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A Comparison of Erysipelothrix rhusiopathiae Bacteremia With and Without Endocarditis in Frequent Fish Handlers

Hornak, J. Patrik, MD*; McLean, Maranatha R., MD; Webb, Camille M., MD; Keiser, Philip H., MD

Infectious Diseases in Clinical Practice: May 2019 - Volume 27 - Issue 3 - p 175–177
doi: 10.1097/IPC.0000000000000725
Case Reports

A facultatively anaerobic gram-positive bacillus, Erysipelothrix rhusiopathiae is widely present in the environment and also as a commensal and pathogenic organism associated with livestock, birds, and fish. Invasive infections in humans are rare, classically affect patients with exposures to animal products, and frequently progress to include endocarditis. Here we present our successful experience of treating 2 patients with E. rhusiopathiae bacteremia, both frequently exposed to fish. One patient presented in new-onset heart failure after a protracted illness and was found to have subacute aortic and mitral valve endocarditis successfully treated with surgical valve replacement and prolonged intravenous penicillin therapy. The other patient had acute uncomplicated bacteremia responsive to ceftriaxone followed by step-down treatment with oral penicillin, the first published report using such regimen. Our experience highlights the spectrum of clinical disease seen in E. rhusiopathiae bacteremia and offers new perspectives to optimize treatment for these patients.

From the *Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX;

Department of Anesthesiology, Westchester Medical Center, Valhalla, NY; and

Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX.

Correspondence to: J. Patrik Hornak, MD, Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, 4.174 John Sealy Annex, Galveston, TX 77555-0566. E-mail:

The authors have no funding or conflicts of interest to disclose.

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