Erysipelas Infection of the Skin and Lymphatics

Erysipelas is a bacterial infection of the superficial layer of the skin. It is also known as the upper epidermis. It extends to the superficial lymphatic vessels within the skin, which are characterized by a raised, well-defined, tender, bright red rash, typically on the face or legs, but which may occur anywhere on the skin. It is a sort of cellulitis disease and is potentially serious.

Erysipelas is typically caused by the bacteria Streptococcus pyogenes, which is also known as A beta-hemolytic streptococci. It grows within the skin like scratches or a sting. It is more superficial than cellulitis and is usually more raised and demarcated. The term is from Greek that means red skin. This is the erysipela's meaning. Further, we will understand the erysipelas treatment and its causes along with its signs and symptoms. 

Erysipelas Meaning in Animals

In animals, erysipelas may be a disease caused by infection with the bacterium Erysipelothrix rhusiopathiae. The disease caused in animals is named Diamond disease of the skin, which occurs especially in pigs. Heart valves and skin are affected. Erysipelothrix rhusiopathiae also can infect humans, but in that case, the infection is understood as erysipeloid.

Signs and Symptoms

Symptoms often occur suddenly. The individuals that are infected with the disease can develop a fever, shivering, chills, fatigue, headaches, vomiting. This leads to their bad health in the first 48 hours only. The red plaque enlarges rapidly and features a sharply demarcated, raised edge. It is going to appear swollen, feel firm, warm, and tender to the touch, and should have a consistency almost like an orange rind. Pain could also be extreme. These signs and symptoms can be studied so as for an effective erysipelas treatment. Pox or insect bite-like marks may appear as a result of a very severe infection. It can also have blisters and petechiae. They are small purple or red spots, with possible skin necrosis. Lymph nodes could also be swollen, and lymphedema may occur. Occasionally, a red streak extending to the lymph gland is also seen in this case. 

The face, arms, fingers, legs, toes, and almost all the parts of the skin are susceptible to infection. This way it can be seen that it tends to favour the extremities. The umbilical stump and sites of lymphoedema also are common sites affected. Fat tissue and facial areas, typically around the eyes, ears, and cheeks, are most vulnerable to infection. Repeated infection of the extremities can cause chronic swelling. Lymphoedema is the name given to common swelling. 

Erysipelas Causes

Streptococcus pyogenes is the most common species of bacteria that causes erysipelas. It is also known as A beta-hemolytic streptococci, less commonly by group C or G streptococci. Staphylococcus aureus is also responsible to cause the disease. Newborns may contract erysipelas from Streptococcus agalactiae, It is also known as B streptococcus. 

The infecting bacteria can enter the skin through minor trauma, human, insect, or animal bites, surgical incisions, ulcers, burns, and abrasions. There could also be underlying eczema, tinea pedis, and it can originate from streptococci bacteria within the subject's own nasal passages or ear. The rash is caused by an exotoxin, and not the Streptococcus bacteria, and is found in areas where no symptoms are present. For example, the infection could also be within the nasopharynx, but the rash is found usually on the epidermis and superficial lymphatics.

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Diagnosis

Erysipelas is typically diagnosed by the clinician watching the characteristic well-demarcated rash following a history of injury or recognition of one of the danger factors. Tests, if performed, may show a high leukocyte count, positive blood culture identifying the organism.

Erysipelas is different from many diseases such as herpes zoster, angioedema, dermatitis, erythema chronicum migrans of early Lyme disease, gout, vasculitis, allergy to a sting, acute drug reaction, deep phlebothrombosis, and diffuse inflammatory carcinoma of the breast. Erysipelas is often distinguished from cellulitis by two particular features, that are, its raised advancing edge and its sharp borders. The redness in cellulitis is not raised and its border is comparatively indistinct. The bright redness of erysipelas has been described as a third differentiating feature. Erysipelas does not affect subcutaneous tissue. Only serum or serous fluid is released and no pus is released. The physician may get misguided by thinking of cellulitis.

Erysipelas Treatment

Depending on the severity, treatment involves either oral or intravenous antibiotics, using penicillin, clindamycin, or erythromycin. The illness symptoms may get resolved in one or two days but for the skin, it may take weeks to return to normal. The FDA approved 4 antibiotics that are omadacycline, oritavancin, dalbavancin, and tedizolid, for the treatment of acute bacterial skin and skin structure infections. Due to the danger of reinfection, prophylactic antibiotics are sometimes used after resolution of the initial condition.

Erysipelas Prognosis

The disease prognosis includes:

• Spread of infection to other areas of the body can occur through the bloodstream (bacteremia), including septic arthritis. Glomerulonephritis can follow an episode of streptococcal erysipelas or other skin infection, but not an infectious disease.

• Recurrence: In several cases, the infection is seen to have occurred again. In 18–30% of cases even after antibiotic treatment. A chronic state of recurrent erysipelas infections can occur with several predisposing factors including alcoholism, diabetes, and athlete's foot. Another predisposing factor is chronic cutaneous edema, which can successively be caused by venous insufficiency or coronary failure. 

• Lymphatic damage

• Necrotizing fasciitis commonly referred to as "flesh-eating" bacterial infection, maybe a potentially deadly exacerbation of the infection if it spreads to deeper tissue.