Yersiniosis is a zoonotic bacterial disease that takes the form of enteritis, with abdominal pain and often high fever. Infection most often occurs through the consumption of undercooked meat or unpasteurised milk. Diagnosis takes time and treatment is based on the use of antibiotics, usually from the fluoroquinolone group. There are an increasing number of reported cases of Yersinia infection.
Where does yersiniosis come from?
Yesinia enterocolitica is a pathogen that has been identified relatively recently. It belongs to the Yershinia group, gram-negative bacteria belonging to the Enterobacteriaceae family. As many as 12 species of this bacterium have been identified. Among others, the plague bacillus, Yersinia pestis, belongs to this group.
Its main reservoir is animals, and infection in humans occurs through the consumption of infected pork, particularly if the meat is undercooked or raw. The risk of infection exists with the consumption of unpasteurised milk and contaminated water. A few cases of infection have also been described during contact with animals and their faeces (also domestic: cat, dog). When the pathogen enters the intestinal lumen, it travels through the lymphatic vessels to the lymph nodes, usually the mesenteric lymph nodes, causing inflammation, and in extreme cases, a generalised bloodstream infection (septicaemia) can occur.
When to suspect yersiniosis?
The course of the disease is usually sparse or self-limiting - requiring no medical intervention. The most common age group for diagnosis of Yersinia infection is patients aged 0-4 years. The disease can present in a variety of ways. Some of the most common forms include mesenteric lymphadenitis, enteritis, erythema nodosum and arthritis. It can also take the form of food poisoning with the typical symptoms of gastroenteritis (diarrhoea, fever and features of dehydration). Intestinal inflammation is usually of an acute nature, with symptoms dominated by vomiting, profuse diarrhoea (sometimes with an admixture of blood) high fever (even up to 39 C) and severe intra-abdominal pain, which may suggest other acute conditions in children, such as intestinal intussusception or appendicitis. The extreme form of yersiniosis is a bloodstream infection that causes systemic effects in the form of lung abscesses, liver abscesses, osteomyelitis, arthritis and peritonitis. Yersinia infection can also present as a rash resembling the fine-needle rash of scarlet fever.
If diagnosed, how?
Testing for yersiniosis is neither quick nor simple. Diagnosis is mainly based on bacteriological examination of material taken from the patient to identify the pathogenic pathogen. Suspicion of infection can be raised by abdominal ultrasound, during which enlargement of the mesenteric lymph nodes is observed. However, confirmation of infection is still dependent on the identification of bacteria in a specimen taken during endoscopy. In addition, sections are taken during endoscopy for histopathological examination, which serves to differentiate the infection from other inflammatory bowel conditions (Crohn's disease, coeliac disease). A throat swab or blood may also be used for analysis. Serological diagnostics are also performed to identify IgM antibodies suggestive of a recent infection.
photo: panthermedia
Treatment options
Yersinia belongs to a group of bacteria, so treatment is directed towards the use of antibiotic therapy. We have different groups of antibiotics to which the bacterium shows sensitivity. The choice of the appropriate preparation depends on the course of the disease and the child's clinical condition. Usually antibiotics from the fluoroquinolone group are used, but sometimes a combination of several antibiotics is necessary. Various studies are seeking new therapeutic and prophylactic methods that are effective against this pathogen.
Is there anything to fear?
According to epidemiological data, the incidence of yersiniosis is increasing worldwide. Infections occur in highly developed and developing countries. In Poland, there is also an annual increase in new cases of Yersinia enterocolitica infection. Relatively recently, Yersinia enterocolitica first appeared in Poland - in 2002, the first case of infection was reported by the National Hygiene Institute. The symptoms of yersiniosis are not very characteristic and diagnosis can be problematic. Often symptoms such as diarrhoea, vomiting, abdominal pain and fever suggest food poisoning at first, and its most common aetiology in children is rotavirus. Certainly, long-lasting pain accompanied by diarrhoea, high fever and the patient being at an age of increased likelihood of illness should be taken into account in the differential diagnosis of yersiniosis. Diagnosis usually begins with Medical US of the abdomen. However, further diagnosis is not readily available and always feasible. A patient with a strong suspicion of yersiniosis should have an endoscopic examination and microbiological examination of the specimen collected. The increase in the number of new cases of Yersinia infection in children should prompt the initiation of diagnostics for infection with this pathogen.
