Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Isolated Case of Yersinia Enterocolitica in South Carolina Gabrielle Aluisio 1 ,OMS-III, MBA , Naina Kohli 1 , OMS-III, Emily Young 2 , MD

1 Edward Via College of Osteopathic Medicine – Carolinas campus 2 Roper St. Francis Physician Partners Primary Care, Charleston, SC

Introduction

Case

Discussion

• Yersinia enterocolitica is a gram-negative bacillus zoonotic pathogen known for causing enteric infections, often associated with consumption of contaminated food, such as undercooked pork [1-3] • Less common causes of infection include drinking contaminated milk or untreated water, contact with animals or their feces [1] • In young children, yersiniosis typically causes fever, pain in abdomen, and bloody diarrhea [1] . In older children and adults, symptoms typically include fever and pain on the right side of the abdomen [1,2] • Treatment typically includes fluid replacement and anti-diarrheal medication, unless the stool is bloody. • Most people with yersinia infection do not require antibiotics and are generally reserved for those with severe illness [1,4] • Risk factors that could predispose individuals to Y. Enterocolitica infections are conditions that involve high iron levels such as thalassemia, hemochromatosis, and patients undergoing iron chelation treatment [5]. An 82-year-old female presents to the office with a chief complaint of diarrhea for the past two weeks. • PMHx: congestive heart failure, lupus, and hyperlipidemia • The patient reported an unusual bowel movement the morning following a dinner in which she shared pork loin from a local grocery store with a friend. • The stool was watery, light brown with reddish and orange tones, and contained small particulate matter. • The patient had no reported recent illnesses, surgeries, or significant medication use beyond routine prescriptions. • The patient had no remarkable findings of physical examination. • She denied abdominal pain, fever, chills, rash, nausea, vomiting, or fatigue. • At the visit she was prescribed azithromycin for presumed traveler’s diarrhea. Case

Conclusions This case highlights a few interesting points: • The difference between the age range with the highest rate of incidence in South Carolina versus the age range most likely to be infected • The variability of patient presentation and absence of systemic symptoms in this elderly patient • The tailoring of antibiotic pharmacotherapy to best fit the patient needs and reduce adverse effects with regards to age • Isolated nature of case even though it was a shared meal and the possibility for a predisposition to infection • Although antibiotics are not typically administered to patients with yersiniosis because symptoms usually resolve on their own, this patient was started on antibiotics since her symptoms had not resolved in three weeks. • Ciprofloxacin could have been chosen however due to possible adverse reactions like nausea and vomiting, which could exacerbate risks in an elderly patient, Doxycycline was selected. • Although generally children are more likely to get sporadic cases of Y. Enterocolitica, in South Carolina the age group of 65+ has the highest rate of contractility as shown in Table 1 [1] • There is not much data collected in the United States regarding incidence of Y. Enterocolitica infection

• Initial stool sample of watery consistency was collected and after running a gastrointestinal panel, it was positive for Yersinia Enterocolitica PCR. • Other diagnostic labs that were collected included CRP, sedimentation rate, CBC w/ diff, phosphorus, magnesium, and CMP all of which had normal findings. • A week later she presented to the office with no change in her symptoms while on the azithromycin. • Patient was switched to Doxycycline. The patient reported resolution of diarrhea after completing the prescribed antibiotic course.

Discussion

Table 1. Rates of Yersinia in South Carolina per 100,000 by Age Group from 2013-2021. Based on data collected from South Carolina Annual Morbidity Report 2021 There was a six-fold increase in the number of cases reported in 2018 compared to 2010 [4] . This is thought to be due to an increase in testing for multiple germs at once [4] . In South Carolina, the disease was found primarily in the elderly with half of the cases accounted for by those 65 years or older [Table 1].

References

[1]Centers for Disease Control and Prevention. (n.d.). About yersinia infection . Centers for Disease Control and Prevention. https://www.cdc.gov/yersinia/about/index.html [2]Aziz M, Yelamanchili VS. Yersinia Enterocolitica. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499837/ [3]Rosner, B. M., Werber, D., Höhle, M., & Stark, K. (2013). Clinical aspects and self-reported symptoms of sequelae of Yersinia enterocolitica infections in a population-based study, Germany 2009-2010. BMC infectious diseases , 13 , 236. https://doi.org/10.1186/1471 2334-13-236 [4] Division of Acute Disease Epidemiology. 2019. The South Carolina Annual Morbidity Report on Reportable Conditions – 2018 . Columbia, SC: South Carolina Department of Health and Environmental Control, Bureau of Communicable Disease Prevention and Control. [5] Watkins, L., & Friedman, C. (2024). Yersiniosis . Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2024/infections diseases/yersiniosis#:~:text=Most%20yersiniosis%20cases%20are%20reported,enterocolitica%20infections%20were%20travel%2Dassocia ted.

2025 Research Recognition Day

91