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Erysipelas


Infectious disease with general intoxication and inflammation of the skin. The causative agent is erysipelatous streptococcus, is stable outside the human body, tolerates drying and low temperature, dies when heated to 56 ± C for 30 minutes. The source of the disease is the patient and the carrier. Contagiousness (contagion) is insignificant. The disease is recorded in the form of individual cases. Infection occurs mainly in violation of the integrity of the skin contaminated objects, tools or hands.
By the nature of the lesions are distinguished:
1) erythematous form in the form of redness and swelling of the skin; 2) hemorrhagic form with symptoms of blood vessel permeability and bleeding; 3) the bullous form with blisters on the inflamed skin, filled with serous exudate.
According to the degree of intoxication emit - light, moderate, heavy. By multiplicity - primary, recurrent, repeated.
According to the prevalence of local manifestations - localized (nose, face, head, back, etc.), wandering (moving from one place to another) and metastatic.
Symptoms and course:
The incubation period is from 3 to 5 days. The onset of the disease is acute, sudden. On the first day, symptoms of general intoxication are more pronounced (severe headache, chills, general weakness, nausea, vomiting, fever up to 39-40 ± C).
Erythematous form. After 6-12 hours from the onset of the disease, there is a burning sensation, pain in the arching nature, redness (erythema) on the skin and swelling at the site of inflammation. The area affected by erysipelas is clearly separated from the healthy by an elevated, sharply painful roller. The skin in the hearth is hot to the touch, tense. If there are punctate hemorrhages, then they say about erythematous and hemorrhagic form of erysipelas. In the case of a bullous face against the background of erythema at various times after its appearance, bulle elements are formed - bubbles containing a clear and transparent liquid. Later, they subside, forming dense brown crusts, rejected in 2-3 weeks. In place of blisters erosion and trophic ulcers may form. All forms of erysipelas are accompanied by damage to the lymphatic system - lymphadenitis, lymphangitis.
Primary erysipelas is more often localized on the face, recurrent on the lower limbs. There are early relapses (up to 6 months) and late (over 6 months). Concomitant diseases contribute to their development. Of greatest importance are chronic inflammatory foci, diseases of the lymphatic and blood vessels of the lower extremities (phlebitis, thrombophlebitis, varicose veins); diseases with a pronounced allergic component (bronchial asthma, allergic rhinitis), skin diseases (mycoses, peripheral ulcers). Relapses occur as a result of adverse professional factors.
The duration of the disease, local manifestations of erythematous erysipelas pass by 5-8 days of illness, with other forms they can last more than 10-14 days. Residual manifestations of erysipelas - pigmentation, desquamation, pastoznost skin, the presence of dry dense crusts in place of the bullous elements. Perhaps the development of lymphostasis, leading to elephantish limbs.
Treatment:
It depends on the form of the disease, its frequency rate, the degree of intoxication, the presence of complications. Etiotropic therapy: penicillin antibiotics in average daily dosages (penicillin, tetracycline, erythromycin or oleandomycin, goletrip, etc.). Samples of sulfonamides, combined chemotherapy drugs (bactrim, septin, biseptol) are less effective. The course of treatment is usually 8-10 days. With frequent persistent relapses, ceporin, oxacillin, ampicillip, and methicillin are recommended. It is desirable to conduct two courses of antibiotic therapy with a change of drugs (intervals between courses of 7-10 days). With often recurrent erysipelas, corticosteroids are used at a daily dosage of 30 mg. With persistent infiltration, non-steroidal anti-inflammatory drugs are indicated - chlotazol, butadione, reopirin, etc. It is expedient to prescribe ascorbic acid, rutin, and vitamins of group B. Autohemotherapy gives good results.
The eastern period of the disease at the site of inflammation shows the appointment of UFO, UHF, followed by the use of ozokerite (paraffin) or naphthalan. Local treatment of uncomplicated erysipelas is carried out only in its bullous form: a bulla is incised at one of the edges and dressings are applied to the inflammatory focus with a solution of rivanol and furatsilina. Subsequently prescribed dressings with Ekteritsin, Shostakovsky balm, as well as manganese-petroleum jelly dressings. Topical treatment alternates with physiotherapy procedures.
The prognosis is favorable.
Prevention of erysipelas in persons exposed to this disease is difficult and requires careful treatment of concomitant diseases of the skin, peripheral vessels, as well as the rehabilitation of foci of chronic streptococcal infection. Erysipelas does not give immunity, there is a special hypersensitivity of all those who have been ill.