Yersinia enterocolitica, a Gram-negative coccobacillus, is an important pathogen [1] [2]. This bacterial microorganism causes infections all over the world, both sporadically and in the form of outbreaks [1] [2] [3]. Pigs are established as the main reservoir of Yersinia enterocolitica and unprocessed, raw, or undercooked pork meat are regarded as the primary source of infection, while contaminated water sources are also described in the pathogenesis [1] [2] [4] [5] [6]. Furthermore, cattle, goats, sheep, wild boars, cats, dogs, and small rodents are also identified as reservoirs of Yersinia enterocolitica [7]. Several outbreaks were attributed to the consumption of contaminated dairy products and tofu cheese [1] [6]. Gastroenteritis is the hallmark of Yersinia enterocolitica infection and is primarily encountered in infants and children under 10 years of age [1] [2] [3] [6] [8]. The spectrum of manifestations ranges from a benign and self-limiting abdominal discomfort to severe right lower quadrant abdominal pain (often mimicking appendicitis), tenesmus, vomiting, fever, and watery or bloody diarrhea [2] [3] [6] [7] [8] [9]. The symptoms are typically present for 7-14 days, but complications of Yersinia enterocolitica infection may be glomerulonephritis, myocarditis, reactive arthritis, and erythema nodosum [3] [6], whereas sepsis and extraintestinal dissemination of the infection are seen in rare cases [2] [3]. The presence of cirrhosis, malignancies, diabetes mellitus, and iron overload is associated with an increased risk for a systemic infection [2] [3] [8].

• Fever

  The patient was a 34-year-old Indian woman who had a four day history of fever, abdominal pain and cough and loose stools for 2 days. She was diagnosed and treated as a case, initially of bacillary dysentery, and then of urban typhus. [ncbi.nlm.nih.gov]

  Gastroenteritis is the main way of presentation with reported manifestations of watery or bloody diarrhea, vomiting, tenesmus, abdominal pain, and fever. [symptoma.com]

• Reiter's Syndrome

  Links: Reiter's syndrome traveller's diarrhoea [gpnotebook.co.uk]

  Dworkin MS, Shoemaker PC, Goldoft MJ, Kobayashi JM: Reactive arthritis and Reiter’s syndrome following an outbreak of gastroenteritis caused by Salmonella enteritidis. Clin Infect Dis. 2001, 33: 1010-1014. 10.1086/322644. 37. [bmcinfectdis.biomedcentral.com]

• Euthyroid

  For study B, 388 euthyroid women without thyroid antibodies at baseline were enrolled. [ncbi.nlm.nih.gov]

• Chronic Infection

  In another two patients this titre remained significantly elevated greater than or equal to 80, indicating chronic infection. Five patients experienced joint symptoms and four erythema nodosum, symptoms common to both yersiniosis and sarcoidosis. [ncbi.nlm.nih.gov]

  Enzyme-linked immunosorbent assay (ELISA), mainly used in the setting of chronic infections, is a reliable serologic study that can detect IgA, IgM or IgG antibodies, while polymerase chain reaction (PCR) is now regarded as an optimal procedure, being [symptoma.com]

• Camping

  Secondary transmission cannot be eliminated as a source of infection in the military camps. The most likely source of the outbreak was salad mix containing imported radicchio rosso, due to its long shelf life. [eurosurveillance.org]

• Diarrhea

  RESULTS: Patients with diarrhea were younger than those without diarrhea (P 0.014). Older children had abdominal pain or irritability more frequently than younger children (P 0.004). [ncbi.nlm.nih.gov]

• Abdominal Pain

  Older children had abdominal pain or irritability more frequently than younger children (P 0.004). CONCLUSIONS: In Yersinia enterocolitica infections, younger children are predisposed to diarrhea and older children are predisposed to abdominal pain. [ncbi.nlm.nih.gov]

• Food Poisoning

  Not refrigerating dairy products and those containing mayonnaise for example Eating food beyond expiry date Further Reading What is Food poisoning? Food poisoning Symptoms Food poisoning Diagnosis Food poisoning Treatments [news-medical.net]

  Y. enterocolitica (Y. e.) and Y. pseudotuberculosis (Y. p.) are pathogenic bacteria to cause food poisoning. They are infrequently isolated from stool of patients with diarrhea, but it is necessary to isolate them as the pathogen specifically. [webview.isho.jp]

  poisoning A05.2 Foodborne Clostridium perfringens [Clostridium welchii] intoxication A05.3 Foodborne Vibrio parahaemolyticus intoxication Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. [icd10data.com]

• Blood in Stool

  headache; moderate: symptoms of mild severity plus fever and/or abdominal pain in lower right quadrant; severe: at least one symptom plus visible blood in stool and/or hospitalization. [bmcinfectdis.biomedcentral.com]

• Right Lower Quadrant Tenderness

  Four of the Pediatric Surgery patients presented with abdominal pain and right lower quadrant tenderness. The preliminary diagnosis of appendicitis was excluded during hospitalization and none of them underwent appendectomy. [ncbi.nlm.nih.gov]

• Arthritis

  Abstract The majority of patients with reactive arthritis have the major histocompatibility complex class I gene HLA-B27. [ncbi.nlm.nih.gov]

• Neglect

  We believe that the importance of Y. enterocolitica infection in children has been neglected and that results from this study can be used to develop preventive recommendations. [ncbi.nlm.nih.gov]

  Diarrhea: a neglected nosocomial hazard ? Infect Control Hosp Epidemiol. 1991 ; 12 : 343 – 344. 10. Haley, RW, Emori, TG. The employee health service and infection control in US hospitals, 19761977. Managingemployee illness. [cambridge.org]

With a properly obtained patient history and a detailed physical examination, a presumptive diagnosis of Yersinia enterocolitica infection can be made. During the interview, the physician should assess whether the patient recently consumed undercooked or unprocessed pork or dairy products, whereas the presence of bloody stools may narrow the list of causative agents responsible for the infection. To confirm Yersinia enterocolitica as the culprit, microbiological studies need to be used. One of the first and most important investigations are stool cultures (although blood, peritoneal fluid, throat swabs, and excised mesenteric lymph nodes might also be used for cultivation) but their long turnaround time mandates the use of other methods, such as serologic and molecular studies [3] [6]. Enzyme-linked immunosorbent assay (ELISA), mainly used in the setting of chronic infections, is a reliable serologic study that can detect IgA, IgM or IgG antibodies, while polymerase chain reaction (PCR) is now regarded as an optimal procedure, being able to provide results within a very short time span [3] [6].

• Colitis

  We propose that Yersinia enterocolitica infection may be a triggering factor for the development of collagenous colitis in some cases. Duodenal villous atrophy not responding to gluten withdrawal is common in association with collagenous colitis. [ncbi.nlm.nih.gov]

  A 71-year-old man with Y enterocolitica colitis complicated by perforation and abscess formation is described. This complication is very rare, and the four other cases that have been reported in the literature are reviewed. [jamanetwork.com]

  […] and colitis NOS ( A09 ) neonatal diarrhea (noninfective) ( P78.3 ) psychogenic diarrhea ( F45.8 ) due to Yersinia enterocolitica A04.6 infectious NOS A09 ICD-10-CM Diagnosis Code A09 Infectious gastroenteritis and colitis, unspecified 2016 2017 2018 [icd10data.com]

• Liver Biopsy

  A liver biopsy revealed granulomatous hepatitis. Follow-up after six months revealed normal liver function and histology. [ncbi.nlm.nih.gov]

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9. Chakraborty A, Komatsu K, Roberts M, et al. The Descriptive Epidemiology of Yersiniosis: A Multistate Study, 2005–2011. Public Health Rep. 2015;130(3):269-277.