erysipeloid

Introduction

Skin infection with Erysipelothrix rhusiopathiae.

Etiology

• infection with Erysipelothrix rhusiopathiae

Epidemiology

• handling of raw fish, animal hides, meat, poultry or bones
• farmers, veternarians, butchers, housewives
• male:female ratio is 3:1
• no vectors
• NOT contagious
• worldwide in distribution
• occurs largely in summer & early fall

Pathology

• infection follows abrasion, scratch or puncture wound while handling organic material contaminated with the organism
• acute dermal inflammation
  • bacilli are extracellular, located deep in dermis
• rare invasive form associatede with endocarditis

Clinical manifestations

• incubation time 2-7 days
• tender, localized violacious swelling of the skin with elevated irregular borders
• itching, burning, throbbing, pain
• skin eruption is brief
• brown pigmentation follows acute infection
• fever/chills are uncommon
• lymphadenitis may occur

Laboratory

• biopsy & culture of biopsy material
• culture aspirated saline injected into advancing edge of lesion
• blood culture if bacteremia suspected
• echocardiogram to rule out endocarditis

Complications

• septic arthritis
• endocarditis: 2/3 of cases of endocarditis from subclinical infection after ingestion of infected meat or fish

Differential diagnosis

• Vibrio cellulitis
• allergic contact dermatitis

Management

• prevention
  • use of gloves by workers handling meat & fish
• pharmaceutical agents
  • penicillin G: 1.2 million units of benzathine penicillin;
    • 600,000 units into each buttocks
  • erythromycin 250-500 mg QID for 7 days
  • prognosis
  • generally self-limited infection, subsiding spontaneously in about 3 weeks
  • relapses may occur
  • mortality from endocarditis is 30-40%

More general terms

• bacterial infection
• skin disease (dermatologic disorder, dermatopathy, dermatosis)

Additional terms

• Erysipelothrix rhusiopathiae