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

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.