Erysipeloid A26.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 03.10.2022

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

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Baker 1873; Rosenbach 1887; Klauder 1926

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Bacterial zoonosis in which the pathogen Erysipelotrix rhusiopathiae is transmitted via contact with infected vertebrates (e.g. pigs (= red pork), saltwater fish, crabs, shellfish or poultry - especially turkeys). The infection is exclusively limited to contact persons (fishermen, butchers, housewives) and usually occurs in the summer months. Epidemics are also known among crab fishermen(crab dermatitis).

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Erysipelothrix rhusiopathiae (Erysipelothrix insidiosa), gram-positive bacterium.

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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).

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Mainly occurring in butchers, housewives, fishermen.

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Especially hands (fingers) are affected.

Clinical features
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Three clinical courses of infection are distinguished in humans (Wang T et al. 2020):

  • the localized erysipeloid
  • the diffuse cutaneous erysipeloid
  • Rare are septic forms that can lead to infective endocarditis.

Localized erysipeloid (classic course form): After an incubation period of 3-8 days, (one or) multiple 2.0-5.0 cm, moderately painful or only mildly tense, livid spots/plaques develop at the inoculation site(s) with a tendency to centrifugal extension. The affected area is arcuately bordered by the active zones of progression. Centrally, healing occurs. In contrast to erysipelas, the flame-like margins are absent, as is the acuity of erysipelas with painful lymphadenitis.

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

Bronchitis occurs after inhalation of the causative agent.

Septic erysipeloid: Rarely, septicFforms with endocarditis may also occur in immunocompetent patients.

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Culture from biopsy material. Culutreal detection is also possible from tissue fluid material obtained by scarification from the marginal area of the focus of infection.

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.

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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.

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  1. Baker WM (1873) Erythema serpens. St Bartholomew's Hosp Rep (London) 9: 198-211.
  2. Rosenbach AJF (1887) On 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.

  8. Wang T et al (2020) Erysipelothrix rhusiopathiae endocarditis. IDCases 22:e00958.


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


Last updated on: 03.10.2022