eMedicine Specialties > Dermatology > Bacterial Infections

Erysipeloid: Treatment & Medication

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

Treatment

Medical Care

The antibiotics of choice for the 3 forms of erysipeloid is penicillin or cephalosporin.6,7 Ceftriaxone proved to have an effect against Erysipelothrix 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.8

Surgical Care

  • Procedures usually are not used 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 of erysipeloid 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 of erysipeloid may be advised to be on bed rest.

Medication

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.

Antibiotics

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


Penicillin G (Pfizerpen, Wycillin)

Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms. However, it is not effective against penicillinase-producing bacteria.

Adult

Cutaneous disease: 250-500 mg PO qid for 7-10 d
Arthritis or endocarditis: 12-20 million U/d IV for 4 wk

Pediatric

25-50 mg/kg/d PO for 7-10 d

Increases risk of bleeding when administered concurrently with warfarin; ethacrynic acid, aspirin, indomethacin, and furosemide may compete with penicillin G for renal tubular secretion, increasing penicillin serum concentrations; probenecid can increase effects of penicillin; coadministration of tetracyclines can decrease effects of penicillin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in asthma and allergies; dose must be adjusted in renal failure because drug is cleared by kidneys; inadvertent injection of penicillin into sciatic nerve may cause severe pain and dysfunction at the site that may persist for weeks


Erythromycin (Erythrocin, EES, E-Mycin)

For penicillin-allergic patients. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes causing RNA-dependent protein synthesis to arrest.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

Adult

250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) q6h PO 1 h ac or 500 mg q12h; alternatively, 333 mg q8h; increase to 4 g/d depending on severity of infection

Pediatric

30-50 mg/kg/d (15-25 mg/lb/d) PO divided q6-8h; double dose for severe infection

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin, increases risk of rhabdomyolysis

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur

More on Erysipeloid

Overview: Erysipeloid
Differential Diagnoses & Workup: Erysipeloid
Treatment & Medication: Erysipeloid
Follow-up: Erysipeloid
References
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References

  1. Wang Q, Chang BJ, Riley TV. Erysipelothrix rhusiopathiae. Vet Microbiol. Aug 8 2009;[Medline].

  2. 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].

  3. Reboli AC, Farrar WE. Erysipelothrix rhusiopathiae: an occupational pathogen. Clin Microbiol Rev. Oct 1989;2(4):354-9. [Medline].

  4. 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].

  5. Wang Q, Chang BJ, Mee BJ, Riley TV. Neuraminidase production by Erysipelothrix rhusiopathiae. Vet Microbiol. May 20 2005;107(3-4):265-72. [Medline].

  6. Veraldi S, Girgenti V, Dassoni F, Gianotti R. Erysipeloid: a review. Clin Exp Dermatol. Jul 29 2009;[Medline].

  7. Veraldi S, Girgenti V, Dassoni F, Gianotti R. Erysipeloid: a review. Clin Exp Dermatol. Jul 29 2009;[Medline].

  8. Fidalgo SG, Longbottom CJ, Rjley TV. Susceptibility of Erysipelothrix rhusiopathiae to antimicrobial agents and home disinfectants. Pathology. Oct 2002;34(5):462-5. [Medline].

  9. Barnett JH, Estes SA, Wirman JA, Morris RE, Staneck JL. Erysipeloid. J Am Acad Dermatol. Jul 1983;9(1):116-23. [Medline].

  10. Dunbar SA, Clarridge JE 3rd. Potential errors in recognition of Erysipelothrix rhusiopathiae. J Clin Microbiol. Mar 2000;38(3):1302-4. [Medline].

  11. Gorby GL, Peacock JE Jr. Erysipelothrix rhusiopathiae endocarditis: microbiologic, epidemiologic, and clinical features of an occupational disease. Rev Infect Dis. Mar-Apr 1988;10(2):317-25. [Medline].

  12. Razsi L, Sanchez MR. Progressively enlarging painful annular plaque on the hand. Erysipeloid. Arch Dermatol. Oct 1994;130(10):1311-2, 1314-5. [Medline].

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Further Reading

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Keywords

erysipeloid, (insidiosa), infected meat, erysipeloid of Rosenbach, skin lesions, endocarditis

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Contributor Information and Disclosures

Author

Zeina Nehme Ghorayeb, MD, Lecturer, University of Balamand School of Medicine
Zeina Nehme Ghorayeb, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Coauthor(s)

Mona Matta-Muallem, MD, Associate Professor, Department of Dermatology, American University of Beirut, Lebanon
Mona Matta-Muallem, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Shyam Verma, MBBS, DVD, FAAD, Adjunct Clinical Assistant Professor, Department of Dermatology, University of Virginia, State University of New York at Stonybrook, Penn State University
Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn State Milton S Hershey Medical Center
Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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