Yersiniosis

 Q: Which of the acute bacterial diarrheas commonly cause pharyngitis, and provides a diagnostic clue with history and clinical exam (hint: pseudoappendicitis)? 

Answer: Yersiniosis 

Y. enterocolitica has a propensity to involve lymphoid tissue like tonsils. It is a good diagnostic clue when put with an outbreak and physical exam as no other acute bacterial diarrhea usually causes pharyngitis. A pharyngeal abscess needs to be ruled out. Progression to Yersinia septicemia is more common in patients with impaired immunity or with iron-overload. Patients with iron overload may very quickly culminate into septic shock if receive blood transfusion while infected. The mortality is high. 

Another interesting presentation is pseudoappendicitis with right lower quadrant pain, fever, vomiting, and leukocytosis. Interestingly, at the OR table surgeons find the appendix normal. The symptoms are due to inflammation around the appendix and terminal ileum and inflammation of the mesenteric lymph nodes.

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References:

1. Tacket CO, Davis BR, Carter GP, et al. Yersinia enterocolitica pharyngitis. Ann Intern Med 1983; 99:40. 

2. Shorter NA, Thompson MD, Mooney DP, Modlin JF. Surgical aspects of an outbreak of Yersinia enterocolitis. Pediatr Surg Int 1998; 13:2. 

3. Guinet F, Carniel E, Leclercq A. Transfusion-transmitted Yersinia enterocolitica sepsis. Clin Infect Dis 2011; 53:583.