Erysipelas
| Erysipelas | |
|---|---|
| Classification and external resources | |
 Erysipelas of the face due to invasive Streptococcus. |
|
| ICD-10 | A46.0 |
| ICD-9 | 035 |
| DiseasesDB | 4428 |
| MedlinePlus | 000618 |
| eMedicine | derm/129 |
| MeSH | D004886 |
Erysipelas (Greek ἐρυσίπελας—red skin; also known as "Ignis sacer", "holy fire", and "St. Anthony's fire"[1]:260 in some countries) is an acute streptococcus bacterial infection[2] of the deep epidermis with lymphatic spread.
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[edit] 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.
[edit] Signs and symptoms
Patients 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, hardened and painful rash, similar in consistency to an orange peel. More severe infections can result in vesicles, bullae, and petechiae, with possible skin necrosis. 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, but it tends to favor the extremities. Fat tissue is most susceptible to infection, and facial areas typically around the eyes, ears, and cheeks. Repeated infection of the extremities can lead to chronic swelling (lymphadenitis).
[edit] Etiology
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. Historically, the face was most affected; today the legs are affected most often.[3] The rash is due to an exotoxin, not the Strep. bacteria itself and is found in areas where no bacteria 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, eczema, surgical incisions and ulcers, and often originate from strep 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.
[edit] 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 (ASO) titer occurs after around 10 days of illness.
[edit] 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.[4]
[edit] Complications
- Spread of infection to other areas of body through the bloodstream (bacteremia), including septic arthritis and infective endocarditis (heart valves).
- Septic shock.
- Recurrence of infection—Erysipelas can recur in 18–30% of cases even after antibiotic treatment.
- Lymphatic damage
- Necrotizing fasciitis—commonly known as "the flesh-eating bug". A potentially deadly exacerbation of the infection if it spreads to deeper tissue.
[edit] Deaths
- Patrick Clunie, Sgt., RCR, The South African War, 6 Sep 1900
- Egisto C. Palmieri, California's first Italian-American State Senator, 1854–1901
- Samuel Parr, English schoolmaster & author, 1747–1825
- Rev. Robert Lusk, Reformed Presbyterian minister, 1781-1845, noted for his controversial ecclesiastical career.
- Father Solanus Casey, Capuchin monk and 20th Century spiritual figure, 1870–1957, USA[5]
- Charles Lamb
- Princess Amelia, daughter of George III
- Miller Huggins, manager of the New York Yankees from 1918 until his death in 1929
- James A. Bailey
- George Herbert, 5th Earl of Carnarvon, labeled as a victim of "King Tut's Curse".
- Queen Anne of Great Britain
- William H. Crawford, Secretary of the Treasury in the administration of President James Monroe.
- John of the Cross, Spanish poet and mystic
- Doc Middleton, outlaw, 1851–1913
- John Stuart Mill; political philosopher most famous for his work On Liberty[6]
- Judith of Swabia, daughter of the Holy Roman Emperor Henry III
- Rudolf Schmundt, victim of the attempt made by Claus von Stauffenberg on the life of Adolf Hitler.
- Herbie Roberts, former Arsenal footballer.
- Pope Gregory XVI
- Isaac V. Vanderpoel, NYS Treasurer 1858–1859
- Mary Lyon, Educator and Founder of Mt Holyoke Female Seminary.1797–1849.
- John Dryden, English poet (1631–1700)
- Hannah Perkins Battersby, "fat lady" of the Barnum Circus (1841–1889)
- Thomas Diaper, (1829–1887) Ipswich Poor Union House.
- Édouard Lucas, (1842–1891) Famous French mathematician, inventor of the Tower of Hanoi puzzle, discovered that 2127 − 1 was prime and published 4 large volumes on recreational mathematics.
- John Brown, servant to Queen Victoria
- Ann Rogers Clark, mother of General George Rogers Clark, Revolutionary War Hero and Captain William Clark of Lewis and Clark Corps of Discovery. Born 1734 Virginia, died 1799 Louisville, Kentucky
- Orlando Metcalfe Poe, Civil War engineer and officer, Great Lakes engineer including designer of the original Poe Lock at Sault Ste. Marie, MI.
- Saad Zaghloul, (1859–1927) Egyptian politician, prime minister 1924-1927.
- Johann Joseph Most, (1846--1906) German-American politician, newspaper editor, and orator. And anarchist.
- Lieutenant Frederick Thies, (Apr 8, 1845 - Jan 20, 1888) 1st Lieutenant & Regimental Quartermaster of the 3rd Infantry; Fort Shaw, Montana Territory. Formerly served in Company M of the 7th Calvary. Official cause of death listed as; "Phlegmonous Erysipelas"
[edit] In animals
Erysipelas is also the name given to an infection in animals caused by the bacterium Erysipelothrix rhusiopathiae.
Erysipelothrix rhusiopathiae can also infect humans, but in that case the infection is known as erysipeloid.
[edit] See also
[edit] Footnotes
- ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ^ "erysipelas" at Dorland's Medical Dictionary
- ^ See eMedicine link
- ^ Koster JB, Kullberg BJ, van der Meer JW (2007). "Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies". The Netherlands journal of medicine 65 (3): 89–94. PMID 17387234.
- ^ Wollenweber, Brother Leo (2002). "Meet Solanus Casey". St. Anthony Messenger Press, Cincinnati, Ohio, page 107, ISBN 1-56955-281-9,
- ^ Capaldi, Nicholas (2004). John Stuart Mill: a biography. Cambridge, UK: Cambridge University Press. pp. 356. ISBN 0-521-62024-4.
[edit] External links
- Erysipelas Overview Health in Plain English - with pictures
- Cellulitis Treatment for Skin Infection - Without Pictures
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