zoonoses and communicable diseases common to ... - PAHO/WHO

ANIMAL ERYSIPELAS AND HUMAN ERYSIPELOID 15Occurrence in Man: Human erysipeloid is for the most part an occupational diseaseaffecting workers in slaughterhouses and commercial fowl-processing plants,fishermen and fish-industry workers, and those who handle meat (particularly pork)and seafood products. It is not a notifiable disease and little is known of its incidence.In the former Soviet Union, nearly 3,000 cases were reported between 1956and 1958 in 13 slaughterhouses in the Ukraine, and 154 cases were reported in theTula region in 1959. From 1961 to 1970, the U.S. Centers for Disease Control andPrevention confirmed the diagnosis of 15 cases in the US. A few isolated cases haveoccurred in Latin America. Some epidemic outbreaks have occurred in the formerSoviet Union, in the United States, and on the southern Baltic coast (see section onsource of infection and mode of transmission).Occurrence in Animals: The disease in swine (rose disease, swine erysipelas) isimportant in Asia, Canada, Europe, Mexico, and the United States. It has also beenseen in Brazil, Chile, Guatemala, Guyana, Jamaica, Peru, and Suriname, but theincidence is low in these countries. However, the disease seems to be increasing inimportance in Chile (Skoknic et al., 1981). Polyarthritis in sheep due to E. rhusiopathiaehas been described in many sheep-breeding areas of the world.The Disease in Man: The cutaneous form is known by the name erysipeloid todistinguish it from erysipelas caused by a hemolytic streptococcus. The incubationperiod ranges from one to seven days. Erysipeloid localizes primarily in the handsand fingers and consists of an erythematous, edematous skin lesion with violet colorationaround a wound (the inoculation point) that may be a simple abrasion.Arthritis in the finger joints occurs with some frequency. The patient experiences aburning sensation, a pulsating pain, and at times an intense pruritus.The course of the disease is usually benign and the patient recovers in two to fourweeks. If the infection becomes generalized, septicemia and endocarditis may causedeath. In the US, most cases reported in recent years have been the septicemic formgenerally associated with endocarditis (McClain, 1991). An analysis of 49 cases ofsystemic infection occurring over a 15-year period (Gorby and Peacock, 1988) foundthat E. rhusiopathiae has a peculiar tropism toward the aortic valve. In 40% of thecases, there was a concomitant cutaneous erysipeloid lesion and fatality was 38%. Inslightly more than 40%, there was a history of prior valvular disease. Only 17% had ahistory that could be characterized as involving a compromised immune system. Theprincipal symptoms were fever (92%), splenomegaly (36%), and hematuria (24%).Nelson (1955) did not record any cases of endocarditis among 500 cases oferysipeloid in the US, which would indicate that the systemic disease is rather rare.The first case of endocarditis in Brazil was described by Rocha et al. (1989). Thedisease began with an erysipeloid and progressed to septicemia and endocarditis.The patient was an alcoholic with a prior history of aortic insufficiency, who hadpricked himself with a fishbone.The preferred treatment is penicillin, to which E. rhusiopathiae is very sensitive.Treatment with cephalosporins can be substituted for patients who are allergic topenicillin (McClain, 1991).The Disease in Animals: Many species of domestic and wild mammals and birdsare hosts to the etiologic agent. In several animal species, E. rhusiopathiae producespathologic processes. Swine are the most affected species.