Yersiniosis

Yersinosis is an inflammatory gastroenteritis with a usual incubation period of 4-6 days. Food sources include milk, tofu, undercooked pork, and pork intestines (chitterlings). Contaminated water is another source of infection.

CASES/YEAR
96,368 (US); 1,927,360 (Global)
AGENT TYPE
Bacteria
OTHER NAMES
Yersinia enterocolitica; Yersinia pseudotuberculosis;
ACUITY
Acute-Moderate
INCUBATION
4-6 days (range of 1-14 days); [CDC Travel]
INITIAL SYMPTOMS
Diarrhea, abdominal pain, and fever; Blood and leukocytes may be present in the stool; Mesenteric adenitis or terminal ileitis may present as pseudoappendicitis; [PPID, p. 2790-1]
PRECAUTIONS
Standard; "Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks." [CDC 2007 Guideline for Isolation Precautions]
COMMENTS
FINDINGS:
May cause acute mesenteric lymphadenitis with a syndrome similar to acute appendicitis (pseudoappendicitis); Bloody diarrhea may occur. Diarrhea may be absent in up to 1/3 of patients infected with Y. enterocolitica. Complications include erythema nodosum and reactive arthritis. Sepsis is usually reported in patients with iron overload or immunosuppression. [CCDM, p. 689-91] Most patients have acute gastroenteritis lasting 1-3 weeks. Some patients present with pharyngitis and fever. About 3% of patients with Y. enterocolitica infections develop erythema nodosum, typically on the legs and 2 weeks after the abdominal symptoms. Y. pseudotuberculosis infections usually present as mesenteric lymphadenitis or pseudoappendicitis. Some strains of Y. pseudotuberculosis can produce superantigens and a toxic shock illness. [PPID, p. 2790-1] Septicemia precedes complications such as abscesses, skin infections, pneumonia, meningitis, endocarditis, osteomyelitis, and panophthalmitis. Other sequelae are myocarditis, glomerulonephritis, and uveitis. [ID, p. 657]

EPIDEMIOLOGY:
Food sources include milk, tofu, undercooked pork, and pork intestines (chitterlings). Contaminated water is another source of infection. Natural reservoirs are swine for Y. enterocolitica and birds, rodents, and other small mammals for Y. pseudotuberculosis. Cases have been associated with sick puppies and kittens. Transmission by transfusion and sick patients has been reported. [CCDM, p. 690] Y. enterocolitica is frequently present in the intestines of pigs. It can grow at refrigerator temperature. [PPID, p. 2789] Outbreaks in former USSR were linked to root vegetables contaminated with rodent excreta. [Cecil, p. 1959]
DIAGNOSTIC
Blood and stool cultures; Also cultures of mesenteric lymph nodes and pharyngeal exudate; Serology (limited); Multiplex gastrointestinal molecular assays; [ABX Guide]
SCOPE
Most common in northern Europe (Scandinavia), Japan, and Canada; [CDC Travel]
SIGNS & SYMPTOMS
  • >arthralgia
  • >fever
  • E pharyngitis
  • G abdominal pain
  • G blood in stool
  • G diarrhea
  • G fecal leukocytes
  • G nausea, vomiting
  • H leukocytosis
  • N headache
  • S pustule
  • S rash (exanthem)
  • S skin blister or vesicles
  • *arthritis
  • *endocarditis
  • *erythema nodosum
  • *glomerulonephritis
  • *meningitis
  • *myocarditis
  • *osteomyelitis
  • *pneumonia
  • *sepsis
  • *shock
  • *uveitis
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Ingestion, Needle (Includes Drug Abuse), Scalpel or Transfusion
SOURCE
Person-to-Person, Human Fecal-Oral, Animal Excreta, Eating Contaminated Food, Eating Contaminated or Infected Meat, Eating Unpasteurized Milk or Cheese, Eating Contaminated Produce, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Cats, Deer, Elk and Antelope, Dogs, Horses, Rabbits, Rodents, Swine, Wild Animals
RISK FACTORS
  • Care for patients (fecal-oral pathogens)
  • Consume unpasteurized milk/cheese
  • Eat undercooked meat or fish
  • Have a blood transfusion
  • Have dog or cat contact (fecal-oral)
  • Ingest infectious agents in food/water
  • Work in a medical or research lab
REFERENCES FOR CASES/YEAR
1. (US) Estimated 96368 cases in 1997; [Mead1999: PMID 10511517]
2. (Global) Third most common foodborne agent after Campylobacter and Salmonella in Belgium and the Netherlands; In Belgium 305 cases in 1975, 1,469 cases in 1986 and then reduced numbers thought to be due to changing butchering practices; [Gorbach, p. 410] 13-52 infections/year (Y. enterocolitica and other Y. species) reported in England & Wales from 2002-2012; [Public Health England website] Estimate global cases/yr at 20 X US cases/yr;