Yersinia enterocolitica: Difference between revisions

Latest revision as of 04:38, 30 March 2025

Yersinia is a genus of Gram-negative bacteria that contains 11 known species. Among them, four are pathogenic, but only Yersinia enterocolitica and Yersinia pseudotuberculosis are commonly associated with gastroenteritis in humans.

Overview[edit]

Both Y. enterocolitica and Y. pseudotuberculosis are small, rod-shaped, facultatively anaerobic bacteria. They are significant causes of diarrheal disease and share similar mechanisms of infection and transmission.

Transmission[edit]

These bacteria are primarily transmitted through the fecal–oral route, typically via the ingestion of contaminated food or water.

Y. enterocolitica and Y. pseudotuberculosis have been isolated from a range of animal reservoirs including:

Pigs
Birds
Beavers
Cats and Dogs
(For Y. enterocolitica): Frogs, flies, and fleas

Environmental sources such as soil and untreated water (e.g., ponds and lakes) have also been implicated in the spread of Y. enterocolitica. However, most strains isolated from these environments are considered non-pathogenic.

Pathogenesis[edit]

Mortality: Rarely fatal.
Infective dose: Estimated to be between 10⁴ to 10⁶ organisms.
Incubation period: Typically 1 to 11 days, but in rare cases, it can last up to several months.
Entry: Oral ingestion of contaminated food or water.

Once inside the host, the bacteria colonize the intestinal mucosa and release enterotoxins and cytotoxins that cause tissue damage and inflammation.

Symptoms[edit]

Yersinia enterocolitica

Yersinia enterocolitica

Infection with Y. enterocolitica typically presents as a self-limiting diarrheal illness, most commonly in children under the age of 5.

Common symptoms include:

Diarrhea (sometimes bloody stool)
Vomiting
Fever
Abdominal pain (especially in the right lower quadrant)
Headache
Sore throat

The illness mimics appendicitis and mesenteric lymphadenitis. It can also manifest in other sites such as wounds, joints, and the urinary tract.

Duration: Ranges from a few days to three weeks. In chronic cases, chronic enterocolitis may persist for several months.

Complications[edit]

While the primary infection is self-limited, a small number of patients may develop:

Reactive arthritis (especially in individuals with HLA-B27)
Glomerulonephritis
Endocarditis
Erythema nodosum (more common in women)
Uveitis
Graves' disease, hyperthyroidism, nontoxic goiter, Hashimoto's thyroiditis
Bacteremia (rare)

In Japan, Y. pseudotuberculosis has been associated with the development of Kawasaki disease.

Reactive Arthritis[edit]

Post-infectious arthritis occurs in 2–3% of yersiniosis cases. It may present without obvious gastrointestinal symptoms. The arthritis usually affects large joints and can be mistaken for rheumatic disease.

Diagnosis[edit]

Diagnosis is confirmed through:

Treatment[edit]

Most cases resolve with supportive care such as fluid and electrolyte replacement. However, in cases of sepsis or invasive infection, treatment may include:

Prevention[edit]

Preventive measures include:

Proper food handling and cooking
Avoidance of unpasteurized dairy products
Handwashing after contact with animals or soil

@@ Line 1: / Line 1: @@
-The Yersinia genus has 11 species;
+[[File:Yersinia enterocolitica 01.png|alt=Yersinia enterocolitica|thumb|''Yersinia enterocolitica'']]
-are pathogenic, but only Y. enterocolitica and Y. pseudotuberculosis cause gastroenteritis. Y. enterocolitica and Y. pseudotuberculosis are small, rod-shaped, Gram-negative bacteria.
+'''Yersinia''' is a genus of [[Gram-negative bacteria]] that contains 11 known species. Among them, four are pathogenic, but only '''''Yersinia enterocolitica''''' and '''''Yersinia pseudotuberculosis''''' are commonly associated with [[gastroenteritis]] in humans.
-[[File:Yersinia enterocolitica 01.png|alt=Yersinia enterocolitica |thumb|Yersinia enterocolitica ]]
+== Overview ==
+Both ''Y. enterocolitica'' and ''Y. pseudotuberculosis'' are small, rod-shaped, [[facultatively anaerobic]] bacteria. They are significant causes of [[diarrheal disease]] and share similar mechanisms of infection and transmission.
 == Transmission ==
-Both pathogens are transmitted through the fecal-oral route.
+These bacteria are primarily transmitted through the [[fecal–oral route]], typically via the ingestion of contaminated [[food]] or [[water]].
-Both of these gastroenteritis-causing species have been isolated from animals, such as pigs, birds, beavers, cats, and dogs, and, in the case of Y. enterocolitica, frogs, flies, and fleas. Y. enterocolitica has been detected in environmental sources, such as soil and water (e.g., ponds and lakes).
-Most isolates are not pathogenic.
+''Y. enterocolitica'' and ''Y. pseudotuberculosis'' have been isolated from a range of [[animal]] reservoirs including:
+* [[Pig]]s
+* [[Bird]]s
+* [[Beaver]]s
+* [[Cat]]s and [[Dog]]s
+* (For ''Y. enterocolitica''): [[Frog]]s, [[Fly|flies]], and [[flea]]s
+Environmental sources such as [[soil]] and untreated [[water]] (e.g., [[pond]]s and [[lake]]s) have also been implicated in the spread of ''Y. enterocolitica''. However, most strains isolated from these environments are considered non-pathogenic.
 <youtube>
-title='''{{PAGENAME}}'''
+title='''Yersinia enterocolitica'''
 movie_url=http://www.youtube.com/v/J9ngjURZ1Lg
 &rel=1
@@ Line 19: / Line 29: @@
 == Pathogenesis ==
-Mortality: Fatalities are extremely rare.
+[[File:3D computer generated image of Yersinia enterocolita.jpg|alt=3D image of Yersinia enterocolitica|thumb|3D image of ''Yersinia enterocolitica'']]
+* '''Mortality''': Rarely fatal.
-Infective dose: The medium infective dose for humans is not known, but is estimated to be between 104 to 106 organisms.
+* '''Infective dose''': Estimated to be between 10⁴ to 10⁶ organisms.
+* '''Incubation period''': Typically 1 to 11 days, but in rare cases, it can last up to several months.
-The infective dose and clinical presentation of symptoms may depend on pathogen (strain-dependent) and host factors. For example, in some cases, in people with gastric hypoacidity, the infective dose may be lower.
+* '''Entry''': Oral ingestion of contaminated food or water.
-Onset: Incubation times from 1 to 11 days have been observed, but occasionally last for several months.
-Illness / complications: In some patients, complications arise due to the strain type causing the initial infection and specific human immunologic leukocyte antigen, HLA-B27.
-These sequelae include reactive arthritis; glomerulonephritis; endocarditis; erythema nodosum (which occurs predominantly in women); uveitis; thyroid disorders, such as Graves’ disease; hyperthyroidism; nontoxic goiter; and Hashimoto’s thyroiditis.
-[[File:3D computer generated image of Yersinia enterocolita.jpg|alt=3D computer generated image of Yersinia enterocolita|thumb|3D computer generated image of Yersinia enterocolita]]
-== Reactive arthritis ==
-Y. enterocolitica has been associated with reactive arthritis, which may occur even in the absence of obvious symptoms.
-The frequency of such postenteritis arthritic conditions is about 2% to 3%.
-In Japan, Y. pseudotuberculosis was implicated in the etiology of [[Kawasaki’s disease]].
-Another complication is bacteremia, which raises the possibility of disease dissemination. However, this is rare. Performance of unnecessary appendectomies also may be considered a major complication of yersiniosis, as one of the main symptoms of the disease is abdominal pain in the lower right quadrant.
-== Treatment ==
+Once inside the host, the bacteria colonize the [[intestinal mucosa]] and release [[enterotoxins]] and [[cytotoxins]] that cause tissue damage and inflammation.
-Treatment includes supportive care, since the gastroenteritis is self-limiting. If septicemia or other invasive diseases occur, antibiotic therapy with gentamicin or cefotaxime (doxycycline and ciprofloxacin) typically are administered.
 == Symptoms ==
-Infection with Y. enterocolitica manifests as nonspecific, self-limiting diarrhea, but may cause a variety of autoimmune complications, as noted above. Most symptomatic infections occur in children younger than 5 years old. Yersiniosis in these children is frequently characterized as gastroenteritis, with diarrhea and/or vomiting; however, fever and abdominal pain are the hallmark symptoms. A small proportion of children (less than 10%) produce bloody stools. Children usually complain of abdominal pain and headache and sore throat at the onset of the illness. Yersinia infections mimic appendicitis and mesenteric lymphadenitis, but the bacteria may also cause infection in other sites, such as wounds, joints, and the urinary tract.
+[[File:Figure 6 (7245535388).png|alt=Yersinia enterocolitica|thumb|''Yersinia enterocolitica'']]
-[[File:Figure 6 (7245535388).png|alt=Yersinia enterocolita|thumb|Yersinia enterocolita]]
+Infection with ''Y. enterocolitica'' typically presents as a self-limiting [[diarrheal]] illness, most commonly in [[children]] under the age of 5.
-Duration: The illness might last from a few days to 3 weeks, unless it becomes chronic enterocolitis, in which case it might continue for several months. 	 Route of entry: Oral.
-Pathway: As zoonotic pathogens, Y. enterocolitica and Y. pseudotuberculosis enter the gastrointestinal tract after ingestion of contaminated food or water. Gastric acid is a significant barrier to infection.
+'''Common symptoms include''':
-'''Duration''':  The illness might last from a few days to 3 weeks, unless it becomes chronic enterocolitis, in which case it might continue for several months.
+* [[Diarrhea]] (sometimes [[bloody stool]])
+* [[Vomiting]]
+* [[Fever]]
+* [[Abdominal pain]] (especially in the right lower quadrant)
+* [[Headache]]
+* [[Sore throat]]
-===Route of entry===
+The illness mimics [[appendicitis]] and [[mesenteric lymphadenitis]]. It can also manifest in other sites such as [[wound]]s, [[joint]]s, and the [[urinary tract]].
-Oral.
-'''Pathway''': As zoonotic pathogens, ''Y. enterocolitica'' and ''Y. pseudotuberculosis'' enter the gastrointestinal tract after ingestion of contaminated food or water.
+'''Duration''': Ranges from a few days to three weeks. In chronic cases, [[chronic enterocolitis]] may persist for several months.
-Gastric acid is a significant barrier to infection. The infective dose might be lower among people with gastric hypoacidity.
-Both pathogens harbor plasmid (pYV)-encoded virulence genes that affect pathogenesis. These include an outer-membrane protein, YadA (''Yersinia'' adhesion A), and the genetic suite comprising the type III secretory system. This process usually is facilitated by Yops proteins, which contribute to the ability of ''Y. enterocolitica'' cells to resist phagocytosis by causing disruption (cytotoxic changes) of mammalian (human) cells. [[File:Yersinia enterocolitica in SIM Agar1 125.jpg|alt=Yersinia enterocolitica in SIM Agar1 125|thumb|Yersinia enterocolitica in SIM Agar1 125]]
-'''3.'''  '''Frequency'''
+== Complications ==
+While the primary infection is self-limited, a small number of patients may develop:
+* [[Reactive arthritis]] (especially in individuals with [[HLA-B27]])
+* [[Glomerulonephritis]]
+* [[Endocarditis]]
+* [[Erythema nodosum]] (more common in women)
+* [[Uveitis]]
+* [[Graves' disease]], [[hyperthyroidism]], [[nontoxic goiter]], [[Hashimoto's thyroiditis]]
+* [[Bacteremia]] (rare)
-Yersiniosis is far more common in Northern Europe, Scandinavia, and Japan than in the United States. It does not occur frequently and tends to be associated with improper food-processing techniques. ''Y. enterocolitica'' is a more frequent cause of yersiniosis than is    ''Y. pseudotuberculosis'', and cases have been reported on all continents. Different biotypes of       ''Y. enterocolitica'' have been associated with infections around the world, with the most common biotype being 4/O:3. Information on ''Y. pseudotuberculosis'' is not as well defined and, as such, is reported less frequently than is ''Y. enterocolitica''.
+In Japan, ''Y. pseudotuberculosis'' has been associated with the development of [[Kawasaki disease]].
-'''4.'''  '''Sources'''
+== Reactive Arthritis ==
+Post-infectious [[arthritis]] occurs in 2–3% of yersiniosis cases. It may present without obvious gastrointestinal symptoms. The arthritis usually affects large joints and can be mistaken for [[rheumatic disease]].
-Strains of ''Y. enterocolitica'' can be found in meats (pork, beef, lamb, etc.), oysters, fish, crabs, and raw milk. However, the prevalence of this organism in soil, water, and animals, such as beavers, pigs, and squirrels, offers many opportunities for ''Yersinia'' to enter the food supply. For example, poor sanitation and improper sterilization techniques by food handlers, including improper storage, may be a source of contamination. Raw or undercooked pork products have drawn much attention as a source of ''Y. enterocolitica'', and ''Y. pseudotuberculosis'', particularly since ''Y. enterocolitica'' has been associated with pigs.
+== Diagnosis ==
-[[File:Yersinia enterocolitica gram.jpg|alt=Yersinia enterocolitica gram stain|thumb|Yersinia enterocolitica gram stain]]
+Diagnosis is confirmed through:
-'''5.'''  '''Diagnosis'''
+* [[Stool culture]]
+* [[Serology]]
+* [[Polymerase chain reaction|PCR]]
+* [[Radiologic imaging]] for complications
-Yersiniosis may be misdiagnosed as Crohn’s disease (regional enteritis) or appendicitis. Diagnosis of yersiniosis begins with isolation of the organism from the human host’s feces, blood, or vomit, and sometimes at the time of appendectomy. Confirmation occurs with the isolation, as well as biochemical and serological identification, of ''Y. enterocolitica'' from both the human host and the ingested food. Diarrhea occurs in about 80% of cases; abdominal pain and fever are the most reliable symptoms.
+== Treatment ==
+Most cases resolve with [[supportive care]] such as fluid and electrolyte replacement. However, in cases of [[sepsis]] or invasive infection, treatment may include:
-''Y. enterocolitica'' or ''Y. pseudotuberculosis'' in patients with acute gastroenteritis can be readily isolated via conventional bacteriological media designed to isolate ''Yersinia''. It is much more challenging to isolate these pathogens in asymptomatic carriers or from foods. Since many ''Y. enterocolitica'' isolated from non-human sources are not considered pathogenic, it is imperative to distinguish these isolates from pathogenic ''Yersinia'' species. Molecular-based assays, particularly PCR methods, have been developed to target ''Y. enterocolitica'' and can be used to rapidly confirm the pathogenicity of the isolate. Several PCR primer sets are directed to either plasmid-borne genes, e.g., ''virF'' or ''yadA'', or chromosomally located loci, such as ''ail''.
+* [[Gentamicin]]
+* [[Cefotaxime]]
-Serology is used to identify the biotype (based on biochemical analysis) and serogroup (O-antigen). Sera from acute or convalescent patients are titered against the suspect serotype of ''Yersinia'' spp.
+* [[Doxycycline]]
+* [[Ciprofloxacin]]
-'''6.'''  '''Target populations'''
+== Prevention ==
+Preventive measures include:
-The most susceptible populations for the main disease and potential complications are the very young (< 10 years), the debilitated, the very old, and people undergoing immunosuppressive therapy. Those most susceptible to post-enteritis arthritis are people with the antigen HLA-B27 (or related antigens, such as B7).
+* Proper food handling and cooking
+* Avoidance of unpasteurized dairy products
-'''7.'''  '''Food Analysis'''
+* Handwashing after contact with animals or soil
-The isolation method is relatively easy to perform, but in some instances, cold enrichment (25 g sample of the food mixed with 225 ml of Peptone Sorbitol bile broth for 10 days at 10°C) may be required. ''Y. enterocolitica'' can be presumptively identified in 36 to 48 hours using biochemical testing or API 20E or Vitek GNI. The genes encoding for invasion of mammalian cells are located on the chromosome, while a 70 kb plasmid, present in almost all pathogenic ''Yersinia'' species, encodes most of the other virulence-associated phenotypes. PCR-based assays have been developed to target virulence genes on both the chromosome and plasmid'''.'''
+== See also ==
+* [[Yersiniosis]]
+* [[Zoonotic disease]]
+* [[Reactive arthritis]]
+* [[Enterobacteriaceae]]
+{{nt}}
 {{Gram-negative bacterial diseases}}
-{{Taxonbar|from=Q135177}}
 [[Category:Bacteria described in 1939]]
 [[Category:Yersinia|enterocolitica]]