Gastrointestinal features of culture-positive Yersinia enterocolitica infection

Yersinia enterocolitica was cultured from feces of 122 symptomatic adults in a single facility using selective culture media; all isolates were confirmed in an independent reference laboratory. Of 128 isolates, multiple serotypes were defined and all were biochemically typical for Yersinia enterocolitica. Other agents were seen in 20 patients; of these, seven were Yersinia fredriksenii and six were Clostridium difficile. Diarrhea (80%) and abdominal pain (64%) were common, whereas other features such as fever (9%) and bloody stools (8%) were unusual. Use of antibiotics (24%) or opiates (28%) in the month before culture was common. The terminal ileum was seen radiographically in 20 patients, but only two barium studies showed abnormalities. Fiberoptic endoscopy and biopsy studies, done in greater than 50% of the cases, showed minimal or no changes in most patients. However, 3 patients had pseudomembranous colitis with concomitant Clostridium difficile cytotoxin and 7 had diffuse severe colitis. New culture techniques, and possibly geographic differences, have contributed to the high isolation rates of this organism. Yersinia enterocolitica occurs sporadically, involves a variety of serotypes, and is associated with a broader clinical spectrum than was formerly appreciated.