Which is more common in pediatric patients, Campylobacter or Yersinia enterocolitica as a cause of gastrointestinal infections?

Campylobacter vs Yersinia enterocolitica in Pediatric Patients

Campylobacter is significantly more common than Yersinia enterocolitica in pediatric patients with gastrointestinal infections. Among the five most common bacterial pathogens causing gastroenteritis in children under 5 years in the United States, Campylobacter accounts for 28% of cases while Yersinia represents only 5% 1.

Relative Frequency Data

The epidemiologic data clearly demonstrate Campylobacter's predominance:

• In the U.S. pediatric population, Campylobacter is the second most common bacterial pathogen after Salmonella (42%), representing 28% of bacterial gastroenteritis cases in children under 5 years 1
• Yersinia enterocolitica accounts for only 5% of bacterial gastroenteritis in the same age group 1
• Among all bacterial intestinal pathogens isolated, Yersinia represents approximately 12.6% in some hospital-based studies, but this is still substantially less frequent than Campylobacter 2

Geographic and Temporal Patterns

Yersinia shows distinct epidemiologic characteristics that differ from Campylobacter:

• Yersinia infections occur predominantly during winter months (November through January), with significantly higher incidence during this period (P < 0.002) 2, 3
• The majority (85%) of Yersinia cases occur in infants younger than 1 year 2
• Campylobacter infections occur year-round without the same seasonal clustering 4

Clinical Implications for Diagnosis

When evaluating pediatric patients with gastroenteritis, consider testing for both pathogens under specific circumstances:

• Test for Yersinia in infants presenting with high fever and bloody diarrhea during winter months, particularly those under 3 months who have increased risk for bacteremia (9% of cases) 2, 3
• Test for Yersinia in school-aged children with right lower quadrant abdominal pain mimicking appendicitis, as this may represent mesenteric adenitis 1
• Test for Campylobacter when children present with bloody or mucoid stools, fever, and abdominal tenderness 1

Risk Factor Considerations

Specific exposures increase likelihood of each pathogen:

• Yersinia infection is strongly associated with exposure to raw or undercooked pork products, particularly chitterlings (raw pork intestines), which was documented in 83% of cases where exposure history was obtained 2
• Higher risk groups for Yersinia include young African American and Asian children, diabetics, and those with chronic liver disease or iron-overload states 1
• Campylobacter is associated with consumption of undercooked poultry and contaminated water 1

Clinical Presentation Differences

While both cause bloody diarrhea, Yersinia typically produces more systemic symptoms:

• Yersinia infections more frequently present with abdominal pain (68%) compared to Campylobacter (38%) (P < 0.01) 5
• Yersinia is associated with higher fever (≥39°C), elevated WBC count (>11 × 10⁹/L), and elevated C-reactive protein (≥10 mg/L) 5
• Fecal leukocytes are present in 87% of Yersinia cases versus 83% of Campylobacter cases 5

Common Pitfalls to Avoid

• Do not assume all winter gastroenteritis in infants is viral—Yersinia should be specifically requested on stool cultures as it requires special culture conditions 2, 3
• Do not overlook the possibility of Yersinia bacteremia in infants under 3 months presenting with fever and bloody diarrhea, as blood cultures are positive in 9% of cases 2
• Remember that standard stool culture protocols may not routinely include Yersinia testing, so specifically request it when clinical suspicion is high 1