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.

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.

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.

[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.

A PCR assay to specifically detect serovar 1a strains of Erysipelothrix rhusiopathiae and differentiate them from serovar 2 strains possessing an intact ERH_1440 gene.

The Erysipelothrix rhusiopathiae ERH_1440 gene, which encodes CDP-glycerol:poly (glycerophosphate) glycerophosphotransferase, is conserved in serovar 1a strains. The gene is usually missing or truncated in other serovar strains and therefore has been used for PCR detection of serovar 1a strains. We have previously reported a rare case of an E. rhusiopathiae serovar 2 strain possessing an intact ERH_1440. In this study, we analyzed three additional serovar 2 strains with an intact ERH_1440 and developed a new PCR assay for the specific detection and differentiation of serovar 1a strains from these serovar 2 strains. PCR with primers designed based on serovar 1a-specific gene sequences upstream of ERH_1440 showed 100% specificity for four hundred thirty Erysipelothrix strains isolated from extensive origins.

Erysipelothrix rhusiopathiae infection by geese to human transmission.

Erysipelothrix rhusiopathiae transmission to human is often occupation-related, but in most cases, a detailed case history is missing. This case report is based on an interdisciplinary approach and includes a thorough medical record. A 58-year-old laboratory technician working on geese necropsy cut open her glove at a rib fragment of a goose and subsequently noticed a slowly progressive, reddish skin alteration in the particular region of the hand. Bacteriological investigations on the geese revealed septicaemia due to E. rhusiopathiae and therefore substantiated the diagnosis of the patient. The infectious agent could not be cultured from the patient; however, antibiotic susceptibility testing was performed using the goose isolate. An entire follow-up until full recovery of the patient was conducted. Zoonotic infections possibly have a significant impact on certain occupations. This case report analyses a rare but important zoonotic infection to create awareness of this in physicians caring for human patients.

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.

Infective endocarditis due to Erysipelothrix rhusiopathiae in a dog - a case report.

BACKGROUND: Infective endocarditis is a rare but severe condition associated with a high mortality rate in small animal patients. This condition is caused by a microbial (most often bacterial) infection of the valvular portion of the endocardium, from which proliferative and/or erosive lesions on the cardiac valves or immediately adjacent structures develop. The two most commonly affected cardiac valves are the aortic and mitral valves. CASE PRESENTATION: We report the clinical case of a 4-year old male neutered Bull terrier, 27.6 kg, body condition score 4/9, that presented with a 3-months history of pyrexia and general weakness. The patient history also revealed a transient left hind limb lameness (grade 2/4), which coincided with the onset of clinical signs about 3 months before presentation. On physical examination, a left-sided systolic heart murmur (grade 3/6) with the same intensity at the left heart base and apex, and an irregularly irregular heart rhythm were noted. Electrocardiography showed ventricular premature complexes, and echocardiography revealed lesions consistent with endocarditis involving the aortic and mitral valve. Bacterial culture of blood yielded a positive result, and the organism isolated was identified as Erysipelothrix rhusiopathiae. The extended patient history revealed that the dog lived close to a farm housing pigs and other livestock. CONCLUSION: We report a rare case of the premortal diagnosis of infective bacterial endocarditis in a dog due to E. rhusiopathiae infection. Most reports about this condition are from necropsy series. This clinical case report emphasizes that E. rhusiopathiae infection and bacteremia should be considered as a differential diagnosis in dogs with suspected infective endocarditis, especially in dogs living in rural areas with access to livestock and particularly farm pigs. Also, particular emphasis should be placed on the zoonotic potential of this infectious disease.

Celulitis recurrente importada, la importancia de la anamnesis / Imported recurrent cellulitis, the relevance of anamnesis

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Development of a Multiplex PCR-Based Assay for Rapid Serotyping of Erysipelothrix Species.

The Gram-positive bacterium Erysipelothrix rhusiopathiae is a zoonotic pathogen that causes erysipelas in a wide range of mammalian and avian species. Historically, E. rhusiopathiae has been differentiated from other Erysipelothrix species by serotyping. Among 28 serovars of Erysipelothrix species, specific serovars, namely, 1a, 1b, and 2 of E. rhusiopathiae, are associated mainly with the disease in pigs, poultry, and humans; however, other serovar strains are often simultaneously isolated from diseased and healthy animals, indicating the importance of isolate serotyping for epidemiology. The traditional serotyping protocol, which uses heat-stable peptidoglycan antigens and type-specific rabbit antisera in an agar-gel precipitation test, is time-consuming and labor-intensive. To develop a rapid serotyping scheme, we analyzed sequences of the 12- to 22-kb chromosomal region, which corresponds to the genetic region responsible for virulence of serovar 1a and 2 strains of E. rhusiopathiae, of the 28 serovars of Erysipelothrix species. We confirmed that the serovar 13 strain lacks the genomic region and that some serovar strains possess very similar or the same genetic structure, prohibiting differentiation of the serovars. We created 4 multiplex PCR sets allowing the simultaneous detection and differentiation of the majority of Erysipelothrix serovars. Together with a previously reported multiplex PCR that can differentiate serovars 1a, 1b, 2, and 5, the multiplex PCR-based assay developed in this study covers all but one (serovar 13) of the reported serovars of Erysipelothrix species and should be a valuable tool for etiological as well as epidemiological studies of Erysipelothrix infections.

Erisipela suína: Relato de caso no município de Cachoeiras de Macacu-RJ / Swine erysipelas: case report in the city of Cachoeiras de Macacu-RJ

Na suinocultura perdas econômicas ainda são elevadas devido aos baixos padrões de qualidade e sanidade dos animais. Dentre as afecções que afetam a produção, a erisipela é uma doença considerada importante em função dos prejuízos econômicos que causa, e pela questão de saúde pública visto ser uma zoonose. Ela é uma enfermidade do tipo hemorrágica comumente causada pela bactéria ubíqua Erysipelotrix rhusiopathiae. O objetivo deste trabalho foi relatar um caso desta afecção em uma matriz da raça Large White, de dois anos de idade, recém desmamada, não vacinada, de uma pequena granja de ciclo completo no munícipio de Cachoeiras de Macacu, estado do Rio de Janeiro. Ela amanheceu prostrada, com dificuldade de locomoção, sem febre e com manchas avermelhadas sobre toda a superfície corporal. As lesões cutâneas, ligeiramente elevadas, apresentavam um formato losangular (diamante) característico e sugestivo de Erisipela. Após a identificação do problema, o animal foi isolado e tratado. O tratamento iniciou-se na manhã do mesmo dia, observando-se a regressão da maioria das lesões à tarde e na manhã seguinte. A suspeita clínica foi confirmada através do diagnóstico terapêutico, sendo a associação de penicilina e estreptomicina eficiente no tratamento.

In swine industry, economic losses are still high due to low standards of quality and health of animals. Among the diseases that affect production, erysipelas is a disease considered important due to the economic losses it causes, and because of the public health issue as it is a zoonosis. It is a hemorrhagic type disease commonly caused by the ubiquitous bacteria Erysipelotrix rhusiopathiae. The aim of this study was to report a case of this condition in a Large White breed sow, two years old, recently weaned, not vaccinated, from a small pig farm (farrow to finish operation) in the municipality of Cachoeiras de Macacu, state of Rio de Janeiro. The sow was prostrate and with limited mobility, without fever and with reddish spots on the entire body surface. The cutaneous lesions were elevated, with a characteristic diamond shape suggestive of erysipelas. After identifying the problem, the animal was isolated and treated. The treatment started in the morning of the same day, observing the regression of most lesions in the afternoon and the following morning. The clinical diagnosis was confirmed through therapeutic diagnosis, and the association of penicillin and streptomycin was efficient in the treatment.

Native valve endocarditis caused by E rysipelothrix Rh usiopathiae: presenting with refractory heart failure and requiring surgical valve replacement-report on a rare zoonosis.

Erysipelothrix Rhusiopathiae is a Gram-positive bacillus that is ubiquitous in nature. The bacterium is a zoonotic pathogen known to infect wild and domestic animals. Human infections, however, are uncommon and typically present with localised or generalised cutaneous lesions. Systemic infection in the form of bacteraemia with seeding to various organs is the least common form of the disease. Infections in humans tend to be associated with occupational exposure and close contact with animals. Clinical data of a 61-year-old male patient with Gram-positive bacilli bacteraemia and E. Rh usiopathiae-induced endocarditis are presented here. The patient presented with refractory congestive heart failure secondary to severe acute aortic regurgitation mandating surgical valve replacement. The described case has special clinical merit given the lack of fever and leukocytosis, absence of erysipeloid cutaneous manifestations and refractoriness to medical management. E. Rhusiopathiae should be considered in the differential diagnosis for Gram-positive bacilli bacteraemia and endocarditis. In the proper clinical setting, occupational exposure and animal contacts are helpful clues to raise suspicion for this bacillus. The high mortality associated with the pathogen should urge for early identification and initiation of antimicrobial treatment.

Pericarditis due to an unusual microorganismin an immunocompromised patient.

A 77-year-old man with a past medical history of myelodysplastic syndrome, coronary artery disease, hypertension, and chronic atrial fibrillation presented at the hematology outpatient clinic with progressive shortness of breath, weakness, and chest and back pain. Echocardiography was performed and the patient was diagnosed with severe pericardial effusion near the right ventricle. Pericardial drainage was performed. Erysipelothrix rhusiopathiae was isolated from the pericardial fluid. Complications of respiratory and renal failure developed during follow-up. The clinical and laboratory findings of vegetation on the tricuspid valve, pericardial effusion, and atrial fibrillation with a low heart rate suggested possible pancarditis. A multidisciplinary treatment approach with the cardiology and infectious disease departments was critical to successful management of this case.