Clinical features and diagnosis of Yersinia enterocolitica and Yersinia pseudotuberculosis infection

INTRODUCTION

Yersinia species are gram-negative coccobacilli which are facultative anaerobes [1]. Three species of Yersinia produce human illness: Y. pestis (the causative agent of human plague), Y. enterocolitica, and Y. pseudotuberculosis. Y. enterocolitica causes the infection referred to as yersiniosis. Y. pseudotuberculosis infrequently causes disease in North America, although the spectrum of illnesses is similar to Y. enterocolitica [2].

Contaminated food and water serve as the major routes of transmission of infection to humans for both of these agents [3]. As an example, an outbreak of Y. pseudotuberculosis infection in Finland was traced to consumption of locally grown iceberg lettuce [4]. Sixteen of the 47 patients were hospitalized; five underwent appendectomy and one bacteremic patient died.

The clinical features and diagnosis of Y. enterocolitica and Y. pseudotuberculosis infections will be reviewed here. The microbiology, treatment, and prevention of these infections and issues related to plague are discussed separately. (See "Microbiology of Yersinia enterocolitica and Yersinia pseudotuberculosis" and "Epidemiology of Yersinia enterocolitica infection (yersiniosis)" and "Treatment and prevention of Yersinia enterocolitica and Yersinia pseudotuberculosis infection" and "Microbiology, pathogenesis, and epidemiology of plague (Yersinia pestis infection)" and "Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection)".)

PATHOGENESIS

After oral ingestion, the organism invades the intestinal epithelium using an array of virulence factors [1]. It then localizes to lymphoid tissues of the intestinal mucosa, particularly Peyer's patches, and is carried to regional lymph nodes within the mesentery. These features of infection result in the major clinical manifestations of acute yersiniosis, namely acute gastroenteritis, pseudo-appendicular syndrome, and mesenteric adenitis. (See "Microbiology of Yersinia enterocolitica and Yersinia pseudotuberculosis".)

In some reports, the occurrence of the various clinical syndromes is age dependent. Yersinia septicemia can occur during acute infection, particularly among infants and those with impaired immunity or iron-overload states [5,6]. Experience with transfusion-associated yersiniosis suggests that transient bacteremia may be more common than previously believed, even among otherwise healthy persons [7]. This asymptomatic bacteremia can occur either during or after acute infection. A variety of extraintestinal manifestations related to yersiniosis have been reported. Post-infectious chronic complications of yersiniosis include reactive arthritis alone or with conjunctivitis and urethritis (formerly Reiter syndrome) [8].