Name
ERYSIPELAS
DESCRIPTION
DETAIL
CAUSES Group A beta-hemolytic streptococcus primarily; occasionally other strep groups or staph -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS : β’ Erysipeloid (little toxicity) β’ Contact dermatitis (no fever) β’ Angioneurotic edema (no fever) β’ Scarlet fever (usually more widespread without edema) β’ Lupus (of the face, less fever, positive antinuclear antibodies) β’ Polychondritis (of the ear) β’ Dermatophytid β’ Tuberculoid leprosyβ’ Leukocytosis (usually > 15,000) β’ Strep may be cultured from exudate or from noninvolved sites β’ Antistreptolysin (ASO), streptozyme, anti-DNase may be helpful β’ Blood culture (< 5% positive)
TYPENOTES
RISK FACTORS; Operative wounds, Fissured skin (especially at the nose and ears), Any infl amed skin, Traumatic wounds/abrasions, Leg ulcers/stasis dermatitis, Chronic diseases (diabetes, malnutrition, nephrotic syndrome), Immunocompromised.GENERAL MEASURES β’ Symptomatic treatment of aches and fever β’ Adequate fluid intake β’ Local treatment with cold compresse DRUG(S) OF CHOICE : β’ Penicillin V (Pen VK) for at least ten days (improvement in 24-48 hours). Children: 90 mg/kg/day divided q6h; adults: 500 mg/dose q6h (approximately 1000 mg bid). β’ Parenteral antibiotics are recommended for severe or complicated cases (1-2 million units every 4-6 hours) β’ In chronic recurrent infections some authors recommend lower dose daily maintenance/prophylactic treatment after the acute infection resolves ALTERNATIVE DRUGS: β’ Erythromycin. Children: 30-40 mg/kg/day divided q6h; adults: 250-500 mg/dose q6h. β’ Clarithromycin total 1000 mg/day β’ Azithromycin β’ Cephalosporins β’ Consider penicillinase-resistant penicillin such as dicloxacillin 500 mg q6h in facial involvement due to possible staph PATIENT MONITORING: Patients should be treated until all symptoms and skin manifestations have resolved PREVENTION/AVOIDANCE : β’ Maintenance antibiotics for chronic recurrent cases β’ Men who shave within fi ve days of facial erysipelas are more likely to have a recurrence β’ In recurrent cases, search for other possible source of streptococcal infection (e.g., tonsils, sinuses, teeth, toenails, etc.) POSSIBLE COMPLICATIONS : β’ Bacteremia β’ Scarlet fever β’ Pneumonia β’ Abscess β’ Embolism β’ Gangrene β’ Meningitis β’ Sepsis β’ Death EXPECTED COURSE/PROGNOSIS : β’ Adequate treatment results in full recovery β’ Chronic edema/scarring can result from chronic recurrent cases β’ Rarely elephantiasis may result from chronic recurrent cases β’ Untreated cases sometimes will resolve spontaneously AGE-RELATED FACTORS: Pediatric: β’ Group B strep may be a cause in neonates/infants β’ Abdominal involvement more common in infants β’ Face, scalp, and leg common in older children Geriatric: β’ Fever may not be as prominent β’ More prone to complications β’ High output cardiac failure may occur in debilitated patients with underlying cardiac disease β’ Face and lower extremity most common areas
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, PUS CULTURE TEST, GRAM STAINING