Genomic characterization and virulence gene profiling of Erysipelothrix rhusiopathiae isolated from widespread muskox mortalities in the Canadian Arctic Archipelago.

BACKGROUND: Muskoxen are important ecosystem components and provide food, economic opportunities, and cultural well-being for Indigenous communities in the Canadian Arctic. Between 2010 and 2021, Erysipelothrix rhusiopathiae was isolated from carcasses of muskoxen, caribou, a seal, and an Arctic fox during multiple large scale mortality events in the Canadian Arctic Archipelago. A single strain ('Arctic clone') of E. rhusiopathiae was associated with the mortalities on Banks, Victoria and Prince Patrick Islands, Northwest Territories and Nunavut, Canada (2010-2017). The objectives of this study were to (i) characterize the genomes of E. rhusiopathiae isolates obtained from more recent muskox mortalities in the Canadian Arctic in 2019 and 2021; (ii) identify and compare common virulence traits associated with the core genome and mobile genetic elements (i.e. pathogenicity islands and prophages) among Arctic clone versus other E. rhusiopathiae genomes; and iii) use pan-genome wide association studies (GWAS) to determine unique genetic contents of the Arctic clone that may encode virulence traits and that could be used for diagnostic purposes. RESULTS: Phylogenetic analyses revealed that the newly sequenced E. rhusiopathiae isolates from Ellesmere Island, Nunavut (2021) also belong to the Arctic clone. Of 17 virulence genes analysed among 28 Arctic clone isolates, four genes - adhesin, rhusiopathiae surface protein-A (rspA), choline binding protein-B (cbpB) and CDP-glycerol glycerophosphotransferase (tagF) - had amino acid sequence variants unique to this clone when compared to 31 other E. rhusiopathiae genomes. These genes encode proteins that facilitate E. rhusiopathiae to attach to the host endothelial cells and form biofilms. GWAS analyses using Scoary found several unique genes to be overrepresented in the Arctic clone. CONCLUSIONS: The Arctic clone of E. rhusiopathiae was associated with multiple muskox mortalities spanning over a decade and multiple Arctic islands with distances over 1000 km, highlighting the extent of its spatiotemporal spread. This clone possesses unique gene content, as well as amino acid variants in multiple virulence genes that are distinct from the other closely related E. rhusiopathiae isolates. This study establishes an essential foundation on which to investigate whether these differences are correlated with the apparent virulence of this specific clone through in vitro and in vivo studies.

Erysipelothrix rhusiopathiae infection in a captive white-lipped peccary (Tayassu pecari) in Finland.

Erysipelothrix rhusiopathiae is a zoonotic pathogen that causes infections in several animal species, including erysipelas in swine, lambs and turkeys. In October 2022, a captive, 1-year-old white-lipped peccary (Tayassu pecari), kept in a herd of five peccaries in a zoo in Finland, suddenly developed signs of inappetence and reluctance to move. Despite treatment, the peccary was found dead. At necropsy, the main gross finding was severe acute segmental necrotizing enteritis. Several other organs had lesions compatible with acute septicaemia, including petechiae and ecchymoses. Histopathology of the intestine revealed severe acute multifocal necrotizing enteritis with neutrophilic vasculitis, vascular fibrinoid microthrombi and myriad clusters of densely packed, rod-shaped, gram-positive bacteria on the tips of the intestinal villi. Bacterial culture was identified as E. rhusiopathiae by MALDI-TOF mass spectrometry. To our knowledge, this is the first report of a naturally occurring E. rhusiopathiae infection in a captive white-lipped peccary. Our findings suggest that regular vaccination of captive white-lipped peccaries should be taken into consideration in preventing infections due to E. rhusiopathiae.

Integrative and Conjugative Elements and Prophage DNA as Carriers of Resistance Genes in Erysipelothrix rhusiopathiae Strains from Domestic Geese in Poland.

Goose erysipelas is a serious problem in waterfowl breeding in Poland. However, knowledge of the characteristics of Erysipelothrix rhusiopathiae strains causing this disease is limited. In this study, the antimicrobial susceptibility and serotypes of four E. rhusiopathiae strains from domestic geese were determined, and their whole-genome sequences (WGSs) were analyzed to detect resistance genes, integrative and conjugative elements (ICEs), and prophage DNA. Sequence type and the presence of resistance genes and transposons were compared with 363 publicly available E. rhusiopathiae strains, as well as 13 strains of other Erysipelothrix species. Four strains tested represented serotypes 2 and 5 and the MLST groups ST 4, 32, 242, and 243. Their assembled circular genomes ranged from 1.8 to 1.9 kb with a GC content of 36-37%; a small plasmid was detected in strain 1023. Strains 1023 and 267 were multidrug-resistant. The resistance genes detected in the genome of strain 1023 were erm47, tetM, and lsaE-lnuB-ant(6)-Ia-spw cluster, while strain 267 contained the tetM and ermB genes. Mutations in the gyrA gene were detected in both strains. The tetM gene was embedded in a Tn916-like transposon, which in strain 1023, together with the other resistance genes, was located on a large integrative and conjugative-like element of 130 kb designated as ICEEr1023. A minor integrative element of 74 kb was identified in strain 1012 (ICEEr1012). This work contributes to knowledge about the characteristics of E. rhusiopathiae bacteria and, for the first time, reveals the occurrence of erm47 and ermB resistance genes in strains of this species. Phage infection appears to be responsible for the introduction of the ermB gene into the genome of strain 267, while ICEs most likely play a key role in the spread of the other resistance genes identified in E. rhusiopathiae.

Erysipelothrix amsterdamensis sp. nov., associated with mortalities among endangered seabirds.

Infectious diseases threaten endangered species, particularly in small isolated populations. Seabird populations on the remote Amsterdam Island in the Indian Ocean have been in decline for the past three decades, with avian cholera caused by Pasteurella multocida proposed as the primary driver. However, Erysipelothrix species have also been sporadically detected from albatrosses on Amsterdam Island and may be contributing to some of the observed mortality. In this study, we genomically characterized 16 Erysipelothrix species isolates obtained from three Indian yellow-nosed albatross (Thalassarche carteri) chick carcasses in 2019. Histological analyses suggest that they died of bacterial septicaemia. Two isolates were sequenced using both Illumina short-read and MinION long-read approaches, which - following hybrid assembly - resulted in closed circular genomes. Mapping of Illumina reads from the remaining isolates to one of these new reference genomes revealed that all 16 isolates were closely related, with a maximum of 13 nucleotide differences distinguishing any pair of isolates. The nucleotide diversity of isolates obtained from the same or different carcasses was similar, suggesting all three chicks were likely infected from a common source. These genomes were compared with a global collection of genomes from Erysipelothrix rhusiopathiae and other species from the same genus. The isolates from albatrosses were phylogenetically distinct, sharing a most recent common ancestor with E. rhusiopathiae. Based on phylogenomic analysis and standard thresholds for average nucleotide identity and digital DNA-DNA hybridization, these isolates represent a novel Erysipelothrix species, for which we propose the name Erysipelothrix amsterdamensis sp. nov. The type strain is A18Y020dT (=CIP 112216T=DSM 115297T). The implications of this bacterium for albatross conservation will require further study.

Erysipelas with preferential brain and skin involvement in a Mediterranean bottlenose dolphin Tursiops truncatus.

Infections by Erysipelothrix rhusiopathiae occur in domestic animals and cause the disease known as 'erysipelas'. The ubiquity of Erysipelothrix spp. makes infection possible in a wide range of vertebrates and invertebrates. Cetaceans are highly susceptible to erysipelas, especially those under human care. The number of cases documented in wild cetaceans is low, the pathogenesis is incompletely understood, and the full spectrum of lesions is not well defined. The possible serotypes and species of the genus that can cause disease are unknown. In October 2022, a common bottlenose dolphin Tursiops truncatus stranded in Vilassar de Mar (Catalonia) showing skin lesions consistent with 'diamond skin disease', a characteristic lesion of erysipelas shared by swine and cetaceans. Necropsy was performed following standardized procedures, and multiple samples were taken for histopathology and bacteriology. Erysipelothrix sp. grew in pure culture in many tissue samples. Genetic characterization by multi-locus sequence analysis identified the species as E. rhusiopathiae. Histologically, the main lesions were an intense suppurative vasculitis of leptomeningeal arteries and veins with abundant intramural Gram-positive bacilli and meningeal hemorrhages. Meningeal lesions were considered the cause of death. The affected skin showed moderate suppurative dermatitis. Herein we document a case of erysipelas in a Mediterranean common bottlenose dolphin with unusual lesions in the leptomeningeal vessels and marked skin tropism. To our knowledge, this is the first case of severe brain involvement in erysipelas in a cetacean. We also provide a review of available cases in wild cetaceans, to highlight the characteristics of the disease and improve future diagnosis.

Systemic Erysipelas Outbreak among Free-Ranging Bottlenose Dolphins, San Diego, California, USA, 2022.

We diagnosed fatal Erysipelothrix rhusiopathiae sepsis in 3 stranded bottlenose dolphins (Tursiops truncatus) during summer 2022, in San Diego, California, USA. The previously undetected disease in this relatively small, regional population of dolphins most likely indicates an environmental or biological change in the coastal ocean or organisms.

An integrative and multi-indicator approach for wildlife health applied to an endangered caribou herd.

Assessing wildlife health in remote regions requires a multi-faceted approach, which commonly involves convenient samplings and the need of identifying and targeting relevant and informative indicators. We applied a novel wildlife health framework and critically assessed the value of different indicators for understanding the health status and trends of an endangered tundra caribou population. Samples and data from the Dolphin and Union caribou herd were obtained between 2015 and 2021, from community-based surveillance programs and from captured animals. We documented and categorized indicators into health determinants (infectious diseases and trace elements), processes (cortisol, pathology), and health outcomes (pregnancy and body condition). During a recent period of steep population decline, our results indicated a relatively good body condition and pregnancy rates, and decreasing levels of stress, along with a low adult cow survival. We detected multiple factors as potential contributors to the reduced survival, including Brucella suis biovar 4, Erysipelothrix rhusiopathiae and lower hair trace minerals. These results remark the need of targeted studies to improve detection and investigations on caribou mortalities. We also identified differences in health indicators between captured and hunter sampled caribou, highlighting the importance of accounting for sampling biases. This integrative approach that drew on multiple data sources has provided unprecedented knowledge on the health in this herd and highlights the value of documenting individual animal health to understand causes of wildlife declines.

Immunogenicity and Protection by DnaK and SpaA Recombinant Proteins Against Erysipelothrix Rhusiopathiae in a Murine Model.

BACKGROUND/AIMS: Swine erysipelas is a disease caused by Erysipelothrix rhusiopathiae, a Gram-positive bacillus, which has great economic importance because it leads to the loss of the swine herd. To control this disease, animals are immunized with a cellular vaccine of killed or attenuated E. rhusiopathiae, but even with herd vaccination, cases of swine erysipelas outbreaks have been reported in the United States, China and Japan, leading to the search for other antigenic components of the bacteria that may promote greater protection against E. rhusiopathiae. The surface protein SpaA from E. rhusiopathiae has been shown to be a candidate to constitute a subunit vaccine, since it has already been reported to induce a host immune response against the bacterium. DnaK, a hsp70 molecular chaperone, also seems to be a good candidate in the composition of a vaccine, as it has been demonstrated to be an antigenic protein of the bacteria. METHODS: This work evaluated the immunogenicity and protection induced by the E. rhusiopathiaee SpaA and DnaK recombinant proteins in a murine model, by intramuscular administration to mice with two doses of 100 µg at 21-day interval between them. The candidate proteins were tested either separately and together, compared with the commercial vaccine and the non-vaccination condition, and mice were challenged with a virulent strain of E. rhusiopathiae. Serum was collected to assess the produced antibodies and peripheral blood cells, whereas spleen and kidney tissues were assayed for E. rhusiopathiae presence by colony counting. RESULTS: A survival curve of the animals was performed, which confirmed the protection induced by the proteins. IgG antibodies increased in the animal serum inoculated with the proteins when compared to the control, and a significant delay in disease symptoms was observed. CONCLUSION: These results suggest that E. rhusiopathiae DnaK and SpaA are immunogenic in mice and interfere with the disease development.

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.

Disseminated Erysipelothrix rhusiopathiae with Secondary Prosthetic Hip Joint Infection: A Case of Successful Identification and Management in a Regional Hospital.

CASE: This article reports a case of a 72-year-old man with bilateral total hip joint replacements who suffered cuts to his hands while butchering a wild boar. He presented to the emergency department with fevers and unilateral hip pain. Erysipelothrix rhusiopathiae (E. rhusiopathiae) was isolated on hip aspirate and blood cultures. E. rhusiopathiae is a well-recognized zoonotic infection in humans, particularly in at-risk hosts, most commonly infecting swine. Infection is spread by ingestion or through skin abrasion. CONCLUSION: This illustrates an example of successful operative and perioperative management of prosthetic joint infection secondary to E. rhusiopathiae, particularly microbiological identification, within a multispecialty team of physicians and surgeons.

Erysipelothrix rhusiopathiae Infection Associated with Swollen Head Syndrome in a Broiler Breeder Flock in North Georgia.

An unusual case of swollen head syndrome in a 55-wk-old broiler breeder flock was identified in north Georgia in the summer of 2019. The presenting complaint was elevated mortality and visibly swollen heads. Necropsy of affected birds on the farm primarily revealed signs of bacterial septicemia, with few large scab lesions near the vent area. Bacterial culture analysis identified multiple organisms, but the primary organism of interest was identified as Erysipelothrix rhusiopathiae, cultured from affected liver, lung, sinuses, and one swollen wattle of birds in the affected house. Histopathologic analysis identified gram-positive rod-shaped bacteria in the spleen and liver (consistent with bacterial septicemia) confirmed with special staining (Brown & Hopps Gram stain). These organisms were noted to be consistent with E. rhusiopathiae; E. rhusiopathiae infection in broiler breeder chickens is a rare occurrence and is primarily associated with turkeys and/or swine production systems.

Reporte de caso- Infección por Erysipelothrix rhusiopathiae asociada con el síndrome de cabeza hinchada en un pollo de engorde. En el verano del 2019, se identificó un caso inusual de síndrome de cabeza hinchada en una parvada de reproductoras de pollos de engorde de 55 semanas de edad en el norte de Georgia. Las observaciones iniciales incluyeron mortalidad elevada y cabezas visiblemente inflamadas. La necropsia de las aves afectadas en la granja reveló principalmente signos de septicemia bacteriana, con pocas lesiones costrosas grandes cerca del área de extractores de la ventilación. El análisis de cultivos bacterianos identificó múltiples organismos, pero el principal organismo de interés fue identificado como Erysipelothrix rhusiopathiae, cultivado a partir de hígado, pulmón, senos paranasales y de una barbilla inflamada de aves en la caseta afectada. El análisis histopatológico identificó bacterias grampositivas en forma de bastón en el bazo y el hígado (compatibles con septicemia bacteriana) confirmadas con tinción especial (tinción de Gram de Brown y Hopps). Se observó que estos organismos eran compatibles con E. rhusiopathiae; La infección por E. rhusiopathiae en pollos de engorde se presenta de forma esporádica y se asocia principalmente con sistemas de producción de pavos y/o cerdos.

Harbor Porpoise Deaths Associated with Erysipelothrix rhusiopathiae, the Netherlands, 2021.

In August 2021, a large-scale mortality event affected harbor porpoises (Phocoena phocoena) in the Netherlands. Pathology and ancillary testing of 22 animals indicated that the most likely cause of death was Erysipelothrix rhusiopathiae infection. This zoonotic agent poses a health hazard for cetaceans and possibly for persons handling cetacean carcasses.

Endocarditis infecciosa con compromiso bivalvular por Erysipelothrix rhusiopathiae / 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.

[Infective endocarditis with bivalvular involvement due to Erysipelothrix rhusiopathiae. Report of one case]. / Endocarditis infecciosa con compromiso bivalvular por Erysipelothrix rhusiopathiae.

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.

Erysipelothrix rhusiopathiae-specific T-cell responses after experimental infection of chickens selectively bred for high and low serum levels of mannose-binding lectin.

Erysipelas, caused by infection with Erysipelothrix rhusiopathiae (ER) is an important emerging disease in laying hens. We have earlier observed prominent mannose-binding lectin (MBL) acute phase responses in experimentally ER infected chickens. The present study aimed to further examine immune responses to ER by using chickens selectively bred for high (L10H) and low (L10L) serum MBL levels. Chickens were infected with ER at 3 weeks of age and immune parameters and bacterial load were monitored in blood until day 18 after infection. Blood and spleen leukocytes collected on day 18 were stimulated in vitro with ER antigens and blast transformation of different T-cell populations was assessed. The ER infection gave a very varied outcome and no clear differences were observed between L10H and L10L chickens with respect to leukocyte counts, bacterial load or clinical outcome. Nonetheless, rapid innate responses, e.g., heterophilia and increased serum MBL levels were noted in bacteraemic chickens. All ER infected chickens also showed transient increased expression of mannose receptor MRC1L-B and decreased expression of major histocompatibility complex II on monocytes day 1 after infection indicating monocyte activation or relocation. In vitro ER stimulation showed antigen specific blast transformation of CD4+, TCRγ/δ-CD8αß+ and TCRγ/δ+CD8αß+ spleen cells from all infected chickens. For CD4+ and TCRγ/δ-CD8αß+ cells the proportions of blast transformed cells were significantly higher for samples from L10L chickens than those for samples from L10H chickens. This is the first observation of ER-specific T-cells in chickens and interestingly a Th1-type response comprising cytotoxic T-cells was indicated.

Rational Design of Live-Attenuated Vaccines against Genome-Reduced Pathogens.

To develop safe and highly effective live vaccines, rational vaccine design is necessary. Here, we sought a simple approach to rationally develop a safe attenuated vaccine against the genome-reduced pathogen Erysipelothrix rhusiopathiae. We examined the mRNA expression of all conserved amino acid biosynthetic genes remaining in the genome after the reductive evolution of E. rhusiopathiae. Reverse transcription-quantitative PCR (qRT-PCR) analysis revealed that half of the 14 genes examined were upregulated during the infection of murine J774A.1 macrophages. Gene deletion was possible only for three proline biosynthesis genes, proB, proA, and proC, the last of which was upregulated 29-fold during infection. Five mutants bearing an in-frame deletion of one (ΔproB, ΔproA, or ΔproC mutant), two (ΔproBA mutant), or three (ΔproBAC mutant) genes exhibited attenuated growth during J774A.1 infection, and the attenuation and vaccine efficacy of these mutants were confirmed in mice and pigs. Thus, for the rational design of live vaccines against genome-reduced bacteria, the selective targeting of genes that escaped chromosomal deletions during evolution may be a simple approach for identifying genes which are specifically upregulated during infection. IMPORTANCE Identification of bacterial genes that are specifically upregulated during infection can lead to the rational construction of live vaccines. For this purpose, genome-based approaches, including DNA microarray analysis and IVET (in vivo expression technology), have been used so far; however, these methods can become laborious and time-consuming. In this study, we used a simple in silico approach and showed that in genome-reduced bacteria, the genes which evolutionarily remained conserved for metabolic adaptations during infection may be the best targets for the deletion and construction of live vaccines.

Human Erysipelothrix rhusiopathiae infection via bath water - case report and genome announcement.

Erysipelothrix rhusiopathiae is a facultative anaerobic, environmentally stable, Gram-positive rod that causes swine and avian erysipelas as a zoonotic pathogen. In humans, the main manifestations described are circumscribed erysipeloid, generalized erysipeloid, and endocarditis. Here, we report a 46-year-old female patient who presented to the physician because of redness and marked functio laesa of the hand, in terms of a pain-related restricted range of motion, and was treated surgically. E. rhusopathiae was detected in tissue biopsy. The source of infection was considered to be a pond in which both swine and, later, her dog bathed. The genome of the isolate was completely sequenced and especially the presumptive virulence associated factors as well as the presumptive antimicrobial resistance genes, in particular a predicted homologue to the multiple sugar metabolism regulator (MsmR), several predicted two-component signal transduction systems, three predicted hemolysins, two predicted neuraminidases, three predicted hyaluronate lyases, the surface protective antigen SpaA, a subset of predicted enzymes that potentially confer resistance to reactive oxygen species (ROS), several predicted phospholipases that could play a role in the escape from phagolysosomes into host cell cytoplasm as well as a predicted vancomycin resistance locus (vex23-vncRS) and three predicted MATE efflux transporters were investigated in more detail.

[Sacroiliitis with Erysipelothrix Rhusiopathiae revealing tricuspid endocarditis, the first case reported on the Guiana Shield: clinical case and review of the literature]. / Sacro-Iliite à Erysipelothrix Rhusiopathiae révélant une endocardite tricuspide, premier cas rapporté sur le bouclier des Guyanes : cas clinique et revue de la littérature.

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.

A recurrent prosthetic joint infection caused by Erysipelothrix rhusiopathiae: case report and literature review.

Prosthetic knee joint infection caused by Erysipelothrix rhusiopathiae is uncommon and only one case of recurrent infection has previously been described. Here, we describe the case of a 77-year-old male patient who was admitted to the teaching hospital of Rennes (France) with bilateral and nocturnal gonalgia evolving for 1 month. He had bilateral knee prosthesis 10 years ago, and a history of large B-cell lymphoma in remission. A diagnosis of infective endocarditis, with prosthetic knee infection, was made, with positive cultures of synovial fluids and blood; colonies of E. rhusiopathiae were identified by MALDI-TOF MS. Initial treatment involved debridement, implant retention surgery and intravenous amoxicillin (12 g day-1) for 6 weeks with gentamicin 3 mg kg-1 day-1 added for the first 4 days. One year later, a second episode of E. rhusiopathiae infection occurred, suggesting a recurrence or reinfection due to the same bacterial species. The patient was finally cured after a two-stage exchange with a cemented articulated spacer and a 3 month course of amoxicillin (12 g day-1, iv). Different characteristics of E. rhusiopathiae infection were discussed, with a review of all cases of prosthetic joint infections caused by Erysipelothrix species. This case highlights the need for a long-term survey of patients, and a good knowledge of their environment to avoid any risk of reinfection.