Background Information

Bacterial, parasitic, and viral agents can cause infectious gastroenteritis. Approximately 48 million people become ill and 128,000 require hospitalization from foodborne diseases in the United States each year.¹ Enterohemorrhagic Escherichia coli (EHEC) is one of the top five causes of foodborne illness requiring hospitalization in the United States.¹ Most clinical laboratories that perform enteric cultures on stool samples routinely include media and methods to rule out Campylobacter spp., Salmonella spp., Shigella spp., and EHEC.

Shigella, which accounts for less disease prevalence in the U.S. (~14,000 cases/year), is highly infectious and its detection in all stool samples is important to prevent further disease from spreading person to person. Yersinia enterocolitica can also cause foodborne disease, but at a much lower incidence; consequently, most laboratories do not routinely look for this pathogen. The incidence of Y. enterocolitica, as reported by CDC Food Net activities, is about one culture-confirmed case per 100,000 population per year. This compares to the > 1 million cases of Salmonella and > 800,000 cases of Campylobacter reported annually to CDC in the U.S.² Blood transfusion reactions have occurred from blood products contaminated with Y. enterocolitica, however, gastroenteritis is not usually a part of the resultant bacteremia.

Y. enterocolitica can cause gastroenteritis in an individual who has consumed contaminated food or water. Y. enterocolitica has been isolated from raw meats, such as beef, lamb, pork and chicken, but can also be found in cooked, pre-packaged deli meats. Consumption of raw or improperly cooked pork is the main source of gastroenteritis in humans, with the specific association with improperly prepared and handled pork chitterlings.^3,4,5,6 Drinking unpasteurized milk, untreated water, or coming into contact with infected animals also can be the source of infection.

The severity of the disease is related to the specific serotype of Y. enterocolitica as well as load of organism consumed. The range of diseases associated with Y. enterocolitica is self-limited gastroenteritis to terminal ileitis, to mesenteric lymphadenitis that is often mistaken as appendicitis. Occasionally, skin rash and joint pains can accompany Yersinia gastroenteritis.^1,3

Children are more commonly diagnosed with Y. enterocolitica than adults. Patients with gastroenteritis associated with Yersinia are more likely to present with fever, diarrhea, and abdominal pain that can last for seven days. A carrier state of the organism can ensue for up to several months. Septicemia can result if organisms migrate out of the gastrointestinal tract via the lymphatics and find their way to lymph nodes. Persons at the highest risk for systemic disease are the elderly and immunocompromised populations. In particular, persons with underlying metabolic diseases that are associated with iron overload (hemochromatosis), cancer, liver disease, and steroid therapy are at the highest risk of more serious Y. enterocolitica disease. A case of ileal perforation post gastroenteritis has been reported with a review of other surgical complications of Yersinia gastroenteritis.⁶