History

Fact Explanation
Localized skin rash Erysipeloid is an acute bacterial infection of the skin and other organs caused by the microorganism Erysipelothrix rusiopathiae. The transmission occurs when the infected animals or meat contacts with traumatized (abrasion or cut) human skin. Erysipelothrix rusiopathiae secrets neuraminidase enzymes. Neuraminidase enzymes are glycoside hydrolase enzymes which cleave the glycosidic linkages of neuraminic acids. This leads to dissections through the tissues. This tissue destruction triggers an inflammatory response. So the affected area presents as a local burning type of pain along with erythema, warmth and swelling. The localized cutaneous form of erysipeloid is most often occur as single or multiple lesions localized on the hands, webs of the fingers, forearms, or any other exposed area of the body. [1,2,3,4,5]
Generalized skin rash Diffuse cutaneous form of erysipeloid can occur in some patients. They are presented with multiple lesions appear on various parts of the body at the same time. [1,2,3]
Fever A few patients may experience mild fever, chills and malaise. A low grade persistent fever with fatigue in history should raise the concerns about infective endocarditis. [2,3,4,5]
Complications Rarely, a severe systemic form of erysipeloid may develop. This is where other organs are infected, such as the heart, brain, joints and lungs. Patients with systemic disease may experience symptoms such as chills, fever, headache, joint pain and weight loss. Skin lesions may or may not be apparent in patients with systemic erysipeloid. Endocarditis is the commonest systemic involvement among all those rare conditions. [1,3,4,5]
Population at risk Cutaneous erysipeloid is more of a occupational disease. Farmers, butchers (specially pork) and cooks are at higher risk.
References
  1. REBOLI AC, FARRAR WE. Erysipelothrix rhusiopathiae: an occupational pathogen. Clin Microbiol Rev [online] 1989 Oct, 2(4):354-9 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2680056
  2. ADAMSON HG. Erythema serpens of Morrant Baker, or Erysipeloid of Rosenbach. Proc R Soc Med [online] 1909, 2(Dermatol Sect):4-5 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19973510
  3. PRICE JE, BENNETT WE. The erysipeloid of Rosenbach. Br Med J [online] 1951 Nov 3, 2(4739):1060-2 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14869813
  4. ENTA T. Dermacase. Erysipeloid. Can Fam Physician [online] 1995 Sep:1481, 1485 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8520235
  5. BROOKE CJ, RILEY TV. Erysipelothrix rhusiopathiae: bacteriology, epidemiology and clinical manifestations of an occupational pathogen. J Med Microbiol [online] 1999 Sep, 48(9):789-99 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10482289

Examination

Fact Explanation
Localized skin rash The skin inflammation often occurs in hands, specially in the webs of the fingers. However it may involve any other area of the body. In localized cutaneous erysipeloid, a particular area is involved. The lesion is well-demarcated, bright red-to-purple plaques with a smooth, shiny surface. It is tender and warm due to the underlying inflammation. The lesion also has an advancing border and central clearing. Sometimes vesicles may be present. As it they are resolving a brownish discoloration will remain on the site. [1,2,3]
Generalized skin rash Diffuse cutaneous form of erysipeloid presents with multiple similar lesions with same characteristics appear on various parts of the body. [1,2,3]
Murmur When cutaneous erysipeloid is complicated with systemic involvements such as endocarditis, patient may have low grade fever with new, changing cardiac murmur. When the joints are involved, they may become tender and swollen. [2,3,4]
References
  1. BROOKE CJ, RILEY TV. Erysipelothrix rhusiopathiae: bacteriology, epidemiology and clinical manifestations of an occupational pathogen. J Med Microbiol [online] 1999 Sep, 48(9):789-99 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10482289
  2. REBOLI AC, FARRAR WE. Erysipelothrix rhusiopathiae: an occupational pathogen. Clin Microbiol Rev [online] 1989 Oct, 2(4):354-9 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2680056
  3. PRICE JE, BENNETT WE. The erysipeloid of Rosenbach. Br Med J [online] 1951 Nov 3, 2(4739):1060-2 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14869813
  4. ADAMSON HG. Erythema serpens of Morrant Baker, or Erysipeloid of Rosenbach. Proc R Soc Med [online] 1909, 2(Dermatol Sect):4-5 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19973510

Differential Diagnoses

Fact Explanation
Erysipelas A bacterial skin infection that characteristically extends into the lymphatics which are superficial and cutaneous . It involves the upper dermis. It is an intensely erythematous, tender and indurated plaque with a border which is sharply demarcated. The well-defined margin help differentiating from other skin infections such as cellulitis. Erysipelas is usually caused by streptococcus. [1]
Cellulitis Cellulitis is a common bacterial infection of the skin, which can affect all ages. It usually affects a limb but can occur anywhere on the body. Signs and symptoms include an area of redness which increases in size over a couple of days. The borders of the area of redness are generally not sharp and the skin may be swollen. The bacteria most commonly involved are streptococci and Staphylococcus aureus. [2]
References
  1. INGHAMMAR M, RASMUSSEN M, LINDER A. Recurrent erysipelas--risk factors and clinical presentation. BMC Infect Dis [online] 2014 May 18:270 [viewed 01 August 2014] Available from: doi:10.1186/1471-2334-14-270
  2. KELLER EC, TOMECKI KJ, ALRAIES MC. Distinguishing cellulitis from its mimics. Cleve Clin J Med [online] 2012 Aug, 79(8):547-52 [viewed 01 August 2014] Available from: doi:10.3949/ccjm.79a.11121

Investigations - for Diagnosis

Fact Explanation
Gram staining Skin scrapings from the rash may sometimes reveal gram positive bacillus, Erysipelothrix rusiopathiae. [1,2,3,4]
Bacterial culture Specimen from the leading edge of the lesion may demonstrate the the organism upon culture. Blood cultures ae important in making the diagnosis of systemic disease. [2,3,4,5]
Skin biopsy Though it is confirmatory, skin biopsy is rarely done. The epidermis shows spongiosis and sometimes intraepidermal vesiculation. Marked papillary dermal edema with blood and lymphatic dilation occurs. Perivascular inflammatory cell infiltrate can be observed in the reticular dermis. [3,4,5]
Imaging studies Imaging studies are helpful only when cutaneous erysipeloid is complicated by systemic involvements. (eg- Echocardiography, if suspecting endocarditis. CT or MRI brain in abscess or cerebral infarction, Radiography or CT of the chest, if suspecting pleural effusion.) [2,4,5]
References
  1. REBOLI AC, FARRAR WE. Erysipelothrix rhusiopathiae: an occupational pathogen. Clin Microbiol Rev [online] 1989 Oct, 2(4):354-9 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2680056
  2. BROOKE CJ, RILEY TV. Erysipelothrix rhusiopathiae: bacteriology, epidemiology and clinical manifestations of an occupational pathogen. J Med Microbiol [online] 1999 Sep, 48(9):789-99 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10482289
  3. ADAMSON HG. Erythema serpens of Morrant Baker, or Erysipeloid of Rosenbach. Proc R Soc Med [online] 1909, 2(Dermatol Sect):4-5 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19973510
  4. PRICE JE, BENNETT WE. The erysipeloid of Rosenbach. Br Med J [online] 1951 Nov 3, 2(4739):1060-2 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14869813
  5. ENTA T. Dermacase. Erysipeloid. Can Fam Physician [online] 1995 Sep:1481, 1485 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8520235

Management - General Measures

Fact Explanation
Prevention Simple home disinfectants have been shown to kill Erysipelothrix rhusiopathiae when applied on work surfaces, so this is an effective way to prevent infection. By far the most cost-effective home disinfectant is the commonly used chlorine bleach (a 5% solution of sodium hypochlorite). Disinfectant Spray and Wipes such as chloroxylenol and lysol can also be used. Workers who use knives must be provided with metal mesh gloves and aprons, and wrist and forearm guards to protect them from knife cuts.[1,2]
References
  1. BROOKE CJ, RILEY TV. Erysipelothrix rhusiopathiae: bacteriology, epidemiology and clinical manifestations of an occupational pathogen. J Med Microbiol [online] 1999 Sep, 48(9):789-99 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10482289
  2. REBOLI AC, FARRAR WE. Erysipelothrix rhusiopathiae: an occupational pathogen. Clin Microbiol Rev [online] 1989 Oct, 2(4):354-9 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2680056

Management - Specific Treatments

Fact Explanation
Antibiotic therapy The skin disease is usually self-limiting and resolves spontaneously within 2-4 weeks. However antibiotic treatment quickens the healing and lessen the spread. The antibiotics of choice for erysipeloid are penicillin or cephalosporin. In case of a penicillin allergy, erythromycin combined with rifampin or ciprofloxacin alone may be used. Prompt diagnosis and early treatment of the rare but severe systemic erysipeloid is essential to prevent serious or fatal complications. [1,2,3,4]
Surgery Surgical care is not usually indicated in cutaneous erysipeloid as they can prolong the recovery time. [2,4]
References
  1. ROOKE CJ, RILEY TV. Erysipelothrix rhusiopathiae: bacteriology, epidemiology and clinical manifestations of an occupational pathogen. J Med Microbiol [online] 1999 Sep, 48(9):789-99 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10482289
  2. ENTA T. Dermacase. Erysipeloid. Can Fam Physician [online] 1995 Sep:1481, 1485 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8520235
  3. PRICE JE, BENNETT WE. The erysipeloid of Rosenbach. Br Med J [online] 1951 Nov 3, 2(4739):1060-2 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14869813
  4. ADAMSON HG. Erythema serpens of Morrant Baker, or Erysipeloid of Rosenbach. Proc R Soc Med [online] 1909, 2(Dermatol Sect):4-5 [viewed 01 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19973510