Erysipelothrix rhusiopathiae Native Value Endocarditis: A Unique Case Presentation

Abstract

ER is a facultative, non-spore-forming, non-acid-fast, gram-positive bacillus. It is a ubiquitous commensal in wild and domestic animals, birds, and fish and has an enormous economic impact on animal husbandry and marine industry, causing animal erysipelas. Human infections are extremely rare, occupationally acquired zoonosis. Human infections are acquired through wounds, contact with sick animals, and carriers and commonly includes localized or generalized self-limited cutaneous erysipelas. Seldom, systemic infection and septicemia occur. We present here, a case of a 50-year-old immunocompetent retired shipyard welder who enjoyed fishing in his spare time and presented to the emergency room with fever, chest pain, significant weight loss, and dry cough lasting 2 to 3 months. He did not report any bites or injuries, intravenous drug abuse, or travel history. An echocardiogram showed mobile vegetation on aortic valve with severe regurgitation. Blood and tissue cultures grew E rhusiopathiae, identified by MALDI-TOF method. He was treated with empiric vancomycin followed by penicillin and aortic valve replacement with a mechanical valve. Cases of E rhusiopathiae–induced native valve endocarditis and septicemia are extremely infrequent in immunocompetent individuals, especially when occupation-related exposure is not noted. Even after surgery, it may entail fatality rates as high as 40%, higher than endocarditis caused by other bacteria. While some current reports suggest incidences of human infections are declining due to technological advances in animal industry, infection still occurs in specific environments. Additionally, it may be underdiagnosed due to its resemblance to other infections and problems encountered in isolation and identification. The natural resistance of E rhusiopathiae to glycopeptides underlines the importance of a prompt microbiological diagnosis of such an uncommon human infection, especially when presented in an unusual clinical presentation. Clinicians and microbiologists working with exposed population should be aware of this microbe and its manifestations.