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PubMed2000

Erysipelas and tinea pedis.

During a 2-year period 30 adults were selected out of a group of patients diagnosed with erysipelas, who, except for tinea pedis, were apparently otherwise healthy patients. Clinical and epidemiological studies were performed to establish how tinea pedis and erysipelas are related. Thirteen of 30 patients with a diagnosis of erysipelas were found to have tinea pedis due to Trichophyton mentagrophytes and Trichophyton rubrum. In seven of the patients (23%) tinea pedis was found to be the unique predisposing factor for erysipelas. Tinea pedis may be a risk factor for streptococcal infections such as erysipelas, mainly in tropical countries, where tinea pedis is a frequent disease.

Erysipelas↗
PubMedDate not supplied

[Erysipelas in the young population of a military hospital].

INTRODUCTION: Erysipelas usually affects either elderly patients or patients with predisposing factors. We studied erysipelas in a young healthy military population. SUBJECTS AND METHODS: A retrospective study of patients, less than 30 years old, admitted to the Hôpital d'Instruction des Armées Robert Picqué between 1991 and 1997 was performed. RESULTS: Eighty-one patients were studied, 80 were men, mean age was 21.4 years. Localization of erysipelas was: face: 2; leg: 74. Facilitating factors were: portal of entry in 100 p. 100; venous insufficiency in 1 case; alcohol abuse in 1 case. Anti-inflammatory agents had been given at the beginning of treatment in 32.1 p. 100 cases. 7.1 p. 100 patients had a recurrence.. Complications were: abscess in 8 cases and bursitis in 1 case. No facilitating factor was detected. The course was not related with bacterial findings. No thrombo-embolic complication was observed. DISCUSSION: In a young healthy population, erysipelas is not a rare infection. Face is an exceptional localization of erysipelas in relation to older population. The main risk factor for developing this infection is local factor found in 100 p. 100 cases but general factors as repeated hikes, care access, long standing could also be incriminated. Use of anti-inflammatory agents is frequent but role of anti-inflammatory agents in developing complications is not clear. Complications are rare and benign except for frequence of recurrences while the good health.

Abscess↗
PubMed2001

Collaborative study for the establishment of erysipelas ELISA coating antigen. European Biological Reference Preparation batch no. 1.

The development and validation of suitable alternatives for the replacement of in vivo challenge testing in the evaluation of vaccines is an important goal for national authorities and manufacturers involved in the assessment of quality, safety and efficacy of such products. To that end, 13 laboratories from 9 European countries, including 5 manufacturers, 7 authorities and EDQM, have taken part in a collaborative study to evaluate the suitability of a candidate reference preparation of erysipelas coating antigen for ELISA as a European Pharmacopoeia Biological Reference Preparation (Ph. Eur. BRP No. 1). The new Ph. Eur. BRP is intended for use in a serological assay, which would significantly reduce the suffering of animals in the potency assays of inactivated erysipelas vaccines. Participants were provided with sufficient study material, including the candidate coating antigen, and a panel of test sera from mice which had been immunised with vaccines representative of products on the European market, in order to evaluate the performance of the coating antigen in an enzyme-linked immunosorbent assay (ELISA) which had previously performed successfully in a prevalidation study [1] and in an international validation study [2]. Results of the collaborative study indicate that the candidate batch of erysipelas ELISA coating antigen is suitable to act as a Ph. Eur. biological reference preparation. The final study report was presented at the 110th session of the Ph. Eur. Commission (June 19-21, 2001) and the material was duly adopted as Erysipelas ELISA Coating Antigen Ph. Eur. BRP No. 1 for use in the enzyme-linked immunosorbent assay in the context of the serological potency assay for inactivated erysipelas vaccines.

Animals↗
PubMed2002

[Erysipelas after breast cancer treatment].

BACKGROUND: Study of the epidemiological, clinical and evolutive characteristics of the erysipelas of patients treated for breast cancer. PATIENTS AND METHODS: Between February 93 and December 99, 20 patients among 700 (2.85%) treated for breast cancer in the radiotherapy department of sfax have presented an erysipelas. All of these patients had undergone a chirurgical treatment containing an axillary lymph node dissection with radiotherapy in 95% and adjuvent chemotherapy in 80% of cases. RESULTS: The medium delay between the appearance of the eryslpelas and the end of treatment was 23 months. The preferential localisation was the homolateral upper limb to the treated breast (95%). The immediate evolution was favourable in 85% after antibiotherapy. Recurrence of erysipelas was seen in 20% in cases. DISCUSSION: Erysipelas after treatment of breast cancer is known but rarely reported. The secondary lymphedema of the upper limb is the major favouring factor. CONCLUSION: Appearance of erysipelas among women treated for breast cancer is frequent, his recurrent character must always lead to antibiotic prophylaxis.

Adult↗
PubMedDate not supplied

[How I prevent erysipelas and its consequences and recurrences].

Erysipelas is a serious infection of the skin. In case of delay in initiating adequate antibiotic treatment, complications, sometimes dismal, can supervene. In addition, erysipelas shows a tendancy to recurrences. The prevention of an episode of erysipelas calls for correct personal hygiene and adequate use of topical antiseptics in case of skin effraction, even when minimal. When erysipelas is established, a rapidly initiated antibiotic treatment for a prolonged period prevents streptococcal gangrene complications. Elastic contention of any leg edema from venous or lymphatic origin and prophylactic antisepsis of discrete wounds help in preventing erysipelas recurrences.

Erysipelas↗
PubMed2004

[Erysipelas. Retrospective study of 647 patients].

We conducted a retrospective at the department of dermatology of Charles Nicolle hospital of Tunis between January 1994 and December 2000 to determine the epidemiological, clinical profile and the evolution of erysipelas. A total of 647 patients were studied. The mean age was 44.73 years and sex ratio about 1.55. Erysipelas predominately involved in the lower limbs (91.2%). Antecedents of erysipelas were found in 26.12 %. Portal of entry was found in 76.66% represented essentially by toe-web intertrigo. 26.6% of patients were hospitalised. Erysipelas can be controlled with antibiotics; treatment is essentially based on penicillin G 4 mega units intramuscularly every day (60.58%) for mean duration of 10.13 days. Satisfying results were observed in 87.78%. Erysipelas is common disease source of over-morbidity. Many predisposing factors were incriminated, account for the frequency of recurrence, justifying implement of primary and secondary prevention.

Adolescent↗
PubMed1991

[Recurrent erysipelas].

Erysipelas is clinically defined as a febrile skin infection with a sudden onset of a red indurated expanding plaque with distinct border. A typical erysipelas presents various degrees of cutaneous erythema, oedema and is characterized by less well-defined margins. The responsible agent can be a beta-hemolytic streptococcus (group A), Staphylococcus aureus and other streptococci (group B, C and D). Common predisposing factors are venous insufficiency, lymphatic obstruction and underlying illnesses. Guidelines for the diagnosis and the management of erysipelas are proposed. The episodes of erysipelas ordinarily respond promptly to penicillin or a beta-lactamase resistant antibiotic. Prevention of recurrent erysipelas by means of an antibiotic prophylaxis is discussed.

Anti-Bacterial Agents↗
PubMed1991

[Erysipelas: epidemiological, clinical and therapeutic data (111 cases)].

A retrospective study of 111 patients admitted to the Dermatology department of the Bichat hospital, Paris, between 1981 and 1988 for treatment of erysipelas revealed the following data: 1. Erysipelas was located on the lower limbs in 88.3 p. 100 of the cases and on the face in only 9.8 p. 100. 2. Facilitating and/or aggravating factors were: portal of entry in 75 p. 100 of the cases; impairment of venous and lymphatic circulations (41 p. 100); diabetes mellitus (13.5 p. 100); alcoholism and its socio-economic consequences (29 p. 100); unnecessary prescription of anti-inflammatory agents (11 p. 100). 3. Insufficient consideration was given to the clinical diagnosis: in 7.2 p. 100 of the patients erysipelas was diagnosed either after failure of heparin therapy or because phlebography was normal; some clinical features, notably bullae (30 p. 100) or purpura on the lower limbs (13 p. 100), confused the physicians. Delayed treatment was the main cause of local complications, such as abscess (4 cases) or focal cutaneous necrosis (4 cases). Erysipelas was recurrent in 23.5 p. 100 of the patients. 4. Bacteriological data in this series were insufficient to establish percentages of responsible organisms. However, penicillin G in mean doses of 12 million units per day administered intravenously for 5.5 days, then intramuscularly for 10 days was effective as first-line treatment in 80 p. 100 of the cases. Penicillin therapy may fail in patients with insulin-dependent diabetes or belated treatment with complications. No thromboembolic complication was observed (89 p. 100 of patients with lower limb erysipelas had received anticoagulants). There was only one death due to a severe underlying condition.

Administration, Oral↗
PubMed1987

[Erysipelas and lymphedema--egg or hen?].

The initial lymphatics and peripheral lymph-collectors of both legs of 16 patients were visualized by means of indirect lymphography, after the patients had undergone a rash of erysipelas on their lower extremities. 14 out of 19 legs showed clinical signs of lymphedema after one or several erysipelas. In 16 out of 19 legs after erysipelas, but also in 6 out of 11 healthy contralateral extremities, we found pathological initial lymphatics and changes in size, irregularities of the course, and pathological stops of peripheral lymph-collectors. These findings indicate that in the majority of the patients with erysipelas--contrary to the common opinion--resulting lymphedema should not be termed as secondary. In fact, they are primary lymphedemas deteriorated by erysipelas, with the typical pathological findings in indirect lymphography, as they are seen in simple primary forms.

Adult↗
PubMed1975

[Antibodies to group A streptococcal polysaccharides in erysipelas].

In determination (in the precipitation reaction in agar gel) of antibodies to the polysaccharide (streptococcus, group A) in the sera of patients suffering from erysipelas there were revealed antibodies against the specific determinant of polysaccharide A. An increase in antibodies in the patients with primary and repeated erysipelas was observed from the second week of the disease; in patients suffering from relapsing erysipelas their titre was increased from the first days of the disease and persisted at this level during the whole observation period (4 weeks). The majority of the patients suffering from relapsing erysipelas 4 weeks and 6 to 12 months after the relapse displayed no changes in the serum antibody level, or its slight fall was seen. The duration of persistence of antibodies to polysaccharide A in testing at the remote periods after the relapse apparently depended on slow reduction of their level and was not associated with any new infection with streptococcus, since the great percentage of the patients studied at this period were subjected to bicillin-5 therapy. The data obtained served as an additional confirmation of participation of hemolytic streptococcus of group A in the development of erysipelas.

Adult↗
PubMedDate not supplied

[Immunopathology and pathogenesis of chronic erysipelas polyarthritis of swine].

Several immuno-pathological aspects of polyarthritis following experimental infection with erysipelas in pigs were studied for two years. Aseptic and specifically pathogenfree animals were infected subcutaneously and intravenously-intraarticularly with living erysipeals bacteria (erysipelothrix rhusiopathiae) of serotype B. After an initial febrile phase a progressive polyarthritis and disco-spondylitis developed. Some animals also developed thrombo-endocarditis. Hypergammaglobulinemia and high titers of specific antibodies were observed during the whole experimental period. Antiglobulin factors, however, were not detected in the serum or the synovium. In some animals collagen antibodies were demonstrated in synovial tissue. Bacterial examination of the synovium showed that erysipelas bacteria were present in arthritic joints for months. Living erysipelas bacteria were isolated 24 months after the experimental infection from synovial tissue of two pigs. The polyarthritis was characterised by exudates rich in fibrin, villous proliferation, pannus formation, cartilage erosions, and peri-articular fibrosis. IgG and specific erysipelas antibodies were demonstrated in plasma cells from synovial tissue by immuno-histological methods. The findings emphasize the morphological resemblance of the erysipelas induced chronic polyarthritis in pigs to human rheumatoid arthritis.

Animals↗
PubMed1999

Risk factors for erysipelas of the leg (cellulitis): case-control study.

OBJECTIVE: To assess risk factors for erysipelas of the leg (cellulitis). DESIGN: Case-control study. SETTING: 7 hospital centres in France. SUBJECTS: 167 patients admitted to hospital for erysipelas of the leg and 294 controls. RESULTS: In multivariate analysis, a disruption of the cutaneous barrier (leg ulcer, wound, fissurated toe-web intertrigo, pressure ulcer, or leg dermatosis) (odds ratio 23.8, 95% confidence interval 10.7 to 52.5), lymphoedema (71.2, 5.6 to 908), venous insufficiency (2.9, 1.0 to 8.7), leg oedema (2.5, 1.2 to 5.1) and being overweight (2.0, 1.1 to 3.7) were independently associated with erysipelas of the leg. No association was observed with diabetes, alcohol, or smoking. Population attributable risk for toe-web intertrigo was 61%. CONCLUSION: This first case-control study highlights the major role of local risk factors (mainly lymphoedema and site of entry) in erysipelas of the leg. From a public health perspective, detecting and treating toe-web intertrigo should be evaluated in the secondary prevention of erysipelas of the leg.

Analysis of Variance↗
PubMedDate not supplied

Antibiotic prophylaxis in recurrent erysipelas.

Recurrences of erysipelas are especially prevalent in patients suffering from local impairment of circulation and intervention might thus be of benefit. Therefore a prospective, randomized, open study was undertaken to evaluate whether daily antibiotic prophylaxis would reduce the risk of recurrence. Patients with venous insufficiency or lymphatic congestion who had suffered two or more episodes of erysipelas during the previous 3 years and were admitted to the Infectious Disease Department at Roslagstull Hospital, Stockholm, Sweden, between November 1988 and November 1991 were included. Fourty patients, 20 on prophylaxis and 20 controls were followed according to a life table analysis during a median time of 15 months. Phenoxymethylpenicillin was prescribed as daily prophylaxis (while erythromycin was given to patients allergic to penicillin). Recurrences of erysipelas appeared to be reduced by daily antibiotic prophylaxis but the effect was not dramatic (p = 0.06). Only in patients with a high recurrence rate continuous antibiotic prophylaxis against erysipelas is indicated.

Adult↗
PubMed1991

Facial erysipelas: report of a case and review of the literature.

The diagnosis of erysipelas is usually made clinically. Features that help distinguish erysipelas are acute onset, erythema, warmth, edema, pain, fever, and isolated regional involvement with clearly demarcated margins. High ASO titers and response to penicillin therapy are reassuring. Simple uncomplicated erysipelas or cellulitis in adults can usually be treated on an outpatient basis. Extensive facial involvement with fever and a toxic appearance warrants hospitalization. Facial cellulitis or erysipelas in children, unless quite limited, requires hospitalization because of the high risk of Hemophilus influenzae infection and sepsis. Hospitalized patients should show visible signs of resolution and be afebrile for at least 24 hours prior to discharge. They should be maintained on oral antibiotic therapy at home for an additional 7 to 10 days.

Adult↗
PubMed2005

Erysipelas of the upper extremity following locoregional therapy for breast cancer.

Cellulitis is a well-known complication of lymphedema of the lower extremities. Erysipelas of the upper extremity complicating breast cancer therapy has never been reported in the English-language literature. We describe seven breast cancer patients with erysipelas of the upper extremity. Five had a predisposing injury to the extremity. All patients responded very well to intravenous antibiotics without any sequelae. They had rapid resolution with typical desquamation. No long-term sequelae were seen except for mild increase of lymphedema. Erysipelas should be listed as a rare complication after locoregional therapy for breast cancer. Intravenous penicillin should be used as the initial therapy. Prevention of arm lymphedema and avoidance of any trauma to the arm are important prophylactic measures. Sentinel lymph node biopsy reduces the rate of axillary lymph node dissection and thus should reduce the incidence of lymphedema and erysipelas.

Adult↗
PubMed2005

[Erysipelas after osteoarticular prosthesis].

OBJECTIVE: The occurrence of erysipelas after implantation of osteoarticular prosthesis is rarely reported in literature except when it may indicate infection of the implant. PATIENTS AND METHODS: We studied retrospectively 77 files of patients that had been hospitalized for erysipelas from January 1999 to December 2003. RESULTS: We included 3 patients (3.8%) 2 women and a man (average age: 61 years) with a history of osteoarticular prosthesis implantation on the same side as erysipelas. The period between implantation of the prosthesis and erysipelas varied from 6 months to 30 years. The 3rd patient also presented with chronic venous insufficiency and was treated for legs ulcers of venous origin. There were neither clinical nor radiological signs of prosthesis infection. The clinical schedule was typical. The initial outcome was favorable under intravenous penicillin G and local care. Antibiotic prophylaxis was recommended for all the patients, however, 2 patients relapsed.

Arthroplasty, Replacement↗
PubMed2001

Quality control of inactivated erysipelas vaccines: results of an international collaborative study to establish a new regulatory test.

According to the specifications of the European Pharmacopoeia (Ph. Eur.) monograph (Swine Erysipelas Vaccine (Inactivated), Monograph no. 64, European Pharmacopoeia, 3rd edn., 1997) on erysipelas vaccines for veterinary use, batch potency is estimated in a multi-dilution assay after immunisation and infection of mice. Recently, we described a serological assay system (ELISA) which has the potential to replace this challenge-based model (Beckmann R, Cussler K. Wirksamkeitsprüfung von Rotlaufimpfstoffen an der Labormaus. ELISA kontra Infektionsversuch. ALTEX 1994;Suppl. 1:39-45; Rosskopf-Streicher U, Johannes S, Hausleithner D, Gyra H, Cussler K. Suitability of an ELISA for the batch potency test in laboratory mice. Pharmeuropa BIO 1998;1:65-70). The humoral immune response is quantified in pooled sera of ten mice three weeks after immunisation. The results are expressed as relative potency (RP) in comparison to a reference serum. After a pre-validation study had been performed with success (Rosskopf-Streicher U, Johannes S, Wilhelm M, Gyra H, Cussler K. Potency testing of swine erysipelas vaccines by serology - results of a pre-validation study. ALTEX 1999;16:123-8), we initiated an international collaborative study with five European manufacturers and seven regulatory authorities to validate the assay and model. All participants were provided with blind-coded erysipelas vaccines of different potencies, the ELISA kit and test instructions. The participants had to immunise mice, to prepare serum samples and to perform the ELISA. Inter-laboratory reproducibility was reported by the pass/fail criteria of the vaccines under test. Intra-laboratory precision was assessed by comparing repeated measurements on three consecutive days. Day-to-day variation within the laboratories was statistically analysed by comparing pairs of RPs using Lin's concordance correlation coefficient. The results show that the ELISA is indeed a suitable alternative to replace the vaccination-challenge test. Furthermore, this new model reduces the number of animals required for the potency test by approximately 80%.

Analysis of Variance↗
PubMed2007

Recurrent erysipelas: 47 cases.

BACKGROUND: Recurrence is a common complication of erysipelas (cellulitis). OBJECTIVES: Todescribe the characteristics of patients with recurrent erysipelas and thereby, identify potential risk factors and evaluate prophylaxis efficacy. METHODS: Data were retrospectively recorded from the files of 47 patients admitted to hospital between 1995 and 2003 for erysipelas recurrence. Studied variables included: general condition, regional and local factors, e.g. broken cutaneous barrier. Patient characteristics were used to construct tree-based models according to the classification and regression tree methodology. RESULTS: Our patients suffered a mean of 4.1 recurrences. Cutaneous barrier disruption was observed in 81%, mainly intertrigo (60%). Antibiotic prophylaxis was taken by 68% of the patients for 30.6 months. After 1 and 2 years, 84 and 72% of the patients, respectively, were recurrence-free. CONCLUSION: Our results showed that erysipelas recurrence has the same risk factors as single episodes and underlines the potential benefit of oral or parenteral antibiotic prophylaxis to prevent recurrences.

Adult↗