Today the topic of our presentation is yersiniosis.
Yersiniosis is a chronic infection typically due to yersinia enterocolitica.
And it represents a growing problem in the United States
and in California in particular.
Why are we talking about yersiniosis in our clinic?
Well because on an annual basis we see approximately
40-50 new patients with chronic yersiniosis.
And typically this infection is linked to various musculoskeletal problems.
So what is yersiniosis?
It is a food-borne chronic infection which is typically
caused by yersinia enterocolitica and to a lesser degree
by yersinia pseudotuberculosis.
And again, it is a chronic infection due to these microorganisms.
Obviously yersinia comes from the environment, from nature.
This microorganism can be found in the gastrointestinal
tract of numerous large animals such as
cattle, deer, pigs and birds.
Yersinia enterocolitica typically found in porcine
intestines and as an infection which is harmful to humans.
Basically the initial infection presents as diarrhea
and inflammation of the small intestine.
Humans contract yersinia with contaminated food or water.
The most common sources include under cooked pork,
pig intestines, or porcine intestines, and raw chitterlings.
So what are the signs and symptoms?
We should separate acute yersiniosis and chronic yersiniosis
Typically the acute infection with yersinia enterocolitica
presents as a typical food poisoning with
fever, chills, watery diarrhea, and nausea.
So the chronic yersiniosis represents a completely different animal.
So typically patients who have chronic yersiniosis
they complain about frequent bouts of right lower
quadrant abdominal pain and frequently they are diagnosed with pseudoappendicitis.
So this right lower quadrant abdominal pain
is also frequently associated with right sided
low back pain and right sided hip pain.
In our clinic we frequently see an association
between chronic yersiniosis and various degrees
of scoliosis as well as various problems
associated with sternoclavicular joints.
Sometimes it's pain, sometimes it's deformity.
What is interesting is that the majority of patients
with yersiniosis have pain predominantly over the
right side of their body.
It has been described in numerous articles
that yersiniosis also has a close association with
autoimmune thyroid disease such as Hasimoto thyroiditis.
What can we expect to see on images?
So the typical presentation of chronic yersiniosis
is ileocecal valve or distal ileum thickening
on either abdominal CT scan or MRI.
When you see a patient with a musculoskeletal condition
or other chronic inflammatory situations...
how do you chose who needs to be tested
for yersiniosis?
So this slide actually talks about the most common
conditions which we see in our practice
which are associated with yersiniosis,
chronic yersiniosis obviously.
So we are talking about inflammatory arthritis
and a subset of patients with rheumatoid arthritis in particular.
Patients with ankylosing spondilitis frequently dealing
with chronic yersiniosis.
Based on my estimation, approximately 5-10% of people
who are HLA B27 positive do carry yersinia enterocolitica
and they do have problems with chronic yersiniosis.
Patients with psoriatic arthritis, patients who have
irritable bowel syndrome with chronic diarrhea.
Obviously patients who have chronic right lower quadrant
abdominal pain without any detectable problems.
Patients with chronic right hip pain and right
sided low back pain.
Also there is a high prevalence of chroinic yersiniosis
in patients with ulcerative colitis and patients
who have chron's disease.
Patients who have scoliosis, hashimoto thyroiditis, and
also patients who have iron overload disease and
hemochromatosis.
So it is well recognized that patients who have
yersiniosis can demonstrate positive Lyme serology
due to cross reactivity with borrelia burgdorferi.
And it is my recommendation to check patients
who have atypical Lyme disease presentation
for the presence of chronic yersiniosis.
So how do we test for chronic yersiniosis?
We do stool culture for yersinia if diarrhea is present.
So you can do stool PCR as well for both
yersinia enterocolitica and yersinia pseudotuberculosis.
But most commonly the diagnosis is based on the
combination of clinical presentation and elevated
levels of IgM or IgG, or and IgA antibodies to yersinia enterocolitica.
This test is commercially available through LabCorp and Quest.
So in our clinic we also using thermography
as a screening tool.
And quite frequently patients with chronic yersiniosis
they have abnormal appearance of the surface
thermographic picture around right lower quadrant.
One of them you can see on this particular slide.
What's the therapy for chronic yersiniosis?
So first of all antibiotics, anti-inflammatory drugs,
as well as botanicals, probiotics, and dietary modifications.
So antibiotic therapy includes tetracyclines,
azithromycin, trimethoprim with sulfomethaxazole,
known as bactrim.
Fluoroquinolones in rare situations.
As well as 3rd and 4th generation cephalosporins.
One thing which I need to mention, the therapy of
yersiniosis is a long-term therapy. And the specific
duration of the therapy needs to be defined on a
case by case basis.
We also like using anti-inflammatory drugs such as
sulfasalazine or 5 aminosalicylic acid.
And we have a very good success rate by combining
antibiotic and anti-inflammatory therapy.
So let's talk about nutraceuticals, more specifically,
botanicals. We can use botanicals alone, we can use
botanicals in combination with pharmaceuticals as well.
So what is known about botanicals?
Well there is a very very strong database supporting
the use of Arjun, Berberine, Guava Leaf, Lomatium,
and neem to treat chronic yersiniosis.
Typically we like combining several botanicals together.
The second tier drugs represent Alpha Lipoic Acid,
one thing I need to mention is that yersinia thrives on
iron and alpha lipoic acid is an iron binder, it's an
iron chelating agent and it has a definitive place
in the therapy of yersiniosis.
And there are quite a few other botanicals which
we are using in our practice including
Anamu, Ashoka, Cat's Claw, neutraceutical Colloidal Silver,
Olive Leaf Extract and Oregano Oil.
Again, the specific combination of nutraceuticals and
botanicals needs to be determined on a case to case basis.
In addition to botanicals, we are using various probioitcs
including for example high dose Bacillus coagulans
and saccharomyces boulardii. As well as dietary modifications
including a low-carb diet and definitely low iron diet.
So the question which comes up quite frequently
in our clinic is how to avoid yersiniosis?
Or how to diminish the risk of contracting a
yersinia infection?
And so typically we recommend to avoid eating
raw or under cooked pork, including various products
such as salami for example or bacon.
Store food properly. Consume only pasteurized dairy
products and obviously wash your hands when preparing food.