Erysipelothrix rhusiopathiae infection

Erysipelothrix rhusiopathiae infection is usually localized to the fingers/hands and is self-limited within 3 weeks. Swine are the major reservoir. Most infections are occupational (fishermen, fish handlers, butchers, farmers, slaughterhouse workers, veterinarians, and homemakers).

CASES/YEAR
500 (US); 10,000 (Global)
CATEGORY
AGENT TYPE
Bacteria
OTHER NAMES
Erysipeloid; Fish-handlers' disease;
ACUITY
Acute-Moderate
INCUBATION
Days
INITIAL SYMPTOMS
Skin infection, usually localized to one of the fingers;
PRECAUTIONS
Wear gloves, aprons, and boots to prevent occupational exposure; [ID, p. 1640]
COMMENTS
These bacteria are an important cause of disease in swine. Humans acquire occupational skin infections called "fish handler's disease," "whale finger," and "seal finger." Other workers affected include those handling infected tissues of turkeys, or rarely, chickens, sheep, or cattle. The typical skin lesion is purplish-red and indurated. There may be a hemorrhagic blister but suppuration is unusual. Systemic symptoms (fever, lymphangitis, and lymphadenopathy) are present in only about 10% of cases. Complications include bacteremia, endocarditis, and rarely, brain abscesses, myocarditis, pericarditis, renal failure, infectious arthritis, and osteomyelitis. [ID, p. 1638-40; CCDM, p. 583] Swine are the major reservoir. Most infections are occupational (fishermen, fish handlers, butchers, farmers, slaughterhouse workers, veterinarians, and homemakers). Lymphangitis and lymphadenitis accompany about 1/3 of infections. Low-grade fever and arthralgias are reported in about 10% of infections. Most infections resolve in 3-4 weeks without treatment. Diffuse cutaneous disease is a rare form of erysipeloid. The skin lesions may resemble urticaria, and most patients have fever and arthralgias. Another rare form of the disease is bacteremia. More than 90 cases of bacteremia, usually associated with endocarditis, have been reported. Congestive heart failure, glomerulonephritis, meningitis, brain infarctions, septic arthritis, and osteomyelitis are complications of Erysipelothrix endocarditis. [PPID, p. 2575-6] Workers are infected after contact with infected animals (swine, sheep, cattle, horses, dogs, rodents, chickens, ducks, turkeys, penguins, parrots). At risk are fishers, farmers, butchers, slaughterhouse workers, and veterinarians. Infections are usually localized to the fingers and hands. "Lesions usually resolve within 3 weeks without treatment." Diffuse cutaneous infection is rare. Systemic infection is uncommon. [Cecil, 24th Ed, p. 1889-90] E. rhusiopathiae usually causes cellulitis in workers (bone renderers and fishmongers) exposed to infected swine and fish. [Harrison ID, p. 260] The primary reservoir is swine, but also sheep, fish, shellfish, and domestic fowl. The cellulitis is purplish-red and spreads with a raised border and central clearing. Sepsis (rare) and endocarditis are complications. [ABX Guide]
DIAGNOSTIC
Culture of skin biopsy--organism resembles diphtheroids and coryneforms but produces hydrogen sulfide; Also more likely to produce positive blood cultures than other causes of cellulitis; [ABX Guide] Grows on standard laboratory media; [Cecil, p. 1890]
SCOPE
Global
SIGNS & SYMPTOMS
  • >arthralgia
  • >fever
  • H lymphadenopathy
  • S cellulitis or rash, circinate
  • S entry wound with lymph nodes
  • S lymphangitis
  • S papules or plaques
  • S rash (exanthem)
  • S skin blister or vesicles
  • *acute renal failure
  • *arthritis
  • *brain abscess or lesion
  • *endocarditis
  • *glomerulonephritis
  • *meningitis
  • *myocarditis
  • *osteomyelitis
  • *pericarditis
  • *sepsis
  • *shock
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Skin or Mucous Membranes (Includes Conjunctiva)
SOURCE
Animal Tissue
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Dogs, Fish and Shellfish, Horses, Rodents, Swine, Wild Animals
RISK FACTORS
  • Handle animal carcasses or placentas
  • Touch infected farm animals
  • Touch infected fish or shellfish
  • Touch infected meat or poultry
TREATMENT
"Penicillin G is the treatment of choice." [Cecil, p. 1890]
REFERENCES FOR CASES/YEAR
1. (US) Guesstimate: 1/20 of global cases/yr;
2. (Global) Rare in the UK; [Public Health England website] "No cases of systemic disease were seen among the 500 cases of erysipeloid described by Nelson or among the 329 cases reported by Gilchrist. Fifty cases of systemic E. rhusiopathiae infection have been reported, with a very high incidence of endocarditis (90%) among them." [PMID 2680056] Guesstimate: 10,000 cases/year;