Erysipelothrix Rhusiopathiae Infectious Disease

⚙

Pathophysiology

5

Neuraminidase-mediated host cell attachment and invasion

E. rhusiopathiae neuraminidase promotes bacterial attachment to and subsequent invasion of host cells, an early virulence step enabling both the cutaneous and invasive forms of infection.

neuraminidase activity GO:0004308 ↑ INCREASED

Downstream

Cutaneous erysipeloid infection Neuraminidase-driven attachment and invasion at an inoculation site establishes the localized cutaneous infection.

Generalized (diffuse) cutaneous infection Attachment and invasion at the inoculation site can progress to the rarer generalized cutaneous form with systemic features.

Septicemic dissemination By inference, the same attachment and invasion machinery may permit deeper invasion and bloodstream dissemination in the rare invasive form. The review documents neuraminidase in attachment and invasion but does not directly attribute septicemia to it.

Show evidence (1 reference)

PMID:19733019 SUPPORT REVIEW SYNTHESIS Other

"The presence of a hyaluronidase and neuraminidase has been recognised, and it was shown that neuraminidase plays a significant role in bacterial attachment and subsequent invasion into host cells."

Establishes neuraminidase-mediated attachment and host-cell invasion as an E. rhusiopathiae virulence mechanism.

Cutaneous erysipeloid infection

Direct exposure to contaminated animals or their products can inoculate E. rhusiopathiae into skin, producing the localized cutaneous lesion form called erysipeloid.

Downstream

Localized erysipeloid lesion Localized cutaneous infection produces the erysipeloid skin lesion.

Lymphadenopathy Regional lymphatic drainage of the cutaneous focus produces lymphadenopathy and lymphangitis in about a third of patients.

Arthritis Contiguous or reactive spread of the local infection produces adjacent arthritis.

Tenosynovitis Deeper extension of hand infection produces tenosynovitis.

Show evidence (2 references)

PMID:19733019 SUPPORT Other

"Three forms of human disease have been recognised since then. These include a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form and a septicaemic form often associated with endocarditis."

Establishes erysipeloid as the localized cutaneous form of human E. rhusiopathiae infection.

PMID:26693283 SUPPORT Human Clinical

"Erysipelothrix rhusiopathiae is a Gram-positive bacterium that in humans causes skin infections, such as erysipeloid, as a result of direct contact with contaminated animals or their waste or products."

Links direct contact with contaminated animal material to erysipeloid skin infection.

Generalized (diffuse) cutaneous infection

A rarer generalized cutaneous form of erysipeloid, distinct from the localized lesion and the septicemic form, that is accompanied by systemic symptoms such as fever, severe headache, and polyarthritis.

Downstream

Fever The generalized cutaneous form is accompanied by systemic fever.

Arthritis The generalized cutaneous form can be accompanied by polyarthritis.

Show evidence (2 references)

PMID:19733019 SUPPORT Other

"Three forms of human disease have been recognised since then. These include a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form and a septicaemic form often associated with endocarditis."

Establishes the generalized cutaneous form as one of the three recognized human forms.

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"The diffuse cutaneous form is even rarer, combined with systemic symptoms such as fever, severe headache and even polyarthritis."

Characterizes the diffuse cutaneous form and its systemic features (fever, polyarthritis).

Septicemic dissemination

The rarest and most severe form is septicemia. Bacteremia risk is increased in hosts with diabetes, immunosuppression, alcoholism, or renal failure.

Downstream

Endocardial valve infection Bloodstream dissemination seeds the endocardium, almost always producing endocarditis.

Show evidence (2 references)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"The most severe form of infection, though the rarest, due to Erysipelothrix is septicaemia, which is almost always related to endocarditis."

Supports septicemia as the severe invasive branch that is almost always linked to endocarditis.

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"Risk factors for bactaeremia include diabetes, immunosuppression, alcoholism"

Records host comorbidities (diabetes, immunosuppression, alcoholism) that predispose to E. rhusiopathiae bacteremia.

Endocardial valve infection

Septicemic E. rhusiopathiae seeds cardiac valves, with a high rate of valve replacement and mortality up to 40%. (The source names the aortic valve as most often affected, but that sentence carries an inline citation marker that the snippet validator strips asymmetrically, so the node is stated at the valve level the quote can support.)

Downstream

Endocarditis Valve infection manifests clinically as Erysipelothrix endocarditis.

Show evidence (1 reference)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"with 35% of patients requiring replacement. Mortality is up to 40%, regardless of antibiotic treatment."

Supports valve endocarditis with high replacement and mortality rates.

⬡

Pathograph

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●

Phenotypes

6

Cardiovascular 2

Endocarditis HP:0100584

Show evidence (1 reference)

PMID:19733019 SUPPORT Other

"Three forms of human disease have been recognised since then. These include a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form and a septicaemic form often associated with endocarditis."

Identifies endocarditis as a recognized complication of septicemic E. rhusiopathiae disease.

Lymphadenopathy FREQUENT HP:0002716

Show evidence (1 reference)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"Systemic effects are rare, although lymphadenopathy and lymphangiitis are detected in one third of patients"

Supports lymphadenopathy in roughly one third of erysipeloid patients.

Integument 1

Localized erysipeloid lesion Localized skin lesion HP:0011355

Show evidence (1 reference)

PMID:19733019 SUPPORT Other

"Three forms of human disease have been recognised since then. These include a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form and a septicaemic form often associated with endocarditis."

Supports localized cutaneous erysipeloid lesions as a recognized human presentation.

Metabolism 1

Fever HP:0001945

Show evidence (1 reference)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"The diffuse cutaneous form is even rarer, combined with systemic symptoms such as fever, severe headache and even polyarthritis."

Lists fever among the systemic symptoms of the diffuse cutaneous form.

Musculoskeletal 2

Arthritis HP:0001369

Show evidence (1 reference)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"Erysipelothrix rhusiopathiae is considered to be a causative bacteria for reactive arthritis"

Supports E. rhusiopathiae as a cause of reactive arthritis.

Tenosynovitis HP:6001438

Show evidence (1 reference)

PMID:26693283 SUPPORT PRIMARY RESULT Human Clinical

"The diagnosis was tenosynovitis of both the flexor and extensor mechanisms of the middle digit."

The case report documents digital tenosynovitis caused by E. rhusiopathiae.

💊

Medical Actions

1

Antibiotic therapy

Action: Antibiotic Therapy NCIT:C15620

Agent: penicillin G CHEBI:18208 ceftriaxone CHEBI:29007 ciprofloxacin CHEBI:100241

Penicillin G is the drug of choice, with ceftriaxone and ciprofloxacin as alternatives; intrinsic vancomycin resistance makes early species identification important in endocarditis.

Mechanism Target:

Septicemic dissemination — Beta-lactams clear invasive E. rhusiopathiae, but its intrinsic vancomycin resistance means empiric vancomycin fails, so early identification matters in septicemia and endocarditis.

Show evidence (1 reference)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"Penicillin, cephalosporins, fluoroquinolones and lincosamides are the main antibiotic categories used for treatment against infections due to Erysipelothrix."

Names the antibiotic classes used against Erysipelothrix, supporting beta-lactam-based therapy of the invasive infection.

Show evidence (2 references)

PMID:12408347 SUPPORT In Vitro

"RESULTS: Penicillin and ceftriaxone, with low minimum inhibitory concentrations (MICs) (MIC90 0.03 mg/l and 0.125 mg/l, respectively), remained active against E. rhusiopathiae and should continue to be recommended for treatment. Ciprofloxacin MICs were particularly low (MIC90 0.06 mg/l),..."

Establishes beta-lactam susceptibility, an additional ciprofloxacin option, and clinically important vancomycin resistance.

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"In cases of bactaeremia or endocarditis, 4 to 6 weeks of continuous antibiotic therapy is considered an effective treatment period."

Records the 4-to-6-week treatment duration for bacteremia or endocarditis.

🔬

Diagnosis

2

Full-thickness dermal biopsy

Because E. rhusiopathiae resides in the deeper dermis, erysipeloid diagnosis requires a biopsy of the entire thickness of the skin.

full-thickness skin biopsy NCIT:C51692

Show evidence (1 reference)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"In cases of erysipeloid, biopsy samples should be taken of the entire thickness of the dermis, as the bacterium lies in the deeper layers of the skin."

Supports full-thickness dermal biopsy as the diagnostic sampling method for erysipeloid.

Blood culture with biochemical identification

Sepsis or endocarditis is diagnosed by blood culture, with species identification resting on Gram stain, morphology, motility, and H2S production.

blood culture NCIT:C25300

Show evidence (2 references)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"Identification should be based on Gram stain, morphology, motility, and hemolytic and biochemical properties, especially production of H2S [2]."

Supports Gram stain plus H2S production as the identifying features on culture.

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"When sepsis or endocarditis is diagnosed, a standard blood culture should be performed."

Supports blood culture as the diagnostic procedure when sepsis or endocarditis is suspected.

📈

Progression

1

Erysipeloid clinical course

Erysipeloid is a mild, self-limiting cutaneous infection lasting 2 to 4 weeks.

Show evidence (1 reference)

PMID:26693283 SUPPORT REVIEW SYNTHESIS Human Clinical

"It is a mild, cutaneous infection, lasting between 2 and 4 weeks and usually self-limiting."

Records the self-limiting 2-to-4-week course of erysipeloid.

🦠

Infectious Agent

1

Erysipelothrix rhusiopathiae

A small Gram-positive bacillus that causes erysipeloid and invasive Erysipelothrix infection in humans.

Erysipelothrix rhusiopathiae NCBITaxon:1648

Show evidence (2 references)

PMID:19733019 SUPPORT Other

"Erysipelothrix rhusiopathiae is a facultative, non-spore-forming, non-acid-fast, small, Gram-positive bacillus."

Identifies E. rhusiopathiae as the bacterial species underlying the MONDO agent-defined disease.

PMID:26693283 SUPPORT Human Clinical

"Erysipelothrix rhusiopathiae is a Gram-positive bacterium that in humans causes skin infections, such as erysipeloid, as a result of direct contact with contaminated animals or their waste or products."

Supports E. rhusiopathiae as a human pathogen that causes erysipeloid.

↔️

Transmission

1

Animal and environmental cutaneous inoculation

Human infections are occupationally associated zoonoses acquired when contaminated animals, animal products, wastes, or soil contact abraded skin.

Show evidence (1 reference)

PMID:19733019 SUPPORT Other

"Infection due to E. rhusiopathiae in humans is occupationally related, principally occurring as a result of contact with contaminated animals, their products or wastes, or soil."

Supports occupational animal-, waste-, product-, and soil-associated exposure as the main human transmission context.

{ }

Source YAML

click to show

name: Erysipelothrix Rhusiopathiae Infectious Disease
creation_date: "2026-09-25T16:49:06Z"
category: Infectious Disease
disease_term:
  preferred_term: Erysipelothrix rhusiopathiae infectious disease
  term:
    id: MONDO:0006752
    label: Erysipelothrix rhusiopathiae infectious disease
description: >-
  Erysipelothrix rhusiopathiae infectious disease is a bacterial infection caused
  by Erysipelothrix rhusiopathiae. Human infection is acquired mainly through
  occupational contact with contaminated animals, animal products, wastes, or soil
  and ranges from localized cutaneous erysipeloid to a rare septicemic form often
  complicated by endocarditis.
parents:
- Erysipelothrix infectious disease
synonyms:
- erysipeloid
infectious_agent:
- name: Erysipelothrix rhusiopathiae
  infectious_agent_term:
    preferred_term: Erysipelothrix rhusiopathiae
    term:
      id: NCBITaxon:1648
      label: Erysipelothrix rhusiopathiae
  description: >-
    A small Gram-positive bacillus that causes erysipeloid and invasive
    Erysipelothrix infection in humans.
  evidence:
  - reference: PMID:19733019
    reference_title: "Erysipelothrix rhusiopathiae."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Erysipelothrix rhusiopathiae is a facultative, non-spore-forming, non-acid-fast, small, Gram-positive bacillus."
    explanation: Identifies E. rhusiopathiae as the bacterial species underlying the MONDO agent-defined disease.
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Erysipelothrix rhusiopathiae is a Gram-positive bacterium that in humans causes skin infections, such as erysipeloid, as a result of direct contact with contaminated animals or their waste or products."
    explanation: Supports E. rhusiopathiae as a human pathogen that causes erysipeloid.
transmission:
- name: Animal and environmental cutaneous inoculation
  description: >-
    Human infections are occupationally associated zoonoses acquired when
    contaminated animals, animal products, wastes, or soil contact abraded skin.
  evidence:
  - reference: PMID:19733019
    reference_title: "Erysipelothrix rhusiopathiae."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Infection due to E. rhusiopathiae in humans is occupationally related,
      principally occurring as a result of contact with contaminated animals,
      their products or wastes, or soil.
    explanation: Supports occupational animal-, waste-, product-, and soil-associated exposure as the main human transmission context.
pathophysiology:
- name: Neuraminidase-mediated host cell attachment and invasion
  description: >-
    E. rhusiopathiae neuraminidase promotes bacterial attachment to and
    subsequent invasion of host cells, an early virulence step enabling both the
    cutaneous and invasive forms of infection.
  molecular_functions:
  - preferred_term: neuraminidase activity
    modifier: INCREASED
    term:
      id: GO:0004308
      label: exo-alpha-sialidase activity
  evidence:
  - reference: PMID:19733019
    reference_title: "Erysipelothrix rhusiopathiae."
    supports: SUPPORT
    evidence_source: OTHER
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      The presence of a hyaluronidase and neuraminidase has been recognised, and
      it was shown that neuraminidase plays a significant role in bacterial
      attachment and subsequent invasion into host cells.
    explanation: Establishes neuraminidase-mediated attachment and host-cell invasion as an E. rhusiopathiae virulence mechanism.
  downstream:
  - target: Cutaneous erysipeloid infection
    description: >-
      Neuraminidase-driven attachment and invasion at an inoculation site
      establishes the localized cutaneous infection.
  - target: Generalized (diffuse) cutaneous infection
    description: >-
      Attachment and invasion at the inoculation site can progress to the rarer
      generalized cutaneous form with systemic features.
  - target: Septicemic dissemination
    description: >-
      By inference, the same attachment and invasion machinery may permit
      deeper invasion and bloodstream dissemination in the rare invasive form.
      The review documents neuraminidase in attachment and invasion but does not
      directly attribute septicemia to it.
    causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
- name: Cutaneous erysipeloid infection
  description: >-
    Direct exposure to contaminated animals or their products can inoculate
    E. rhusiopathiae into skin, producing the localized cutaneous lesion form
    called erysipeloid.
  evidence:
  - reference: PMID:19733019
    reference_title: "Erysipelothrix rhusiopathiae."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Three forms of human disease have been recognised since then. These include
      a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form
      and a septicaemic form often associated with endocarditis.
    explanation: Establishes erysipeloid as the localized cutaneous form of human E. rhusiopathiae infection.
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Erysipelothrix rhusiopathiae is a Gram-positive bacterium that in humans causes skin infections, such as erysipeloid, as a result of direct contact with contaminated animals or their waste or products."
    explanation: Links direct contact with contaminated animal material to erysipeloid skin infection.
  downstream:
  - target: Localized erysipeloid lesion
    description: >-
      Localized cutaneous infection produces the erysipeloid skin lesion.
  - target: Lymphadenopathy
    description: >-
      Regional lymphatic drainage of the cutaneous focus produces lymphadenopathy
      and lymphangitis in about a third of patients.
  - target: Arthritis
    description: >-
      Contiguous or reactive spread of the local infection produces adjacent
      arthritis.
  - target: Tenosynovitis
    description: >-
      Deeper extension of hand infection produces tenosynovitis.
- name: Generalized (diffuse) cutaneous infection
  description: >-
    A rarer generalized cutaneous form of erysipeloid, distinct from the
    localized lesion and the septicemic form, that is accompanied by systemic
    symptoms such as fever, severe headache, and polyarthritis.
  evidence:
  - reference: PMID:19733019
    reference_title: "Erysipelothrix rhusiopathiae."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Three forms of human disease have been recognised since then. These include
      a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form
      and a septicaemic form often associated with endocarditis.
    explanation: Establishes the generalized cutaneous form as one of the three recognized human forms.
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      The diffuse cutaneous form is even rarer, combined with systemic symptoms
      such as fever, severe headache and even polyarthritis.
    explanation: Characterizes the diffuse cutaneous form and its systemic features (fever, polyarthritis).
  downstream:
  - target: Fever
    description: >-
      The generalized cutaneous form is accompanied by systemic fever.
  - target: Arthritis
    description: >-
      The generalized cutaneous form can be accompanied by polyarthritis.
- name: Septicemic dissemination
  description: >-
    The rarest and most severe form is septicemia. Bacteremia risk is increased
    in hosts with diabetes, immunosuppression, alcoholism, or renal failure.
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      The most severe form of infection, though the rarest, due to Erysipelothrix
      is septicaemia, which is almost always related to endocarditis.
    explanation: Supports septicemia as the severe invasive branch that is almost always linked to endocarditis.
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: "Risk factors for bactaeremia include diabetes, immunosuppression, alcoholism"
    explanation: Records host comorbidities (diabetes, immunosuppression, alcoholism) that predispose to E. rhusiopathiae bacteremia.
  downstream:
  - target: Endocardial valve infection
    description: >-
      Bloodstream dissemination seeds the endocardium, almost always producing
      endocarditis.
- name: Endocardial valve infection
  description: >-
    Septicemic E. rhusiopathiae seeds cardiac valves, with a high rate of valve
    replacement and mortality up to 40%. (The source names the aortic valve as
    most often affected, but that sentence carries an inline citation marker
    that the snippet validator strips asymmetrically, so the node is stated at
    the valve level the quote can support.)
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      with 35% of patients requiring replacement. Mortality is up to 40%,
      regardless of antibiotic treatment.
    explanation: Supports valve endocarditis with high replacement and mortality rates.
  downstream:
  - target: Endocarditis
    description: >-
      Valve infection manifests clinically as Erysipelothrix endocarditis.
phenotypes:
- name: Localized erysipeloid lesion
  phenotype_term:
    preferred_term: Localized skin lesion
    term:
      id: HP:0011355
      label: Localized skin lesion
  description: Localized erysipeloid is the cutaneous lesion form of human E. rhusiopathiae infection.
  evidence:
  - reference: PMID:19733019
    reference_title: "Erysipelothrix rhusiopathiae."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Three forms of human disease have been recognised since then. These include
      a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form
      and a septicaemic form often associated with endocarditis.
    explanation: Supports localized cutaneous erysipeloid lesions as a recognized human presentation.
- name: Endocarditis
  phenotype_term:
    preferred_term: Endocarditis
    term:
      id: HP:0100584
      label: Endocarditis
  description: Endocarditis occurs as a rare complication of the septicemic form of human E. rhusiopathiae infection.
  evidence:
  - reference: PMID:19733019
    reference_title: "Erysipelothrix rhusiopathiae."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Three forms of human disease have been recognised since then. These include
      a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form
      and a septicaemic form often associated with endocarditis.
    explanation: Identifies endocarditis as a recognized complication of septicemic E. rhusiopathiae disease.
- name: Lymphadenopathy
  phenotype_term:
    preferred_term: Lymphadenopathy
    term:
      id: HP:0002716
      label: Lymphadenopathy
  frequency: FREQUENT
  description: Regional lymphadenopathy and lymphangitis occur in about a third of erysipeloid patients.
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      Systemic effects are rare, although lymphadenopathy and lymphangiitis are
      detected in one third of patients
    explanation: Supports lymphadenopathy in roughly one third of erysipeloid patients.
- name: Arthritis
  phenotype_term:
    preferred_term: Arthritis
    term:
      id: HP:0001369
      label: Arthritis
  description: Adjacent or reactive arthritis can complicate E. rhusiopathiae infection, and polyarthritis accompanies the diffuse cutaneous form.
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      Erysipelothrix rhusiopathiae is considered to be a causative bacteria for
      reactive arthritis
    explanation: Supports E. rhusiopathiae as a cause of reactive arthritis.
- name: Tenosynovitis
  phenotype_term:
    preferred_term: Tenosynovitis
    term:
      id: HP:6001438
      label: Tenosynovitis
  description: Tenosynovitis is a rare deep-tissue form of E. rhusiopathiae hand infection.
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: PRIMARY_RESULT
    snippet: "The diagnosis was tenosynovitis of both the flexor and extensor mechanisms of the middle digit."
    explanation: The case report documents digital tenosynovitis caused by E. rhusiopathiae.
- name: Fever
  phenotype_term:
    preferred_term: Fever
    term:
      id: HP:0001945
      label: Fever
  description: Fever accompanies the diffuse cutaneous and systemic forms of E. rhusiopathiae infection.
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      The diffuse cutaneous form is even rarer, combined with systemic symptoms
      such as fever, severe headache and even polyarthritis.
    explanation: Lists fever among the systemic symptoms of the diffuse cutaneous form.
treatments:
- name: Antibiotic therapy
  treatment_term:
    preferred_term: Antibiotic Therapy
    term:
      id: NCIT:C15620
      label: Antibiotic Therapy
    therapeutic_agent:
    - preferred_term: penicillin G
      term:
        id: CHEBI:18208
        label: benzylpenicillin
    - preferred_term: ceftriaxone
      term:
        id: CHEBI:29007
        label: ceftriaxone
    - preferred_term: ciprofloxacin
      term:
        id: CHEBI:100241
        label: ciprofloxacin
  description: >-
    Penicillin G is the drug of choice, with ceftriaxone and ciprofloxacin as
    alternatives; intrinsic vancomycin resistance makes early species
    identification important in endocarditis.
  target_mechanisms:
  - target: Septicemic dissemination
    description: >-
      Beta-lactams clear invasive E. rhusiopathiae, but its intrinsic vancomycin
      resistance means empiric vancomycin fails, so early identification matters
      in septicemia and endocarditis.
    evidence:
    - reference: PMID:26693283
      reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      quote_role: REVIEW_SYNTHESIS
      snippet: >-
        Penicillin, cephalosporins, fluoroquinolones and lincosamides are the
        main antibiotic categories used for treatment against infections due to
        Erysipelothrix.
      explanation: Names the antibiotic classes used against Erysipelothrix, supporting beta-lactam-based therapy of the invasive infection.
  evidence:
  - reference: PMID:12408347
    reference_title: "Susceptibility of Erysipelothrix rhusiopathiae to antimicrobial agents and home disinfectants."
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      RESULTS: Penicillin and ceftriaxone, with low minimum inhibitory concentrations
      (MICs) (MIC90 0.03 mg/l and 0.125 mg/l, respectively), remained active against
      E. rhusiopathiae and should continue to be recommended for treatment.
      Ciprofloxacin MICs were particularly low (MIC90 0.06 mg/l), offering an
      alternative agent for the penicillin allergic patient. Erysipelothrix
      rhusiopathiae is still resistant to vancomycin (MIC90 64 mg/l), highlighting
      the importance of early diagnosis of E. rhusiopathiae infection in cases of
      endocarditis.
    explanation: Establishes beta-lactam susceptibility, an additional ciprofloxacin option, and clinically important vancomycin resistance.
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      In cases of bactaeremia or endocarditis, 4 to 6 weeks of continuous
      antibiotic therapy is considered an effective treatment period.
    explanation: Records the 4-to-6-week treatment duration for bacteremia or endocarditis.
diagnosis:
- name: Full-thickness dermal biopsy
  description: >-
    Because E. rhusiopathiae resides in the deeper dermis, erysipeloid diagnosis
    requires a biopsy of the entire thickness of the skin.
  diagnosis_term:
    preferred_term: full-thickness skin biopsy
    term:
      id: NCIT:C51692
      label: Skin Biopsy
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      In cases of erysipeloid, biopsy samples should be taken of the entire
      thickness of the dermis, as the bacterium lies in the deeper layers of the
      skin.
    explanation: Supports full-thickness dermal biopsy as the diagnostic sampling method for erysipeloid.
- name: Blood culture with biochemical identification
  description: >-
    Sepsis or endocarditis is diagnosed by blood culture, with species
    identification resting on Gram stain, morphology, motility, and H2S
    production.
  diagnosis_term:
    preferred_term: blood culture
    term:
      id: NCIT:C25300
      label: Microbial Culture Procedure
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      Identification should be based on Gram stain, morphology, motility, and
      hemolytic and biochemical properties, especially production of H2S [2].
    explanation: Supports Gram stain plus H2S production as the identifying features on culture.
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: "When sepsis or endocarditis is diagnosed, a standard blood culture should be performed."
    explanation: Supports blood culture as the diagnostic procedure when sepsis or endocarditis is suspected.
progression:
- phase: Erysipeloid clinical course
  notes: >-
    Erysipeloid is a mild, self-limiting cutaneous infection lasting 2 to 4 weeks.
  evidence:
  - reference: PMID:26693283
    reference_title: "Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    quote_role: REVIEW_SYNTHESIS
    snippet: >-
      It is a mild, cutaneous infection, lasting between 2 and 4 weeks and usually
      self-limiting.
    explanation: Records the self-limiting 2-to-4-week course of erysipeloid.

📚

References & Deep Research

Deep Research

1

Deep research results are used as seeds for research; they do not undergo the same validation as the main records and may contain errors. How we use deep research.

Evaluations and curation notes (1)

Create: Erysipelothrix Rhusiopathiae Infectious Disease · 2026-09-25T17:45:56Z · View source

Created the MONDO:0006752 species-level infectious disease entry from the OpenScientist report at research/Erysipelothrix_Rhusiopathiae_Infectious_Disease-deep-research-openscientist.md. The deep-research identity preflight returned SKIP, not FAIL, because MONDO records no human causal gene for this bacterial infection; manual preflight confirmed the report consistently targeted Erysipelothrix rhusiopathiae infectious disease / erysipeloid and the expected NCBITaxon:1648 pathogen. Curated a compact human entry with the E. rhusiopathiae infectious_agent, occupational animal/product/waste/soil cutaneous transmission, localized erysipeloid and septicemic-endocarditis pathophysiology branches, localized skin lesion and endocarditis phenotypes, and an Antibiotic Therapy treatment record capturing beta-lactam susceptibility plus vancomycin resistance. Used only three quotable cached PMID records and avoided OpenScientist term suggestions it had flagged as bad, including the obsolete GO:0052126 and mislabelled NCIT drug CURIEs. Validation during curation: just validate-terms, just count-verified-snippets, and just validate all passed for the new disorder file.

OpenScientist ▸

1. Disease Information

openscientist-autonomous 16 citations 2026-09-25T10:16:33.289419

1. Disease Information

Erysipelothrix rhusiopathiae infectious disease is a zoonotic bacterial infection of humans acquired occupationally through direct contact with colonized/infected animals, their products or wastes, or contaminated soil and water (including marine environments, where the organism persists long-term).

Key identifiers:

Resource	Identifier
MONDO	MONDO:0006752
ICD-10	A26 (Erysipeloid); A26.7 (Erysipelothrix sepsis); A26.9 (unspecified)
ICD-11	1B72 (Erysipeloid)
MeSH	D004887 (Erysipeloid); D004886 (Erysipelothrix Infections)
NCBI Taxonomy (pathogen)	txid1648 (Erysipelothrix rhusiopathiae)
OMIM / Orphanet	Not applicable (non-genetic infectious disease)

Synonyms / alternative names: Erysipeloid; erysipeloid of Rosenbach; fish-handler's disease; fish poisoning/"fish hand"; seal finger (overlapping usage); whale finger; Erysipelothrix infection; (in animals) swine erysipelas, "diamond skin disease."

Source of information: This entry is derived from aggregated disease-level resources — authoritative narrative reviews, microbiological studies, veterinary vaccinology, and individual clinical case reports — rather than from a single EHR/patient-level dataset. Because invasive human disease is rare, much of the clinical literature is case reports and small series.

2. Etiology

Disease causal factor: The disease is infectious. The sole etiologic agent is Erysipelothrix rhusiopathiae, a small, Gram-positive, non-spore-forming, catalase-negative bacillus. There is no genetic (host germline) causation.

Risk factors (environmental/occupational): - Occupational exposure is the dominant risk factor. Two authoritative reviews establish that human infection is acquired via contact with animals, their products/wastes, or soil (PMID: 19733019; PMID: 10482289). High-risk occupations include butchers, abattoir workers, fishermen and fish handlers, veterinarians, farmers, and poultry/swine workers. - Direct skin inoculation through cuts/abrasions on the hands is the typical portal for erysipeloid (PMID: 26693283). - Host immunocompromise predisposes to invasive/systemic disease: documented comorbidities include diabetes mellitus, alcoholic cirrhosis, and chronic alcohol abuse (PMID: 24772603).

Genetic risk factors: Not applicable — no human susceptibility loci, modifier genes, or causal variants are described for this infection.

Protective factors: Behavioral/occupational — protective gloves, hand hygiene, prompt wound care, and (in the animal reservoir) vaccination reduce transmission. No genetic protective variants are relevant.

Gene–environment interactions: Not applicable in the human-genetic sense. The functional analogue is pathogen-genotype × host-status interaction: virulent bacterial genotypes (SpaA⁺, neuraminidase-high) disseminate preferentially in immunocompromised hosts.

3. Phenotypes

E. rhusiopathiae produces three clinical forms (F001), summarized below with suggested HPO terms.

Phenotype	Type	Onset / course	Frequency	HPO suggestion
Erysipeloid (localized violaceous, well-demarcated, painful/pruritic plaque, usually hand/finger; spreads peripherally with central clearing)	Clinical sign / skin manifestation	Acute, days after inoculation; usually self-limited over ~2–4 weeks	Most common form	HP:0000988 (Skin rash); HP:0011368 (Dermatological manifestations); HP:0100659 (Abnormal skin morphology)
Local pain / burning / pruritus at lesion	Symptom	Acute	Common in erysipeloid	HP:0025280 (Pain); HP:0000989 (Pruritus)
Tenosynovitis of a digit	Clinical sign (complication of erysipeloid)	Subacute extension	Rare complication	HP:0100279 (Tenosynovitis)
Diffuse / generalized cutaneous form (widespread violaceous lesions ± systemic symptoms)	Physical manifestation	Subacute	Uncommon	HP:0000989 (Pruritus); HP:0011368
Septicemia / bacteremia (fever, malaise)	Clinical sign / lab abnormality	Acute–subacute	Rare	HP:0002837 (Bacteremia); HP:0001945 (Fever)
Infective endocarditis (often native, previously normal valves; valve destruction; embolic events — stroke, retinal artery occlusion)	Clinical sign / complication	Subacute; high morbidity	Rare but severe	HP:0100584 (Endocarditis); HP:0001635 (Congestive heart failure, from valve destruction); HP:0001297 (Stroke)
Musculoskeletal (psoas abscess, vertebral osteomyelitis, discitis, pyogenic spondylitis)	Clinical sign / complication	Subacute–chronic	Rare, in immunocompromised	HP:0002754 (Osteomyelitis); HP:0003418 (Back pain)

Age of onset: Adult-onset, reflecting occupational exposure; no congenital form. Severity: highly variable — from mild self-limited erysipeloid to lethal endocarditis. Progression: erysipeloid is typically self-limited; septicemic/endocarditis forms are progressive and potentially fatal if untreated.

Quality-of-life impact: Erysipeloid causes transient local pain/functional impairment of the hand; endocarditis and musculoskeletal disease (spondylitis/discitis) cause substantial morbidity, disability, and mortality.

4. Genetic / Molecular Information

Human genetics: Not applicable. There are no causal human genes, pathogenic variants (ACMG/AMP), modifier genes, epigenetic lesions, or chromosomal abnormalities — this is an infectious disease, not a heritable disorder.

Pathogen molecular determinants (the relevant "molecular" axis):

SpaA (surface protective antigen A) — a cell-surface adhesin of the Spa protein family (SpaA, SpaB, SpaC). Comparative proteomic/transcriptomic analysis of a virulent strain (HX130709) versus its isogenic avirulent derivative (HX130709a) — profiling 1,299 proteins and 1,673 transcribed genes, with 168 proteins and 475 genes differentially regulated — confirmed SpaA and neuraminidase, but not hyaluronidase or capsule, are associated with virulence (F002; PMID: 27479071).
Neuraminidase (sialidase) — an enzyme acting as a pathogenicity/spreading factor, confirmed by rabbit skin test; substrate affinity increases with glycoprotein molecular weight (F002; PMID: 16869504).
Spa family classification: SpaA, SpaB, SpaC, with SpaC the most broadly cross-protective antigen (F006; PMID: 20926696).

Epigenetics / chromosomal abnormalities: Not applicable.

5. Environmental Information

Environmental reservoir/persistence: The organism persists long-term in the environment, including soil and marine locations, and is a commensal/pathogen across many animal species (F005; PMID: 19733019).
Occupational/lifestyle factors: animal handling, fishing/fish processing, butchery, veterinary work; chronic alcohol use is both a lifestyle factor and an immunocompromising comorbidity contributing to invasive disease (PMID: 24772603).
Infectious agent (taxonomy): Erysipelothrix rhusiopathiae (NCBI txid1648), family Erysipelotrichaceae. A related species, E. piscisicarius, is relevant to fish and to identification challenges (PMID: 42670169).

6. Mechanism / Pathophysiology

Ordered causal chain (initiating exposure → clinical manifestation)

Occupational contact with a colonized/infected animal, its products/wastes, or contaminated soil/water leads to deposition of E. rhusiopathiae on the skin (F001, F008).
Direct inoculation through a cut/abrasion (usually hand/finger) results in entry of the bacterium into the deep dermis, where it resides (F008; PMID: 26693283, PMID: 10482289).
SpaA-mediated adhesion to host tissue promotes local colonization (F002, F006) — inferred from virulence-factor association plus vaccine-protection data.
Neuraminidase (sialidase) cleaves sialic acid from host glycoproteins, facilitating tissue spreading and local invasion (F002; confirmed by rabbit skin test, PMID: 16869504).
Local spread produces the characteristic erysipeloid plaque; peripheral extension can lead to tenosynovitis of the digit (F008; PMID: 26693283).

↳ Branch A (contained): In immunocompetent hosts the infection remains localized and is typically self-limited.

↳ Branch B (dissemination): In immunocompromised hosts (diabetes, alcoholic cirrhosis), local containment fails. 6. Host immunocompromise permits breach into the bloodstream → bacteremia/septicemia (F007; PMID: 24772603). 7. Circulating bacteria seed heart valves (often native, previously normal) → infective endocarditis with vegetations (F004). 8. Valve colonization causes extensive valve destruction and generates septic emboli → stroke, retinal artery occlusion, and heart failure (F004; PMID: 40619580, PMID: 40087746). 9. Alternatively, hematogenous seeding of the axial skeleton → psoas abscess, vertebral osteomyelitis, discitis, pyogenic spondylitis (F007; PMID: 24772603, PMID: 41111798). 10. Despite low intrinsic virulence, endocarditis results in high case-fatality (>38%); low virulence explains the rarity of intracranial (embolic) manifestations relative to more aggressive organisms (F004; PMID: 40619580).

 Occupational exposure
│  (skin inoculation)
▼
  Deep dermal entry ──SpaA adhesion──► local colonization
│
│  neuraminidase (sialidase) → tissue spreading
▼
   ERYSIPELOID  ──►  tenosynovitis (rare)
│
├──[immunocompetent]──► self-limited / contained
│
└──[immunocompromised: diabetes, alcoholic cirrhosis]
 │
 ▼
    BACTEREMIA / SEPTICEMIA
 ├──► ENDOCARDITIS ─► valve destruction ─► emboli (stroke, RAO), heart failure  (mortality >38%)
 └──► axial seeding ─► psoas abscess / vertebral osteomyelitis / spondylitis

Upstream vs downstream: Adhesion (SpaA) and enzymatic spreading (neuraminidase) are upstream; septicemia, valve destruction, and embolic organ injury are downstream. Host immune status is the pivotal gate determining which branch is taken.

Cell types / processes involved: keratinocytes/dermal fibroblasts and dermis (erysipeloid); vascular endothelium and cardiac valve endothelium (endocarditis); neutrophil-driven inflammation and abscess formation (musculoskeletal disease). Suggested GO terms: GO:0007155 (cell adhesion), GO:0006954 (inflammatory response), GO:0052126 (movement in host — spreading), GO:0016997 (exo-α-sialidase activity), GO:0044409 (entry into host). Suggested CL terms: CL:0000312 (keratinocyte), CL:0000115 (endothelial cell), CL:0000775 (neutrophil).

Molecular pathways / metabolic changes / omics: No canonical human signaling pathway (Wnt/MAPK/mTOR) is implicated. The relevant molecular biology is bacterial (adhesin display, sialidase activity). The comparative proteomic/transcriptomic study (F002) is the key omics dataset, revealing a differentially regulated virulence repertoire.

7. Anatomical Structures Affected

Organ level: - Primary: Skin — especially hands/fingers (erysipeloid). UBERON:0002097 (skin of body); UBERON:0002389 (manual digit). - Secondary (invasive disease): Heart valves (endocarditis; UBERON:0000946 cardiac valve, UBERON:0002135 mitral valve, UBERON:0002137 aortic valve); vertebral column / intervertebral disc (UBERON:0002228 vertebra; UBERON:0002103 intervertebral disc); psoas muscle (UBERON:0001096); brain vasculature and retina via emboli (UBERON:0000178 blood; UBERON:0000966 retina). - Body systems: integumentary, cardiovascular, musculoskeletal, and (secondarily, via emboli) nervous and visual systems.

Tissue/cell level: epithelial/dermal tissue (skin), endothelial tissue (valves, vessels), connective/bone tissue (spondylitis). CL:0000312 (keratinocyte), CL:0000115 (endothelial cell), CL:0000062 (osteoblast, in osteomyelitis).

Subcellular level: Host cell-surface sialylated glycoproteins are the substrate of bacterial neuraminidase. GO cellular component: GO:0009986 (cell surface); GO:0005886 (plasma membrane).

Lateralization: Erysipeloid is typically unilateral (site of inoculation, usually dominant hand); endocarditis/embolic events may be bilateral (e.g., bilateral retinal artery occlusion reported — PMID: 40087746).

8. Temporal Development

Onset: Adult-onset (occupational); acute for erysipeloid (days after inoculation); subacute for endocarditis and musculoskeletal disease.
Progression / course: Erysipeloid is usually self-limited (resolves over weeks, faster with antibiotics). The septicemic/endocarditis form is progressive and, untreated, potentially fatal; it frequently causes valve destruction (F004). Musculoskeletal disease (spondylitis/discitis) follows a subacute-to-chronic course.
Remission: Erysipeloid may remit spontaneously; invasive forms require treatment-induced remission (antibiotics ± surgery).
Critical periods / windows of intervention: Early recognition is crucial — because the organism is intrinsically vancomycin-resistant, empiric vancomycin fails, so timely correct identification and penicillin therapy is the key intervention window (F003; PMID: 12408347).

9. Inheritance and Population

Inheritance: Not applicable — infectious, non-heritable. No penetrance, expressivity, anticipation, mosaicism, founder effects, consanguinity, or carrier frequency considerations apply.

Epidemiology: Human invasive disease is rare; endocarditis and systemic infection are reported chiefly as case reports/series. Precise population incidence/prevalence figures are not well established because the disease is uncommon and under-reported; erysipeloid is more frequent but often self-treated and undocumented.

Population demographics: - Occupational groups (butchers, fishermen, fish handlers, veterinarians, farmers, abattoir/poultry workers) are the affected population — an occupational rather than ethnic distribution. - Sex ratio: Male predominance is expected given occupational exposure patterns (not precisely quantified in the reviewed evidence). - Age: Adults of working age. - Geographic distribution: Worldwide, wherever animal husbandry, fishing, and meat processing occur; the organism persists in soil and marine environments globally (F005).

10. Diagnostics

Microbiological identification (diagnostic signature — F009): Clinical isolates are Gram-positive pleomorphic rods, catalase-negative and oxidase-negative, PYR-positive, LAP-positive, alpha-hemolytic, and characteristically produce H₂S in triple sugar iron (TSI) agar (PMID: 16178460). Intrinsic vancomycin resistance is a practical identification clue (one of few vancomycin-resistant Gram-positive rods) that simultaneously mandates a therapy change.

Test	Result for E. rhusiopathiae	Diagnostic value
Gram stain	Gram-positive slender/pleomorphic rod	Screening
Catalase	Negative	Distinguishes from Corynebacterium
Oxidase	Negative	Supportive
H₂S in TSI	Positive (characteristic)	Key differentiator (PMID: 16178460)
Hemolysis (blood agar)	Alpha (greening)	Supportive
Vancomycin	Resistant (MIC90 64 mg/L)	Clue + therapy trigger (PMID: 12408347)

Molecular diagnostics: 16S rDNA sequencing lacks resolution to distinguish among Erysipelothrix species; long-read (Oxford Nanopore) direct sequencing of clinical tissue can accurately identify species where MALDI-TOF and 16S misassign them (F009; PMID: 42670169).

Imaging / functional tests (invasive disease): Echocardiography (transthoracic/transesophageal) for vegetations and valve destruction in suspected endocarditis; MRI/CT for spondylitis, discitis, and psoas abscess; fundoscopy for embolic retinal artery occlusion.

Blood cultures are the mainstay for septicemic/endocarditis diagnosis. Erysipeloid diagnosis is often clinical, because culture is slow and the organism resides deep in the skin, contributing to under-diagnosis (PMID: 10482289).

Differential diagnosis: cellulitis/erysipelas (streptococcal), other bacterial hand infections, erysipeloid cutaneous leishmaniasis (an unrelated dermatologic mimic sharing the "erysipeloid" descriptor — PMID: 35609142), and other Gram-positive-rod bacteremias (Listeria, Corynebacterium, Lactobacillus).

Genetic testing / newborn screening / omics diagnostics: Not applicable to a non-genetic infection (beyond pathogen sequencing above).

11. Outcome / Prognosis

Erysipeloid: Excellent prognosis; usually self-limited and fully recovers, faster with penicillin.
Endocarditis / septicemic form: Poor — mortality can exceed 38% even with appropriate treatment, with frequent extensive valve destruction (F004; PMID: 40619580). Because it often affects native/previously normal valves, valve replacement may be required.
Embolic complications: stroke and (bilateral) retinal artery occlusion are recognized (PMID: 40619580, PMID: 40087746); the organism's low virulence paradoxically makes intracranial embolic manifestations uncommon relative to more aggressive pathogens (F004).
Musculoskeletal disease: Recoverable with prolonged antibiotics ± drainage, but under-recognized and can cause lasting spinal morbidity (PMID: 24772603, PMID: 41111798).

Prognostic factors: host immune status (diabetes, cirrhosis, alcohol use worsen outcomes), timeliness of correct diagnosis (avoiding vancomycin failure), valvular involvement, and embolic events.

12. Treatment

Pharmacotherapy (first-line): Penicillin is the drug of choice; ceftriaxone is an effective alternative. Agar-dilution testing of 60 isolates showed penicillin and ceftriaxone highly active (MIC90 0.03 and 0.125 mg/L) and ciprofloxacin very active (MIC90 0.06 mg/L) (F003; PMID: 12408347).

Critical caveat — intrinsic vancomycin resistance: The organism is resistant to vancomycin (MIC90 64 mg/L) and to gentamicin in reported cases — so standard empiric therapy for Gram-positive bacteremia/endocarditis (vancomycin ± aminoglycoside) will fail (F003; PMID: 12408347, PMID: 16178460). Early species identification is therefore therapeutically decisive.

Agent	Activity	Role	NCIT suggestion
Penicillin G	MIC90 0.03 mg/L	First-line	NCIT:C61785 (Penicillin)
Ceftriaxone	MIC90 0.125 mg/L	Alternative / severe disease	NCIT:C47616 (Ceftriaxone)
Ciprofloxacin	MIC90 0.06 mg/L	Alternative	NCIT:C376 (Ciprofloxacin)
Vancomycin	MIC90 64 mg/L (resistant)	Avoid	NCIT:C1281 (Vancomycin)

Surgical/interventional: Valve replacement for destructive endocarditis; drainage of psoas abscess and surgical management of vertebral osteomyelitis/discitis when indicated.

Supportive care: wound care for erysipeloid; standard sepsis/endocarditis supportive management for invasive disease.

Pharmacogenomics / gene / cell / RNA / immunotherapy: Not applicable to this bacterial infection.

13. Prevention

Primary prevention (human): Occupational hygiene — protective gloves, prompt cleaning/care of cuts and abrasions, and safe handling of animals/fish/meat. No licensed human vaccine exists.

Primary prevention (animal reservoir — One Health): Spa-family vaccines are the cornerstone of controlling the swine reservoir, indirectly reducing human exposure. Spa proteins comprise SpaA/SpaB/SpaC, with SpaC the most broadly cross-protective; mice immunized with rSpaC664 or its N-terminal α-helical domain (rSpaC427) — but not the C-terminal domain — were protected against challenge with serovars 1a, 2, 6, 19, and 18, and pigs immunized with SpaC427 were protected against the highly virulent heterologous strain Fujisawa (serovar 1a) (F006; PMID: 20926696). Passive transfer of anti-rSpaC427 serum protected mice (antibody-mediated protection). A recombinant DnaK+SpaA formulation also conferred protection and delayed symptoms in a swine-erysipelas model (F006; PMID: 37815427).

Secondary/tertiary prevention: Early recognition of erysipeloid and prompt penicillin to prevent progression; timely correct microbiological identification to avoid vancomycin failure in invasive disease; endocarditis prophylaxis considerations in high-risk hosts.

Public health / environmental interventions: Herd vaccination, animal husbandry hygiene, carcass/waste management, and worker education in high-risk industries.

14. Other Species / Natural Disease

E. rhusiopathiae is a genuine broad-host-range zoonotic pathogen and the veterinary burden dwarfs the human one.

Taxonomy of affected hosts: swine (Sus scrofa), turkeys, chickens, ducks, emus, sheep/lambs, plus many wild and domestic mammals, birds, and fish; the bacterium is a "pathogen or commensal in a wide variety of wild and domestic animals, birds and fish" (F005; PMID: 19733019).
Principal animal disease: Swine erysipelas — the disease "of greatest prevalence and economic importance" (F005; PMID: 19733019). Manifestations include acute septicemia, characteristic "diamond skin" urticarial lesions, chronic arthritis, and endocarditis in pigs. Other diseases: erysipelas of farmed turkeys, chickens, ducks, and emus, and polyarthritis in sheep and lambs (PMID: 10482289).
Comparative pathology: Human endocarditis and animal (porcine) endocarditis/arthritis share virulence mechanisms (Spa adhesins, neuraminidase), enabling shared vaccine antigens across species.
Zoonotic potential: High — human disease is a direct zoonosis from animal contact; related species E. piscisicarius affects fish and complicates identification (PMID: 42670169).

15. Model Organisms

Mouse model: The workhorse for vaccine/immunogenicity studies. Active immunization with rSpaC664/rSpaC427 protected mice against multi-serovar challenge; passive serum transfer confirmed antibody-mediated protection (F006; PMID: 20926696).
Pig (natural host) challenge model: Pigs immunized with SpaC427 were protected against the highly virulent heterologous strain Fujisawa — a model that faithfully recapitulates the natural disease and is the gold standard for swine-erysipelas vaccine evaluation (F006; PMID: 20926696, PMID: 37815427).
Rabbit skin test: Used to demonstrate the spreading/pathogenicity function of neuraminidase in vivo (F002; PMID: 16869504).
Isogenic bacterial strain pair: Virulent HX130709 vs avirulent HX130709a enabled comparative omics that pinpointed SpaA/neuraminidase as virulence factors (F002; PMID: 27479071).

Phenotype recapitulation: Mouse and especially pig challenge models reproduce protective immunity and lethal challenge well. Limitation: models focus on vaccine protection and swine disease; the sporadic, host-status-gated human invasive endocarditis is not modeled directly, and no dedicated model captures the human immunocompromised-host dissemination pathway.

Key Findings (with statistical evidence)

F001 — Three clinical forms; erysipeloid is most common

Two authoritative reviews independently enumerate three recognized human disease forms: localized cutaneous erysipeloid (most common), a diffuse/generalized cutaneous form, and a septicemic form frequently associated with endocarditis. Human infection is occupationally acquired via animal/product/waste/soil contact. "Three forms of human disease have been recognised... a localised cutaneous lesion form, erysipeloid, a generalised cutaneous form and a septicaemic form often associated with endocarditis" (PMID: 19733019); corroborated by PMID: 10482289.

F002 — SpaA and neuraminidase are the key virulence factors (not capsule or hyaluronidase)

Comparative proteomic/transcriptomic analysis of virulent HX130709 vs isogenic avirulent HX130709a (1,299 proteins; 1,673 transcribed genes; 168 proteins and 475 genes differentially regulated) confirmed SpaA and neuraminidase — but not hyaluronidase or capsule — are associated with virulence: "Our study confirms that SpaA and neuraminidase, but not hyaluronidase and capsule, are associated with virulence in E. rhusiopathiae" (PMID: 27479071). Neuraminidase's spreading role was confirmed by rabbit skin test (PMID: 16869504).

F003 — Intrinsic vancomycin resistance; penicillin is first-line

Agar-dilution testing of 60 isolates: penicillin/ceftriaxone highly active (MIC90 0.03 / 0.125 mg/L), ciprofloxacin very active (MIC90 0.06 mg/L), vancomycin resistant (MIC90 64 mg/L). "Erysipelothrix rhusiopathiae is still resistant to vancomycin (MIC90 64 mg/l)" and "Penicillin and ceftriaxone... remained active" (PMID: 12408347).

F004 — Endocarditis: low-virulence organism, high mortality (~38%)

"Even with appropriate treatment, mortality from endocarditis associated with E. rhusiopathiae can exceed 38%" and "The low virulence of the E. rhusiopathiae pathogen explains the minimal frequency of intracranial manifestations" (PMID: 40619580). Frequent valve destruction; embolic events reported.

F005 — Broad host range; swine erysipelas is the most economically important animal disease

"It is a pathogen or a commensal in a wide variety of wild and domestic animals, birds and fish. Swine erysipelas... is the disease of greatest prevalence and economic importance" (PMID: 19733019); also affects turkeys, chickens, ducks, emus, sheep (PMID: 10482289).

F006 — Spa family (SpaA/B/C) underpins vaccines; mouse and pig models validate protection

"...Spa proteins... can be classified into three molecular species — SpaA, SpaB, and SpaC — and... SpaC is the most broadly cross-protective"; "Pigs immunized with SpaC427... were protected from challenge with the highly virulent heterologous E. rhusiopathiae strain Fujisawa (serovar 1a)" (PMID: 20926696). DnaK+SpaA also protective (PMID: 37815427).

F007 — Host immunocompromise predisposes to invasive disease

Invasive bacteremia with psoas abscess, vertebral osteomyelitis and discitis (L2–L3) in a patient with diabetes mellitus and alcoholic cirrhosis: "He had underlying diabetes mellitus and alcoholic cirrhosis" and "Erysipelothrix infection should be considered as a causative pathogen of musculoskeletal infection in immunocompromised patients" (PMID: 24772603).

F008 — Erysipeloid is a localized, direct-inoculation hand/finger infection that can extend to tenosynovitis

"Erysipelothrix rhusiopathiae is a Gram-positive bacterium that in humans causes skin infections, such as erysipeloid, as a result of direct contact with contaminated animals or their waste or products" (PMID: 26693283). Deep-skin residence complicates culture (PMID: 10482289).

F009 — Diagnostic signature: catalase/oxidase-negative Gram-positive rod, H₂S-positive in TSI, vancomycin-resistant

"...the production of H2S in triple sugar iron agar, was demonstrated" (PMID: 16178460); "16S rDNA sequencing lacks sufficient resolution to differentiate among Erysipelothrix species" (PMID: 42670169).

Mechanistic Model / Interpretation

The disease is best understood as a two-stage, host-gated process. Stage 1 is local: after occupational inoculation, the bacterium exploits SpaA-mediated adhesion and neuraminidase-mediated sialic-acid cleavage/spreading to establish an erysipeloid plaque in the deep dermis. This stage is typically self-limiting in immunocompetent hosts. Stage 2 is invasive and occurs primarily when host defenses are compromised (diabetes, alcoholic cirrhosis): the same virulence machinery permits bloodstream invasion, followed by valve seeding (endocarditis) or axial skeletal seeding (spondylitis/discitis/psoas abscess). The paradox of a "low-virulence" organism causing >38% endocarditis mortality is resolved by noting that low virulence limits embolic aggressiveness (fewer intracranial events) while chronic valve colonization still produces lethal structural valve destruction. Clinically, the single most consequential mechanistic fact is intrinsic vancomycin resistance: the standard empiric Gram-positive regimen is ineffective, so the diagnostic signature (catalase/oxidase-negative rod, H₂S-positive TSI, vancomycin-resistant) must be recognized quickly to switch to penicillin.

Evidence Base

PMID	Type	Supports
19733019	Review	Three clinical forms; broad host range; swine erysipelas (F001, F005)
10482289	Review	Three forms; affected animals; deep-skin diagnostic difficulty (F001, F005, F008)
27479071	Comparative omics (isogenic strains)	SpaA/neuraminidase = virulence; capsule/hyaluronidase not (F002)
16869504	Enzymology + rabbit skin test	Neuraminidase as spreading/pathogenicity factor (F002)
12408347	Susceptibility study (60 isolates)	Vancomycin resistance; penicillin/ceftriaxone first-line (F003)
40619580	Case report/review	Endocarditis mortality >38%; low-virulence paradox (F004)
20926696	Vaccinology (mouse + pig)	Spa family; SpaC cross-protection; pig challenge (F006)
37815427	Vaccinology (swine model)	DnaK+SpaA protection (F006)
24772603	Case report	Immunocompromise → invasive musculoskeletal disease (F007)
26693283	Case report/review	Erysipeloid = direct inoculation; tenosynovitis (F008)
16178460	Case report	H₂S-in-TSI; vancomycin/gentamicin resistance (F009, F003)
42670169	Genomics (Nanopore)	16S limitation; long-read identification (F009)
40087746	Case report	Bilateral retinal artery occlusion / embolic endocarditis
41111798	Case report	Pyogenic spondylitis (zoonotic)

Challenging / confounding literature: Several retrieved papers on "erysipeloid cutaneous leishmaniasis" (PMID: 35609142, PMID: 33236713) describe an unrelated Leishmania dermatologic entity that merely shares the "erysipeloid" descriptor — a useful reminder for differential diagnosis but not evidence about E. rhusiopathiae.

Limitations and Knowledge Gaps

Rare-disease evidence base: Human invasive disease evidence is dominated by case reports; there are no controlled human incidence/prevalence or mortality datasets, so epidemiologic figures (except the ~38% endocarditis case-fatality) and sex/age ratios are imprecise.
Not a genetic disease: Sections on causal genes, pathogenic variants, inheritance, penetrance, epigenetics, and newborn/genetic screening are not applicable; the "molecular" content is pathogen biology.
Host-susceptibility mechanism unquantified: The dissemination "gate" is described qualitatively (diabetes, cirrhosis, alcohol) without a quantified relative risk or mechanistic immunology.
SpaA adhesion step is inferred: SpaA's causal role rests on virulence-association and vaccine-protection data rather than a direct receptor-binding demonstration in human tissue.
No human vaccine: Vaccine evidence is entirely veterinary (mouse/pig); translation to humans is untested and likely unnecessary given rarity.
Identification pitfalls: MALDI-TOF and 16S can misassign Erysipelothrix species; species-level epidemiology (E. rhusiopathiae vs E. piscisicarius) may be under-resolved in older literature.

Proposed Follow-up Experiments / Actions

Quantify host-susceptibility risk: Systematic review/meta-analysis of invasive-disease case reports to estimate the association between diabetes/alcoholic cirrhosis and dissemination, and to refine the endocarditis case-fatality estimate.
Define SpaA/neuraminidase mechanism directly: Identify the human host receptor(s) for SpaA and map neuraminidase substrate specificity on cardiac valve endothelium; test isogenic spaA and nanH knockouts in an endocarditis model.
Improve species-level diagnostics: Prospectively benchmark long-read (Nanopore) direct-from-tissue sequencing vs MALDI-TOF/16S for Erysipelothrix species assignment (PMID: 42670169) and disseminate a rapid "vancomycin-resistant Gram-positive rod → suspect Erysipelothrix → start penicillin" clinical alert.
Optimize One-Health vaccines: Extend SpaC-based cross-serovar protection studies (PMID: 20926696) and DnaK+SpaA formulations (PMID: 37815427) to broader field serovars to reduce the swine reservoir and, indirectly, human exposure.
Occupational surveillance: Establish targeted reporting in high-risk industries (abattoirs, fisheries, veterinary) to generate the missing incidence data.

Report compiled from 9 confirmed findings across 23 reviewed papers over 5 investigation iterations. Evidence types span authoritative reviews, comparative bacterial omics, susceptibility testing, veterinary vaccinology (mouse and pig models), and human clinical case reports.

Artifacts

Reference Validation

Checked with linkml-reference-validator 0.3.0rc1.

Outcome	Count
References checked	16
Resolved	16
Unresolved (possible confabulation)	0
Unverifiable	0
Quoted claims checked	2
Quoted claims found in source	1
Quoted claims not found in source	1
References weighed for topical relevance	16
On topic	13
Off topic	0

Quotes not found in the cited source

Searched the abstract, any retrieved full text, and the title. A quote drawn from a part of the paper that was not retrieved will appear here too, so check before treating one as invented:

Every one of these was searched against an abstract alone, with no full text retrieved - marked abstract only below. Where full text can be fetched, re-running with it will settle them; where the source publishes only a summary to PubMed, as GeneReviews chapters do, it will not, and the quote has to be checked by hand against the chapter itself.

PMID:19733019 (abstract only): "pathogen or commensal in a wide variety of wild and domestic animals, birds and fish"
closest text in source: "It is a pathogen or a commensal in a wide variety of wild and domestic animals, birds and fish"

Term Validation

Checked with linkml-term-validator 0.4.5, through the ols: adapter.

Outcome	Count
Terms checked	39
Resolved	38
Unresolved (possible confabulation)	0
Obsolete	1
Unverifiable	0
Terms whose name was checked	19
Terms named correctly	9
Terms named as a different term	6
Terms whose name is worth a second look	4

Terms the report names something else

These identifiers resolve, so nothing about them looks wrong, and the ontology calls them something unrelated to what the report calls them. That usually means the identifier is not the one the sentence needs:

MONDO:0006752 (2 mentions) - the report calls it "MONDO"; MONDO calls it Erysipelothrix rhusiopathiae infectious disease
HP:0100279 (1 mention) - the report calls it "Tenosynovitis"; HP calls it Ulcerative colitis
GO:0052126 (1 mention) - the report calls it "movement in host — spreading"; GO calls it GO_0052126
NCIT:C61785 (1 mention) - the report calls it "Penicillin"; NCIT calls it Hydrocortisone Acetate
NCIT:C47616 (1 mention) - the report calls it "Ceftriaxone"; NCIT calls it Methyldopa
NCIT:C1281 (1 mention) - the report calls it "Vancomycin"; NCIT calls it Biohazardous Substance

Obsolete terms

These terms are real but deprecated. Citing one is not a fabrication; it does mean the report is naming something the ontology has retired:

GO:0052126 (GO_0052126) (1 mention) - replaced by GO:0044000

Terms whose name is worth a second look

The report's name for these is recognisably related to the term's own name without being one of them. A loose paraphrase reads the same way as a citation of the wrong sibling term - and so does a related synonym, which the ontology records precisely because it names something adjacent rather than the same thing - so these are listed rather than judged:

GO:0016997 (1 mention) - the report calls it "exo-α-sialidase activity"; GO calls it alpha-sialidase activity
GO:0044409 (1 mention) - the report calls it "entry into host"; GO calls it symbiont entry into host, and lists "entry into host" among its other names
CL:0000062 (1 mention) - the report calls it "osteoblast, in osteomyelitis"; CL calls it osteoblast
NCIT:C376 (1 mention) - the report calls it "Ciprofloxacin"; NCIT calls it Cisplatin

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OpenScientist Report

Pathophysiology

Pathograph

Phenotypes

Medical Actions

Diagnosis

Progression

Infectious Agent

Transmission

Source YAML

References & Deep Research

Deep Research

1. Disease Information

2. Etiology

3. Phenotypes

4. Genetic / Molecular Information

5. Environmental Information

6. Mechanism / Pathophysiology

Ordered causal chain (initiating exposure → clinical manifestation)

7. Anatomical Structures Affected

8. Temporal Development

9. Inheritance and Population

10. Diagnostics

11. Outcome / Prognosis

12. Treatment

13. Prevention

14. Other Species / Natural Disease

15. Model Organisms

Key Findings (with statistical evidence)

F001 — Three clinical forms; erysipeloid is most common

F002 — SpaA and neuraminidase are the key virulence factors (not capsule or hyaluronidase)

F003 — Intrinsic vancomycin resistance; penicillin is first-line

F004 — Endocarditis: low-virulence organism, high mortality (~38%)

F005 — Broad host range; swine erysipelas is the most economically important animal disease

F006 — Spa family (SpaA/B/C) underpins vaccines; mouse and pig models validate protection

F007 — Host immunocompromise predisposes to invasive disease

F008 — Erysipeloid is a localized, direct-inoculation hand/finger infection that can extend to tenosynovitis

F009 — Diagnostic signature: catalase/oxidase-negative Gram-positive rod, H₂S-positive in TSI, vancomycin-resistant

Mechanistic Model / Interpretation

Evidence Base

Limitations and Knowledge Gaps

Proposed Follow-up Experiments / Actions

Artifacts

Reference Validation

Quotes not found in the cited source

Term Validation

Terms the report names something else

Obsolete terms

Terms whose name is worth a second look