Erysipeloid

Last Updated: 2021-09-25

Author(s): Anzengruber, Navarini

Rosenbach 1887.

Swine erysipelas

Local and systemic infection caused by Erysipelothrix rhusiopathiae.

  • Infections occur exclusively in the summer months.
  • Particularly affects fishermen, housewives, butchers, crab fishermen (crab dermatitis), button making (if made from bones).
  • In 3.5% of all cat bites, E. rhusiopathiae could be detected.

Erysipelothrix rhusiopathiae is a non-motile, gram-positive rod. The pathogen passes through the skin through small injuries and infection occurs. Rarely, transmission can occur through food. Cat and dog bites can also lead to the appearance of erysipeloid.

  • Incubation period: 2–7 days.
  • Pathogen: Erysipelothrix rhusiopathiae.

 

  • Localised erysipeloid
    • Most common form.
    • Mostly affecting the fingers or hands.
    • Partly pruritic, partly painful, bright red, spreading centrifugally, erysipelas-like erythema, often with a feeling of tension. In the course, there may be a central subsiding of the redness.
    • Generally good general condition.
  • Diffuse cutaneous infection
    • Rarely occurs.
    • In this case, there is involvement of other localisations.
    • Urticaria or vesicles appear and usually there is the expression of febrile temperatures and arthralgias.
    • The ingestion of contaminated food is considered a possible trigger.
  • Systemic infection with and without endocarditis
    • Systemic infection is extremely rare.
    • Mostly fever occurs. In approx. 40%, erysipeloid skin changes exist or can be determined from the medical history.
    • Serpiginous or bullous lesions may appear on the trunk and extremities.
    • Liver failure and immunosuppression are predisposing factors. Approximately 1/3 of all patients with systemic E. rhusiopathiae infection are alcoholics.
  • As a possible complication, endocarditis is feared. In particular, the aortic valve may be involved. For 1/3 of patients, involvement of the heart valves is lethal, another 1/3 requires valve replacement.
  • Anamnesis (important occupational history!)
  • Clinical
  • Bact. smear
  • If necessary, take a sample biopsy (this is the best way to detect the pathogen).
  • Blood cultures (often negative or misidentified as Lactobacillus or Enterococcus).
  • Frequently on the hands, but any localisation possible.
  • Bronchitis occurs after inhalation.
  • Sepsis.
  • Endocarditis
  • Cardiac failure.
  • Valvular perforation.
  • Myocardial abscess.
  • Renal failure.
  • Abscesses (myocardial, cerebral, intra-abdominal, epidural and paravertebral).
  • Meningitis.
  • Endophtalmitis.
  • Osteomyelitis.
  • Septic arthritis.
  • Pneumonia.
  • Necrotising fasciitis.
  • Vaccination for risk groups veterinarians, animal dealers.
  • Wearing gloves in the well-defined situations that allow infection.
  • Individual course. Healing occurs after 2 weeks to several months later.
  • Provided no complication occurs, there is a good prognosis.
  • No lasting immunity develops.
  • Restraint of the affected limb.
  • Antibiotic therapy shortens the duration of disease and reduces the risk of recurrence.
  • Local heat application for painful joint.
  • Incisions or surgical interventions are not indicated.

 

  • Topical therapy
    • Moist, antiseptic compresses (e.g.: Lavasept®, Octenisept®-Lsg).

 

  • For localised erysipeloid
    • The duration of therapy should be made dependent on clinical findings, but should be at least 7 days.
    • Penicillin V p.o. 500 mg 4x tgl.
    • Alternatively: Ciprofloxacin p.o. 250 mg 2x tgl.
    • Alternatively: Clindamycin p.o. 300 mg 3x tgl.
    • Alternatively: Erythromycin p.o. 500mg 4x tgl.
  • For diffuse cutaneous infection or systemic infection
    • The duration of therapy should depend on the clinical findings, but should be at least 7 days for diffuse cutaneous infection and 14 days for systemic infection.
    • Penicillin G: i.v. 2-4 million IU 6x tgl.
    • Alternatively: Ceftriaxone i.v. 2g 1x tgl.
    • Alternatively: Imipenem i.v. 500 mg 4x tgl.
    • Alternatively: Ciprofloxacin i.v. 400mg 2x tgl.
    • Alternatively: Daptomycin i.v. 6 mg/kg bw 1x tgl.
    • Resistance of E. rhusiopathiae is common to suflonamides, trimethoprim-sulfamethoxazole, vancomycin and aminoglycosides.
  1. Venditti M, Gelfusa V, Tarasi A, Brandimarte C, Serra P. Antimicrobial susceptibilities of Erysipelothrix rhusiopathiae. Antimicrob Agents Chemother 1990;34:2038-40.
  2. Rose JD. Midbrain and pontine unit responses to lordosis-controlling forms of somatosensory stimuli in the female golden hamster. Exp Neurol 1978;60:499-508.
  3. Dunbar SA, Clarridge JE, 3rd. Potential errors in recognition of Erysipelothrix rhusiopathiae. J Clin Microbiol 2000;38:1302-4.
  4. Fernandez-Crespo P, Serra A, Bonet J, Gimenez M. Acute oliguric renal failure in a patient with an Erysipelothrix rhusiopathiae bacteremia and endocarditis. Nephron 1996;74:231.
  5. Gorby GL, Peacock JE, Jr. Erysipelothrix rhusiopathiae endocarditis: microbiologic, epidemiologic, and clinical features of an occupational disease. Rev Infect Dis 1988;10:317-25.
  6. Reboli AC, Farrar WE. Erysipelothrix rhusiopathiae: an occupational pathogen. Clin Microbiol Rev 1989;2:354-9.
  7. Schuster MG, Brennan PJ, Edelstein P. Persistent bacteremia with Erysipelothrix rhusiopathiae in a hospitalized patient. Clin Infect Dis 1993;17:783-4.
  8. Ognibene FP, Cunnion RE, Gill V, Ambrus J, Fauci AS, Parrillo JE. Erysipelothrix rhusiopathiae bacteremia presenting as septic shock. Am J Med 1985;78:861-4.
  9. Drekonja DM. Erysipelothrix bacteremia without endocarditis: rare event or under-reported occurrence? Diagn Microbiol Infect Dis 2013;77:280-1.
  10. Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med 1999;340:85-92.
  11. Burke WA, Jones BE. Cutaneous infections of the coast. N C Med J 1987;48:421-4.
  12. Reboli, A. (2016). Erysipelothrix infection. Uptodate.com. Retrieved 13 May 2016, from http://www.uptodate.com/contents/erysipelothrix-infection?source=search_result&search=Erysipeloid&selectedTitle=1~31