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Changes in rat leukocyte populations in peripheral blood, spleen, lymph nodes, and synovia during Erysipelas bacteria-induced polyarthritis.

Kinetics of leukocyte subsets were followed for several weeks in rats suffering from polyarthritis induced by experimental infection with erysipelas bacteria (Erysipelothrix rhusiopathiae, serovar 2, strain T28). A marked leukocytosis was found in peripheral blood, and, with some delay, in the synovia and draining lymph nodes of affected joints. In the lymphoid organs tested considerable blast formation of lymphoid cells with a paucity of polymorphonuclear granulocytes was found, while the latter represented the majority of leukocytes in acutely inflamed joints. Cells isolated from spleen showed only moderate and transient alterations in proportions of subpopulations during the first week after inoculation of erysipelas bacteria. In contrast, cells isolated from synovia of inflamed joints and draining lymph nodes displayed more intense and longer lasting alterations: In arthritic animals, the proportion of MHC class II-positive lymphocytes generally increased and remained elevated at least during the first three weeks of the disease. Spontaneous release of IL-2 from cells isolated up to 20 days post induction of the arthritis indicated a considerable activation of lymphocytes in vivo. Interestingly, with exception of synovia, the relative amount of T-lymphocytes including their major CD4+ and minor CD8+ subsets showed little alteration during the course of the disease. Much more pronounced were the rapidly and the extent the membrane Ig-positive B-lymphocytes increased in the synovia as well as in the lymph nodes. Thus, B-lymphocytes may be of particular relevance for elucidating pathomechanisms of erysipelas polyarthritis.

Animals↗

[Erysipelas as a disease factor].

The infection with Erysipelas rhusiopathiae demonstrates that it is possible to characterize the significance of predisposing factors. The virulence of the agent is most important among the exogenous factors; it determines decisively the course of the disease: 1. paracute course as septicemia; 2. chronic course as polyarthritis; 3. subclinical course nearly without any symptoms. The immune status and the genotype of the host are predominant out of endogenous factors. The importance of immunity is known since a long time. A series of field observations supported the potential genetical influence in the pig. Within the hereditability an association to the MHC (in special genetic lines of rats to the RT 1 system of the MHC) was most recently determined in inbred laboratory animals. Additionally several environmental conditions, which can be summarized as stress, and as endogenous factor the age of the animals are relevant for the pathogenesis of the erysipelas infection. A non variable but most important disposition for special tissues are the so-called "borderline tissues", where accumulation, sedimentation and persistence of bacterial antigens are wellknown as described earlier. This phenomenon is determined by hemodynamic manifestation and quantifiably regulated by cytokines especially interleukin (IL 1) as well as by the tumor necrosis factor (TNF alpha) and prostaglandin PgE2. Additionally the cross reactivity of antibodies of Erysipelas rhusiopathiae against most specific collagen of type II, IX and XI in the pig and in laboratory animals was elaborated. This autoimmune phenomenon called "immunologic mimicry" supports besides the special physiologic conditions as niche of defense a very successful evolutionary adaptation of the agent.

Age Factors↗

Use of a live oral vaccine to immunize turkeys against erysipelas.

Turkeys were vaccinated via the drinking water with a commercial live erysipelas vaccine licensed for use in swine. The vaccine provided partial protection against challenge with a virulent isolate of the same serotype. Efficacy was determined by comparing the mortality rates of vaccinates with nonvaccinates. Two vaccine treatments (2 weeks apart) with the live vaccine, each treatment consisting of two doses (4 x 10(9) organisms/dose), were effective in inducing protection. Turkeys vaccinated similarly with live vaccine doses containing 10(5) or 10(7) organisms/dose were not protected against challenge. A bacterin-production strain of Erysipelothrix rhusiopathiae (EW-2) was not effective as a live vaccine. Turkeys vaccinated subcutaneously with a commercial bacterin, the current immunoprophylactic agent for erysipelas control, were protected against challenge. These results indicate the potential usefulness of an orally administered live vaccine for erysipelas control in turkeys.

Administration, Oral↗

The course, costs and complications of oral versus intravenous penicillin therapy of erysipelas.

Oral versus intravenous antibiotic therapy of severe erysipelas was compared in a controlled trial of 60 patients. No clinical benefit of intravenous therapy was found, as evaluated by fever duration, hospital stay and sick leave. Untoward reactions were comparable between the groups. No difference in recurrence was found. The difference in administration time and drug cost was considerable. It is therefore suggested that erysipelas without complications should be treated orally.

Administration, Oral↗

Erysipelas and group G streptococci.

In a prospective study, 73 patients with erysipelas were studied bacteriologically, serologically and clinically. Pathogenic bacteria were isolated from 41% of the patients. Group G streptococci (GGS) were found as frequently as group A streptococci (GAS), in 12.5% and 15% of patients, respectively. Staphylococcus aureus was isolated in 10%, and streptococci groups B, C and D were isolated from one case each. Raised ASO titres were found among patients with GAS and GGS, while a rise in ADNase B titre was found only in patients with GAS. Patients with GGS tended to be older than other patients. Otherwise no clinical differences were noticed. The infection was located to the lower extremity in 68%. Predisposing factors were observed in 44% of the patients, predominantly local circulatory insufficiency and malignancies. In 55% a possible portal of entry was present. GGS seems to be a common cause of erysipelas, especially among patients older than 50 years.

Adult↗

Recurrent erysipelas: predisposing factors and costs of prophylaxis.

After an average follow-up time of three years, recurrent erysipelas was observed in 29% of 143 patients admitted primarily with erysipelas. Nineteen patients (13%) had two or more recurrences during this period. The predisposing factor with the highest recurrence rate was venous insufficiency. Regular prophylaxis with phenoxymethylpenicillin (or erythromycin in penicillin allergics) after the second recurrence may be cost-effective. This antibiotic prophylaxis is only recommended in patients with predisposing factors who have suffered severe attacks.

Adult↗

Incidence of erysipelas following venectomy for coronary artery bypass surgery.

The incidence of erysipelas in extremities used for saphenous vein donation was evaluated by interviewing 302 patients who had undergone coronary artery bypass surgery. Erysipelas occurred in 6.2% of patients, and was twice as common as in patients with a history of varicose vein stripping. The difference, however, was not statistically significant.

Adult↗

Skin concentrations of phenoxymethylpenicillin in patients with erysipelas.

In 45 patients hospitalized with febrile erysipelas that had been treated with oral penicillin, punch biopsies of infected skin were performed and analysed for phenoxymethylpenicillin (pcV) concentrations. The curves for the concurrent serum and tissue levels followed the same course, indicating a rapid diffusion of pcV from serum into tissue. Penicillin concentrations in infected skin exceeded the minimal inhibitory concentrations (MIC) of the streptococci isolated for the first 4 h after tablet ingestion. Venous insufficiency was highly prevalent and pcV concentrations in affected patients were slightly but not significantly higher. A theoretical basis for the successful treatment of erysipelas with oral penicillin is therefore at hand.

Adult↗

Upper airway obstruction due to erysipelas.

Erysipelas is a rare cause of airway compromise. A case of a 57-year-old female is described who developed upper airway obstruction secondary to erysipelas of the neck. Emergency treatment by awake fiberoptic bronchoscopy with intubation over the bronchoscope followed by intravenous antibiotics produced rapid clinical improvement. Lymphatic obstruction of the laryngeal structures is the most likely physiologic mechanism.

Airway Obstruction↗

Virulence properties of erysipelas-associated group A streptococci.

Group A streptococcal isolates (n = 53) recovered from 38 erysipelas patients in 1988 and 1990 in Sweden were analysed with respect to serotype, erythrogenic toxin production and polymorphism in the emm gene region. Serotype determination showed a dominance of type T1M1 (28.6% of the strains), but T type 8 was also prevalent (14.3%). In the majority of the strains only a low production of erythrogenic toxin A was demonstrated, while both toxin B and C production were high. Polymorphism was detected in the emm gene region of T1M1 strains at a frequency of 64%. These erysipelas associated group A streptococci were more heterogenic with respect to serotype distribution and polymorphism in the emm gene region compared to previously studied group A streptococci isolated during an outbreak of serious streptococcal infections in Sweden in 1988/1989. The material included isolates from two cases of recurrence, and typing of the isolates indicated that the patients had been infected by the same serotype as in the primary infection.

Adult↗

[Relapsing facial erysipelas caused by nickel allergy. Significance of allergy diagnostics in ENT practice].

This case report shows a typical complication of allergic contact dermatitis as it is often seen in hand and foot eczema: relapsing erysipelas. To our knowledge the occurrence of such a complication in the face has never been reported. In the case presented, relapsing facial erysipelas were treated four times in a period of 2 years symptomatically without having identified or eliminated the causing allergen. This clearly indicates how important it is to have a sound knowledge of allergology and its diagnostic procedures, especially in ENT-practice.

Adult↗

Uncommon manifestations of erysipelas.

Erysipelas is a common infection of soft tissues by streptococci or Staphylococcus aureus. Uncommon manifestations of erysipelas include atypical localizations, unusual spreading of lesions, and atypical clinical morphology or course of the disease including the absence of general signs.

Diagnosis, Differential↗

[Relapsing polychondritis as a rare different diagnosis of erysipelas].

A 76-year old patient with painful erythematous swelling of the right ear was initially treated with antibiotics under the suspected diagnosis of erysipelas. Her failure to respond and a history of previous laryngeal and nasal swelling suggested the possibility of relapsing polychondritis. High dose prednisolone therapy produced marked improvement. Relapsing polychondritis should be considered as a rare, but important differential diagnostic consideration for erysipelas.

Aged↗

Influence of antibiotics used as feed additives on the immune effect of erysipelas live vaccine in swine.

To investigate the influence of antibiotics used as feed additives on the immune response to erysipelas live vaccine, the pig inoculation test was applied. Avilamycin, oxytetracycline quaternary salt, enramycin, virginiamycin and tylosin phosphate were selected as test antibiotics. Five experimental feeds containing each antibiotic at the highest concentration permitted for feed additives in Japan, and the basal diet lacking antibiotics were examined. Twenty-nine pigs were divided into six groups. At first all the groups were fed with the antibiotic-free basal diet for 7 days, and then each group received the experimental feeds. On the 14th day after feeding with test feeds all the pigs, except for one control pig in each group, were immunized with the vaccine and all the pigs were then challenge-exposed to a virulent strain of Erysipelothrix rhusiopathiae 14 days after vaccination. The clinical response was observed every day for 14 days. In all the groups, most of the vaccinated pigs did not develop any clinical signs of acute erysipelas after the challenge exposure, whereas non-vaccinated control pigs died or showed severe generalized erythema with profound depression and anorexia. No differences in the protection against the challenge exposure were observed among the groups. Therefore, the present results suggest that these selected antibiotics would not interfere with the immune effect of the vaccine if given at the usual concentrations used for feed additives.

Animal Feed↗

[Toxic-shock-like-syndrome caused by beta-hemolysing group G streptococci in a multimorbid patient with erysipelas].

HISTORY AND FINDINGS: A 41-year-old, obese man with a history of incomplete paraplegia of both legs and chronic venous insufficiency with stasis dermatitis presented with acute respiratory and hyperdynamic hemodynamic failure. He was transferred from another hospital to the department of intensive care medicine for further diagnosis and treatment. A livid coloured, necrotizing-hemorrhagic swelling of the right lower leg was noted. INVESTIGATIONS: Laboratory tests revealed an inflammation probably due to bacterial infection, anemia, acute renal failure, acute hepatic dysfunction, coagulopathy and lactic acidosis, indicating multi-organ failure and septic shock. No focus of sepsis was found at abdominal sonography and exploratory laparotomy. Chest X-Ray and computed tomography revealed bilateral pneumonia. Doppler ultrasonography of both legs showed acute isolated thrombosis of the right posterior tibial vein. TREATMENT AND COURSE: In addition to a chronic venous ulcer-necrotizing hemorrhagic erysipelas had developed in the right lower leg. A swab taken at surgery and blood cultures grew Streptococcus dysgalactiae ssp. equisimilis (group G streptococci, GGS). Despite intensive care treatment and high dosage penicillin G therapy the patient died two days after admission from septic shock and multi-organ failure. CONCLUSIONS: Group G streptococci cause a variety of common and severe infections. Erysipelas is infrequently associated with GGS but, much more often, with group A streptococci (GAS). This unusual and fulminant case emphasizes the importance of considering Streptococcus dysgalactiae as a causative agent in septicemia with multiple predisposing factors and soft-tissue infections.

Adult↗

Relapse of erysipelas following treatment with prednisolone or placebo in addition to antibiotics: a 1-year follow-up.

Of 112 patients with erysipelas, who were randomized to treatment with 8 d of either prednisolone or placebo in addition to antibiotics, 103 were followed-up for 12 months after they had been cured. The results of the period from 3 weeks up to 1 y after the day of cure are presented. 52 patients came from the prednisolone group and 6 of them had further episodes of erysipelas, whereas 13/51 patients from the placebo group relapsed. The difference is not statistically significant.

Anti-Bacterial Agents↗

Erysipelas in the critically endangered kakapo (Strigops habroptilus).

This paper describes the effect of a disease outbreak on the success of a translocation for conservation management in a critically endangered species. Three juvenile kakapo from a group of 19 translocated birds died within 72 h of transport between New Zealand offshore islands. Clinical findings, gross necropsy changes, cytology, histopathology and bacterial culture confirmed systemic disease caused by Erysipelothrix rhusiopathiae. On the island from which the kakapo were sourced, positive cultures of E. rhusiopathiae were obtained from the medulla of the ulna from 10 out of 15 seabird carcasses examined, suggesting that this could be the source of infection for the kakapo. Immediately after the diagnosis, all of the translocated birds were re-captured and treated with antibiotics. A vaccination programme has commenced using a commercial killed bacterin developed for turkeys. The disease outbreak has had costly implications for the population and conservation management of the species. This is the first report of erysipelas in wild parrots, and the first report of the management of erysipelas in a critically endangered wild population of birds.

Animals↗

Roxithromycin versus penicillin in the treatment of erysipelas in adults: a comparative study.

A prospective, randomized, multicentre trial was conducted to evaluate the efficacy and safety of roxithromycin (150 mg b.i.d. orally) and penicillin (2.5 MU x 8 daily intravenously, then 6 MU daily orally) in the treatment of hospitalized adult patients with erysipelas. Seventy-two patients entered the study. Thirty-one patients in the roxithromycin group and 38 patients in the penicillin group completed the trial. The overall efficacy rates (cure without additional antibiotics) were 84% (26/31) in the roxithromycin group and 76% (29/38) in the penicillin group (P = 0.43). No side-effects were observed in the roxithromycin-treated patients whereas rashes occurred in two cases in the penicillin group, leading to exclusion from the study. Oral roxithromycin can thus be considered an effective and well-tolerated treatment for erysipelas in adult hospitalized patients.

Acute Disease↗