Disease/Syndrome

Erysipeloid

Category

Infection, Occupational

Acute/Chronic

Acute-Moderate

Synonyms

Fish-handlers' disease; Erysipelothrix rhusiopathiae infection

Biomedical References

Search PubMed

Comments

INITIAL SYMPTOMS: Skin infection, usually localized to one of the fingers; These bacteria are an important cause of disease in swine. Humans acquire occupational skin infections called "fish handler's disease," "whale finger," and "seal finger." Other workers affected include those handling infected tissues of turkeys, or rarely, chickens, sheep, or cattle. The typical skin lesion is purplish-red and indurated. There may be a hemorrhagic blister but suppuration is unusual. Systemic symptoms (fever, lymphangitis, and lymphadenopathy) are present in only about 10% of cases. Complications include bacteremia, endocarditis, and rarely, brain abscesses, myocarditis, pericarditis, renal failure, infectious arthritis, and osteomyelitis. [ID, p. 1638-40; CCDM, p. 583] Swine are the major reservoir. Most infections are occupational (fishermen, fish handlers, butchers, farmers, slaughterhouse workers, veterinarians, and homemakers). Lymphangitis and lymphadenitis accompany about 1/3 of infections. Low-grade fever and arthralgias are reported in about 10% of infections. Most infections resolve in 3-4 weeks without treatment. Diffuse cutaneous disease is a rare form of erysipeloid. The skin lesions may resemble urticaria, and most patients have fever and arthralgias. Another rare form of the disease is bacteremia. More than 90 cases of bacteremia, usually associated with endocarditis, have been reported. Congestive heart failure, glomerulonephritis, meningitis, brain infarctions, septic arthritis, and osteomyelitis are complications of Erysipelothrix endocarditis. [PPID, p. 2415-6] Workers are infected after contact with infected animals (swine, sheep, cattle, horses, dogs, rodents, chickens, ducks, turkeys, penguins, parrots). At risk are fishers, farmers, butchers, slaughterhouse workers, and veterinarians. Infections are usually localized to the fingers and hands. Diffuse cutaneous infection is rare. Systemic infection is uncommon. [Cecil, p. 1840] E. rhusiopathiae usually causes cellulitis in workers (bone renderers and fishmongers) exposed to infected swine and fish. [Harrison ID, p. 256] The primary reservoir is swine, but also sheep, fish, shellfish, and domestic fowl. The cellulitis is purplish-red and spreads with a raised border and central clearing. Sepsis (rare) and endocarditis are complications. [ABX Guide]

Latency/Incubation

Days

Diagnostic

Culture of skin biopsy--organism resembles diphtheroids and coryneforms but produces hydrogen sulfide; Also more likely to produce positive blood cultures than other causes of cellulitis; [ABX Guide] Grows on standard laboratory media; [Cecil, p. 1840]

ICD-9 Code

027.1

Effective Antimicrobics

Yes

Reference Link

Merck Manual: Erysipelothricosis

Image

DermIS: Erysipeloid

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