Yersinia enterocolitica infection in children.
BACKGROUND
Yersinia enterocolitica can cause illness ranging from self-limited enteritis to life-threatening systemic infection. The present study was undertaken to review the epidemiology, clinical manifestations, complications and outcome of Y. enterocolitica enteritis in children seen at a large children's hospital.


METHODS
The project consisted of a retrospective chart review of medical and microbiologic records of all children with stool cultures positive for Y. enterocolitica during a 7-year period.


RESULTS
The review included 142 patients with Y. enterocolitica enteritis. Patients' ages ranged from 18 days to 12 years, and the majority (85%) were younger than 1 year. Most patients presented during November, December and January. History of exposure to chitterlings (raw pork intestines) at home was elicited in 25 of 30 cases. Y. enterocolitica accounted for 12.6% (142 of 1,120) of all bacterial intestinal pathogens isolated during the study period. Blood cultures were positive in 7(9%) of 78 patients; 6 were younger than 1 year and one 12-year-old had sickle cell disease. Of 132 isolates tested all were susceptible to trimethoprim-sulfamethoxazole, tobramycin and gentamicin; the majority were susceptible to cefotaxime (99%), ceftazidime (89%) and cefuroxime (88%). All bacteremic patients responded to cefotaxime treatment. Follow-up evaluation of 40 ambulatory patients revealed no difference in clinical improvement between those treated with oral trimethoprim-sulfamethoxazole (17 of 23) and those who were not treated (8 of 17) (P = 0.1).


CONCLUSIONS
Y. enterocolitica is an important cause of enteritis in our young patient population during the winter holidays. Exposure of infants to chitterlings appears to be a risk factor. Infants younger than 3 months are at increased risk for bacteremia. Cefotaxime is effective in the treatment of Y. enterocolitica bacteremia; however, the role of oral antibiotics in the management of enteritis needs further evaluation.
Abdel-Haq
N M
NM
Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit 48201, USA.
Asmar
B I
BI
Abuhammour
W M
WM
Brown
W J
WJ
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004751:Enteritis / Q000453:epidemiology* / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015009:Yersinia Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D015008:Yersinia enterocolitica / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents