J Pediatr Infect Dis 2023; 18(06): 289-294
DOI: 10.1055/s-0043-1772209
Original Article

Outbreak of Gastrointestinal Infections Caused by Yersinia enterocolitica in Children, Medellín, Colombia

1   Laboratorio Médico de Referencia, Medellín, Antioquia, Colombia
Claudia Beltrán
2   Clínica El Rosario, Medellín, Antioquia, Colombia
Elizabeth Sierra
1   Laboratorio Médico de Referencia, Medellín, Antioquia, Colombia
Aleyda M. Montaño
1   Laboratorio Médico de Referencia, Medellín, Antioquia, Colombia
Faiver Ramírez
2   Clínica El Rosario, Medellín, Antioquia, Colombia
Pablo Villa
2   Clínica El Rosario, Medellín, Antioquia, Colombia
Alejandro Diaz
3   Hospital General de Medellín, Antioquia, Colombia
Carlos Robledo
1   Laboratorio Médico de Referencia, Medellín, Antioquia, Colombia
Jaime Robledo
1   Laboratorio Médico de Referencia, Medellín, Antioquia, Colombia
4   Corporación para Investigaciones Biológicas, Medellín, Antioquia, Colombia
5   School of Health Sciences, Universidad Pontificia Bolivariana, Santander, Colombia
› Author Affiliations


Objective In this study, we describe the clinical and epidemiological characteristics of a cluster of children with acute gastrointestinal (GI) infection caused by Yersinia enterocolitica in Medellín, Colombia.

Methods A retrospective descriptive observational study was performed with the information recorded in clinical charts of GI infection cases caused by Y. enterocolitica in pediatric population of two hospital institutions in Medellín, Colombia. The microorganism identification was performed directly from stool samples using molecular biology techniques and from stool cultures using mass spectrometry. Space-time simulations and antibiotic susceptibility profiles were performed using Whonet 5.6 and Clinical and Laboratory Standards Institute 2020 guide.

Results A total of 37 cases were identified in children younger than 15 years; between November 2020 and January 2021, 45.9% of cases were in children aged 1 to 5 years. Most children had diarrhea (97.3%) and fever (67.6%), 21.6% had abdominal pain and vomiting, and 13.5% had hyporexia. Sixteen of the patients (43.2%) received azithromycin, 24.3% (n = 9) received ceftriaxone, and 13.5% (n = 5) received a combined treatment of ceftriaxone and azithromycin or azithromycin and metronidazole. Based on space-time simulations, the clonality analysis and the characteristics of the cases suggest a community outbreak of unknown origin.

Conclusion Our findings confirm the occurrence of an outbreak related to Y. enterocolitica from the community whose source could not be identified. Although it is presumed that the frequency of this microorganism is low in these regions, the use of new diagnostic tools in clinical microbiology allowed the early identification of the epidemiological event.


All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Publication History

Received: 27 February 2023

Accepted: 11 July 2023

Article published online:
11 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Diarrhoeal disease. Accessed September 29, 2022 at: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
  • 2 Tesfaye TS, Magarsa AU, Zeleke TM. Moderate to severe diarrhea and associated factors among under-five children in Wonago District, South Ethiopia: a cross-sectional study. Pediatric Health Med Ther 2020; 11: 437-443
  • 3 Florez ID, Niño-Serna LF, Beltrán-Arroyave CP. Acute infectious diarrhea and gastroenteritis in children. Curr Infect Dis Rep 2020; 22 (02) 4
  • 4 Grützkau A, Hanski C, Hahn H, Riecken EO. Involvement of M cells in the bacterial invasion of Peyer's patches: a common mechanism shared by Yersinia enterocolitica and other enteroinvasive bacteria. Gut 1990; 31 (09) 1011-1015
  • 5 Pathogenesis of Y. enterocolitica and Y. pseudotuberculosis in Human Yersiniosis. Accessed September 29, 2022 at: https://www.hindawi.com/journals/jpath/2011/182051/
  • 6 Pepe JC, Miller VL. Yersinia enterocolitica invasin: a primary role in the initiation of infection. Proc Natl Acad Sci U S A 1993; 90 (14) 6473-6477
  • 7 Aziz M, Yelamanchili VS. Yersinia enterocolitica . In: StatPearls. StatPearls Publishing; 2023
  • 8 Yersinia enterocolitica: Revisitation of an Enduring Human Pathogen - ScienceDirect. The Study Guide from StatPearls Publishing, Treasure Island (FL), 16 May 2018. Accessed September 29, 2022 at: https://www.sciencedirect.com/science/article/abs/pii/S0196439914000865
  • 9 Vila J, Alvarez-Martínez MJ, Buesa J, Castillo J. Microbiological diagnosis of gastrointestinal infections [in Spanish]. Enferm Infecc Microbiol Clin 2009; 27 (07) 406-411
  • 10 Luciani M, Schirone M, Portanti O. et al. Development of a rapid method for the detection of Yersinia enterocolitica serotype O:8 from food. Food Microbiol 2018; 73: 85-92
  • 11 Petsios S, Fredriksson-Ahomaa M, Sakkas H, Papadopoulou C. Conventional and molecular methods used in the detection and subtyping of Yersinia enterocolitica in food. Int J Food Microbiol 2016; 237: 55-72
  • 12 Riahi SM, Ahmadi E, Zeinali T. Global prevalence of Yersinia enterocolitica in cases of gastroenteritis: a systematic review and meta-analysis. Int J Microbiol 2021; 2021: 1499869
  • 13 Poulain C, Galeno H, Loayza S. et al. Molecular detection of gastrointestinal pathogens among children under 5 years old with diarrhea in a hospital center for rotavirus sentinel surveillance in Chile [in Spanish]. Rev Chilena Infectol 2021; 38 (01) 54-60
  • 14 Podewils LJ, Mintz ED, Nataro JP, Parashar UD. Acute, infectious diarrhea among children in developing countries. Semin Pediatr Infect Dis 2004; 15 (03) 155-168
  • 15 Rodríguez-García R, Rodríguez-Silva R. Epidemiology of acute diarrhea in children. Bol Clin Hosp Infant Edo Son 2022; 37 (02) 94-102
  • 16 Cabrera-Gaytán DA, Maldonado-Burgos MA, Rojas-Mendoza T, Grajales-Muñiz C. Enfermedad diarreica aguda en niños menores de cinco años de edad: aportaciones de los núcleos trazadores de vigilancia epidemiológica 2012–2013. Arch Inv Mat Inf 2013; 5 (03) 118-125
  • 17 Béjar Mde FE, Flórez R, Estrella AN, Saltos ME. Agentes etiológicos en pacientes con enfermedad diarreica aguda detectados por PCR en niños de 0 a 14 años de edad en el Hospital Metropolitano de Quito. Metro Ciencia 2017; 25 (02) 51-57
  • 18 Hernández-Porras EE, Rosero-Torres LE, Parra-Barrera EL, Guerrero-Montilla JA, Gómez-Rubio AL, Moreno J. Brotes de enfermedades transmitidas por los alimentos estudiados mediante técnicas moleculares. Rev Salud Publica (Bogota) 2017; 19 (05) 671-678
  • 19 Guillier L, Fravalo P, Leclercq A. et al. Risk factors for sporadic Yersinia enterocolitica infections: a systematic review and meta-analysis. Microb Risk Anal 2021; 17: 100141
  • 20 Gruber JF, Morris S, Warren KA. et al. Yersinia enterocolitica outbreak associated with pasteurized milk. Foodborne Pathog Dis 2021; 18 (07) 448-454
  • 21 Longenberger AH, Gronostaj MP, Yee GY. et al. Yersinia enterocolitica infections associated with improperly pasteurized milk products: southwest Pennsylvania, March-August, 2011. Epidemiol Infect 2014; 142 (08) 1640-1650
  • 22 Espenhain L, Riess M, Müller L. et al. Cross-border outbreak of Yersinia enterocolitica O3 associated with imported fresh spinach, Sweden and Denmark, March 2019. Euro Surveill 2019; 24 (24) 1900368
  • 23 YERSINIA ENTEROCOLITICA INFECTIONS AND PORK. THE MISSING LINK - ScienceDirect. Accessed October 10, 2022 at: https://www.sciencedirect.com/science/article/abs/pii/S0140673687916837
  • 24 Ostroff SM, Kapperud G, Hutwagner LC. et al. Sources of sporadic Yersinia enterocolitica infections in Norway: a prospective case-control study. Epidemiol Infect 1994; 112 (01) 133-141
  • 25 Rosner BM, Stark K, Höhle M, Werber D. Risk factors for sporadic Yersinia enterocolitica infections, Germany 2009-2010. Epidemiol Infect 2012; 140 (10) 1738-1747
  • 26 Van Cauteren D, Le Strat Y, Sommen C. et al. Estimated annual numbers of foodborne pathogen-associated illnesses, hospitalizations, and deaths, France, 2008-2013. Emerg Infect Dis 2017; 23 (09) 1486-1492
  • 27 Tack DM, Ray L, Griffin PM. et al. Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2016-2019. MMWR Morb Mortal Wkly Rep 2020; 69 (17) 509-514
  • 28 Wang X, Chen ZH, Ran L. et al. [Interpretation for diagnosis of yersiniosis]. Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40 (09) 1048-1051
  • 29 Zhang H, Morrison S, Tang YW. Multiplex polymerase chain reaction tests for detection of pathogens associated with gastroenteritis. Clin Lab Med 2015; 35 (02) 461-486