Erysipelothrix infection
Erysipelothrix infection is caused by the bacterium *Erysipelothrix rhusiopathiae*, which is primarily found in animals, particularly swine, as well as in fish and decaying organic matter. This infection is mainly an occupational hazard for food workers who handle infected animals or animal products, with transmission occurring through abrasions or puncture wounds in the skin. Symptoms typically include a localized, painful skin lesion, often on the fingers, which can be swollen and may be accompanied by fever. While most cases are localized, serious systemic infections can occur, especially in immunocompromised individuals or chronic alcoholics, potentially leading to bacteremia or endocarditis.
Diagnosis of Erysipelothrix infection generally relies on clinical and epidemiological information, with definitive diagnosis achieved through culturing the organism from affected tissues or fluids. Treatment usually involves antibiotics, particularly penicillin, which can significantly shorten recovery time. Prevention strategies focus on protecting the skin from injuries, such as using gloves and practicing good hygiene. No vaccine is available for humans, although one exists for swine. Overall, awareness and precautionary measures are crucial for individuals in high-risk occupations.
Erysipelothrix infection
- ANATOMY OR SYSTEM AFFECTED: Skin
- ALSO KNOWN AS: Erysipeloid
Definition
The bacterium Erysipelothrix rhusiopathiae, found as a commensal organism in animals, birds, and fish, causes an occupational disease in food workers who come into contact with infected animals or animal products.
Causes
E. rhusiopathiae is a nonmotile, nonencapsulated, gram-positive bacillus that grows aerobically or as a facultative anaerobe. In most cases, infection occurs through abrasions or puncture wounds in the skin. The organism is found in many animals, especially swine, and in fish, shellfish, and decaying matter. In animals, transmission may be facilitated by mites. No human-to-human transmission occurs.
Risk Factors
Infection is common in fish and seafood handlers, particularly those who handle crabs. Immunocompromised persons or persons with chronic alcoholism may be more likely to have the infection enter the bloodstream, resulting in serious and even life-threatening illness.
Symptoms
In most cases, the infection results in a localized skin lesion. Because the organism enters through a break in the skin, lesions on the fingers predominate. After an incubation period of two to seven days, a discrete, violaceous lesion develops on the finger or other part of the hand. The lesion is painful and slightly raised, and the affected finger or hand is usually swollen. An associated fever is sometimes present.
Less common is a more diffuse skin lesion, which spreads to other areas. When this occurs, fever is more often noted, but there is no bloodstream invasion. Systemic infection, though the most severe form of the disease, is much less common. Bacteremia, often with endocarditis, can occur with alcoholics. Bacteremia spreads the infection to other organs, causing sepsis; this occurs primarily in immunocompromised persons.
Screening and Diagnosis
In the usual case of Erysipelothrix infection, a diagnosis is made based on epidemiological and clinical information. A definitive diagnosis can be made by culturing the organism from a skin biopsy or from blood or other sterile body fluids when systemic infection occurs. The organism, however, may be challenging to grow and identify in a laboratory. Polymerase chain reaction can be used to make a specific diagnosis but is not widely available.
Treatment and Therapy
The organism is highly susceptible to penicillin and several other antibiotics. Erysipelothrix infection will usually resolve without treatment, but antibiotic therapy will shorten the recovery time. Endocarditis and other types of systemic infection require four to six weeks of treatment with an effective antibiotic.
Prevention and Outcomes
Protection from skin abrasions and punctures is important for those persons engaged in risky occupational or recreational activities. Wearing gloves is one form of prevention. Other methods include handwashing and disinfection of contaminated surfaces. A vaccine is available for swine but not for humans.
Bibliography
Mileto, Irene, et al. "Bloodstream Infection Caused by Erysipelothrix rhusiopathiae in an Immunocompetent Patient." Microorganisms, vol. 12, no. 5, 7 May 2024, p. 942, doi: 10.3390/microorganisms12050942. Accessed 2 Feb. 2025.
Reboli, Annette C. “Erysipelothrix rhusiopathiae.” In Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, edited by Gerald L. Mandell, John F. Bennett, and Raphael Dolin. 7th ed. New York: Churchill Livingstone/Elsevier, 2010.
Reboli, Annette C., and W. Edmund Farrar. “ Erysipelothrix rhusiopathiae: An Occupational Pathogen.” Clinical Microbiology Reviews 2 (1989): 354-359.
Stevens, Dennis L. “Infections of the Skin, Muscle, and Soft Tissues.” In Harrison’s Principles of Internal Medicine, edited by Joan Butterton. 17th ed. New York: McGraw-Hill, 2008.
Woods, Gail L., et al. Diagnostic Pathology of Infectious Diseases. Philadelphia: Lea & Febiger, 1993.