Yersinia infection is a notifiable condition. Patients with signs of pneumonic plague should be isolated immediately and placed on droplet precautions.
Diagnosis of plague may be suggested by characteristic clinical findings together with a history of potential exposure in an endemic area. Yersiniosis presents generally as a self-limiting gastroenteritis, but invasive infection may occur. Microbiological studies are used to confirm a suspected diagnosis.
Early treatment of plague with antibiotics is essential as a delay of >24 hours from the onset of symptoms is associated with high mortality. Post-exposure antibiotic prophylaxis is indicated in people who have been in close contact (within 2 m) with people with plague.
Yersiniosis requires supportive care. Treatment with intravenous antibiotics is appropriate in patients with invasive infection.
In humans, Yersinia pestis causes plague and Yersinia enterocolitica causes yersiniosis. Infection with Yersinia pseudotuberculosis is uncommon and causes similar symptoms to yersiniosis.
The plague bacillus Y pestis is transmitted to people mainly by the bites of infected fleas. Infection is characterised by the sudden onset of systemic symptoms such as fever and painful swelling of lymph nodes (buboes) in the bubonic plague; systemic features, but without buboes, in the septicaemic plague; and chest pain, dyspnoea, and haemoptysis in the pneumonic plague.
Y enterocolitica and Y pseudotuberculosis are mainly acquired by consuming contaminated food and water. Symptoms are mostly confined to the gastrointestinal tract (self-limiting gastroenteritis), but reactive arthritis is a common complication.
History and exam
- exposure to fleas (plague)
- exposure to people with plague (plague)
- residence in, or travel to, an endemic area (plague)
- contact with infected animals (plague)
- young children (yersiniosis)
- consumption of raw or undercooked pork products (yersiniosis)
- iron-overload syndromes (yersiniosis)
- chronic liver disease, diabetes, alcoholism (yersiniosis)
- blood culture (plague)
- bubo aspirate culture (bubonic plague)
- sputum culture (pneumonic plague)
- cerebrospinal fluid culture (septicemic plague)
- antigen detection (plague)
- WBC count (plague)
- Chest x-ray (pneumonic plague)
- stool culture (yersiniosis)
John Williams, MRCP, DTM&H, Dip HIV Med
Consultant Infectious Diseases Physician
Department of Infection and Travel Medicine
The James Cook University Hospital
JW declares that he has no competing interests.
Vladimir L. Motin, PhD
Pathology/Microbiology and Immunology
University of Texas Medical Branch
VLM declares that he has no competing interests.
Waleed Javaid, MD, FACP, FIDSA
Medical Director of Infection Control
Department of Medicine
SUNY Upstate Medical University
WJ declares that he has no competing interests.
Alistair Leanord, BSc, MBChB, MD, DTM&H, FRCPath
Southern General Hospital
AL declares that he has no competing interests.
Janak Koirala, MD
Associate Professor of Medicine
Division of Infectious Diseases
Department of Internal Medicine
Southern Illinois University School of Medicine
JK declares that he has no competing interests.
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