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Clinical Summary

Erysipeloid, also known as “fish handler’s disease,” is a bacterial skin infection caused by Erysipelothrix rhusiopathiae. This condition is frequently seen in people who handle raw meat, fish, and shellfish. The offending organism enters the body through a break in the skin and causes a local infection within 2 to 7 days. Lesions are characterized by an edematous central purplish-red area, surrounded first by central clearing and then circumscribed by an advancing raised, erythematous ring. The area is usually pruritic and painful and may be associated with fever, malaise, and regional lymphadenopathy.

FIGURE 16.129

Erysipeloid Envenomation. Typical appearance of Erysipelothrix rhusiopathiae skin infection. (Photo contributor: Paul S. Auerbach, MD; reprinted with permission from Auerbach PS (ed). Wilderness Medicine: Management of Wilderness and Environmental Emergencies. 3rd ed. St. Louis, MO: Mosby-Year Book; 1995. Copyright © Elsevier.)

Management and Disposition

If left untreated, erysipeloid will usually resolve spontaneously in about 3 weeks. Skin infections may be treated with penicillin, a first-generation cephalosporin, or a macrolide antibiotic such as erythromycin. If severe infection occurs, it should be treated with appropriate broad-spectrum antibiotics.

Pearls

  1. A history of occupational or recreational exposure to fish or shellfish is the key to diagnosis.

  2. E rhusiopathiae is usually resistant to aminoglycoside antibiotics. These should be avoided.

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