1/24. Potential errors in recognition of erysipelothrix rhusiopathiae. Here we describe four isolations of erysipelothrix rhusiopathiae associated with polyarthralgia and renal failure, septic arthritis, classic erysipeloid, and peritonitis. Although the biochemical identification was straightforward in each case, recognition presented a challenge to the clinical microbiologist, since in three cases E. rhusiopathiae was not initially considered due to unusual clinical presentations, in two cases the significance might not have been appreciated because growth was in broth only, and in one case the infection was thought to be polymicrobic. Because the Gram stain can be confusing, abbreviated identification schemes that do not include testing for H(2)S production could allow E. rhusiopathiae isolates to be misidentified as lactobacillus spp. or enterococcus spp. in atypical infections. ( info) |
| bacteremia due to erysipelothrix rhusiopathiae is rare; the most common presentation reported in the literature is endocarditis. We report a 32-year-old man with oropharyngeal cancer who developed aspiration pneumonia and E. rhusiopathiae bacteremia, and presented with fever, chills, dyspnea, and productive cough with purulent sputum. Despite treatment with amoxicillin/clavulanate and nutritional support for 9 days, he died of respiratory failure. He had no clinical evidence of endocarditis. He had no history of animal or occupational exposure, and might have been colonized with E. rhusiopathiae in the oral cavity, followed by aspiration pneumonia and bacteremia. A fatal outcome in a patient with bacteremia due to E. rhusiopathiae without endocarditis is rare. ( info) |
3/24. Infective endocarditis in renal transplant recipients. Because of the increasing number of renal transplantations performed and the rarity of reported cases of infective endocarditis in these patients, we studied the clinical characteristics of this infection in this population. We report on two cases from our experience and review reported cases of infective endocarditis in renal transplant recipients retrieved from the medline system. In addition, we reviewed a large series of infective endocarditis looking for patients with renal transplants. In addition to our 2 cases, 12 previously reported cases were found. The mean time from transplantation to diagnosis of infective endocarditis was 3.5 years (range 2 months to 15 years). Causative organisms included fungi, staphylococcus aureus (3 cases each), corynebacterium sp. (2 cases), streptococcus viridans, VRE, brucella sp., clostridium sp., nocardia sp. and erysipelothrix sp. (one case each). skin manifestations of endocarditis and/or splenomegaly were not reported in these patients. Septic emboli and mycotic aneurysms were relatively common. The overall mortality rate was 50% (7 of 14 patients died). Infective endocarditis seems to be rare in renal transplant recipients. The few reported cases are characterized by unusual causative micro-organisms and atypical clinical presentation. Further studies are needed to delineate the magnitude and scope of this association. ( info) |
| This communication describes the second reported Australian case of erysipelothrix endocarditis; after treatment with penicillin, the patient survived. It also gives up-to-date summary and brief discussion of the literature. ( info) |
| A case of septic arthritis caused by erysipelothrix rhusiopathiae, after an arthroscopically assisted anterior cruciate ligament (ACL) substitution in a non-immunosuppressed patient is described. An 18-year-old man underwent an ACL reconstruction with a quadruple hamstring graft. Eight days postoperatively, the patient developed fever, knee pain, and effusion without erythema or suppuration. He was readmitted to the hospital with the diagnosis of septic arthritis. The patient's erythrocyte sedimentation rate, c-reactive protein level, and white blood cell count were high. The joint was aspirated and the fluid was sent for cultures that revealed the presence of E rhusiopathiae. E rhusiopathiae is widespread in nature, it is transmitted by direct cutaneous laceration, and it causes septic arthritis, meningitis, endocarditis, and renal failure in immunosuppressed people with poor prognosis. In our case, the infection was treated with arthroscopic lavage and debridement, retention of the graft and hardware, and intravenous antibiotic administration for 6 weeks, followed by oral administration for 16 weeks. ( info) |
6/24. A case of multiple brain infarctions associated with erysipelothrix rhusiopathiae endocarditis. A 63-year-old woman was admitted to our hospital because of fever and altered mentality. brain magnetic resonance imaging showed multiple infarctions at the basal ganglia, cerebellum, and subcortical white matter with petechial hemorrhage, which was more easily seen on gradient echo images. erysipelothrix rhusiopathiae was cultured from her blood, and echocardiography showed septic vegetations in the mitral valve. She recovered fully after 6 weeks of appropriate antibiotic treatment. ( info) |
| We describe herein the case of a man with erysipelothrix rhusiopathiae septic arthritis and possible infective endocarditis. This is the first report in the English-language medical literature of septic arthritis caused by this organism. ( info) |
8/24. Chronic monoarthritis of the knee in systemic lupus erythematosus. We describe a middle-aged lady with systemic lupus erythematosus who presented with chronic left knee monoarthritis without constitutional symptoms. The histology of synovial tissue taken at arthroscopy showed acute inflammation and erysipelothrix rhusiopathiae, identified with some difficulty, was isolated from the enrichment broth only. Blood cultures were negative. Her history revealed significant exposure to pond fish. She responded well to intravenous penicillin and remains well 12 months later. ( info) |
| BACKGROUND: erysipelothrix rhusiopathiae is a bacterium ubiquitous in the environment. It can cause a variety of diseases and the risk of infection is closely related to the level of occupational exposure to infected or colonised animals. AIMS: To discuss the clinical features and treatment of this zoonosis, to increase awareness of this pathogen and to emphasise the need for meticulous attention to hygienic work practices in reducing the risk of infection. METHOD: A case report of a farmer with E. rhusiopathiae endocarditis and the management of the infection. RESULTS: The patient was successfully treated with valve replacement surgery and antimicrobial therapy. CONCLUSIONS: Early identification of this microorganism is essential for appropriate treatment of endocarditis. Greater awareness and safe work practices can help reduce the risk of human infection by this microorganism. ( info) |
| A woman with diabetes mellitus type 2 had a thigh infection that drained foul-smelling pus. Necrotizing fasciitis was diagnosed surgically and histopathologically, with erysipelothrix rhusiopathiae being the predominant organism. A pet goldfish might have been the source. ( info) |