Yersinia infection

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. Microbiologic 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. Postexposure antibiotic prophylaxis is indicated in people who have been in close contact (within 6.5 feet) 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 characterized 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 septicemic plague; and chest pain, dyspnea, and hemoptysis 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.

BMJ talk medicine podcast: plague - a guide to diagnosing and managing Yersinia with Dr Amesh Adalja external link opens in a new window