Introduction
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
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.
More on Erysipeloid |
 Overview: Erysipeloid |
| Differential Diagnoses & Workup: Erysipeloid |
| Treatment & Medication: Erysipeloid |
| Follow-up: Erysipeloid |
| References |
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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].
Further Reading
Keywords
Erysipelothrix rhusiopathiae (insidiosa), E rhusiopathiae, infected meat, erysipeloid of Rosenbach, skin lesions, endocarditis
