title: Infectious tenosynovitis with bloodstream infection caused by Erysipelothrix rhusiopathiae, a case report on an occupational pathogen.
abstract: Erysipelothrix rhusiopathiae is an established animal pathogen, which may cause infections in humans. It is a gram-positive rod and found in the tonsils or the digestive tracts of animals. The bacterium is occupationally related, as usually only people with frequent animal contacts are infected. We report a case of a patient who was admitted with an infectious tenosynovitis with bloodstream infection due to E. rhusiopathiae, and to our knowledge, this is the first report of a tenosynovitis with systemic manifestation associated with this bacterium.
  
  
  
  A 52-year old Norwegian man, who worked with transportation of swine cadavers, was admitted to the local hospital with sepsis and unknown focus of infection. A few days earlier he had an injury to the skin of one of his fingers that later proved to be infected with E. rhusiopathiae. There were no other causes for his symptoms than the infectious tenosynovitis with systemic manifestation. The infection resolved on treatment with antibiotics and surgery. A transoesophageal echocardiogram was performed to exclude endocarditis, which may be associated with this pathogen.
  
  
  
  This case report highlights the importance of clinicians being aware of this bacterium, and we describe risk factors for infection, differences in the clinical manifestations of the disease, challenges with diagnosing the bacterium and adverse effects of immunosuppressive drugs. Recommended treatment is appropriate antibiotic therapy and adequate debridement and surgical drainage of the tendon sheath.
authors.affiliation: Department of Orthopedic Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
authors.forename: Kristine
authors.initials: K
authors.lastname: Hofseth
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.|Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Department of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
authors.forename: Håvard
authors.initials: H
authors.lastname: Dalen
authors.affiliation: Department of Orthopedic Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
authors.forename: Leif
authors.initials: L
authors.lastname: Kibsgaard
authors.affiliation: Department of Laboratory Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
authors.forename: Solrun
authors.initials: S
authors.lastname: Nebb
authors.affiliation: Department of Laboratory Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
authors.forename: Angela
authors.initials: A
authors.lastname: Kümmel
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway. Arne.Mehl@helse-nordtrondelag.no.|Mid-Norway Sepsis Research Group, Norwegian University of Science and Technology, Trondheim, Norway. Arne.Mehl@helse-nordtrondelag.no.
authors.forename: Arne
authors.identifier: 0000-0001-6711-0333
authors.initials: A
authors.lastname: Mehl
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology*; D004696:Endocarditis / Q000188:drug therapy / Q000382:microbiology; D004888:Erysipelothrix / Q000302:isolation & purification*; D004889:Erysipelothrix Infections / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000382:microbiology; D012307:Risk Factors; D013552:Swine; D013553:Swine Diseases / Q000382:microbiology; D013717:Tenosynovitis / Q000097:blood / Q000382:microbiology*; D015047:Zoonoses / Q000175:diagnosis / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bloodstream infection; Case report; Endocarditis; Erysipelothrix rhusiopathiae; Infectious tenosynovitis; Sepsis; Surgical treatment; TNF-α inhibitor