[Erysipeloid cutaneous leishmaniasis: about a clinical observation]

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.

Erysipeloid--case report

Erysipeloid is an acute, bacterial infection of traumatized skin in an individual who was in direct contact with meat or other animal products contaminated with a gram-positive bacillus Erysipelothrix rhusiopathiae. We present a case of a 50-year-old housewife whose hobby was fishing, with a reddish, tender patch on the fifth finger and dorsum of the left hand, which developed a week after she had sustained an injury while boning the fish. The patient was treated with orally administered penicillin V 1,500,000 IU t.i.d. for 7 days, with complete resolution.

Erysipeloid cutaneous leishmaniasis: treatment with a new, topical, pure herbal extract

Fourteen consecutive cases of erysipeloid cutaneous leishmaniasis were seen and evaluated. There were 13 females and one male patient with a mean age of 59 years. Diagnosis was based on clinical grounds and the presence of amastigotes in the lesions. Patients were divided into acute and chronic groups, with chronicity being defined as a disease duration of more than a year. All cases were treated with a fresh preparation of a herbal mixture, namely "Z-HE". The paste was applied once daily for 5 consecutive days and thereafter every 2 weeks, as needed, for a maximum period of 3 months. Two patients didn't appear for their regular follow up, the remaining 12 cases were followed up for more than a year after termination of therapy. Eleven (92%) of patients had complete healing in a matter of 1 to 7 months with no relapse after 12 months of follow up. In spite of a successful initial clinical response, the remaining one patient with the acute type of ECL had a subsequent relapse. Otherwise the acute and chronic cases had similar responses to therapy and outcome. No drug related side effect was noted. The high success rate, low cost, ease of preparation, and lack of toxicity makes "Z-HE" a promising new drug. Further investigations are needed to illuminate its mechanism(s) of action and also controlled trials are recommended to confirm its efficacy.

[Cutaneous manifestations of erysipeloid septicemia]

BACKGROUND

Rouget du porc, or swine erysipelas, usually occurs in man as Rosenbach's erysipeloid. Septicemic forms are more uncommon and can be associated with dermal involvement far from the site of inoculation. We report a case in a patient given corticosteroid therapy for systematic lupus.

CASE REPORT

A 50-year-old farmer was seen with fever, infiltrative erythema of the long finger and dorsal lesions on the ring finger which developed after a skin lesions caused by a duck. The diagnosis of septicemic rouget du porc was made after isolating the germ from blood cultures. There was no associated endocarditis. Fever and skin lesions totally regressed after treatment with ceftriaxone.

DISCUSSION

The diagnosis of erysipeloid was supported by epidemiologic arguments and characteristic clinical features. The corticosteroid therapy was probably a favoring factor for development of septicemia. Positive diagnosis is usually obtained from blood culture but the germ can be isolated from skin biopsies at the site of inoculation. Our patient was free of endocarditis which should always be suspected. Endocarditis is frequent and often fatal. Intravenous high-dose penicillin G is recommanded treatment.

Erysipelothrix rhusiopathiae: an occupational pathogen

Erysipelothrix rhusiopathiae is a nonsporulating, gram-positive, rod-shaped bacterium which was identified more than 100 years ago as the etiologic agent of swine erysipelas. Since then, it has been found to cause infection in several dozen species of mammals and other animals. Humans become infected through exposure to infected or contaminated animals or animal products. By far the most common type of human infection is a localized, self-limited cutaneous lesion, erysipeloid. Diffuse cutaneous and systemic infections occur rarely. Approximately 50 cases of endocarditis have been reported; all but one recent case have involved native valves. The organism may be isolated from biopsy or blood specimens on standard culture media. It is identified by morphology, lack of motility, and biochemical characteristics; identification may be confirmed by the mouse protection test. It is susceptible to penicillins, cephalosporins, erythromycin, and clindamycin, but it is often resistant to many other antibiotics, including vancomycin, a drug frequently used in empiric therapy for infections due to gram-positive bacteria.

Erysipeloid

Erysipelothrix infections have been a well-known clinical entity for over a century. Only a few cases have been studied histologically, and the agent has rarely been cultured from infected patients. We present here a case of erysipeloid of Rosenbach, in which histologic study and electron microscopy document the presence of microorganisms. We also present a complete review of the clinical and pathologic features of Erysipelothrix infections and their treatment. Our observations suggest that Erysipelothrix rhusiopathiae is capable of producing L forms that may revert to a bacterial form and produce sepsis at a later time.

[On the dermal form of erysipeloid in slaughter house workmen (author's transl)]

We described the incidence and clinical course of the dermal form of erysipeloid in 125 workmen of a central slaughter-house in Bukarest. The highest frequency of the illness was observed in summer and autumn (83 cases), especially in the group aged 21 to 50 years (96 cases). Most of the cases of erysipeloid are occupationally acquired by various persons engaged in handling meat, often butchers and workmen in meat, skin, and bone processing factories. The most frequent localisation of the process was at the index fingers and thumbs of both hands.

[Modification of a rheumatoid model disease using a benzopyron preparation]

The influence of a benzopyrone-preparation on the process of an experimental erysipelas in the rat, an animal model for the human rheumatoid arthritis, was studied. By plethysomometric determination of the paw volume it was shown that the swelling of the paw was significantly smaller in the benzopyrone-group than in the control-group. Furthermore it was observed that the administration of benzopyrones significantly reduced cornea-oedemas, a characteristic of the erysipelas model. The reduction of body weight, occurring during erysipelas disease, is not significantly improved by benzopyrone administration. The mortality, which is much smaller in the benzopyrone-group (30%) than in the matened control group (60%), demonstrates the good tolerance of the drug. The revealed results are described and the influence of benzopyrones on this rheumatoid disease is discussed.