Erysipelas

Erysipelas

Erysipelas of the face due to invasive Streptococcus
Classification and external resources
Specialty Dermatology, infectious disease
ICD-10 A46.x
ICD-9-CM 035
DiseasesDB 4428
MedlinePlus 000618
eMedicine derm/129
MeSH D004886

Erysipelas (/ɛrˈsɪpələs/; Greek ἐρυσίπελας, "red skin"; also known as "ignis sacer", "holy fire", and "St. Anthony's fire"[1] in some countries) is an acute infection[2] typically with a skin rash, usually on any of the legs and toes, face, arms, and fingers. It is an infection of the upper dermis and superficial lymphatics, usually caused by beta-hemolytic group A Streptococcus bacteria on scratches or otherwise infected areas.[3] Erysipelas is more superficial than cellulitis, and is typically more raised and demarcated.[4]

Signs and symptoms

Erysipelas on an arm
Erysipelas on a leg

Affected individuals typically develop symptoms including high fevers, shaking, chills, fatigue, headaches, vomiting, and general illness within 48 hours of the initial infection. The erythematous skin lesion enlarges rapidly and has a sharply demarcated, raised edge. It appears as a red, swollen, warm, and painful rash, similar in consistency to an orange peel. More severe infections can result in vesicles (pox or insect bite-like marks), blisters, and petechiae (small purple or red spots), with possible skin necrosis (death). Lymph nodes may be swollen, and lymphedema may occur. Occasionally, a red streak extending to the lymph node can be seen.

The infection may occur on any part of the skin, including the face, arms, fingers, legs, and toes; it tends to favour the extremities. Fat tissue and facial areas, typically around the eyes, ears, and cheeks, are most susceptible to infection. Repeated infection of the extremities can lead to chronic swelling (lymphangitis).

Cause

Most cases of erysipelas are due to Streptococcus pyogenes (also known as beta-hemolytic group A streptococci), although non-group A streptococci can also be the causative agent. Beta-hemolytic, non-group A streptococci include Streptococcus agalactiae, also known as group B strep or GBS. Historically, the face was most affected; today, the legs are affected most often.[5] The rash is due to an exotoxin, not the Streptococcus bacteria, and is found in areas where no symptoms are present; e.g., the infection may be in the nasopharynx, but the rash is found usually on the face and arms.

Erysipelas infections can enter the skin through minor trauma, insect bites, dog bites, eczema, athlete's foot, surgical incisions and ulcers and often originate from streptococci bacteria in the subject's own nasal passages. Infection sets in after a small scratch or abrasion spreads, resulting in toxaemia.

Erysipelas does not affect subcutaneous tissue. It does not release pus, only serum or serous fluid. Subcutaneous edema may lead the physician to misdiagnose it as cellulitis, but the style of the rash is much more well circumscribed and sharply marginated than the rash of cellulitis.

Risk factors

This disease is most common among the elderly, infants, and children. People with immune deficiency, diabetes, alcoholism, skin ulceration, fungal infections, and impaired lymphatic drainage (e.g., after mastectomy, pelvic surgery, bypass grafting) are also at increased risk.

Diagnosis

This disease is diagnosed mainly by the appearance of well-demarcated rash and inflammation. Blood cultures are unreliable for diagnosis of the disease, but may be used to test for sepsis. Erysipelas must be differentiated from herpes zoster, angioedema, contact dermatitis, and diffuse inflammatory carcinoma of the breast.

Erysipelas can be distinguished from cellulitis by its raised advancing edges and sharp borders. Elevation of the antistreptolysin O titer occurs after around 10 days of illness.

Treatment

Depending on the severity, treatment involves either oral or intravenous antibiotics, using penicillins, clindamycin, or erythromycin. While illness symptoms resolve in a day or two, the skin may take weeks to return to normal.

Because of the risk of reinfection, prophylactic antibiotics are sometimes used after resolution of the initial condition. However, this approach does not always stop reinfection.[6]

Prognosis

The disease prognosis includes:

Notable deaths

In order of death

Richard Wagner, German composer, also suffered from erysipelas, although he died of a heart attack.

In D. H. Lawrence's famous novel Sons and Lovers one of the major characters in the novel, William Morel (who is the main character Paul's older brother) dies quickly from the complications of erysipelas in conjunction with pneumonia.[18]

Other animals

Erysipelas is also the name given to an infection in animals caused by the bacterium Erysipelothrix rhusiopathiae. E. rhusiopathiae can also infect humans, but in that case the infection is known as erysipeloid.

See also

References

  1. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 260. ISBN 0-7216-2921-0.
  2. "erysipelas" at Dorland's Medical Dictionary
  3. Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A (2006). "Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance". Dermatology 212 (1): 31–5. doi:10.1159/000089019. PMID 16319471.
  4. Bisno AL, Stevens DL (January 1996). "Streptococcal infections of skin and soft tissues". The New England Journal of Medicine 334 (4): 240–5. doi:10.1056/NEJM199601253340407. PMID 8532002.
  5. See eMedicine link
  6. Koster JB, Kullberg BJ, van der Meer JW (March 2007). "Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies". The Netherlands Journal of Medicine 65 (3): 89–94. PMID 17387234.
  7. Entry on Geni.com (Dutch language). Retrieved 10 June 2015.
  8. http://encyclopediavirginia.org/Berkeley_Norborne_baron_de_Botetourt_1717-1770#start_entry
  9. Dennis Butts, "Hofland , Barbara (bap. 1770, d. 1844)", Oxford Dictionary of National Biography (Oxford, UK: OUP, 2004 Retrieved 20 December 2015, pay-walled.
  10. Green, Elizabeth Alden (1979). Mary Lyon and Mount Holyoke. Hanover, New Hampshire: University Press of New England. p. 310. ISBN 0-87451-172-0.
  11. http://www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=15331022
  12. Møller, Jan (1994). Frederik 7. En kongeskæbne. Copenhagen: Aschehoug Dansk Forlag. p. 235. ISBN 978-87-11-22878-4.
  13. Capaldi, Nicholas (2004). John Stuart Mill: a biography. Cambridge, UK: Cambridge University Press. p. 356. ISBN 0-521-62024-4.
  14. Australian Variety Theatre Archive • http://ozvta.com/practitioners-other-a-l/
  15. Ridley, Jane (2013). The Heir Apparent: a life of Edward VII, the Crown Prince. New York, NY: Penguin Random House LLC. p. 287.
  16. America the Beautiful by Lynn Sherr
  17. Wollenweber, Brother Leo (2002). "Meet Solanus Casey". St. Anthony Messenger Press, Cincinnati, Ohio, page 107, ISBN 1-56955-281-9,
  18. Chapter 6, "Death in the Family" – summary on GradeSaver website. Retrieved 25 January 2016.

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