Yersinia infection

Last reviewed: June 2019

Last updated: April 2019

Summary

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.

Definition

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.

History and exam

Key diagnostic factors

residency in, or travel to, a plague-endemic area
exposure to fleas or contact with infected animals
constitutional symptoms
lymphadenitis (bubonic plague)
hemoptysis (pneumonic plague)
diarrhea (yersiniosis)
abdominal pain (yersiniosis)

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Other diagnostic factors

pleuritic chest pain (pneumonic plague)
dyspnea (pneumonic plague)

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Risk factors

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)

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Diagnostic investigations

1st investigations to order

blood culture (plague)
bubo aspirate culture (bubonic plague)
sputum culture (pneumonic plague)
cerebrospinal fluid culture (septicemic plague)
antigen detection (plague)
WBC count (plague)
CXR (pneumonic plague)
stool culture (yersiniosis)

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Investigations to consider

serology

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Emerging tests

polymerase chain reaction (PCR)

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Treatment algorithm

INITIAL

Contributors

Authors VIEW ALL 

John Williams, MRCP, DTM&H, Dip HIV Med

Consultant Infectious Diseases Physician

Department of Infection and Travel Medicine

The James Cook University Hospital

Middlesbrough

Disclosures

JW declares that he has no competing interests.

Peer reviewers VIEW ALL 

Vladimir L. Motin, PhD

Professor

Pathology/Microbiology and Immunology

University of Texas Medical Branch

Galveston

Disclosures

VLM declares that he has no competing interests.

Waleed Javaid, MD, FACP, FIDSA

Associate Professor

Medical Director of Infection Control

Infectious Disease

Department of Medicine

SUNY Upstate Medical University

Syracuse

Disclosures

WJ declares that he has no competing interests.

Alistair Leanord, BSc, MBChB, MD, DTM&H, FRCPath

Consultant Microbiologist

Microbiology Department

Southern General Hospital

Glasgow

Disclosures

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

Springfield

Disclosures

JK declares that he has no competing interests.

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Yersinia infection

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

asymptomatic with Yersinia pestis exposure

plague: contained casualty setting

plague: mass casualty setting

yersiniosis

Contributors

Authors VIEW ALL 

John Williams, MRCP, DTM&H, Dip HIV Med

Disclosures

Peer reviewers VIEW ALL 

Vladimir L. Motin, PhD

Disclosures

Waleed Javaid, MD, FACP, FIDSA

Disclosures

Alistair Leanord, BSc, MBChB, MD, DTM&H, FRCPath

Disclosures

Janak Koirala, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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