|Year : 2015 | Volume
| Issue : 1 | Page : 45-47
A case of erysipeloid presenting as abscesses along the lymphatics
Kundoli Velayudhan Suseela1, Sebastian Criton2, Santosh Patil1, Geethu Gangadharan2
1 Department of Microbiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
2 Department of Dermatology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
|Date of Web Publication||16-Jun-2015|
Kundoli Velayudhan Suseela
Department of Microbiology, Amala Institute of Medical Sciences, Thrissur, Kerala
Source of Support: None, Conflict of Interest: None
Erysipeloid is a cutaneous infection produced by Erysipelothrix rhusiopathiae following trauma. Here, we present a case of erysipeloid with lesions along the lymphatics on the right lower leg in a man who was working in a prawn farm. The lesion resembled sporotrichosis clinically.
Keywords: Abscess, erysipeloid, Erysipelothrix rhusiopathiae, lymphatics, prawn farm
|How to cite this article:|
Suseela KV, Criton S, Patil S, Gangadharan G. A case of erysipeloid presenting as abscesses along the lymphatics. J Acad Clin Microbiol 2015;17:45-7
| Introduction|| |
Erysipelothrix is a Gram-positive bacterium present in aquatic environments and causes diseases following entry through trauma.  Erysipelothrix rhusiopathiae is the common species causing erysipeloid. The reservoir of the infection is believed to be the domestic animals. It may live long enough in the soil and contaminate the wounds. Persons at risk include fishermen, fish handlers, butchers, veterinarians, and homemakers.  This bacterium has got resemblance to other Gram-positive bacteria like Lactobacillus, Actinomyces, and Enterococcus. E. rhusiopathiae is an occupational pathogen prevalent in those working in association with animals a proper occupational history is helpful for the diagnosis. ,
| Case Report|| |
A 57-year-old man came to the dermatology outpatient department with painful multiple swellings on the right leg of 3 weeks duration. There was a history of trauma to the right leg 3 weeks back in a prawn farm where he was working, after which he developed a swelling on the lower 1/3 rd of right leg [Figure 1]. According to the patient, multiple lesions appeared above the original lesion, and there was a discharge of pus from these lesions. On examination, there were multiple pus pointing abscesses and on upper 1/3 rd there was an indurated swelling. Later, it formed discharging sinuses on the lower half of right leg. Lesions seemed to spread proximally along the lymphatics and resembled sporotrichosis.
On routine blood examination, the total count was 10,600/cu.mm, and differential count showed 82% neutrophils and 18% lymphocytes. Erythrocyte sedimentation rate was 45 mm/1 st h.
On surgical consultation, incision and drainage of one of the abscesses were done, and a smear of the pus was sent for Gram staining to the microbiology laboratory. On seeing the Gram-positive filamentous bacteria in the smear [Figure 2], a full thickness skin biopsy was asked to do culture and sensitivity. The biopsy material was inoculated into brain heart infusion broth. Another bit was cultured on Sabouraud's dextrose agar to rule out a fungal infection. After overnight incubation subculture from the brain heart infusion broth was done on blood agar and McConkey agar. Alpha lytic wrinkled colonies with matte surface appeared on the blood agar after 2 days incubation [Figure 3]. The colonies were seen embedded in the medium. Gram staining was done, and Gram-positive filamentous bacteria were seen [Figure 4].
|Figure 2: Grams stain of the pus showing Gram-positive filamentous bacteria|
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Biochemical reactions were performed. It was catalase and oxidase negative. In triple sugar iron, slope was alkaline and butt was slight yellow with black discoloration [Figure 5]. Mannitol was not fermented, urease and citrate were negative. There was no growth on McConkey agar. The strain was identified as E. rhusiopathiae. Fungus culture was negative. The strain was susceptible to Penicillin, Ciprofloxacin, Piperacillin, and Clindamycin and was resistant to Gentamicin, Cotrimoxazole, and Vancomycin. Patient was on Cloxacillin, after identification of the causative agent treatment was changed to oral Ciprofloxacin for 10 days. Lesions healed well, and the patient was discharged with instructions on physical prophylactic measures like protective gloves and boots. Patient was reviewed after 1-week and found cured.
| Discussion|| |
Erysipelothrix rhusiopathiae may live long enough in the soil to cause infections for weeks and months after the initial contamination from domestic animals.  This bacterium also can be isolated from fresh water and sea water fish and crustaceans. ,
Erysipeloid is a subacute cellulitis and is the most common type of Erysipelothrix infection seen in humans as an occupational disease.  It can even produce infective endocarditis in susceptible patients.  Lesion in erysipeloid may progress proximally from the site of inoculation. Our patient had a history of injury, and the lesions were spreading along the lymphatics, so clinically diagnosed as sporotrichosis. The presence of Gram-positive filamentous bacteria and the favorable occupational history for Erysipelothrix led to the culture of a full thickness skin biopsy. As these bacteria are usually present in the deeper skin layers, the culture of lesion containing full thickness dermis is suggested.  There are two variants of colonies are seen on culture, namely smooth and rough. Rough forms are seen as filaments.  Our patient was infected with rough forms. Differentiation from other Gram-positive filamentous bacteria like lactobacilli and Actinomyces is based on the production of hydrogen sulfide (H 2 S).  Identification to the species level is based on the sucrose fermentation  and the species isolated from our patient were sucrose negative, and so it was identified as E. rhusiopathiae. Penicillin is the drug of the choice for the treatment and Ciprofloxacin is an alternative.  Other antibiotics such as Imipenem and Erythromycin can also be used.  Our patient was successfully treated with Ciprofloxacin. Apart from skin lesions, this agent can cause polyarthralgia, peritonitis, etc.  Normally, the lesions may be self-limiting but it may persist and go for septicemia.  Hence, the identification of this bacterium is essential not only to prevent the complication like septicemia but to take appropriate prophylactic measures occupationally. Incision and drainage in erysipeloid are contraindicated because it may prolong the duration of erysipeloid lesions.  Even though in our patient incision and drainage of the abscess were done, the early diagnosis and timely treatment resulted in complete healing.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]