Erysipelas

Causes and mechanism of development

The disease is caused by streptococcus. In most cases, the microflora penetrates from the external environment through skin damage (microtraumas, abrasions, wounds); lymphatic and hematogenous routes are extremely rare. Erysipelas can occur as a primary infection (from exo- and endogenous sources) or as a secondary process—a complication of other purulent diseases, such as a furuncle, carbuncle, or osteomyelitis.

The pathogenesis is based on an allergic factor — sensitization of the organism, which explains the high tendency of the infection toward frequent relapses (they occur in 20–25% of cases).

General clinical picture

Erysipelas begins acutely, with deterioration of the general condition preceding local changes. A prodromal period is rare (weakness, malaise); more often, the disease manifests with shattering chills, severe headache, and a rapid temperature spike to 40–41 °C (sometimes hectic in type).

Signs of intoxication:

• Marked tachycardia and tachypnea.
• Insomnia; in severe cases, delirium and agitation.
• Decreased diuresis. Protein, red blood cells, white blood cells, and casts appear in the urine.
• Enlargement of the liver and spleen is possible (hepatosplenic syndrome).

Blood tests show pronounced leukocytosis, neutrophilia, moderate anemia, and a decrease in eosinophils. Upon recovery, the blood picture normalizes, and lymphocytosis appears.

Clinical forms (local symptoms)

The clinical forms of erysipelas represent phases of a single process that can stop at any stage.

1. Erythematous form: serous inflammation of the reticular layer of the skin. It manifests as bright redness with distinct, jagged edges (resembling a "geographical map" or "flame tongues"). The skin is edematous and hot to the touch. Pain and hyperemia are most pronounced at the periphery of the lesion, where a raised inflammatory ridge is palpable.
2. Bullous form: against the background of erythema, epidermal detachment (desquamation) occurs with the formation of blisters. Their contents (serous, purulent, or hemorrhagic) contain streptococci and are highly contagious.
3. Phlegmonous form: purulent infiltration of tissues with the formation of subcutaneous phlegmon.
4. Necrotic (gangrenous) form: circulatory disorders and vascular thrombosis lead to the formation of skin necrosis.

Complications and treatment

Frequent relapses of erysipelas of the extremities lead to sclerosis of the subcutaneous tissue, lymphostasis, and ultimately to the development of elephantiasis.

Treatment is carried out in a hospital setting and requires strict adherence to asepsis and patient isolation. The main areas of therapy:

• UV irradiation: used for erythematous and bullous forms (3–5 biodoses). It lowers temperature and reduces hyperemia. Physiotherapy is contraindicated for phlegmonous and gangrenous forms.
• Drug therapy: antibiotics (penicillins, semisynthetic penicillins), long-acting sulfonamides. In severe cases, endolymphatic administration of drugs is indicated.
• Local treatment: wet dressings, compresses, and baths are strictly prohibited! In the bullous form, blisters are opened and dressings with antibacterial emulsions are applied. In phlegmonous and necrotic forms, surgical intervention is indicated (opening of abscesses, drainage, necrectomy).
• Regimen: high-calorie dairy-vegetable diet with vitamins.

Class and exam questions

What else to study on this topic

• Features of the course of erysipelas depending on localization (face, scalp, mucous membranes)
• Differential diagnosis of erysipelas with erysipeloid, anthrax, and clostridial fasciitis
• Indications and techniques for surgical treatment of phlegmonous and necrotic forms
• Anti-epidemic measures in a surgical hospital when a patient with erysipelas is identified

Other topics from the section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"

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