AUTHOR AND EDITOR INFORMATION

Section 1 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

INTRODUCTION

Section 2 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Background

Erysipeloid is an acute bacterial infection of traumatized skin and other organs. It is caused by the microorganism Erysipelothrix rhusiopathiae (insidiosa), which long has been known to cause animal and human infections. Direct contact between meat infected with E rhusiopathiae and traumatized human skin results in erysipeloid. In animals, the organism causes swine erysipelas and several other diseases in poultry and sheep.

Erysipeloid is an occupational disease. Humans acquire the infection after direct contact with infected animals. The disease is more common among farmers, butchers, cooks, homemakers, and anglers. The infection is more likely to occur during the summer or early fall.

Pathophysiology

E rhusiopathiae, which is highly resistant to environmental factors, enters the skin through scratches or pricks. In the skin, the organism is capable of producing certain enzymes that help it dissect its way through the tissues. It has recently been discovered that only pathogenic strains of E rhusiopathiae are capable of producing the neuraminidase enzyme. This enzyme is speculated to help the microorganism invade tissues. Moreover, 2 adhesive surface proteins were discovered and their nucleotide sequence encoded. The proteins are named RspA and RspB and serve in helping the microorganism bind to biotic (collagen types I and IV) and abiotic (polystyrene) surfaces.

Meanwhile, the host's immune system is activated to start fighting against this foreign bacterium. The organism may escape immune surveillance and may spread in the body via the vascular system to the joints, heart, brain, CNS, and lungs. The organ most commonly affected other than the skin is the heart.

Frequency

International

Infection with E rhusiopathiae occurs in worldwide distribution in a variety of animals, especially hogs.

Mortality/Morbidity

Erysipeloid usually is an acute, self-limited infection of the skin that resolves without consequences. Individuals with the systemic form, in which organs other than the skin are involved, may have neurologic, cardiologic, or other impairments. Individuals with systemic infection may even die of sepsis, if the proper diagnosis is not made, and treatment is not initiated early on.

Race

No racial predilection is recognized.

Sex

Both sexes may be equally affected; however, the disease seems to affect more males than females because of occupational exposure.

Age

Erysipeloid can affect any age group.

CLINICAL

Section 3 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

History

Erysipeloid may present in humans as one of 3 clinical forms.

• Localized cutaneous form (also known as erysipeloid of Rosenbach)
• Diffuse cutaneous form
• Generalized or systemic infection as evidenced by bacteremia. Endocarditis may or may not develop.
• In the first two forms, patients present with local burning or pain at lesion sites. They may or not have fever, malaise, and other constitutional symptoms.
• In the generalized form, patients present complaining of fever, chills, weight loss, and a variety of other symptoms (eg, joint pain, cough, headache), depending on the organ system involved.

Physical

• Localized form
• • Lesions most commonly affect the hands, mainly the webs of the fingers; however, any exposed area of the body may be affected.
  • Lesions consist of well-demarcated, bright red-to-purple plaques with a smooth, shiny surface. Lesions are warm and tender. They leave a brownish discoloration on the skin when resolving. Sometimes vesicles may be present.
• Diffuse cutaneous form
• • Multiple lesions appear on various parts of the body.
  • Lesions are well-demarcated, violaceous plaques with an advancing border and central clearing.
• Systemic form
• • Skin lesions may not be apparent. If present, skin lesions appear as localized areas of swelling surrounding a necrotic center. Skin lesions also may present as several follicular, erythematous papules.
  • Endocarditis is the most common, but still rare, manifestation of systemic erysipeloid.

Causes

Erysipelothrix rhusiopathiae causes all 3 forms of erysipeloid. E rhusiopathiae is a thin, gram-positive bacillus that may be straight or slightly curved. The microorganism is present in the soil and in poultry, fish, and birds. Homemakers, farmers, anglers, and butchers are at increased risk of acquiring the infection.

DIFFERENTIALS

Section 4 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Other Problems to be Considered

Seal finger

WORKUP

Section 5 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Lab Studies

• Several studies may be requested, depending on the clinical presentation.
• Gram stain may be performed on a skin scraping, which may show gram-positive rods; however, the stain often is negative because the infection is deep, and the microorganism is not reached with scraping.
• Bacterial culture on special media fortified with serum and at room temperature may be attempted. Culture of a biopsy from the leading edge of the lesion may reveal the organism.
• Blood culture aids in the diagnosis of systemic erysipeloid.
• Skin biopsy may be taken to confirm the diagnosis (see Histologic findings).

Imaging Studies

• Imaging studies usually are ordered when an individual has the systemic form, depending on the clinical presentation and probability of organ involvement.
• Echocardiography may be ordered, if endocarditis is suspected.
• CT or MRI of the brain may be used to rule out brain abscess or cerebral infarct.
• Radiography or CT of the chest may be ordered, if pleural effusion is suspected.
• Bone scan or MRI of bone may be performed, if osseous necrosis is suspected.

Histologic Findings

The epidermis shows spongiosis, which may be severe enough to cause intraepidermal vesiculation. Marked edema of the papillary dermis with dilatation of blood and lymphatic vessels occurs. In the reticular dermis, a perivascular inflammatory cell infiltrate made of neutrophils and eosinophils is observed.

TREATMENT

Section 6 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Medical Care

The antibiotic of choice for the 3 forms of erysipeloid is penicillin. Ceftriaxone proved to have an effect against E rhusiopathiae. In patients who are allergic to penicillin, ciprofloxacin alone or erythromycin in combination with rifampin may be used. The microorganism is resistant to vancomycin, an important consideration in patients with endocarditis caused by E rhusiopathiae.

E rhusiopathiae has been shown to be eradicated from surfaces by the use of simple home disinfectants; thus, an important step in the prevention of infection may be to spray hazardous work areas (eg, fishing boats, meat counters) with disinfectants.

Surgical Care

• Procedures usually are not employed in the cutaneous form of erysipeloid. Even a simple incision and drainage of lesions is not recommended as this may prolong the recovery time.
• Individuals with the systemic form may undergo surgery (eg, cardiac valve replacement), pleural tap, or other procedures, depending on extent of organ involvement.

Consultations

• An infectious disease specialist may be consulted when deciding treatment, especially in cases of bone and joint involvement.
• Opinions from a cardiologist and cardiothoracic surgeon are mandatory in cases of endocarditis.
• Pulmonologists are consulted in cases of pleural effusion.
• Neurologists and neurosurgeons are consulted when presence of CNS disease.

Activity

Activity usually is not restricted. Individuals with the systemic form may be advised to be on bed rest.

MEDICATION

Section 7 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

The 2 cutaneous forms of erysipeloid are self-limited and may remit spontaneously within 2-4 weeks; however, treatment with penicillin hastens the recovery and limits further progression of the disease.

Drug Category: Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

FOLLOW-UP

Section 8 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Further Inpatient Care

• The corresponding physicians provide inpatient care to patients with the systemic form of the disease.

In/Out Patient Meds

• Penicillin (see Medication section)

Deterrence/Prevention

• Educate patients to use care when handling animals and their products.

Complications

• Permanent neurological damage (eg, cerebrovascular accident)
• Endocarditis with long-term valvular heart disease
• Septic arthritis with long-term joint diseases

Prognosis

• Cutaneous forms of the disease usually are self-limited even without treatment; therefore, skin-limited erysipeloid has a fairly good prognosis with no long-term sequelae.
• Prognosis of the systemic form depends on the organ systems involved and on the extent of involvement. Early recognition and proper initiation of therapy is crucial to prevent sequelae.

Patient Education

• Instruct patients to be cautious while handling animals and animal products.

REFERENCES

Section 9 of 9

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

• Barnett JH, Estes SA, Wirman JA, et al. Erysipeloid. J Am Acad Dermatol. Jul 1983;9(1):116-23. [Medline].
• Brooke CJ, Riley TV. Erysipelothrix rhusiopathiae: bacteriology, epidemiology and clinical manifestations of an occupational pathogen. J Med Microbiol. Sep 1999;48(9):789-99. [Medline].
• Dunbar SA, Clarridge JE. Potential errors in recognition of Erysipelothrix rhusiopathiae. J Clin Microbiol. Mar 2000;38(3):1302-4. [Medline].
• Fidalgo SG, Longbottom CJ, Rjley TV. Susceptibility of Erysipelothrix rhusiopathiae to antimicrobial agents and home disinfectants. Pathology. 2002;34(5):462-5. [Medline].
• Gorby GL, Peacock JE. Erysipelothrix rhusiopathiae endocarditis: microbiologic, epidemiologic, and clinical features of an occupational disease. Rev Infect Dis. Mar-Apr 1988;10(2):317-25. [Medline].
• Razsi L, Sanchez MR. Progressively enlarging painful annular plaque on the hand. Erysipeloid. Arch Dermatol. Oct 1994;130(10):1311-2, 1314-5. [Medline].
• Reboli AC, Farrar WE. Erysipelothrix rhusiopathiae: an occupational pathogen. Clin Microbiol Rev. Oct 1989;2(4):354-9. [Medline].
• Shimoji Y, Ogawa Y, Osaki M, et al. Adhesive surface proteins of Erysipelothrix rhusiopathiae bind to polystyrene, fibronectin, and type I and IV collagens. J Bacteriol. May 2003;185(9):2739-48. [Medline].
• Wang Q, Chang BJ, Mee BJ, Riley TV. Neuraminidase production by Erysipelothrix rhusiopathiae. Vet Microbiol. 2005;20, 107 (3-4):265-72. [Medline].

Article Last Updated: Jan 24, 2007