Clinical manifestations and diagnosis of Yersinia infections
- Robert V Tauxe, MD, MPH
Robert V Tauxe, MD, MPH
- Division of Bacterial and Mycotic Diseases
- Centers for Disease Control and Prevention
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
The genus Yersinia includes 11 species, 3 of which are important human pathogens: Yersinia pestis, Yersinia enterocolitica, and Yersinia pseudotuberculosis [1,2]. The yersinioses are zoonotic infections of domestic and wild animals; humans are considered incidental hosts that do not contribute to the natural disease cycle.
Y. enterocolitica and Y. pseudotuberculosis cause yersiniosis, a diarrheal illness; human infection with Y. enterocolitica is much more common than human infection with Y. pseudotuberculosis. The clinical manifestations and diagnosis of these infections will be reviewed here. The epidemiology, microbiology, pathogenesis, and treatment of these infections are discussed separately. (See "Epidemiology of yersiniosis" and "Treatment and prevention of Yersinia enterocolitica and Yersinia pseudotuberculosis infection".)
Y. pestis causes plague and is discussed separately. (See "Epidemiology, microbiology and pathogenesis of plague (Yersinia pestis infection)" and "Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection)".)
Major clinical manifestations include acute yersiniosis (eg, acute febrile gastroenteritis) and pseudoappendicitis syndrome. A variety of complications (both gastrointestinal and extraintestinal) and post-infectious sequelae have also been described, as outlined in the following sections .
Acute yersiniosis — The incubation period for yersiniosis is typically 4 to 6 days (range 1 to 14 days) [4-6].
- Loftus CG, Harewood GC, Cockerill FR 3rd, Murray JA. Clinical features of patients with novel Yersinia species. Dig Dis Sci 2002; 47:2805.
- Butler T. Plague and other Yersinia infections, Plenum Medical Books Co., New York 1983.
- van der Heijden IM, Res PC, Wilbrink B, et al. Yersinia enterocolitica: a cause of chronic polyarthritis. Clin Infect Dis 1997; 25:831.
- Cover TL, Aber RC. Yersinia enterocolitica. N Engl J Med 1989; 321:16.
- Tacket CO, Ballard J, Harris N, et al. An outbreak of Yersinia enterocolitica infections caused by contaminated tofu (soybean curd). Am J Epidemiol 1985; 121:705.
- Lee LA, Gerber AR, Lonsway DR, et al. Yersinia enterocolitica O:3 infections in infants and children, associated with the household preparation of chitterlings. N Engl J Med 1990; 322:984.
- El Qouqa IA, El Jarou MA, Samaha AS, et al. Yersinia enterocolitica infection among children aged less than 12 years: a case-control study. Int J Infect Dis 2011; 15:e48.
- Ostroff SM, Kapperud G, Lassen J, et al. Clinical features of sporadic Yersinia enterocolitica infections in Norway. J Infect Dis 1992; 166:812.
- Tauxe RV, Vandepitte J, Wauters G, et al. Yersinia enterocolitica infections and pork: the missing link. Lancet 1987; 1:1129.
- Marks MI, Pai CH, Lafleur L, et al. Yersinia enterocolitica gastroenteritis: a prospective study of clinical, bacteriologic, and epidemiologic features. J Pediatr 1980; 96:26.
- Naqvi SH, Swierkosz EM, Gerard J, Mills JR. Presentation of Yersinia enterocolitica enteritis in children. Pediatr Infect Dis J 1993; 12:386.
- Feeney GF, Kerlin P, Sampson JA. Clinical aspects of infection with Yersinia enterocolitica in adults. Aust N Z J Med 1987; 17:216.
- Tacket CO, Narain JP, Sattin R, et al. A multistate outbreak of infections caused by Yersinia enterocolitica transmitted by pasteurized milk. JAMA 1984; 251:483.
- Tacket CO, Davis BR, Carter GP, et al. Yersinia enterocolitica pharyngitis. Ann Intern Med 1983; 99:40.
- Gayraud M, Scavizzi MR, Mollaret HH, et al. Antibiotic treatment of Yersinia enterocolitica septicemia: a retrospective review of 43 cases. Clin Infect Dis 1993; 17:405.
- alMohsen I, Luedtke G, English BK. Invasive infections caused by Yersinia enterocolitica in infants. Pediatr Infect Dis J 1997; 16:253.
- Guinet F, Carniel E, Leclercq A. Transfusion-transmitted Yersinia enterocolitica sepsis. Clin Infect Dis 2011; 53:583.
- Centers for Disease Control and Prevention (CDC). Red blood cell transfusions contaminated with Yersinia enterocolitica--United States, 1991-1996, and initiation of a national study to detect bacteria-associated transfusion reactions. MMWR Morb Mortal Wkly Rep 1997; 46:553.
- Amphlett A. Far East scarlet-like fever: A review of the epidemiology, symptomatology, and role of superantigenic toxin: Yersinia pseudotuberculosis-derived mitogen A. Open Forum Infect Dis 2016; 3:1.
- American Academy of Pediatrics. Yersinia enterocolitica and Yersinia pseudotuberculosis infections (Enteritis and other illnesses). In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.868.
- Shorter NA, Thompson MD, Mooney DP, Modlin JF. Surgical aspects of an outbreak of Yersinia enterocolitis. Pediatr Surg Int 1998; 13:2.
- Black RE, Jackson RJ, Tsai T, et al. Epidemic Yersinia enterocolitica infection due to contaminated chocolate milk. N Engl J Med 1978; 298:76.
- Niléhn B, Sjöström B. Studies on Yersinia enterocolitica. Occurrence in various groups of acute abdominal disease. Acta Pathol Microbiol Scand 1967; 71:612.
- Van Noyen R, Selderslaghs R, Bekaert J, et al. Causative role of Yersinia and other enteric pathogens in the appendicular syndrome. Eur J Clin Microbiol Infect Dis 1991; 10:735.
- Puylaert JB, Bodewes HW, Vermeijden RJ, et al. [Bacterial ileocecitis, a "new" disease]. Ned Tijdschr Geneeskd 1991; 135:2176.
- Black RE, Slome S. Yersinia enterocolitica. Infect Dis Clin North Am 1988; 2:625.
- Reed RP, Robins-Browne RM, Williams ML. Yersinia enterocolitica peritonitis. Clin Infect Dis 1997; 25:1468.
- Blinkhorn RJ Jr, Marino JA. Lateral pharyngeal abscess due to Yersinia enterocolitica. Am J Med 1988; 85:851.
- Krogstad P, Mendelman PM, Miller VL, et al. Clinical and microbiologic characteristics of cutaneous infection with Yersinia enterocolitica. J Infect Dis 1992; 165:740.
- Crowe M, Ashford K, Ispahani P. Clinical features and antibiotic treatment of septic arthritis and osteomyelitis due to Yersinia enterocolitica. J Med Microbiol 1996; 45:302.
- Kellogg CM, Tarakji EA, Smith M, Brown PD. Bacteremia and suppurative lymphadenitis due to Yersinia enterocolitica in a neutropenic patient who prepared chitterlings. Clin Infect Dis 1995; 21:236.
- Jaspers CA, Begashaw K. Case report: an unusual presentation of Yersinia enterocolitica infection. Neth J Med 2001; 59:98.
- Leirisalo-Repo M. Yersinia arthritis. Acute clinical picture and long-term prognosis. Contrib Microbiol Immunol 1987; 9:145.
- Ahvonen P. Human yersiniosis in Finland. II. Clinical features. Ann Clin Res 1972; 4:39.
- Vasala M, Hallanvuo S, Ruuska P, et al. High frequency of reactive arthritis in adults after Yersinia pseudotuberculosis O:1 outbreak caused by contaminated grated carrots. Ann Rheum Dis 2014; 73:1793.
- Leirisalo-Repo M, Suoranta H. Ten-year follow-up study of patients with Yersinia arthritis. Arthritis Rheum 1988; 31:533.
- Granfors K, Jalkanen S, von Essen R, et al. Yersinia antigens in synovial-fluid cells from patients with reactive arthritis. N Engl J Med 1989; 320:216.
- Granfors K, Merilahti-Palo R, Luukkainen R, et al. Persistence of Yersinia antigens in peripheral blood cells from patients with Yersinia enterocolitica O:3 infection with or without reactive arthritis. Arthritis Rheum 1998; 41:855.
- Shenkman L, Bottone EJ. Antibodies to Yersinia enterocolitica in thyroid disease. Ann Intern Med 1976; 85:735.
- Bottone EJ. Yersinia enterocolitica: the charisma continues. Clin Microbiol Rev 1997; 10:257.
- Saebø A, Lassen J. Survival and causes of death among patients with Yersinia enterocolitica infection. A Norwegian 10-year follow-up study on 458 hospitalized patients. Scand J Infect Dis 1992; 24:613.
- Long C, Jones TF, Vugia DJ, et al. Yersinia pseudotuberculosis and Y. enterocolitica infections, FoodNet, 1996-2007. Emerg Infect Dis 2010; 16:566.
- Khare R, Espy MJ, Cebelinski E, et al. Comparative evaluation of two commercial multiplex panels for detection of gastrointestinal pathogens by use of clinical stool specimens. J Clin Microbiol 2014; 52:3667.
- Tourdjman M, Ibraheem M, Brett M, et al. Misidentification of Yersinia pestis by automated systems, resulting in delayed diagnoses of human plague infections--Oregon and New Mexico, 2010-2011. Clin Infect Dis 2012; 55:e58.
- Mäki-Ikola O, Heesemann J, Toivanen A, Granfors K. High frequency of Yersinia antibodies in healthy populations in Finland and Germany. Rheumatol Int 1997; 16:227.
- Harnett N, Lin YP, Krishnan C. Detection of pathogenic Yersinia enterocolitica using the multiplex polymerase chain reaction. Epidemiol Infect 1996; 117:59.
- Hoogkamp-Korstanje JA, de Koning J, Samsom JP. Incidence of human infection with Yersinia enterocolitica serotypes O3, O8, and O9 and the use of indirect immunofluorescence in diagnosis. J Infect Dis 1986; 153:138.