What is Erisipeloid?
Erysipeloid is a bacterial infection from the group of zoonoses with moderate general toxic effects and predominant damage to the skin and joints.
Erysipeloid is ubiquitous and quite often carries the features of a professional pathology. Often sick butchers, cooks, hunters, livestock breeders, fishermen, housewives. Sporadic cases are usually recorded, although outbreaks are described.
Causes of Erisipeloid
The causative agent of erisipeloid is a gram-positive immobile non-spore-forming bacillus Erysipelothrix rhusiopathiae of the family Corynebacteriaceae. Two serovars of the pathogen are known: pork (suis) and murine (murisepticum), circulating respectively among domestic or wild animals.
The reservoir and sources of infection are many types of animals (pigs, sheep, cattle, dogs, chickens, ducks, rodents, fish, crayfish, etc.) that retain the pathogen indefinitely. The most common source is pigs suffering an acute illness. Mice and rats that contaminate meat carcasses in meat processing plants and during storage can play a role in the spread of infection. A sick person is not a danger to others.
The transmission mechanism is pin. A person becomes infected when a pathogen enters the damaged skin of his hands. Sick animals secrete the pathogen with urine and feces, infecting the environment and various objects. The transmission factors are the skin and meat of sick animals contaminated with pathogen hay, soil, water. The natural susceptibility of people is low. A rise in the incidence in the summer-autumn season is noted.
Pathogenesis during Erisipeloid
The causative agent enters the human body through microtrauma of the skin, most often the fingers. In the dermis, a focus of infection is formed, a local inflammatory process develops with the seizure of interphalangeal joints. Generalized forms are rarely observed, with the dissemination of bacteria through the lymphatic and blood vessels, leading to the occurrence of common skin lesions and the formation of secondary foci of infection in the internal organs. In the area of the affected areas of the skin, serous inflammation develops with perivascular lymphocytic infiltration, impaired microcirculation and outflow of lymph. The mechanisms of chronization of erisipeloid are not well understood.
Symptoms of Erisipeloid
The incubation period varies from 1 to 7 days. There are four clinical forms of erysipeloid: cutaneous, cutaneous-articular, generalized and anginal form.
Skin form. Meet most often. Against the background of normal or subfebrile body temperature and mild manifestations of other signs of intoxication, burning sensation and itching occur at the site of the entrance gate of the infection, and then erythema appears. Most often it is localized on the skin of fingers or hands. Gradually increasing in size, erythema can capture the skin of the entire finger, and vesicles with serous or serous-hemorrhagic contents sometimes appear on its background. The skin temperature in the affected area is slightly elevated or normal. Often the phenomena of regional lymphangitis and lymphadenitis develop. In the dynamics of the disease, erythema pales, in its place peeling of the skin occurs, peripheral edema disappears. The skin form of the disease lasts an average of about 10 days.
Skin-articular form. It is distinguished by the simultaneous development of erythema and arthritis of regional interphalangeal joints. The latter are manifested by a fusiform swelling of the joints, pain, limitation of movement in them. Usually, the disease lasts about 2 weeks, but in some cases chronic relapsing arthritis with joint deformity may develop.
Generalized form. Rarely observed. High fever, severe intoxication symptoms, the development of hepatolienal syndrome and the appearance of a large-spotted or erythematous rash in various areas of the skin are characteristic. Arthritis, endocardial damage, meningitis, pneumonia, and other secondary focal manifestations of infection are possible.
Angina form. It can occur when eating infected foods – a clinic of acute tonsillitis (tonsillitis) with erythema on the skin. The diagnosis is confirmed by the isolation of the pathogen from the biopsy skin.
Complications are more often recorded in a generalized form; possible meningitis, pneumonia, endocarditis, sepsis.
Diagnosis of Erisipeloid
The disease should be distinguished from erysipelas, arthritis of various etiologies, panaritiums, exudative polymorphic erythema, various dermatitis, in severe cases – from sepsis.
The causative agent of the disease can be isolated from the blood with a generalized infection or from vesicles formed in the skin form against the background of erythema. Serological methods are used (RA, RNGA), as well as a biological test on white mice. In most cases, special research methods for erisipeloid are practically not used, and the diagnosis is established on the basis of clinical and epidemiological data.
The basis is antibacterial agents. The first-line drug is benzylpenicillin (6 million units / day or more), the second-line drug is doxycycline (0.2 g on the first day, followed by 0.1 g / day). As alternative agents, macrolides, cephalosporins of the 1st and 2nd generations can be used. The course of antibiotic therapy is 7-10 days. According to indications, detoxification, antihistamines, anti-inflammatory drugs and physiotherapeutic procedures are prescribed.
For the prevention of relapse, intramuscular injections of benzathine benzylpenicillin + benzylpenicillin procaine are administered in doses of 1.5 million units once every 3 weeks for 6–12 months.