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Skin-nontumor / Clinical Dermatology

Infectious disorders

Erysipelothrix

Reviewer: Ha Kirsten Do, M.D. (see Reviewers page)
Revised: 5 September 2011, last major update July 2011
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

Definition
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● A rare disease, with ~ 50 articles published from 1950-2008
● Erysipelothrix rhusiopathiae, formerly named Erysipelothrix insidiosa, is a rod-shaped, nonmotile, gram-positive bacteria that forms long-branching filaments with characteristic hyaline granules
● Bacteria are present on dead animal skin, more frequently swine

Terminology
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● Previously called Rosenbach’s disease, Baker-Rosenbach disease and pseudoerysipelas

Epidemiology
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● Erysipeloid is an occupational infection caused by traumatic penetration of skin by Erysipelothrix rhusiopathiae
● Causes cutaneous disease in humans who work with animals or fish

Clinical features
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● Two clinical varities of erysipeloid exist: a more common localized cutaneous form and a rare generalized variety
● 2-7 day incubation period
● According to some authors, serotypes 2, 7 and 16 are most commonly involved in human erysipeloid
● Clinical diagnosis is based on patient occupation history, history of traumatic skin contact with infected meat and classic erythematous, edematous skin lesions of back of hands/fingers with well-defined and raised borders
● Causes cutaneous erysipeloid and rarely septicemia, with endocarditis of aortic and mitral valves
● Insidious onset over months
● May also cause botryomycosis, a pseudomycosis

Treatment
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● Most mild cases of erysipeloid run a self-limited course of about 3 weeks
● Recurrent eruptions can be treated with Penicillin; use ciprofloxacin, clindamycin and imipenem if penicillin allergy
● Use IV penicillin up to 6 weeks for severe systemic form
● Bacteria is resistant to Vancomycin (important for endocarditis cases)

Case reports
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● 54 year old black man with fatal endocarditis, no skin lesions, no history of animal/fish exposure (Hum Pathol 2005;36:117)

Clinical description
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● Marginated or polygonal thin plaques of purplish painful swelling on the back of the hands and fingers
● Condition is migratory, with new purplish red patches appearing at nearby sites and centrifugally
● Rarely severe swelling of fingers, termed “whale finger” or “seal finger”

Clinical images
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Various images

Micro description
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● Slender or filamentous gram positive rod similar to actinomycetes
● Often nonspecific histopathology
● Dermoepidermal detachment with many neutrophils floating in the blisters
● Upper and mid-dermis is edematous with vascular dilatation; infiltrate consists mainly of neutrophils and lymphocytes with some eosinophils

Micro images
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Gram stain of culture

Virtual slides
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Erysipelas

EM images
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Images of bacteria

Differential diagnosis
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● Erysipelas
● Acute irritant or allergic contact dermatitis

End of Skin-nontumor / Clinical Dermatology > Infectious disorders > Erysipelothrix

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