Clinical aspects of infection with Yersinia enterocolitica in adults.

Yersinia enterocolitica was isolated from the feces of 29 patients over a three-year period following the introduction of a selective culture medium. Y. enterocolitica was the third most common enteric pathogen after Campylobacter jejuni and Salmonella in this series of 3795 specimens from a predominantly adult population. The isolation rate of Y. enterocolitica was 0.9% and this represented 15.8% of positive cultures. The usual symptoms of Yersinia infection were diarrhea (93%) and abdominal pain (72%), often associated with tenderness in the right iliac fossa and fever. Fourteen patients required admission to hospital and four came to surgery for possible appendicitis. Acute terminal ileitis and mesenteric lymphadenitis were noted in each case. Two patients who were HLA-B27 positive had a reactive arthritis as their dominant complaint. In conclusion, Y. enterocolitica has emerged as a common cause of diarrhea in adults. It is an important cause of symptoms resembling those of acute appendicitis and is occasionally complicated by reactive arthritis.