Erysipelothrix rhusiopathiae cellulitis with associated bacteraemia following seafood preparation

Erysipelothrix rhusiopathiae is a pleomorphic Gram-positive bacillus, zoonotic pathogen of mammals, birds and fish. Human disease caused by this organism most commonly occurs following occupational or recreational exposure to infected animals and typically presents as a localised cutaneous disease. Invasive infection resulting in bacteraemia, endocarditis or other distant sequelae is infrequently seen. Most commonly, invasive infection is seen in patients with predisposing risk factors including diabetes, immunocompromising conditions, alcohol use disorder or chronic kidney disease. The organism is highly susceptible to penicillin-class drugs which serve as first-line antimicrobial therapy with prolonged courses typically prescribed for invasive disease, given the predilection of this organism to cause endocarditis. In this report, we present an interesting case of a polymicrobial finger abscess with E. rhusiopathiae bacteraemia following laceration with a fish spine in an immunocompetent patient in Southern US state. This bacteraemic episode was successfully treated with a fluoroquinolone course owing to patient's penicillin allergy.

[Infective endocarditis with bivalvular involvement due to Erysipelothrix rhusiopathiae. Report of one case]

The microbiology of infective endocarditis (IE) varies in different populations and depends on public health conditions and socioeconomic status. In low-income countries, oral Streptococci affect hearts with rheumatic valve disease in patients with poor dentition. In high-income countries, Staphylococci are the most common cause, affecting elderly and immunocompromised patients, or those with invasive devices. Gram - positive bacili as IE pathogens are unusual. Erysipelothrix rhusiopathiae is a Gram positive bacili. It causes skin diseases in domestic and farm animals, but in humans, is a very unusual pathogen. This infection is considered a zoonosis, since most cases are linked to direct contact with vector animals. We report a 62 year-old male patient with a history of exposure to animals, who developed an infective endocarditis with severe bivalve regurgitation and septic shock, requiring antimicrobials and surgical resolution. Erysipelothrix rhusiopathiae was isolated from blood and valve vegetation cultures. The patient had a successful evolution and was discharged from the hospital.

[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.

[Infective endocarditis caused by Erysipelothrix rhusiopathie. Report of one case]

Erysipelothrix rhusiopathie is an immobile, not sporulated, gram positive bacillus. Man is an accidental host. Infection is acquired through wounds on contact with sick animals or carriers, their products or objects contaminated with their waste. We report a 40 years old tannery male worker, presenting in the emergency room with fever lasting one month. An echocardiogram showed a vegetation and perforation of the aortic valve with severe aortic regurgitation. Blood cultures gave growth to E. rhusiopathiae. The patient was treated with penicillin. After three weeks of treatment an aortic valve replacement with a mechanical valve was performed. At six weeks, he was discharged from the hospital.

Human Erysipelothrix rhusiopathiae Infection: Unsolved Issues and Possible Solutions

Erysipelothrix rhusiopathiae infection in humans may not be as rare as previously thought. In most cases, the disease is acquired from animals through work-related exposure. Human infection has been reported since the early 1900's up to the present. Unsolved issues associated with this organism include inadequate disease control in animals, difficulty in identification and isolation of the bacteria, diagnostic delay due to unawareness of this uncommon disease or unfamiliarity with the increasingly diverse clinical manifestations, and inappropriate antibiotic use due to misdiagnosis, as well as drug resistance. In this review, we attempt to address the unsolved issues related to human Erysipelothrix infection and suggest possible solutions.

Development of an indirect immunofluorescence technique for the evaluation of generated antibody titers against Erysipelothrix rhusiopathiae in captive bottlenose dolphins (Tursiops truncatus)

Erysipelothrix rhusiopathiae is the causative agent of erysipelas, a disease of many mammalian and avian species, mainly swine and turkeys. In cetaceans, erysipelas is considered to be the most common infection in juvenile individuals, which have not been vaccinated. Moreover, the disease manifest in both forms, the dermatologic and the acute septicemic forms, has been reported in various species of dolphins and whales. It is difficult to diagnose erysipelas by currently available approaches. Moreover, it is mainly based on culture methods and also PCR methods, which are currently being developed. At the present stage, prophylactic approaches are based on antibiotic therapy and vaccination mostly with porcine erysipelas vaccines. In the present study, an Indirect Immuno Fluorescence method for the detection of dolphin antibodies levels against E. rhusiopathiae was developed and applied in two different groups of captive bottlenose dolphins (Tursiops truncatus) from Loro Parque (Tenerife, Canary Islands, Spain) and L'Oceanogràfic de Valencia (Valencia, Spain) in order to check the tittering levels of antibodies after application of porcine erysipelas vaccines in the studied dolphins.

Improving ante mortem diagnosis of Erysipelothrix rhusiopathiae infection by use of oral fluids for bacterial, nucleic acid, and antibody detection

Swine erysipelas is an economically important disease caused by Erysipelothrix rhusiopathiae. Pen-based collection of oral fluids has recently been utilized for monitoring infection dynamics in swine operations. The diagnostic performance of bacterial isolation, real-time PCR, and antibody detection by enzyme-linked immunosorbent assay (ELISA) and fluorescent microbead-based immunoassay (FMIA) methods were evaluated on pen-based oral fluid samples from pigs experimentally infected with E. rhusiopathiae (n=112) and from negative controls (n=32). While real-time PCR was a sensitive method with an overall detection rate of 100% (7/7 pens) one day post inoculation (dpi), E. rhusiopathiae was successfully isolated in only 28.6% (2/7 pens). Anti-Erysipelothrix IgM and IgG antibodies in pen-based oral fluids were detected at 4 to 5 dpi by FMIA and at 5 and 8 dpi by ELISA. The number of infected animals per pen, and in particular the timing of antimicrobial treatment administration impacted bacterial isolation and ELISA results. In oral fluid field samples, E. rhusiopathiae DNA was found in 23.3% of the samples while anti-E. rhusiopathiae IgG and IgM antibodies were found in 59.6% and 5.5% of the samples, respectively. The results suggest that an algorithm integrating oral fluids as specimen and real-time PCR and FMIA as detection methods is effective for earlier detection of an erysipelas outbreak thereby allowing for a more effective treatment outcome.

Erysipelothrix rhusiopathiae pneumonia in an immunocompetent patient

Erysipelothrix rhusiopathiae is a Gram-positive bacillus that causes infections primarily in animals. In humans, this bacterium usually causes localized cutaneous infections called erysipeloid. Here we report a case of pneumonia with isolation of E. rhusiopathiae from bronchoalveolar lavage and sputum. To our knowledge, this is the first report of a pneumonia case caused by E. rhusiopathiae confirmed by culture.

Serological and pathogenic characterization of Erysipelothrix rhusiopathiae isolates from two human cases of endocarditis in Japan

We characterized the serological and pathogenic properties of two Erysipelothrix rhusiopathiae isolates from human cases of infective endocarditis in Japan. One isolate was recovered from a fisherman, and was identified as serovar 3, which is known to be prevalent among fish isolates. This strain exhibited high virulence in mice but was avirulent in swine. Another was untypable, and avirulent in both mice and swine. Our results suggest that various serological and athogenical types of E. rhusiopathiae can induce human endocarditis. This is the first report to characterize the pathogenicity of E. rhusiopathiae isolates from human endocarditis.

Erysipelothrix rhusiopathiae peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis

Erysipelothrix rhusiopathiae is known as a pathogen of occupational diseases or a zoonosis. We report a case of E. rhusiopathiae peritonitis in a 50-yr-old male undergoing continuous ambulatory peritoneal dialysis (CAPD). He was suffered from mild abdominal pain with a distinctive erysipeloid skin lesion. E. rhusiopathiae was considered to be introduced through a lacerated wound on his hand when he was exposed to contaminated materials. He was treated successfully with a first generation cephalosporin. To our knowledge, CAPD peritonitis due to E. rhusiopathiae is very rare, and this is a report of the first case in Asia.

An autopsy case of Erysipelothrix rhusiopathiae endocarditis

A 58-year-old man was admitted to our hospital with fever. The vegetation was confirmed by echocardiography on the tricuspid valve and Erysipelothrix rhusiopathiae was isolated by blood culture. The patient died due to heart failure, and tricuspid valve vegetation was confirmed on autopsy and the sample of Gram's staining showed gram-positive microcolonies. Although about 60 cases of E. rhusiopathiae endocarditis have been reported, Japanese cases are extremely rare.

Chronic meningitis caused by Erysipelothrix rhusiopathiae

A 47-year-old man presented with headache, nausea, vomiting and fever. Laboratory findings including analysis of cerebrospinal fluid suggested bacterial meningitis. Erysipelothrix rhusiopathiae was identified in cultures of cerebrospinal fluid. The patient recovered without any neurological sequelae after antimicrobial treatment. It is interesting that intracranial infection by E. rhusiopathiae reappeared after scores of years and that it presented with absence of an underlying cause or bacteraemia.

Occupational injury in a fishmonger with a macular rash, hepatosplenomegaly and pancytopenia

A 47-year-old fishmonger presented with a history of weight loss and lethargy. On investigation he was found to have myeloma. He presented again before follow up, with a 3-day history of fever and a maculopapular rash. He was admitted to the haematology ward and treated with broad-spectrum antibiotics. Blood cultures were found to be positive for Erysipelothrix rhusiopathiae. Penicillin treatment was given, and he made a good recovery. The importance of occupational illness in an already immunocompromised patient and of taking a proper social and occupational history from patients on admission is illustrated through this case.

[One case with Erysipelothrix rhusiopathiae endocarditis]

We report case of a 67-year-old alcoholic fisherman who developed infective endocarditis caused by Erysipelothrix rhusiopathiae. The initial manifestations were fever and back pain of approximately three months' duration. Auscultation of the heart revealed a loud systolic murmur at the apex and a diastolic murmur over the aortic valve area. Echocardiographic studies showed vegetations on both the aortic valve and mitral valve. Blood cultures grew Erysipelothrix rhusiopathiae, and it was sensitive to aminobenzyl penicillin. No other bacteria grew aut. A diagnosis of infective endocarditis caused by the Erysipelothnx rhusiopatniae was made, and the patient was treated with aminobenzyl penicillin 12g/day for 6 weeks. His clinical course was complicated by heart failure, multiple cerebral embolism, and renal infarctions. However, he recovered without valve replacement. Although the exact route of infection remains unknown, erosions of the skin, of his palms at the time of tho initial examination appeared to be one possible source of the systemic infection in this case. The serotype of the bacteria was Ib. To our knowledge this is the first case of serotyping of bacterium that caused endocarditis in humans.

Mitro-aortic infective endocarditis produced by Erysipelothrix rhusiopathiae: case report and review of the literature

Endocarditis produced by Erysipelothrix rhusiopathiae is an uncommon disease in humans. This bacterial species is found worldwide as a commensal or a pathogen in many animals. Infection in humans is usually due to occupational exposure. The case is reported of a 43-year-old male parrot breeder with native aortic and mitral valve endocarditis and NYHA class II heart failure at six months after wound infection. The patient was discharged after six weeks' treatment with intravenous penicillin G and replacement of the mitral and aortic valves due to severe regurgitation. At one year after surgery the patient was asymptomatic and infection-free.

[Fatal mitral valve endocarditis by Erysipelothrix rhusiopathiae]

A fatal case of Erysipelothrix rhusiopathiae mitral valve endocarditis is described in a 45 years old male, with a history of chronic alcohol abuse and without animals contact. He presented intermittent fever, polyarthralgia, weight loss, and low back pain. In blood cultures (2 bottles), gram-positive pleomorphic rods grew after 48 hours of incubation. The subculture on blood agar media showed a small, alpha-hemolytic colony, catalase and oxidase negative, PYR and LAP positive and the production of H2S in triple sugar iron agar, was demonstrated. The isolate was initially identified as E. rhusiopathiae, and confirmed by API Coryne (BioMérieux). On the basis of these findings and a transthoracic echocardiogram, an endocarditis was confirmed. Intravenous ampicillin and gentamicin treatment was initiated. The patient became afever, nevertheless he died on day 19 after admission as a consequence of acute pulmonary edema. Susceptibility testing by E-test showed that the microorganism was resistant to vancomycin and gentamicin, and susceptible to penicillin and cefotaxime. We emphasize the importance to consider the isolates of gram-positive pleomorphic rods, catalase and oxidase negative, and the addition of H2S production test in TSI medium. Vancomycin-resistance helps in the identification, and to establish the correct antimicrobial therapy. Although E. rhusiopathiae is usually reported as an occupational pathogen, the contact with pigs and other farm animals may be underestimated.

[Erysipelothrix rhusiopathiae--rare etiology of persistent febrile syndrome]

Erysipelothrix rhusiopathiae is a Gram-positive rod, carried by many domestic and pet animals and very resistant in the environmental habitat, causing an anthropo-zoonosis infection in humans. It can determine, most frequently, a skin infection and may cause also septic arthritis or systemic infection, usually associated with aortic endocarditis. Bacteremia without endocarditis is a very rare presentation, generally seen in immunocompromised patients. We report such an unexpected diagnosis in a 75-years old woman, with mitral regurgitation, who was investigated for a persistent febrile syndrome, with no evidence of vegetation on repeated echo examinations and no evidence of the entry portal and who recovered successfully from an E. rhusiopathiae bacteremia with Ampicillin iv. therapy for 14 days.

[Infective endocarditis caused by Erysipelothrix rhusiopathiae--case report]

Infective endocarditis (IE) is an infectious disease, which leads to death when is untreated. In most cases IE is caused by typical bacteria. IE caused by atypical bacteria is rare. In this paper, we describe a female patient with IE caused by Erysipelothrix rhusiopathiae (ER). Due to inflammation and leaflets' damage she underwent double-valve implantation (aortic and mitral ones). A long-term antibiotic therapy was given with good outcome. We also describe the organism, types of human diseases caused by ER and treatment options.

Subacute endocarditis due to Erysipelothrix rhusiopathiae

Erysipelothrix rhusiopathiae is a rare cause of endocarditis. Most cases were observed in people working with animals. We report a case in a 45-year old man without any exposure to animals. He was admitted to our hospital because of dyspnoea. Blood cultures were drawn following fever on day 8 of hospitalisation. Erysipelothrix rhusiopathiae was cultured and echocardiography showed a vegetation on the mitral valve. Appropriate antibiotic therapy and surgical treatment led to a good outcome of the infection.

Diagnosis by polymerase chain reaction of Erysipelas septicemia in a flock of ring-necked pheasants

A flock of 810 pheasants experienced 6.2% mortality over 6 days. Affected birds were weak and lethargic for up to 24 hr before death. Examined birds were thin, and gross lesions consisted of thick opaque crops and cecal cores. Histologically, there was capillariasis of the crop and multifocal ulcerative typhlitis with Heterakis spp. infection, and numerous systemic intravascular monocytes were filled with clusters of blue rod-shaped organisms. The organisms were gram-positive bacilli by Brown and Brenn staining and ultrastructural analysis. Liver bacterial cultures were negative for pathogenic bacteria. Erysipelas septicemia was diagnosed by an Erysipelothrix species-specific polymerase chain reaction method with the substrate DNA isolated from formalin-fixed, paraffin-embedded liver.

[Mitral valve endocarditis caused by Erysipelothrix rhusiopathiae]

HISTORY AND CLINICAL FINDINGS

A 67 year-old country woman was admitted to the hospital because of a four weeks history of continuous catarrh, arthralgia and fever. Recently, she had also developed upper abdominal pain after oral ibuprofen treatment. The clinical examination showed a patient of impaired general condition. The heart and lungs were auscultatory normal and there were no signs of dyspnea, cyanosis or inflammatory skin lesions.

EXAMINATIONS

Physical examination of heart and lung, electrocardiography and transthoracic echocardiography were without pathological findings.

CLINICAL COURSE

Gastroscopy revealed acute antral gastritis and duodenitis with presence of Helicobacter pylori. Eradication therapy resolved the abdominal symptoms but fever returned after the antibiotic therapy was stopped. The patient developed a severe endocarditis with progressive mitral regurgitation within a few days. Erysipelothrix rhusiopathiae was isolated from blood cultures and identified by conventional and molecular methods. The patient was treated successfully with 3 x 2 g ampicillin daily, applied parenterally for six weeks, and a mitral valve replacement.

CONCLUSION

This was an unusual manifestation of systemic Erysipelothrix rhusiopathiae infection. The bacterium Erysipelothrix rhusiopathiae has still to be considered in the diagnosis and treatment of endocarditis in patients with increased risk of exposure (e.g. farmers, butchers and fishermen).

Potential errors in recognition of Erysipelothrix rhusiopathiae

Here we describe four isolations of Erysipelothrix rhusiopathiae associated with polyarthralgia and renal failure, septic arthritis, classic erysipeloid, and peritonitis. Although the biochemical identification was straightforward in each case, recognition presented a challenge to the clinical microbiologist, since in three cases E. rhusiopathiae was not initially considered due to unusual clinical presentations, in two cases the significance might not have been appreciated because growth was in broth only, and in one case the infection was thought to be polymicrobic. Because the Gram stain can be confusing, abbreviated identification schemes that do not include testing for H(2)S production could allow E. rhusiopathiae isolates to be misidentified as Lactobacillus spp. or Enterococcus spp. in atypical infections.

Direct and rapid detection by PCR of Erysipelothrix sp. DNAs prepared from bacterial strains and animal tissues

A PCR method for rapid screening of Erysipelothrix spp. in the slaughterhouse was carried out by using four species-specific sets of oligonucleotide primers after initial amplification with the primer set MO101-MO102, which amplifies the 16S rRNA sequences of all four Erysipelothrix species. The DNA sequences coding for the rRNA gene cluster, including 16S rRNA, 23S rRNA, and the noncoding region downstream of 5S rRNA, were determined in order to design primers for the species-specific PCR detection system. The homology among the 4.5-kb DNA sequences of the rRNA genes of Erysipelothrix rhusiopathiae serovar 2 (DNA Data Bank of Japan accession no. AB019247), E. tonsillarum serovar 7 (accession no. AB019248), E. rhusiopathiae serovar 13 (accession no. AB019249), and E. rhusiopathiae serovar 18 (accession no. AB019250) ranged from 96.0 to 98.4%. The PCR amplifications were specific and were able to distinguish the DNAs from each of the four Erysipelothrix species. The results of PCR tests performed directly with tissue specimens from diseased animals were compared with the results of cultivation tests, and the PCR tests were completed within 5 h. The test with this species-specific system based on PCR amplification with the DNA sequences coding for the rRNA gene cluster was an accurate, easy-to-read screening method for rapid diagnosis of Erysipelothrix sp. infection in the slaughterhouse.

Infective endocarditis in renal transplant recipients

Because of the increasing number of renal transplantations performed and the rarity of reported cases of infective endocarditis in these patients, we studied the clinical characteristics of this infection in this population. We report on two cases from our experience and review reported cases of infective endocarditis in renal transplant recipients retrieved from the MEDLINE system. In addition, we reviewed a large series of infective endocarditis looking for patients with renal transplants. In addition to our 2 cases, 12 previously reported cases were found. The mean time from transplantation to diagnosis of infective endocarditis was 3.5 years (range 2 months to 15 years). Causative organisms included fungi, Staphylococcus aureus (3 cases each), Corynebacterium sp. (2 cases), Streptococcus viridans, VRE, Brucella sp., Clostridium sp., Nocardia sp. and Erysipelothrix sp. (one case each). Skin manifestations of endocarditis and/or splenomegaly were not reported in these patients. Septic emboli and mycotic aneurysms were relatively common. The overall mortality rate was 50% (7 of 14 patients died). Infective endocarditis seems to be rare in renal transplant recipients. The few reported cases are characterized by unusual causative micro-organisms and atypical clinical presentation. Further studies are needed to delineate the magnitude and scope of this association.

Erysipelothrix rhusiopathiae endocarditis: clinical features of an occupational disease

Erysipelothrix rhusiopathiae is becoming more commonly recognized in humans and has the potential for significant morbidity and mortality. In this article, we describe one patient's clinical symptoms after occupational exposure to E rhusiopathiae and its sequela. We discuss the natural history of the organism, three major categories of human disease, and treatment options.

Direct and rapid detection of Erysipelothrix rhusiopathiae DNA in animals by PCR

Erysipelothrix rhusiopathiae is a gram-positive rod capable of causing erysipelas in swine. To establish a method for specifically detecting E. rhusiopathiae for practical applications, such as for the inspection of slaughterhouses, the feasibility of using primers derived from the DNA sequence coding for 16S rRNA in a PCR-specific detection system was investigated. Oligonucleotide primers were designed to amplify a 407-bp DNA fragment by PCR. The amplification was specific to the Erysipelothrix DNA but not to that of other bacterial genera tested. This PCR-based method efficiently and specifically detected the Erysipelothrix DNA sequence in joint and spleen samples from mice within 6 h, and application of the 407-bp DNA segment from samples containing very low numbers of bacteria (< 20 bacteria per spleen from mice) was possible. Although this PCR amplification is specific for the Erysipelothrix genus, which contains at least two species, E. rhusiopathiae and E. tonsillarum, it can be concluded that all Erysipelothrix strains detected by this PCR system in diseased pigs are E. rhusiopathiae because only E. rhusiopathiae is virulent for pigs. These results show that this PCR amplification system using the DNA sequence coding for 16S rRNA is very rapid and reliable and avoids cumbersome and lengthy cultivation steps, demonstrating that this system could be used for practical applications.

[Bacterial endocarditis due to Erysipelothrix rhusiopathiae. A clinical case report]

The authors describe an unusual case of bacterial endocarditis. A very rare etiologic agent, Erysipelothrix rhusiopathiae, was isolated. The patient was not fisherman or butcher and he did ot other risky job. Moreover the disease had an atypical course.

Persistent bacteremia with Erysipelothrix rhusiopathiae in a hospitalized patient

A patient with a history of alcohol abuse and pancreatitis presented with a pleural effusion resulting from a fistula between the pancreatic duct and left pleural space. Two weeks into her hospitalization, fever and persistent bloodstream infection with Erysipelothrix rhusiopathiae and Candida albicans developed. The patient had no history of exposure to animals. To our knowledge this is the first report of an E. rhusiopathiae infection presenting during hospitalization. This case suggests the possibility of a carrier state of infection and illustrates that a high index of suspicion is necessary for identification of unusual pathogens in hospitalized patients.

[Endocarditis caused cy Erysipelothrix rhusiopathiae. Study of 2 cases and review of the literature]

Endocarditis produced by E. rhusiopathiae is a uncommon disease. Most of the infected persons (90%) work in environments with frequent exposure to E. rhusiopathiae (butchers, fisherman). Although the clinical picture of endocarditis produced by E. rhusiopathiae is indistinguishable from other forms of subacute endocarditis, this infection has a mortality rate of 40% and a high morbidity. Microbiological diagnosis should consider the possibility of making a mistake considering that isolation of a gram-positive bacillus may represent contamination by an agent without clinical relevance. Treatment with penicillin G during 4 weeks is commonly sufficient to cure the disease.

External quality assessment for clinical microbiology in Norway 1985

During 1985 four external quality assessment tests for clinical microbiology were performed, each consisting of four simulated clinical specimens. The results are reported, evaluated and some problem areas discussed.

Application of the indirect enzyme immunoassay for the detection of antibodies against Erysipelothrix rhusiopathiae

Sera from swine and rats experimentally infected with Erysipelothrix rhusiopathiae and field sera from swine were investigated for antibodies against E. rhusiopathiae using the microtiter enzyme immunoassay (EIA) and, for comparison, the growth test (GT) and the agglutination test (AT). In principle there was a good correspondence between the results of EIA and those of the two other methods, but EIA and GT were more sensitive than AT. On the basis of the evaluation pattern of GT and AT on swine sera, EIA titers of 1/320 were considered as "chronic erysipelas titers". Compared with GT and AT, the EIA has some advantages: it is not influenced by contamination of the test sera, it takes only a few hours and using the microtiter system it is easy and economical to perform.