Infectious tenosynovitis with bloodstream infection caused by Erysipelothrix rhusiopathiae, a case report on an occupational pathogen.

BACKGROUND: Erysipelothrix rhusiopathiae is an established animal pathogen, which may cause infections in humans. It is a gram-positive rod and found in the tonsils or the digestive tracts of animals. The bacterium is occupationally related, as usually only people with frequent animal contacts are infected. We report a case of a patient who was admitted with an infectious tenosynovitis with bloodstream infection due to E. rhusiopathiae, and to our knowledge, this is the first report of a tenosynovitis with systemic manifestation associated with this bacterium. CASE PRESENTATION: A 52-year old Norwegian man, who worked with transportation of swine cadavers, was admitted to the local hospital with sepsis and unknown focus of infection. A few days earlier he had an injury to the skin of one of his fingers that later proved to be infected with E. rhusiopathiae. There were no other causes for his symptoms than the infectious tenosynovitis with systemic manifestation. The infection resolved on treatment with antibiotics and surgery. A transoesophageal echocardiogram was performed to exclude endocarditis, which may be associated with this pathogen. CONCLUSIONS: This case report highlights the importance of clinicians being aware of this bacterium, and we describe risk factors for infection, differences in the clinical manifestations of the disease, challenges with diagnosing the bacterium and adverse effects of immunosuppressive drugs. Recommended treatment is appropriate antibiotic therapy and adequate debridement and surgical drainage of the tendon sheath.

Evaluation of anti-Erysipelothrix rhusiopathiae IgG response in bottlenose dolphins Tursiops truncatus to a commercial pig vaccine.

Erysipelothrix rhusiopathiae is the causative agent of erysipeloid in humans and of erysipelas in various animals, including bottlenose dolphins Tursiops truncatus, in which an infection has the potential to cause peracute septicemia and death. The purpose of this study was to evaluate the efficacy of using an off-label porcine (ER BAC PLUS®, Zoetis) E. rhusiopathiae bactrin in a bottlenose dolphin vaccination program by determining the anti-E. rhusiopathiae antibody levels in vaccinated dolphins over a 10 yr period. Serum samples (n = 88) were analyzed using a modified fluorescent microbead immunoassay from 54 dolphins, including 3 individuals with no history of vaccination and 51 dolphins with an average of 5 vaccinations, 3 of which had previously recovered from a natural E. rhusiopathiae infection. A mean 311-fold increase in the immunoglobulin G (IgG) antibody index was measured in a subsample of 10 dolphins 14 d after the first booster vaccination. Serum IgG antibody titers were influenced by number of vaccines received (r2 = 0.47, p < 0.05) but not by age, gender, history of natural infection, adverse vaccine reaction, vaccination interval or time since last vaccination. The commercial pig bacterin was deemed effective in generating humoral immunity against E. rhusiopathiae in dolphins. However, since the probability of an adverse reaction toward the vaccine was moderately correlated (p = 0.07, r2 = 0.1) with number of vaccines administered, more research is needed to determine the optimal vaccination interval.

Serological surveillance for antibodies against Erysipelothrix species in wild boar and deer in Japan.

We investigated the seroprevalence of antibodies against Erysipelothrix in wild animals in Japan. Serum samples were collected from 48 wild boar, 26 Yezo deer and 26 Japanese deer in Japan. Growth agglutination (GA) test was performed to estimate antibody titers. As a result, positive results were obtained from 32 (66.7%), 1 (3.6%) and 6 (23.1%) samples from wild boar, Yezo deer and Japanese deer, respectively. Our findings suggest that wild animals may be an important reservoir of Erysipelothrix.

Fluorescent microbead-based immunoassay for anti-Erysipelothrix rhusiopathiae antibody detection in cetaceans.

A fluorescent microbead-based immunoassay (FMIA) for detection of anti-Erysipelothrix rhusiopathiae antibodies in pigs was adapted for use in cetaceans. The FMIA was validated and adjusted using serum samples from 10 vaccinated captive bottlenose dolphins Tursiops truncatus collected between 1 and 13 mo after immunization. The technique was then used to analyze specimens from 15 free-ranging cetaceans stranded alive on the Valencian Mediterranean coast between 2006 and 2014: 11 striped dolphins Stenella coeruleoalba, 3 Risso's dolphins Grampus griseus and 1 bottlenose dolphin Tursiops truncatus. One of these wild animals was confirmed to have died from E. rhusiopathiae septicemia, but no anti-E. rhusiopathiae antibodies were detected in its serum, pericardial fluid or milk samples. Another free-ranging individual, which lacked any signs or lesions that might be indicative of E. rhusiopathiae infection, showed high fluorescence intensity similar to that measured in captive dolphins at 6-13 mo after vaccination. These results suggest that this animal underwent an E. rhusiopathiae infection several months before stranding. The findings in the present study suggest that FMIA can be useful for detecting anti-E. rhusiopathiae antibodies in cetaceans, and its application to free-ranging animals is particularly interesting because of the great value of these specimens. Furthermore, the FMIA can be multiplexed to allow the determination of up to 100 analytes per sample in a single well, thereby reducing the cost, time and sample volume needed.

Exposure of extensively farmed wild boars (Sus scrofa scrofa) to selected pig pathogens in Greece.

BACKGROUND: Increased density and distribution of wild boar populations are likely to promote interactions and transmission of certain pathogens, not only among wild boar but also from wild boar to livestock or humans and vice versa. OBJECTIVE: The purpose of this study was to determine seroprevalence against seven selected pathogens in wild boar living in four different areas in Greece. ANIMALS AND METHODS: In total, 359 serum samples were collected from extensively farmed wild boar (Sus scrofa scrofa) originating from four distinct geographical areas throughout Greece from April 2012 to August 2013. Samples were tested for antibodies to Actinobacillus pleuropneumoniae, African swine fever virus (ASFV), Aujeszky's disease virus (ADV), classical swine fever virus (CSFV), Erysipelothrix rhusiopathiae, Mycoplasma hyopneumoniae and porcine reproductive and respiratory syndrome virus (PRRSV). Prevalence was compared among the four regions using Fisher's exact test. RESULTS: Low overall seropositivities of 2.4% and 5.6% were detected for E. rhusiopathiae and PRRSV, respectively, higher ones for ADV (32.0%) and the highest (72.5% and 90.5%) for M. hyopneumoniae and A. pleuropneumoniae, respectively. All sera tested were found negative for antibodies directed against CSFV and ASFV. CONCLUSIONS: This is the first report of exposure of wild boars to selected pig pathogens in Greece. These results are indicative of the circulation of these pathogens in Greece with the exception of CSFV and ASFV and suggestive of the potential role of wild boars on their maintenance and transmission to their domestic counterparts and vice versa.

Development of an enzyme-linked immunosorbent assay for the serological detection of exposure of poultry in New Zealand to Erysipelothrix rhusiopathiae and their serological response to vaccination.

AIMS: To modify and validate an existing swine erysipelas ELISA for use with poultry serum and to assess the safety of a swine erysipelas vaccine for use in New Zealand layer birds. METHODS: An existing swine erysipelas ELISA was modified for use in domestic poultry and was validated using sera from birds injected with either 2 mL of a commercially available killed swine erysipelas vaccine (low-dose; n=12 birds), 4 mL of vaccine (high-dose; n=11 birds), or 2 mL saline (control; n=11 birds) on Day 0 and again on Day 21. Blood samples were collected on Days 0, 21, 42, and 63, and safety of the vaccine for use in layer birds was determined by assessing cloacal temperature and injection site reactions in birds at 0, 4, 24, 48, 72 and 96 h post-vaccination. RESULTS: The ELISA that was developed had a diagnostic sensitivity and specificity of 93% and 98%, respectively, after being optimised for a positive cut-off at an optical density (OD) ≥ 1.50 read at 450-nm wavelength. OD readings were higher on Days 21, 42, and 63 than Day 0 in both the low-dose and high-dose groups (p<0.05), and differed amongst the three groups on Days 21, 42, and 63 (p<0.05), suggesting that vaccination using either dose induced detectable levels of antibody, even after a single dose. In addition, the high-dose protocol induced higher levels of antibody production than the low-dose protocol. No local or systemic reactions to the vaccine were observed and cloacal temperatures remained in the normal biological range after vaccination. CONCLUSIONS: The ELISA that was developed had satisfactory diagnostic performance characteristics and the vaccine appeared to be safe for use in layer birds. However, the study design did not permit an assessment of the vaccine's efficacy to protect birds from clinical erysipelas. CLINICAL RELEVANCE: A diagnostic ELISA has been developed for determining the exposure of layer birds to E. rhusiopathiae. The test will be useful for monitoring flock-level erysipelas, response to vaccination, and in epidemiological studies designed to identify risk factors for exposure to the disease.

Serological survey of exposure to Erysipelothrix rhusiopathiae in poultry in New Zealand.

AIMS: To estimate the seroprevalence of antibodies to Erysipelothrix rhusiopathiae in chickens in New Zealand, and to estimate the effect of housing type, geographical location and age on seroprevalence. METHODS: A cross-sectional serological survey of a convenience sample of 545 broiler, breeder, and layer chickens in 55 flocks was conducted in 2010-2011. Birds were aged 5-83 weeks; housing types were free-range, shed, caged, and unknown; and flocks were located in the Auckland, Manawatu, North Canterbury, Otago, Taranaki, Waikato, and Wairarapa regions of New Zealand. An ELISA was used to measure antibodies to E. rhusiopathiae. Samples with an optical density reading ≥ 1.50 were considered to be positive. Logistic regression analysis was used to model the effect of housing type, geographical location and flock age on the prevalence of samples positive for antibodies to E. rhusiopathiae. RESULTS: The overall prevalence of samples with antibodies to E. rhusiopathiae was 39.8 (95% CI=35.68-44.06)% for the 545 samples, and 46/55 (84%) farms that were tested had at least one positive sample. Mean seroprevalence for types of housing was 44.2 (95% CI=37.79-50.70)% for free-range (n=240 birds), 23.7 (95% CI=17.83-30.38)% for shed (n=190), 73 (95% CI=56-86)% for caged (n=37) and 50 (95% CI=38-62)% for unknown (n=78). The disease was present in all seven geographical locations from which samples were obtained for this study. Seroprevalence increased with increasing age of birds (p<0.001); for birds ≤ 12 weeks of age it was 2 (95% CI=0.3-8)% (n=91), 13-24 weeks 29.1 (95% CI=23.34-35.46)% (n=230), 25-36 weeks 47 (95% CI=32-64)% (n=40), 37-48 weeks 75 (95% CI=51-91)% (n=20), >48 weeks 63.8 (95% CI=54.78-72.12)% (n=127). Neither housing type nor geographical location had a significant effect on the likelihood of samples being positive for antibodies to E. rhusiopathiae. CONCLUSIONS: The results of this study suggest the prevalence of erysipelas under New Zealand field conditions may be higher than expected and that the disease is significantly associated with increasing age. Housing type and geographical location appear to be unrelated to seroprevalence. CLINICAL RELEVANCE: Further study of the epidemiology of E. rhusiopathiae in chickens in New Zealand should be considered in order to minimise the extent of birds' exposure to the organism. These findings will assist in the design of further studies.

Comparison of three DNA extraction methods for detection of Erysipelothrix rhusiopathiae in chicken blood by polymerase chain reaction.

A previously reported Erysipelothrix-specific polymerase chain reaction (PCR) was used to detect Erysipelothrix bacteremia in chickens. The sensitivity of PCR using 3 DNA extraction methods (boiling method, commercial gene matrix, and DNA extractor kit) was compared by using a serial 10-fold dilution of a chicken isolate of Erysipelothrix rhusiopathiae strain in chicken blood. Of the techniques used, the DNA extractor kit, followed by PCR, provided the most sensitive method for the detection of the E. rhusiopathiae strain in chicken blood (approximately 10(0) CFU/0.1 ml of blood). Two E. rhusiopathiae infection experiments were then attempted. In a total of 10 inoculated chickens, bacteremia developed in 9 chickens, consisting of all 5 chickens used in the first trial (ranging from 5.1 x 10(1) to 2.0 x 10(3) CFU/0.1 ml of blood) and 4 of the 5 chickens used in the second trial (ranging from 1.0 x 10(0) to 3.3 x 10(2) CFU/0.1 ml of blood). In the second trial, the 3 detection techniques were applied to the chickens with bacteremia, and the organism could be detected by using the DNA extractor kit in blood specimens from the 3 chickens exhibiting bacteremia of > or =4.2 x 10(1) CFU/0.1 ml of blood. This observation suggests that most E. rhusiopathiae-infected chickens develop more critical bacteremia than the detectable level by PCR with the DNA extractor kit, and the PCR detection method can be used as a first-line screening of avian erysipelas.

Effect of blood sample handling post-collection on Erysipelothrix rhusiopathiae antibody titres.

A study was conducted to determine the effect of blood sample mishandling on the performance of an enzyme-linked immunosorbent assay for the detection of antibodies against Erysipelothrix rhusiopathiae. Eleven sample maltreatments (storage at -10 degrees C, storage at 4 degrees C, heat treatment of clotted blood, haemolysis, repetitive freeze-thaw cycling, and substitution of plasma in place of serum) were simulated in a laboratory environment and then run concurrently against a gold standard sample (storage at -80 degrees C). The mishandling treatment groups that simulated high levels of haemolysis had significantly lower optical density (OD) readings when compared to the gold standard. However, the magnitude of the effects was relatively small and only samples with OD values close to the cut-off changed state from positive to negative. Heat treatment had a minor, but non-significant, effect on OD values. Findings from this study suggested that immunoglobulin G antibody was stable in the face of most common sample mishandling events.

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.

Distribution of antibody against Erysipelothrix rhusiopathiae in cattle.

Serum samples collected from 854 cattle in nine prefectures of Japan, from Hokkaido to Okinawa, between 1988 and 1992 were examined for presence of antibodies against Erysipelothrix rhusiopathiae by growth agglutination test. Most of the sera showed positive reactions, and the antibody titers ranged from below 4 to above 128. Seventy-six percent of the sera showed titers of 32 or above, and 34% showed titers of 128 or above. The titers had a tendency to be higher in the south and lower in the north and were clearly low in sera from areas with no swine industry. These results indicated that Japanese cattle had been infected with E. rhusiopathiae and that clinical cases of the disease were possible.

Disseminated intravascular coagulation in chickens inoculated with Erysipelothrix rhusiopathiae.

In a first experiment, 28 specific pathogen-free chickens aged 3 weeks showed clinical signs 1 to 5 days after intramuscular inoculation with Erysipelothrix rhusiopathiae. Twelve of 28 birds died 2 to 4 days after inoculation. Macroscopically, the liver, spleen and kidneys were seen to be enlarged and congested. Histologically, fibrinous thrombus formation, seen in the hepatic sinusoids, renal glomerular capillaries and small pulmonary blood vessels, was a characteristic feature. In addition, the liver showed marked congestion, increase of mononuclear cells and heterophils in the sinusoids, hyperplasia of sinusoidal lining cells, and vacuolar changes in hepatic cells. The spleen showed fibrinous exudation of the lymphoid follicles and ellipsoids with lymphocytic depletion, and hyperplasia of ellipsoidal reticular cells. There was oedema, congestion and cellular infiltration in the interstitium of the kidney. The bursa of Fabricius and thymus showed marked lymphocytic depletion. In a second experiment, the blood chemical values (uric acid, glutamic-oxalacetic transaminase, lactate dehydrogenase and gamma-glutamyl transpeptidase) of birds inoculated intramuscularly with E. rhusiopathiae were significantly higher than those of uninfected controls. The blood prothrombin times and activated partial thromboplastin times of the inoculated group were significantly greater than those of the control group. The pathological and haematological findings demonstrated that E. rhusiopathiae induced disseminated intravascular coagulation in the chickens.

Protective activity and antigenic analysis of fractions of culture filtrates of Erysipelothrix rhusiopathiae.

The protective activity in mice and antigenic composition of the culture filtrate of 11 strains of Erysipelothrix rhusiopathiae were compared. Protective activity was found in the first (P-1) fraction obtained by Sephadex G-200 gel filtration of the culture filtrate of each strain. Comparing the 50% protective dose (PD50) of the P-1 fraction of the 11 strains by active immunization, highly protective activity was shown by 5 strains, such as Agata, Fujisawa, Shizuoka-63, Koganei 65-0.15 and SE-9. For the 50% effective dose (ED50) determined by passive protective studies, the four strains, Agata, Fujisawa, Koganei 65-0.15 and SE-9 were shown to be highly protective. However, strains 2179 and 2553 showed low activities in both PD50 and ED50. The highly and weakly protective strains were compared by western blot analysis for the protein components. In most strains tested, there were two protein bands of molecular weight of 64 kDa and 43 kDa. Therefore, these two structural proteins were common to the strains and were associated with stimulation of a protective effect in mice.

[Morphological and biochemical changes in the blood of lambs with experimental Erysipelothrix polyarthritis]. / Morfologichni i biokhimichni promeni v kruvta na agneta s eksperimentalen chervenkov poliartrit.

Polyarthritis was induced in lambs via the i/v infection with 2 cm3 of 24-hour Erysipelothrix rhusiopathiae broth culture, which led to distinctive morphologic and biochemical changes in the peripheral blood. The hemoglobin content, the erythrocyte count, and the hematocrit value dropped, while ESR rose with the development of the infection process. The white blood picture presented transient and slight drop of the leukocyte count followed by leukocytosis with shifting to the left, aneosinophilia, lympho- and monopenia in the acute stage, and well manifested eosinophilia in the chronic stage of the infection. The changes in the total protein and the protein fractions consisted in hypoproteinemia in the first days following infection, hypoalbuminemia during the entire period, and hyperproteinemia and hypergammaglobulinemia in the chronic stage. The changes in the blood electrolites consisted in the rise of Ca and K, the drop of Na, and transient changes in the level of P, tending toward a rise in the chronic stage. It was also established that the values of sialic acid were raised in the entire period of polyarthritis development, while those of aspartate aminotransferase and alanine aminotransferase were higher in the first seven-day period only.

Diagnosis and successful treatment of subacute erysipelas in a captive dolphin.

Ersipelas, a common disease of swine, is caused by Erysipelothrix rhusiopathiae. The organism was isolated in a blood culture taken from an infected captive dolphin. The dolphin showed typical subacute symptoms of square- and diamond-shaped skin lesions as seen in swine. It was surmised, in retrospect, that the disease was secondary to a primary pneumonia. The symptoms, clinical pathology and other special examinations, treatment and response are discussed.

[Significance of coagulation disorders and inflammatory immune reaction in an infectious model of rheumatoid arthritis. I. Systemic, shock-like coagulopathy and fibrin incorporation as indicators of rheumatoid manifestations in the erysipelas model]. / Zur Bedeutung von Gerinnungsstörungen und entzündlicher Abwehr einer infektiös verursachten rheumatoiden Modellkrankheit. I. Systemische, schockartige Koagulopathie und Fibrininkorporation als Indikatoren der rheumatoiden Organmanifestation im Rotlaufmodell

A combined study employing plethysmographical, scintillation counting and coagulation methods indicates that a coagulation crisis in combination with fibrin overproduction may be an indicator of a beginning arthritis of rheumatoid character. Rats which received a single subcutaneous infection with erysipelas bacteria exhibit a shock resembling crisis two days post inoculation as substantiated by the consumption of coagulation factors II, V, VIII, XII and decrease of platelets. This consumption of coagulation factors is characterized by a rapid compensatory increase of platelets, antihaemophilic factor VIII and fibrin, 5 times more in the pig and 3 1/2 times more in the rat than in control animals. In adult rats the overproduction of fibrin is combined with an intense concealed consumption of fibrin in all organs of manifestation. Only in young rats an absolute consumption of fibrin is observed. The incorporation of fibrin into connective tissue is accompanied by fibrin consumption as demonstrated by immunofluorescence, by oedema of the paw, and by mesenchymal proliferation as substantiated by scintillation counting of incorporated 35SO4 and 3H-Proline, as markers for the beginning synthesis of ground substances and collagen. This model supports the importance of an initial vascular phase for the subsequent phase of manifestation in chronic rheumatoid diseases. It is discussed whether the organ specific permeability of the affected organs (joints, heart, arteries and eyes) may be a localizing factor of organ manifestation, parallel to the hormonal mesenchymal reaction.