Erysipelothrix Rhusiopathiae Endocarditis and Presumed Osteomyelitis

Abstract

Erysipelothrix rhusiopathiae is known to cause infections in humans following exposure to decaying organic matter or animals colonized with the organism, such as swine and fish. Invasive infections with this organism are unusual and are manifested primarily as infective endocarditis. The present report is believed to be the first to report a case of E rhusiopathiae endocarditis and presumptive osteomyelitis. E rhusiopathiae appears to have intrinsic resistance to vancomycin. Because vancomycin is often used empirically for the treatment of endocarditis, rapid differentiation of E rhusiopathiae from other Gram-positive organisms is critical. In patients with endocarditis caused by a Gram-positive bacillus and epidemiological risk factors for E rhusiopathiae exposure, empirical treatment with vancomycin should be reconsidered.

Skin and Soft Tissue Infections Following Marine Injuries and Exposures in Travelers

“…36 Erysipelothrix rhusiopathiae is alpha-hemolytic on blood agar and is frequently misidentified in culture as Streptococcus viridians. 36 Microbiological differentiation of E. rhusiopathiae from other Gram-positive bacilli usually requires a positive test for hydrogen sulfide on triple sugar iron agar or DNA detection by PCR. 36 In fish, the organism can persist for long periods in the exterior slime without causing cutaneous infections.…”

“…36 Microbiological differentiation of E. rhusiopathiae from other Gram-positive bacilli usually requires a positive test for hydrogen sulfide on triple sugar iron agar or DNA detection by PCR. 36 In fish, the organism can persist for long periods in the exterior slime without causing cutaneous infections. 36 In humans, E. rhusiopathiae infection usually occurs following skin injury while handling or preparing colonized fish with an incubation period of 1 to 2 days.…”

“…36 In fish, the organism can persist for long periods in the exterior slime without causing cutaneous infections. 36 In humans, E. rhusiopathiae infection usually occurs following skin injury while handling or preparing colonized fish with an incubation period of 1 to 2 days. 36,37 Most human infections are of two cutaneous forms, localized cutaneous (erysipeloid) and generalized cutaneous; both of which are characterized by painful, throbbing erythematous and intensely pruritic lesions.…”

“…36 In humans, E. rhusiopathiae infection usually occurs following skin injury while handling or preparing colonized fish with an incubation period of 1 to 2 days. 36,37 Most human infections are of two cutaneous forms, localized cutaneous (erysipeloid) and generalized cutaneous; both of which are characterized by painful, throbbing erythematous and intensely pruritic lesions. 36,37 Unlike cutaneous infections, invasive E. rhusiopathiae infections are unusual with less than 100 cases reported and characterized by septicemia and subacute bacterial endocarditis (SBE), which can be easily misidentified as S. viridians SBE.…”

“…36,37 Most human infections are of two cutaneous forms, localized cutaneous (erysipeloid) and generalized cutaneous; both of which are characterized by painful, throbbing erythematous and intensely pruritic lesions. 36,37 Unlike cutaneous infections, invasive E. rhusiopathiae infections are unusual with less than 100 cases reported and characterized by septicemia and subacute bacterial endocarditis (SBE), which can be easily misidentified as S. viridians SBE. 36 Erysipelothrix rhusiopathiae SBE more commonly involves the aortic valve and has a higher CFR (40%) than other types of SBE.…”