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), staphylococcus aureus 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:

• fever with chills, headache, sometimes nausea and general exhaustion.

Local symptoms:

• 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.

• 

  Erysipelas on the face

• 

  Erysipelas on the leg

• 

  Erysipelas phlegmonosum

• 

  Lymphedema of the right lower limb after recurrent erysipelas

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 cellulitis 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.

Links

Related articles

• Impetigo
• Group A streptococcal infection
• Pyoderma
• Ecthyma

References

1. BENEŠ, Jiří, et al. Infekční lékařství. 1. vydání. Galén, 2009. 651 s. s. 204, 205, 494. ISBN 978-80-7262-644-1.
2. ↑ Státní zdravotní ústav. Vybrané infekční nemoci v ČR v letech 2005-2014 - relativně [online]. ©2014. [cit. 2015-12-02]. <http://www.szu.cz/publikace/data/vybrane-infekcni-nemoci-v-cr-v-letech-2003-2012-relativne>.
3. ↑ MUDr. Petr Herle, MUDr. Jiří Appelt,odborná společnost všeobecného lékařství,<http://www.cls.cz/dokumenty2/resitele/t092.rtf>
4. ↑ Rozsypal, Hanuš. . Základy infekčního lékařství. - vydání. Charles University in Prague, Karolinum Press, 2015. 572 s. s. 293–293. ISBN 8024629321.
5. ↑ Skočit nahoru k:a b http://www.szu.cz/tema/prevence/erysipel-manual-iv
6. ↑ DRLÍK, L a H ŠKODOVÁ. Erysipel se závěžnými interními komplikacemi. Dermatologie pro praxi [online]. 2008, roč. 2, vol. 3, s. 154-155, dostupné také z <http://solen.cz/pdfs/der/2008/03/10.pdf>. 

Použitá literatura

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