Erysipeloid

Erysipeloid is an uncommon cutaneous infection with a Gram-positive corynebacteria, Erysipelothrix rusiopathiae. The characteristic clinical features are a slowly evolving red-purple eruption, predominantly on the fingers and hands, in a patient who is constitutionally well.

This chapter is set out as follows:

• Human infection is acquired through direct contact with contaminated raw fish or meat, the infection entering the skin through an abrasion. Infection from a living animal is uncommon

• Incubation period - three days

Distribution

• Predominantly the fingers and hands, occasionally other exposed sites

Morphology

• A hot and tender, purple-red, slightly oedematous eruption
• The leading edge is raised, well-defined, irregular, and sometimes vesicular
• The rash slowly evolves over 3-4 days, generally to a size of no more than 10 cm in diameter
• The rash has a tendency to heal at its original site
• Unlike in cellulitis/erysipelas, systemic upset is very uncommon
• The eruption usually resolves within 2-4 weeks  

Other presentations (rare)

• A diffuse cutaneous form with violaceous lesions, which have an advancing pink edge and central resolution. There can be associated systemic upset. The eruption may run a longer course than localised erysipeloid, and there can be recurrences

• A severe, potentially life-threatening, systemic form with endocarditis and other organ involvement. Patients have marked systemic upset, and blood cultures are normally positive. Skin lesions may or may not be apparent

• The lesions of cutaneous erysipeloid (local and diffuse) are usually self-limiting, however, treatment with antibiotics speed up the healing process and lessen the chance of the infection becoming systemic

• The first-line treatment is penicillin, or, clarithromycin/erythromycin for those allergic to penicillin

• The organism can survive outside of the body, so decontamination of suspect environments is important