Yersinia enterocolitica enteritis and bacteremia in children

During 7 years (1990-1997) 142 children with Y. enterocolitica enteritis were treated at our hospital. Age range was 18 days to 12 years (mean:9mo, median:5mo); 87% were <1 year. All but one were black. Most (84%) presented during November, December, & January. Chitterlings (pig intestines) preparation at home was reported in 8 of 9 cases questioned Presenting symptoms included diarrhea (99%), fever (74%), bloody stools (46%), & vomiting (38%). Intussusception was suspected in 2. White blood cell counts (WBC) were obtained in 90 & 31% had WBC > 20,000/mm³. Sixty (42%) were hospitalized. Seven (9%) of 78 had bacteremia: 6 were <10 months, & 1 was a 12-year-old with SS hemoglobin on chronic transfusion protocol. Seven of 39 had cerebrospinal fluid (CSF) pleocytosis. All CSF cultures were negative. Bacteremic patients had abdominal distention (2), pneumatosis intestinalis (1), pneumonia (1), & CSF pleocytosis (2). Susceptibilities by minimal inhibitory concentration were available for 132 isolates. All isolates were susceptible to trimethoprim/sulfamethoxasole (TMP/SMX), gentamicin, & tobramycin; 98.5% to cefotaxime, 89% to ceftazidime, & 88% to cefuroxime. Most (83%) were resistant to ampicillin. Six bacteremic patients were treated with cefotaxime & 1 (pneumatosis intestinalis) with cefotaxime, metronidazole & ampicillin; all recovered. Of 82 ambulatory patients 65 received TMP/SMX & 17 no treatment. Forty were followed 3-14 days later. Improvement occurred in 17 of 23 treated & in 8 of 17 untreated patients (P=0.1). Y. enterocolitica is an important cause of enteritis in our young patients around whiter holidays. Infants appear to be at higher risk for bacteremia. Cefotaxime is effective therapy for bacteremia. Further studies are needed to clarify the role of oral antibiotics in the management of uncomplicated Y. enterocolitica enteritis.