Yersiniosis is an infection caused most often by eating raw or undercooked pork contaminated with Yersinia enterocolitica bacteria. CDC estimates Y. enterocolitica causes almost 117,000 illnesses, 640 hospitalizations, and 35 deaths in the United States every year. Children are infected more often than adults, and the infection is more common in the winter.

Yersiniosis is an infection caused most often by eating raw or undercooked pork contaminated with Yersinia enterocolitica bacteria. CDC estimates Y. enterocolitica causes almost 117,000 illnesses, 640 hospitalizations, and 35 deaths in the United States every year. Children are infected more often than adults, and the infection is more common in the winter.

What are Yersinia?

Yersinia are bacteria that can cause illnesses in humans.

What are Yersinia enterocolitica?

Y. enterolitica are the most common species causing human enteric (intestinal) yersiniosis.

Pigs are the major animal reservoir for the few strains of Y. enterocolitica that cause human illness, but rodents, rabbits, sheep, cattle, horses, dogs, and cats also can carry strains that cause human illness.

What is yersiniosis?

Yersiniosis refers to the illnesses caused by Y. enterocolitica and less often by Y. pseudotuberculosis infections.

What are the symptoms of yersiniosis?

The symptoms of yersiniosis depend on the age of the person infected. Infection occurs most often in young children. Common symptoms in children are fever, abdominal pain, and diarrhea, which is often bloody. Symptoms typically develop 4 to 7 days after exposure and may last 1 to 3 weeks or longer. In older children and adults, right-sided abdominal pain and fever may be the predominant symptoms and may be confused with appendicitis. Complications are rare, and may include skin rash, joint pains, or spread of bacteria to the bloodstream.

How do people get yersiniosis?

Most people become infected by eating contaminated food, especially raw or undercooked pork, or through contact with a person who has prepared a pork product, such as chitlins. For example, babies and infants can be infected if their caretakers handle contaminated food and then do not wash their hands properly before handling the child or the child’s toys, bottles, or pacifiers.

People occasionally become infected after drinking contaminated milk or untreated water, or after contact with infected animals or their feces.

On rare occasions, people become infected through person-to-person contact. For example, caretakers can become infected if they do not wash their hands properly after changing the diaper of a child with yersiniosis.

Even more rarely, people may become infected through contaminated blood during a transfusion.

How common is yersiniosis?

CDC estimates that infections with Yersinia enterocolitica cause almost 117,000 illnesses, 640 hospitalizations, and 35 deaths in the United States every year. Children are infected more often than adults, and the infection is more common in the winter.

How is yersiniosis diagnosed?

Yersiniosis usually is diagnosed by detecting the bacteria in the stool of an infected person. Many laboratories do not routinely test for Yersinia, so it is important that the clinician notifies the laboratory when yersiniosis is suspected so that special tests can be done.

How is yersiniosis treated?

Yersiniosis usually goes away on its own without antibiotic treatment. However, antibiotics may be used to treat more severe or complicated infections.

Are there long-term consequences of yersiniosis?

Most symptoms go away completely. However, some people may experience the following:

• Joint pain, called reactive arthritis, most commonly in the knees, ankles, or wrists. These joint pains usually develop about 1 month after yersiniosis illness begins and generally goes away after 1 to 6 months.
• A skin rash, called “erythema nodosum,” on the legs and torso. The rash is more common in women and usually goes away within a month.

How can I help protect myself and my family from infection?

• Avoid eating raw or undercooked pork. Learn more about the safe minimum cooking temperature for pork.
• Consume only pasteurized milk and milk products, such as soft cheese, ice cream, and yogurt. Find out about the dangers of raw milk.
• Wash hands thoroughly with soap and water before eating and preparing food, after contact with animals, and after handling raw meat. See how handwashing can help keep you healthy.
• After handling raw chitlins, clean hands and fingernails carefully with soap and water before touching infants or their toys, bottles, or pacifiers. Someone other than the person handling food should care for children while chitlins are being prepared. Get more tips on staying safe when preparing chitlins.
• Prevent cross-contamination in the kitchen by using one cutting board for raw meat and another cutting board for fresh produce. Carefully clean all cutting boards, countertops, and utensils with soap and hot water after preparing raw meat. Learn four simple steps to food safety.
• Dispose of animal feces (poop) in a sanitary manner. Get tips to help keep you and your pets healthy.

Symptoms of yersiniosis can vary depending on the age of the person infected.

In young children, common symptoms are

• fever,
• abdominal pain, and
• diarrhea, which is often bloody.

Symptoms in older children and adults may include

• fever and
• pain on the right side of the abdomen, and may be confused with appendicitis.

Symptoms typically develop 4 to 7 days after exposure and may last 1 to 3 weeks or longer. Complications are rare and can include skin rash, joint pains, or spread of bacteria to the bloodstream.

Yersiniosis usually is diagnosed by detecting the organism in the stool of an infected person. Many laboratories do not routinely test for Yersinia, so it is important to notify laboratory personnel when yersiniosis is suspected so that special tests can be done. The organism can also be recovered from other sites, including the throat, lymph nodes, joint fluid, urine, bile, and blood.

Yersiniosis usually goes away on its own without antibiotic treatment. However, antibiotics may be used to treat more severe or complicated infections.

The following tips can help protect you and your family from yersiniosis.

• Avoid eating raw or undercooked pork.
• Drink only pasteurized milk. Consume only pasteurized milk and milk products, such as soft cheese, ice cream, and yogurt.
• Wash hands with soap and water. Wash hands with soap and water before eating and preparing food, after contact with animals, and after handling raw meat.
• Take care when preparing chitlins. After handling raw chitlins, clean hands and fingernails thoroughly with soap and water before touching infants or their toys, bottles, or pacifiers. Someone other than the person handling food should care for children while chitlins are being prepared.
• Use separate cutting boards. Use separate cutting boards for meat and other foods and carefully clean all cutting boards, countertops, and utensils with soap and hot water after preparing raw meat.
• Clean up after animals. Pick up and dispose of animal poop, especially in areas where children might play. Be sure to wash your hands with soap and running water contact with pets and other animals, their poop, or their belongings.

Handwashing is one of the best ways to protect yourself and your family from getting sick. Learn when and how you should wash your hands to stay healthy.

How Germs Spread

Washing hands can keep you healthy and prevent the spread of respiratory and diarrheal infections. Germs can spread from person to person or from surfaces to people when you:

• Touch your eyes, nose, and mouth with unwashed hands
• Prepare or eat food and drinks with unwashed hands
• Touch surfaces or objects that have germs on them
• Blow your nose, cough, or sneeze into hands and then touch other people’s hands or common objects

Key Times to Wash Hands

You can help yourself and your loved ones stay healthy by washing your hands often, especially during these key times when you are likely to get and spread germs:

• Before, during, and after preparing food
• Before and after eating food
• Before and after caring for someone at home who is sick with vomiting or diarrhea
• Before and after treating a cut or wound
• After using the toilet
• After changing diapers or cleaning up a child who has used the toilet
• After blowing your nose, coughing, or sneezing
• After touching an animal, animal feed, or animal waste
• After handling pet food or pet treats
• After touching garbage

To prevent the spread of germs during the COVID-19 pandemic, you should also wash your hands with soap and water for at least 20 seconds:

• Before touching your eyes, nose, or mouth
• After touching your mask
• After leaving a public place
• After touching objects or surfaces that may be frequently touched by other people, such as door handles, tables, gas pumps, shopping carts, or electronic cashier registers/screens

If soap and water are not readily available, use a hand sanitizer with at least 60% alcohol to clean your hands.

Follow Five Steps to Wash Your Hands the Right Way

Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands can help stop germs from spreading from one person to another and in our communities—including your home, workplace, schools, and childcare facilities.

Follow these five steps every time.

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
4. Rinse your hands well under clean, running water.
5. Dry your hands using a clean towel or air dry them.

Use Hand Sanitizer When You Can’t Use Soap and Water

You can use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

Washing hands with soap and water is the best way to get rid of germs in most situations. If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol. You can tell if the sanitizer contains at least 60% alcohol by looking at the product label.

Sanitizers can quickly reduce the number of germs on hands in many situations. However,

• Sanitizers do not get rid of all types of germs.
• Hand sanitizers may not be as effective when hands are visibly dirty or greasy.
• Hand sanitizers might not remove harmful chemicals from hands like pesticides and heavy metals.

Caution! Swallowing alcohol-based hand sanitizer can cause alcohol poisoning if more than a couple of mouthfuls are swallowed. Keep it out of reach of young children and supervise their use.

How to Use Hand Sanitizer

1. Apply the gel product to the palm of one hand (read the label to learn the correct amount).
2. Rub your hands together.
3. Rub the gel over all the surfaces of your hands and fingers until your hands are dry. This should take around 20 seconds.

Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others. Many diseases and conditions are spread by not washing hands with soap and clean, running water.

How germs get onto hands and make people sick

Feces (poop) from people or animals is an important source of germs like Salmonella, E. coli O157, and norovirus that cause diarrhea, and it can spread some respiratory infections like adenovirus and hand-foot-mouth disease. These kinds of germs can get onto hands after people use the toilet or change a diaper, but also in less obvious ways, like after handling raw meats that have invisible amounts of animal poop on them. A single gram of human feces—which is about the weight of a paper clip—can contain one trillion germs. Germs can also get onto hands if people touch any object that has germs on it because someone coughed or sneezed on it or was touched by some other contaminated object. When these germs get onto hands and are not washed off, they can be passed from person to person and make people sick.

Washing hands prevents illnesses and spread of infections to others

Handwashing with soap removes germs from hands. This helps prevent infections because:

• People frequently touch their eyes, nose, and mouth without even realizing it. Germs can get into the body through the eyes, nose and mouth and make us sick.
• Germs from unwashed hands can get into foods and drinks while people prepare or consume them. Germs can multiply in some types of foods or drinks, under certain conditions, and make people sick.
• Germs from unwashed hands can be transferred to other objects, like handrails, table tops, or toys, and then transferred to another person’s hands.
• Removing germs through handwashing therefore helps prevent diarrhea and respiratory infections and may even help prevent skin and eye infections.

Teaching people about handwashing helps them and their communities stay healthy. Handwashing education in the community:

• Reduces the number of people who get sick with diarrhea by 23-40%
• Reduces diarrheal illness in people with weakened immune systems by 58%
• Reduces respiratory illnesses, like colds, in the general population by 16-21%
• Reduces absenteeism due to gastrointestinal illness in schoolchildren by 29-57%

Not washing hands harms children around the world

About 1.8 million children under the age of 5 die each year from diarrheal diseases and pneumonia, the top two killers of young children around the
world.

• Handwashing with soap could protect about 1 out of every 3 young children who get sick with diarrhea and almost 1 out of 5 young children with respiratory infections like pneumonia.
• Although people around the world clean their hands with water, very few use soap to wash their hands. Washing hands with soap removes germs much more effectively.
• Handwashing education and access to soap in schools can help improve attendance.
• Good handwashing early in life may help improve child development in some settings.
• Estimated global rates of handwashing after using the toilet are only 19%.

Handwashing helps battle the rise in antibiotic resistance

Preventing sickness reduces the amount of antibiotics people use and the likelihood that antibiotic resistance will develop. Handwashing can prevent about 30% of diarrhea-related sicknesses and about 20% of respiratory infections (e.g., colds). Antibiotics often are prescribed unnecessarily for these health issues. Reducing the number of these infections by washing hands frequently helps prevent the overuse of antibiotics—the single most important factor leading to antibiotic resistance around the world. Handwashing can also prevent people from getting sick with germs that are already resistant to antibiotics and that can be difficult to treat.

Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others. Many diseases and conditions are spread by not washing hands with soap and clean, running water. CDC recommends cleaning hands in a specific way to avoid getting sick and spreading germs to others. The guidance for effective handwashing and use of hand sanitizer was developed based on data from a number of studies.

Microbes are all tiny living organisms that may or may not cause disease.

Germs, or pathogens, are types of microbes that can cause disease.

Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.

Why? Because hands could become recontaminated if placed in a basin of standing water that has been contaminated through previous use, clean running water should be used. However, washing with non-potable water when necessary may still improve health. The temperature of the water does not appear to affect microbe removal; however, warmer water may cause more skin irritation and is more environmentally costly.

Turning off the faucet after wetting hands saves water, and there are few data to prove whether significant numbers of germs are transferred between hands and the faucet.

Using soap to wash hands is more effective than using water alone because the surfactants in soap lift soil and microbes from skin, and people tend to scrub hands more thoroughly when using soap, which further removes germs.

To date, studies have shown that there is no added health benefit for consumers (this does not include professionals in the healthcare setting) using soaps containing antibacterial ingredients compared with using plain soap. As a result, FDA issued a final rule in September 2016 that 19 ingredients in common “antibacterial” soaps, including triclosan, were no more effective than non-antibacterial soap and water and thus these products are no longer able to be marketed to the general public. This rule does not affect hand sanitizers, wipes, or antibacterial products used in healthcare settings.

Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.

Why? Lathering and scrubbing hands creates friction, which helps lift dirt, grease, and microbes from skin. Microbes are present on all surfaces of the hand, often in particularly high concentration under the nails, so the entire hand should be scrubbed.

Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.

Why? Determining the optimal length of time for handwashing is difficult because few studies about the health impacts of altering handwashing times have been done. Of those that exist, nearly all have measured reductions in overall numbers of microbes, only a small proportion of which can cause illness, and have not measured impacts on health. Solely reducing numbers of microbes on hands is not necessarily linked to better health. The optimal length of time for handwashing is also likely to depend on many factors, including the type and amount of soil on the hands and the setting of the person washing hands. For example, surgeons are likely to come into contact with disease-causing germs and risk spreading serious infections to vulnerable patients, so they may need to wash hands longer than a woman before she prepares her own lunch at home. Nonetheless, evidence suggests that washing hands for about 15-30 seconds removes more germs from hands than washing for shorter periods.

Rinse your hands well under clean, running water.

Why? Soap and friction help lift dirt, grease, and microbes—including disease-causing germs—from skin so they can then be rinsed off of hands. Rinsing the soap away also minimizes skin irritation. Because hands could become recontaminated if rinsed in a basin of standing water that has been contaminated through previous use, clean running water should be used.While some recommendations include using a paper towel to turn off the faucet after hands have been rinsed, this practice leads to increased use of water and paper towels, and there are no studies to show that it improves health.

Dry your hands using a clean towel or air dry them.

Why? Germs can be transferred more easily to and from wet hands; therefore, hands should be dried after washing. However, the best way to dry hands remains unclear because few studies about hand drying exist, and the results of these studies conflict. Additionally, most of these studies compare overall concentrations of microbes, not just disease-causing germs, on hands following different hand-drying methods. It has not been shown that removing microbes from hands is linked to better health . Nonetheless, studies suggest that using a clean towel or air drying hands are best.

CDC recommends washing hands with soap and water whenever possible because handwashing reduces the amounts of all types of germs and chemicals on hands. But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help you avoid getting sick and spreading germs to others. The guidance for effective handwashing and use of hand sanitizer in community settings was developed based on data from a number of studies.

Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs.

Why? Soap and water are more effective than hand sanitizers at removing certain kinds of germs, like Cryptosporidium, norovirus, and Clostridium difficile. Although alcohol-based hand sanitizers can inactivate many types of microbes very effectively when used correctly , people may not use a large enough volume of the sanitizers or may wipe it off before it has dried .

Hand sanitizers may not be as effective when hands are visibly dirty or greasy.

Why? Many studies show that hand sanitizers work well in clinical settings like hospitals, where hands come into contact with germs but generally are not heavily soiled or greasy. Some data also show that hand sanitizers may work well against certain types of germs on slightly soiled hands. However, hands may become very greasy or soiled in community settings, such as after people handle food, play sports, work in the garden, or go camping or fishing. When hands are heavily soiled or greasy, hand sanitizers may not work well. Handwashing with soap and water is recommended in such circumstances.

Hand sanitizers might not remove harmful chemicals, like pesticides and heavy metals, from hands.

Why? Although few studies have been conducted, hand sanitizers probably cannot remove or inactivate many types of harmful chemicals. In one study, people who reported using hand sanitizer to clean hands had increased levels of pesticides in their bodies . If hands have touched harmful chemicals, wash carefully with soap and water (or as directed by a poison control center).

If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Why? Many studies have found that sanitizers with an alcohol concentration between 60–95% are more effective at killing germs than those with a lower alcohol concentration or non-alcohol-based hand sanitizers . Hand sanitizers without 60-95% alcohol 1) may not work equally well for many types of germs; and 2) merely reduce the growth of germs rather than kill them outright.

When using hand sanitizer, apply the product to the palm of one hand (read the label to learn the correct amount) and rub the product all over the surfaces of your hands until your hands are dry.

Why? The steps for hand sanitizer use are based on a simplified procedure recommended by CDC. Instructing people to cover all surfaces of both hands with hand sanitizer has been found to provide similar disinfection effectiveness as providing detailed steps for rubbing-in hand sanitizer .

Swallowing alcohol-based hand sanitizers can cause alcohol poisoning.

Why? Ethyl alcohol (ethanol)-based hand sanitizers are safe when used as directed, but they can cause alcohol poisoning if a person swallows more than a couple of mouthfuls .

From 2011 – 2015, U.S. poison control centers received nearly 85,000 calls about hand sanitizer exposures among children . Children may be particularly likely to swallow hand sanitizers that are scented, brightly colored, or attractively packaged. Hand sanitizers should be stored out of the reach of young children and should be used with adult supervision. Child-resistant caps could also help reduce hand sanitizer-related poisonings among young children. Older children and adults might purposefully swallow hand sanitizers to become drunk.

Hygiene Overview

• According to the World Bank, hygiene promotion is the most cost-effective health action to reduce disease.
• As of 2020, 2.3 billion people lacked basic hygiene services (handwashing facility with soap and water), and 1.6 billion people had access to handwashing facilities that lacked water or soap.
• Worldwide, 70% of people used basic hygiene services in 2020.

Hand Hygiene

• Research shows that washing hands with soap and water could reduce deaths from diarrheal disease by up to 50%.
• Researchers estimate that if everyone routinely washed their hands, 1 million deaths a year could be prevented.
• A large percentage of foodborne disease outbreaks are spread by contaminated hands. Handwashing can reduce the risk of foodborne illness and other infections.
• Handwashing can reduce the risk of respiratory illnesses, like colds, in the general population by 16–21%.
• The use of an alcohol-based hand sanitizer in U.S. classrooms reduced absenteeism due to infection by about 20% overall among 16 elementary schools and 6,000 students.
• Handwashing education in the community:
  • Reduces diarrheal illness in people with weakened immune systems by 58%
  • Reduces absenteeism due to gastrointestinal illness in schoolchildren by 29–57%

Face and Body Hygiene

• More than 50% of healthy people have Staphylococcus aureus living in or on their nasal passages, throats, hair, or skin. Within the first 15 minutes of bathing, the average person sheds 6 x 106 colony forming units (CFU) of Staphylococcus aureus. Showering before entering recreational waters (such as pools) prevent the spread of germs by reducing the microbial load.
• The average individual swimmer contributes at least 0.14 grams of fecal material to the water, usually within the first 15 minutes of entering. Showering with soap before swimming helps stop the spread of germs by removing fecal material from the body.
• Trachoma, the leading cause of preventable blindness worldwide, is related to the lack of facial hygiene. An estimated 41 million people suffer from active trachoma, and nearly 10 million people are visually impaired or irreversibly blind as a result of trachoma.
• Inadequate contact lens hygiene, such as failure to properly disinfect lenses, increases the risk of acquiring the eye infection Acanthamoeba keratitis.
• The spread of pinworms can be reduced by proper hygiene, including clipping nails and showering children immediately after they wake in the morning.

Use this chart and a food thermometer to ensure that meat, poultry, seafood, and other cooked foods reach a safe minimum internal temperature.

Remember, you can’t tell whether meat is safely cooked by looking at it. Any cooked, uncured red meats – including pork – can be pink, even when the meat has reached a safe internal temperature.

Why the Rest Time is Important

After you remove meat from a grill, oven, or other heat source, allow it to rest for the specified amount of time. During the rest time, its temperature remains constant or continues to rise, which destroys harmful germs.

Making chitlins is a time-honored and tasty tradition for many families, especially during the winter holidays in the South. Chitlins, which are pork intestines and sometimes called chitterlings, can be contaminated with Yersinia enterocolitica and other harmful germs that can make you sick.

That’s why you should take precautions when you’re making chitlins or another dish that uses pork intestines – or any time you handle raw pork.

Young children are at high risk for infection. They can become infected when people preparing chitins do not wash their hands carefully before touching children or items children put in their mouths, such as toys, bottles, and pacifiers.

Follow these food safety tips to help keep you and your family safe while you clean and cook chitlins.

Getting Ready

• Keep all children out of the kitchen while you prepare chitlins.
• Ask someone else to watch infants and other children in your care so that you don’t accidently spread germs from the chitlins to them.
• Before you begin, take out everything you’ll need to prepare the chitlins and to clean up when you’re done – chopping boards, knives and other utensils, pots and pans, measuring cups and spoons, ingredients and seasonings, bleach solution, paper towels – so you don’t spread germs to other parts of the kitchen after you’ve begun handling the chitlins.

Preparing Chitlins

• Buy cooked chitlins when possible because these should be safe to handle.
• Freeze raw chitlins unless you plan to clean and cook them within 2 days.
• Thaw raw frozen chitlins in the refrigerator in a bowl or bucket completely covered in plastic wrap to prevent drips that can contaminate the refrigerator and items in it. Use raw chitlins within 2 days after thawing them.
• Wash hands thoroughly with soap and warm water for at least 20 seconds before preparing chitlins.
• Boil raw chitlins in water for at least 5 minutes before cleaning to reduce germs that may get on your hands and counter while you are cleaning the chitlins.
• Boil and simmer chitlins until well cooked and tender before serving.

Cleaning Up

• Use a solution of 1 tablespoon bleach to 1 gallon of water to wash anywhere raw chitlins, their juice, or your hands touched.
  • These items may include chopping boards, knives and other utensils, refrigerator (including shelves, doors, and handles), countertop, stovetop (including knobs and switches), outside of cabinets and drawers (and their handles), dishwasher front, sink (including the basin, drain, handles, and spout), floor, light switches.
  • Pots, pans, lids, buckets and utensils can be washed on the hot cycle of the dishwasher or by hand in hot water.
  • Consider using paper towels to clean. If you use cloth towels, wash them on the hot cycle in the dishwasher or washing machine.
• Flood the surface with the bleach solution and allow it to stand for several minutes. Then rinse with plain water and let it air dry or pat it dry with paper towels.
• Wash your hands thoroughly with soap and warm water for at least 20 seconds before preparing any other food or touching children or their toys, bottles, or pacifiers.

The genus Yersinia is best known for Yersinia pestis, a gram-negative rod that causes the plague. However, Y. enterocolitica and Y. pseudotuberculosis can cause gastroenteritis. The infection is generally transmitted through the fecal-oral route, with ingestion of food or water that has been contaminated by feces. Intoxication can also result because of the activity of its endotoxin and exotoxins (enterotoxin and cytotoxin necrotizing factor). The illness is normally relatively mild and self-limiting. However, severe diarrhea and dysentery can develop in infants. In adults, the infection can spread and cause complications such as reactive arthritis, thyroid disorders, endocarditis, glomerulonephritis, eye inflammation, and/or erythema nodosum. Bacteremia may develop in rare cases.

Diagnosis is generally made by detecting the bacteria in stool samples. Samples may also be obtained from other tissues or body fluids. Treatment is usually supportive, including rehydration, without antibiotics. If bacteremia or other systemic disease is present, then antibiotics such as fluoroquinolones, aminoglycosides, doxycycline, and trimethoprim-sulfamethoxazole may be used. Recovery can take up to two weeks.