vomiting
+**May cause [[Causes::terminal ileitis]], which causes right lower quadrant pain mimicking [[appendicitis]] ([[Causes::pseudoappendicitis]])
 *Concurrent [[Causes::pharyngitis]] in 20%, can can be isolated from throat swabs
-*Complications include hematogenous dissemination with metastatic abscesses in the [[Causes::liver abscess|liver]] and [[Causes::splenic abscess|spleen]], [[Causes::mesenteric adenitis]], [[Causes::terminal ileitis]], and [[Causes::pseudoappendicitis]]
+*Complications include [[Causes::bacteremia]], with hematogenous dissemination with metastatic abscesses in the [[Causes::liver abscess|liver]] and [[Causes::splenic abscess|spleen]] and [[Causes::mesenteric adenitis]]
+*Can also cause [[Causes::pneumonia]], [[Causes::septic arthritis]], [[Causes::meningitis]], [[Causes::panophthalmitis]], [[Causes::cellulitis]], [[Causes::empyema]], [[Causes::osteomyelitis]], and [[Causes::infective endocarditis]] or [[Causes::mycotic aneurysm]]
-*Can lead to [[Causes::reactive arthritis]] and [[Causes::erythema nodosum]]
+**More common in immunodeficiency or iron overload
+*Can lead to post-infectious [[Causes::reactive arthritis]], [[Causes::erythema nodosum]], and [[Causes::glomerulonephritis]]
 ==Management==
+*Stop [[deferoxamine]], if taking
 *Unclear if antimicrobial treatment is beneficial unless severe
-*Generally indicated in:
+*Antibiotics are generally indicated in:
 **Severe disease
 **Extraintestinal disease, including [[meningitis]], [[cellulitis]], [[pneumonia]], [[osteomyelitis]], and [[endocarditis]]
 **High risk populations, including the elderly, people with [[diabetes]], people with [[cirrhosis]], and immunocompromised patients
 *Options include [[Is treated by::ciprofloxacin]], [[Is treated by::ceftriaxone]], [[Is treated by::TMP-SMX]], [[Is treated by::doxycycline]], and [[Is treated by::aminoglycosides]]
+**Duration typically 7 to 14 days
 [[Category:Gram-negative bacilli]]