Transcript Chapter 14

KAVITA NATHAN
Group 318
It
is a streptococcal infection of the
superficial lymphatic vessels, usually
associated with broken skin on the face.
The area affected is erythematous and
oedematous.
 The patient may be febrile and have a
leucocytosis.
Bacteria
inoculation into an
area of skin, trauma
is the initial event in
the developing
erysipelas
In
erysipelas, the infection rapidly
invades and spreads through the
lymphatic vessels. This can produce
overlying skin "streaking" and
regional lymph node swelling and
tenderness. Immunity does not
develop to the inciting organism.
Regional
lymphnode
swelling
and
tenderness
A
cut in the skin
Problem
with drainage through the veins
or lymph system
Skin
sores( ulcers)
•
Streptococcal toxins are thought to
contribute to the brisk inflammation
that is pathognomonic of this
infection.
they
clearly coexist with streptococci
at sites of inoculation.
Recently,
atypical forms reported
to be caused by :
 * Streptococcus pneumoniae,
 *Klebsiella pneumoniae,
 * Haemophilus influenzae,
 *Yersinia enterocolitica,
 *Moraxella species,
*
Streptococci are the
primary cause of erysipelas.
* Most facial infections are
attributed to group A
streptococci,
*lower extremity infections
being caused by non–group
A streptococci.
Group
A beta- hemolytic streptocci
 Hemolytic streptococcus
Skin infection
Painful rashes
Erythematous rash
Edematous rash
Skin ulcer
Abrasions
Skin ulcer
Insect bite
eczema
Blisters
Fever,
shaking, and chills
Painful, very red, swollen, and warm
skin underneath the sore (lesion)
Skin lesion with a raised border
Sores (erysipelas lesions) on the
cheeks and bridge of the nose
Erysipelas
begins as a small
erythematous patch that progresses to
a fiery-red, indurated , tense, and
shiny plaque
The
lesion classically exhibits raised
sharply demarcated advancing margins.
 Local signs of inflammation
 warmth,
 edema,
tenderness
are universal.
Lymphatic
involvement often
is manifested by
overlying skin
streaking and
regional
lymphadenopathy
More severe
infections may
exhibit numerous
vesicles and
bullae along with
petechiae and
even frank
necrosis.
Erysipelas
is diagnosed based
on how the skin looks. A
biopsy of the skin is usually not
needed.
1)
Erythema Annulare Centrifugum
2) Stasis Dermatitis
3) Cellulitis
4) Erysipeloid
* Eruptions
occur at any
age.
Lesions most often
appear on the
thighs, legs, face,
trunk and arms.
linked to
underlying
diseases , viral ,
bacterial or even
tumor.
* acute bacterial infection of traumatized skin.
 * caused by Erysipelothrix rhusiopathiae (gram
positive rod-shaped bacterium), which cause
animal and human infections.
 * Direct contact between infected meat and
traumatized human skin results in Erysipeloid.
• more common among farmers, butchers, cooks,
homemakers.
 * Lesions most commonly affect the hands.

Antibiotics
such as penicillin are
used to eliminate the infection. In
severe cases, antibiotics may need to
be given through an IV (intravenous
line).
Those who have repeated episodes of
erysipelas may need long-term
antibiotics.
*
Elevation and rest of the affected
limb are recommended to reduce local
swelling, inflammation, and pain.
* Saline wet dressings should be
applied to ulcerated and necrotic
lesions and changed every 2-12 hours,
depending on the severity of the
infection.
*A first-generation
cephalosporin or macrolide,
such as erythromycin or
azithromycin, may be used if
the patient has an allergy to
penicillin.
•Two
new drugs:
• roxithromycin &
pristinamycin,
have been reported to be
extremely effective in the
treatment of erysipelas.
With
treatment, the outcome is
good. It may take a few weeks for
the skin to return to normal.
Peeling is common.
In
some patients, the bacteria may travel
to the blood. This results in a condition
called bacteremia. The infection may
spread to the heart valves, joints, and
bones.
Other complications include:
Return of infection
Septic shock







abscess,
gangrene,
Thrombophlebitis .
acute glomerulonephritis ,
endocarditis ,
septicemia,
streptococcal toxic shock
syndrome.
Patients with recurrent erysipelas
should be educated regarding :
•local antisepstic .
•general wound care.
•Predisposing lower extremity skin
lesions (eg , tineapedis , toe
web intertrigo , stasis ulcers) should
be treated aggressively to prevent
super-infection.
Keep
your skin healthy by
avoiding dry skin and
preventing cuts and scrapes.
This may reduce the risk for
erysipelas.
Patients
with acute infections
involving the extremities should be
encouraged to limit their activity
and keep the limb elevated to
decrease swelling.
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