(P04) A Case of Yersinia Enterocolitica Enteritis

Introduction: Yersinia enterocolitica (Y. enterocolitica) is a gram-negative enteric bacterium that can result in human disease, in the form of fever, diarrhea, abdominal pain and may result in complications mimicking acute appendicitis. Other complications include bloodstream infections. Raw or undercooked pork is the most significant food source that can serve as a reservoir for this bacteria and result in food-borne transmission. We describe the case of an older adult residing in a long-term care facility (LTCF) with Y. enterocolitica enteritis.

Case Description: An 88-year-old male with type 2 diabetes mellitus, chronic kidney disease, stroke, hypertension, coronary artery disease, heart failure, atrial fibrillation, hyperlipidemia, hypothyroidism, anemia, and Vitamin D deficiency; long-term resident of an urban skilled nursing facility, complained of diarrhea. One day, he reported 3 loose bowel movements (T=0) and 2 loose bowel movements 4 days later (T+4). He denied all other somatic complaints including nausea, emesis, bloating, abdominal cramps, and pain.
Vital signs were normal (temperature: 98.6F, blood pressure: 118/59 mm Hg, pulse: 70 beats/min, respiratory rate: 16/min, oxygen saturation: 98% on room air). Physical examination revealed an elderly male in no acute distress with a soft, non-tender abdomen upon palpation. COVID-19 rapid antigen testing resulted negative. Stool samples were sent for ova and parasites, culture, and Clostridium difficile (C. diff) polymerase chain reaction. Stool ova, parasites and C. diff were negative. 3 stool cultures examined for Shigella, Salmonella, Campylobacter, Aeromonas, Plesiomonas, Vibrio, Escherichia coli O157 and Yersinia resulted positive for rare Y. enterocolitica. Antibiotic susceptibilities were reported as resistant to Ampicillin, Amoxicillin/Clavulanic Acid and Cefazolin; and sensitive to Cefoxitin, Ceftriaxone, Cefepime, Piperacillin-Tazobactam, Ciprofloxacin, Levofloxacin, Trimethoprim-sulfamethoxazole, Gentamicin, Tobramycin, Amikacin, Ertapenem and Meropenem.
The patient continued to experience loose bowel movements intermittently and was thus treated with intravenous ceftriaxone 1 gm daily for 7 days, which resulted in full clinical resolution upon completion of treatment (T+11).

Discussion: Yersiniosis, caused by Y. enterocolitica is an enteric illness characterized by abdominal symptoms including diarrhea. Most cases are self-limiting; however, older adults may have a slightly different clinical trajectory. Judicious antibiotic therapy may be needed. Providers in LTCFs must be aware of food reservoirs of enteric bacteria, their modes of transmission and antimicrobials of choice. Raw pork is the most important source of Y. enterocolitica. Proper hand hygiene, food handling and cooking to minimum internal temperature of 165F can mitigate disease occurrence and spread. LTCF kitchens must be periodically inspected to ensure proper handling, storage and cooking of meat and poultry.