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PubMed1975

[Antibodies to type antigens of group A streptococcal cell walls in erysipelas patients].

The passive hemagglutination test was used to determine antibodies to type antigens of the cell wall of streptococcus group A in 167 patients suffering from erysipelas, from whom 488 sera were obtained. Antibodies were revealed in 97.2% of the sera. There was a definite relationship between the clinical form of the disease and the level of antibodies: their lowest level and the absence of elevation in the course of the disease was noted in continuous-relapsing form of erysipelas; the appearance of antibodies to the new types of streptococcus was usually noted in late relapses of the disease, which permitted to attribute their occurrence to infection by the new types of the microbes. In individual cases the appearance of antibodies to the new types of streptococcus was observed at the early relapses of erysipelas; this could be explained by the exacerbation of a focus of chronic (endogenous) infection in the skin in the absence of reinfection. Continuous prophylactic administration of bicillin-5 produced no depressive effect on the antibody level in patients with relapsing erysipelas.

Antibodies, Bacterial↗
PubMed2000

Lymphoscintigraphic evaluation in patients after erysipelas.

Erysipelas (cellulitis/lymphangitis) is a superficial cutaneous infection spread by the lymphatic system which may result in permanent injury to the lymphatic vessels. The study evaluated the lymphatic drainage in the lower limbs of 30 patients with at least two episodes of erysipelas by means of lymphoscintigraphy. Twenty-two (73%) were female and 8 (27%) were male with ages ranging from 26 to 77 years (mean 52 years). Lymphoscintigraphy was performed by intradermal administration of 500 microCi (20 Mbq) of 99mTc antimony sulfur-colloid in two interdigital spaces of the feet. Whole body scintigraphy was performed 45 minutes after the administration of the radiopharmaceutical using a computerized gamma camera. Significant lymphatic abnormalities were found in 23 (77%) of these patients. We conclude that most patients with repeated erysipelas have significant and even permanent abnormalities in regional lymphatic drainage. Recurrent erysipelas suggests underlying primary or secondary lymphedema.

Adult↗
PubMed1975

[Experimental erysipelas in different species as a model for systemic connective tissue disease. II. The chronic phase with special reference to polyarthritis (author's transl)].

INTRODUCTION: In part I of this paper (Schulz et al., 1975) it was shown that in the initial phase of experimental erysipelas a transition from the vascular processes to a systemic connective tissue reaction can be demonstrated in different species. It is the purpose of this paper to describe the chronic phase of the disease with special emphasis on polyarthritis. MATERIALS AND METHODS: 12 spontaneously diseased and 22 experimentally infected pigs were used in experiments to study the pathogenesis of the disease. In addition, 74 Wistar rats and 148 Sprague-Dawley rats were used in the experiments. All experimental animals were specific-pathogen-free and were parenterally infected with the standardized E. insidiosa serotype B strain T 28. The observation period for the pigs was up to 2 years, for the rats up to 11 months. The methods used for pathohistological and electron microscopical studies are described in part I. Immunihistological studies were carried out on synovial tissue with peroxidase-conjugates of goat-anti-pig-IgG, goat-anti-pig-IgM, pig-collagen, E. insidiosa-homogenate and heat-aggregated-pig-IgG. Furthermore, goat-anti-pig-IgG and rabbit-anti-pig-C3 conjugated with FITC were used. Passive hemagglutination tests and Latex agglutination test (Singer and Plotz) were performed to demonstrate rheumatoid factors and collagen antibodies. RESULTS: Polyarthritis occurred in pigs between the 4th and 10th day p.i. and between the 4th and 8th day p.i. in nearly 100% of the infected rats. Fibrinous exudation, proliferation and destruction with pannus formation are marked in most of the joints examined during the first three months. Fibrosis begins 30 days p.i. in the rats' joints and is most severe in both species between the 5th and 8th month. 3 types of lining cells may be differentiated electron microscopically: A (M) cells, B (F) cells and an intermediate form which is found in both species most frequently. Swelling of the endothelial cells together with constriction of the lumen and thickening of the basal membrane occurs in the capillaries. DISCUSSION: A comparison of chronic erysipelas polyarthritis in pigs and rats with rheumatoid arthritis of men reveals many morphological and immunological similarities between the two diseases. Systemic connective tissue activation manifests itself in organs predilected for rheumatic changes, such as heart valves, endocardium and joints. The possible prepetuation of the processes by specific or nonspecific immunomechanisms or by deposits of fibrin is discussed. In addition, experimental erysipelas is reproducible in nearly 100% of the animals given one single subcutaneous application of one defined bacteria strain. Therefore too, erysipelas is suited as an animal model for human rheumatic diseases.

Animals↗
PubMed2001

[Is anticoagulant therapy useful when treating erysipelas?].

INTRODUCTION: Low or high dosage heparin adjuvant therapy for Erysipelas (E) has become frequent, especially in France. MATERIAL AND METHODS: Publications on erysipelas complications were reviewed, and 2 studies were found in which the detection of deep venous thrombosis (DVT) was systematically performed: Mahe A (6DVT/40E), and Perrot JL (4DVP/155E). We calculated the relative incidence (CRI) at 4.9 p. 100, for all studies systematically detecting the DVT (whether symptomatic or not). The other studies reported clinical DVT. CRI was at 0.7 p. 100 without heparin adjuvant therapy. CRI was at 0, not statistically significant, with low or high dosage heparin adjuvant therapy. The most frequent complications for heparin treatment were: thrombocytopenia (5.7 and 0.9 p. 100 respectively with standard and low weight heparin), and hemorrhage (less than 3 p. 100 for DVT treatment). DISCUSSION: The risk of DVT associated with E is inferior to 10 p. 100 (the level of risk for DVT is small according to consensus conferences on thromboembolism). The incidence of asymptomatic DVT is superior to that of symptomatic DVT. But we do not know if asymptomatic DVT is equivalent to symptomatic DVT. Consensus conferences on thromboembolism do not recommend the preventive administration of heparin to bedfast patients with a low risk of DVT. CONCLUSION: There is no indication of adjuvant anticoagulant therapy for erysipelas. There is no indication for systematic prophylactic anticoagulant therapy for erysipelas. Prophylactic anticoagulant therapy is used depending on other risk factors of DVT. Wearing stockings may be another indication for patients.

Anticoagulants↗
PubMed2001

[What data is needed today to deal with erysipelas?].

Erysipelas are common dermo-hypodermal infections. In spite of that, different questions are not clearly resolved. To improve our knowledge of this infection, it is important to have epidemiological, microbiological and diagnostical data. The current data are summarized in this article after a bibliographic research. The epidemiology has changed, with an increase of the number of erysipelas of the leg whereas face localization is less frequent. Some facilitating factors can be individualized, like circulatory insufficiency of the legs. There are only few data concerning pathophysiology. The diagnosis is mainly made on clinical symptoms. There is no specific diagnostic test. The bacteria that cause erysipelas is rarely isolated in clinical practice. The group A Streptococcus is the most frequent bacteria in erysipelas. It is important for physicians, to have a better knowledge of this infection, so that the efficacy of the treatment can be improved.

Erysipelas↗
PubMed2001

[Incidence of erysipelas of the lower limbs in a spa resort. Efficacy of a strategy of sanitation education (La Lechere: 1992-1997)].

OBJECTIVE: Erysipela is a common skin infection readily found in patients with venous insufficiency or lymphedema. The aim of this work was to measure the incidence of erysipela in a spa resort specialized in the treatment of venous and lymphatic diseases and to evaluate the influence of a preventive strategy principally based on education of patients at risk. PATIENTS AND METHODS: The measurement of incidence was based on the detection of the reasons for which the patients did not attend their thermal care sessions. Quality control was obtained from the reports of cases diagnosed by local private and public health care centers. RESULTS: The incidence of erysipela in this high risk population was 40.2 and 48.5 cases for 1000 persons per exposure-year in 1993 and 1994 respectively. The preventive strategy carried out was able to induce a reduction of 65% during the next years (p<0.01). CONCLUSION: This study confirms the high incidence of erysipela in subjects with severe venous insufficiency or lymphedema and the efficacy of an active educational preventive strategy.

Balneology↗
PubMed2001

Antibiotic use in patients with erysipelas: a retrospective study.

BACKGROUND: Erysipelas is a skin infection generally caused by group A streptococci. Although penicillin is the drug of choice, some physicians tend to treat erysipelas with antibiotics other than penicillin. OBJECTIVES: To define the pattern of antibiotic use, factors affecting antibiotic selection, and outcome of patients treated with penicillin versus those treated with other antimicrobial agents. METHODS: A retrospective review of charts of adult patients with discharge diagnosis of erysipelas was conducted for the years 1993-1996. RESULTS: The study group comprised 365 patients (median age 67 years). In 76% of the cases infection involved the leg/s. Predisposing condition/s were present in 82% of cases. Microorganisms were isolated from blood cultures in only 6 of 176 cases (3%), and Streptococcus spp. was recovered in four of these six patients. Cultures from skin specimens were positive in 3 of 23 cases. Penicillin alone was given to 164 patients (45%). Other antibiotics were more commonly used in the second half of the study period (P < 0.0001) in patients with underlying conditions (P = 0.06) and in those hospitalized in the dermatology ward (P < 0.0001). Hospitalization was significantly shorter in the penicillin group (P = 0.004). There were no in-hospital deaths. CONCLUSIONS: We found no advantage in using antibiotics other than penicillin for treating erysipelas. The low yield of skin and blood cultures and their marginal impact on management, as well as the excellent outcome suggest that this infection can probably be treated empirically on an outpatient basis.

Adult↗
PubMed2001

[Dynamics of erythrocyte electrophoretic mobility in patients with various forms of erysipelas].

AIM: To study electrophoretic mobility (EM) of erythrocytes in the course of various forms of erysipelas. MATERIAL AND METHODS: 78 patients with various erysipelas clinical forms were examined in the disease acute period and early in convalescence. RESULTS: EM of erythrocytes was significantly higher in hemorrhagic forms of erysipelas vs an erythematous form. CONCLUSION: Manifest changes in functional condition of erythrocytic membranes in patients with erythematous-hemorrhagic and bullous-hemorrhagic forms of erysipelas play an important part in the development of local hemorrhagic syndrome.

Adolescent↗
PubMed2006

Rheological properties of erythrocytes in patients suffering from erysipelas. Examination with LORCA device.

The rheological properties of erythrocytes: elongation and the aggregation, as well as basic peripheral blood parameters: RBC number, hematocrit, MCV, MCH, MCHC reticulocytes, fibrinogen level, ESR, and glucose level were studied in a group of erysipelas patients. The concentration of malonyl dialdehyde (MDA) in erythrocytes was also measured, as an indicator of oxidative stress exerted. The study involved 18 erysipelas patients and 18 healthy subjects. The rheological properties and the aggregation of erythrocytes were studied with the use of a LORCA instrument (Laser-assisted Optical Rotational Cell Analyser). Differences were found in elongation index (EI) between the blood control (C) and patients (P), with an increase of this value only at 0.58 Pa shear stress and at 1.13 Pa shear stress. Upstroke were used as the indexes of RBC deformability, and the following aggregation parameters: intensity of light scattering in the prior disaggregation (Isc dis) - C - 43.0 au (arbitrary units), P - 44.8 au, time when cells are round and not aggregated (Isc top) - C - 51.6 au, P - 49.3 au, the amplitude of aggregation, the difference between Isc max and Isc min (AMP) - C - 39.9 au, P - 28.7 au, aggregation index (AI) - C - 64.6%, P - 70.0%, time for reach one half of the maximum aggregation (t(1/2)) - C - 2.0 s, P - 1.5 s, threshold shear stress, the lowest force that breaks the aggregation formed (Y(thr)) in P exceed 170% control group were measured. A decrease in the elasticity of erythrocytes in erysipelas patients was associated with the simultaneous increase of MDA - C - 0.08 nM/mgHb, P - 0.11 nM/mgHb content in the membranes of red blood cells. Basic peripheral blood parameters studied in patients with erysipelas did not differ significantly from the control group except for WBC, fibrinogen (C - 3.8 g/l, P - 7.8 g/l), and ESR (C - 6.1 mm/h, P - 45.4 mm/h) which were significantly higher.

Aged↗
PubMed2006

Erysipelas of the left upper limb occurring after elbow dislocation.

BACKGROUND: Erysipelas is an acute infection occurring chiefly in the lower limbs, rarely in the upper limbs. OBSERVATION: A 45-year-old patient suffering from Charcot-Marie-Tooth disease with neuropathy of the limbs, presented with fever and a 24-hour history of a well-circumscribed inflammatory and infiltrated plaque of the left arm. Erysipelas was diagnosed and intravenous penicillin was administered leading to regression of the inflammatory signs, however edema persisted in the inner part of the left elbow. An x-ray showed left elbow dislocation. The patient revealed trauma of the left upper limb 5 weeks before. DISCUSSION: The occurrence of erysipelas is usually associated with lymphatic edema or venous incontinence. Lymphatic lesions due to radiotherapy or surgery may afflict draining vessels leading to venous and lymphatic stasis and then infection occurs. We find no reported cases of erysipelas following elbow dislocation but we postulate its pathogenesis to be similar.

Arm↗
PubMed1991

[The use of the kallikrein-kininogen system indices in the prognosis of the development of hemorrhagic erysipelas].

A number of the kallikrein-kinin system parameters (kallikrein, prekallikrein, total arginine esterase activity, alpha 1 protease inhibitor, and alpha 2 macroglobulin) were measured in 59 patients with erythematous erysipelas and in 51 ones with hemorrhagic erysipelas over the course of the disease. Marked activation of the blood kallikrein-kinin system was seen in all the patients during the initial period of the disease, manifesting by elevated levels of kallikrein, total arginine esterase activity, alpha 1 protease inhibitor, alpha 2 macroglobulin, and a lowered prekallikrein concentration. In erythematous erysipelas the peak of activation was recorded in the first days of the disease, whereas in hemorrhagic condition it was observed during the second week of erysipelatous inflammation. Different patterns of changes in the kallikrein-kinin system over the course of the disease permit using one of its parameters, kallikrein activity, for the prediction of the development of local hemorrhagic syndrome in erysipelas patients already during the earliest (prehemorrhagic) stage of the condition.

Adult↗
PubMed1991

[The pathogenetic and prognostic significance of the level of class-E immunoglobulins in erysipelas].

The authors determined the content of total immunoglobulins of the E class in the blood plasma: native (IgE) and exhausted by a streptococcal allergen in the dynamics of the disease in 145 patients with erysipelas. The level of antistreptococcal reagins was evaluated. It was established that at the onset of erysipelas the concentration of IgE and a-IgE showed a short-term increase in 52 +/- 4% and 87 +/- 3% of patients correspondingly. During convalescence the level of these antibodies did not differ from that of the normal excluding high risk patients for recurrence. The participation of IgE-mediated type of allergic reactions in the pathogenesis of erysipelas is suggested. It is recommended to use the content of IgE and a-IgE for the prognosis of immediate and remote recurrences of erysipelas.

Adult↗
PubMed1991

[Changes in the kallikrein-kinin system of patients with erythematous and hemorrhagic forms of erysipelas].

The state of the kallikrein-kinin system of the blood (KKS): kallikrein (KK), prekallikrein (PK), general arginine-esterase activity (GAEA), alpha 1 inhibitor of protease (IP) and alpha 2-macroglobulin (MG). The initial period of the disease was characterized by an increase of the level of KK, GAEA, IP and MG and a reduction of PK. It was established that the maximal activation of KKS develops in patients with the erythematous form of erysipelas during the first days of the disease, with the hemorrhagic form--on the 2 week. During convalescence KKS indices showed the reverse dynamics but did not reach normal levels in most patients. It is suggested that there is a relationship of the "rapid" form of KKS activation with formation of erythematous erysipelas, the "slow"--with hemorrhagic erysipelas. It is recommended to use the KKS indices, primarily KK activity for prediction of hemorrhagic erysipelas at the early prehemorrhagic stage.

Adult↗
PubMed1991

[The immunogenetic aspects of erysipelas infection].

The distribution of the antigens of the HLA system in 517 erysipelas patients, constant residents of Voroshilovgrad and the adjoining region (the Ukrainian SSR), has been studied. The HLA system has been found to take part in the formation of predisposition to erysipelas and its clinical forms. Predisposition to erysipelas infection has a polygenic nature and is associated with antigens HLA-A2, B5, B12, Bw35. The specific features of HLA-A10, Aw12, B7, B8 have, seemingly, a protective character. The most pronounced connection between the disease and histocompatibility antigens has been detected in patients with frequent and multiple relapses of erysipelas.

Disease Susceptibility↗
PubMed1989

Streptococcal cause of erysipelas and cellulitis in adults. A microbiologic study using a direct immunofluorescence technique.

We prospectively studied 42 adult patients with acute dermis and soft-tissue infections (27 with erysipelas and 15 with acute cellulitis) involving the lower limb in all except one case. Streptococcus organisms (groups A, C, D, and G) were researched in skin biopsy specimens by a direct immunofluorescent (DIF) technique using commercially available antibodies. Our results showed that DIF gives a sensitivity of 0.70 for the in situ detection of streptococci in cases of erysipelas and cellulitis. With the obvious contribution of this DIF technique, streptococcal pathogens could be detected in situ and grouped in 19 of 27 cases of erysipelas (group A, 13; group B, 1; group C, 1; and group G, 4) and in ten of 15 cases of cellulitis (group A, 9; group B, 1). Combined data, including conventional cultures, DIF studies, and serologic findings, established that Streptococcus organisms, especially Streptococcus pyogenes (A), were, in nearly all cases, responsible for both erysipelas (26/27 cases) and acute cellulitis (11/15 cases) involving the lower limb in adults.

Adult↗
PubMed1986

[Determination of antibodies against ribosomes and various cell wall components and detection of circulating antigens of group A Streptococcus in patients with erysipelas].

The level of antibodies to the ribosomes, polysaccharide A and peptidoglycan of group A streptococcus in the blood of patients with primary, secondary, and often relapsing erysipelas was studied by means of the enzyme immunoassay with the use of the sandwich techniques. For control, the sera of healthy donors were used. In the sera obtained from all groups of erysipelas patients a significant rise in the levels of antibodies to ribosomes and peptidoglycan in comparison with the controls was revealed. An increase in the level of antibodies to polysaccharide A was revealed only in patients with frequently relapsing and secondary erysipelas. Depending on the clinical form and the duration of the disease, polysaccharide A was detected in 32-51.9% of erysipelas patients and protein-ribosomal antigen was detected in 28.6-51.9% of such patients.

Antigens, Bacterial↗
PubMed1987

[Etiology of erysipelas].

Bacterial cultures were taken from 31 patients by scarification from the dermal compartment of recent erysipelas foci. Pathogenic organisms were isolated from the dermis while cultures from the skin surface remained sterile in 5 patients; Streptococcus pyogenes was cultured in 2 of these patients and Staphylococcus aureus in the other 3 patients. Our findings indicate that staphylococcal erysipelas does exist and we suppose that Staphylococcus aureus is able to induce erysipelas, above all in the presence of dysfunction of lymph vessels. When treatment with penicillin G is not successful, erysipelas caused by staphylococci has to be considered. In these cases treatment has to be changed to penicillinase-resistant penicillin.

Bacteriological Techniques↗
PubMedDate not supplied

[Enzyme, enzyme-histochemical and immunohistological studies in chronic erysipelas polyarthritis of swine].

The chronic Erysipelas-polyarthritis in pigs has been considered an animal model resembling human rheumatoid arthritis. Fifteen specifically pathogenfree (SPF) pigs 45 days old were experimentally infectec with strain T 28 of Erysipelothrix rhusiopathiae-bacteria. During the subsequent 32 weeks several enzymatic, immunohistological and microbiological parameters were monitored. Compared to 5 age and sex matched healthy controls the infected pigs showed increased activity of plasma acid phosphatase starting 4 weeks after the infection. Acid phosphatase activity was usually enhanced in synovial fluid of chronically ill animals. Histochemically increased activity of acid phosphatase, beta-glucuronidase and beta-acetylglucosaminidase was found in lining cells and fibroblasts of the synovial membrane of chronically diseased joints. Immunohistochemically Erysipelas-antigen was demonstrated in the synovial membrane even of those inflamed joints from which no living bacteria had been isolated. The microbiological and immunohistochemical results correlated positively with the enzymehistochemical data. The release of lysosomal enzymes from cells of the synovial membrane in chronically diseased joints due to the influence of Erysipelas-bacteria and the possible implications of persistent bacteria on the perpetuation of chronic Erysipelas-polyarthritis are discussed.

Animals↗