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PubMed2001

[Acute osteomyelitis. A rare erysipelas differential diagnosis].

INTRODUCTION: Acute haematogenous osteomyelitis, whose clinical features may mimic erysipelas, is an uncommon disease in adults. OBSERVATION: A 56 year-old man was hospitalized for a suspicion of leg erysipelas. Oral and intravenous antibiotic therapy was inefficient. Magnetic Resonance Imaging (MRI) of the leg revealed osteomyelitis with subperiosteal abscess. Change of antibiotics and surgical debridement improved the patient's condition. DISCUSSION: Erysipela is a common disease which most often responds to anti-streptococcal therapy. Unfavourable evolution under antibiotherapy must lead to consider necrotizing fasciitis but also acute osteomyelitis. In these cases MRI is necessary. In our observation, the leg pain which preceded other signs of local inflammation, suggested the existence of primitive bone infection which further diffused in soft tissues, thus explaining the erysipelatoid aspect.

Abscess↗
PubMed2002

[A case of fulminant acute poststreptococcal glomerulonephritis showing mesangiolysis and crescent formation preceded by erysipelas].

A 66-year-old man with erysipelas was admitted with complaints of oliguria and massive proteinuria/hematuria. He was diagnosed as having acute poststreptococcal glomerulonephritis(APSGN) due to erysipelas infected by group A streptococcus pyogenes. On admission, his white cell count increased to 31,000, and CRP was 27.3 mg/dl. Serum urea nitrogen and creatinine were increased to 90.1 mg/dl and 4.5 mg/dl, respectively. He had diabetes mellitus(HbA1c 7.9%) and liver dysfunction(total bilirubin 3.5 mg/dl, AST 76 IU, ALT 41 IU) caused by alcoholic liver cirrhosis. Hypocomplementemia was found in addition to ASO 216 U/ml and ASK 10,240 x. After antibiotics treatment was initiated, inflammation of the erysipelas began to improve. Disseminated intravascular coagulation syndrome, probably due to sepsis, occurred on the 5th hospital day. He died of gastrointestinal bleeding on the 18th hospital day. Renal autopsy revealed 37% formation of fibrocellular crescents, and marked mesangiolysis was noted by light microscopy. Granular deposition of C3 and IgG was seen along the capillary walls on immunofluorescence study. Intramembranous deposits were scattered on electron microscopy. This case illustrates a fulminant type of APSGN, which was in part attributed to the presence of diabetes and alcoholic liver cirrhosis. Histological findings of crescent formation and marked mesangiolysis may account for the fulminant clinical course.

Aged↗
PubMed1992

[Effect of indirect endolymphatic antibiotic therapy on clinical and immunological indicators in patients with erysipelas of the lower extremities].

Two groups of patients with erysipelas of the lower extremities underwent indirect endolymphatic therapy with bicillin-3 (58 patients) and routine penicillin therapy (79 patients). Comparative clinicoimmunological examinations in the two groups revealed that lymphotropic administration of the antibiotic had a more favourable effect on the disease process, as evidenced by more rapid reverse time courses of erysipelas clinical signs, less frequent incidence of early relapses and normalization of the majority of immunological parameters by the end of the treatment. For estimation of the anti-recurrence efficacy of the antibiotic therapy in the patients with erysipelas, it was recommended to use a specific scale based on the principles of the Wald successive alternative analysis.

Adult↗
PubMedDate not supplied

Wound healing of chronic leg ulcers under the influence of erysipelas.

We report four patients with long-lasting therapy-resistant ulcus cruris, on which a new erysipelas was superimposed. In one case there was a total closure of the ulcers under the erysipelas. In three patients a reduction in size occurred. All ulcers became flatter. Other stimuli of wound healing were excluded. Because of the long-lasting existence and well known therapy resistance in each case, these changes suggest a positive effect of the erysipelas on the healing of the ulcers. We assume that serum cytokines could offer a possible explanation for this. The concentrations of the IL-6 and IL-2-receptor were initially raised and then later decreased in three of the four cases. Because of the complex stimulation and regulation mechanisms in the cytokine network which are triggered by inflammation, systemic and local effects of keratinocytes, monocytes/macrophages, fibroblasts and endothelium cells could also be assumed to support wound healing.

Biomarkers↗
PubMed2005

[Erysipelas as the cause of lymphedema].

The results of the treatment of 237 patients with lymphedema and recurrent erysipelas are analyzed. Direct correlation between the number of erysipelas in anamnesis and degree of lymphedema, and also their reciprocal aggravation are demonstrated that permits us to regard erysipelas as the cause of lymphedema.

Adolescent↗
PubMed1989

[T-activin in the treatment of patients with recurrent erysipelas and concomitant eczema].

Increased levels of circulating immune complexes (CIC) have been revealed in 156 patients suffering from erysipelas and chronic eczema, 109 of these with frequent recurrences of erysipelatous inflammation, during all periods of the disease. The maximal rises of CIC levels have been associated with a combination of erysipelas relapse with eczema exacerbation, with the most pathogenic medium- and low-molecular complexes, making up together 80.4 +/- 4% of CICs, predominating in the blood. T-activin therapy results in an essential decrease of CIC level and in 2.5 times reduction of the number of early recurrences of erysipelas.

Adjuvants, Immunologic↗
PubMed1986

[Associated vaccination of pigs against swine fever, erysipelas and Aujeszky's disease].

Tested was the simultaneous vaccination of pigs against swine fever, swine erysipelas, and Aujeszky's disease. Parallel to this experiment a second group of test pigs were treated with each of the three vaccines at twenty-day intervals. The effect of vaccination was assessed through clinical observations with the test groups and by challenging part of the animals with virulent strains of the swine fever and erysipelas agents. It was found that the successive application of the three vaccines at 20-day intervals (at the age of 50, 70, and 90 days) could induce immunity that lasted for a longer period than the immunity resulting from the simultaneous treatment at the age of 90 days. In order to protect the pigs for sure up to the end of the fattening period a revaccination against swine fever with the simultaneous use of the vaccine against swine erysipelas in both cases was necessary.

Animals↗
PubMed1985

[The importance of local factors in recurrent erysipelas].

We report on 366 patients suffering from erysipelas who have been treated in 1977 to 1981. 263 of them had primary infections, 103 showed relapsing erysipelas. In the course of treatment, sex, age, localisation, as well as local terrain factors have been evaluated. Therapy consisted of high dosage antibiotic treatment and correction of the local predisposing terrain factors. 41 of the 103 patients with relapsing erysipelas have been controlled during an observation period between 2 and 6 years. 27 patients of these 41 (63.9%) did not suffer a relapse within the observation period, 14 (34.1%) reported relapses. Local predisposing factors were found more frequently in patients with recurrence of the disease. Therefore, strict therapeutic control of terrain factors seems to be much more important than long-term antibiotic treatment.

Adolescent↗
PubMed1984

[Effect of sodium nucleinate on the effectiveness of antibiotic therapy of erysipelas].

The clinical effect of sodium nucleinate (SN) was investigated by comparison of the clinico-laboratory findings in 70 patients treated with this drug during the acute stage of erysipelas in addition to antibiotic therapy and the same tests in 100 patients treated with the antibiotics alone. It was shown that SN had a favourable therapeutic effect on the patients with erysipelas. It accelerated the elimination of the local inflammation foci and lowered the incidence of relapses. The therapeutic effect of SN was due to its stimulating effect on the cell and humoral immunity and natural resistance to infection. The results of the study allowed recommending the use of SN in combined therapy of erysipelas for increasing the antibiotic efficacy.

Adjuvants, Immunologic↗
PubMed1980

Recurrent erysipelas caused by group B streptococcus organisms.

Group B beta-hemolytic streptococcus (GBS) has emerged as a major cause of neonatal infections. Serious GBS infections in adults occur most frequently when predisposing illness is present. Recurrent erysipelas caused by GBS is reported in a woman who had chronic lymphedema after a radical hysterectomy and radiation therapy. Type III GBS was identified from cultures of vulvar vesicles, vaginal mucosa, and blood. Prophylactic penicillin V potassium therapy prevented further episodes of erysipelas. Group B beta-hemolytic streptococcus should be considered a possible cause of erysipelas or cellulitis.

Abdomen↗
PubMed1982

Atypical erysipelas caused by group G streptococci in a patient with cured Hodgkin's disease.

Erysipelas developed in a young woman whose condition had been in remission for ten years after treatment of stage IIIA Hodgkin's disease. The erysipelas was atypical both in its clinical manifestation and its causative organism. The patient had an erythematous, macular eruption on both buttocks and thighs. Group G streptococci, a rare cause of erysipelas, were isolated from both blood cultures and a skin biopsy specimen. The unusual clinical manifestation of the disease when the patient was initially seen may have been the result of a group G streptococcal bacteremia, coupled with impairment of the lymphatic drainage of the involved area from a partial thoracic duct obstruction and a restrictive cardiomyopathy, both secondary to previous irradiation treatment.

Adult↗
PubMed1995

St. Anthony's Fire: diagnosis and management of erysipelas.

Erysipelas, a beta-hemolytic streptococcal infection of the skin and subcutaneous tissue, was once a common disease but nearly disappeared after the advent of antibiotics. In the past few years, however, the incidence of erysipelas has been increasing. At particular risk for infection are young patients, elderly patients and immunocompromised patients. The diagnosis is confirmed by the typical appearance of erythema and fever, constitutional symptoms and laboratory findings indicative of streptococcal infection. Penicillin and close follow-up can prevent significant morbidity and possible mortality. The prognosis for patients with erysipelas is excellent.

Erysipelas↗
PubMed1997

[Erysipelas of the leg in hospital environment in Lome (Togo)].

A study was conducted during 5 years to determine the epidemiological clinical profile and the evolution of legs erysipelas in patients attending Lome teaching hospital. During this period, 60 subjects (43 females et 17 males) were hospitalized for legs erysipelas. The average age was 40 years old. General facilitating factors were noted in 58% of the patients (n = 35), and local in 50% of cases (n = 30). The first line treatment was in all patients penicillin G. Satisfactory results were observed in 70%. Local complications were noted in 10% (n = 6), and recurrence in 17% (n = 10). The erysipela is common in hospital environment. The precocious penicillinotherapy allowed to have satisfactory results.

Adult↗
PubMedDate not supplied

[The lipid peroxidation and chemiluminescence indices of patients with erysipelas and concomitant diabetes mellitus].

Parameters characterizing chemiluminescence (spontaneous and hydrogen peroxide-induced) and state of lipid peroxidation were studied in 58 patients with erysipelas without diabetes mellitus (group I) and 46 patients with clinically manifest decompensated DM, predominantly type II one (group II), to get more specific information about their role in the pathogenesis of erysipelas presenting with concurrent DM. Group II patients showed more significant increase in measures of lipid peroxidation and degree of chemiluminescence, that did not reverse by the time a patient was discharged from the hospital, which fact is to be considered in instituting therapeutic and rehabilitative measures in those patients with erysipelas concurrent with DM.

Acute Disease↗
PubMed2003

The poultry red mite, Dermanyssus gallinae, a potential vector of Erysipelothrix rhusiopathiae causing erysipelas in hens.

Erysipelas is a bacterial disease caused by Erysipelothrix rhusiopathiae, which may infect swine as well as several other species of mammals and birds, including domestic fowl. In poultry, erysipelas may cause sudden high mortality due to septicemia. This communication describes the first isolation of E. rhusiopathiae from the haematophagous poultry red mite, Dermanyssus gallinae DeGeer (Acari: Dermanyssidae), that was collected on three farms where hen erysipelas was diagnosed. The bacteria were isolated from the integument as well as from the interior of the mites. Serotypes 1a and 1b of E. rhusiopathiae found in the mites corresponded with those isolated from the diseased birds. These findings imply that D. gallinae is a potential vector of E. rhusiopathiae. The current lack of effective measures to control D. gallinae causes recurring mite problems in poultry facilities once afflicted by this parasite. Consequently, mites containing E. rhusiopathiae may act as reservoir hosts of this bacterium, allowing it to persist in the poultry house between flock cycles as a source of infection for the replacement pullets. The zoonotic potentials of both E. rhusiopathiae and D. gallinae should also be considered.

Animals↗
PubMed2000

Erysipelas-like erythema of familial Mediterranean fever: clinicopathologic correlation.

BACKGROUND: Familial Mediterranean fever (FMF) is an autosomal recessive disease that tends to affect certain ethnic groups. It is characterized by recurrent, self-limited attacks of peritonitis, pleuritis, and synovitis. Erysipelas-like erythema (ELE) is the pathognomonic skin manifestation. Lesions are characterized by tender erythematous plaques, usually located on the lower legs. They may be triggered by physical effort and subside spontaneously within 48 to 72 hours of bed rest. Fever and leukocytosis may accompany this condition. OBJECTIVE: The purpose of this study was to describe the histology and the immunofluorescence findings in ELE and to discuss these observations in relation to the clinical findings in FMF. METHODS: We studied 7 patients with FMF in whom ELE developed. In all patients a biopsy was performed within 18 hours from onset of the lesion. In addition to routine hematoxylin and eosin stains, immunohistochemistry to evaluate the infiltrate and direct immunofluorescence were performed. Patients were followed up for their ELE lesions. RESULTS: Histologic examination revealed edema of the superficial dermis and sparse perivascular infiltrate composed of a few lymphocytes, neutrophils, and nuclear dust. Vasculitis was not observed. Direct immunofluorescence showed, in all cases, deposits of C3 in the wall of the small vessels of the superficial vascular plexus. In some cases fibrinogen and IgM were also observed. CONCLUSION: These findings are in accordance both with those found previously in the erysipelas-like phenomenon and those in the peritoneum of patients with FMF. The sparse infiltrate and the deposition of C3 also are compatible with the clinical picture of self-resolving lesions of short duration. It also suggests that erysipelas-like erythema belongs to the spectrum of neutrophilic dermatoses and supports a pathogenesis that involves abnormal inhibition of the inflammatory cascade.

Adult↗
PubMed2000

Erysipelas-like cellulitis with Pasteurella multocida bacteremia after a cat bite.

A 73-year-old female patient presented with Pasteurella multocida erysipelas-like cellulitis, bacteremia, and shock. The onset of the disease occurred 24 h after a cat bit her to the right lower leg. Initially, the picture of bacteremia and shock developed, with minimal local cellulitis. Pasteurella multocida grew in blood culture. A combination of amoxicillin and clavulanic acid was therapeutically successful in respect that the signs of bacteremia and shock disappeared. However, extensive erysipelas-like cellulitis developed on the bitten leg within the next 2 days. The disease was efficiently treated with penicillin G combined with netilmicin and administered for 10 days. This report documents the first case of Pasteurella multocida erysipelas-like cellulitis with bacteremia and shock.

Aged↗
PubMed1994

[Investigation about development of alternative efficacy verifications of swine erysipelas vaccines]

Vaccination is the most effective prophylaxis against swine erysipelas. Vaccines are usually tested for efficacy by a challenge of vaccinated and untreated pigs. Up to now the efforts to replace the infection test by a serological method have been limited to the potency test in laboratory animals. Here we provide evidence that the measurement of antibodies by an enzyme-linked immunosorbent assay (ELISA) after vaccination and challenge is also possible in the target species. Pig sera were tested for titre development after a single and repeated vaccination in clinical trials. The efficacy of the vaccines was confirmed by a challenge, which demonstrated that all immunized pigs survived with no signs of disease whereas all control animals became severely ill. The ELISA was also used to measure erysipelas antibodies after immunization of pigs with several vaccines in a field trial. The ELISA may be a suitable alternative to replace the challenge methods currently used for testing of erysipelas vaccines.

Journal Article↗