Erysipelas

Erysipelas ( emphasis: Erysi'pel, literal meaning as reddened skin: gr ἐρυσίπελας from ἐρυθρός erythros "red" and πέλλα Pélla "skin" ) is a bacterial infection of the upper layers of the skin and lymph vessels and appears as a sharply defined severe redness. Erysipelas is based on small skin lesions and usually occurs on the face, arms or legs and rarely at the navel. Other names for erysipelas are erysipelas and swine erysipelas.

Cause

Cause is usually an acute infection of the skin caused by β -hemolytic group A streptococci (Streptococcus pyogenes ). Rarely may be responsible for the development of erysipelas other pathogens. Including other groups, Streptococcus, Staphylococcus aureus, and Gram negative rods such as Klebsiella pneumoniae. The portal of entry for pathogens is often an epithelial defect - a wound, a rhagade or athlete's foot. For example, athlete's foot deforms when the nail, which usually leads to minor injuries of the nail bed and thus to a portal of entry for bacteria. In some cases, such a wound be searched for in vain.

Patients with edema fluid retention ( edema ) are more at risk of suffering from erysipelas, particularly when pre-existing Lymphgefäßschaden. Reason for this is that the lymphatic vessels cause a removal of invading bacteria in the lymph nodes, where the bacteria are then killed by immune cells. When Lymphgefäßschaden this transport works only partially.

Symptoms

Typical of erysipelas is a rapidly spreading, bright red, graded, flame-shaped and sharply demarcated erythema. The red skin is initially in the level of ambient swells later and is warm. The symptoms can range from small red dots with no side effects to the highly febrile infection with chills and severe impairment. In some cases, bubbles form, which can -Bleeding ( bullous erysipelas / hemorrhagic erysipelas ).

Course

After an incubation period of a few hours to 2 days erysipelas usually starts suddenly with fever and chills. Only hours later, show the typical skin lesions.

Diagnosis and differential diagnosis

The recognition of this disease usually prepares no difficulties and can sometimes be found as a " visual diagnosis ". The diagnosis is therefore usually provided " clinically " - a pathogen is usually not possible. Difficulties for erysipelas on damaged skin, eg in post-thrombotic syndrome. Likelihood of confusion with so-called stasis dermatitis, especially in the legs and an acute dermatitis on the face area. A symmetrically propagating from the bridge of the nose to the adjacent cheek Erysipelas is called " Schmetterlingserysipel ". This is to distinguish from a butterfly rash lupus erythematosus. Also, allergic contact dermatitis or angioedema must be differentiated from erysipelas. In the not infrequent Erysipelas of the outer ear is the differential diagnosis perichondritis to consider, since the choice of antibiotic depends on it. One may start similar looking bacterial disease of the skin and subcutaneous tissue, but has a raging course, is the necrotizing fasciitis.

Treatment

Patients with bullous ( blasenbildendem ) or bullous - hemorrhagic ( bleeding - vesicant ) erysipelas are usually admitted to the hospital to the hospital. In general, high-dose intravenous antibiotic therapy is necessary because erysipelas shows a marked tendency to recur ( relapse ). First are penicillin or cephalosporins such as cefuroxime. The therapy for severe disease ( depressed level of general health, high fever, etc. ) takes place as a continuous intravenous drip infusion.

The treatment of lighter forms can also take place with antibiotic tablets. Occurs during a non- residential treatment blistering ( bullous ) to immediately, the doctor must be consulted in order to prevent an aggravation of the open ( hemorrhagic ) state.

Antibiotic resistance to penicillin almost never make in the treatment of the disease a problem dar. to acute treatment will continue to cool envelopes with water or disinfectant substances used (eg hydroxyquinolone solution). Bed rest is recommended. In addition, the portal of entry of bacteria must be treated (eg, athlete's foot, nail fungus ) in order to avoid a recurrence.

Consequential damages are to be expected only in extreme, untreated cases of operated patients with heart valve. Risk patients should visit their doctor early on. In hemorrhagic erysipelas may occur scarring that leads to permanent skin discoloration after the healing of the bubble zone.

Complications

Although erysipelas shows a spontaneous tendency of; without treatment, but relapses often occur that can lead (secondary lymphedema up to elephantiasis ) of an arm or leg through the bonding of the lymphatics to disturbances of the lymphatic drainage. About a recurrence rate of 30% within three years is reported and often intravenous antibiotic treatment is recommended for ten days.

Other complications include thrombophlebitis and cerebral venous thrombosis and meningitis in occurrence in the face. Due to the entry of pathogens into collateral veins in the deep facial region A necrotizing fasciitis can occur in erysipelas of the lower leg and can be confused in the early stages with this.

Molding

Bullous erysipelas with cellulitis of the foot.

Participation of the earlobe as opposed to perichondritis.