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Yersinia enterocolitica infection in children

ABDEL-HAQ, NAHED M. MD; ASMAR, BASIM I. MD; ABUHAMMOUR, WALID M. MD; BROWN, WILLIAM J. PhD

Pediatric Infectious Disease Journal:
Original Studies
Abstract

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.

Author Information

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 basmar@wayne.edu.

This work was presented in part at the Infectious Diseases Society of America 35th Annual Meeting, San Francisco, CA, September 13 to 16, 1997.

© 2000 Lippincott Williams & Wilkins, Inc.