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Erysipelas

Erysipelas is a dermatological disorder caused by bacterial infection. The infection usually involves the epidermal layers of the face or leg and manifests as a well-defined, elevated, painful and erythematous skin lesion. Causative bacteria are mainly members of the Streptococcus family. Antibiotic treatment and in severe cases surgical debridement are required for a recovery. The probability of erysipelas recurrence is up to twenty percent.


Presentation

Erysipelas occurs when bacteria invade the epidermis as a consequence of skin lesions. Patients with eczema or patients who engage in strong physical activities as well as patients with a weakened or systemically impaired immune system are at an increased risk of developing erysipelas. Children younger than six and seniors older than sixty are mostly affected by erysipelas. Furthermore, patients with a history of drug use also face an increased erysipelas risk because of regular injections. Possible other causes for erysipelas include skin ulcers, surgical incisions, insect bites, psoriasis, and edema feet secondary to cardiac insufficiency and diabetes [1] [2].

Erysipelas has been shown to be caused by an infection with the following bacteria: group A / C / D streptococci, Klebsiella pneumonia, Haemophilus influenza, Escherichia coli, and Moraxella. Notably, methicillin-resistant Staphylococcus aureus has also been found in the context of erysipelas [3] [4].

Typical symptoms of erysipelas are a large, elevated, painful erythematous skin patch with sharp borders, blisters, swollen glands, fever, chills and general malaise. Most facial infections are attributed to group A streptococci and usually affect both cheeks and the nose. Erysipelas can also occur after a throat infection with subsequent bacterial migration to the nasal passages [1].

The most common complications of erysipelas include abscess, gangrene, and thrombophlebitis. In selected cases, acute glomerulonephritis, endocarditis, septicemia, and streptococcal toxic shock syndrome may occur. Osteoarticular complications may present as bursitis, osteitis, arthritis, and tendinitis [5] [6].

Fever
  • Atypical fever patterns were also noted. In one patient, the facial lesion followed the onset of fever by 48 hours, and, in the other, the facial swelling preceded the fever.[ncbi.nlm.nih.gov]
  • FMF is a monogenic autoinflammatory syndrome highlighted by recurrent fever associated with polyserositis involving mainly the peritoneum, synovium and pleura.[ncbi.nlm.nih.gov]
  • Extensive facial involvement with fever and a toxic appearance warrants hospitalization.[ncbi.nlm.nih.gov]
  • The results suggest that group A streptococci induce contact activation and HBP release during skin infection, which likely contribute to the symptoms seen in erysipelas: fever, pain, erythema, and edema.[ncbi.nlm.nih.gov]
  • Fever was present in 25% of patients. The most commonly used antibiotic was intravenous penicillin G (64%).[ncbi.nlm.nih.gov]
Chills
  • Fever with chills and general malaise may be prominent symptoms. Antibiotics are usually effective. Patients handled in a timely manner tend to recover without problems.[ncbi.nlm.nih.gov]
  • Symptoms of Erysipelas The symptoms of erysipelas include: Sharply defined, bright red area of the skin Hot and painful area Slightly elevated as compared to the rest of the skin Sometimes a red streak extending to the lymph node can be noticed Fever and chills[healthinplainenglish.com]
  • The onset is usually abrupt with high fever, chills, and weakness. Over the next 24- 48 hours a red shiny plaque forms usually proximal to the area of entry into the skin.[aocd.org]
  • Typical symptoms of erysipelas are a large, elevated, painful erythematous skin patch with sharp borders, blisters, swollen glands, fever, chills and general malaise.[symptoma.com]
Malaise
  • Fever with chills and general malaise may be prominent symptoms. Antibiotics are usually effective. Patients handled in a timely manner tend to recover without problems.[ncbi.nlm.nih.gov]
  • Typical symptoms of erysipelas are a large, elevated, painful erythematous skin patch with sharp borders, blisters, swollen glands, fever, chills and general malaise.[symptoma.com]
  • High fever, chills, and malaise frequently accompany erysipelas. There is also a bullous form of erysipelas.[merckmanuals.com]
  • Also, at the same time general malaise, headache, sickness and an urge to vomit are present.[en.dermatim.net]
Rigor
  • URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services.[umms.org]
  • This suggests firstly that poor initial management plays an important role in the occurrence of complications, and secondly the erythrocyte sedimentation rate can be a good biomarker ofcomplication risk and hospital criterion for rigorous monitoring and[panafrican-med-journal.com]
Hodgkin's Disease
  • Erysipelas developed in a young woman whose condition had been in remission for ten years after treatment of stage IIIA Hodgkin's disease. The erysipelas was atypical both in its clinical manifestation and its causative organism.[ncbi.nlm.nih.gov]
Tachycardia
  • Examination findings included resting tachycardia and melenic stool. Blood pressure was 95/50 mm Hg. Multiple raised, soft, bluish 0.3 to 1 cm lesions were noted on the trunk and extremities.[consultant360.com]
  • Up to 25% of patients will die from the disease The following cases of cellulitis: Associated with marked systemic upset eg fever, vomiting, tachycardia, hypotension Spreading cellulitis that is not responding to oral medication Lymphangitis Have a lower[pcds.org.uk]
Eye Swelling
  • Some patients have swelling of the eyelids, sometimes so severe that their eyes swell shut. The patient may have fever, chills, loss of energy, nausea and vomiting, and swollen, tender lymph nodes.[encyclopedia.com]
Erythema
  • All had a painful erythema of the medial part of one or both calves and all failed numerous antibiotic regimens. In all patients a sharply demarcated, tender indurated erythema of the medial part of one or both calves was seen.[ncbi.nlm.nih.gov]
  • The unusual presentation with absence of erythema in the skin lesion is emphasized. Atypical fever patterns were also noted.[ncbi.nlm.nih.gov]
  • Features that help distinguish erysipelas are acute onset, erythema, warmth, edema, pain, fever, and isolated regional involvement with clearly demarcated margins. High ASO titers and response to penicillin therapy are reassuring.[ncbi.nlm.nih.gov]
  • His edema and erythema resolved with no recurrence; graduated compression stockings were prescribed.[cmaj.ca]
  • The results suggest that group A streptococci induce contact activation and HBP release during skin infection, which likely contribute to the symptoms seen in erysipelas: fever, pain, erythema, and edema.[ncbi.nlm.nih.gov]
Flushing
  • Baking Soda Remedy Baking soda is widely used for deep cleansing the skin and for erysipelas you can use this remedy which would flush out all the bacteria and get you a clean skin without infections and disorders.[homeremedyfind.com]
  • , rosarium, redness noun فورة fawra outburst, flush, gust noun, verb تهيج tahij irritation, agitation, excitement, go red noun, verb توهج tawhaj glow, flare, flamboyance, radiance, flush noun القساوة alqasawa hardness, rawness الآلام alalam pain Watch[wordhippo.com]
  • Both erysipelas and cellulitis present clinically as a skin infection, that is, flushing (redness), local heat, intense pain and edema (swelling) in the affected area.[uncanxietyclinic.com]
  • You may get a bright strawberry-red tongue and flushed (rosy) face, while the area around your mouth remains pale. The skin on the tips of your fingers and toes often peels after you get better.[medicinenet.com]
Cellulitis of the Face
  • The anatomic diagnosis was erysipelas with acute cellulitis of the face, neck, and chest; acute mediastinitis involving the pericardium and pleurae with pleural effusion; and acute congestion of the viscera.[jamanetwork.com]
Malar Rash
Facial Swelling
  • In one patient, the facial lesion followed the onset of fever by 48 hours, and, in the other, the facial swelling preceded the fever. Various aspects of the patient's altered host status are discussed in light of the atypical clinical presentation.[ncbi.nlm.nih.gov]
Headache
  • Also, at the same time general malaise, headache, sickness and an urge to vomit are present.[en.dermatim.net]
  • […] compare Latin pellis skin) Latin erysipelas 1350–1400; Middle English erisipila Collins Concise English Dictionary HarperCollins Publishers:: erysipelas / ˌɛrɪˈsɪpɪləs / n an acute streptococcal infectious disease of the skin, characterized by fever, headache[wordreference.com]
  • It is characterized by well demarcated areas of redness, heat, pain, and swelling and may be associated with constitution symptoms including fever, chills, headache, joint pain, and back pain.[aocd.org]

Workup

Classical erysipelas usually does not require elaborate diagnostic workup. However, it is important to distinguish erysipelas from a symptomatically similar type of cellulitis, which does not present with sharp borders with inflammation.

Erysipelas diagnosis is based on a clinical examination of the affected area and an analysis of the patient history. In selected cases, routine blood analysis may be ordered, which commonly reveals an increased erythrocyte sedimentation rate and C-reactive proteins. Standard imaging techniques are usually not necessary for the diagnosis [1] [7].

Bacterial cultures extracted from the infected tissue rarely yield satisfying results. Histological characteristics are dermal edema, vascular dilatation and streptococcal invasion of lymphatics and tissues resulting in an increased presence of neutrophils and mononuclear cells. Bacteria may also infiltrate proximal blood vessels [1].

Erysipelas symptoms can be efficiently countered with cold compresses on the affected skin area, sufficient water intake and fever-reducing measures as well as painkillers.

Surgical removal of erysipelas may be necessary if the infection has led to tissue necrosis. Recurrent erysipelas may occur in around 20% of the patients [8] with potentially disabling disfigurements (e.g. elephantiasis nostras verrucosa).

Treatment

  • No patient stopped the treatment because of side-effects. No predictive factor of erysipelas recurrence under antibiotic prophylactic treatment was identified.[ncbi.nlm.nih.gov]
  • AIM: The aim of this study was to evaluate the prevalence of erysipelas and lymphangitis in a group of patients under treatment for lymphedema after breast-cancer therapy.[ncbi.nlm.nih.gov]
  • […] antibiotic treatment, intramuscular versus intravenous route, the addition of corticosteroid to antibiotic treatment compared with antibiotic alone, and vibration therapy, so there was insufficient evidence to form conclusions.[ncbi.nlm.nih.gov]
  • Treatment with penicillin was undertaken for all patients; the length of treatment varied from 11 to 26 days. Lympadenectomy and radiotherapy in breast cancer may lead to lymphedema, which can be evident or sometimes discrete.[ncbi.nlm.nih.gov]
  • Penicillin seems to preserve its fundamental role in the treatment of disease.[ncbi.nlm.nih.gov]

Prognosis

  • It has favourable prognosis, and rarely develops any complication with timely and appropriate therapy.[ncbi.nlm.nih.gov]
  • OBJECTIVES: Vulvar carcinoma is mainly treated surgically and has an overall good prognosis. Despite the development of minimally invasive surgical procedures in recent years, morbidity remains significant.[ncbi.nlm.nih.gov]
  • Prognosis With prompt treatment, the prognosis from erysipelas is excellent. Delay of treatment, however, increases the chance for bacteremia and the potential for death from overwhelming sepsis.[encyclopedia.com]
  • Prognosis for Erysipelas With proper treatment, the prognosis of Erysipelas is very good. With antibiotics, erysipelas can resolve within a week. It takes another week for the skin to return to its normal state and the skin may also peel.[epainassist.com]

Etiology

  • The most frequently involved bacterial agent is group A Streptococcus, which is also an etiologic agent of erysipelas. We present the case of a man aged 46 years with left-leg erysipelas who developed myocarditis.[ncbi.nlm.nih.gov]
  • The causal relationship between etiology and recurrent disease is illustrated here by 2 cases. Therapy options are also discussed.[ncbi.nlm.nih.gov]
  • Group A Beta-hemolytic streptococcus (GABHS, Streptoccocus pyogenes) is the usual etiologic agent.[ncbi.nlm.nih.gov]
  • The infection's predictable response to penicillin, even when S aureus is present, argues against S aureus as an etiologic agent.[emedicine.com]

Epidemiology

  • Despite the relative frequency of erysipelas, data on its basic epidemiological characteristics are scant. This study describes the trends in erysipelas epidemiology in Slovenia.[ncbi.nlm.nih.gov]
  • BACKGROUND/AIMS: Most studies on the epidemiology of erysipelas are done in hospitals, resulting in patient selection. The aim of this study is to determine epidemiological characteristics and comorbidity of erysipelas based on primary care data.[ncbi.nlm.nih.gov]
  • Seventy patients were identified and their medical records were retrospectively reviewed so as to record the epidemiological and clinical data.[ncbi.nlm.nih.gov]
  • The changing epidemiology and clinical spectrum of erysipelas are reviewed.[ncbi.nlm.nih.gov]
  • The analysis included demographic, epidemiologic, and medical chart review data with special attention to background disorders. The patients with single and recurrent episodes of erysipelas were compared.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Two cases of facial lymphangitis have been described, and the pathophysiology of erysipelas has been discussed.[ncbi.nlm.nih.gov]
  • Pathophysiology and Etiology Pathophysiology In erysipelas, the infection rapidly invades and spreads through the lymphatic vessels. This can produce overlying skin "streaking" and regional lymph node swelling and tenderness.[emedicine.com]
  • Pathophysiology •Bacterial inoculation into an area of skin traumais the initial event in developing erysipelas. 4.[slideshare.net]

Prevention

  • OBJECTIVES: To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes.[ncbi.nlm.nih.gov]
  • Prophylactic penicillin V potassium therapy prevented further episodes of erysipelas. Group B beta-hemolytic streptococcus should be considered a possible cause of erysipelas or cellulitis.[ncbi.nlm.nih.gov]
  • Hypervirulence of strains and persistence of a bacterial reservoir may explain why 5 months of prophylaxis with penicillin V (1 million U daily) was necessary to achieve permanent eradication of vaginal carriage and to prevent recurrence of erysipelas[ncbi.nlm.nih.gov]
  • Despite their burden of morbidity, the evidence for different prevention strategies is unclear.[cochrane.org]
  • CONCLUSIONS: Patients with erysipelas, especially when it involves the lower limb, should be instructed to reduce weight, control venous insufficiency and/or lymphedema and to emphasize prevention and treatment of tinea pedis.[ncbi.nlm.nih.gov]

References

Article

  1. Bonnetblanc JM, Bedane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003; 4(3):157-163.
  2. Bernard P. Management of common bacterial infections of the skin. Curr Opin Infect Dis. 2008; 21(2):122-128.
  3. Matz H, Orion E, Wolf R. Bacterial infections: uncommon presentations. Clin Dermatol. 2005; 23(5):503-508.
  4. Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A. Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance. Dermatology. 2006; 212(1):31-35.
  5. Gunderson CG, Chang JJ. Risk of deep vein thrombosis in patients with cellulitis and erysipelas: a systematic review and meta-analysis. Thromb Res. 2013; 132(3):336-340.
  6. Coste N, Perceau G, Leone J, et al. Osteoarticular complications of erysipelas. J Am Acad Dermatol. 2004; 50(2):203-209.
  7. Grosshans EM. The red face: erysipelas. Clin Dermatol. 1993; 11(2):307-313.
  8. Eriksson BKG. Anal Colonization of Group G β-Hemolytic Streptococci in Relapsing Erysipelas of the Lower Extremity. Clin Infect Dis. 1999; 29(5): 1319-1320.

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Last updated: 2019-07-11 22:35