Erysipelas( erysipelas) - Causes, symptoms and treatment. MF.

Erysipelas( erysipelas) is a disease that is caused by a microorganism - streptococcus and is characterized by a local inflammatory process of the skin and mucous membranes, an increase in temperature and manifestations of intoxication of the body.

The Greek name for the disease is "erysipelas", which literally translates as red skin. This definition very accurately characterizes the appearance of the skin in the acute stage of the disease. The name "erysipelas" is originally Russian. It is believed that it is associated with a change in facial features due to swelling and redness at the height of the disease.

Erysipelas is a widespread infectious disease with a low degree of infectiousness. The disease is found everywhere, 15-20 cases per 10,000 people are diagnosed every year. Up to 70% of all cases occur in the summer and autumn months.

Causes of erysipelas as

The erysipelas are caused by a special microorganism - beta-hemolytic group A streptococcus. In uncomplicated course of the disease, it plays a major role. In conditions of reduced immunity to streptococcal inflammation, representatives of other flora, in particular, staphylococcus aureus, may join. Then the disease proceeds more severely due to the development of purulent complications, worse gives in to treatment.

Beta-hemolytic streptococcus is highly resistant to environmental factors. It permanently remains viable upon drying, freezing, when the temperature rises to 560 ° C, it dies only after 30 minutes. At the same time standard disinfectant solutions completely destroy the pathogen.

The factors that contribute to infection of erysipelas include:

• existing diseases associated with damage to the integrity of the skin and skin nutrition disorders: fungal skin damage, diabetes mellitus, obesity, chronic venous insufficiency;

• permanent traumatization of skin in the performance of professional duties, work related to the constant contamination of the skin( miners), prolonged wearing of rubber shoes, etc.;

• decreased immunity after a disease, hypothermia, hypovitaminosis;

• Presence of sources of chronic infection( tonsillitis, dental caries, otitis, etc.).

The source of infection is a sick person with signs of erysipelas or a carrier. The patient is called the patient, in whose organism streptococcus is constantly present without the appearance of characteristic symptoms of erysipelas.

Streptococcus enters the human body with dirty hands, clothes, shoes, as well as non-observance of sterilization rules with dressings and medical instruments. To penetrate the microorganism, we need the so-called "gateway infection."This can be a scratch, scrub, crack, insect bites, especially if they have been combed, and sometimes even invisible to the eye, microscopic skin lesions. Erysipelas is formed only in persons with reduced immunity. In other people, the body's own defense systems cope with microorganisms and the disease does not arise. Therefore, the most common erysipelas is diagnosed in the elderly, women during pregnancy and the postpartum period, as well as in people with long-term chronic diseases.

After penetration into the skin of the pathogen begins the process of intensive multiplication of microorganisms. At the same time, a large number of toxins are released, which, entering the bloodstream, cause fever, chills and other manifestations of body intoxication. In the future streptococcus settles in the lymph nodes, where it is destroyed with the help of natural protective factors of the organism or under the influence of antibacterial therapy. In individuals with reduced immunity, the complete death of the pathogen is not possible, which leads to the return of the disease after a while.

Immunity after recovery does not develop. On the contrary, because of the increased sensitivity of the body to streptococcus, in patients after the transferred erysipelas, relapse of the disease more often develops.

Possible symptoms of erysipelas

From infection to the appearance of the first symptoms of erysipelas several hours pass, rarely 2-3 days. As a rule, the disease begins suddenly with an increase in body temperature to 39-40 ° C, the appearance of headache, muscle pain, weakness, nausea, in some cases, vomiting at the time of fever. Very quickly, the lymph nodes increase, primarily in the closest proximity to the affected area.

On the skin in the affected area at the beginning of the disease there is itching, burning. Approximately within a day at this place develops pain, fever, reddening, which literally in a few hours significantly increases in size. Classical erysipelas is a skin of bright red color with clear boundaries, uneven edges in the form of "tongues of flame", somewhat above the surface of healthy skin.

Erysipelous inflammation of the right lower limb. The characteristic appearance of the affected area: the area of ​​the skin is red, with clear boundaries, uneven edges in the form of "flame tongues."

When feeling, the skin in this area is hot, painful. On the skin, it is possible to form blisters with clear, bloody or purulent contents.

Erysipelous inflammation of the left lower extremity, bullous form. Bubbles are seen, detachment of the upper layers of the skin with the formation of wet surfaces.

Often in the area of ​​redness, hemorrhages, similar to small bruises, form.

Erysipelas in the right shoulder and forearm, hemorrhagic form. Small pinpoint hemorrhages are seen.

The most common inflammation occurs in the nose, on the cheeks in the form of a butterfly, at the corners of the mouth, in the zone of the external auditory canal. Erysipelas of the face. Attention is drawn to the pronounced edema in the affected area.

Less common pathological process is formed in the zone of hair growth on the head, on the skin of the lower extremities. In a minimal percentage of cases, erysipelas is diagnosed in other areas. Erysipelas in the face area is characterized by pronounced edema and soreness.

Elevated body temperature persists with treatment for up to 10 days. Skin manifestations last a little longer - up to 15 days. Relapse of the disease can occur up to 2 years after recovery. Usually, when the illness returns, the patient's state of health does not deteriorate, the disease is diagnosed when soft red spots appear on the skin, the swelling is usually not expressed.

Diagnosis of erysipelatous inflammation

Laboratory methods of investigation do not have independent significance in case of erysipelas, and the diagnosis of erysipelas, in most cases, is made when characteristic clinical signs of the disease are found:

• sudden onset of the disease with fever, expressed intoxication symptoms.

• damage to the skin of the face and lower limbs.

• typical manifestations of erysipelas on the skin.

• enlarged lymph nodes.

• at rest, no pain in the affected area.

Treatment of erysipelas

Patients with erysipelas, despite the leading role of infection in the onset of the disease, usually do not pose a danger to others. Therefore, hospitalization in the infectious department is recommended only in cases of severe disease with a marked manifestation of intoxication, with a significant spread of inflammation, with frequent relapses, and also in any case with the development of the disease in children and the elderly.

With increased body temperature, increased fluid intake is recommended. Antipyretics( aspirin) are indicated only when the temperature rises to 39 ° C and above. In the period of fever, as well as with the development of erysipelas of the skin of the lower limbs, all patients need a bed rest.

Drug therapy for erysipelas includes the following components:

• Antibacterial drugs. For the treatment of the house, preparations are given in the form of tablets. Preference is given to such drugs as erythromycin, doxycycline, azithromycin, ciprofloxacin. In the hospital intramuscularly injected drugs penicillin series and cephalosporins. The course of antibiotic treatment is 7-10 days. After this, when the condition improves, the patient is considered to be non-contagious to others, and can be discharged.

• Anti-inflammatory drugs are recommended for severe swelling and soreness of the skin of the affected area. The most common are drugs such as butadione, chlorotazole, which are prescribed for 10-15 days. At the expressed symptoms of intoxication intravenous drip introduction of solutions( hemodes, isotonic sodium chloride solution, glucose solution) in combination with diuretics and anti-inflammatory drugs is indicated.

• Local treatment of erysipelas is only necessary if there are bubbles in the area of ​​inflammation. Otherwise, the use of ointments and compresses will not only be useless, but also harmful. In the presence of undamaged blisters, they are carefully opened, and after the release of the contents, dressings with rivanol or furacilin are applied. Change of dressings is carried out several times a day. With local hemorrhages, applications with dibunol are recommended.

• From physiotherapeutic methods of treatment in the acute period, it may be recommended to use ultraviolet irradiation on the affected area, as well as on the area of ​​the lymph nodes. For an early recovery, ozokerite, naphthalan ointment, paraffin applications, lidase electrophoresis, calcium chloride are prescribed.

Erysipelas is a disease with a proven development mechanism that, if untimely, can lead to the death of the patient. Therefore, the use of traditional methods of treatment, as well as conspiracies in the already developed lesion of the skin is contraindicated.

After the disease, the patients are under the supervision of the infectious diseases clinic for three months, after the recurrence of erysipelas within two years.

Possible complications of erysipelatous inflammation

Complications of erysipelas, as a rule, occur in the affected area, and occur in 5-8% of cases. With the concomitant infection, abscesses, phlegmons, thrombophlebitis of the veins, lymphangitis( inflammation of the lymphatic vessels) develop. These complications are treated in the department of purulent surgery. Systemic complications of erysipelas develop extremely rarely, only in individuals with a significant decrease in the protective properties of the body. Such conditions include sepsis, infectious-toxic shock, pulmonary embolism, etc. In this case, the patient is hospitalized in the intensive care unit.

Prognosis for erysipelasitis

With timely treatment, complete recovery is possible. In some cases there are relapses of the disease.

Prevention of erysipelatous inflammation

General preventive measures are the observance of the rules of personal hygiene, treatment of skin diseases. If the integrity of the skin is disturbed, timely disinfection and application of an insulating bandage is recommended.

In case of recurrent inflammation with the prophylactic purpose, an antibacterial preparation of bicillin is intramuscularly administered. The dose of the drug and the frequency of administration are calculated individually for each patient, depending on the frequency and severity of the relapses.

Doctor therapist Sirotkina EV