# Current Challenges in _Yersinia_ Diagnosis and Treatment
## 10 Treatment of _Yersinia_ Infection  
### Treatment of Intestinal _Yersinia_  
Mild intestinal ischemia usually resolves spontaneously. Diarrhea requires adequate hydration, electrolytes, and nutrient supplementation (Table 5). Severe and prolonged disease may require antibiotics, primarily quinolones; however, aminoglycos or tetracyclines in combination with trimethoprim-sulfamethoxazole (TMP-SMX) have also been used [151; 170; 171; 172]. Most organisms are sensitive to aminoglycos and fluorquinolones [173]. However, antibiotic treatment is recommended only in severe or complicated diarrheal infections, especially in the case of concomitant or suspected bacteremia or in immunocompromised individuals [171; 172]. In specific populations, such as the elderly; diabetics; or those with iron overload, alcoholism, or chronic diseases, treatment should be considered [173]. An example is the use of antibiotics in patients with predominant extramesenteric symptoms such as lymphadenopathy with high fever, weight loss, septic syndrome, and hepatitis. Tetracycline is also used in the treatment of human yersinia [170]. Although antimicrobial therapy alleviates symptoms, it does not affect the course of the disease. This fact is confirmed by studies that could not link the duration of symptoms of the enteritis caused by _Y. enterocolitica_ infections with antimicrobial treatment [174]. \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Diagnostic Test** & \multicolumn{2}{c}{**Characteristics**} & \multicolumn{2}{c}{**Clinical Meaning**} \\ \hline ELISA & \(\bullet\) & Commonly used to detect IgG, IgA, and IgM [151]; & \(\bullet\) & Confirms the infection; \\  & \(\bullet\) & Allows for the detection of antibodies & \(\bullet\) & Useful in final diagnosis, particularly in ReA [151]. \\  & & against _Yersinia_ LPS, ECA-specific & \(\bullet\) & Allows for the differentiation of specific antibody isotypes: \\  & & antibodies & \(\bullet\) & Enables differentiation between IgG \\ Western blot & \(\bullet\) & _Yersinia_ antibodies against _Y._ & \(\bullet\) & and IgA antibodies (acute vs. chronic infection) [151]; \\  & & _pseudotuberculosis_s [151]. & \(\bullet\) & Enables IgG and IgA detection in patients with IgM deficiency [153]. \\ \hline Endoscopy & \(\bullet\) & Detects changes in terminal inflammation of the ileum, ileoccal valve, and ecum (sometimes ascending colon) [168]. & \(\bullet\) & Enables taking a biopsy with an assessment of the degree and type of inflammation [168]. \\ \hline  & \(\bullet\) & Not pathogenomic; & \\  & \(\bullet\) & Patchy villous atrophy and crypt hyperplasia; & \(\bullet\) & Histological findings are relatively nonspecific [168]; \\ The histological & \(\bullet\) & Mixed acute and chronic inflammation; & \(\bullet\) & Usually reflects mixed acute and chronic inflammation with focal \\ findings of _Yersinia_ & \(\bullet\) & Focal neutrophylic cryptitis [169]; & \(\bullet\) & Usually reflects mixed acute and chronic inflammation with focal \\ infection & \(\bullet\) & Epithelial cell granulomas composed of histiocytes, small T-lymphocytes, and plasma monocytes with suppuration of the centers [151]. & \\ \hline  & ReA—reactive arthritis; SpA—spondylropathy; RA—rheumatoid arthritis; ELISA—enzyme-linked immunosorbent assay; LPS—lipopolysaccharide, ECA—enterobacterial common antigen; GI—gastrointestinal; ReA—reactive arthritis. & \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Diagnostic tests used in _Yersinia_ infection. Unfortunately, there are little data on the efficacy of _Y. enterocolitica_ treatment; however, available data show that ciprofloxacin has a beneficial influence and causes the disappearance of bacteria from the gut-associated lymphoid tissue compared with placebo. Conversely, patients receiving a placebo have a higher amount of circulating IgA antibodies against YOPs, which are detected for a long time, than patients treated with ciprofloxacin [175]. Similar serologic changes were observed in the case of _Y.