Erysipelas

Erysipelas (

Erysipelas is usually caused by the bacterium Streptococcus pyogenes, also known as group A β-hemolytic streptococci, which enters the body through a break in the skin, such as a scratch or an insect bite. It is more superficial than cellulitis and is typically more raised and demarcated.^[4] The term comes from the Greek ἐρυσίπελας (erysípelas), meaning red skin.^[5]

In animals erysipelas is a disease caused by infection with the bacterium Erysipelothrix rhusiopathiae. In animals it is called Diamond Skin Disease and occurs especially in pigs. Heart valves and skin are affected. Erysipelothrix rhusiopathiae can also infect humans but in that case the infection is known as erysipeloid and is an occupational skin disease.^[6]

Signs and symptoms

Symptoms often occur suddenly. Affected individuals may develop a fever,

The infection may occur on any part of the skin, including the face, arms, fingers, legs and toes; it tends to favour the extremities.[1] The umbilical stump and sites of lymphoedema are also common sites affected.^[7]

Fat tissue and facial areas, typically around the eyes, ears and cheeks, are most susceptible to infection.

• 
  Erysipelas (ear)
• 
  Erysipelas (arm)
• 
  Erysipelas (leg)
• 
  Recurrent erysipelas

Cause

Most cases of erysipelas are due to Streptococcus pyogenes, also known as group A β-hemolytic streptococci, less commonly to group C or G streptococci and rarely to Staphylococcus aureus. Newborns may contract erysipelas due to Streptococcus agalactiae, also known as group B streptococcus or GBS.^[7]

The infecting bacteria can enter the skin through minor trauma, human, insect or animal bites, surgical incisions, ulcers, burns and abrasions. There may be underlying

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 epidermis and superficial lymphatics.^[10]

Diagnosis

Erysipelas is usually diagnosed by the clinician looking at the characteristic well-demarcated rash following a history of injury or recognition of one of the risk factors.^[2]

Tests, if performed, may show a high white cell count, raised CRP or positive blood culture identifying the organism.^[2] Skin cultures are often negative.^[11]

Erysipelas must be differentiated from

Erysipelas can be distinguished from cellulitis by two particular features: its raised advancing edge and its sharp borders. The redness in cellulitis is not raised and its border is relatively indistinct.[7] Bright redness of erysipelas has been described as a third differentiating feature.^[13]

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.^{[14][clarification needed]}

Treatment

Treatment is with

Because of the risk of reinfection, prophylactic antibiotics are sometimes used after resolution of the initial condition.[2]

Prognosis

The disease prognosis includes:

• Spread of infection to other areas of body can occur through the bloodstream (
  bacteremia), including septic arthritis. Glomerulonephritis can follow an episode of streptococcal erysipelas or other skin infection but not rheumatic fever.^{[citation needed}
  ]
• Recurrence of infection: Erysipelas can recur in 18–30% of cases even after antibiotic treatment. A chronic state of recurrent erysipelas infections can occur with several predisposing factors, including alcoholism, diabetes and athlete's foot.^[16] Another predisposing factor is chronic cutaneous edema, such as can in turn be caused by venous insufficiency or heart failure.^[17]
• Lymphatic damage^{[citation needed]}
• Necrotizing fasciitis, commonly known as ‘flesh-eating’ bacterial infection, is a potentially deadly exacerbation of the infection if it spreads to deeper tissue.^{[citation needed]}

Epidemiology

There is currently no validated recent data on the worldwide incidence of erysipelas.^[18] From 2004 to 2005 UK hospitals reported 69,576 cases of cellulitis and 516 cases of erysipelas.^[18] One book stated that several studies have placed the prevalence rate between one and 250 in every 10,000 people.^[19] The development of antibiotics, as well as increased sanitation standards, has contributed to the decreased rate of incidence.^[20] Erysipelas caused systemic illness in up to 40% of cases reported by UK hospitals and 29% of people had recurrent episodes within three years.^[18] Anyone can be infected, although incidence rates are higher in infants and elderly.^[20] Several studies also reported a higher incidence rate in women.^[20] Four out of five cases occur on the legs, although historically the face was a more frequent site.^[3]

Risk factors for developing the disease include^{[19][18][20][21]}

• Arteriovenous fistula
• Chronic skin conditions such as psoriasis, athlete's foot, and eczema
• Excising the saphenous vein
• Immune deficiency or compromise, such as
  • Diabetes
  • Alcoholism
  • Obesity
  • Human immunodeficiency virus (HIV)
• In newborns, exposure of the umbilical cord and vaccination site injury
• Issues in lymph or blood circulation
• Leg ulcers
• Lymphatic edema
• Lymphatic obstruction
• Lymphoedema
• Nasopharyngeal infection
• Nephrotic syndrome
• Pregnancy
• Previous episode(s) of erysipelas
• Toe web intertrigo
• Traumatic wounds
• Venous insufficiency or disease

Preventive measures

Individuals can take preventive steps to decrease their risk of catching the disease. Properly cleaning and covering wounds is important for people with an open wound. Effectively treating athlete's foot or eczema if they were the cause of the initial infection will decrease the chance of the infection occurring again. People with diabetes should pay attention to maintaining good foot hygiene.^[19] It is also important to follow up with doctors to make sure the disease has not come back or spread. About one third of people who have had erysipelas will be infected again within three years.^[18] Rigorous antibiotics may be needed in the case of recurrent bacterial skin infections.^[19]

Notable cases

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In Rodrigo Souza Leão's autobiographical novel All Dogs are Blue, he says that his erysipelas is cured by the antibiotic Benzetacil (Benzathine benzylpenicillin).^[41]

History

It was historically known as St Anthony's fire.^[3]

Citations

1. ^
   ISBN 978-0-323-53042-2
   .
2. ^ ^{a b c d e f g} Stanway, Amy; Oakley, Amanda; Gomez, Jannet (2016). "Erysipelas | DermNet NZ". dermnetnz.org. Retrieved 6 June 2020.
3. ^ ^{a b c} Davis, Loretta S. (9 November 2019). "Erysipelas: Background, Pathophysiology and Etiology, Epidemiology". Medscape.
4. ^ ^{a b} Wanat, Karolyn A.; Norton, Scott A. "Skin & Soft Tissue Infections – Chapter 11 – 2020 Yellow Book | Travelers' Health | CDC". Centres for Disease Control and Prevention. Retrieved 6 June 2020.
5. ISBN 978-93-5270-545-0
   .
6. S2CID 26805689
   .
7. ^
   ISBN 978-0-07-163342-0
   .
8. ^ "Cellulitis". The Lecturio Medical Concept Library. Retrieved 7 July 2021.
9. ^ "Erysipelas". The Lecturio Medical Concept Library. Retrieved 21 July 2021.
10. ^ "Erysipelas". The Lecturio Medical Concept Library. Retrieved 7 July 2021.
11. ISBN 9781870905206.{{cite book}}: CS1 maint: multiple names: authors list (link
    )
12. PMID 30335280
    . Retrieved 7 July 2021.
13. PMID 26866211
    , retrieved 8 June 2020
14. ^ Spelman, Denis. "Cellulitis and skin abscess: Clinical manifestations and diagnosis". UpToDate. Retrieved 30 July 2019.
15. ^ The WHO AWaRe (Access, Watch, Reserve) antibiotic book. World Health Organization. 2022. pp. 193–205.
16. S2CID 29789051
    .
17. ISBN 9781451113648. Page 194
18. ^
    PMID 19450336
    .
19. ^ ^{a b c d} Erysipelas and cellulitis: Overview. Institute for Quality and Efficiency in Health Care. 22 February 2018.
20. ^
    PMID 30335280
    , retrieved 13 November 2020
21. ^ "Erysipelas | DermNet NZ". dermnetnz.org. Retrieved 30 November 2020.
22. ISBN 0521403235
    .
23. ISBN 9780198614111. Retrieved 31 January 2021. (Subscription or UK public library membership
    required.)
24. ^ "Berkeley, Norborne, baron de Botetourt (1717–1770)".
25. ^ Dennis Butts, "Hofland, Barbara (bap. 1770, d. 1844)", Oxford Dictionary of National Biography (Oxford, UK: OUP, 2004 Retrieved 20 December 2015, pay-walled.
26. ISBN 978-0-87451-172-7
    .
27. ISBN 978-87-11-22878-4
    .
28. ^ Castillo, Dennis (14 April 2017). "Viewpoints: Remembering Buffalo's first Catholic bishop, John Timon, 'a great and good man'". The Buffalo News. Retrieved 17 April 2017.
29. ISBN 978-0-521-62024-6
    .
30. ^ "Marcus Clarke". Australian Variety Theatre Archive. 31 July 2011.
31. ^ Ridley, Jane (2013). The Heir Apparent: a life of Edward VII, the Crown Prince. New York, NY: Penguin Random House LLC. p. 287.
32. ^ America the Beautiful by Lynn Sherr
33. ^ Macy, Beth. Truevine. Little, Brown & Co, New York, 2016, page 151.
34. ^ Cox, A. M. "The death of Lord Carnarvon"; The Lancet; 7 June 2003.
35. ISBN 0-87972-677-6
    .
36. ISBN 1-56955-281-9
    ,
37. ISBN 978-0304318148
    . pp. 77–78.
38. ISBN 9780333726259
    . p. 150.
39. ISBN 978-0-465-01395-1
    pp. 85–87.
40. ISBN 0-297-77265-1
    . p. 236.
41. ISBN 978-1-908-27620-9
    . p. 49.

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