Erysipelas

Erysipelas


Key Words:  Strep A,  Lymphedema,  Cellulitis,  Bacteremia,  Septicemia, Cutaneous lympatics, immunocompromised,  St. Anthony's Fire,  Staph aureus,  Strep G, Penicillin,  Probenecid, Dicloxacillin,  Erythromycin,  Keflex,  Augmentin,  Necrosis,  Gangrene,  Thrombophebitis, Bacterial endocarditis,  Soft tissue infections




Discussion

Erysipelas (also called St. Anthony's Fire)is a superficial bacterial skin infection skin generally caused by (Strep A bacteria or Strep B bacteria. It can spread with alarming rapidity as it invades the cutaneous lymphatics.

While some classify it as a "form of cellulitis," it actually can be differentiated by the clear lines of demarcation of the infection. Symptoms include marked lines of infection, fever, pain, an overall achy feeling and swollen lymph nodes. Most cases involve the legs, and the second largest number of cases involve the face.  However a delay in treatment can result in deeper cellulitis or lymphangitis.

Like any type of infection a lymphedema patient experiences, antibiotic treatment needs to start immediately so as to prevent septicemia or bacteremia.  As with any infection erysipelas present a serious threat due to the immunocompromised state of the lymphedemous limb and because possible fibrosis handicaps effective antibiotic therapy. Also, in lymphedema patients Staph aureus (not Strep A) has been implicated as the infective bacteria.
While very similar and often confused with actual cellulitis it can be differentiated by the raised borders and advancing edges. The most commonly affected body areas are the legs, followed by the face.

Risk Factors

There are a number of factors that might predispose one to erysipelas.  The primary cause of course is a break, cut or entry foci in the skin and subsequent infection usually by a Strep A bacterium.  Susceptibility factors include edema, lymphedema, venous insufficiency, venous stasis, dermatosis, diabetes, HIV infection, and other immunocompromising medical conditions.
Transmission factors include port of entry through nasal cavity, insect bites, cut, incisions.

Symptoms

The infection may start out as a inconspicuous small red patch and spread rapidly to a painful fiery red plaque.  The infection area will be warm or hot and quite tender.  Over-all body symptoms might include feeling unusually drained of energy, achiness, chills, fever and malaise. There may also be blisters on the infected area and possible red streaking. 

Treatment

Treatment generally will involve the administration of an oral antibiotic.  The infection responds well to penicillin based antibiotic. In addition Probenecid may be used as it increase the effectiveness of penicillins. For more resistant infections dicloxacillin may be used.  Other antibiotics may include  Nafcillin, Erythromycin, Keflex and Augmentin.  

Depending upon the severity and spread IV antibiotic therapy may also be used for lymphedema patients.  Also, limiting one's activity with limb elevation is standard protcol.

Blood cultures and/or wound cultures may be needed to determine the exact bacteria involved. 

Complications

Complications may include bacteremia or septicemia, abscess, tissue necrosis (gangrene)in the most severe cases, thrombophlebitis, bacterial endorcarditis.

Prognosis

Prompt diagnosis and treatment will bring favorable results and in all but a very few patients recovery will be complete and without complications.  At risk groups, including those with lymphedema may experience recurrent episodes.

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