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Waterton KA, Lipner SR. Gram-Negative Toe Web Infections. Dermatol Pract Concept 2024; 14:dpc.1401a59. [PMID: 38364399 PMCID: PMC10868792 DOI: 10.5826/dpc.1401a59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 02/18/2024] Open
Abstract
Gram-negative bacterial toe web infection (GNTWI) is a common dermatologic condition affecting the interdigital spaces. The clinical presentation ranges from mild erythema to exudative maceration of the web spaces that may extend to in other areas of the foot and lead to cellulitis in severe cases. Pseudomonas aeruginosa is the most commonly identified etiologic agent. Occlusive and humid environments, pre-existing dermatologic conditions, and fungal infections increase the risk of developing GNTWI. GNTWI has a broad differential diagnosis including erythrasma, tinea pedis, pitted keratolysis, eczematous dermatitis, and malignancies. Diagnosis is performed using bacterial and fungal cultures. There is a lack of a standardized treatment regimen for GNTWI. While GNTWI is fairly common, it may still be under-recognized by dermatologists due to the limited medical literature. This article presents a review of GNTWI, its clinical features, epidemiologic factors, etiologic agents, predisposing factors, diagnostic methods, and therapeutic options.
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Affiliation(s)
- Kelita A. Waterton
- SUNY Downstate Health Sciences University College of Medicine, Brooklyn, NY, USA
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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Erysipelas of the leg: A cross-sectional study of risk factors for recurrence. Ann Dermatol Venereol 2021; 149:119-122. [PMID: 34742579 DOI: 10.1016/j.annder.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/28/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Erysipelas is a common infection of the superficial layer of skin. The main causative agent is group A β-hemolytic streptococci. One of the most challenging aspects of this disease is its high rate of recurrence. OBJECTIVES To identify risk factors for recurrence of erysipelas of the leg. PATIENTS AND METHODS We included in a cross-sectional study all patients hospitalized for erysipelas of the leg seen at the dermatology department of the Ibn Rochd University Hospital in Casablanca, Morocco, from January 2015 to April 2020. Patients were divided into two groups: those with a single episode (SE) and those with recurrent erysipelas (RE). These two groups were compared for clinical and laboratory characteristics, with particular focus on systemic and local risk factors. RESULTS The study included 270 patients, of whom 132 had SE and 138 had RE. Age, gender, hospital stay as well as laboratory findings did not differ significantly between the two groups. In multivariable analysis, cutaneous disruption [adjusted odds ratio (aOR)=1.9; 95% confidence interval (95% CI): 1.0-3.71], lymphedema [aOR=19.6; 95% CI: 8.0-57.2], and obesity [aOR=2.3; 95% CI: 1.1-5.2] were significantly associated with RE. Venous insufficiency and diabetes were not found to be associated with risk of recurrence. CONCLUSION Our results suggest that erysipelas is a potentially chronic disease and patients with identified local risk factors or obesity should be considered as exposed to recurrence and considered as targets for antibiotic prophylaxis and other preventive methods.
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Chamli A, Jaber K, Ben Lagha I, Malek BS, Rabhi F, Doss N, Dhaoui MR. Factors associated with acute and recurrent erysipelas in a young population: a retrospective of 147 cases. LA TUNISIE MEDICALE 2021; 99:886-889. [PMID: 35261016 PMCID: PMC9003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND erysipelas is a common infection of the superficial layer of the skin, predominantly caused by groups A β-hemolytic streptococci. It is an acute infection of the skin and frequently affects the legs. It is common in the elderly and favoured by the associated comorbidities. Its occurrence in young healthy people is rare. AIM The present study aimed to elucidate factors associated with acute and recurrent erysipelas in a young population. METHODS We retrospectively analyzed 147 cases of erysipelas admitted to the dermatology department of the Military Hospital of Tunis, Tunisia, over 18 years, identifying factors associated with recurrence. All patients were aged less than 35 years. RESULTS During the study period, 147 patients were registered with the diagnosis of erysipelas. There were 125 military soldiers and 22 non-military patients. The prevalence of erysipelas was 2.23%. The median age was 25 years. Almost 86.2% of patients were male. The main favorable factors were: obesity (9%), alcoholism (8%), chronic venous insufficiency (6.5%), chronic lymphedema (3%), leg fracture (2%), and diabetes mellitus (1%). The lesions were mostly located in the lower limbs in 94.9%. According to our multivariate analysis, there was an association between recurrence and diabetes mellitus (p=0.02), female sex (p=0.004), onychomycosis (p=0.004), and plantar dyshidrotic eczema (p<0.005). CONCLUSION Identifying factors associated with recurrent erysipelas in a young population remains essential for proposing primary and secondary prevention measures.
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Affiliation(s)
- Amal Chamli
- 1- Hôpital Militaire de Tunis, Université de Tunis El Manar/ Faculté de médecine de Tunis
| | - Kahena Jaber
- 1- Hôpital Militaire de Tunis, Université de Tunis El Manar/ Faculté de médecine de Tunis
| | - Imen Ben Lagha
- 1- Hôpital Militaire de Tunis, Université de Tunis El Manar/ Faculté de médecine de Tunis
| | - Ben Slimane Malek
- 1- Hôpital Militaire de Tunis, Université de Tunis El Manar/ Faculté de médecine de Tunis
| | - Faten Rabhi
- 1- Hôpital Militaire de Tunis, Université de Tunis El Manar/ Faculté de médecine de Tunis
| | - Nejib Doss
- 1- Hôpital Militaire de Tunis, Université de Tunis El Manar/ Faculté de médecine de Tunis
| | - Mohamed Raouf Dhaoui
- 1- Hôpital Militaire de Tunis, Université de Tunis El Manar/ Faculté de médecine de Tunis
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Li A, Wang N, Ge L, Xin H, Li W. Risk factors of recurrent erysipelas in adult Chinese patients: a prospective cohort study. BMC Infect Dis 2021; 21:26. [PMID: 33413190 PMCID: PMC7792156 DOI: 10.1186/s12879-020-05710-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Erysipelas is a common skin infection that is prone to recur. Recurrent erysipelas has a severe effect on the quality of life of patients. The present study aimed to investigate the risk factors of recurrent erysipelas in adult Chinese patients. METHODS A total of 428 Chinese patients with erysipelas who met the inclusion criteria were studied. The patients were divided into the nonrecurrent erysipelas group and the recurrent erysipelas group. Clinical data were collected on the first episode and relapse of erysipelas. The patients were followed up every 3 months. Statistical analysis was performed to analyze and determine the risk factors of erysipelas relapse. RESULTS Univariate analysis was performed to analyze the data, including surgery, types of antibiotics administered in the first episode, obesity, diabetes mellitus, venous insufficiency, lymphedema, and malignancy. The differences between the groups were statistically significant (p < 0.05). The Cox proportional hazards regression model analysis showed that the final risk factors included surgery, obesity, diabetes mellitus, venous insufficiency, and lymphedema. CONCLUSIONS Surgery, obesity, diabetes mellitus, venous insufficiency, and lymphedema are considered as risk factors for recurrent erysipelas.
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Affiliation(s)
- Ang Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Ni Wang
- Department of Dermatology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, China
| | - Lingzhi Ge
- Department of Dermatology, The Second Affiliated Hospital of Shandong First Medical University, 706 Taishan Street, Tai'an, 271000, China
| | - Hongyan Xin
- Department of Surgery, Shandong Chest Hospital, 46 Lishan Road, Jinan, 250013, China
| | - Wenfei Li
- Department of Dermatology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, China
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Abstract
Dermatology in French-speaking African countries is facing many challenges. Dermatology societies, if they exist, are relatively young and have limited financial resources to provide regular training opportunities for their members and those in training. In several sub-Saharan nations, the small number of dermatologists is truly alarming with the prevalence of such major skin diseases as cutaneous leishmaniasis, AIDS, mycetoma, leprosy, and the consequences of skin bleaching procedures, reaching catastrophic figures.
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Norazirah MN, Khor IS, Adawiyah J, Tamil AM, Azmawati MN. The risk factors of lower limb cellulitis: A case-control study in a tertiary centre. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:23-29. [PMID: 32284801 PMCID: PMC7136668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Lower limb cellulitis is a common superficial skin infection that leads to morbidity and mortality. Cellulitis risk factors have been well studied in many countries, but to date, not in Malaysia. Geographical and climate variables may affect risk factors. Early identification of the preventable risk factors is vital to prevent cellulitis and improve holistic patient care. OBJECTIVE To determine the risk factors of lower limb cellulitis amongst hospitalized patients at a tertiary center. METHODS A prospective case-control study of hospitalized patients with a clinical diagnosis of lower limb cellulitis was conducted at UKM Medical Centre, January-August 2015. Each patient was compared to two age and gender-matched control patients. All patients were interviewed and examined for risk factors of cellulitis. RESULTS A total of 96 cellulitis patients and 192 controls participated in this study. The cellulitis patients included 61 males and 35 females with a mean age of 62.07±15.43 years. The majority of patients were experiencing their first episode of cellulitis. Multivariate analysis showed a previous history of cellulitis (OR 25.53; 95% CI 4.73-137.79), sole anomalies (OR 16.32; 95% CI 6.65-40.06), ulceration (OR 14.86; 95% CI 1.00-219.39), venous insufficiency (OR 10.46 95% CI 1.98-55.22), interdigital intertrigo (OR 8.86; 95% CI 3.33-23.56), eczema (OR 5.74; 95% CI 0.96.-34.21), and limb edema (OR 3.95; 95% CI 1.82-8.59) were the significant risk factors for lower limb cellulitis. CONCLUSION Previous cellulitis and factors causing skin barrier disruption such as sole anomalies, ulceration, venous insufficiency, eczema, intertrigo, and limb edema were the risk factors for lower limb cellulitis. Physician awareness, early detection, and treatment of these factors at the primary care level may prevent hospital admission and morbidity associated with cellulitis.
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Affiliation(s)
- M N Norazirah
- Department of Medicine, Faculty of Medicine Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - I S Khor
- Department of Medicine, Penang General Hospital, Malaysia
| | - J Adawiyah
- Department of Medicine, Faculty of Medicine Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - A M Tamil
- Department of Public Health, Faculty of Medicine Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - M N Azmawati
- Department of Public Health, Faculty of Medicine Universiti Kebangsaan Malaysia Medical Centre, Malaysia
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Raya-Cruz M, Payeras-Cifre A, Ventayol-Aguiló L, Díaz-Antolín P. Factors associated with readmission and mortality in adult patients with skin and soft tissue infections. Int J Dermatol 2019; 58:916-924. [PMID: 30770547 DOI: 10.1111/ijd.14390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) are a common cause of consultation, and complicated cases require hospitalization. We describe factors that are related to readmission and/or mortality of hospitalized patients diagnosed with SSTIs. METHODS Retrospective review of hospital-admitted patients with a diagnosis of cellulitis, abscess, hidradenitis, fasciitis, and Fournier's gangrene. Cases from January 2002 to October 2015 were extracted from the diagnostic codification database of the Archives and Clinical Documentation Department. FINDINGS We studied 1,482 episodes of hospitalized patients diagnosed with SSTIs. There were 187 (12.3%) readmissions, the most frequent diagnosis was cellulitis (72.7%), and the most commonly isolated microorganism was Staphylococcus aureus (25; 30.1%). Factors associated with readmissions were healthcare-related infections (P = 0.002), prior antibiotic therapy (P < 0.001), ischemic heart disease (P = 0.01), chronic liver disease (P = 0.001), and diabetes mellitus (DM) (P = 0.006). The number of patients who died as a result of an infection was 34 (2.2%) and, in these patients, the most common diagnosis was also cellulitis (79.4%), which in 52.9% (P = 0.001) was community acquired. DM (P = 0.01), heart failure (P = 0.001), and chronic liver disease (P = 0.003) were the most frequent comorbidities. This group presented more complications (P < 0.005) such as endocarditis (P < 0.005), amputation (P = 0.018), severe sepsis (P < 0.005), and septic shock (P < 0.001). CONCLUSIONS Readmitted patients had healthcare-related S. aureus infection, had received prior antibiotic therapy, and presented comorbid conditions such as ischemic heart disease, peripheral vascular disease, chronic liver disease, or DM. Comorbidities such as advanced age, DM, heart failure, and chronic liver disease were associated with complications and higher infection-related mortality.
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Affiliation(s)
- Manuel Raya-Cruz
- Internal Medicine and Infectious Diseases, Son Llàtzer Hospital, Balearic Islands, Spain
| | - Antonio Payeras-Cifre
- Head of Internal Medicine and Infectious Diseases, Son Llàtzer Hospital, Balearic Islands, Spain
| | - Lola Ventayol-Aguiló
- Internal Medicine and Infectious Diseases, Son Llàtzer Hospital, Balearic Islands, Spain
| | - Paz Díaz-Antolín
- Clinical Microbiology Department, Son Llàtzer Hospital, Balearic Islands, Spain
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Jendoubi F, Rohde M, Prinz JC. Intracellular Streptococcal Uptake and Persistence: A Potential Cause of Erysipelas Recurrence. Front Med (Lausanne) 2019; 6:6. [PMID: 30761303 PMCID: PMC6361840 DOI: 10.3389/fmed.2019.00006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/10/2019] [Indexed: 12/21/2022] Open
Abstract
Erysipelas is a severe streptococcal infection of the skin primarily spreading through the lymphatic vessels. Penicillin is the treatment of choice. The most common complication consists in relapses which occur in up to 40% or more of patients despite appropriate antibiotic treatment. They cause lymphatic damage resulting in irreversible lymphedema and ultimately elephantiasis nostras and lead to major health restrictions and high socio-medical costs. Prevention of relapses is an unmet need, because even long-term prophylactic penicillin application does eventually not reduce the risk of recurrence. In this article we assess risk factors and causes of erysipelas recurrence. A systematic literature search for clinical studies addressing potential causes and measures for prevention of erysipelas recurrence was combined with a review of experimental and clinical data assessing the ability and clinical relevance of streptococci for intracellular uptake and persistence. The literature review found that venous insufficiency, lymphedema, and intertrigo from fungal infections are considered to be major risk factors for recurrence of erysipelas but cannot adequately explain the high recurrence rate. As hitherto unrecognized likely cause of erysipelas relapses we identify the ability of streptococci for intracellular uptake into and persistence within epithelial and endothelial cells and macrophages. This creates intracellular streptococcal reservoirs out of reach of penicillins which do not reach sufficient bactericidal intracellular concentrations. Incomplete streptococcal elimination due to intracellular streptococcal persistence has been observed in various deep tissue infections and is considered as cause of relapsing streptococcal pharyngitis despite proper antibiotic treatment. It may also serves as endogenous infectious source of erysipelas relapses. We conclude that the current antibiotic treatment strategies and elimination of conventional risk factors employed in erysipelas management are insufficient to prevent erysipelas recurrence. The reactivation of streptococcal infection from intracellular reservoirs represents a plausible explanation for the frequent occurrence erysipelas relapses. Prevention of erysipelas relapses therefore demands for novel antibiotic strategies capable of eradicating intracellular streptococcal persistence.
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Affiliation(s)
- Fatma Jendoubi
- Department of Dermatology, University Clinics, Ludwig-Maximilian University of Munich, Munich, Germany.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Manfred Rohde
- Central Facility for Microscopy, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Jörg Christoph Prinz
- Department of Dermatology, University Clinics, Ludwig-Maximilian University of Munich, Munich, Germany
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Abou Dagher G, Hajjar K, Khoury C, El Hajj N, Kanso M, Makki M, Mailhac A, Bou Chebl R. Outcomes of patients with systolic heart failure presenting with sepsis to the emergency department of a tertiary hospital: a retrospective chart review study from Lebanon. BMJ Open 2018; 8:e022185. [PMID: 30068620 PMCID: PMC6074621 DOI: 10.1136/bmjopen-2018-022185] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Patients with congestive heart failure (CHF) may be at a higher risk of mortality from sepsis than patients without CHF due to insufficient cardiovascular reserves during systemic infections. The aim of this study is to compare sepsis-related mortality between CHF and no CHF in patients presenting to a tertiary medical centre. DESIGN A single-centre, retrospective, cohort study. SETTING Conducted in an academic emergency department (ED) between January 2010 and January 2015. Patients' charts were queried via the hospital's electronic system. Patients with a diagnosis of sepsis were included. Descriptive analysis was performed on the demographics, characteristics and outcomes of patients with sepsis of the study population. PARTICIPANTS A total of 174 patients, of which 87 (50%) were patients with CHF. PRIMARY AND SECONDARY OUTCOMES The primary outcome of the study was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) and hospital lengths of stay, and differences in interventions between the two groups. RESULTS Patients with CHF had a higher in-hospital mortality (57.5% vs 34.5%). Patients with sepsis and CHF had higher odds of death compared with the control population (OR 2.45; 95% CI 1.22 to 4.88). Secondary analyses showed that patients with CHF had lower instances of bacteraemia on presentation to the ED (31.8% vs 46.4%). They had less intravenous fluid requirements in first 24 hours (2.75±2.28 L vs 3.67±2.82 L, p =0.038), had a higher rate of intubation in the ED (24.2% vs 10.6%, p=0.025) and required more dobutamine in the first 24 hours (16.1% vs 1.1%, p<0.001). ED length of stay was found to be lower in patients with CHF (15.12±24.45 hours vs 18.17±26.13 hours, p=0.418) and they were more likely to be admitted to the ICU (59.8% vs 48.8%, p=0.149). CONCLUSION Patients with sepsis and CHF experienced an increased hospital mortality compared with patients without CHF.
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Affiliation(s)
- Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Karim Hajjar
- Department of Emergency Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Christopher Khoury
- Department of Emergency Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Nadine El Hajj
- Department of Emergency Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Mohammad Kanso
- Department of Emergency Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Maha Makki
- Department of Emergency Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Aurelie Mailhac
- Department of Emergency Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
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Abstract
OBJECTIVE To summarise available data on the risk factors, complications and the factors associated with complications of lower limb cellulitis in Africa. METHODS We did electronic searches on PubMed, EMBASE, Scopus and African Journals Online from 1 January 1986 to 30 October 2017, extracted and summarised data on the risk factors, complications and the factors associated with the complications of lower limb cellulitis from eligible literature. RESULTS A total of seven studies were retained for final review after the search and screening processes. Local risk factors of cellulitis reported were: disruption of the skin barrier, neglected wounds, toe-web intertrigo, leg ulcers, use of depigmentation drugs and leg oedema. Obesity was the only reported general risk factor of cellulitis. Five studies reported on the complications of cellulitis which included: abscess formation, necrotising fasciitis, bullae, haemorrhagic lesions, necrosis, phlebitis and amputations. Nicotine addiction, chronic use of non-steroidal anti-inflammatory drugs, delay in the initiation of antibiotic treatment and elevated erythrocyte sedimentation rate were risk factors of complications of lower limb cellulitis identified from three studies. CONCLUSION This review highlights the important role of local risk factors in the pathogenesis of lower limb cellulitis in Africa. The association between voluntary skin depigmentation and lower limb cellulitis should alert public health authorities and the general population to the health risks associated with this practice. The identification and improved management of the risk factors of lower limb cellulitis and its complications could go a long way in decreasing the morbidity and health costs incurred by lower limb cellulitis in Africa.
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Affiliation(s)
- Frank-Leonel Tianyi
- Department of General Medicine, Mayo Darley Sub-divisional Hospital, Banyo, Cameroon
| | | | - Celestin Danwang
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Valirie Ndip Agbor
- Department of General Medicine, Ibal Sub-divisional Hospital, Oku, Cameroon
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OKAMOTO O, SUZUKI R, KUSATSU M, MATSUDA K, SATO S, KAI Y, SHIOTA S, HASHIMOTO H. A Statistical Study about Clinical and Laboratory Trends in Cellulitis/Erysiperas. ACTA ACUST UNITED AC 2018. [DOI: 10.2336/nishinihonhifu.80.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Osamu OKAMOTO
- Division of Dermatology, Oita City Medical Association's Almeida Memorial Hospital
| | - Rui SUZUKI
- Division of Plastic Surgery, Oita City Medical Association's Almeida Memorial Hospital
| | - Manami KUSATSU
- Division of Plastic Surgery, Oita City Medical Association's Almeida Memorial Hospital
| | - Kaho MATSUDA
- Division of Plastic Surgery, National Hospital Organization Beppu Medical Center
| | | | - Yoshitaka KAI
- Division of Dermatology, National Hospital Organization Beppu Medical Center
| | - Seiji SHIOTA
- Division of General Medicine, Oita City Medical Association's Almeida Memorial Hospital
| | - Hiroyuki HASHIMOTO
- Division of Plastic Surgery, Oita City Medical Association's Almeida Memorial Hospital
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Sondermann W, Leister L, Rompoti N, Dissemond J, Klode J, Körber A. [Insufficient tetanus vaccination protection in psoriasis and systemic immunosuppression : Results of a retrospective investigation of 101 patients]. Hautarzt 2018; 69:922-927. [PMID: 29845363 DOI: 10.1007/s00105-018-4200-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND With a prevalence of approximately 3 % worldwide, psoriasis is one of the most frequent chronic inflammatory skin diseases. Patients with moderate to severe psoriasis are treated guideline-conform with immunomodulatory or immunosuppressive agents. According to current guidelines physicians should be vigilant about the vaccination status of immunosuppressed patients. OBJECTIVE The aim of the study was to serologically objectify the tetanus vaccination status in systemically treated patients with moderate to severe psoriasis in Germany. MATERIAL AND METHODS Within the context of this retrospective study the concentration of immunoglobulin G antibodies against Clostridium tetani was determined in 101 patients with systemic immunosuppression suffering from psoriasis. RESULTS In a total of 27.7% (n = 28; 11 male, 17 female) of the patients, insufficient immunoglobulin G antibody concentrations were detected, corresponding to a higher risk of an infection with C. tetani. Group subanalyses indicated an insufficient tetanus protection especially in patients ≥65 years old (50%). CONCLUSION The tetanus immune status of psoriasis patients was shown to be comparable with the general population. The results of our investigation underline that people suffering from psoriasis have to be tested for tetanus protection and if necessary, vaccinations have to be renewed.
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Affiliation(s)
- W Sondermann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - L Leister
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - N Rompoti
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - J Klode
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - A Körber
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Sočan K, Sočan M. Trends in the epidemiology of erysipelas in Slovenia. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2017.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cannon J, Dyer J, Carapetis J, Manning L. Epidemiology and risk factors for recurrent severe lower limb cellulitis: a longitudinal cohort study. Clin Microbiol Infect 2018; 24:1084-1088. [PMID: 29427799 DOI: 10.1016/j.cmi.2018.01.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/24/2018] [Accepted: 01/28/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the epidemiology and risk factors for recurrence of severe lower leg cellulitis (LLC). METHODS A longitudinal cohort study using state-wide data of adults presenting with recurrent LLC following a primary episode occurring between January 2002 and December 2013. The incidence of recurrent LLC was estimated using the cumulative incidence function, accounting for mortality. Independent risk factors for recurrence were identified using Fine-Gray sub-distribution and Cox proportional hazards models. RESULTS Of 36 276 patients presenting with their first episode of LLC, 4598 had at least one recurrence during the follow-up period. The cumulative incidence of first, second, and third recurrences at 12 months since previous infection was 6.3% (95% CI 6.0-6.5), 17.2% (95% CI 16.1-18.4), and 29.4% (95% CI 26.8-31.9), respectively, and at 5 years was 13.9% (95% CI 13.5-14.3), 35.9% (95% CI 34.2-37.5), and 52.9% (95% CI 49.5-56.2), respectively. The length of hospitalization increased from 3 days for the primary episode to 4 and 5 days for first and all subsequent recurrences, respectively. Independent risk factors for recurrent LLC included age, ethnicity (Indigenous Australian), local factors relating to lower leg pathology, conditions that commonly result in peripheral oedema, and systemic conditions that may be associated with increased leg size. CONCLUSIONS LLC recurrences are frequent, and each episode increases the likelihood of subsequent recurrence and length of hospitalization. These data provide context and scope to develop workable and effective strategies to prevent secondary episodes for all cases of primary LLC.
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Affiliation(s)
- J Cannon
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - J Dyer
- Infectious Diseases Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - J Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - L Manning
- Infectious Diseases Department, Fiona Stanley Hospital, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Research Institute, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
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Sočan K, Sočan M. Trends in the epidemiology of erysipelas in Slovenia. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Quirke M, Ayoub F, McCabe A, Boland F, Smith B, O'Sullivan R, Wakai A. Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis. Br J Dermatol 2017; 177:382-394. [DOI: 10.1111/bjd.15186] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 01/03/2023]
Affiliation(s)
- M. Quirke
- Emergency Care Research Unit (ECRU); Division of Population Health Sciences (PHS); Royal College of Surgeons in Ireland (RCSI); 123 St Stephens Green Dublin 2 Ireland
| | - F. Ayoub
- Department of Surgery; Beaumont Hospital; Dublin Ireland
| | - A. McCabe
- Emergency Care Research Unit (ECRU); Division of Population Health Sciences (PHS); Royal College of Surgeons in Ireland (RCSI); 123 St Stephens Green Dublin 2 Ireland
| | - F. Boland
- Division of Population Health Sciences (PHS); Royal College of Surgeons in Ireland (RCSI); Dublin Ireland
| | - B. Smith
- RCSI Library; Beaumont Hospital; Dublin Ireland
| | - R. O'Sullivan
- Paediatric Emergency Care Research Unit (PERU); National Children's Research Centre; Dublin Ireland
- School of Medicine; University College Cork; Cork Ireland
| | - A. Wakai
- Emergency Care Research Unit (ECRU); Division of Population Health Sciences (PHS); Royal College of Surgeons in Ireland (RCSI); 123 St Stephens Green Dublin 2 Ireland
- Department of Emergency Medicine; Beaumont Hospital; Dublin Ireland
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Dalal A, Eskin‐Schwartz M, Mimouni D, Ray S, Days W, Hodak E, Leibovici L, Paul M. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev 2017; 6:CD009758. [PMID: 28631307 PMCID: PMC6481501 DOI: 10.1002/14651858.cd009758.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Erysipelas and cellulitis (hereafter referred to as 'cellulitis') are common bacterial skin infections usually affecting the lower extremities. Despite their burden of morbidity, the evidence for different prevention strategies is unclear. OBJECTIVES To assess the beneficial and adverse effects of antibiotic prophylaxis or other prophylactic interventions for the prevention of recurrent episodes of cellulitis in adults aged over 16. SEARCH METHODS We searched the following databases up to June 2016: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS. We also searched five trials registry databases, and checked reference lists of included studies and reviews for further references to relevant randomised controlled trials (RCTs). We searched two sets of dermatology conference proceedings, and BIOSIS Previews. SELECTION CRITERIA Randomised controlled trials evaluating any therapy for the prevention of recurrent cellulitis. DATA COLLECTION AND ANALYSIS Two authors independently carried out study selection, data extraction, assessment of risks of bias, and analyses. Our primary prespecified outcome was recurrence of cellulitis when on treatment and after treatment. Our secondary outcomes included incidence rate, time to next episode, hospitalisation, quality of life, development of resistance to antibiotics, adverse reactions and mortality. MAIN RESULTS We included six trials, with a total of 573 evaluable participants, who were aged on average between 50 and 70. There were few previous episodes of cellulitis in those recruited to the trials, ranging between one and four episodes per study.Five of the six included trials assessed prevention with antibiotics in participants with cellulitis of the legs, and one assessed selenium in participants with cellulitis of the arms. Among the studies assessing antibiotics, one study evaluated oral erythromycin (n = 32) and four studies assessed penicillin (n = 481). Treatment duration varied from six to 18 months, and two studies continued to follow up participants after discontinuation of prophylaxis, with a follow-up period of up to one and a half to two years. Four studies were single-centre, and two were multicentre; they were conducted in five countries: the UK, Sweden, Tunisia, Israel, and Austria.Based on five trials, antibiotic prophylaxis (at the end of the treatment phase ('on prophylaxis')) decreased the risk of cellulitis recurrence by 69%, compared to no treatment or placebo (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.13 to 0.72; n = 513; P = 0.007), number needed to treat for an additional beneficial outcome (NNTB) six, (95% CI 5 to 15), and we rated the certainty of evidence for this outcome as moderate.Under prophylactic treatment and compared to no treatment or placebo, antibiotic prophylaxis reduced the incidence rate of cellulitis by 56% (RR 0.44, 95% CI 0.22 to 0.89; four studies; n = 473; P value = 0.02; moderate-certainty evidence) and significantly decreased the rate until the next episode of cellulitis (hazard ratio (HR) 0.51, 95% CI 0.34 to 0.78; three studies; n = 437; P = 0.002; moderate-certainty evidence).The protective effects of antibiotic did not last after prophylaxis had been stopped ('post-prophylaxis') for risk of cellulitis recurrence (RR 0.88, 95% CI 0.59 to 1.31; two studies; n = 287; P = 0.52), incidence rate of cellulitis (RR 0.94, 95% CI 0.65 to 1.36; two studies; n = 287; P = 0.74), and rate until next episode of cellulitis (HR 0.78, 95% CI 0.39 to 1.56; two studies; n = 287). Evidence was of low certainty.Effects are relevant mainly for people after at least two episodes of leg cellulitis occurring within a period up to three years.We found no significant differences in adverse effects or hospitalisation between antibiotic and no treatment or placebo; for adverse effects: RR 0.87, 95% CI 0.58 to 1.30; four studies; n = 469; P = 0.48; for hospitalisation: RR 0.77, 95% CI 0.37 to 1.57; three studies; n = 429; P = 0.47, with certainty of evidence rated low for these outcomes. The existing data did not allow us to fully explore its impact on length of hospital stay.The common adverse reactions were gastrointestinal symptoms, mainly nausea and diarrhoea; rash (severe cutaneous adverse reactions were not reported); and thrush. Three studies reported adverse effects that led to discontinuation of the assigned therapy. In one study (erythromycin), three participants reported abdominal pain and nausea, so their treatment was changed to penicillin. In another study, two participants treated with penicillin withdrew from treatment due to diarrhoea or nausea. In one study, around 10% of participants stopped treatment due to pain at the injection site (the active treatment group was given intramuscular injections of benzathine penicillin).None of the included studies assessed the development of antimicrobial resistance or quality-of-life measures.With regard to the risks of bias, two included studies were at low risk of bias and we judged three others as being at high risk of bias, mainly due to lack of blinding. AUTHORS' CONCLUSIONS In terms of recurrence, incidence, and time to next episode, antibiotic is probably an effective preventive treatment for recurrent cellulitis of the lower limbs in those under prophylactic treatment, compared with placebo or no treatment (moderate-certainty evidence). However, these preventive effects of antibiotics appear to diminish after they are discontinued (low-certainty evidence). Treatment with antibiotic does not trigger any serious adverse events, and those associated are minor, such as nausea and rash (low-certainty evidence). The evidence is limited to people with at least two past episodes of leg cellulitis within a time frame of up to three years, and none of the studies investigated other common interventions such as lymphoedema reduction methods or proper skin care. Larger, high-quality studies are warranted, including long-term follow-up and other prophylactic measures.
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Affiliation(s)
- Adam Dalal
- Beilinson Hospital, Rabin Medical CenterDepartment of Dermatology39 Jabotinski StreetPetah TikvaIsrael49100
- Tel Aviv UniversityThe Sackler School of MedicineTel AvivIsrael
| | - Marina Eskin‐Schwartz
- Beilinson Hospital, Rabin Medical CenterDepartment of Dermatology39 Jabotinski StreetPetah TikvaIsrael49100
- Tel Aviv UniversityThe Sackler School of MedicineTel AvivIsrael
| | - Daniel Mimouni
- Beilinson Hospital, Rabin Medical CenterDepartment of Dermatology39 Jabotinski StreetPetah TikvaIsrael49100
- Tel Aviv UniversityThe Sackler School of MedicineTel AvivIsrael
| | - Sujoy Ray
- St. John's Medical College and HospitalDepartment of PsychiatrySarjapur RoadBangaloreKarnatakaIndia560008
| | - Walford Days
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Emmilia Hodak
- Beilinson Hospital, Rabin Medical CenterDepartment of Dermatology39 Jabotinski StreetPetah TikvaIsrael49100
- Tel Aviv UniversityThe Sackler School of MedicineTel AvivIsrael
| | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine EKaplan StreetPetah TikvaIsrael49100
| | - Mical Paul
- Rambam Health Care CampusDivision of Infectious DiseasesHa‐aliya 8 StHaifaIsrael33705
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Rob F, Hercogová J. Benzathine penicillin G once-every-3-week prophylaxis for recurrent erysipelas a retrospective study of 132 patients. J DERMATOL TREAT 2017; 29:39-43. [DOI: 10.1080/09546634.2017.1329507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Filip Rob
- Dermatovenereology Department, Na Bulovce Hospital, 2nd Medical Faculty Charles University, Prague, Czech Republic
| | - Jana Hercogová
- Dermatovenereology Department, Na Bulovce Hospital, 2nd Medical Faculty Charles University, Prague, Czech Republic
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Pitché PV, Saka B, Diatta AB, Faye O, Diané BF, Sangaré A, Niamba P, Mandengue C, Kobengue L, Diop A, Ly F, Dieng MT, Dicko A, Soumah MM, Cissé M, Kourouma SH, Kouassi I, Boukari T, Akakpo S, Landoh DE, Tchangaï-Walla K. Risk factors associated with abscess formation among patient with leg erysipelas (cellulitis) in sub-Saharan Africa: a multicenter study. BMC DERMATOLOGY 2015; 15:18. [PMID: 26666633 PMCID: PMC4678644 DOI: 10.1186/s12895-015-0037-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/02/2015] [Indexed: 12/04/2022]
Abstract
Background Abscess formation is a frequent local complication of leg erysipelas. In this study we aimed at identifying factors associated with abscess formation of leg erysipelas in patients in sub-Saharan African countries. Method This is a multicenter prospective study conducted in dermatology units in eight sub-Saharan African countries from October 2013 to September 2014. We performed univariate and multivariate analysis to compare characteristics among the group of patients with leg erysipelas complicated with abscess against those without this complication. Results In this study, 562 cases of leg erysipelas were recruited in the eight sub-Saharan African countries. The mean age of patients was 43.67 years (SD =16.8) (Range: 15 to 88 years) with a sex-ratio (M/F) of 5/1. Out of the 562 cases, 63 patients (11.2 %) had abscess formation as a complication. In multivariate analysis showed that the main associated factors with this complication were: nicotine addiction (aOR = 3.7; 95 % CI = [1.3 – 10.7]) and delayed antibiotic treatment initiation (delay of 10 days or more) (aOR = 4.6; 95 % CI = [1.8 – 11.8]). Conclusion Delayed antibiotics treatment and nicotine addiction are the main risk factors associated with abscess formation of leg erysipelas in these countries. However, chronic alcohol intake, which is currently found in Europe as a potential risk factor, was less frequent in our study.
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Affiliation(s)
- Palokinam Vincent Pitché
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, Université de Lomé, 08 BP 81056, Lomé 08, Togo.
| | - Bayaki Saka
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, Université de Lomé, 08 BP 81056, Lomé 08, Togo.
| | - Ahy Boubacar Diatta
- Service de dermatologie, CHU Le Dantec, Dakar, Université Cheik Anta Diop, Dakar, Sénégal.
| | - Ousmane Faye
- Service de dermatologie, CNAM, Bamako, Université de Bamako, Bamako, Mali.
| | - Boh Fanta Diané
- Service de dermatologie-MST, CHU Donka, Conakry, Université de Conakry, Conakry, Guinée.
| | - Abdoulaye Sangaré
- Centre de dermatologie, CHU Treichville, Université de Cocody, Cocody, Côte d'Ivoire.
| | - Pascal Niamba
- Service de dermatologie CHU Yaldago Ouédraogo, Ouagadougou, Université de Ouagadougou, Ouagadougou, Burkina Faso.
| | - Christine Mandengue
- Service de dermatologie, Clinique universitaire des Montagnes, Bangangté, Cameroun.
| | - Léon Kobengue
- Service de dermatologie, CHU Bangui, Université de Bangui, Bangui, Centrafrique.
| | - Assane Diop
- Service de dermatologie, CHU Le Dantec, Dakar, Université Cheik Anta Diop, Dakar, Sénégal.
| | - Fatimata Ly
- Service de dermatologie, CHU Le Dantec, Dakar, Université Cheik Anta Diop, Dakar, Sénégal.
| | - Mame Thierno Dieng
- Service de dermatologie, CHU Le Dantec, Dakar, Université Cheik Anta Diop, Dakar, Sénégal.
| | - Alassane Dicko
- Service de dermatologie, CNAM, Bamako, Université de Bamako, Bamako, Mali.
| | - Maciré Mohamed Soumah
- Service de dermatologie-MST, CHU Donka, Conakry, Université de Conakry, Conakry, Guinée.
| | - Mohamed Cissé
- Service de dermatologie-MST, CHU Donka, Conakry, Université de Conakry, Conakry, Guinée.
| | - Sarah Hamdan Kourouma
- Centre de dermatologie, CHU Treichville, Université de Cocody, Cocody, Côte d'Ivoire.
| | - Isidore Kouassi
- Centre de dermatologie, CHU Treichville, Université de Cocody, Cocody, Côte d'Ivoire.
| | - Taniratou Boukari
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, Université de Lomé, 08 BP 81056, Lomé 08, Togo.
| | - Sefako Akakpo
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, Université de Lomé, 08 BP 81056, Lomé 08, Togo.
| | | | - Kissem Tchangaï-Walla
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, Université de Lomé, 08 BP 81056, Lomé 08, Togo.
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Pitché P, Diatta B, Faye O, Diané BF, Sangaré A, Niamba P, Mandengue C, Kobengue L, Saka B, Diop A, Ly F, Dieng MT, Dicko A, Soumah MM, Cissé M, Kourouma SH, Kouassi YI, Boukari T, Akakpo S, Tchangaï-Walla K. [Risk factors associated with leg erysipelas (cellulitis) in sub-Saharan Africa: A multicentre case-control study]. Ann Dermatol Venereol 2015; 142:633-8. [PMID: 26364000 DOI: 10.1016/j.annder.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/04/2015] [Accepted: 08/05/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context. PATIENTS AND METHODS We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors. RESULTS During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5). CONCLUSION The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.
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Affiliation(s)
- P Pitché
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo.
| | - B Diatta
- Service de dermatologie, CHU Le Dantec, Dakar, université Cheik Anta Diop, Dakar, Sénégal
| | - O Faye
- Service de dermatologie, CNAM, Bamako, université de Bamako, Bamako, Mali
| | - B-F Diané
- Service de dermatologie-MST, CHU Donka, Conakry, université de Conakry, Conakry, Guinée
| | - A Sangaré
- Centre de dermatologie, CHU Treichville, université de Cocody, Cocody, Côte d'Ivoire
| | - P Niamba
- Service de dermatologie, CHU Yaldago Ouédraogo, Ouagadougou, université de Ouagadougou, Ouagadougou, Burkina Faso
| | - C Mandengue
- Service de dermatologie, clinique universitaire des Montagnes, Banganté, Cameroun
| | - L Kobengue
- Service de dermatologie, CHU de Bangui, université de Bangui, Bangui, Centrafrique
| | - B Saka
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo
| | - A Diop
- Service de dermatologie, CHU Le Dantec, Dakar, université Cheik Anta Diop, Dakar, Sénégal
| | - F Ly
- Service de dermatologie, CHU Le Dantec, Dakar, université Cheik Anta Diop, Dakar, Sénégal
| | - M-T Dieng
- Service de dermatologie, CHU Le Dantec, Dakar, université Cheik Anta Diop, Dakar, Sénégal
| | - A Dicko
- Service de dermatologie, CNAM, Bamako, université de Bamako, Bamako, Mali
| | - M-M Soumah
- Service de dermatologie-MST, CHU Donka, Conakry, université de Conakry, Conakry, Guinée
| | - M Cissé
- Service de dermatologie-MST, CHU Donka, Conakry, université de Conakry, Conakry, Guinée
| | - S-H Kourouma
- Centre de dermatologie, CHU Treichville, université de Cocody, Cocody, Côte d'Ivoire
| | - Y-I Kouassi
- Centre de dermatologie, CHU Treichville, université de Cocody, Cocody, Côte d'Ivoire
| | - T Boukari
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo
| | - S Akakpo
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo
| | - K Tchangaï-Walla
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo
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De Britto LJ, Yuvaraj J, Kamaraj P, Poopathy S, Vijayalakshmi G. Risk Factors for Chronic Intertrigo of the Lymphedema Leg in Southern India: A Case-Control Study. INT J LOW EXTR WOUND 2015; 14:377-83. [PMID: 26353823 DOI: 10.1177/1534734615604289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rich clinical experiences indicate that toe web intertrigo is a major predisposing condition for cellulitis/acute dermatolymphango adenitis (ADLA) and the number of lesions is the strongest predictor of frequency of ADLA in lymphedema (LE) patients. However, there is scanty information on the risk factors for the establishment of chronic toe web intertrigo in LE patients. We performed a case-control study recruiting 52 lower limb LE with intertrigo and 52 lower limb LE without intertrigo in community settings and assessed general and local potential risk factors for chronic intertrigo. Analysis of local risk factors revealed that topical application of oil, tingling and numbness of the extremities were associated independently with chronic intertrigo. In multivariate analysis, LE grades III and IV were associated with chronic intertrigo, after adjusting for tingling and numbness, prophylactic antibiotic, age group, and gender. From a public health perspective, LE patients of grades III and IV and patients under antibiotic prophylaxis should be self-motivated to look for the early symptoms of toe web intertrigo to prevent chronic stage and recurrent episodes of cellulitis. Patients with history of tingling and numbness of the periphery need to be monitored for pressure effects leading to poor vascularization and delayed healing of intertrigo.
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Affiliation(s)
| | - Jayaram Yuvaraj
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Pattabi Kamaraj
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Subbiah Poopathy
- Vector Control Research Centre, Indian Council of Medical Research, Puducherry, India
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Rast AC, Knobel D, Faessler L, Kutz A, Felder S, Laukemann S, Steiner D, Haubitz S, Fux CA, Huber A, Mueller B, Schuetz P. Use of procalcitonin, C-reactive protein and white blood cell count to distinguish between lower limb erysipelas and deep vein thrombosis in the emergency department: A prospective observational study. J Dermatol 2015; 42:778-85. [PMID: 25982244 DOI: 10.1111/1346-8138.12922] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/24/2015] [Indexed: 12/13/2022]
Abstract
Early differentiation of erysipelas from deep vein thrombosis (DVT) based solely on clinical signs and symptoms is challenging. There is a lack of data regarding the usefulness of the inflammatory biomarkers procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) count in the diagnosis of localized cutaneous infections. Herein, we investigated the diagnostic value of inflammatory markers in a prospective at-risk patient population. This is an observational quality control study including consecutive patients presenting with a final diagnosis of either erysipelas or DVT. The association of PCT (μg/L) and CRP (mg/L) levels and WBC counts (g/L) with the primary outcome was assessed using logistic regression models with area under the receiver-operator curve. Forty-eight patients (erysipelas, n = 31; DVT, n = 17) were included. Compared with patients with DVT, those with erysipelas had significantly higher PCT concentrations. No significant differences in CRP concentrations and WBC counts were found between the two groups. At a PCT threshold of 0.1 μg/L or more, specificity and positive predictive values (PPV) for erysipelas were 82.4% and 85.7%, respectively, and increased to 100% and 100% at a threshold of more than 0.25 μg/L. Levels of PCT also correlated with the severity of erysipelas, with a stepwise increase according to systemic inflammatory response syndrome criteria. We found a high discriminatory value of PCT for differentiation between erysipelas and DVT, in contrast to other commonly used inflammatory biomarkers. Whether the use of PCT levels for early differentiation of erysipelas from DVT reduces unnecessary antibiotic exposure needs to be assessed in an interventional trial.
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Affiliation(s)
- Anna C Rast
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Demian Knobel
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Lukas Faessler
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Susan Felder
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Svenja Laukemann
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Deborah Steiner
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- University Clinic of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Christoph A Fux
- Division of Infectious Diseases, University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau , Switzerland
| | - Beat Mueller
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Karppelin M, Siljander T, Aittoniemi J, Hurme M, Huttunen R, Huhtala H, Kere J, Vuopio J, Syrjänen J. Predictors of recurrent cellulitis in five years. Clinical risk factors and the role of PTX3 and CRP. J Infect 2015; 70:467-73. [DOI: 10.1016/j.jinf.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 09/22/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022]
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Oh CC, Ko HCH, Lee HY, Safdar N, Maki DG, Chlebicki MP. Antibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis. J Infect 2014; 69:26-34. [DOI: 10.1016/j.jinf.2014.02.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/29/2014] [Accepted: 02/18/2014] [Indexed: 11/15/2022]
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Chlebicki MP, Oh CC. Recurrent Cellulitis: Risk Factors, Etiology, Pathogenesis and Treatment. Curr Infect Dis Rep 2014; 16:422. [DOI: 10.1007/s11908-014-0422-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Glatz M, Degen D, French LE, Aberer W, Müllegger RR. Erysipelas of the thigh and the gluteal region: retrospective multicenter analysis of a very rare entity in 39 patients. Dermatology 2012; 225:277-83. [PMID: 23257902 DOI: 10.1159/000345619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/05/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Erysipelas of the thigh and the gluteal region are rarely described and not well characterized. Therefore we aim to describe the prevalence, clinical characteristics, and risk factors of these erysipelas types. METHODS The files of 1,423 patients with erysipelas were analyzed. Data from patients with erysipelas of the thigh or the gluteal region were compared between the two groups and with a control group with erysipelas of the lower leg. RESULTS The thigh was exclusively affected in 2.1%, and the gluteal region in 0.6% of erysipelas patients. Gluteal erysipelas had conspicuous irregular borders and sometimes appeared bilaterally. Major risk factors for erysipelas of both sites were previous surgical interventions. Gluteal erysipelas was common in patients with the metabolic syndrome and required a more intense antibiotic therapy. CONCLUSION Erysipelas of the thigh and the gluteal region are rare and significantly associated with prior surgical disruption of lymphatic vessels.
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Affiliation(s)
- Martin Glatz
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
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Lower limb cellulitis and its mimics. J Am Acad Dermatol 2012; 67:163.e1-12; quiz 175-6. [DOI: 10.1016/j.jaad.2012.03.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/28/2012] [Accepted: 03/29/2012] [Indexed: 12/17/2022]
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Régnier-Rosencher E, Farhi D, Lebrun A, Salliot C, Dougados M, Dupin N. Factors associated with severe skin infections in patients treated with biologic therapies for inflammatory rheumatic diseases. Dermatology 2012; 224:72-83. [PMID: 22487697 DOI: 10.1159/000337422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 02/07/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of severe infections is increased under biologic therapies and the skin is the second localization. OBJECTIVE To appraise the factors associated with severe skin infections (SSI) in patients under biologic therapies for inflammatory rheumatic diseases (IRD). METHODS We performed a case-control (ratio 1:3) study nested in a prospective cohort of patients with IRD. SSI was defined as requiring hospitalization or intravenous anti-infectious therapy. We defined two imbedded periods: period A was the time window between the first biologic therapy and the SSI; period B was the last 3 or 12 months (for tumor necrosis factor blockers or rituximab, respectively) before the SSI. RESULTS Among 4,361 patients with IRD, 29 had a SSI under biologic therapy. In multivariate analyses, SSI were significantly associated with smoking, baseline C-reactive protein and gammaglobulinemia, non-steroidal anti-inflammatory drugs before biologic therapy, cumulative dose of steroids, concomitant steroids during period A, number of different biologic therapies during period A, treatment with infliximab during period A, period B or as first biologic therapy and treatment at high dose during period B. CONCLUSION In patients under biologic therapies for IRD, the risk of SSI is associated with several factors including tobacco, treatment with infliximab or high dose range.
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Affiliation(s)
- E Régnier-Rosencher
- Department of Dermatology, Hôpital Cochin, APHP, Université René Descartes Paris V, Paris, France
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Chosidow O, Le Cleach L. Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg. A commentary. Br J Dermatol 2011; 166:6. [DOI: 10.1111/j.1365-2133.2011.10740.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thomas K, Crook A, Foster K, Mason J, Chalmers J, Bourke J, Ferguson A, Level N, Nunn A, Williams H. Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the UK Dermatology Clinical Trials Network's PATCH II trial. Br J Dermatol 2011; 166:169-78. [PMID: 21910701 PMCID: PMC3494300 DOI: 10.1111/j.1365-2133.2011.10586.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cellulitis (erysipelas) of the leg is a common, painful infection of the skin and underlying tissue. Repeat episodes are frequent, cause significant morbidity and result in high health service costs. OBJECTIVES To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes. METHODS Double-blind, randomized controlled trial including patients recently treated for an episode of leg cellulitis. Recruitment took place in 20 hospitals. Randomization was by computer-generated code, and treatments allocated by post from a central pharmacy. Participants were enrolled for a maximum of 3 years and received their randomized treatment for the first 6 months of this period. RESULTS Participants (n=123) were randomized (31% of target due to slow recruitment). The majority (79%) had suffered one episode of cellulitis on entry into the study. The primary outcome of time to recurrence of cellulitis included all randomized participants and was blinded to treatment allocation. The hazard ratio (HR) showed that treatment with penicillin reduced the risk of recurrence by 47% [HR 0·53, 95% confidence interval (CI) 0·26-1·07, P=0·08]. In the penicillin V group 12/60 (20%) had a repeat episode compared with 21/63 (33%) in the placebo group. This equates to a number needed to treat (NNT) of eight participants in order to prevent one repeat episode of cellulitis [95% CI NNT(harm) 48 to ∞ to NNT(benefit) 3]. We found no difference between the two groups in the number of participants with oedema, ulceration or related adverse events. CONCLUSIONS Although this trial was limited by slow recruitment, and the result failed to achieve statistical significance, it provides the best evidence available to date for the prevention of recurrence of this debilitating condition.
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Affiliation(s)
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- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, Nottingham NG7 2N, UK
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Larivière D, Blavot-Delépine A, Fantin B, Lefort A. [Survey of general practitioners management of erysipelas]. Rev Med Interne 2011; 32:730-5. [PMID: 21862184 DOI: 10.1016/j.revmed.2011.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 05/30/2011] [Accepted: 07/15/2011] [Indexed: 01/22/2023]
Abstract
PURPOSE A few studies only have focused on ambulatory management of erysipelas. METHODS To assess the diagnostic and therapeutic management of erysipelas by general practitioners, and their adherence to the French Society of Infectious Diseases and Dermatology joint 2000 recommendations, we surveyed 114 general practitioners during a 1 year period (from May 1st, 2005 to April 30th, 2006). RESULTS Seventy-three general practitioners accepted to participate to the study and 54 cases of erysipelas were reported. Median age of patients was 63 years (range, 18-94) and sex ratio was 0.77. Lower limbs were affected in 83% out of the cases. A skin lesion was reported in 65% of the cases. None of the 15 doppler ultrasonography that were performed identified deep vein thrombosis. Five patients (9%) were initially hospitalized. Only 18% out of the patients were treated by amoxicillin. Most prescribed antimicrobial agents were pristinamycin (31%) and amoxicillin-clavulanate (27%). Median duration of treatment was 10 days. Six patients received an anti-inflammatory drug. Among the 44 patients who had a follow-up visit, 37 patients (84%) recovered and two patients were hospitalized after this follow-up assessment. Two patients experienced a recurrence of erysipelas during the study. CONCLUSION As previously reported in the literature, outcome of erysipelas after ambulatory management remains excellent, although recommendations are poorly followed.
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Affiliation(s)
- D Larivière
- Service de médecine interne, hôpital Beaujon, Clichy, France
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Krasagakis K, Samonis G, Valachis A, Maniatakis P, Evangelou G, Tosca A. Local complications of erysipelas: a study of associated risk factors. Clin Exp Dermatol 2010; 36:351-4. [PMID: 21198795 DOI: 10.1111/j.1365-2230.2010.03978.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local complications of erysipelas include haemorrhagic, bullous, abscessing and necrotic lesions. The risk factors predisposing patients to local complications are not fully known. AIM To examine local complications of erysipelas and to identify possible risk factors predisposing to their appearance. METHODS Medical records from all patients hospitalized with complications of erysipelas (purpura, bullae, abscesses and necrosis), admitted to the University Hospital of Heraklion between 1994 and 2002, were retrospectively studied. Clinical and laboratory data were compared with those from patients with erysipelas without local complications. RESULTS In total, 145 patients were analysed, of whom 46 had local disease complications. Using bivariate analysis, the factors significantly associated with disease complications were found to be age ≥ 51 years, obesity, longer duration of local symptoms, and fever on admission. During hospitalization, increased C-reactive protein level, isolation of pathogens, longer duration of fever and/or presence of leucocytosis, absence of response to initial antibiotic therapy, and longer length of hospitalization were also associated with complications in the bivariate analysis. However, in the multivariate analysis, obesity (OR 4.489, 95% CI 1.719-11.725, P = 0.002) was the only independent factor associated with complicated erysipelas. CONCLUSIONS This study found obesity to be an independent risk factor for local complications, of erysipelas. Hence, obese patients with erysipelas are prone to complications, and should be carefully evaluated because of the potential severity of disease and the increased risk of failure of empirical antimicrobial therapy.
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Affiliation(s)
- K Krasagakis
- Department of Dermatology, University Hospital of Heraklion, Heraklion, Greece.
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Krasagakis K, Valachis A, Maniatakis P, Krüger-Krasagakis S, Samonis G, Tosca AD. Report: Analysis of epidemiology, clinical features and management of erysipelas. Int J Dermatol 2010; 49:1012-7. [DOI: 10.1111/j.1365-4632.2010.04464.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
BACKGROUND Cellulitis and erysipelas are now usually considered manifestations of the same condition, a skin infection associated with severe pain and systemic symptoms. A range of antibiotic treatments are suggested in guidelines. OBJECTIVES To assess the efficacy and safety of interventions for non-surgically-acquired cellulitis. SEARCH STRATEGY In May 2010 we searched for randomised controlled trials in the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and the ongoing trials databases. SELECTION CRITERIA We selected randomised controlled trials comparing two or more different interventions for cellulitis. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. MAIN RESULTS We included 25 studies with a total of 2488 participants. Our primary outcome 'symptoms rated by participant or medical practitioner or proportion symptom-free' was commonly reported. No two trials examined the same drugs, therefore we grouped similar types of drugs together.Macrolides/streptogramins were found to be more effective than penicillin antibiotics (Risk ratio (RR) 0.84, 95% CI 0.73 to 0.97). In 3 trials involving 419 people, 2 of these studies used oral macrolide against intravenous (iv) penicillin demonstrating that oral therapies can be more effective than iv therapies (RR 0.85, 95% CI 0.73 to 0.98).Three studies with a total of 88 people comparing a penicillin with a cephalosporin showed no difference in treatment effect (RR 0.99, 95% CI 0.68 to 1.43).Six trials which included 538 people that compared different generations of cephalosporin, showed no difference in treatment effect (RR 1.00, 95% CI 0.94 to1.06).We found only small single studies for duration of antibiotic treatment, intramuscular versus intravenous route, the addition of corticosteroid to antibiotic treatment compared with antibiotic alone, and vibration therapy, so there was insufficient evidence to form conclusions. Only two studies investigated treatments for severe cellulitis and these selected different antibiotics for their comparisons, so we cannot make firm conclusions. AUTHORS' CONCLUSIONS We cannot define the best treatment for cellulitis and most recommendations are made on single trials. There is a need for trials to evaluate the efficacy of oral antibiotics against intravenous antibiotics in the community setting as there are service implications for cost and comfort.
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Affiliation(s)
- Sally A Kilburn
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, Hampshire, UK, PO1 2FR
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Karppelin M, Syrjänen J, Siljander T, Vuopio-Varkila J, Kere J, Huhtala H, Vuento R, Jussila T. Factors predisposing to acute and recurrent bacterial non-necrotizing cellulitis in hospitalized patients: a prospective case–control study. Clin Microbiol Infect 2010; 16:729-34. [DOI: 10.1111/j.1469-0691.2009.02906.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pereira de Godoy JM, Galacini Massari P, Yoshino Rosinha M, Marinelli Brandão R, Foroni Casas AL. Epidemiological Data and Comorbidities of 428 Patients Hospitalized With Erysipelas. Angiology 2010; 61:492-4. [DOI: 10.1177/0003319709351257] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the epidemiological data and the main comorbidities of patients with erysipelas admitted to a tertiary hospital. All patients admitted due to erysipelas during the period from 1999 to 2008 were included in a prospective and cross-sectional study. The Fisher exact test and logistic regression were used for statistical analysis. A total of 428 individuals were hospitalized with 41 rehospitalizations; 51.17% of the patients were women, the mean age was 58.6 years. The main comorbidities were hypertension (51.6%), diabetes mellitus (41.6%), chronic venous insufficiency (36.2%), other cardiovascular diseases (33.2%) including angina, peripheral arterial insufficiency, acute myocardial infarction, and strokes, obesity (12.1%), chronic renal failure (6.8%), neoplasms (4.9%), cirrhosis (4.9%), chronic lymphedema (4.2%), and leg ulcers (2.6%). Erysipelas is a seasonal disease that affects adults and the elderly people, has a repetitive nature, and is associated with comorbidities.
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Affiliation(s)
- José Maria Pereira de Godoy
- Cardiology and Cardiovascular Surgery, Department of the Medicine School in São José do Rio Preto-FAMERP, Sao Paulo, Brazil,
| | | | | | | | - André Luís Foroni Casas
- Cardiology and Cardiovascular Surgery, Department of the Medicine School in São José do Rio Preto-FAMERP, Sao Paulo, Brazil
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Concheiro J, Loureiro M, González-Vilas D, García-Gavín J, Sánchez-Aguilar D, Toribio J. Erysipelas and Cellulitis: A Retrospective Study of 122 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70560-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
AIMS To review the current evidence for the presence of fungal foot infection (tinea pedis and toenail onychomycosis) as a risk factor for the development of cellulitis within the lower limb, particularly for those individuals with diabetes. METHODS A structured review of medline, embase and cinahl databases was undertaken to identify publications investigating fungal foot infection as a risk factor for the development of cellulitis. RESULTS Sixteen studies were identified. Eight studies adopted a case-control methodology, with the remainder being cross-sectional surveys. The majority of studies established the presence of tinea infection by clinical rather than established microbiological methods. Although the majority of papers suggested a link, only two case-control studies employed microbiological diagnosis to demonstrate that fungal foot infection was a risk for the development of lower limb cellulitis, particularly when infection was located between the toes. There were insufficient data to suggest that fungal foot infection posed an increased risk to patients with diabetes. CONCLUSION There is some evidence to suggest that fungal infection of the foot is a factor in the development of lower limb cellulitis, but further robust research is needed to confirm these findings and quantify the risk that fungi pose, particularly to the diabetic foot. Meanwhile, improved surveillance and treatment of tinea infections on the foot by healthcare professionals should be encouraged to reduce potential complications.
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Affiliation(s)
- I R Bristow
- School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK.
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Halpern J, Holder R, Langford N. Ethnicity and other risk factors for acute lower limb cellulitis: a U.K.-based prospective case–control study. Br J Dermatol 2008; 158:1288-92. [DOI: 10.1111/j.1365-2133.2008.08489.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Siljander T, Karppelin M, Vahakuopus S, Syrjanen J, Toropainen M, Kere J, Vuento R, Jussila T, Vuopio-Varkila J. Acute Bacterial, Nonnecrotizing Cellulitis in Finland: Microbiological Findings. Clin Infect Dis 2008; 46:855-61. [DOI: 10.1086/527388] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Körber A, Graue N, Rietkötter J, Kreuzfelder E, Grabbe S, Dissemond J. Insufficient Tetanus Vaccination Status in Patients with Chronic Leg Ulcers. Dermatology 2008; 217:69-73. [DOI: 10.1159/000127317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 10/31/2007] [Indexed: 11/19/2022] Open
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Cisse M, Keïta M, Toure A, Camara A, Machet L, Lorette G. Dermohypodermites bactériennes : étude monocentrique rétrospective de 244 cas observés en Guinée. Ann Dermatol Venereol 2007; 134:748-51. [DOI: 10.1016/s0151-9638(07)92530-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Motegi SI, Tamura A, Okada E, Nagai Y, Ishikawa O. Successful Treatment with Lymphaticovenular Anastomosis for Secondary Skin Lesions of Chronic Lymphedema. Dermatology 2007; 215:147-51. [PMID: 17684378 DOI: 10.1159/000104267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 02/03/2007] [Indexed: 11/19/2022] Open
Abstract
The treatment of severe lymphedema is a difficult challenge. We performed lymphaticovenular anastomosis on two patients with secondary skin lesions of chronic lymphedema; one patient exhibited acquired lymphangioma circumscriptum of the vulva and the other presented elephantiasis nostras verrucosa of the lower leg. Both patients obtained a remarkable improvement in skin lesions and also in the reduction of lymphedema of the lower extremity. During a 6-month-follow-up period, constant reduction in the circumference of the lower extremities without exacerbation of skin lesions was achieved in both patients. Lymphaticovenular anastomosis is a useful surgical treatment for secondary lymphedema in the lower extremities. In addition, this surgical treatment is effective for secondary lesions of lymphedema, including acquired lymphangioma circumscriptum and elephantiasis nostras verrucosa.
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Affiliation(s)
- Sei-ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan.
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Bartholomeeusen S, Vandenbroucke J, Truyers C, Buntinx F. Epidemiology and Comorbidity of Erysipelas in Primary Care. Dermatology 2007; 215:118-22. [PMID: 17684373 DOI: 10.1159/000104262] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 03/15/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Most studies on the epidemiology of erysipelas are done in hospitals, resulting in patient selection. The aim of this study is to determine epidemiological characteristics and comorbidity of erysipelas based on primary care data. METHODS Incidence rate study and nested case-control study. A database containing data from 52 general practices in Flanders, Belgium, with morbidity data on 160,000 different patients in the period 1994-2004. Excess comorbidity was determined in patients with erysipelas in 2004. RESULTS In the period 1994-2004, the age-standardized incidence of erysipelas increased significantly from 1.88 (95% confidence interval, CI, 1.62-2.13) per 1,000 patients to 2.49 (95% CI 2.24-2.74). Of patients with erysipelas, 16% had one or more recurrences. Local factors such as dermatophytosis, chronic ulcer of the skin, varicose veins of the leg and phlebitis and general disorders such as obesity, non-insulin-dependent diabetes and heart failure increased the risk of erysipelas. CONCLUSION The incidence of erysipelas increased from 1994 to 2004. More attention should be paid to local factors such as dermatophytosis to prevent erysipelas.
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Abstract
PURPOSE OF REVIEW Acute bacterial skin infections are very common, with various presentations and severity. This review focuses on deep skin infections. We separate acute nonnecrotizing infections of the hypodermis (erysipelas), forms with abscesses or exudates and necrotizing fasciitis. These three types actually differ in risk factors, bacteriology, treatment and prognosis. RECENT FINDINGS Leg erysipelas/cellulitis occurs in more than one person/1000/year. It remains mainly due to streptococci. Foot intertrigo is an important risk factor. Necrotizing fasciitis is much rarer and usually occurs in patients with chronic diseases. Staphylococci, especially community-acquired methicillin-resistant strains in some areas, play a growing role in the intermediate form of cellulitis with abscesses and exudates. For erysipelas or noncomplicated cellulitis, antibiotic treatment at home, when feasible, is much less expensive and as effective as hospital treatment. Intermediate cases with collections and exudates often require surgical drainage. For necrotizing fasciitis early surgery remains essential in order to decrease the mortality rate. SUMMARY Antibiotic treatment of deep skin infections must be active on streptococci; the choice of a larger spectrum of activity depends on clinical presentation, risk factors and the burden of methicillin-resistant staphylococci in the environment.
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CO31 - Érysipèle : particularités de 244 cas observés en Guinée. Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)89064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Leclerc S, Teixeira A, Mahé E, Descamps V, Crickx B, Chosidow O. Recurrent Erysipelas: 47 Cases. Dermatology 2006; 214:52-7. [PMID: 17191048 DOI: 10.1159/000096913] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 07/28/2006] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- S Leclerc
- Department of Internal Medicine, Hôpital de la Pitié-Salpêtrière, AP-HP, Université Pierre et Marie Curie-Paris 6, Paris, France
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Affiliation(s)
- O Chosidow
- Service de Médecine Interne, Hôpital de la Pitié, Salpétrière, Paris, France
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