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erysipeloid
Skin infection with Erysipelothrix rhusiopathiae.
Etiology:
- infection with Erysipelothrix rhusiopathiae
Epidemiology:
1) handling of raw fish, animal hides, meat, poultry or bones
2) farmers, veternarians, butchers, housewives
3) male:female ratio is 3:1
4) no vectors
5) NOT contagious
6) worldwide in distribution
7) occurs largely in summer & early fall
Pathology:
1) infection follows abrasion, scratch or puncture wound while handling organic material contaminated with the organism
2) acute dermal inflammation
- bacilli are extracellular, located deep in dermis
3) rare invasive form associatede with endocarditis [3]
Clinical manifestations:
1) incubation time 2-7 days
2) tender, localized violacious swelling of the skin with elevated irregular borders
3) itching, burning, throbbing, pain
4) skin eruption is brief
5) brown pigmentation follows acute infection
6) fever/chills are uncommon
7) lymphadenitis may occur
Laboratory:
1) biopsy & culture of biopsy material
2) culture aspirated saline injected into advancing edge of lesion
3) blood culture if bacteremia suspected
4) echocardiogram to rule out endocarditis
Differential diagnosis:
1) Vibrio cellulitis
2) allergic contact dermatitis
Complications:
1) septic arthritis
2) endocarditis: 2/3 of cases of endocarditis from subclinical infection after ingestion of infected meat or fish
Management:
1) prevention
- use of gloves by workers handling meat & fish
2) 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
c) prognosis
- generally self-limited infection, subsiding spontaneously in about 3 weeks
- relapses may occur
- mortality from endocarditis is 30-40%
Related
Erysipelothrix rhusiopathiae
General
bacterial infection
skin disease (dermatologic disorder, dermatopathy, dermatosis)
References
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 883
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 618-619
- Medical Knowledge Self Assessment Program (MKSAP) 16,
American College of Physicians, Philadelphia 2012