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Erysipelothrix rhusiopathiae is a facultative anaerobic, environmentally stable, Gram-positive rod that causes swine and avian erysipelas as a zoonotic pathogen. In humans, the main manifestations described are circumscribed erysipeloid, generalized erysipeloid, and endocarditis. Here, we report a 46-year-old female patient who presented to the physician because of redness and marked functio laesa of the hand, in terms of a pain-related restricted range of motion, and was treated surgically. E. rhusopathiae was detected in tissue biopsy. The source of infection was considered to be a pond in which both swine and, later, her dog bathed. The genome of the isolate was completely sequenced and especially the presumptive virulence associated factors as well as the presumptive antimicrobial resistance genes, in particular a predicted homologue to the multiple sugar metabolism regulator (MsmR), several predicted two-component signal transduction systems, three predicted hemolysins, two predicted neuraminidases, three predicted hyaluronate lyases, the surface protective antigen SpaA, a subset of predicted enzymes that potentially confer resistance to reactive oxygen species (ROS), several predicted phospholipases that could play a role in the escape from phagolysosomes into host cell cytoplasm as well as a predicted vancomycin resistance locus (vex23-vncRS) and three predicted MATE efflux transporters were investigated in more detail.

Erysipelothrix rhusiopathiae is a zoonotic pathogen that causes erysipelas in a variety of animals. In humans, in contrast to the cutaneous form called erysipeloid, which is an occupational disease and common in individuals who handle raw meat and fish, invasive systemic infections are unusual. E. rhusiopathiae expresses an immunogenic surface protein, Spa (surface protective antigen), which is involved in virulence. Among the antigenically different Spa proteins (SpaA, B and C), which are mostly associated with serovars, SpaA is by far the most prevalent in E. rhusiopathiae isolates from diseased animals. However, the Spa type has not been examined for human isolates, and it is unknown whether SpaB- or SpaC-possessing isolates can cause disease in humans. A Gram-positive, rod-shaped bacterium isolated from a case of human pyogenic spondylitis was analysed. The bacterium was identified as E. rhusiopathiae by a routine biochemical test and MS, and ultimately confirmed by an E. rhusiopathiae -specific PCR assay. Spa typing by sequencing revealed the SpaB type, and the serovar of the strain was identified as untypeable by a conventional agar gel precipitation test, but determined to be serovar 6 by a serotyping PCR assay. Sequence analysis of the serovar-defining chromosomal region revealed that the isolate displayed the same gene organization as the serovar 6 reference strain, but the region was disrupted by an insertion sequence element, suggesting that the isolate originated from a serovar 6 strain. These results highlight that unusual, spaB-possessing E. rhusiopathiae strains can potentially pose serious risks to humans.

Cutaneous leishmaniasis (CL) can present with various skin lesions ranging from a single ulcer to diffuse multiple nodules. Here, we present a case of a 67-year-old man with a large erythematous well-defined indurated plaque over the left face for a duration of 4 months. A slit skin smear was performed, and it was stained with Giemsa stain which showed multiple amastigotes confirming the diagnosis of CL. Oral miltefosine was started at a dose of 150 mg/day but had to be stopped after 20 days as the patient developed diarrhea, bipedal edema, and renal impairment. This case emphasizes an uncommon variant of CL and the role of systemic treatment with oral miltefosine and its associated adverse effects.

Cutaneous leishmaniasis, which is the most common form of leishmaniasis, classically presents as small erythematous papules and nodules that develop into ulcers with indurated, raised outer borders. However, lesions of cutaneous leishmaniasis can have pleomorphic and atypical presentations. The erysipeloid form is one of the rare, atypical presentations of cutaneous leishmaniasis. Reported is a case of a 58-year-old man from the hilly region of Nepal who presented with an atypical erythematous and edematous plaque over the left antecubital fossa. Cutaneous leishmaniasis was not considered as an initial diagnosis because of the atypical appearance of the lesion as well as his residence in the hilly region of Nepal. The diagnosis was made after detection of amastigotes on histopathological examination of a cutaneous biopsy specimen. There was complete regression of the lesion after treatment with oral miltefosine followed by oral fluconazole. Clinicians should be aware of atypical presentations of cutaneous leishmaniasis and it should be considered in the differential diagnosis, regardless of the presentation or geographic location.

Erysipelas is a disease caused by the Erysipelothrix genus, whose main species is the E. rhusiopathiae, the causative agent of animal erysipelas and human erysipeloid. We isolated Erysipelothrix sp. strain 2 (ES2) from turkey’s organs during an outbreak in Brazilian commercial and breeder flocks with sepsis and high mortality levels. We studied 18 flocks, accounting for 182 samples, being eight flocks (84 samples) as ES2 positive with individuals demonstrating clinical symptoms and high mortality. We obtained the genetic variability of 19 samples with PFGE and found two clones, both from the same flock but different samples, and two clusters. Interestingly, we found 15 strains with high genetic variability among and within flocks. We have found a positive association between the proximity of ES2 positive turkey flocks and commercial swine sites through epidemiological analysis. We infected Vero cells with two different isolates and three distinct concentrations of ES2. After performing the morphometry, we recorded enlargement of the nucleus and nucleolus. Moreover, we performed fluorescence assays that resulted in apoptotic and necrotic cells. We demonstrated that ES2 could multiply in the extracellular medium and invade and survive inside Vero cells. For the first time, our finds show that ES2 may have similar behavior as E. rhusiopathiae as a facultative intracellular microorganism, which may represent a hazard for humans.

Erysipelothrix spp. comprise a group of small Gram-positive bacteria that can infect a variety of hosts including mammals, fish, birds, reptiles and insects. Among the eight Erysipelothrix species that have been described to date, only Erysipelothrix rhusiopathiae plays a major role in farmed livestock where it is the causative agent of erysipelas. E. rhusiopathiae also has zoonotic potential and can cause erysipeloid in humans with a clear occupational link to meat and fish industries. While there are 28 known Erysipelothrix serovars, over 80% of identified isolates belong to serovars 1 or 2. Vaccines to protect pigs against E. rhusiopathiae first became available in 1883 as a response to an epizootic of swine erysipelas in southern France. The overall vaccine repertoire was notably enlarged between the 1940s and 1960s following major outbreaks of swine erysipelas in the Midwest USA and has changed little since. Traditionally, E. rhusiopathiae serovar 1a or 2 isolates were inactivated (bacterins) or attenuated and these types of vaccines are still used today on a global basis. E. rhusiopathiae vaccines are most commonly used in pigs, poultry, and sheep where the bacterium can cause considerable economic losses. In addition, erysipelas vaccination is also utilized in selected vulnerable susceptible populations, such as marine mammals in aquariums, which are commonly vaccinated at regular intervals. While commercially produced erysipelas vaccines appear to provide good protection against clinical disease, in recent years there has been an increase in perceived vaccine failures in farmed animals, especially in organic outdoor operations. Moreover, clinical erysipelas outbreaks have been reported in animal populations not previously considered at risk. This has raised concerns over a possible lack of vaccine protection across various production species. This review focuses on summarizing the history and the present status of E. rhusiopathiae vaccines, the current knowledge on protection including surface antigens, and also provides an outlook into future directions for vaccine development.

Cutaneous leishmaniasis (CL) is an infectious dermatosis caused by a parasite (Leishmania spp) and transmitted to humans by the bite of a female sandfly (Phlebotomus spp). It is still endemic in more than 100 countries, representing an important public health problem worldwide. The clinical presentations of this disease are very polymorphic and sometimes very difficult to diagnose. Nearly 17 clinical variants of CL qualified as “atypical†or “unusual†were described; their prevalence is estimated at 2-5% of all CL. As rare as they are, these atypical clinical presentations of CL deserve to be well known by clinicians, particularly those in first line consultations and in endemic areas.

Gemcitabine is a commonly used chemotherapy for the treatment of various solid tumors as well as sarcomas and hematologic malignancies. Although side effects such as bone marrow suppression are well described, cutaneous side effects are less recognized. Certain gemcitabine-associated cutaneous reactions have been categorized under the umbrella terminology pseudocellulitis, including lipodermatosclerosislike and erysipeloid reactions, sclerodermalike changes, and radiation recall events.1, 2 Additionally, these reactions are often confused with other diagnoses, in particular, infectious cellulitis, which may subject patients to unnecessary treatment with antibiotics, hospitalizations, and interruption of chemotherapy. Given the widespread use of gemcitabine and the relatively few reported cases of associated acute lipodermatosclerosis (ALDS), we believe that the condition is underrecognized and underreported. We propose using a more specific diagnosis for cutaneous reactions to gemcitabine that will guide appropriate management. In this series, we report 4 cases of gemcitabine-associated ALDS-like eruptions and a literature review of 16 similar cases. To the best of our knowledge, this is the largest case series review reported for gemcitabine-associated ALDS-like eruptions.

36 cases of human infection with anthrax, manifested in various clinical forms, were registered in the territory of Yamalo-Nenets Autonomous District in 2016. Cutaneous anthrax was characterized by emergence of carbuncle, however objective difficulties of clinical diagnostics, associated with atypicality of clinical manifestations (erysipeloid form of the disease, crusting) were outlined. Clinical manifestations of oropharyngeal anthrax were severe febrile reaction, intoxication, edema of subcutaneous fat on face and neck, and lesions of mucous membranes. Intestinal anthrax was diagnosed in one patient and characterized by the acute onset followed by faintness, loss of appetite, vomiting, and abdominal pain. Based on the results of carried out investigations, put forward were the measures on optimization of approaches to clinical diagnostics of anthrax.

Background: \ud Erysipelothrix rhusiopathiae is a zoonotic pathogen that causes erysipeloid and is most frequently associated with exposure to domestic swine. Infection of native and prosthetic joints is a rarely reported manifestation.\ud \ud Case presentation: \ud We describe a case of E. rhusiopathiae prosthetic joint infection in a woman with a history of exposure to wild animals in the Canadian Arctic. Patient management involved a 1-stage surgical revision exchange with an antibiotic impregnated cement spacer and 6 weeks of intravenous penicillin G followed by 6 weeks of oral amoxicillin. Ten previously reported cases of E. rhusiopathiae joint infection are reviewed. Recent increases in mortality due to infection with this organism among host animal populations in the Canadian Arctic have generated concern regarding a potential increase in human infections. However, whole genome sequencing (WGS) of the organism was unable to identify a zoonotic origin for this case.\ud \ud Conclusions: \ud Consideration should be given to E. rhusiopathiae as a cause of joint infections if the appropriate epidemiologic and host risk factors exist. Expanded use of WGS in other potential animal hosts and environmental sources may provide important epidemiologic information in determining the source of human infections.

Erysipelothrix rhusiopathiae is the causative agent of erysipeloid in humans and of erysipelas in various animals, including bottlenose dolphins Tursiops truncatus, in which an infection has the potential to cause peracute septicemia and death. The purpose of this study was to evaluate the efficacy of using an off-label porcine (ER BAC PLUS®, Zoetis) E. rhusiopathiae bactrin in a bottlenose dolphin vaccination program by determining the anti-E. rhusiopathiae antibody levels in vaccinated dolphins over a 10 yr period. Serum samples (n = 88) were analyzed using a modified fluorescent microbead immunoassay from 54 dolphins, including 3 individuals with no history of vaccination and 51 dolphins with an average of 5 vaccinations, 3 of which had previously recovered from a natural E. rhusiopathiae infection. A mean 311-fold increase in the immunoglobulin G (IgG) antibody index was measured in a subsample of 10 dolphins 14 d after the first booster vaccination. Serum IgG antibody titers were influenced by number of vaccines received (r2 = 0.47, p < 0.05) but not by age, gender, history of natural infection, adverse vaccine reaction, vaccination interval or time since last vaccination. The commercial pig bacterin was deemed effective in generating humoral immunity against E. rhusiopathiae in dolphins. However, since the probability of an adverse reaction toward the vaccine was moderately correlated (p = 0.07, r2 = 0.1) with number of vaccines administered, more research is needed to determine the optimal vaccination interval.

Erysipelothrix rhusiopathiae is a zoonotic gram positive coccobacillus. It is rarely found in humans as an occupational pathogen that mainly infects animal handlers. There are three forms of human infection: localized erysipeloid, diffuse cutaneous form and lastly, bacteremia that could progress to infective endocarditis. We present a case of a 59-year-old male who was found to have E. rhusiopathiae bacteremia that was diagnosed as aortic valve endocarditis with severe aortic regurgitation. The patient was treated with ampicillin-sulbactam then transitioned to six weeks of intravenous ampicillin. This report summarizes a rare organism that causes a serious human infection and discusses its epidemiology, clinical presentation, diagnosis and treatment options.

Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is found ubiquitously in the environment. It is known to colonise a wide range of animals, most commonly farmed pigs, turkeys and hens, in which it can cause pathology. The disease swine erysipelas affects growing pigs, significantly impacting pork production, and so its early detection and control is economically important. Infection of humans with E. rhusiopathiae is primarily associated with occupational exposure and most often results in a localised skin infection called erysipeloid. More severe infections can cause serious illness and even death in both animals and humans. The accurate identification of E. rhusiopathiae is often dependent on the inclusion in the clinical history of relevant information regarding exposure. Since the bacterium is often mistaken for other species of Grampositive bacillus this ensures that appropriate differential tests are required. There are confirmed cases of E. rhusiopathiae infection in individuals with no reported animal exposure so it is possible that there are other modes of transmission. Regarding treatment regimens, E. rhusiopathiae is intrinsically resistant to vancomycin but susceptible to penicillins and carbapenems.

Erysipelothrix rhusiopathiae has an economic impact in animal husbandry by causing infection in swine, sheep and poultry. E. rhusiopathiae is present in the surface mucoid slime on fish, although fishes do not seem to be affected. Humans can get infected, maost often through occupational exposure and may suffer typical erysipeloid infection on exposed skin such as on hands and fingers, or deeper skin infections, and sometimes sepsis and endocarditis, associated with high case-fatality rate. We describe a case of aortic valve endocarditis caused by E. rhusiopathiae in a 59-year-old man who enjoyed fishing in his spare time.

Erysipelothrix Rhusiopathiae is a Gram-positive bacillus that is ubiquitous in nature. The bacterium is a zoonotic pathogen known to infect wild and domestic animals. Human infections, however, are uncommon and typically present with localised or generalised cutaneous lesions. Systemic infection in the form of bacteraemia with seeding to various organs is the least common form of the disease. Infections in humans tend to be associated with occupational exposure and close contact with animals. Clinical data of a 61-year-old male patient with Gram-positive bacilli bacteraemia and E.Rhusiopathiae-induced endocarditis are presented here. The patient presented with refractory congestive heart failure secondary to severe acute aortic regurgitation mandating surgical valve replacement. The described case has special clinical merit given the lack of fever and leukocytosis, absence of erysipeloid cutaneous manifestations and refractoriness to medical management. E. Rhusiopathiae should be considered in the differential diagnosis for Gram-positive bacilli bacteraemia and endocarditis. In the proper clinical setting, occupational exposure and animal contacts are helpful clues to raise suspicion for this bacillus. The high mortality associated with the pathogen should urge for early identification and initiation of antimicrobial treatment.

Objective The goal of this study was to characterize the epidmiological, geographic, and historical characteristics of erysipeloid outbreaks in the Republic of Armenia. Introduction Erysipeloid is a zoonotic bacterial infection transmitted to humans from animals. Symptoms include inflamed joints and skin; there is also a generalized type of the infection in which bacteria spread through the lymphatic and blood vessels, leading to the emergence of widespread skin lesions and the formation of secondary foci of infection in internal organs. Morbidity has no age or gender specifics; there is summer and autumn seasonality. The agent of the infection - Erysipelothrix rhusiopathiae can be found in many domestic and wild animals. Wild rodents and ectoparasites play an essential role in spreading the disease and serve as a source of infection contaminating the environment. Methods Tests are conducted on both national and Marz levels in Reference Laboratory Center of NCDC SNCO and Marz branch laboratories of Especially Dangerous, Zoonotic and Natural Foci Infections respectively. Tests for detection of E. rhusiopathiae and confirmation of epizootics are conducted on rodents and ectoparasites collected from their hair and nests from 373 sectors of Armenia. Tests include smear microscopy and a bioassay in which cultures from a suspension of rodent organs or an emulsion of ticks and fleas are injected into white mice to assess the presence of agent in the organs or parasites. Results Ten years of monitoring indicates that erysipeloid epizootics have been recorded annually in Armenia with a total number of 119 cases. The most outbreaks were recorded in 2011 when 26 cases were recorded while in 2009 there were 20. The lowest number of cases recorded was five in 2008. Kotayk, Aragatsotn and Lori Marzes have the least number of cases with only 1-3 recorded epizootics, while Vayk, Gegharkunik and Shirak Marzes are considered active foci with 5-7 cases reported. Microbiological analyses indicates that 80% of cultures were isolated from field mice, 13.3% from gamasid ticks, 4.2% from fleas and 2.5% from ixodid ticks. Conclusions The presence of E. rhusiopathiae is stable in Armenia. It is found among rodents, where the epidemiological situation remains unfavorable. Constant regular tests/analyses are required to prevent human and animal infection. There is a need to enhance the area of test sites and apply most up-to-date methods of analysis i.e. ELISA, PCR so that the live bioassays in mice can be halted.

Erysipelothrix rhusiopathiae is the causative agent of animal erysipelas and human erysipeloid. Previous studies suggested glyceraldehyde 3-phosphate dehydrogenase (GAPDH) plays a role in the pathogenesis of E. rhusiopathiae infection. We studied E. rhusiopathiae GAPDH interactions with pig vascular endothelial cells, fibronectin, and plasminogen. Recombinant GAPDH (rGAPDH) was successfully obtained, and it was shown that it plays a role in E. rhusiopathiae adhesion to pig vascular endothelial cells. Moreover, rGAPDH could bind fibronectin and plasminogen in a dose-dependent manner. To our knowledge, this is the first study demonstrating that a moonlighting protein plays a role in pathogenesis of E. rhusiopathiae infections. Electronic supplementary material The online version of this article (doi:10.1186/s13567-017-0421-x) contains supplementary material, which is available to authorized users.

Erysipelothrix rhusiopathiae is the causative agent of animal erysipelas and human erysipeloid. Some pathogenic bacteria are able to recruit host plasminogen and then use the plasminogen system for migration across tissue barriers or for nutritional demands during infection. However, there is no study on E. rhusiopathiae recruitment of plasminogen. SpaA has long been known to be a major protective antigen of E. rhusiopathiae, but its roles in virulence have not yet been well clarified. The aim of this study was to detect the activity of E. rhusiopathiae to recruit host plasminogen and evaluate the ability of SpaA to act as a receptor in the recruitment process. It was found that E. rhusiopathiae could recruit host plasminogen. SpaA could specifically bind host plasminogen. Anti-SpaA serum could significantly decrease the activity of E. rhusiopathiae to recruit plasminogen. In addition, this binding activity was lysine dependent. In conclusion, E. rhusiopathiae was able to recruit host plasminogen via SpaA. To our knowledge, this is the first report on E. rhusiopathiae recruitment of host plasminogen and the receptor in the process.

Les auteurs rapportent les caractéristiques épidémiologiques et cliniques de la forme érysipéloïde de leishmaniose cutanée ainsi que ses difficultés diagnostiques et thérapeutiques. Chez une patiente âgée de 44 ans, sans antécédents, a consulté pour une tuméfaction nasale inflammatoire évoluant depuis 4 mois. L'examen clinique a révélé un placard érythémateux, infiltré centrofaciale. Une antibiothérapie avec des soins locaux quotidiens n'ont pas entraîné une amélioration, voire l'extension de lésions sous anti-inflammatoire non stéroïdiens. Le diagnostic de leishmaniose cutanée a été confirmé par le frottis cutané. Un traitement par l'antimoniate de méglumine par voie intramusculaire a été instauré à la dose de 20 mg/kg par jour avec évolution favorable. La forme érysipéloïde de leishmaniose cutanée constitue une entité rare et inhabituelle entraînant souvent un retard diagnostique. Le diagnostic repose sur l'examen parasitologique direct, la recherche de l'ADN des leishmanies par PCR et sur l'examen histologique. Et il existe plusieurs options thérapeutiques. L'évolution est généralement favorable.Keywords: Leishmaniose cutamée, forme érysipéloide, antimoniate de méglumine

E. rhusiopathiae is the causative agent of erysipelas in animals and erysipeloid in humans, but its pathogenicity is poorly understood. To identify virulence factors associated with E. rhusiopathiae and screen engineered vaccine candidates, we used proteomics and transcriptomics to compare the highly virulent strain HX130709 with an isogenic avirulent derivative, HX130709a. 1,299 proteins and 1,673 transcribed genes were identified and 1,292 of the proteins could be associated with genes. In a comparison between HX130907 and HX130709a, 168 proteins and 475 genes exhibited differences in regulation level. Among these, levels for 61 proteins and transcripts were positively or negatively correlated. Gene Ontology (GO) analysis suggests that many of the down-regulated proteins in the attenuated strain have catalytic or binding functions. Potential protein-protein interactions suggest that some of the down-regulated proteins may regulate PTS, GMP synthase and ribosomal proteins. Morphological results showed that HX130709 and HX130709a have similar colony and capsule morphology. Growth curves and pyruvate measurements suggest that TCA cycle and saccharide phosphorylation levels were decreased and gluconeogenesis was increased in HX130709a. Our study confirms that SpaA and neuraminidase, but not hyaluronidase and capsule, are associated with virulence in E. rhusiopathiae. We conclude that the virulence of E. rhusiopathiae may be associated with slow reactions of the TCA cycle and down-regulation of selected proteins.

Gemcitabine is a chemotherapeutic agent whose cutaneous toxicities are easily mistaken for infections. We describe 2 patients, 1 with gemcitabine-induced radiation recall dermatitis and 1 with gemcitabine-related erysipeloid reaction, who received misdiagnoses of infectious cellulitis and were given empirical antibiotics. Recognition of these syndromes is important to avoid unnecessary antibiotic use.

DISCUSSION Erysipelothrix rhusiopathiae (formerly known as E. insidosa) is a nonmotile, non sporulating, nonencapsulated gram-positive microarophilic bacillus. This slowgrowing organism tends to become pleomorphic and gram negative on prolonged incubation ~, and it can be mistaken for Haernophilus in)quenzae on Gram smear. Poultry, fish, crab, and swine are frequently infected. Direct swine to man contact is the most significant mode of acquisition, whereas direct perSon-to-person transmission is rare. Erysipeloid is usually an occupational disease of butchers and fishermen. Typically, one to seven days after an exposure to meat or fish products, a red maculopapular lesion appears. The lesion progresses by centrifugal spreading and central clearing, taking on a target-shaped appearance with a normal center, a bluish ring, and sometimes a red peripheral halo. The differential diagnosis includes H. influenzae cellulitis and erysipelas. Hoeprich:' states, "The clinical appearance of erysipeloid is unique; once seen, the disease will always be recognized when encountered again." Usually there is no fever or leukocytosis, and the disease subsides spontaneously in three weeks. However, septicemia, septic arthritis, and endocarditis are occasional complications. The appearance of the skin lesion in this case was typical. We recovered E. rhusipathiae from an aspirate of the center of the lesion, but it is usually recommended to obtain the specimen from the margin? ~' We found only one other case report in the pediatric literature? The fever and elevated blood count in our patient suggest a more severe involvement in this age group. The prognosis is good in adults with or without treatment, but penicillin therapy is advised3; we believe that this recommendation is especially warranted in infants.

Les auteurs rapportent les caractéristiques épidémiologiques et cliniques de la forme érysipéloïde de leishmaniose cutanée ainsi que ses difficultés diagnostiques et thérapeutiques. Chez une patiente âgée de 44 ans, sans antécédents, a consulté pour une tuméfaction nasale inflammatoire évoluant depuis 4 mois. L'examen clinique a révélé un placard érythémateux, infiltré centrofaciale. Une antibiothérapie avec des soins locaux quotidiens n'ont pas entraîné une amélioration, voire l'extension de lésions sous anti-inflammatoire non stéroïdiens. Le diagnostic de leishmaniose cutanée a été confirmé par le frottis cutané. Un traitement par l'antimoniate de méglumine par voie intramusculaire a été instauré à la dose de 20 mg/kg par jour avec évolution favorable. La forme érysipéloïde de leishmaniose cutanée constitue une entité rare et inhabituelle entraînant souvent un retard diagnostique. Le diagnostic repose sur l'examen parasitologique direct, la recherche de l'ADN des leishmanies par PCR et sur l'examen histologique. Et il existe plusieurs options thérapeutiques. L’évolution est généralement favorable.

Dear Editor, We would like to discuss on the report on “Zosteriform cutaneous leishmaniasis” [1] Ramot et al. reported that “dermoscopy has proven to be an accessible and easy tool to diagnose such atypical presentation of cutaneous leishmaniasis, and dermatologists in endemic areas should be familiar with its typical dermoscopic features” [1]. In fact, cutaneous leishmaniasis is an important tropical dermatological infection. To diagnose it, the practitioner has to perform laboratory investigation to confirm the diagnosis [2]. The use of “in vivo confocal microscopy” is presently mentioned as a new noninvasive tool to diagnose cutaneous leishmaniasis [3,4]. As noted by Taheri et al., the appearance by dermoscopy of cutaneous leishmaniasis is varied [4]. The “paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid” appearance of cutaneous leishmaniasis is not common and can be easily missed. The limitation in diagnosis seems not due to limitation of the dermoscopy toll but the awareness of the practitioner on the disease, cutaneous leishmaniasis [5]. In endemic areas of cutaneous leishmaniasis, use of dermoscopy in the investigation of any cases of zosteriform cutaneous lesions to rule out cutaneous leishmaniasis is suggested.

Erysipelothrix rhusiopathiae has been recognised as a cause of infection in animals and man since the late 1880s. It is the aetiological agent of swine erysipelas, and also causes economically important diseases in turkeys, chickens, ducks and emus, and other farmed animals such as sheep. The organism has the ability to persist for long periods in the environment and survive in marine locations. Infection in man is occupationally related, occurring principally as a result of contact with animals, their products or wastes. Human infection can take one of three forms: a mild cutaneous infection known as erysipeloid, a diffuse cutaneous form and a serious although rare systemic complication with septicaemia and endocarditis. While it has been suggested that the incidence of human infection could be declining because of technological advances in animal industries, infection still occurs in specific environments. Furthermore, infection by the organism may be under-diagnosed because of the resemblance it bears to other infections and the problems that may be encountered in isolation and identification. Diagnosis of erysipeloid can be difficult if not recognised clinically, as culture is lengthy and the organism resides deep in the skin. There have been recent advances in molecular approaches to diagnosis and in understanding of Erysipelothrix taxonomy and pathogenesis. Two PCR assays have been described for the diagnosis of swine erysipelas, one of which has been applied successfully to human samples. Treatment by oral and intramuscular penicillin is effective. However, containment and control procedures are far more effective ways to reduce infection in both man and animals.

Cutaneous metastasis is a phenomenon that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. The primary malignant tumor that most commonly metastasizes to the skin in women is breast cancer, which can be manifested through papulonodular lesions, erysipeloid or sclerodermiform infiltration, en cuirasse. We report the case of a female patient, 78 years old, with papular, scaly and confluent lesions in the right breast for one year, progressing to edema and skin infiltration, reduction of breast volume and plaque en cuirasse, and similar lesions in the contralateral breast and abdomen for four months. The pathological diagnosis was invasive ductal breast carcinoma with Paget-like foci, epidermal skin metastases and lymphatic embolization. A metástase cutânea é conseqüente à disseminação do tumor por embolização linfática, vascular, implantação direta durante cirurgias ou envolvimento da pele por contiguidade. Em mulheres, o tumor maligno primário que mais comumente metastatiza para a pele é o de mama, que tanto pode se expressar por lesões tumorais papulonodulares, infiltração erisipelóide ou esclerodermiforme, em couraça. Relatamos o caso de paciente do sexo feminino, 78 anos, apresentando lesões nodulares, descamativas e confluentes em mama direita, evoluindo com edema e infiltração cutânea, com redução do volume mamário e placa endurecida ilimitada. Invasão da mama contralateral e abdome ocorreram 4 meses após o início dos sinais. O diagnóstico histopatológico foi de adenocarcinoma ductal invasivo de mama com focos pagetóides epidérmicos e embolização linfática.

Erysipelothrix rhusiopathiae, a pleomorphic gram-positive bacillus, is found widely in nature or as a commensal pathogen. It infects domestic animals such as swine, which may be the major reservoir of the organism.E. rhusiopathiaeis primarily an occupational illness; 89% of the cases are linked to high-risk epidemiological situations. Humans that are infected by this bacillus typically present with one or a combination of the following symptoms: localized skin lesion (erysipeloid), diffuse cutaneous eruptions with systemic symptoms, or bacteremia, which is often followed by endocarditis. We report a case ofE. rhusiopathiaebacteremia that was present without severe clinical illness such as endocarditis, arthritis, or skin lesions. The patient was a 64-year-old male with a complicated past medical history including subclinical alcoholic liver disease. Penicillin-G therapy completely resolved the patients bacteremia. The case presented has exceptional clinical merit due to 2 key factors: the patient does not fit the occupational demographic typically affected by this bacterium, and the patient presented with subclinical septicemia, which has a high correlation with fatal endocarditis. This case brings a new prospective toE. rhusiopathiaebacteremia.

Resumen —El erisipeloide es una infeccion ocupacional causada por Erysipelothrix rhusiopathiae. El organismo es ubicuo, pero el reservorio mas comun es el cerdo. Existen tres formas clinicas principales descritas en humanos: el erisipeloide, la forma cutanea difusa y la sistemica. Es importante considerar la posible existencia de endocarditis asociada. Presentamos el caso de una forma cutanea difusa de erisipeloide en un varon de 63 anos, ganadero, que presentaba lesiones cutaneas anulares en dorso de mano derecha y region dorsolumbar.

Erysipelothrix rhusiopathiae is a Gram-positive bacillus that causes infections primarily in animals. In humans, this bacterium usually causes localized cutaneous infections called erysipeloid. Here we report a case of pneumonia with isolation of E. rhusiopathiae from bronchoalveolar lavage and sputum. To our knowledge, this is the first report of a pneumonia case caused by E. rhusiopathiae confirmed by culture.

Summary We report the epidemiological and clinical characteristics of the erysipeloid form of cutaneous leishmaniasis as well as its diagnostic and therapeutic challenges. Case report A 63-year-old woman, with no medical history, presented with a one-month history of erythematous nasal swelling. The lesion appeared after an accidental trauma. Erythematous infiltrative plaque was noted on the center of the face. There were also crust formations on the traumatic region. Despite local treatment and oral antibiotherapy, there was no improvement. The diagnosis of cutaneous leishmaniasis was confirmed by positive skin smears. Histopathological examinations of a skin biopsy showed no malignancy. The patient was treated intramuscularly with 10 mg/kg per day systemic meglumine antimoniate with partial regression of symptoms. Conclusion The erysipeloid type is a rare and unusual presentation of cutaneous leishmaniasis that often causes late diagnosis. Diagnosis is confirmed by the demonstration of the parasite by skin smear, histopathological examination and polymerase chain reaction. There are various therapeutic options. The evolution is generally favourable.

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.

Erysipelothrix rhusiopathiae is known as a pathogen of occupational diseases or a zoonosis. We report a case of E. rhusiopathiae peritonitis in a 50-yr-old male undergoing continuous ambulatory peritoneal dialysis (CAPD). He was suffered from mild abdominal pain with a distinctive erysipeloid skin lesion. E. rhusiopathiae was considered to be introduced through a lacerated wound on his hand when he was exposed to contaminated materials. He was treated successfully with a first generation cephalosporin. To our knowledge, CAPD peritonitis due to E. rhusiopathiae is very rare, and this is a report of the first case in Asia.

Cutaneous leishmaniasis is known for its wide clinical spectrum. The nose is one of the usual sites where the disease can present in many forms, such as psoriasiform plaques, furunculoid nodules, lupoid plaques, and erysipeloid or mucocutaneous types. We present a new morphology, i.e. rhinophyma-like plaque in an elderly male patient who presented with a large infiltrated plaque involving his nose and the adjoining area of his upper lip. It appeared to be rhinophyma of the nose but was diagnosed as cutaneous leishmaniasis after the demonstration of leishmania parasites in a skin smear preparation; he was treated satisfactorily with antimonials.