Erysipelothrix rhusiopathiae Endocarditis in a Patient With Severe Unicuspid Aortic Valve Damage Complicated With Acquired Ventricular Septal Defect.

Erysipelothrix rhusiopathiae, is an important animal pathogen, but rarely reported in humans. To date, only fa ew cases of infective E rhusiopathiae endocarditis of the aortic valve have been described. We introduce the first reported case of severe damage of the native unicuspid aortic valve complicated with acquired ventricular septal defect caused by E rhusiopathiae endocarditis. This case may provide a better understanding of the disease process and transmission and underscores the need to include this pathogen in the differential diagnosis of infective endocarditis.

Polyarthritis caused by Erysipelothrix rhusiopathiae in three Austrian sheep flocks - diagnosis, treatment and management measures.

INTRODUCTION: Polyarthritis caused by Erysipelothrix rhusiopathiae is a well-known disease in pigs, and ovine erysipelas infection also commonly affects two-to-six month-old lambs. This report describes case histories of three sheep flocks where lambs exhibited swollen joints and lameness. Special emphasis was given to clinical and diagnostic imaging findings, synovia sampling and the treatment regime. Lambs with only mild lameness, liquid serofibrinous joint effusion and lambs showing no bone involvement, as revealed by ultrasonography or radiography, were treated with systemically administered antibiotics selected from results of antimicrobial susceptibility testing of E. rhusiopathiae isolated from synovial samples, and non-steroidal anti-inflammatory drugs. Lambs with severe lameness and severely swollen joints were euthanized, and routine necropsy was undertaken with a focus on the joints. Further, a herd-specific autogenous vaccine was produced by a specialized laboratory. In conclusion, E. rhusiopathiae infection should be considered as a differential diagnosis in herds associated with lameness and polyarthritis in lambs aged between two up to 17 months.

INTRODUCTION: La polyarthrite causée par Erysipelothrix rhusiopathiae est une maladie bien connue chez le porc. Chez les ovins, l'infection touche le plus souvent les agneaux âgés de deux à six mois. Ce rapport de cas décrit trois troupeaux de moutons où des agneaux présentaient des articulations enflées et une boiterie. Un accent particulier a été mis sur la clinique, les résultats de l'imagerie diagnostique, les prélèvements de synovie et le mode de traitement. Les agneaux présentant uniquement une légère boiterie, des épanchements articulaires séro-fibrineux et ceux ne présentant pas d'atteinte osseuse, révélée par échographie ou radiographie, ont été traités avec des antibiotiques administrés par voie systémique, sélectionnés à partir des résultats de la sensibilité d'E. Rhusiopathiae isolé sur les échantillons synoviaux, ainsi qu'avec des anti-inflammatoires non stéroïdiens. Les agneaux présentant une boiterie sévère et des articulations gravement enflées ont été euthanasiés et une autopsie de routine a été réalisée avec un accent particulier mis sur les articulations. De plus, un vaccin autogène spécifique au troupeau a été produit par un laboratoire. En conclusion, l'infection à E. rhusiopathiae doit être considérée comme un diagnostic différentiel dans les troupeaux où l'on constate des boiteries et des polyarthrites chez les agneaux âgés de 2 à 17 mois.

Approach to Aquatic Skin Infections.

Aquatic-based infections can present a treatment challenge for primary care physicians because of the likely polymicrobial nature of the infection and the possibility of uncommon pathogenic organisms. Although Staphylococcus and Streptococcus species that colonize the skin are the most common etiologic agents associated with saltwater and freshwater skin and soft tissue infections, other significant pathogens can include Vibrio, Aeromonas, Edwardsiella, Erysipelothrix, and Mycobacterium. Early detection and appropriate management of aquatic infections can significantly decrease morbidity and mortality. This article reviews the pathophysiology, presentation, and management for the most common water-borne pathogens causing skin and soft tissue infections.

Something fishy: an unusual Erysipelothrix rhusiopathiae infection in an immunocompromised individual.

A 39-year-old man with a history of Crohn's disease presented to the emergency department with a 12-h history of worsening febrile illness. He deteriorated rapidly with progression to sepsis and was admitted to the intensive care unit. Initial treatment comprised broad spectrum antibiotics and inotropic support resulting in rapid improvement. With the immunocompromised state of the patient, and multiple blood cultures revealing Erysipelothrix rhusiopathiae, a detailed history disclosed a recent injury sustained from a fishing wire as the probable source of an infection. Treatment was narrowed to target the identified pathogen, the patient made a full recovery, and was counselled to be more cautious in future fishing activities.

Aquatic sports dermatoses: Part 3. On the water.

The third of this three-part series on water-related sports dermatoses discusses skin changes seen in athletes who participate in sporting activities on top of or nearby water. While also susceptible to several of the freshwater and saltwater dermatoses discussed in parts one and two of the series, these athletes may present with skin changes unique to their particular sports. This updated and comprehensive review details those near-water dermatologic conditions commonly seen in sailors, rowers, fishermen, surfers, windsurfers, rafters, and water skiers, and will serve as a guide for dermatologists, sports medicine physicians and other medical practitioners in recognition and treatment of these conditions.

Investigations on the pathogenicity of Erysipelothrix rhusiopathiae in laying hens.

Erysipelas was diagnosed in 1998 from 34-wk-old laying hens in a free range flock in Germany. Erysipelothrix rhusiopathiae of serotype 1 was cultured from internal organs of the affected birds. This article describes the pathogenicity of the field isolate of E. rhusiopathiae in experimentally infected specific pathogen-free (SPF) laying hens. Three experiments were performed with SPF chickens inoculated at 17, 27, and 37 wk of age by either intramuscular (IM) or oral route. Inoculated birds were observed for 14 days. The highest mortality rates occurred in older birds, with 100% mortality observed in the 37-wk-old birds inoculated IM, 60% mortality reported in the younger 27-wk-old birds, and no mortality in the 17-wk-old age group. In the orally infected 27-wk-old birds, 40% mortality was detected, whereas no mortality was observed in the oldest birds by the same route. The results of the experiments support the contention that older birds are more sensitive to infection than younger birds and that mortality in laying hens is age related and dependent on the route of infection.

Septic arthritis caused by Erysipelothrix rhusiopathiae infection after arthroscopically assisted anterior cruciate ligament reconstruction.

A case of septic arthritis caused by Erysipelothrix rhusiopathiae, after an arthroscopically assisted anterior cruciate ligament (ACL) substitution in a non-immunosuppressed patient is described. An 18-year-old man underwent an ACL reconstruction with a quadruple hamstring graft. Eight days postoperatively, the patient developed fever, knee pain, and effusion without erythema or suppuration. He was readmitted to the hospital with the diagnosis of septic arthritis. The patient's erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count were high. The joint was aspirated and the fluid was sent for cultures that revealed the presence of E rhusiopathiae. E rhusiopathiae is widespread in nature, it is transmitted by direct cutaneous laceration, and it causes septic arthritis, meningitis, endocarditis, and renal failure in immunosuppressed people with poor prognosis. In our case, the infection was treated with arthroscopic lavage and debridement, retention of the graft and hardware, and intravenous antibiotic administration for 6 weeks, followed by oral administration for 16 weeks.

Fatal outcome of Erysipelothrix rhusiopathiae bacteremia in a patient with oropharyngeal cancer.

Bacteremia due to Erysipelothrix rhusiopathiae is rare; the most common presentation reported in the literature is endocarditis. We report a 32-year-old man with oropharyngeal cancer who developed aspiration pneumonia and E. rhusiopathiae bacteremia, and presented with fever, chills, dyspnea, and productive cough with purulent sputum. Despite treatment with amoxicillin/clavulanate and nutritional support for 9 days, he died of respiratory failure. He had no clinical evidence of endocarditis. He had no history of animal or occupational exposure, and might have been colonized with E. rhusiopathiae in the oral cavity, followed by aspiration pneumonia and bacteremia. A fatal outcome in a patient with bacteremia due to E. rhusiopathiae without endocarditis is rare.

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.

[Erysipelothrix rhusiopathiae bacteremia in a child with acute leukemia]. / Bacteriemie cu Erysipelothrix rhusiopathiae la un copil cu leucemie acuta.

The systemic infections caused by E. rhusiopathiae and reported in literature are very rare, majority evolving with endocarditis. The authors present a child with acute leukemia, to whom the blood culture during a high temperature episode allows to isolate this bacterium, without valvular lesions. The case is interesting because of the arisen bacteriological diagnosis problems and because of the pathogenic aspects of the infection. An animal source contact being absent, we took in account the intestinal carriage which, under the profound depression of the defence (the underlaying disease and the cytostatic therapy) could result in a persistent bacteremia. The treatment with cefazolin allows the infection to be cured.

Localization of viable bacteria and bacterial antigens in arthritic joints of Erysipelothrix rhusiopathiae-infected pigs.

Chronic polyarthritis was induced in pigs by infection with Erysipelothrix rhusiopathiae (serovar 2, strain T28). Viable bacteria could be reisolated as long as 5 months post-infection from synovial fluid, synovial tissue and from isolated chondrocytes. The number of viable bacteria could be increased by hypotonic shock of the chondrocytes indicating a substantial intracellular amount of bacteria. Bacterial antigens were shown by immunohistochemistry to be present on the surface of both chondrocytes and synovial cells in arthritic joints. Neither viable bacteria nor bacterial antigen were detected in unaffected joints.

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.

Erysipelothrix rhusiopathiae-induced septic arthritis in a calf.

A 14-week-old Holstein heifer with a 48-hour history of left tarsocrural joint effusion was referred for evaluation when lameness developed 24 hours after needle aspiration was attempted at the farm. Results of synovial fluid analysis were compatible with diagnosis of septic arthritis, and bacteriologic culture of the fluid yielded Erysipelothrix rhusiopathiae. The calf responded to tarsocrural joint lavage and penicillin G administration.

[Erysipelas as a disease factor]. / Rotlauf als Faktorenkrankheit.

The infection with Erysipelas rhusiopathiae demonstrates that it is possible to characterize the significance of predisposing factors. The virulence of the agent is most important among the exogenous factors; it determines decisively the course of the disease: 1. paracute course as septicemia; 2. chronic course as polyarthritis; 3. subclinical course nearly without any symptoms. The immune status and the genotype of the host are predominant out of endogenous factors. The importance of immunity is known since a long time. A series of field observations supported the potential genetical influence in the pig. Within the hereditability an association to the MHC (in special genetic lines of rats to the RT 1 system of the MHC) was most recently determined in inbred laboratory animals. Additionally several environmental conditions, which can be summarized as stress, and as endogenous factor the age of the animals are relevant for the pathogenesis of the erysipelas infection. A non variable but most important disposition for special tissues are the so-called "borderline tissues", where accumulation, sedimentation and persistence of bacterial antigens are wellknown as described earlier. This phenomenon is determined by hemodynamic manifestation and quantifiably regulated by cytokines especially interleukin (IL 1) as well as by the tumor necrosis factor (TNF alpha) and prostaglandin PgE2. Additionally the cross reactivity of antibodies of Erysipelas rhusiopathiae against most specific collagen of type II, IX and XI in the pig and in laboratory animals was elaborated. This autoimmune phenomenon called "immunologic mimicry" supports besides the special physiologic conditions as niche of defense a very successful evolutionary adaptation of the agent.

Erysipelothrix rhusiopathiae: an occupational pathogen.

Erysipelothrix rhusiopathiae is a nonsporulating, gram-positive, rod-shaped bacterium which was identified more than 100 years ago as the etiologic agent of swine erysipelas. Since then, it has been found to cause infection in several dozen species of mammals and other animals. Humans become infected through exposure to infected or contaminated animals or animal products. By far the most common type of human infection is a localized, self-limited cutaneous lesion, erysipeloid. Diffuse cutaneous and systemic infections occur rarely. Approximately 50 cases of endocarditis have been reported; all but one recent case have involved native valves. The organism may be isolated from biopsy or blood specimens on standard culture media. It is identified by morphology, lack of motility, and biochemical characteristics; identification may be confirmed by the mouse protection test. It is susceptible to penicillins, cephalosporins, erythromycin, and clindamycin, but it is often resistant to many other antibiotics, including vancomycin, a drug frequently used in empiric therapy for infections due to gram-positive bacteria.