eMedicine Specialties > Dermatology > Bacterial Infections

Erysipeloid

Author: Zeina Nehme Ghorayeb, MD, Lecturer, University of Balamand School of Medicine
Coauthor(s): Mona Matta-Muallem, MD, Associate Professor, Department of Dermatology, American University of Beirut, Lebanon
Contributor Information and Disclosures

Updated: Nov 13, 2009

Introduction

Background

Erysipeloid is an acute bacterial infection of traumatized skin and other organs. Erysipeloid 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.¹

Erysipeloid is an occupational disease.^2,3 Humans acquire erysipeloid after direct contact with infected animals. Erysipeloid 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.^4,5

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 of erysipeloid, 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 for erysipeloid.

Sex

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

Age

Erysipeloid can affect any age group.

Clinical

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 2 forms of erysipeloid, 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 with fever, chills, weight loss, and a variety of other symptoms (eg, joint pain, cough, headache), depending on the organ system involved.

Physical

• Localized form of erysipeloid
  • 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 of erysipeloid
  • Multiple lesions appear on various parts of the body.
  • Lesions are well-demarcated, violaceous plaques with an advancing border and central clearing.
• Systemic form of erysipeloid
  • 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.

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