Erysipelas

Erysipelas is an acute localized inflammation of the skin with an alteration of the general condition, which is typically caused by beta hemolytic streptococci of group A (Streptococcus pyogenes), less often groups C, G and B (Streptococcus agalactiae), golden staphylococci or G-bacteria can sometimes be detected in culture. Erysipelas most often occurs on the feet and face. The gateway to the infection is a broken skin barrier (maceration, leg ulcers, ragads, erosion). It is transmitted from a sick person or endogenously from the nasopharynx to the injured skin, in newborns to the umbilical cord. The incubation period is short, usually 1-3 days. The disease is prone to recurrences, recurrences are usually caused by endogenous reactivation of bacteria. Acute glomerulonephritis may develop after erysipelas after a latency period (1-4 weeks). In the Czech Republic, erysipelas reporting is mandatory.

Clinical manifestations
Rapid development of general symptoms: Local symptoms:
 * fever with chills, headache, sometimes nausea and general exhaustion.


 * after a few hours, inflammatory to phlegmonous changes (redness, burning, itching, tenderness to pain, swelling) occur at the site of infection, the deposit has an irregular shape;


 * regional lymphadenitis.

Species

 * Erysipelas bullosum – vesicles and bullae form in the deposit
 * Erysipelas migrans – the primary deposit heals, but new deposits appear in the area
 * Erysipelas haemorrhagicum – bleeding into blisters
 * Erysipelas gangrenosum – skin necrosis
 * Erysipelas phlegmonosum – deep propagation (possible development of cellulite or necrotizing fasciitis)
 * Erysipelas recidivans – recurrent infections

Diagnostics

 * clinical manifestations;
 * cultivation from erysipelas lesion, aspiration from lesion, biopsy – low capture
 * ASLO titer (antistreptolysin O) - skin infections are very rarely accompanied by increased ASLO titer, because streptolysin O is inactivated by lipids contained in the skin during local infection;
 * the anti-deoxyribonuclease B antibody titer may be increased.

Therapy

 * crystalline penicillin i.v., after improvement procaine penicillin i.m.
 * symptomatic treatment
 * bed rest
 * cardiovascular function should be monitored in the elderly

Complications
Complications include:
 * myocarditis, endocarditis or pericarditis,
 * glomerulonephritis,
 * rheumatic joint involvement,
 * pyartros,
 * metastatic pneumonia,
 * lymphedema,
 * local tissue devastation, phlebitis or phlebothrombosis.

Použitá literatura

 * HAVLÍK, Jiří, et al. Infektologie. 2. vydání. Praha : Avicenum, 1990. 393 s.  ISBN 80-201-0062-8.