Yersiniosis and Food Safety

Yersiniosis

• Yersiniosis is a rare infectious disease that causes bacterial gastroenteritis, primarily affecting young children under 12 months old.
• Symptoms vary according to age, and the disease is more common in Japan, Scandinavia, and Europe.
• The Centers for Disease Control and Prevention (CDC) estimates 17,000 cases occur in the United States each year.

Causes

• Yersinia enterocolitica, a rod-shaped bacterium, causes yersiniosis.
• Pigs are a reservoir for some strains of this bacterium, with other strains found in rodents, rabbits, sheep, cattle, horses, dogs, and cats.
• Transmission occurs through ingestion of contaminated food, especially raw or undercooked pork, as well as tofu, meats, oysters, and fish.
• Transmission can also occur after handling contaminated food, not cleaning hands properly, and then touching toys, bottles, or pacifiers.
• Rarely, yersiniosis can be transmitted through the fecal-oral route due to poor handwashing after defecation.
• Blood transfusion can cause direct inoculation of the bacteria.

Complications

• Complications of yersiniosis are rare but may include joint pain, erythema nodosum, bacteremia, enterocolitis, pseudoappendicitis, mesenteric adenitis, reactive arthritis, septicemia, pharyngitis, dermatitis, myocarditis, and glomerulonephritis.
• Death may occur as a result of bacteremia, which affects older patients more often than younger patients.

Assessment Findings

• In children, symptoms develop 4 to 7 days after exposure and include low-grade fever, abdominal pain, diarrhea, and occasionally, vomiting.
• Symptoms may last 2 to 3 weeks, and in severe cases, diarrhea may become bloody.
• In adults and older children, signs and symptoms often mimic those of appendicitis, with right-sided abdominal pain, fever, and leukocytosis.

Diagnostic Tests

• Stool culture identifies the organism, but the laboratory may need to be asked to test specifically for Y. enterocolitica.
• Throat, lymph node, synovial fluid, urine, bile, and blood cultures may identify Y. enterocolitica.
• Stool samples are positive for leukocytes.
• Computed tomography or ultrasonography of the abdomen may rule out appendicitis.
• Colonoscopy may show exudates and left-sided colitis, but findings are usually nonspecific.

Treatment

• Most cases of yersiniosis resolve without treatment.
• More severe cases may be treated with antibiotics, such as aminoglycosides, doxycycline, trimethoprim-sulfamethoxazole, or fluoroquinolones.
• Fluids and electrolytes should be provided as needed.
• Complications should be treated symptomatically, and analgesia may be administered for pain.
• Skin care should be provided, especially in patients with frequent diarrhea.

Prevention

• Avoid eating raw or undercooked pork, as well as unpasteurized milk or milk products.
• Wash hands with soap and water before handling food, including raw meat; after using the bathroom; and after contact with animals.
• Clean all surfaces with hot, soapy water after preparing raw meat.

Nursing Considerations

• Initiate contact precautions for patients who are diapered or incontinent; for all other patients, use standard precautions.
• Wash hands thoroughly after contact with an infected patient.
• Administer pain medications as ordered, and evaluate their effects after 30 minutes.
• Send stool specimens to the laboratory as ordered for testing.
• Assist with acquiring other samples, such as synovial fluid via joint aspiration, as appropriate.
• Provide good skin care, especially in patients with frequent diarrhea.
• Monitor laboratory values, and administer electrolyte replacement therapy as ordered.
• Encourage oral fluids, and if the patient is unable to tolerate oral fluids, administer I.V. fluids as ordered.

This quiz covers the topic of Yersiniosis, a foodborne illness, and discusses the role of government agencies in monitoring food safety.