Erysipelas
Disease Details
Family Health Simplified
- Description
- Erysipelas is a bacterial infection of the upper dermis and superficial lymphatics, typically caused by Streptococcus pyogenes, resulting in red, swollen, and painful skin usually on the face or legs.
- Type
- Erysipelas is an acute bacterial skin infection, typically caused by group A Streptococcus bacteria. It is not a genetic disease and does not have a mode of genetic transmission.
- Signs And Symptoms
- Symptoms often occur suddenly. Affected individuals may develop a fever, shivering, chills, fatigue, headaches and vomiting and be generally unwell within 48 hours of the initial infection. The red plaque enlarges rapidly and has a sharply demarcated, raised edge. It may appear swollen, feel firm, warm and tender to touch and have a consistency similar to orange peel. Pain may be extreme.More severe infections can result in vesicles (pox or insect bite-like marks), blisters, and petechiae (small purple or red spots), with possible skin necrosis (death). Lymph nodes may be swollen and lymphedema may occur. Occasionally a red streak extending to the lymph node can be seen.The infection may occur on any part of the skin, including the face, arms, fingers, legs and toes; it tends to favour the extremities. The umbilical stump and sites of lymphoedema are also common sites affected.Fat tissue and facial areas, typically around the eyes, ears and cheeks, are most susceptible to infection. Repeated infection of the extremities can lead to chronic swelling (lymphoedema).
- Prognosis
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The disease prognosis includes:
Spread of infection to other areas of body can occur through the bloodstream (bacteremia), including septic arthritis. Glomerulonephritis can follow an episode of streptococcal erysipelas or other skin infection but not rheumatic fever.
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 athlete's foot. Another predisposing factor is chronic cutaneous edema, such as can in turn be caused by venous insufficiency or heart failure.
Lymphatic damage
Necrotizing fasciitis, commonly known as ‘flesh-eating’ bacterial infection, is a potentially deadly exacerbation of the infection if it spreads to deeper tissue. - Onset
- Erysipelas typically has a sudden onset, often characterized by the rapid development of distinctive red, swollen, and painful skin lesions. These are usually accompanied by symptoms such as fever, chills, and general malaise.
- Prevalence
- Erysipelas is a bacterial skin infection primarily caused by Group A Streptococcus. It often affects the upper dermis and extends into the superficial cutaneous lymphatics. The prevalence of erysipelas varies geographically and can affect individuals of all ages, but it is more common in infants, young children, the elderly, and individuals with weakened immune systems. The prevalence rate is not universally established and can fluctuate due to factors such as regional healthcare practices, genetic predispositions, and environmental influences.
- Epidemiology
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There is currently no validated recent data on the worldwide incidence of erysipelas. From 2004 to 2005 UK hospitals reported 69,576 cases of cellulitis and 516 cases of erysipelas. One book stated that several studies have placed the prevalence rate between one and 250 in every 10,000 people. The development of antibiotics, as well as increased sanitation standards, has contributed to the decreased rate of incidence. Erysipelas caused systemic illness in up to 40% of cases reported by UK hospitals and 29% of people had recurrent episodes within three years. Anyone can be infected, although incidence rates are higher in infants and elderly. Several studies also reported a higher incidence rate in women. Four out of five cases occur on the legs, although historically the face was a more frequent site.Risk factors for developing the disease include
Arteriovenous fistula
Chronic skin conditions such as psoriasis, athlete's foot, and eczema
Excising the saphenous vein
Immune deficiency or compromise, such as
Diabetes
Alcoholism
Obesity
Human immunodeficiency virus (HIV)
In newborns, exposure of the umbilical cord and vaccination site injury
Issues in lymph or blood circulation
Leg ulcers
Lymphatic edema
Lymphatic obstruction
Lymphoedema
Nasopharyngeal infection
Nephrotic syndrome
Pregnancy
Previous episode(s) of erysipelas
Toe web intertrigo
Traumatic wounds
Venous insufficiency or disease - Intractability
- Erysipelas is not considered an intractable disease. It is an acute bacterial infection of the skin and underlying tissue, typically caused by *Streptococcus* bacteria. With prompt medical treatment, which usually involves antibiotics, most patients recover fully. However, if left untreated or if complications arise, severe cases can develop, leading to more serious health issues.
- Disease Severity
- Erysipelas is typically characterized by an acute onset of symptoms, which can vary in severity. Most cases are considered moderate but can escalate to severe if left untreated or in immunocompromised individuals. The severity often depends on factors such as the patient's overall health, the rapidity of treatment initiation, and the presence of comorbid conditions.
- Healthcare Professionals
- Disease Ontology ID - DOID:11330
- Pathophysiology
- Erysipelas is an acute bacterial infection involving the upper dermis and superficial lymphatics. Its pathophysiology involves the entry of bacteria, typically group A Streptococcus, through a break in the skin. The bacteria then spread rapidly through the skin's lymphatic system, leading to the hallmark signs of erythema, warmth, edema, and a well-demarcated, raised border on the affected area. The infection triggers an inflammatory response, causing increased permeability of blood vessels and the recruitment of immune cells, which contribute to the clinical symptoms.
- Carrier Status
- Erysipelas is a bacterial infection typically caused by *Streptococcus pyogenes*. There is no recognized carrier state for erysipelas, although the bacteria can be present on the skin or in the throat without causing symptoms in some individuals.
- Mechanism
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Erysipelas is a bacterial infection affecting the upper layers of the skin, often caused by Streptococcus pyogenes, a Group A Streptococcus (GAS).
### Mechanism:
1. **Entry**: The bacteria enter the skin through minor cuts, abrasions, or other breaches in the skin barrier.
2. **Infection**: Once inside, the bacteria multiply and produce toxins and enzymes that facilitate spread and tissue invasion.
3. **Inflammation**: The infection triggers an intense local inflammatory response, characterized by redness, warmth, swelling, and pain in the affected area. The immune system reacts by sending white blood cells to the site of infection to combat the bacteria.
### Molecular Mechanisms:
- **Adhesion**: Streptococcus pyogenes express various surface proteins (such as M protein) that help them adhere to host tissues.
- **Toxin Production**: The bacteria produce several exotoxins, such as streptolysins, which can cause direct damage to host tissues and promote inflammation.
- **Evasion of Immune Response**: S. pyogenes employs mechanisms to evade the host immune system, such as producing proteases that degrade antibodies and complement proteins.
- **Hyaluronidase and Streptokinase**: These enzymes break down the extracellular matrix and fibrin, helping the bacteria to spread more easily through tissues.
Understanding these mechanisms offers insights into potential therapeutic targets and helps in the management of the infection. - Treatment
- Treatment is with antibiotics; (amoxicillin/clavulanic acid, cefalexin, or cloxacillin) taken by mouth for five-days; though sometimes longer.Because of the risk of reinfection, prophylactic antibiotics are sometimes used after resolution of the initial condition.
- Compassionate Use Treatment
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Compassionate use treatment for erysipelas is generally not standard because effective mainstream antibiotics are usually available and sufficient. However, if a patient is not responding to standard antibiotic therapy or has severe allergies to available medications, off-label or experimental treatments could be considered.
Off-label or experimental treatments might include:
1. **Linezolid**: This antibiotic is typically used for severe infections caused by Gram-positive bacteria, including MRSA (methicillin-resistant Staphylococcus aureus). It can be considered if there is suspected or confirmed resistance to standard treatments.
2. **Daptomycin**: An alternative for complicated skin infections caused by Gram-positive bacteria, particularly when using vancomycin or other first-line treatments is not possible.
3. **Dalbavancin or Oritavancin**: These long-acting antibiotics are approved for skin infections and offer the convenience of single-dose or infrequent dosing schedules. They might be used off-label if traditional antibiotics are contraindicated or ineffective.
4. **Hyperbaric Oxygen Therapy (HBOT)**: This experimental approach involves breathing pure oxygen in a pressurized room, which could theoretically help by reducing the infection and enhancing wound healing, though evidence is still emerging.
Clinical decisions regarding off-label or experimental treatments should always be made by healthcare providers based on individual patient circumstances and up-to-date clinical guidelines. - Lifestyle Recommendations
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For erysipelas:
**Lifestyle Recommendations:**
1. **Good Hygiene**: Ensuring proper skin hygiene is crucial. Regularly wash the affected area with mild soap and water to keep it clean.
2. **Skin Care**: Keep your skin moisturized to prevent cracks and injuries which can serve as entry points for bacteria.
3. **Protective Measures**: Use protective clothing or dressings if you have a skin condition that leaves you vulnerable to infections.
4. **Weight Management**: Maintain a healthy weight, as obesity can increase the risk of skin infections.
5. **Elevate Affected Limb**: If erysipelas affects a limb, elevating it can reduce swelling.
6. **Manage Underlying Conditions**: Control conditions like diabetes and eczema which could predispose you to skin infections.
7. **Stay Hydrated**: Drink plenty of fluids to support your immune system.
These steps can help prevent recurrence and manage the condition effectively. - Medication
- Erysipelas is typically treated with antibiotics. The first-line treatment is usually penicillin, either orally or intravenously, depending on the severity of the infection. If the patient is allergic to penicillin, alternative antibiotics such as erythromycin, clindamycin, or a cephalosporin may be used. The specific choice of antibiotic and duration of treatment will depend on individual patient factors and the severity of the disease.
- Repurposable Drugs
- For erysipelas, repurposable drugs may include certain antibiotics that are commonly used to treat bacterial infections. Penicillin remains the drug of choice for treating erysipelas. However, in cases where penicillin is not suitable, other antibiotics such as cephalexin, clindamycin, or erythromycin may be repurposed for treatment.
- Metabolites
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Erysipelas is a bacterial skin infection typically caused by Group A Streptococcus (Streptococcus pyogenes). The infection does not directly involve specific metabolites. Instead, it leads to an acute inflammatory response in the skin and subcutaneous tissues.
The metabolite profile in a patient with erysipelas might show elevated markers of inflammation such as C-reactive protein (CRP) and white blood cell counts. These are not metabolites of the bacteria themselves but rather indicators of the body's response to infection.
Regarding "nan," which could refer to a specific technique or term related to metabolites, there is no direct relationship between nanotechnology and the usual treatment or diagnosis of erysipelas. Diagnosis is typically based on clinical evaluation, and treatment usually involves antibiotics, particularly penicillin or other beta-lactam antibiotics. - Nutraceuticals
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Nutraceuticals are food-derived products that provide health benefits beyond basic nutrition. For erysipelas, which is a bacterial skin infection typically caused by Streptococcus bacteria, nutraceuticals might not directly treat the infection but could support general immune health and recovery.
1. **Vitamin C** - Boosts the immune system and may aid recovery.
2. **Probiotics** - Support gut health, which in turn can positively impact overall immune function.
3. **Omega-3 Fatty Acids** - Have anti-inflammatory properties.
It is important to note that while these nutraceuticals can support overall health, they should not replace standard medical treatments such as antibiotics for erysipelas.
NAN (Not Applicable/No relevant data available)
Regarding nanotechnology (nan), there's currently limited direct application in the clinical management of erysipelas specifically, but research in nanomedicine is ongoing and may provide future treatment modalities. - Peptides
- Erysipelas is a bacterial skin infection primarily caused by *Streptococcus pyogenes*. It presents as a raised, red, and well-demarcated area of inflammation, typically on the face or legs. While the role of peptides and nanoparticles (nan) in the treatment or management of erysipelas is an area of ongoing research, current therapies focus on antibiotic treatment, particularly penicillin or other beta-lactams, to manage the infection. Techniques involving peptides and nanoparticles may hold future potential but are not standard practice as of now.