Erysipelas

The erysipelas is an acute bacterial infection of traumatized skin and other organs. It is caused by the microorganism Erysipelothrix rhusiopathiae. Direct contact with infected meat and traumatized human skin cause erizipeloidul. It is a disease. People acquire the infection by direct contact with infected animals. The disease is more common among farmers, butchers, chefs. Infection occurs mainly in summer or autumn.
Erizipeloidul infection is an acute self-limited skin that resolve without sequelae. People with the systemic type, in which organs are involved, other than skin may be neurological or cardiac alterations. People with systemic infection in sepsis patients may die if treatment is not started properly.
The antibiotic of choice is penicillin. For those allergic to penicillin may use third-generation cephalosporins, other macrolides. Cutaneous form of the disease is self-limiting and has a good prognosis. The form of the system depends on the organs involved and the extension of damage. Early recognition of infection and are crucial for appropriate therapy to prevent sequelae: cerebrovascular accident, endocarditis, septic arthritis.
Pathogenesis and causes
Erysipelothrix rhusiothiae is a bacteria resistant to the environment. It penetrates the skin through erosion or small wounds, produces enzymes that help dissecting tissues, neuraminidase and invade tissue. Host immune system is activated to fight off bacteria. The body can escape immunity and can spread through the body via the vascular system to the joints, heart, brain and lungs. The most commonly affected organ after the skin is the heart. Three forms of Erysipelothrix rhusiopathiae erizipeloid cause. It is a fine bacilli, gram-positive straight or slightly curved. It is present in soil and animal manure, fish and birds. At the risk of developing infection are farmers, butchers.
Signs and symptoms
Erizipeloidul can affect any age group. It shows the people in three clinical forms. Localized cutaneous form of erizipeloidul Rosenbach, and diffuse cutaneous form of systemic infection, bacteremia generalized. You can develop endocarditis. In the first two forms the patient has local burning sensation at the lesion. They may not make fever, malaise and other constitutional symptoms. In generalized form accuses patients fever, chills, joint pain, cough, headache, according to the body concerned.
Physical examination
Localized form. Lesions affecting the hands, finger joints, however, any exposed area of the body may be affected. Lesions consist of well-demarcated red tiles with a shiny surface smooth. The lesions are soft and warm. Leave a brown stain on the skin when it solved. Sometimes blisters may be present.
Diffuse cutaneous form. Multiple lesions appear on different parts of the body. Lesions are well demarcated, purple, white center with deep edges.
Systemic form. The skin lesions may not be apparent. If they are present they appear as localized areas of swelling surrounding a necrotic center. The skin lesions may be present as follicular papules, erythematous. Endocarditis is the most common but rare manifestation of systemic erizipeloidului. Complications include permanent neurological impairment, valvular disease, endocarditis term septic arthritis and joint disease long term.
Diagnosis
Laboratory studies: Gram-staining of the lesion taken show gram-positive cocci, a test is usually negative because the infection is deep Bacterial culture on special media-enriched saline at room temperature -Blood cultures in the diagnosis of systemic erizipeloidului -Skin biopsy may confirm the diagnosis. Other studies: If endocarditis is suspected, echocardiography Computed tomography or magnetic resonance, to exclude a brain abscess or cerebral infarction Chest-radiography or computed tomography if it is suspected pleurisy Bone-scan or magnetic resonance if it is suspected bone necrosis.
Histological examination. Show sponginess with intraepidermal epidermal veziculizare. Marked edema of the papillary dermis with dilated blood vessels. in the reticular dermis with perivascular inflammatory infiltrates observed neutrophils and eosinophils. The differential diagnosis is made with the following conditions: cellulitis, erysipelas.
Treatment
The antibiotic of choice for all three forms of erizipeloid is penicillin. For patients allergic to penicillin can choose to ceftriaxone, ciprofloxacin or erythromycin and rifampin. Organism is resistant to vancomycin. The bacteria can be destroyed from the surfaces by using ordinary household disinfectants. Cutaneous forms of the disease are usually self-limiting even without treatment so the skin is limited erizipeloidul a good prognosis without long term sequelae. The prognosis of systemic forms depends on the organs affected and the spread of the infection. Early recognition and appropriate therapy will prevent sequelae.