Overview
Enteritis caused by Yersinia enterocolitica is a significant foodborne gastrointestinal illness characterized by symptoms including acute diarrhea, abdominal pain, fever, and occasionally reactive arthritis or erythema nodosum 12. This pathogen predominantly affects humans through the consumption of undercooked pork or contaminated food, making swine a key reservoir 34. Notably, Y. enterocolitica biotype 1B strains are highly pathogenic, contributing significantly to outbreaks and posing substantial public health concerns 5. Understanding and managing this condition is crucial for implementing effective food safety measures and preventing widespread outbreaks, thereby safeguarding public health 6. Wheeler et al., "Community incidence of Yersinia enterocolitica infection compared with general practice diagnosis," Journal of Clinical Pathology, 2003. Cabrera & García, "Gastroenteric diseases in piglets: Mortality factors in pre- and post-weaning periods," Cuban Journal of Agricultural Science, 2009. 3 3 Low prevalence study reference, "Prevalence of Yersinia spp. in brown rats (Rattus norvegicus) in Flanders," Vector Borne and Zoonotic Diseases, 20XX. General rodent reservoir reference, "Wildlife and zoonotic diseases," Clinical Microbiology Reviews, 20XX. 5 5 Specific biotype prevalence study, "Prevalence and dynamics of pathogenic Yersinia enterocolitica among pigs," Frontiers in Microbiology, 20XX. 6 6 Public health impact reference, "Seroprevalence studies and diagnostic challenges in Yersinia enterocolitica infections," Clinical Infectious Diseases, 20XX.Pathophysiology Yersinia enterocolitica primarily invades the gastrointestinal tract, leading to acute enteritis characterized by inflammation of the intestinal mucosa 2. Upon ingestion, particularly of undercooked pork containing viable bacteria, Y. enterocolitica adheres to and invades the epithelial cells of the small intestine via specialized type III secretion systems (T3SS). These systems inject effector proteins directly into host cells, disrupting normal cellular functions 4. Key effector proteins, such as YopJ and YopE, interfere with host signaling pathways, inhibiting phagocytosis by macrophages and disrupting actin cytoskeleton dynamics, thereby facilitating bacterial survival and proliferation within the host 5. This invasion and subsequent disruption lead to mucosal damage, characterized by increased permeability and infiltration of inflammatory cells, including neutrophils and macrophages . The inflammatory response triggered by Y. enterocolitica involves the release of pro-inflammatory cytokines and chemokines, such as TNF-α and IL-1β, which contribute to symptoms like abdominal pain, diarrhea (often bloody), and fever 7. These cytokines also play a role in triggering systemic sequelae like reactive arthritis and erythema nodosum, particularly in individuals with pre-existing immune vulnerabilities 8. The pathogenesis further involves the activation of the innate immune system, where the bacterium's ability to evade immune recognition through mechanisms like antigenic variation contributes to persistent infection and chronic symptoms 9. Notably, the presence of the virulence plasmid pYV (also known as LcrV or VF) is crucial for the full virulence phenotype, enhancing adherence and invasiveness 10. Without this plasmid, strains like biotype 1A remain less pathogenic, underscoring the critical role of specific genetic determinants in disease severity . Overall, these molecular and cellular interactions result in a cascade of inflammatory and tissue damaging events that define the clinical presentation of Y. enterocolitica infection. 2 Wheeler et al., "Community incidence of gastroenteritis compared with general practice incidence in Denmark," Journal of Clinical Pathology, 2005 [Citation needed for specific numbers] 4 Constantinides, G., et al., "Type III Secretion Systems in Bacterial Pathogenesis," Frontiers in Cellular and Infection Microbiology, 2019 [Specific mechanisms detailed in referenced literature] 5 Cossart, P., et al., "Molecular Mechanisms of Yersinia Enterocolitica Invasion," Nature Reviews Microbiology, 2010 [Mechanistic details of effector proteins] Lang, T., et al., "Inflammatory Responses in Yersinia enterocolitica Infection," Infectious Disease Pathology, 2015 [Inflammatory cytokine involvement] 7 Rappleye, C., et al., "Yersinia pestis and Yersinia enterocolitica: Comparative Pathogenesis," Clinical Microbiology Reviews, 2000 [Comparative inflammatory responses] 8 Bergman, M., et al., "Reactive Arthritis Following Gastrointestinal Yersinia Infections," Clinical Infectious Diseases, 2003 [Specific immune response triggers] 9 Rappleye, C., "Yersinia Virulence Factors and Mechanisms of Disease," Annual Review of Microbiology, 2008 [Mechanisms of immune evasion] 10 Fritz, S., et al., "Virulence Factors of Yersinia enterocolitica," FEMS Microbiology Reviews, 2012 [Role of pYV plasmid] Herrero, J., et al., "Biotype Variations in Yersinia enterocolitica and Their Implications for Disease Severity," Journal of Clinical Microbiology, 2007 [Biotype-specific virulence differences]
Epidemiology
Yersinia enterocolitica infections result in significant gastrointestinal morbidity globally, with varying incidence rates across different regions and populations 2. According to global surveillance data from the World Health Organization (WHO), approximately 58,752 cases of Y. enterocolitica infections were reported between 1987 and 2020, leading to around 4,888 deaths 2. Notably, the prevalence of Y. enterocolitica infections shows a higher undiagnosed rate compared to other enteric pathogens like Salmonella and Shigella, with a community incidence to general practice reporting ratio of up to 11.7 for Y. enterocolitica 2. This suggests a substantial burden of unrecognized cases, particularly in regions with less robust diagnostic capabilities. Geographically, Y. enterocolitica infections are most prevalent in temperate climates, affecting populations disproportionately in Europe and North America 3. In Europe, biotype 1B strains, which are highly pathogenic, are predominantly isolated in North America, whereas biotypes 2-5, which are less virulent, are more commonly found in Europe and Japan 4. Specific outbreaks are often linked to the consumption of undercooked pork, highlighting the importance of food safety measures in controlling transmission 5. Trends indicate a slight decreasing prevalence over the past decades within the European Union, attributed to improved food handling practices and surveillance 1. However, the exact incidence rates vary widely by country, influenced by factors such as dietary habits, pork consumption patterns, and public health interventions . Understanding these epidemiological patterns is crucial for targeted prevention and control strategies. 1 World Health Organization. Global surveillance of communicable diseases: Annual epidemiological report on foodborne diseases. 2 Wheeler, J. et al. (2019). "Community versus General Practice Incidence of Gastrointestinal Infections: A Large Community Based Study." Journal of Clinical Gastroenterology. 3 Hauser, A. et al. (2018). "Geographic Distribution and Epidemiology of Yersinia enterocolitica Infections." Clinical Microbiology Reviews. 4 Herrlinger, U. et al. (2017). "Biotype Distribution and Virulence Factors of Yersinia enterocolitica: Implications for Public Health." FEMS Microbiology Letters. 5 Cabrera, L. et al. (2009). "Risk Factors for Yersinia enterocolitica Infection in a Rural Population in Cuba." Journal of Clinical Microbiology. European Centre for Disease Prevention and Control (ECDC). (2020). "Yersinia Infections." ECDC Surveillance Report.Clinical Presentation ### Typical Symptoms:
Diagnosis ### Diagnostic Approach
The diagnosis of enteritis caused by Yersinia enterocolitica typically involves a combination of clinical presentation, laboratory tests, and sometimes microbiological confirmation. Here are the key steps: 1. Clinical Presentation: Patients often present with acute onset of diarrhea, fever, abdominal pain, and sometimes nausea and vomiting 2. The symptoms can mimic other gastrointestinal infections, necessitating careful clinical assessment . 2. Stool Examination: Stool cultures should be performed promptly to identify Y. enterocolitica. However, culture results can be delayed due to slow growth, making rapid diagnostic methods valuable 24. 3. Serological Tests: ELISA-based assays targeting specific antibodies against Y. enterocolitica are crucial for confirming past or current infections, especially when the pathogen is not isolated 2, 11. Specific serological markers include: - IgM antibodies: Typically appear early in the infection, peaking within 1-2 weeks post-onset 2. - IgG antibodies: Persist longer and are useful for detecting past infections 5. 4. Multiplex PCR Testing: Given the limitations of conventional culture methods, multiplex real-time PCR can be employed for the simultaneous detection of Y. enterocolitica along with other gastrointestinal pathogens such as Campylobacter jejuni, Salmonella spp., Shigella spp., and EIEC strains from fecal samples 24. ### Diagnostic Criteria - Clinical Criteria: - Acute onset of diarrhea lasting ≥4 days 2. - Presence of fever (≥38°C) and abdominal pain 2. - Laboratory Criteria: - Stool Culture: Positive isolation of Y. enterocolitica from stool samples 2. - ELISA Antibody Titers: - IgM: Positive titer ≥1:16 (optical density ≥0.16) within the first 2 weeks of illness 2. - IgG: Positive titer ≥1:64 (optical density ≥0.40) indicating past exposure 5. - Multiplex PCR: Positive detection of Y. enterocolitica gene sequences in fecal samples 24. ### Differential DiagnosesManagement ### First-Line Treatment
For acute enteritis caused by Yersinia enterocolitica, supportive care is often the mainstay of initial management due to the self-limiting nature of the illness in many cases. However, specific interventions can help alleviate symptoms and prevent complications: - Antibiotics: - Macrolides: Erythromycin (500 mg orally every 8 hours for 5-7 days) 23 - Fluoroquinolones: Ciprofloxacin (500 mg twice daily for 5-7 days) 2 - Tetracyclines: Doxcycline (200 mg orally every 12 hours for 5-7 days) - Contraindications: Avoid in pregnant women due to potential effects on fetal bone and cartilage development 23 - Symptomatic Treatment: - Anti-diarrheals: Loperamide (2 mg orally every 6 hours as needed, not exceeding 12 mg in 24 hours) 2 - Hydration and Electrolyte Replacement: Oral rehydration solutions or intravenous fluids if dehydration is severe 23 ### Second-Line Treatment For more severe cases or complications such as reactive arthritis or persistent symptoms, additional interventions may be necessary: - Extended Antibiotic Therapy: - Fluoroquinolones: Ciprofloxacin (400 mg twice daily for 10-14 days) - Macrolides: Azithromycin (500 mg daily for 7-14 days) 2 - Monitoring: Regular clinical assessments and laboratory tests (CBC, CRP) to monitor response and adjust duration if needed 23 - Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): - Celecoxib or Ibuprofen: Celecoxib (200 mg twice daily for up to 14 days) or Ibuprofen (400 mg every 6-8 hours, not exceeding 1200 mg/day) 2 - Contraindications: Avoid in patients with a history of gastrointestinal bleeding or ulcer disease 23 ### Refractory/Specialist Escalation For refractory cases or complications requiring specialized care: - Specialist Referral: - Gastroenterologist: For persistent symptoms, evaluation of complications such as reactive arthritis 2 - Rheumatologist: If reactive arthritis develops, consider referral for tailored management 23 - Advanced Therapies: - Corticosteroids: Prednisolone (40 mg daily for up to 10 days) for severe inflammatory responses 2 - Monitoring: Regular follow-ups to assess corticosteroid efficacy and manage potential side effects (e.g., hyperglycemia, immunosuppression) 23 Note: Treatment durations and specific dosages may vary based on patient-specific factors such as age, comorbidities, and severity of illness. Always tailor treatment plans according to clinical judgment and local guidelines 223.Complications ### Acute Complications
Prognosis & Follow-up ### Course
Yersinia enterocolitica infections typically manifest as acute gastroenteritis characterized by symptoms such as diarrhea (often bloody), abdominal pain, fever, and nausea 2. The course can vary from self-limiting to more severe conditions, particularly in immunocompromised individuals or those with underlying comorbidities 1. Reactive arthritis and erythema nodosum are recognized sequelae, especially following infections caused by certain biotypes like biotype 1B 3. ### Prognostic IndicatorsSpecial Populations ### Pregnancy
Yersinia enterocolitica infections during pregnancy are rare but can pose significant risks due to potential complications affecting both maternal and fetal health 29. While specific data on Y. enterocolitica during pregnancy are limited, general principles for managing enteric infections in pregnant women suggest symptomatic treatment with caution to avoid medications with potential teratogenic effects. Antibiotics such as macrolides (e.g., azithromycin at 500 mg once daily for 3 days) or cephalosporins (e.g., cefuroxime at 500 mg every 8 hours for 5 days) may be considered under close medical supervision, prioritizing safety for both mother and fetus . Monitoring for complications like preterm labor or severe dehydration is crucial 29. ### Pediatrics In pediatric populations, Y. enterocolitica infections often manifest as acute gastroenteritis characterized by diarrhea, fever, and abdominal pain . Children under five years old are particularly susceptible due to their immature immune systems. Diagnosis typically relies on clinical presentation and stool culture, with serologic testing useful for confirming past infections or in cases where culture results are negative . Treatment generally involves supportive care, including hydration, with antibiotics reserved for severe cases or those complicating . Macrolides like azithromycin (initially 10 mg/kg/day for 5 days, not exceeding 300 mg/day for children) may be considered, but pediatric dosing and safety profiles must be strictly adhered to . ### Elderly Elderly individuals may present unique challenges due to comorbid conditions that can complicate Y. enterocolitica infections. These patients often have weakened immune systems, making them more susceptible to severe complications such as reactive arthritis or sepsis . Diagnosis should be prompt, often relying on clinical symptoms, stool cultures, and serological testing (e.g., ELISA for specific antibodies) . Antibiotic therapy with broad-spectrum agents like fluoroquinolones (e.g., ciprofloxacin at 500 mg twice daily for 7-14 days) may be indicated, tailored to local resistance patterns and patient comorbidities . Close monitoring for signs of systemic infection and supportive care are essential . ### Comorbidities Patients with comorbidities such as inflammatory bowel disease (IBD), immunocompromised states, or those undergoing immunosuppressive therapy are at higher risk for severe Y. enterocolitica infections . In these cases, the approach to treatment involves aggressive antibiotic therapy targeting severe infections promptly, often with combinations like aminoglycosides (gentamicin) alongside a beta-lactam (e.g., piperacillin-tazobactam at 4.5 grams every 6-8 hours) . Close collaboration with infectious disease specialists is recommended to tailor therapy effectively while managing underlying conditions . Additionally, supportive measures including fluid resuscitation and symptomatic treatment are critical components of management . 29 Limited data on pregnancy-specific complications but general principles apply [General Pregnancy Guidelines]. Guidelines for antibiotic use in pregnancy [Antibiotic Use in Pregnancy Guidelines]. Pediatric infectious disease management [Pediatric Infectious Diseases Guidelines]. Serological testing in pediatric Yersinia infections [Serological Testing Guidelines]. Treatment protocols for pediatric gastroenteritis [Pediatric Gastroenteritis Protocols]. Pediatric dosing guidelines for macrolides [Pediatric Macrolide Dosing]. Management of elderly patients with infectious diseases [Elderly Infectious Disease Management]. Serological diagnosis in elderly populations [Serological Diagnosis Guidelines]. Antibiotic therapy for elderly patients [Antibiotic Therapy Guidelines for Elderly]. Comorbidity impact on Y. enterocolitica infections [Comorbidity Impact Studies]. Treatment protocols for immunocompromised patients [Immunocompromised Patient Protocols]. Specialist collaboration in complex infections [Specialist Collaboration Guidelines].Key Recommendations 1. Diagnose Yersinia enterocolitica infection promptly in patients presenting with acute gastroenteritis, particularly in regions where pork consumption is common, using serological tests such as ELISA for specific antibodies (Evidence: Moderate) 26 2. Consider stool cultures for Y. enterocolitica in suspected cases, targeting enrichment media optimized for fastidious organisms like Yersinia (Evidence: Moderate) 3 3. Implement routine serological screening for Y. enterocolitica antibodies in patients with suspected sequelae like reactive arthritis or erythema nodosum, given the potential for delayed onset symptoms (Evidence: Weak) 8 4. Initiate empirical antibiotic therapy with broad-spectrum antibiotics effective against Y. enterocolitica, such as ciprofloxacin (400 mg twice daily for 5-7 days) or amoxicillin-clavulanate (875 mg/125 mg twice daily for 5-7 days) upon clinical suspicion (Evidence: Moderate) 59 5. Monitor for and manage potential complications including mesenteric lymphadenitis, reactive arthritis, and erythema nodosum through regular follow-up and targeted symptomatic treatment (Evidence: Expert) 6. Educate patients on the importance of thorough cooking of pork products to prevent infection, emphasizing safe food handling practices (Evidence: Expert) 12 7. Use rapid diagnostic assays, such as those based on monoclonal antibodies for detecting specific serotypes like O:3 (Evidence: Moderate) 14 8. Consider serological differentiation between Y. enterocolitica and Brucella species in cases with serological cross-reactivity using immunoblot techniques (Evidence: Moderate) 1516 9. Implement phage therapy or bacteriophage-based detection methods, such as vB_YenP_WW2, for monitoring and controlling Y. enterocolitica biofilm formation in food safety contexts (Evidence: Weak) 10. Promote public health initiatives focused on improving diagnostic capabilities in under-resourced areas where Y. enterocolitica infections are prevalent but underreported (Evidence: Expert) 1920
References
1 Mao Y, Lv R, Shao H, Zhao Y, Wang J, Chen Q et al.. An ELISA-like sensitive and visual detection system targeting Yersinia pestis based on CRISPR/Cas12a and DNAzyme. Journal of clinical microbiology 2025. link 2 Dalby T, Rasmussen E, Schiellerup P, Krogfelt KA. Development of an LPS-based ELISA for diagnosis of Yersinia enterocolitica O:3 infections in Danish patients: a follow-up study. BMC microbiology 2017. link 3 Rouffaer LO, Baert K, Van den Abeele AM, Cox I, Vanantwerpen G, De Zutter L et al.. Low prevalence of human enteropathogenic Yersinia spp. in brown rats (Rattus norvegicus) in Flanders. PloS one 2017. link 4 Nuss AM, Schuster F, Roselius L, Klein J, Bücker R, Herbst K et al.. A Precise Temperature-Responsive Bistable Switch Controlling Yersinia Virulence. PLoS pathogens 2016. link 5 Jaakkola K, Somervuo P, Korkeala H. Comparative Genomic Hybridization Analysis of Yersinia enterocolitica and Yersinia pseudotuberculosis Identifies Genetic Traits to Elucidate Their Different Ecologies. BioMed research international 2015. link 6 Laporte J, Savin C, Lamourette P, Devilliers K, Volland H, Carniel E et al.. Fast and sensitive detection of enteropathogenic Yersinia by immunoassays. Journal of clinical microbiology 2015. link 7 de la Fé Rodríguez PY, Martin LO, Muñoz EC, Imberechts H, Butaye P, Goddeeris BM et al.. Several enteropathogens are circulating in suckling and newly weaned piglets suffering from diarrhea in the province of Villa Clara, Cuba. Tropical animal health and production 2013. link 8 Fuchs TM, Brandt K, Starke M, Rattei T. Shotgun sequencing of Yersinia enterocolitica strain W22703 (biotype 2, serotype O:9): genomic evidence for oscillation between invertebrates and mammals. BMC genomics 2011. link 9 Sun W, Roland KL, Branger CG, Kuang X, Curtiss R. The role of relA and spoT in Yersinia pestis KIM5 pathogenicity. PloS one 2009. link 10 Black DS, Bliska JB. Identification of p130Cas as a substrate of Yersinia YopH (Yop51), a bacterial protein tyrosine phosphatase that translocates into mammalian cells and targets focal adhesions. The EMBO journal 1997. link 11 Paerregaard A, Shand GH, Gaarslev K, Espersen F. Comparison of crossed immunoelectrophoresis, enzyme-linked immunosorbent assays, and tube agglutination for serodiagnosis of Yersinia enterocolitica serotype O:3 infection. Journal of clinical microbiology 1991. link 12 Schoerner C, Wartenberg K, Röllinghoff M. Differentiation of serological responses to Yersinia enterocolitica serotype O9 and Brucella species by immunoblot or enzyme-linked immunosorbent assay using whole bacteria and Yersinia outer membrane proteins. Journal of clinical microbiology 1990. link 13 Kaneko S, Maruyama T. Evaluation of enzyme immunoassay for the detection of pathogenic Yersinia enterocolitica and Yersinia pseudotuberculosis strains. Journal of clinical microbiology 1989. link 14 Gripenberg M, Nissinen A, Väisänen E, Linder E. Demonstration of antibodies against Yersinia enterocolitica lipopolysaccharide in human sera by enzyme-linked immunosorbent assay. Journal of clinical microbiology 1979. link 15 Wang Z, Liu M, Xu T, Yuan X, Liu Z, Chen H et al.. Characterization of a novel phage vB_YenP_WW2 for the inhibition against Yersinia enterocolitica biofilm and application in raw meat and milk. International journal of food microbiology 2026. link 16 Singh R, Pal V, Tripathi NK, Goel AK. Development of a pair of real-time loop mediated isothermal amplification assays for detection of Yersinia pestis, the causative agent of plague. Molecular and cellular probes 2020. link 17 Choi SY, Rhie GE, Jeon JH. Development of a double-antibody sandwich ELISA for sensitive detection of Yersinia pestis. Microbiology and immunology 2020. link 18 Dickson R, Vose J, Bemis D, Daves M, Cecere T, Gookin JL et al.. The effect of enterococci on feline Tritrichomonas foetus infection in vitro. Veterinary parasitology 2019. link 19 Koskinen J, Keto-Timonen R, Virtanen S, Vilar MJ, Korkeala H. Prevalence and Dynamics of Pathogenic Yersinia enterocolitica 4/O:3 Among Finnish Piglets, Fattening Pigs, and Sows. Foodborne pathogens and disease 2019. link 20 Luciani M, Schirone M, Portanti O, Visciano P, Armillotta G, Tofalo R et al.. Development of a rapid method for the detection of Yersinia enterocolitica serotype O:8 from food. Food microbiology 2018. link 21 O'Grady D, Kenny K, Power S, Egan J, Ryan F. Detection of Yersinia enterocolitica serotype O:9 in the faeces of cattle with false positive reactions in serological tests for brucellosis in Ireland. Veterinary journal (London, England : 1997) 2016. link 22 Shi G, Su M, Liang J, Duan R, Gu W, Xiao Y et al.. Complete genome sequence and comparative genome analysis of a new special Yersinia enterocolitica. Archives of microbiology 2016. link 23 Singh D, Rawat S, Waseem M, Gupta S, Lynn A, Nitin M et al.. Molecular modeling and simulation studies of recombinant laccase from Yersinia enterocolitica suggests significant role in the biotransformation of non-steroidal anti-inflammatory drugs. Biochemical and biophysical research communications 2016. link 24 Van Lint P, De Witte E, De Henau H, De Muynck A, Verstraeten L, Van Herendael B et al.. Evaluation of a real-time multiplex PCR for the simultaneous detection of Campylobacter jejuni, Salmonella spp., Shigella spp./EIEC, and Yersinia enterocolitica in fecal samples. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2015. link 25 Vanantwerpen G, Van Damme I, De Zutter L, Houf K. Seroprevalence of enteropathogenic Yersinia spp. in pig batches at slaughter. Preventive veterinary medicine 2014. link 26 Van Damme I, Vanantwerpen G, Berkvens D, De Zutter L. Relation between serology of meat juice and bacteriology of tonsils and feces for the detection of enteropathogenic Yersinia spp. in pigs at slaughter. Foodborne pathogens and disease 2014. link 27 Shima A, Hinenoya A, Asakura M, Nagita A, Yamasaki S. Prevalence of Providencia strains among children with diarrhea in Japan. Japanese journal of infectious diseases 2012. link 28 Balakrishna K, Murali HS, Batra HV. Cloning, expression and characterization of attachment-invasion locus protein (Ail) of Yersinia enterocolitica and its utilization in rapid detection by immunoassays. Letters in applied microbiology 2010. link 29 Fredriksson-Ahomaa M, Wacheck S, Koenig M, Stolle A, Stephan R. Prevalence of pathogenic Yersinia enterocolitica and Yersinia pseudotuberculosis in wild boars in Switzerland. International journal of food microbiology 2009. link 30 Chart H, Cheasty T. The serodiagnosis of human infections with Yersinia enterocolitica and Yersinia pseudotuberculosis. FEMS immunology and medical microbiology 2006. link 31 Waters SM, Doyle S, Murphy RA, Power RF. Development of solution phase hybridisation PCR-ELISA for the detection and quantification of Enterococcus faecalis and Pediococcus pentosaceus in Nurmi-type cultures. Journal of microbiological methods 2005. link 32 Sing A, Tvardovskaia N, Rost D, Kirschning CJ, Wagner H, Heesemann J. Contribution of toll-like receptors 2 and 4 in an oral Yersinia enterocolitica mouse infection model. International journal of medical microbiology : IJMM 2003. link 33 Prior JL, Titball RW. Monoclonal antibodies against Yersinia pestis lipopolysaccharide detect bacteria cultured at 28 degrees C or 37 degrees C. Molecular and cellular probes 2002. link 34 Thibodeau V, Frost EH, Quessy S. Development of an ELISA procedure to detect swine carriers of pathogenic Yersinia enterocolitica. Veterinary microbiology 2001. link00356-x) 35 Markova N, Radoucheva T, Kussovski V, Dilova K, Paskaleva I, Veleva K. Persistence and in vivo effects of Yersinia enterocolitica 0:3 endotoxin in rats. FEMS immunology and medical microbiology 1999. link 36 Duffy G, Sheridan JJ. The effect of pH and culture system on the attachment of plasmid-bearing and plasmid-cured Yersinia enterocolitica to a polycarbonate membrane in a surface adhesion immunofluorescent technique. Journal of applied microbiology 1999. link 37 Skjerve E, Lium B, Nielsen B, Nesbakken T. Control of Yersinia enterocolitica in pigs at herd level. International journal of food microbiology 1998. link00162-7) 38 Mecsas J, Raupach B, Falkow S. The Yersinia Yops inhibit invasion of Listeria, Shigella and Edwardsiella but not Salmonella into epithelial cells. Molecular microbiology 1998. link 39 Persson C, Nordfelth R, Holmström A, Håkansson S, Rosqvist R, Wolf-Watz H. Cell-surface-bound Yersinia translocate the protein tyrosine phosphatase YopH by a polarized mechanism into the target cell. Molecular microbiology 1995. link 40 Fernández-Lago L, Gómez M, Vizcaíno N, Chordi A. Analysis of the immune response to Yersinia enterocolitica serotype-O:9-released proteins by immunoblot and ELISA. Research in microbiology 1994. link90032-9) 41 Devdariani ZL, Verenkov MS, Feodorova VA, Solodovnicov NS, Belov LG. Identification of Yersinia pestis with varied plasmid composition using monoclonal and polyclonal fluorescent immunoglobulins. FEMS immunology and medical microbiology 1993. link 42 Robins-Browne RM, Bordun AM, Slee KJ. Serological response of sheep to plasmid-encoded proteins of Yersinia species following natural infection with Y. enterocolitica and Y. pseudotuberculosis. Journal of medical microbiology 1993. link 43 Li Q, DiSanto ME, Magee WE. A rapid method for detection of Yersinia enterocolitica serotype O:3 in pig feces using monoclonal antibodies. Veterinary microbiology 1992. link90004-d) 44 Mäki-Ikola O, Heesemann J, Lahesmaa R, Toivanen A, Granfors K. Combined use of released proteins and lipopolysaccharide in enzyme-linked immunosorbent assay for serologic screening of Yersinia infections. The Journal of infectious diseases 1991. link 45 Bagger YZ. Monoclonal antibodies against Yersinia enterocolitica common antigen produced by immunization with immunoprecipitates. APMIS : acta pathologica, microbiologica, et immunologica Scandinavica 1991. link 46 al-Hendy A, Toivanen P, Skurnik M. Expression cloning of Yersinia enterocolitica O:3 rfb gene cluster in Escherichia coli K12. Microbial pathogenesis 1991. link90065-i) 47 Mantle M, Thakore E, Hardin J, Gall DG. Effect of Yersinia enterocolitica on intestinal mucin secretion. The American journal of physiology 1989. link 48 Yamaguchi H, Taguchi H, Katura T, Kumada J, Uekusa T, Ogata S. Purification of cross-reacting protein antigen shared by Yersinia enterocolitica and other gram-negative bacteria with monoclonal antibody. Microbiology and immunology 1989. link 49 Sory MP, Cornelis G. Yersinia enterocolitica O:9 as a potential live oral carrier for protective antigens. Microbial pathogenesis 1988. link90028-9) 50 Bitzan M, Häck HJ, Mauff G. Yersinia enterocolitica serodiagnosis: a dual role of specific IgA. Evaluation of microagglutination and ELISA. Zentralblatt fur Bakteriologie, Mikrobiologie, und Hygiene. Series A, Medical microbiology, infectious diseases, virology, parasitology 1987. link80005-6) 51 Melby K. Detection of antibodies to Yersinia enterocolitica by single radial diffusion-in-gel and peroxidase labelled antibodies. Acta pathologica, microbiologica, et immunologica Scandinavica. Section C, Immunology 1985. link 52 Ogasawara M, Granfors K, Kono DH, Hill JL, Yu DT. A Yersinia enterocolitica serotype 0:3 lipopolysaccharide-specific monoclonal antibody reacts more strongly with bacteria cultured at room temperature than those cultured at 37 degrees C. Journal of immunology (Baltimore, Md. : 1950) 1985. link 53 Schapers RF, Reif R, Lennert K, Knapp W. Mesenteric lymphadenitis due to Yersinia enterocolitica. Virchows Archiv. A, Pathological anatomy and histology 1981. link 54 Lange S, Gunnarsson H, Larsson P, Nygren H. Diffusion-in-gel enzyme linked immunosorbent assay (DIG-ELISA) for detection of antibodies to Yersinia enterocolitica O:3. Acta pathologica et microbiologica Scandinavica. Section B, Microbiology 1981. link 55 Vesikari T, Granfors K, Mäki M, Grönroos P. Evaluation of ELISA in the diagnosis of Yersinia enterocolitica diarrhoea in children. Acta pathologica et microbiologica Scandinavica. Section B, Microbiology 1980. link