Erysipelas

Erysipelas is an acute streptococcal disease characterized by a skin lesion with the formation of a sharply limited inflammatory focus, as well as fever and symptoms of general intoxication, frequent relapses.

Etiology, pathogenesis. The causative agent - hemolytic streptococcus - is no different from the causative agent of other streptococcal diseases (eg, angina). Penetrates through small damage to the skin. Possible exogenous infection (contaminated instruments, dressings). In the occurrence of recurrences of erysipelas, allergic restructuring and sensitization of the skin to hemolytic streptococcus is important in the same place.

Symptoms, course. Duration of the incubation period from several hours to 5 days (usually 3-4 days). According to the nature of local lesions, there are erythematous, erythematous-bullous, erythematous-hemorrhagic and bullous forms, gravity-light, moderate and severe, in multiplicity - primary, recurrent and repeated, localization of local phenomena - localized, widespread and metastatic. Primary mug begins, as a rule, acute, with symptoms of general intoxication. Body temperature rises to 39-40 g. ° C, there is general weakness, chills, headache, myalgia, in severe cases, there may be convulsions, delirium, irritation of the meninges. After 10-24 hours from the onset of the disease, local symptoms are noted: pain, burning and a feeling of tension in the affected area of ​​the skin, and the examination reveals hyperemia and swelling of the skin. Erythema more often uniform, towering above a level of a skin. Edema is especially pronounced when the inflammation is localized in the area of ​​the eyelids, lips, fingers, genitals. Sometimes, on the background of erythema, bubbles are formed, filled with serous (vesicular-bullous) or hemorrhagic (bullous-hemorrhagic erysipelas) contents. Lymphangitis and inflammation of the regional lymph node are also noted. On the site of inflammation in the future there is peeling of the skin. Local changes last 5-15 days; Can last a long time pasty and pigmentation of the skin.

Recurrences of erysipelas can occur between a few days to 2 years after the illness. At a later (more than 2 years) appearance of erysipelas speak of a repeated face. It is usually localized on a new area of ​​the skin. Recidivation is facilitated by insufficient treatment of the primary erysipelas, residual phenomena after erysipelas (lymphostasis, etc.). With frequent relapses, fever and symptoms of intoxication are not pronounced.

The complications and consequences of erysipelas may be the same as in other streptococcal diseases (rheumatism, nephritis, myocarditis), but they may also be specific for erysipelas: ulcers and necrosis of the skin (gangrenous erysipelas), abscesses and phlegmons (abscessed erysipelas), lymphatic impairment , Leading to elephantia. In clinical diagnosis, it is necessary to differentiate from other diseases in which local redness and swelling of the skin can occur (venous thrombosis, erysipiloid, phlegmon and abscesses, acute dermatitis, etc.). In the study of blood there is a small leukocytosis, neutrophilia, an increase in ESR. Immunity after mug does not arise.

Treatment. The antibiotics of the penicillin series are most effective. In the initial face and rare relapses, penicillin is prescribed for a dose of 500,000 units after 6 hours for 7-10 days, at the end of the course bicillin-5 (1500000 units IM) is additionally injected. With significant residual events for the prevention of recurrence, bicillin-5 should be administered within 4-6 months (1,500,000 units every 4 weeks). If penicillin is intolerant, you can prescribe erythromycin (0.3 g 5 times per day) or tetracycline (0.3-0.4 g 4 times a day), the course duration is 7-10 days. With persistent and frequent relapses, antibiotics are combined with corticosteroids (prednisolone 30 mg / day).

The prognosis is favorable. With often recurrent erysipelas, elephantism may occur, disrupting work capacity,

Prevention. Prevention of injuries and abrasions of legs, treatment of streptococcal diseases. If the seasonality of relapses is pronounced, bicillin prophylaxis is carried out, which begins a month before the start of the season and lasts for 3-4 months (every 4 weeks of bicillin-5 injected at 1,500,000 units). With frequent recurrences of erysipelas, year-round bicillin prophylaxis is performed. There are no events in the outbreak. There is no specific prevention.