1. ERYSIPELAS
William Njoroge ML 610

3. ERYSIPELAS St. Anthony’s fire, Ignis Sacer
Erysipelas is an acute beta-hemolytic group A streptococcal infection of the skin involving the superficial dermal lymphatics
Streptococcus pyogenes. Others include group C & G Streptococci
Recently, atypical forms reportedly have been caused by Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae, Yersinia enterocolitica, and Moraxella species.

5. Pathophysiology
Historically, the face was most affected; today the legs are affected most often.
The rash is due to an exotoxin, not the Strep. bacteria itself and is found in areas where no bacteria are present.
Bacterial inoculation into an area of skin trauma is the initial event in developing erysipelas.
Thus, local factors, such as venous insufficiency, stasis ulcerations, inflammatory dermatoses, dermatophyte infections, insect bites, and surgical incisions, have been implicated as portals of entry.

6. strep bacteria often originate from the subject's own nasal passages.
In erysipelas, the infection rapidly invades and spreads through the lymphatic vessels causing regional lymph node enlargement.
Erysipelas does not affect subcutaneous tissue. It does not release pus, only serum or serous fluid.

7. AGE
erysipelas can occur in all age groups, but it does appear that infants, young children, and elderly patients are the most commonly affected groups.
The peak incidence has been reported to be in patients aged years
RISK FACTORS
Preexisting lymphedema
Immunocompromised persons
Skin abrasions, cuts
lymphatic drainage problems

8. Predisposing factors Stasis ulceration Venous insufficiency
Diabetes Mellitus
Inflammatory dermatoses
Lymphatic drainage disorders
Surgical wounds
Nephrotic syndrome
Immunocompromised state

9. Predisposing factors
Stasis ulceration:

11. Venous insufficiency

13. inflammatory dermatoses & dermatophytes infections

14. Diabetes mellitus

16. lymphatic drainage problems
After radical mastectomy

17. Lymphedema

18. Surgical incisions

20. Nephrotic syndrome

21. Clinical picture Prodromal period
Patients typically develop symptoms within 48 hours of the initial infection.
high fever
Chills
Fatigue
Headache
Vomiting
General malaise

22. 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.
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.

26. Lymphatic involvement often is manifested by overlying skin streaking and regional lymphadenopathy.
More severe infections can result in vesicles, bullae, petechiae with possible skin necrosis.

32. 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.
Cultures are perhaps best reserved for very immunosuppressed hosts in whom an atypical etiologic agent might be more likely

33. Differential diagnosis
Erythema Annulare Centri-fugum
Stasis Dermatitis
Cellulitis
Erysipeloid

34. Erythema Annulare Centri-fugum

35. Stasis dermatitis

36. cellulitis

37. treatment
Antibiotics such as penicillin are used to eliminate the infection. In severe cases, antibiotics may need to be given through an IV (intravenous line).
Those who have repeated episodes of erysipelas may need long-term antibiotics

38. Medical care
Elevation and rest of the affected limb are recommended to reduce local swelling, inflammation, and pain.
Saline wet dressings should be applied to ulcerated and necrotic lesions and changed every 2-12 hours, depending on the severity of the infection.

39. A first-generation cephalosporin or macrolide, such as erythromycin or azithromycin, may be used if the patient has an allergy to penicillin.
With treatment, the outcome is good. It may take a few weeks for the skin to return to normal. Peeling is common.

40. complications bacteremia Septicemia Return of infection Septic shock
abscess,
gangrene, necrotizing fasciitis
Thrombophlebitis .
acute glomerulonephritis ,
endocarditis ,
streptococcal toxic shock syndrome
Deep cellulitis