Erysipelothrix Rhusiopathiae Bacteremia without Endocarditis: Rapid Identification from Positive Blood Culture by MALDI-TOF Mass Spectrometry. A Case Report and Literature Review

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Abstract

Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is infrequently responsible for infections in humans. Three forms have been classified: a localized cutaneous form (erysipeloid) caused by traumatic penetration of E. rhusiopathiae, a generalized cutaneous form and a septicemic form. The latter type of disease has been previously associated with a high incidence of endocarditis. Here we report a case of E. rhusiopathiae bacteremia in a 74-year-old man, probably started from an erysipeloid form, in which endocarditis did not develop. This case presents some particular and uncommon features: i) no correlation with animal source; ii) correlation between bacteremia and erysipeloid lesion; iii) absence of endocarditis. MALDI-TOF mass spectrometry allowed to obtain a rapid identification (within 4 hours from bottle positivity) of E. rhusiopathiae. Together with direct antimicrobial susceptibility testing, this approach could improve the rate of appropriate therapy for bloodstream infections due to this fastidious pathogen.

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Modified early warning score predicts the need for hospital admission and inhospital mortality.

G. Tarr, C Morroni, V Burch (2008)

The modified early warning score (MEWS) is a useful tool for identifying hospitalised patients in need of a higher level of care and those at risk of inhospital death. Use of the MEWS as a triage tool to identify patients needing hospital admission and those at increased risk of inhospital death has been evaluated only to a limited extent. To evaluate the use of the MEWS as a triage tool to identify medical patients presenting to the emergency department who require admission to hospital and are at increased risk of inhospital death. Physiological parameters were collected from 790 medical patients presenting to the emergency department of a public hospital in Cape Town, South Africa. MEW scores were calculated from the data and multivariate regression analysis was performed to identify independent predictors of hospital admission and inhospital mortality. The proportion of patients admitted and those who died in hospital increased significantly as the MEW score increased (p or =130 beats per minute, respiratory rate > or =30 breaths per minute, temperature > or =38.5 degrees C and an impaired level of consciousness. Independent predictors of inhospital death were: abnormal systolic blood pressure ( or =200 mm Hg), respiratory rate > or =30 breaths per minute and an impaired level of consciousness. The MEWS, specifically five selected parameters, may be used as a rapid, simple triage method to identify medical patients in need of hospital admission and those at increased risk of inhospital death.

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Erysipelothrix rhusiopathiae.

Qinning Wang, Barbara J Chang, Thomas Riley (2010)

Erysipelothrix rhusiopathiae is a facultative, non-spore-forming, non-acid-fast, small, Gram-positive bacillus. The organism was first established as a human pathogen late in the nineteenth century. Three forms of human disease have been recognised since then. These include a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form and a septicaemic form often associated with endocarditis. The organism is ubiquitous and able to persist for a long period of time in the environment, including marine locations. It is a pathogen or a commensal in a wide variety of wild and domestic animals, birds and fish. Swine erysipelas caused by E. rhusiopathiae is the disease of greatest prevalence and economic importance. Diseases in other animals include erysipelas of farmed turkeys, chickens, ducks and emus, and polyarthritis in sheep and lambs. Infection due to E. rhusiopathiae in humans is occupationally related, principally occurring as a result of contact with contaminated animals, their products or wastes, or soil. Erysipeloid is the most common form of infections in humans. While it has been suggested that the incidence of human infection could be declining due to technological advances in animal industries, infection still occurs in specific environments. Additionally, infection by the organism is possibly under-diagnosed due to the resemblance it bears to other infections, and problems encountered in isolation and identification. Various virulence factors have been suggested as being involved in the pathogenicity of E. rhusiopathiae. The presence of a hyaluronidase and neuraminidase has been recognised, and it was shown that neuraminidase plays a significant role in bacterial attachment and subsequent invasion into host cells. The role of hyaluronidase in the disease process is controversial. The presence of a heat labile capsule has been reported as important in virulence. Control of animal disease by sound husbandry, herd management, good sanitation and immunization procedures is recommended. Copyright 2009 Elsevier B.V. All rights reserved.

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Management of common bacterial infections of the skin.

Philippe Bernard (2008)

Bacterial skin infections commonly encountered in the community include impetigo, folliculitis/furunculosis, simple abscesses, erysipelas and other nonnecrotizing cellulitis. The review focuses on recent epidemiological, bacteriological and therapeutic advances. Impetigo and erysipelas occur in about 20 and 1 person/1000/year, respectively. Main risk factors for erysipelas are toe-web intertrigo and lymphedema. The true incidence of furunculosis is unknown, whereas outbreaks in small communities are reported worldwide. Staphylococcus aureus is the predominant pathogen for impetigo and furunculosis, and methicillin-resistant strains play a growing role in both diseases. Erysipelas are mainly caused by streptococci, whereas local complications (i.e. abscesses or blisters) may be due to staphylococci, including methicillin-resistant strains in involved geographic areas. Recent trends for treating impetigo and furunculosis predate community-acquired methicillin-resistant S. aureus. For outbreaks of furunculosis, stringent decolonization measures are showing promise, whereas there is no validated therapeutic regimen for chronic furunculosis. Current trends for erysipelas involve ambulatory treatments and reduced duration of antibiotics. Despite better epidemiological or bacteriological knowledge of common bacterial skin infections, the exact role of methicillin-resistant staphylococci needs regular surveys in involved geographic areas. Antibiotic treatment must be active on staphylococci and, to a lesser degree, on streptococci.

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Author and article information

Journal

Journal ID (nlm-ta): Infect Dis Rep

Journal ID (iso-abbrev): Infect Dis Rep

Journal ID (publisher-id): IDR

Title: Infectious Disease Reports

Publisher: PAGEPress Publications, Pavia, Italy

ISSN (Print): 2036-7430

ISSN (Electronic): 2036-7449

Publication date (Electronic): 21 March 2016

Publication date Collection: 21 March 2016

Volume: 8

Issue: 1

Electronic Location Identifier: 6368

Affiliations

Microbiology and Virology Unit, A. Manzoni Hospital , Lecco, Italy

Author notes

Microbiology and Virology Unit, A. Manzoni Hospital, Via dell’Eremo 9/11, 23900 Lecco, Italy. +39.0341.489630 - +39.0341.489601. f.luzzaro@ 123456asst-lecco.it

Contributions: LP performed laboratory diagnosis and drafted the manuscript; SB, CM and BP performed susceptibility tests, analysed data and contributed to laboratory diagnosis; ST provided clinical information about the patient; FL conceived of the study, participated in its design and coordination, and critically revised the draft manuscript.

Conflict of interest: the authors declare no potential conflict of interest.

Article

DOI: 10.4081/idr.2016.6368

PMC ID: 4815943

PubMed ID: 27103974

SO-VID: 2c7c37aa-b6c1-4366-89a9-d4ab0e854529

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 17 December 2015

Date revision received : 25 January 2016

Date accepted : 25 January 2016

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Figures: 0, Tables: 2, Equations: 0, References: 35, Pages: 4

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Erysipelothrix Rhusiopathiae Bacteremia without Endocarditis: Rapid Identification from Positive Blood Culture by MALDI-TOF Mass Spectrometry. A Case Report and Literature Review

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Most cited references 33

Modified early warning score predicts the need for hospital admission and inhospital mortality.

Erysipelothrix rhusiopathiae.

Management of common bacterial infections of the skin.

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