Nonspecific Erysipelothrix rhusiopathiae Bacteremia in a Patient with Subclinical Alcoholic Liver Disease

Erysipelothrix rhusiopathiae-associated bloodstream infection in a patient with systemic lupus erythematosus: a case report and literature review

Introduction. Systemic human infections caused by Erysipelothrix rhusiopathiae have been increasingly reported especially within immunocompromised hosts and those with significant occupational exposure to livestock and aquatic animals. We report a case of E. rhusiopathiae bacteraemia in a patient with systemic lupus erythematosus (SLE) and present a literature review on clinical outcomes and microbiologic diagnosis for this organism. Casepresentation. A 43-year-old female patient was reporting a 1-month history of intermittent fevers. She recently increased her immunosuppression medication for her underlying SLE on the advice of her rheumatologist. The patient sustained a finger laceration from butchering cattle meat 2 weeks after the onset of her initial symptoms, with worsening index finger swelling and increased febrile episodes. Two weeks post-injury, multiple blood cultures were drawn, and each isolated Gram-positive bacilli. Given her recurrent intermittent fevers, there was a concern for ongoing infection, and therefore, intravenous vancomycin was started with prompt referral to an outpatient parenteral antibiotic therapy clinic. The Gram-positive bacillus was confirmed as E. rhusiopathiae via matrix-assisted laser desorption/ionization-time of flight analysis. Given intrinsic resistance to vancomycin, vancomycin was switched to intravenous ceftriaxone as targeted antimicrobial therapy for 2 weeks. Reassuringly, there was no echocardiographic evidence of infective endocarditis, warranting the prolonged treatment course. Post-treatment, she remained symptom-free with the resolution of joint symptoms and fevers. Conclusion. Our report illustrates a case of E. rhusiopathiae bacteraemia from an immunodeficient host, with prompt microbiologic diagnosis and intervention with appropriate antimicrobial coverage. Literature reflects the rarity of this infection, predilections to specific susceptible hosts and the importance of raising awareness of zoonotic infections.

[Sacroiliitis with Erysipelothrix Rhusiopathiae revealing tricuspid endocarditis, the first case reported on the Guiana Shield: clinical case and review of the literature]

We report here an atypical case of acute sacroiliitis caused by Erysipelothrix rhusiopathiae revealing tricuspid endocarditis in a 53-year-old woman without medical history. She was admitted to Cayenne hospital because of intense right hip and thigh pain, associated with fever. A right sacroiliitis was visible on the computed tomography (CT) scan, confirmed on MRI. Transesophageal echocardiography revealed a large mobile tricuspid vegetation. Blood cultures were positive for E. rhusiopathiae. CT scan showed pulmonary alveolar opacities, consistent with septic emboli. Clinical improvement was obtained under ceftriaxone followed by ciprofloxacin for 6 weeks of treatment. We present a review of bone and joint infections caused by E. rhusiopathiae. So far, not a single case has been reported in Latin America.

Clinical manifestations, associated diseases, diagnosis, and treatment of human infections caused by Erysipelothrix rhusiopathiae: a systematic review

INTRODUCTION

Erysipelothrix rhusiopathiae is a bacillus that can cause cutaneous and systemic diseases in humans. Studies on the infection caused by this bacterium have been mostly done as case reports. This study aimed to systematically review E. rhusiopathiae infection cases published over the last 20 years.

METHODS

Science Direct, PubMed, Scopus, Google Scholar, and Web of Science were searched using appropriate keywords to find relevant studies. After assessment of the studies, 57 case reports which surveyed 62 patients were included and their data were collected and analyzed.

RESULTS

The majority of cases were adult men living in high-income countries with an animal-related job and/or a history of animal contacts. The number of cases has increased in recent years. The main underlying diseases that were associated with E. rhusiopathiae infections include hypertension, diabetes, and alcoholism. The most frequent presentations were fever, pain, local skin lesions, and heart failure/endocarditis. Two patients died, while 60 patients were recovered following antibiotic therapy, mainly with penicillin and ceftriaxone.

CONCLUSIONS

Altogether, the results indicated that E. rhusiopathiae usually infects people who come into contact with animals and causes mild to severe local or systemic infections, especially in those who have underlying diseases. Therefore, accurate and early diagnosis of E. rhusiopathiae infections by setting up appropriate laboratory tests is required.

Rapid and simple detection of Glaesserella parasuis in synovial fluid by recombinase polymerase amplification and lateral flow strip

Background

Glaesserella parasuis (G. parasuis) is an influential pathogen of the pig, which induces high morbidity and mortality in naive pig populations in the pig industry. Accurate and rapid detection of the agent is important for disease control. In this study, a simple recombinase polymerase amplification (RPA) with a Lateral flow (LF) strip (RPA-LF-GPS) was developed to detect G. parasuis.

Results

The RPA-LF-GPS can specifically detect G. parasuis a limit of 100 CFU from other common related pathogens causing arthritis in the pig. The RPA-LF-GPS assay can use boiled synovial fluid samples as a template with the same sensitivity as other DNA extraction methods. In the detection of clinic positive synovial fluid sample, RPA-LF-GPS is equally sensitive (98.1%) compared with that of PCR (90.4%) (P > 0.05). The whole procedure of the RPA-LF-GPS assay could be finished in 1 hour without professional equipment.

Conclusions

RPA-LF-GPS assay is a rapid and simple method for point-of-care diagnostic testing for G. parasuis infection.

Erysipeloid lesions caused by Erysipelothrix rhusiopathiae in a dog: clinical and histopathological findings, molecular diagnosis and treatment

BACKGROUND

Erysipelothrix rhusiopathiae is a widespread Gram-positive, nonsporulating rod bacterium predominantly associated with skin disease in swine and cetaceans. Cutaneous lesions have yet to be described in dogs.

OBJECTIVE

To describe the clinical presentation, molecular and histopathological diagnosis, and treatment of a case of erysipeloid caused by E. rhusiopathiae in a dog.

ANIMALS

A 6-month-old spayed female standard poodle dog presented with lethargy, fever, vomiting and diarrhoea. Skin lesions appeared 20 days post first examination.

METHODS AND MATERIALS

Complete blood count, serum chemistry profile, urinalysis, urine culture, blood culture, computed topography, forelimb radiography, joint and cerebrospinal fluid aspiration were performed; samples were collected for skin cytological evaluation, culture and histopathological analysis.

RESULTS

Blood cultures yielded Gram-positive, catalase-negative bacilli. Histopathological evaluation of skin biopsies revealed lymphoplasmacytic, neutrophilic and histiocytic perivascular and periadnexal dermatitis, and vasculitis. Cutaneous and blood PCR and sequencing of 16S rRNA identified the bacteria as E. rhusiopathiae. Clinical resolution was observed following the use of of amoxicillin/clavulanic acid and ciprofloxacin therapies.

CONCLUSIONS AND CLINICAL IMPORTANCE

To the best of the authors' knowledge, this is the first confirmed case of erysipeloid caused by E. rhusiopathiae in a dog. Clinical resolution was attained with the extended use of antibiotics. After 13 months, no clinical signs had returned.

Erysipelothrix rhusiopathiae bloodstream infection - A 22-year experience at Mayo Clinic, Minnesota

Erysipelothrix rhusiopathiae is a facultatively anaerobic Gram-positive bacillus found mostly in swine, fish and sheep. E. rhusiopathiae classically causes cutaneous eruptions in butchers, fish handlers and veterinarians. Based solely on case reports, 90% of E. rhusiopathiae bloodstream infections (BSI) have been associated with infective endocarditis (IE). To assess the true frequency of IE in E. rhusiopathiae BSI as well as other clinical associations, we performed a retrospective cohort analysis of E. rhusiopathiae BSI at Mayo Clinic. This is a single-centre, retrospective study conducted between 1/1/1994 and 20/6/2016 at Mayo Clinic in Rochester, MN. Medical records were reviewed for demographics, E. rhusiopathiae BSI, anti-microbial susceptibilities, incidence of IE, patient comorbidities, intensive care unit (ICU) admission and duration of antibiotics. Five cases of E. rhusiopathiae BSI were identified. Risk factors included animal exposures, immunosuppression, diabetes and kidney disease. All cases involved penicillin-sensitive strains and high-grade BSI. Four cases showed no signs of IE on transesophageal echocardiogram. All patients recovered fully with intravenous antibiotics. Our retrospective review illustrates that E. rhusiopathiae can cause invasive BSI in the absence of IE and that the previously reported 90% association between BSI and IE may be overestimated due to reporting bias. E. rhusiopathiae should be suspected in any patient with Gram-positive bacilli in blood cultures and the aforementioned risk factors. A limitation of our study was the low sample size, and future studies may involve multicentre collaborations and the use of polymerase chain reaction (PCR) or serologic testing to increase the number of diagnoses..

A dangerous hobby? Erysipelothrix rhusiopathiae bacteremia most probably acquired from freshwater aquarium fish handling

Erysipelothrix rhusiopathiae is a facultative anaerobic Gram-positive rod that occurs widely in nature and is best known in veterinary medicine for causing swine erysipelas. In humans, infections are rare and mainly considered as occupationally acquired zoonosis. A case of E. rhusiopathiae bacteremia most likely associated with home freshwater aquarium handling is reported. The route of transmission was probably a cut with the dorsal fin of a dead pet fish. A short review of clinical presentations, therapeutic considerations and pitfalls of E. rhusiopathiae infections in humans is presented.

Erysipelothrix Rhusiopathiae Bacteremia without Endocarditis: Rapid Identification from Positive Blood Culture by MALDI-TOF Mass Spectrometry. A Case Report and Literature Review

Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is infrequently responsible for infections in humans. Three forms have been classified: a localized cutaneous form (erysipeloid) caused by traumatic penetration of E. rhusiopathiae, a generalized cutaneous form and a septicemic form. The latter type of disease has been previously associated with a high incidence of endocarditis. Here we report a case of E. rhusiopathiae bacteremia in a 74-year-old man, probably started from an erysipeloid form, in which endocarditis did not develop. This case presents some particular and uncommon features: i) no correlation with animal source; ii) correlation between bacteremia and erysipeloid lesion; iii) absence of endocarditis. MALDI-TOF mass spectrometry allowed to obtain a rapid identification (within 4 hours from bottle positivity) of E. rhusiopathiae. Together with direct antimicrobial susceptibility testing, this approach could improve the rate of appropriate therapy for bloodstream infections due to this fastidious pathogen.