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Świerczewska Z, Lewandowski M, Romanowska N, Barańska-Rybak W. Infectious complications after hyaluronic acid injections - two case reports. Dermatol Ther 2022; 35:e15752. [PMID: 35916468 DOI: 10.1111/dth.15752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/13/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Zuzanna Świerczewska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Poland
| | - Miłosz Lewandowski
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Poland
| | | | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Poland
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Bednarska A, Sosińska-Bryła I, Grąbczewski P, Podlasin R, Paciorek M, Bursa D, Hackiewicz M, Makowiecki M, Horban A. The effectiveness of erysipelas prophylaxis depends on the cumulative dose of benzathine penicillin G. Dermatol Reports 2022; 14:9429. [PMID: 36199905 PMCID: PMC9527694 DOI: 10.4081/dr.2022.9429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Erysipelas is an acute infection due to S. pyogenes and is characterized by a high risk of relapses. The number of patients suffering from one or more recurrences varied depending on the study and accounted for between 16% and 47% of the total number of those affected. Antibiotic prophylaxis with the use of penicillin can reduce the risk of recurrence by 47%. Methods: A number of 873 patients with erysipelas treated at the Hospital for Infectious Diseases in Warsaw from 2010 to 2018 was enrolled in the study. Benzathine-penicillin G was given intramuscularly at a dose of 1.2 MU or 2.4 MU or 3.6 MU. The earliest moment that prophylactic treatment was administered was the first episode of erysipelas recurrence. The decision to administer the antibiotic and the dose to use was discretionally made by the examining physician. Results: Altogether 104 (11.9%) persons experienced at least one episode of erysipelas recurrence during the study period. A total of 2976 doses of benzathine-penicillin G (BP) were administered. The most common dose was that of 2.4 MU (2380, 80 %). The dose of 1.2 MU was given 567 times (19 %). The highest dose, i.e. 3.6 MU, was administered to only 5 patients (8 applications, 0.2%). No effect was shown by either the number of benzathine-penicillin G administered doses (p=0.07) or the median dose (p=0.65), whereas patients without relapse received a statistically higher cumulative dose of the antibiotic (p=0.047). Age was a risk factor of recurrence only in the group of diabetic patients (p=0.03). Conclusion: Benzathine penicillin G given in an appropriate cumulative dose is effective in preventing erysipelas recurrence.
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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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Kassang P, Akakpo AS, Téclessou JN, Esso B, Mahamadou G, Mouhari-Toure A, Kombaté K, Tchangai-Walla K, Pitché P, Saka B. Risk factors associated with recurrence of leg erysipelas in Togo. Ann Dermatol Venereol 2021; 148:253-255. [PMID: 34218937 DOI: 10.1016/j.annder.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/10/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022]
Affiliation(s)
- P Kassang
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, BP: 30785, Lomé, Togo
| | - A S Akakpo
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, BP: 30785, Lomé, Togo
| | - J N Téclessou
- Service de Dermatologie et IST, CHU Campus, Université de Lomé, Lomé, Togo
| | - B Esso
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, BP: 30785, Lomé, Togo
| | - G Mahamadou
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, BP: 30785, Lomé, Togo
| | - A Mouhari-Toure
- Service de Dermatologie et IST, CHU Kara, Université de Kara, Kara, Togo
| | - K Kombaté
- Service de Dermatologie et IST, CHU Campus, Université de Lomé, Lomé, Togo
| | - K Tchangai-Walla
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, BP: 30785, Lomé, Togo
| | - P Pitché
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, BP: 30785, Lomé, Togo
| | - B Saka
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, BP: 30785, Lomé, Togo.
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Kröger K, Schwarzkopf A, Eder S, Protz K, Münter C, Dissemond J. [Diagnosis and therapy of erysipelas: A position paper of the Society Initiative Chronische Wunde (ICW) e. V.]. Dtsch Med Wochenschr 2021; 146:822-830. [PMID: 34130325 DOI: 10.1055/a-1392-8128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Erysipelas is a bacterial soft tissue infection caused by β-haemolytic streptococci that spreads proximally along the lymphatic system of the skin. The entry sites of the pathogens can be minor injuries or chronic wounds. The diagnosis of erysipelas is made clinically by the spreading eythema and overheating of the skin, the reduced general condition with fever and chills as well as by means of serological inflammation parameters and must be distinguished from numerous differential diagnoses.Systemic therapy is carried out with penicillin usually. In local therapy, the value of measures such as compression therapy or cooling is currently still controversial. Long-term therapy of the lymphoedema and the consistent avoidance and treatment of entry sites are essential, especially for the prevention of recurrence.
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Affiliation(s)
- Knut Kröger
- Klinik für Gefäßmedizin, Helios Klinik Krefeld
| | | | - Stephan Eder
- Klinik für Gefäßchirurgie und Gefäßmedizin, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen
| | - Kerstin Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Comprehensive Wound Center, Hamburg
| | | | - Joachim Dissemond
- Klinik für Dermatologie, Venerologie, Allergologie, Universitätsklinik Essen, Essen
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6
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[Antibiotic prophylaxis and recurrent non-necrotizing cellulitis of the male external genitalia]. Med Mal Infect 2019; 49:627-629. [PMID: 31375374 DOI: 10.1016/j.medmal.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/28/2019] [Accepted: 07/03/2019] [Indexed: 11/20/2022]
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7
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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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Mzabi A, Marrakchi W, Alaya Z, Fredj FB, Rezgui A, Bouajina E, Kechrid CL. Cellulitis in aged persons: a neglected infection in the literature. Pan Afr Med J 2017; 27:160. [PMID: 28904688 PMCID: PMC5567966 DOI: 10.11604/pamj.2017.27.160.12007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/29/2017] [Indexed: 11/11/2022] Open
Abstract
Cellulitis is a frequent soft tissue and skin infection. The lower limbs are affected in 70 to 80% of cases. Cellulitis in aged persons is not yet well described in literature. A retrospective descriptive study conducted in the Internal Medicine Department of Sahloul hospital in Sousse in Tunisia. It included patients whose age was up to 65 years old admitted into hospital for cellulitis of the legs, the arms or the face. One hundred fifty eight patients with a mean age of 73 years old (range: 65 to 94 years old) were included. Female to male sex ratio was 0.68. Among them, we noted diabetes mellitus in 81 cases (50.6%). The infection was located in the lower limbs in 155 cases (98%), in the face in two cases (1.3%) and in the upper limb in one case (0.7%). Twenty one patients (13.3%) presented with severe cellulitis and one presented with necrotizing fasciitis. All patients received intra venous antibiotic therapy. Surgical treatment was indicated in 14 cases. Cefazolin was prescribed in 77 cases (48%). Favorable evolution was noted in 144 patients (91.1%). Forty four patients (27.8%) received prophylactic antibiotics. Prevention of skin and soft tissue infection is a crucial step to preserve health in aged persons.
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Affiliation(s)
- Anis Mzabi
- Department of Internal Medicine, Sahloul Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Wafa Marrakchi
- Department of Internal Medicine, Sahloul Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Zeineb Alaya
- Department of Rheumatology, Farhat Hached Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Fatma Ben Fredj
- Department of Internal Medicine, Sahloul Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Amel Rezgui
- Department of Internal Medicine, Sahloul Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Elyès Bouajina
- Department of Rheumatology, Farhat Hached Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Chedia Laouani Kechrid
- Department of Internal Medicine, Sahloul Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
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9
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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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10
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Tay EY, Fook-Chong S, Oh CC, Thirumoorthy T, Pang SM, Lee HY. Cellulitis Recurrence Score: A tool for predicting recurrence of lower limb cellulitis. J Am Acad Dermatol 2015; 72:140-5. [DOI: 10.1016/j.jaad.2014.08.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 07/30/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
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van Zuuren EJ, Fedorowicz Z, Alper B, Mitsuma SF. Penicillin to prevent recurrent leg cellulitis: a critical appraisal. Br J Dermatol 2014; 171:1300-3. [PMID: 25523263 DOI: 10.1111/bjd.13461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E J van Zuuren
- Department of Dermatology, B1-Q, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, the Netherlands.
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Müller DP, Hoffmann R, Welzel J. Mikroorganismen des Zehenzwischenraums - Bedeutung für das Beinerysipel. J Dtsch Dermatol Ges 2014; 12:691-696. [DOI: 10.1111/ddg.12374_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Reinhard Hoffmann
- Institut für Laboratoriumsmedizin, Mikrobiologie und Umwelthygiene, Klinikum Augsburg
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Klinikum Augsburg
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Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue
Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147-59. [DOI: 10.1093/cid/ciu296] [Citation(s) in RCA: 1187] [Impact Index Per Article: 118.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
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Affiliation(s)
- Dennis L. Stevens
- Division of Infectious Diseases, Department of Veterans Affairs, Boise, Idaho
| | - Alan L. Bisno
- Medical Service, Miami Veterans Affairs Health Care System, Florida
| | | | | | - Ellie J. C. Goldstein
- University of California, Los Angeles, School of Medicine, and R. M. Alden Research Laboratory, Santa Monica, California
| | | | - Jan V. Hirschmann
- Medical Service, Puget Sound Veterans Affairs Medical Center, Seattle, Washington
| | - Sheldon L. Kaplan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - James C. Wade
- Geisinger Health System, Geisinger Cancer Institute, Danville, Pennsylvania
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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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Müller DP, Hoffmann R, Welzel J. Microorganisms of the toe web and their importance for erysipelas of the leg. J Dtsch Dermatol Ges 2014; 12:691-5. [PMID: 24961650 DOI: 10.1111/ddg.12374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND There has been a steady increase of the incidence of erysipelas in Germany in the recent past. Affected patients also often show defects in the cutaneous barrier caused by microorganisms. The aim of this non-interventional case-control study was to investigate a possible interrelationship between interdigital tinea pedis and bacterial toe web (interdigital space) infections and erysipelas of the leg, as well as a potential interaction among the microorganisms themselves. MATERIAL AND METHODS The patient population contained 150 people equally distributed among three groups, one retrospective and one prospective erysipelas group (EG = rEG + pEG) plus one control group (KG). RESULTS 51 % of the patients with erysipelas and 32 % of the control group suffered from interdigital tinea pedis. There was a significant association between interdigital tinea pedis and the recurrence rate of erysipelas, but not with erysipelas itself. Staphylococcus aureus (EG: 30.34 %; KG: 3.23 %) and non-pathogenic aerobic bacteria were significantly associated with erysipelas in each statistical analysis. Staphylococcus aureus showed a positive, the non-pathogenic aerobic germs (EG: 28,09 %; KG: 80,65 %) a negative association. CONCLUSIONS This study demonstrates an association between the microorganisms of the toe web and erysipelas of the leg. Erysipelas itself is influenced to a great extent by the bacterial flora, while its recurrence relates more to interdigital tinea pedis.
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Inghammar M, Rasmussen M, Linder A. Recurrent erysipelas--risk factors and clinical presentation. BMC Infect Dis 2014; 14:270. [PMID: 24884840 PMCID: PMC4033615 DOI: 10.1186/1471-2334-14-270] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 05/13/2014] [Indexed: 11/19/2022] Open
Abstract
Background Erysipelas is a common infection that often recurs, but the impact of specific risk factors for reoccurrence remains elusive. In the present study we aimed at clarifying predisposing conditions for reoccurrence. Methods Medical records were reviewed from all patients ≥18 years of age diagnosed with erysipelas at the Department of Infectious Diseases at Skåne University Hospital, Sweden, from January 2007 to February 2011. 502 patients were included, of which 357 were single episode erysipelas and 145 had recurrent erysipelas. These two groups were compared regarding underlying conditions and clinical presentation. Results Erysipelas in the lower limbs had the greatest propensity of recurrence. The associations between underlying conditions and recurrence were largely depending on the site of erysipelas. Overall, the most prominent risk factor for recurrence was lymphedema and other conditions causing a chronic impairment of the defence against microbes. Conditions temporarily disrupting the skin barrier (e.g. a local wound or toe web intertrigo), although likely being risk factors for erysipelas per se, did not seem to predispose to repeated episodes. Individuals with recurrent erysipelas tended to seek medical attention earlier, and were less likely to be hospitalized or receive intravenous antibiotics, but there was no evidence of any difference in inflammatory reaction when taking confounding factors into account. Conclusions In this large cross-sectional study of over 500 patients with erysipelas, lymphedema was the most prominent risk factors for recurrence although the distribution of predisposing conditions varies depending on the site of erysipelas.
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Affiliation(s)
- Malin Inghammar
- Department of Clinical Sciences, Division of Infection Medicine, Klinikgatan 1, Skåne University Hospital, Lund, Lund SE-221 85, Sweden.
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17
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Reading the Red Ear. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31828875c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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19
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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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20
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Erysipelas in breast cancer patients after the radical mastectomy. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0127-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractErysipelas is a bacterial cellulitis usually associated with Streptococcal infection. It may appear as a complication following mastectomy and radiotherapy for breast cancer. The study involved 17 cases of erysipelas of the upper limbs with a median age of 62 years. Here we described the clinical, therapeutic and evolutionary aspects of erysipelas. Our results indicated that the erysipelas appeared with an average of 9 years after mastectomy and was recurrent in three patients (17.64%). It is associated with obesity in 42% and arterial hypertension in 52.9% of patients with breast cancer after radical mastectomy. Breast cancer patients in advance stages of disease at presentation (T2+ T3) are significantly more subject to erysipelas in comparison to those patients with locoregional stage of disease at presentation (T1), Mann Whitney U-test, (p<0.05). All patients had complete response to antibiotics. The recurrence occurred in 2 patients (11.76%) who underwent radiotherapy with adjuvant tamoxifen and in one patient who underwent chemotherapy and radiotherapy combined. Based on these results it is possible to suggest that patients who received radiotherapy may have an additional risk factor for developing lymphedema and erysipelas
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Esposito S, Bassetti M, Borre' S, Bouza E, Dryden M, Fantoni M, Gould IM, Leoncini F, Leone S, Milkovich G, Nathwani D, Segreti J, Sganga G, Unal S, Venditti M. Diagnosis and management of skin and soft-tissue infections (SSTI): a literature review and consensus statement on behalf of the Italian Society of Infectious Diseases and International Society of Chemotherapy. J Chemother 2012; 23:251-62. [PMID: 22005055 DOI: 10.1179/joc.2011.23.5.251] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Skin and soft-tissue infections (SSTIs) are among the most common bacterial infections, posing considerable diagnostic and therapeutic challenges and resulting in significant morbidity and mortality among patients as well as increased healthcare costs. eight members of the SSTI working group of the Italian Society of infectious Diseases prepared a draft of the statements, grading the quality of each piece of evidence after a careful review of the current literature using MEDLINE database and their own clinical experience. Statements were graded for their strength and quality using a system based on the one adopted by the Infectious Diseases Society of America (IDSA). The manuscript was successively reviewed by seven members of the SSTI working group of the international Society of Chemotherapy, and ultimately re-formulated by all e xperts. the microbiological and clinical aspects together with diagnostic features were considered for uncomplicated and complicated SSTIs. Antimicrobial therapy was considered as well -both empirical and targeted to methicillin-resistant Staphylococcus aureus (MRSA) and/or other main pathogens.
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Affiliation(s)
- S Esposito
- Department Infectious Diseases, University Naples, Italy
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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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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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Abstract
Introduction Lymphoedema (LE) is a disorder characterized by persistent swelling caused by impaired lymphatic drainage because of various aetiologies, including lymphatic injury and congenital functional or anatomical defects. Objective Literature review and expert opinion about diagnosis and treatment of LE in children. Results LE is rare in children, with a prevalence of about 1.15/100,000 persons, 20 years old. The management of LE in children differs considerably from adults in terms of origin, co-morbidity and therapeutic approach. The objective of this presentation is to discuss practical issues related to clinically relevant information on the diagnosis, aetiology, work-up and treatment of LE in children. In contrast to adults, who usually experience secondary LE because of acquired lymphatic failure, most cases in children have a primary origin. The diagnosis can be made mainly on the basis of careful personal and family history, and physical examination. LE in children can be part of a syndrome if there are other concomitant phenotypic abnormalities and if a genetic defect is recognizable. Treatment of LE is mostly conservative utilizing decongestive LE therapy including compression therapy, directed exercises, massage and skincare. In the neonate, initial observation alone may be sufficient, as delayed lymphatic development and maturation can result in spontaneous improvement. The role of parents is crucial in providing the necessary input. Conclusion We present a review emphasizing a practical approach to treating a child with LE according to current publications and our own experience.
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Affiliation(s)
- R J Damstra
- Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital Drachten, The Netherlands
| | - P S Mortimer
- Department of Cardiac and Vascular Sciences (Dermatology), St George's Hospital Medical School, University of London, London, UK
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Damstra RJ, van Steensel MAM, Boomsma JHB, Nelemans P, Veraart JCJM. Erysipelas as a sign of subclinical primary lymphoedema: a prospective quantitative scintigraphic study of 40 patients with unilateral erysipelas of the leg. Br J Dermatol 2008; 158:1210-5. [PMID: 18363756 DOI: 10.1111/j.1365-2133.2008.08503.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Erysipelas is a common skin infection that is usually caused by beta-haemolytic group A streptococci. After having had erysipelas in an extremity, a significant percentage of patients develops persistent swelling or suffers from recurrent erysipelas. We hypothesize that in cases of erysipelas without a clear precipitating agent, subclinical pre-existing congenital or acquired disturbances in the function of the lymphatic system are present. The persistent swelling after erysipelas is then most likely caused by lymphoedema. OBJECTIVES We designed a study to examine if erysipelas of unknown origin is associated with a pre-existent insufficiency of the lymphatic system. If our hypothesis is correct, patients with erysipelas of unknown cause without previously evident lymphoedema should have evidence of disturbed lymphatic transport in the unaffected extremity. METHODS A prospective study, in which lymphoscintigraphy of both legs was performed in patients 4 months after presenting with an episode of erysipelas only in one leg. No patient had any known risk factor for erysipelas, such as diabetes mellitus, chronic venous insufficiency or clinical signs of lymphoedema. Lymphoscintigraphy was performed in 40 patients by subcutaneous injection of Tc-99m-labelled human serum albumin in the first web space of both feet. After 30 and 120 min, quantitative and qualitative scans were performed using a computerized gamma camera. During the lymphoscintigraphy, the patients performed a standardized exercise programme. Lymph drainage was quantified as the percentage uptake of Tc-99m-labelled human serum albumin in the groin nodes at 2 h after injection. Groin uptake of < 15% is pathological; uptake between 15-20% is defined as borderline, and uptake of > 20% as normal. RESULTS The mean +/- SD percentage uptake in the groin nodes in the affected limbs was 9.6 +/- 8.5% vs. 12.1% +/- 8.9% in the nonaffected limbs. The mean paired difference in uptake between the nonaffected vs. affected side was 2.5% (95% confidence interval 1.1-3.9%). This indicates that lymphatic drainage in the nonaffected limb was only slightly better than in the affected limb despite the infectious event in the latter. Of 33 patients with objective impairment of lymph drainage in the affected limb, 26 (79%) also had impaired lymph drainage in the nonaffected limb. Agreement in qualitative measurements between affected and nonaffected leg was less pronounced: 21 patients had abnormal qualitative results in the affected leg of whom nine also had impairment of the nonaffected leg (43%). CONCLUSIONS Erysipelas is often presumed to be purely infectious in origin, with a high rate of recurrence and a risk of persistent swelling due to secondary lymphoedema. In this study, we show that patients presenting with a first episode of erysipelas often have signs of pre-existing lymphatic impairment in the other, clinically nonaffected, leg. This means that subclinical lymphatic dysfunction of both legs may be an important predisposing factor. Therefore, we recommend that treatment of erysipelas should focus not only on the infection but also on the lymphological aspects, and long-standing treatment for lymphoedema is essential in order to prevent recurrence of erysipelas and aggravation of the pre-existing lymphatic impairment. Our study may change the clinical and therapeutic approach to erysipelas as well as our understanding of its aetiology.
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Affiliation(s)
- R J Damstra
- Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, 9202 NN Drachen, The Netherlands.
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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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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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