Erysipeloid A26.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Erysipelas infection of humans; Erythema migrans; Fish-handler`s disease; Fishmonger's Red Run; Fish Rose; Piggy-root run; Pseudoerysipelas; Rosenbach's disease; Rotlauf

History
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Baker 1873; Rosenbach 1887; Klauder 1926

Definition
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Bacterial zoonosis in which the pathogen Erysipelotrix rhusipathiae is transmitted via contact with infected vertebrates (e.g. pigs = pig-rot), saltwater fish, crabs, shellfish or poultry - especially turkeys. The infection is exclusively limited to contact persons (fishermen, butchers, housewives). It usually occurs during the summer months. Epidemics have been reported incrab fishermen(crab dermatitis).

Pathogen
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Gram positive bacterium: Erysipelothrix rhusiopathiae (Erysipelothrix insidiosa). From biopsy material the cultural detection is successful. Also from tissue fluid, or from samples the scarification of the marginal areas were obtained.

Etiopathogenesis
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Infection through contact with pork, game, fish. Also after bites from animals, e.g. cat bites (Kobayashi KI et al. 2019).

Manifestation
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Mainly occurring in butchers, housewives, fishermen.

Localization
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Especially hands.

Clinical features
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After an incubation period of 3-8 days, several 2.0 - 5.0 cm large, moderately painful or only slightly tense, livid spots/plaques develop at the inoculation site(s), which have a tendency to expand centrifugally. The affected area is bounded by the active progression zones in an arc shape. Healing occurs centrally. In contrast to the erysipelas, the flame-like marginal borders as well as the acuteity of the erysipelas are missing. In most cases the infection remains limited to a circumscribed area.

Accompanying: moderate fever, mild lymphadenitis, rarely minor arthritic symptoms.

Bronchitis occurs after inhalation of the pathogen. In rare cases endocarditis and sepsis may also occur in immunocompetent patients.

Differential diagnosis
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Erysipelas: higher acuity with fever, pain, lymphadenopathy and lymphadenitis

Drug reaction, fixed: localized, spotty or plaque shaped, also bullous or erosive skin reaction; there is a temporal connection with the intake of drugs.

Erysipeloid-like skin reactions have been described after gemcitabine (Ruiz-Casado A et al. 2015).

Erythema chronicum migrans: 10-30 days after tick bite a roundish-oval, sharply edged, centrally pale red or even livid red erythema which slowly expands centrifugally. If the tick bite persists for a longer period of time, a ring-like structure develops due to central pallor, which often still shows a central bite reaction in the form of a red papule. Rarely localized on the hands. No fever, no pain. Tick bite mostly memorable.

External therapy
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Moist envelopes with antiseptic additives such as quinolinol solution(e.g. quinosol 1:1000) or potassium permanganate (light pink). Immobilization of the affected extremity. After three days the changes usually subside.

Internal therapy
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Penicillin V (e.g. Megacillin) 1,2-3 million IU/day p.o. over 10 days.

Alternatively Clindamycin (e.g. Sobelin) 3 times/day 300-600 mg p.o.

Alternatively erythromycin (e.g. erythrocyin) 3 times/day 500 mg p.o./i.v.

Note(s)
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For infections of animals, there are various vaccines available to veterinarians. Vaccination can be carried out with inactivated vaccines from the 12th week of life. Live vaccines can be used from the age of 6 weeks. The booster vaccination is then usually given twice a year.

Literature
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  1. Baker WM (1873) Erythema serpens. St. Bartholomew's Hosp Rep (London) 9: 198-211
  2. Rosenbach AJF (1887) About the Erysipeloid. Arch klin Chir (Berlin) 36: 346
  3. Klauder JV (1926) Erysipeloid and swine erysipelas in man. A clinical and bacteriological review: Swine erysipelas in the United States. J Am Med Assoc (Chicago) 86: 536-541
  4. Klauder JV et al (1926) A distinctive form of erysipeloid among fish handlers. Arch Dermatol Syphilol (Chicago) 14: 622
  5. Kobayashi KI et al(2019) Erysipelothrix rhusiopathiae bacteremia following a cat bite.
    IDCases 18:e00631.
  6. Ruiz-Casado A et al (2015) Erysipeloid rash: A rare adverse event induced by gemcitabine. J Cancer Res Ther 11:1024.
  7. Veraldi S et al (2009) Erysipeloid: a review. Clin Exp Dermatol 34:859-862

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020