Erysipelas
Erysipelas is a type of skin infection, classified as a common form of cellulitis, primarily affecting the face and lower extremities. It can occur in individuals of all ages, but is particularly prevalent among children and the elderly due to their more vulnerable immune systems. The condition is most often caused by the bacterium Streptococcus pyogenes, although other organisms like Staphylococcus aureus and Haemophilus influenzae can also be responsible. Erysipelas typically arises when bacteria enter the body through the upper respiratory tract or broken skin, leading to inflammation and infection in the upper layers of the skin.
Common symptoms include fatigue, swollen lymph nodes, fever, and the rapid appearance of a painful, bright red area on the skin. Diagnosis is usually made based on these symptoms, and bacterial cultures may be taken for confirmation. Treatment generally involves oral penicillin, with alternatives like erythromycin available for those allergic to penicillin. Preventive measures focus on avoiding injuries, especially to the lower extremities. While the incidence of erysipelas is higher in developing countries due to factors like sanitation and access to antibiotics, awareness and prompt medical attention can significantly improve outcomes for affected individuals.
Erysipelas
Anatomy or system affected: Skin, upper respiratory tract
Also known as: St. Anthony’s fire
Definition
Erysipelas is a common type of cellulitis, or skin infection, that appears on either the face or the lower extremities. The condition can affect anyone, but it is especially common in children and the elderly.
Causes
Erysipelas is typically caused by exposure to the bacterium Streptococcus pyogenes, but other microbial organisms can also cause erysipelas, including other types of Streptococcus, Staphylococcus aureus, Haemophilus influenzae, Yersinia enterocolitica, and Klebsiella pneumoniae. The bacteria enter the body through the upper respiratory tract (nose and mouth) or through an area of broken skin such as a scratch, puncture wound, or bug bite, where they spread throughout the upper layers of the skin (epidermis) and into the nearby lymphatic system.
Risk Factors
Young children and the elderly are at increased risk for erysipelas because their immune systems are more vulnerable. Other risk factors include poor health and malnutrition, having had a recent upper respiratory tract infection, and having a chronic condition, such as lymphedema, that affects the skin, lymph, or the vascular system. Frequency of erysipelas infection is higher in developing countries than in industrialized countries, likely because of poorer sanitation and a lack of access to antibiotics.
Symptoms
The first symptoms of erysipelas are fatigue, swollen lymph nodes, fever, and chills. Next, the skin infection appears rapidly, usually on the face or leg. The infected area becomes inflamed, bright red, and painful, and it is well-defined from the surrounding healthy skin. In some cases, blisters form at the site of infection or the infection spreads into the deeper layers of skin.
Screening and Diagnosis
Erysipelas is diagnosed by its symptoms. A doctor will take bacterial cultures of the affected area of skin and of any drainage.
Treatment and Therapy
Oral penicillin is the preferred treatment for erysipelas; if the patient is allergic to penicillin, erythromycin or another alternative antibiotic may be prescribed. The patient also will be instructed to rest, clean and apply dressing to areas where the skin is broken, and take aspirin or acetaminophen for fever or pain. Hospitalization for a few days may be necessary if the patient is very young or old, is extremely ill, or appears to have a more serious infection.
Prevention and Outcomes
Risk for erysipelas can be reduced by avoiding injury, especially injury to the lower legs. However, some people will remain at risk because of their age or preexisting-condition status.
Bibliography
Chong, F. Y., and T. Thirumoorthy. "Blistering Erysipelas: Not a Rare Entity." Singapore Medical Journal 49 (2008): 809-813.
Marquardt, William C., ed. Biology of Disease Vectors. 2d ed. New York: Academic Press/Elsevier, 2005.
Stanway, Amy, et al. "Erysipelas." DermNet New Zealand, Feb. 2016, www.dermnetnz.org/topics/erysipelas/. Accessed 26 Oct. 2017.
Stevens, Dennis L. "Infections of the Skin, Muscle, and Soft Tissues." In Harrison’s Principles of Internal Medicine, edited by Joan Butterton. 17th ed. New York: McGraw-Hill, 2008.
Swanson, David L. "Erysipelas." MedlinePlus, US National Library of Medicine, 20 Aug. 2016, medlineplus.gov/ency/article/000618.htm. Accessed 26 Oct. 2017.
Van Tonder, Reinier J. "Erysipelas." In The Five-Minute Clinical Consult 2010, edited by Frank J. Domino. 18th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010.
Weedon, David. Skin Pathology. 3d ed. New York: Churchill Livingstone/Elsevier, 2010.