A Woman with a Lesion on Her Finger and Bacteremia

Abstract

Diagnosis: Soft-tissue infection and bacteremia due to Erysipelothrix rhusiopathiae. The cutaneous injury from the catfish (figure 1) suggested a zoonosis, and blood cultures grew a pleomorphic, nonsporulating, gram-positive bacillus identified as E. rhusiopathiae (figure 2). Cutaneous infection is the most common manifestation of human infection with E. rhusiopathiae. Louis Pasteur isolated E. rhusiopathiae from swine in 1882; it was isolated from cutaneous lesions in humans by Rosenbach in 1909. The human disease was named erysipeloid by Rosenbach, in distinction to erysipelas, which was recognized as a manifestation of streptococcal infection [1]. E. rhusiopathiae is recognized as a common commensal or pathogen of many vertebrate and invertebrate species. Swine are a major reservoir, although turkeys, sheep, dolphins, whales, fish, and shellfish commonly carry this organism. Human disease is primarily an occupationally acquired zoonosis, most commonly seen in workers who handle fish or meat [2, 3]. The portal of entry is typically a puncture wound or abrasion on the hand. A variety of bacteria ar pr sent in the exterior slime of fish and shellfish and can be transmitted to humans, causing topically a quired zoonoses. Among th m are Aeromonas hydrophilia, Edwardsiella tarda, Streptoc ccus iniae, Vibrio vulnificus, Mycobacterium marinum, and E. rhusiopat iae [4]. Our patient described a cutaneous injury caused by contact with a host likely colonized with Erysipelothrix, which is the common route of infection.