Erysipelas

Erysipelas
Classification and external resources
Erysipelas of the face due to invasive Streptococcus.

Erysipelas (/ɛrɨˈsɪpələs/; Greek ἐρυσίπελας—red skin; also known as "Ignis sacer", "holy fire", and "St. Anthony's fire"^[1] in some countries) is an acute infection^[2] of the upper dermis and superficial lymphatics, usually caused by streptococcus bacteria.^[3]Erysipelas is more superficial than cellulitis, and is typically more raised and demarcated.^[4]

Signs and symptoms

Erysipelas on an arm

Erysipelas on a leg

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 invesicles, 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 favour 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 (lymphangitis).

Cause

Most cases of erysipelas are due to Streptococcus pyogenes (also known as beta-hemolytic group A streptococci), although non-group A streptococci can also be the causative agent. Beta-hemolytic, non-group A streptococci include Streptococcus agalactiae, also known as group B strep or GBS. Historically, the face was most affected; today the legs are affected most often.^[5] The rash is due to an exotoxin, not the Strep. Bacteria itself and is found in areas where no symptoms are present - e.g. the infection may be in the nasopharynx, but the rash is found usually on the face and arms.

Erysipelas infections can enter the skin through minor trauma, insect bites, dog bites, eczema, surgical incisions and ulcers, and often originate from strep bacteria in the subject's own nasal passages. Infection sets in after a small scratch or abrasion spreads resulting intoxaemia.

Erysipelas does not affect subcutaneous tissue. It does not release pus, only serum or serous fluid. Subcutaneous edema may lead the physician to misdiagnose it as cellulitis, but the style of the rash is much more well circumscribed and sharply marginated than the rash of cellulitis.

Risk factors

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.

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. 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 (ASO) titer occurs after around 10 days of illness.

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.

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.^[6]

Prognosis

• Spread of infection to other areas of body through the bloodstream (bacteremia), including septic arthritis. Glomerulonephritis can follow from a 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.
• Lymphatic damage
• Necrotizing fasciitis—commonly known as "the flesh-eating bug". A potentially deadly exacerbation of the infection if it spreads to deeper tissue.

Notable Deaths

• John of the Cross, Spanish saint and priest (d. 1591)
• Father Solanus Casey, American Capuchin priest declared "venerable" by the Roman Catholic Church (d. 1957)^[7]
• Samuel Augustus Ward, Victorian gentleman, organist, composer, teacher, businessman (d. 1903)^[8]
• Mary Lyon, women's education pioneer (d. 1849)^[9]
• John Stuart Mill, British political philosopher (d. 1873)^[10]
• Princess Amelia of the United Kingdom, daughter of George III of the United Kingdom (1783 – 1810)
• Anne, Queen of Great Britain and Ireland (d. 1714)
• Grand Duchess Catherine Pavlovna of Russia, daughter of Tsar Paul I of Russia and wife of King William I of Württemberg (d. 1819)
• Frederick VII of Denmark, king of Denmark (d. 1863))^[11]
• Christina, Queen of Sweden
• Archibald Douglas, 6th Earl of Angus, 6th Earl of Angus (c.1489 – 22 January 1557) was a Scottish nobleman active during the reigns of James V and Mary, Queen of Scots.
• Pope Gregory XVI (1765-1846).
• George Herbert, 5th Earl of Carnarvon (26 June 1866 – 5 April 1923) was an English aristocrat best known as the financial backer of the search for and the excavation of Tutankhamun's tomb in the Valley of the Kings. His death led to the story of the "Curse of Tutankhamun", the "Mummy's Curse".
• Miller Huggins, baseball player and manager (d. 1929)

Richard Wagner also suffered from erysipelas,^{[citation needed]} although he died of a heart attack.

Other animals

Erysipelas is also the name given to an infection in animals caused by the bacterium Erysipelothrix rhusiopathiae. Erysipelothrix rhusiopathiae can also infect humans, but in that case the infection is known as erysipeloid.