Symptoms and sources of Yersinia enterocolitica-infection: a case-control study

Abstract

BackgroundYersinia enterocolitica (YE) is the causative agent of yersiniosis. YE encompass strains of diverse pathogenicity: YE biotypes 1B and 2-5 are considered pathogenic, whereas biotype 1A is in general considered nonvirulent. Also YE-like species, which can sometimes be misidentified as YE, are considered nonvirulent.MethodsIn order to study differences in clinical picture caused by different YE types and their possible sources a case-control study was conducted in 2006. In this case-control study, 295 case-patients with YE or YE-like finding and their 758 controls responded to the questionnaire about symptoms and possible sources of infection.ResultsStrains of pathogenic YE bio/serotypes 3-4/O:3 or 2/O:9 were found in 18%, YE biotype 1A in 65% and YE -like strains of 17% of the patients. Patients infected with the strains of pathogenic YE bio/serotypes were younger and had fever more often than those with BT 1A who suffered more from vomiting. Symptoms of reactive arthritis were reported by 10% of pathogenic YE infections, 3% of YE BT 1A, and 0.3% of the controls. Eating or tasting raw or medium done pork was a significant risk factor for pathogenic YE bio/serotype infection (OR 6.6; 95% CI 1.7-24.9) as well as eating in a canteen (OR 3.5; 95% CI 1.6-7.9). Imported fruits and berries were associated with increased risk of YE BT 1A finding.ConclusionsThe symptoms of the patients with YE BT 1A differed from yersiniosis caused by the classic pathogenic YE bio/serotypes. In addition, the patients with YE BT 1A had more protracted gastrointestinal disorders and unspecific complaints. Small children were overrepresented in classic pathogenic bio/serotypes while in BT 1A or YE-like species were not found among children younger than two years. This suggests the lacking virulence of the BT 1A strains. We can not, however, rule out the possibility that some strains of genetically heterogeneous group of BT 1A may cause an illness.

Risk factors for sporadicYersinia enterocoliticainfections, Germany 2009–2010

“…It is biologically plausible that consumption of raw or undercooked pork is the main driver of yersiniosis incidence in Germany. About 90% of notified cases are typically infected with Y. enterocolitica biotype 4, serotype O :3, which is frequently isolated from pigs [2,5,[15][16][17] and pork samples [2,5], and the disease association has been established in case-control studies conducted in other countries [6][7][8][9][10]. However, the importance of raw or undercooked pork for yersiniosis in young children in Germany was previously unknown.…”

“…The association of disease with consumption of raw and undercooked pork or pork products is well established [6][7][8][9][10]. However, other risk factors, for example, consumption of untreated drinking water [7], eating in a canteen [10], and, for children, use of a pacifier and contact with pet dogs and cats [9] have also been described. Studies are scarce in children, the population group most affected in Germany and other European countries [3,11].…”

Piglets Are a Source of Pathogenic Yersinia enterocolitica on Fattening-Pig Farms

“…Yersiniosis occurs most often in young children (4). Common symptoms include diarrhea, fever, and abdominal pain (15). In older children and adults, the disease may be confused with appendicitis.…”

A rare case of enteric and systemic Yersinia enterocolitica infection in a chronic, not iron-overloaded dialysis patient

“…Generally, Y. enterocolitica is primarily a gastrointestinal tract pathogen, typically limited in the normal host and usually antimicrobial therapy is not required. However, alcoholism, chronic liver disease, diabetes, immunosuppressive therapy, acute iron overload, malignancy, and malnutrition are conditions, which predispose to infection of Yersinia (6,22,25). In fact, in these particular situations, this bacterium has a strong propensity to circumvent the host defence, to transcend the gastrointestinal tract and cause systemic infections, reaching also the liver and the spleen, with a high mortality rate of about 50% (6,11,16,30).…”