TY - JOUR
T1 - Diagnosis of yersinia enterocolitica infection in cancer patients with diarrhea in the era of molecular diagnostics for gastrointestinal infections
AU - Wang, Elizabeth Wenqian
AU - Bhatti, Micah
AU - Cantu, Sherry
AU - Okhuysen, Pablo C.
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2019/4
Y1 - 2019/4
N2 - Background. Yersinia enterocolitica is an uncommon cause of diarrhea, mesenteric adenitis and bacteremia in the United States. There is limited information regarding the clinical course in immunocompromised patients. We describe the clinical presentations and outcomes in patients with cancer with Y. enterocolitica diagnosed at a US cancer center before and after introduction of gastrointestinal multiplex panel (GIMP) nucleic acid amplification tests (NAATs). Methods. We reviewed medical records of all patients with Y. enterocolitica isolated from cultures or identified by means of NAATs from 2000 to 2018. We then extracted demographic information, clinical characteristics, treatment, and overall mortality rate at 30 days after the diagnosis of yersiniosis. Results. We identified 17 cases: 6 cases by culture before April 2016 and 11 cases by NAATs after that; 4 of the latter were confirmed by means of culture (36%). This represented an 8-fold increase for overall detection and a 3-fold increase in culture-proved infections when adjusted per 1000 admissions. The most common presenting symptom was diarrhea (11 of 14 [79%]), followed by abdominal pain (9 of 14 [64%]) and nausea and vomiting (6 of 14 [43%]). In 1 patient, the infection resolved spontaneously; the other patients received antibiotic treatment, the majority with a fluoroquinolone. The 30-day mortality rate was 7.1%, and the cause of death was a complication of advanced cancer. Conclusion. Since implementing use of the GIMP, we observed an increase in Y. enterocolitica cases, possibly related to increasing number of patients with cancer at our institution who are receiving intensive immunosuppression, increased testing due to ease and availability, and increased sensitivity of NAATs. GIMP NAATs are redefining the epidemiology of Y. enterocolitica infection in patients with cancer.
AB - Background. Yersinia enterocolitica is an uncommon cause of diarrhea, mesenteric adenitis and bacteremia in the United States. There is limited information regarding the clinical course in immunocompromised patients. We describe the clinical presentations and outcomes in patients with cancer with Y. enterocolitica diagnosed at a US cancer center before and after introduction of gastrointestinal multiplex panel (GIMP) nucleic acid amplification tests (NAATs). Methods. We reviewed medical records of all patients with Y. enterocolitica isolated from cultures or identified by means of NAATs from 2000 to 2018. We then extracted demographic information, clinical characteristics, treatment, and overall mortality rate at 30 days after the diagnosis of yersiniosis. Results. We identified 17 cases: 6 cases by culture before April 2016 and 11 cases by NAATs after that; 4 of the latter were confirmed by means of culture (36%). This represented an 8-fold increase for overall detection and a 3-fold increase in culture-proved infections when adjusted per 1000 admissions. The most common presenting symptom was diarrhea (11 of 14 [79%]), followed by abdominal pain (9 of 14 [64%]) and nausea and vomiting (6 of 14 [43%]). In 1 patient, the infection resolved spontaneously; the other patients received antibiotic treatment, the majority with a fluoroquinolone. The 30-day mortality rate was 7.1%, and the cause of death was a complication of advanced cancer. Conclusion. Since implementing use of the GIMP, we observed an increase in Y. enterocolitica cases, possibly related to increasing number of patients with cancer at our institution who are receiving intensive immunosuppression, increased testing due to ease and availability, and increased sensitivity of NAATs. GIMP NAATs are redefining the epidemiology of Y. enterocolitica infection in patients with cancer.
KW - Gastrointestinal multiplex panel (GIMP)
KW - Yersinia enterocolitica
KW - immunocompromised host
KW - molecular diagnostics
KW - nucleic acid amplification testing (NAAT)
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U2 - 10.1093/ofid/ofz116
DO - 10.1093/ofid/ofz116
M3 - Article
C2 - 31049362
AN - SCOPUS:85066398246
SN - 2328-8957
VL - 6
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 4
M1 - ofz116
ER -