Treatment and prevention of Yersinia enterocolitica and Yersinia pseudotuberculosis infection
- 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
Yersinia species are gram-negative coccobacilli, which are facultative anaerobes . Three species of Yersinia produce human illness: Yersinia pestis (the causative agent of human plague), Yersinia enterocolitica (the causative agent of yersiniosis), and Yersinia pseudotuberculosis. Y. enterocolitica and Y. pseudotuberculosis most commonly cause enterocolitis; Y. enterocolitica is the more common of the two species to cause disease.
The treatment of Y. enterocolitica and Y. pseudotuberculosis infection will be reviewed here. The epidemiology, microbiology, pathogenesis, clinical manifestations, and diagnosis of these infections and issues related to plague are discussed separately. (See "Epidemiology of yersiniosis" and "Microbiology and pathogenesis of Yersinia infections" and "Clinical manifestations and diagnosis of Yersinia infections" and "Epidemiology, microbiology and pathogenesis of plague (Yersinia pestis infection)" and "Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection)".)
Optimal treatment strategies for Yersinia spp infections are unclear. Although treatment appears not to impact mild intestinal disease, fecal shedding decreases following antimicrobial treatment . This by itself does not justify treatment, as person-to-person transmission is rare. However, antimicrobial treatment may be lifesaving in invasive infections.
There has been one controlled trial of antimicrobial therapy for Y. enterocolitica infection and one for Y. pseudotuberculosis gastroenteritis [3,4]. Neither demonstrated a clinical benefit from treatment, though, in both treated groups, the pathogen was rapidly cleared from feces. In addition to these studies, treatment recommendations are based on susceptibility data and clinical case series.
In vitro studies — Yersinia susceptibilities vary with the serotype, and therapeutic decisions should be guided by the susceptibility pattern of the clinical isolate . The Y. enterocolitica serotype most commonly associated with illness (O:3) usually produces chromosomally-mediated beta-lactamases and thus is resistant to penicillin, ampicillin, and most first generation cephalosporins [1,5]. Yersinia is also usually resistant to macrolides.
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