Filariasis and erisipela in Santo Domingo

This study examined acute-convalescent changes in diagnostic anti-streptococcal antibodies by the anti-streptolysin O (ASO) and anti-DNAase B (ADAB) tests among patients (n 28) with lymphedema and recurrent erisipela of the lower limb, comparing them with endemic normal control residents (n=25). The study was based in Villa Francisca, an urban focus of Bancroftian filariasis in eastern Santo Domingo, capital of the Dominican Republic. The acute signs and symptoms of erisipela were consistent with a diagnosis of bacterial cellulitis. The ASO test was especially successful at demonstrating a rise in mean titer during convalescence, whereas the ADAB produced about the same frequency of significant increases (0.2 log titer) as did the ASO. When subjects were scored as responders if mounting a minimal titer increase by either test, patients were found more frequently positive than were controls (chi2=5.3, P=0.02). About half (54%) of all patients mounted at least a minimal antibody increase. Filaria-specific IgG4 antibodies were absent from all sera of 20 residents of a nonendemic Dominican mountain town but appeared in about two-thirds of the sampled residents of the endemic barrio. Notably however, levels did not change between the acute phase and convalescence. These findings are consistent with the hypothesis that recurrent streptococcal invasion of the lymphatics may be a significant factor triggering or amplifying lymphedema and elephantiasis in patients with chronic filariasis.

[Efficacy of pefloxacin in the treatment of complicated relapsing erysipelas]

The effect of antimicrobial agents on the clinical and immunological indices was comparatively studied in 30 patients with relapsing erysipelas complicated by pyoderma. The patients were treated with pefloxacin in a daily dose of 800 mg for 7-10 days (15 patients) and with the routine antibiotics such as benzylpenicillin, ampicillin and erythromycin (15 patients). The efficacy of the treatment was defined by disappearance of the clinical signs and normalization of the functional immunity status. The pefloxacin effect was evident at early stages of the treatment and observed at least for 3 months after the patient discharge from the hospital. Gradual elimination of the secondary immune deficiency in the convalescents due to sanitation of the infection chronic foci was recorded.

[Metabolic disorders in erysipelas patients with concomitant diabetes mellitus]

106 patients with erysipelas against the background of manifest diabetes mellitus without pus-inflammatory complications, 102 patients with erysipelas concurrent with diabetes mellitus having pus-necrotic processes and 123 patients with erysipelas without diabetes mellitus (control group) were studied. It has been proved that kallekriin-kinin and sympatho-adrenaline system indices and prostaglandine level are changing depending on the pathological process degree. The most expressed metabolic disorders were found in case of erysipelas pus-necrotic complications against the background of decompensated diabetes mellitus.

Erysipelas and elephantiasis of the scrotum--surgery and drug therapy

Elephantiasis of the scrotum is the terminal stage of persistent refractory lymphedema. Its debilitating functional and cosmetic effects have significant psychological, emotional and social consequences for the affected patient. The causal relationship between etiology and recurrent disease is illustrated here by 2 cases. Therapy options are also discussed. Primary therapeutic success is determined by radical surgery, since chronic inflammation and chronic oedema mutually foster one another. Metabolic stability, sanitization of infected cutaneous areas and the prophylactic administration of antibiotics are essential to ensure that the treatment of recurrent erysipelas is successful in the long term.

Erysipelas: clinical and bacteriologic spectrum and serological aspects

The bacteriologic, serological, and clinical characteristics of 229 patients with erysipelas diagnosed during a 2-year period at a university hospital for infectious diseases in Sweden are presented. Beta-Hemolytic streptococci were detected in 34% of these patients. Group A was the dominant serogroup, but group G streptococci were found in about half as many cases. Bacteremia was present in 5%. A serological response with antistreptolysin O (ASO) and antideoxyribonuclease B (ADNase B) was seen primarily in patients harboring group A streptococci but also in those from whom no pathogen was isolated. ASO was also found in high titers in some patients with Group G streptococcal infection. The clinical course was usually benign, with few complications, but recurrences were common (occurring in 21% of the patients). No cases of streptococcal toxic shock were seen. Culture of skin biopsy specimens had low sensitivity; Beta-hemolytic were isolated from only two of 15 patients.

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.

Secondary milia following bullous erysipelas

Secondary milia associated with bullous erysipelas developed in the right leg of a 64-year-old woman. The milia, measuring up to 6 mm, appeared one month after healing of the erysipelas. Findings of histopathologic and immunohistochemical studies showed that the milia were related to dilated eccrine ducts and not to the hair follicle. Topical treatment with 0.05 percent tretinoin cream resulted in almost full resolution of the lesions.

Serum complement levels before and after the onset of acute post-streptococcal glomerulonephritis. A case report

Low serum C3, properdin, and C5 levels found in the acute stage of acute post-streptococcal glomerulonephritis (APSGN) indicate the presence of aggressive complement activation. We followed serum complement component levels in a child hospitalized with erysipelas who developed APSGN on the 2nd hospital day. Her initial serum sample, obtained prior to the clinical onset of nephritis, had a low properdin level and normal C3 and C5 levels despite the presence of C3 splitting activity. Two days later she developed gross hematuria and subsequent sera contained low C3, properdin, and C5 levels, as is usual in APSGN. These observations suggest that complement activation, predominantly through the alternative pathway, precedes the clinical onset of APSGN.

Coley's toxins, tumor necrosis factor and cancer research: a historical perspective

As far back as the 1700s, it was recorded that certain infectious disease processes could exert a beneficial therapeutic effect upon malignancy. Most prominent among the numerous deliberate efforts made to take advantage of these observations was that of a pioneering New York surgeon, William B. Coley, active career 1891-1936. Using a bacterial vaccine to treat primarily inoperable sarcoma. Coley accomplished a cure rate of better than 10%. This review examines the history of these efforts and presents a discussion of their corresponding relevance to present day immunotherapy.

Erysipelas: not always innocent

The case histories of two patients with the "toxic-strep" syndrome are presented. This syndrome consists of a Streptococcus pyogenes group A infection, complicated by multi-organ failure. In our patients renal failure necessitating haemodialysis was present. General characteristics of the syndrome and long-term follow-up are presented.

[Use of chemiluminescence in predicting suppurative-inflammatory complications in erysipelas and tonsillitis]

The levels of spontaneous and induced chemiluminescence of whole blood were assessed in 165 patients with erysipelas in the acute period of the infection and in 129 patients followed up for 1 to 6 months after it, as well as in 216 patients with tonsillitis in the acute period of the infection and in 182 ones after it. Induced chemiluminescence was 4-5 times more intensive than spontaneous one in the acute period of streptococcal infections (erysipelas, tonsillitis) during the development of pyo-inflammatory complications; when the disease course was uncomplicated, this difference made up 2.6-3.2 times. During remission of streptococcal infections (in case of recurrences or exacerbations) the initial level of spontaneous chemiluminescence was significantly lowered as against the norm, and the intensity of induced chemiluminescence was 2.35 +/- 0.12 times higher, the normal value being 2.83 +/- 0.15.

[Spontaneous splenic rupture associated with facial erysipelas]

Spontaneous rupture of the spleen is rare Although over 100 cases have been reported, only a few were of true spontaneous rupture. Most cases were associated with diseases which directly involved the spleen. We report a 53-year-old woman with facial erysipelas and true spontaneous rupture of the spleen.