Systemic Infection with Yersinia enterocolitica in a Hemodialysis Patient

• Published in: Zentralblatt für Bakteriologie 1998-05, Vol.287 (4), p.485-487
• Main Authors: Stoffel, Markus P., Pollok, Manfred, Seifert, Harald, Baldamus, Conrad A.
• Format: Article
• Language: English
• Subjects: Aged; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Renal Dialysis; Yersinia enterocolitica; Yersinia Infections - microbiology; Yersinia Infections - physiopathology
• ISSN: 0934-8840
• DOI: 10.1016/S0934-8840(98)80188-6

Systemic infection with Yersinia enterocolitica is an uncommon event. Diabetes, malnutrition, malignancy, immunosuppression, blood transfusion and iron overload are predisposing conditions (3, 6). Here we report about a chronic hemodialysis patient who developed systemic Yersinia enterocolitica infection without any of the aforementioned risk factors. A 74-year-old male patient with non-diabetic end-stage renal failure presented with high-grade fever (40 degree C) and chills. He had been on hemodialysis for six years. Diarrhea, arthralgias, deferroxamine treatment and blood transfusions were denied. Neither family members nor patients from his dialysis unit reported diarrhea or any abdominal symptoms. The arterio-venous fistula was insignificant. Blood tests revealed 22 x 10 super(9)/ml leukocytes and a C-reactive protein of 187 mg/l. Transferrin saturation was low (11%). Routine stool samples yielded no pathogenic bacteria. Blood cultures taken on admission yielded Yersinia enterocolitica serovar O:3. The complement-binding reaction for Y. enterocolitica and Y. pseudotuberculosis rose from an undetectable level to 1:64 within one week. Yersinia serology of the daughter, with whom the patient lived in close household contact, was repeatedly negative. Empirical antimicrobial therapy was started with ceftriaxone (2 g/d) and gentamicin (80 mg/d). After the result of the blood cultures, ciprofloxacin (250 mg t.i.d.) was used instead. The patient's clinical condition improved rapidly. He was discharged nine days later. Further follow-up was unremarkable. Fever in hemodialysis patients is a common clinical problem and is mainly due to intermittent bacteremia resulting from vascular accesses and pneumonia (1). Typical etiological agents are staphylococci and gramnegative rods (1).