What is Erysipelas?
It is an infection of the skin generally involving legs, toes, arms, hands, fingers, or face. It generally follows scratches or starts in otherwise infected areas.
The infection is by group A streptococcal bacteria. The infection involves superficial layers of the epidermis and superficial lymphatics.
What are the causes and risk factors for Erysipelas?
Caused by Streptococcus agalactiae, a gram-positive coccus (bacterium)
This disease is common among the elderly with risk factors such as:
- Immune deficiency
- Skin ulceration
- Fungal infections
- Impaired lymphatic drainage (e.g., after mastectomy, pelvic surgery, bypass grafting)
- Steroid therapy and anti-cancer drugs
Since these conditions are especially common among the elderly, incidence among them is significantly higher than in younger adults.
What are the symptoms of Erysipelas?
- High fevers with shivering and chills
- Headache and vomiting
- General illness within 48 hours of the initial infection.
- Rash: Sharply demarcated, raised edge. It appears red, swollen, warm, and painful, similar in consistency to an orange peel.
- More severe infections can result in blisters, and petechiae (small purple or red spots)
- Lymph nodes may be swollen.
How is Erysipelas diagnosed?
Erysipelas is diagnosed clinically with support from:
- Demonstration of the characteristic rash
- Blood cultures
- Blood test reveals elevated ASO (anti streptolysin O) titers after 10 days
What is the treatment for Erysipelas?
Either oral or intravenous antibiotics – using penicillins, clindamycin, or erythromycin.
Application of local antibiotic creams or lotions
Symptoms tend to resolve in a day or two, while the skin may take weeks to return to normal.
What are the complications with Erysipelas?
The following complications are fairly common among the elderly.
- Spread of infection to other areas of the body can occur through the bloodstream. Joints tend to get infected – a condition called septic arthritis.
- Glomerulonephritis (a form of kidney failure) can follow. There is a cross-reaction to the streptococcal antigen. The antibody against the streptococcus causes damage to the filtration membrane called the glomerular basement membrane in the kidney
- 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 fungal infection.
- Lymphatic damage due to trauma or after surgery
- Necrotizing fasciitis, commonly known as “flesh-eating” bacterial infection, is a potentially deadly exacerbation of the infection if it spreads to deeper tissue.
What lifestyle changes are recommended to prevent Erysipelas?
- Good personal hygiene
- Appropriate wound care
- Maintenance of blood sugar levels
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