Yersinia enterocolitica enteritis versus other bacterial enteritis in ultrasonic findings: a single-center case control study

Abstract

Background: Yersinia enterocolitica (Ye) causes enteritis with mesenteric lymphadenitis and terminal ileitis, and can be difficult to distinguish from acute appendicitis, especially in children. In addition, because detection from stool culture is more difficult for Ye than for other bacteria causing enteritis, the diagnosis of Ye enteritis is not easy. Abdominal ultrasonography is useful for diagnosing bacterial enteritis, including Ye enteritis. This study diagnosed Ye enteritis and other bacterial enteritis by stool culture and compared and analyzed the ultrasonic findings and clinical features in children. The aims of this study are to compare and analyze ultrasonic findings and clinical features in children with Ye enteritis and other bacterial enteritis.Methods: Participants in this retrospective study comprised all 34 bacterial enteritis patients (3-18 years old) treated between 2014 and 2017. Patients were divided into the Yersinia enterocolitica enteritis (Ye) group and other bacterial enteritis (non-Ye) group from whom other pathogens were detected. Ultrasonic findings (including maximum and minimum diameters of ileocecal lymph nodes (C-LNs), mean major/minor axis ratio, wall thickness of the terminal ileum, and presence of a pericecal hyperechoic region) and blood examinations at first visit were compared between two groups. Results: The Ye group included 13 patients and the non-Ye group included 21 patients. Mean C-reactive protein level was higher in the Ye group (5.9±3.0 mg/dL) than in the non-Ye group (2.7±3.4 mg/dL, p = 0.049). No difference in mean maximum diameter of C-LNs was seen between two groups. However, mean C-LN major/minor axis ratio was lower in the Ye group than in the non-Ye group (p = 0.002) and terminal ileal wall thickness value was higher in the Ye group than in the non-Ye group (p = 0.004). Pericecal hyperechoic region was more frequent in the Ye group than in the non-Ye group (p = 0.021). Conclusion: The combination of characteristic ultrasonic findings identified in this study may improve ultrasonic differentiation of Yersinia enterocolitica enteritis and other bacterial enteritis.