Background: Yersinia enterocolitica is usually transmitted through ingesting or handling undercooked pork products and is an uncommon cause of diarrhea, mesenteric adenitis and bacteremia in the United States (US). There is limited information regarding its clinical course in immunosuppressed and cancer patients. We describe the clinical presentation and outcomes of cancer patients diagnosed with Y. enterocolitica at a Comprehensive Cancer Center in the US before and after the use of nucleic acid amplification testing (NAAT) using GI multiplex panel (GIMP).
Methods: We studied all patients with Y. enterocolitica isolated from cultures or identified by NAATs. We then obtained demographic information, comorbidities, co-infections, clinical characteristics, treatment and overall mortality at 30 days post diagnosis.
Results: 16 cases were identified (Table 1). The most common symptom of Y. enterocolitica infection was diarrhea [10/16 (62%)], followed by abdominal pain [8/16 (50%)] and fever [4/16 (25%)]. 10 of the cases were identified by NAAT over a 2 year period, compared to 6 cases identified prior to April 2016 over 70 years. Stool cultures confirmed Y. enterocolitica infection in 2 cases identified by NAAT (20%). 3 patients had co-infection with Clostridium difficile, and 4 patients had a history of C. difficile infection. All but 1 patient was treated, mostly with a fluoroquinolone. Thirty day mortality was 7.7%. Cause of death was most often a complication of advanced cancer. The one patient who did not receive antibiotics had maxillary sinus squamous cell cancer and had spontaneous resolution of symptoms.
Conclusion: GIMP NAATs have increased the rates of Y. enterocolitica identification in patients with cancer suggesting this disease was underdiagnosed or is now more common as patients receive increasingly intensive immunosuppression. GIMP NAATs will likely re-define the epidemiology of Y. enterocolitica infection in cancer patients. In patients with Y. enterocolitica who are at high risk for C. difficile relapse and in whom no recent immunosuppression or evidence of systemic illness is present, it may be reasonable to consider observation or shorter course of antibiotics.
P. Okhuysen, None
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