Erysipeloid – an acute infection caused by traumatised skin
Erysipelothrix rhusiopathiae transmission from geese to humans is often related to direct contact with either nasal discharge, saliva or faeces. However, recognising and diagnosing the life-threatening bacterial infection is quite a challenge. Especially in the absence of a case history. This article describes the case of a laboratory technician who got infected while performing necropsy (another term for biopsy) on geese. Doctors diagnosed the patient with erysipeloid.
The otherwise healthy 58-year-old woman without any significant medical history presented to the emergency with complaints of reddish skin alterations at the right interdigital space. 11 days prior to getting infected, she was working as a laboratory technician in the necropsy hall of a faculty of veterinary medicine. While working on geese necropsy at the facility, she got a minor skin wound. The very day four 6-month old geese were submitted for diagnostic pathological examination.
The flock had 350 geese out of which 4 died within 12 hours without any clinical signs.
Mass mortality of birds is often associated with highly contagious zoonotic diseases. For example, avian influenza (AI, influenza A virus) or Newcastle disease (NCD, avian orthoavulavirus-1). To prevent the personnel from zoonotic infections the cloacal swabs were tested for antigens before necropsy started. The test results came back negative without signs of any infectious diseases. In case the test is positive, the veterinary authorities in Switzerland have to be notified.
In this case, two randomly selected carcasses were necropsied. The animal was prepared as per routine methods. To reduce the risk of inhaling pathogens, the animals were wet, a pincette, scissor and poultry shear was used to open the carcasses. Then, the intestine. was opened and most of the inner organs were extracted to perform parasitology. However, while the 58-year-old laboratory technician was opening the thorax of the goose, a sharp fragment of the rib punctures the right protective glove of the patient. The puncture wound was between the 2nd and 3rd digits. She immediately washed and disinfected her hands as per standard procedure.
Although, a day after the incident, the patient noticed slowly progressing reddish skin alteration where the glove was pierced.
She reported it to the supervisor and on the 11th day she was sent to the emergency. On examination she appeared well with no signs of fever or night sweats. Clinical examination was clear of any systemic diseases other than the skin lesion. A delimited erythematous maculopapular discoloration was identified between the digits. All other blood tests did not show any significant findings. Doctors diagnosed the patient with local erysipeloid based on the case history.
References
Erysipelothrix rhusiopathiae infection by geese to human transmission https://casereports.bmj.com/content/14/5/e240073
