Erysipelas

Definition :
Erysipelas is a type of cellulitis (skin infection) generally caused by group A Streptococcus bacteria.It is an acute streptococcus bacterial infection of the dermis, resulting in inflammation and characteristically extending into underlying fat tissue. This disease is also known as Saint Anthony’s fire.

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Causes & Risk Factor:
This disease is most common among the elderly, infants, and children. People with immune deficiency, diabetes, alcoholism, skin ulceration, fungal infections and impaired lymphatic drainage (e.g., after mastectomy, pelvic surgery, bypass grafting) are also at increased risk.

The risk factors associated with this infection include a cut in the skin, skin ulcers, and problems with the drainage through the veins or lymph system.

In the past, the face was most commonly involved site of infection, yet now accounts for only up to 20% of cases. The legs are affected in up to 80% of cases

Symptoms:
Patients typically develop symptoms including high fevers, shaking, chills, fatigue, headaches, vomiting, and general illness within 48 hours of the initial infection. 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. More severe infections can result in vesicles, bullae, and petechiae, with possible skin necrosis. 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, but it tends to favor the extremities. Fat tissue is most susceptible to infection, and facial areas typically around the eyes, ears, and cheeks. Repeated infection of the extremities can lead to chronic swelling (lymphadenitis).

Etiology:
Most cases of erysipelas are due to Streptococcus pyogenes (also known as group A streptococci), although non-group A streptococci can also be the causative agent. Historically, the face was most affected; today the legs are affected most often.

Erysipelas infections can enter the skin through minor trauma, eczema, surgical incisions and ulcers, and often originate from strep bacteria in the subject’s own nasal passages.

Diagnosis:
This disease is mainly diagnosed by the appearance of the rash and its characteristics. Blood cultures are unreliable for diagnosis of the disease, but may be used to test for sepsis. Erysipelas must be differentiated from herpes zoster, angioedema, contact dermatitis, and diffuse inflammatory carcinoma of the breast.

Erysipelas can be distinguished from cellulitis by its raised advancing edges and sharp borders. Elevation of the antistreptolysin O titre occurs after around 10 days of illness.

The diagnosis of erysipelas is based on how the skin looks. A biopsy of the skin is usually not needed.

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Treatment:
Depending on the severity, treatment involves either oral or intravenous antibiotics, using penicillins, clindamycin or erythromycin. While illness symptoms resolve in a day or two, the skin may take weeks to return to normal.

Those who have repeated episodes of erysipelas may need long-term antibiotics.

Because of the risk of reinfection, prophylactic antibiotics are sometimes used after resolution of the initial condition. However, this approach does not always stop reinfection.

Neem Oil is a very good Herbal treatment for Erysipelas

Prognosis:
With treatment, the outcome is good. It may take a few weeks for the skin to return to normal. Peeling is common.

Complications:
*Spread of infection to other areas of body through the bloodstream (bacteremia), including septic arthritis and infective endocarditis (heart valves).

*In some patients, the bacteria may travel to the blood. This results in a condition called bacteremia. The infection may
*spread to the heart valves, joints, and bones.

*Other complications include:Septic shock and Recurrence of infection

Septic shock.
Recurrence of infection – Erysipelas can recur in 18-30% of cases even after antibiotic treatment.
Lymphatic damage
Necrotizing fasciitis –– AKA “the flesh-eating bug.” A potentially-deadly exacerbation of the infection if it spreads to deeper tissue.

Prevention :
Maintain healthy skin by avoiding dry skin and preventing cuts and scrapes. This may reduce the risk for the development of erysipelas.

In animals:
Erysipelas is also the name given to an infection in animals caused by the bacterium Erysipelothrix rhusiopathiae. Infection by Erysipelothrix rhusiopathiae in humans is a separate entity known as erysipeloid.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000618.htm
http://en.wikipedia.org/wiki/Erysipelas

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