Background. Yersinia enterocolitica can cause illness ranging from self-limited enteritis to life-threatening systemic infection. The present study was undertaken to review the epidemiology, clinical manifestations, complications and outcome of Y. enterocolitica enteritis in children seen at a large children’s hospital.
Methods. The project consisted of a retrospective chart review of medical and microbiologic records of all children with stool cultures positive for Y. enterocolitica during a 7-year period.
Results. The review included 142 patients with Y. enterocolitica enteritis. Patients’ ages ranged from 18 days to 12 years, and the majority (85%) were younger than 1 year. Most patients presented during November, December and January. History of exposure to chitterlings (raw pork intestines) at home was elicited in 25 of 30 cases. Y. enterocolitica accounted for 12.6% (142 of 1120) of all bacterial intestinal pathogens isolated during the study period. Blood cultures were positive in 7(9%) of 78 patients; 6 were younger than 1 year and one 12-year-old had sickle cell disease. Of 132 isolates tested all were susceptible to trimethoprim-sulfamethoxazole, tobramycin and gentamicin; the majority were susceptible to cefotaxime (99%), ceftazidime (89%) and cefuroxime (88%). All bacteremic patients responded to cefotaxime treatment. Follow-up evaluation of 40 ambulatory patients revealed no difference in clinical improvement between those treated with oral trimethoprim-sulfamethoxazole (17 of 23) and those who were not treated (8 of 17) (P = 0.1).
Conclusion. Y. enterocolitica is an important cause of enteritis in our young patient population during the winter holidays. Exposure of infants to chitterlings appears to be a risk factor. Infants younger than 3 months are at increased risk for bacteremia. Cefotaxime is effective in the treatment of Y. enterocolitica bacteremia; however, the role of oral antibiotics in the management of enteritis needs further evaluation.
From Wayne State University School of Medicine and Children’s Hospital of Michigan (NMAH, BIA, WMA, WJB); and Detroit Medical Center University Laboratories (WJB), Detroit, MI.
Accepted for publication June 27, 2000.
Address for reprints: Basim I. Asmar, M.D., Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201. Fax 313-993-8846; E-mail firstname.lastname@example.org.
This work was presented in part at the Infectious Diseases Society of America 35th Annual Meeting, San Francisco, CA, September 13 to 16, 1997.