Asunto(s)
Amoxicilina/administración & dosificación , Pabellón Auricular/patología , Erisipela , Celulitis Orbitaria/diagnóstico , Policondritis Recurrente/diagnóstico , Anciano , Antibacterianos/administración & dosificación , Diagnóstico Diferencial , Erisipela/diagnóstico , Erisipela/tratamiento farmacológico , Erisipela/fisiopatología , Eritema/diagnóstico , Dolor Facial/diagnóstico , Dolor Facial/etiología , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Erysipelas, an acute infection of the dermal and subcutaneous tissue, is normally treated with antibiotics. Previous data indicated that treatment with prednisone in combination with antibiotics results in significant acceleration of the healing phase. OBJECTIVES: To investigate the effectiveness of corticosteroids combined with antibiotics for the treatment of erysipelas. METHODS: A retrospective study was conducted on hospitalized patients diagnosed with erysipelas between 2004 and 2011 at the Department of Dermatology at Sheba Medical Center, Israel. Data included epidemiology, medical background, and course of the disease as documented at admission and during hospitalization. RESULTS: Data were collected on 173 patients (66% males) who were divided into two groups: a control group treated with antibiotics only (97 patients) and a study group treated with antibiotics and prednisone (76 patients). The study group presented with a more severe form of erysipelas (bullous) and those patients were hospitalized for a longer period (8.5 vs. 7 days). Nevertheless, the study group exhibited a 71% clinical improvement shortly after being treated with prednisone, without significant side effects. Short-term follow-up revealed more edema in the study group; however, long-term follow-up revealed a higher incidence of erythema and recurrence of erysipelas in the control group. The return to full function was faster in the study group than in the control group. CONCLUSIONS: Combining prednisone with antibiotics for the treatment of erysipelas should be considered, especially in severe cases. In addition, a prospective double-blind study should be conducted to verify these conclusions.
Asunto(s)
Antibacterianos/administración & dosificación , Erisipela/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Hospitalización/estadística & datos numéricos , Prednisona/administración & dosificación , Adulto , Anciano , Quimioterapia Combinada , Erisipela/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Israel , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Hemophagocytosis is well known in cytotoxic cutaneous T-cell lymphomas (CTCLs), in which it may represent a sign of hemophagocytic lymphohistiocytosis syndrome (HLHS), and is also typical of cutaneous Rosai-Dorfman disease (cRDD) (without prognostic relevance). Only rarely, has cutaneous hemophagocytosis (CH) been described in other skin conditions. OBJECTIVE: To characterize the clinicopathologic features of CH in skin biopsy specimens from patients with conditions other than CTCL or cRDD. METHODS: Case series analyzing clinicopathologic features and follow-up data on patients presenting with histopathologic signs of CH. RESULTS: Biopsy specimens from 21 patients were included. None of the patients had HLHS. The majority (n = 11) presented with leukocytoclastic vasculitis. Other associated diseases were lupus erythematous (n = 2), arthropod bite reaction (n = 2), erysipelas (n = 1), acne conglobata (n = 1), and Sweet syndrome (n = 1). Three patients had a nonspecific rash concomitant with Chlamydia pneumonia, middle ear infection, and pharyngitis, respectively. LIMITATIONS: This was a single-center, retrospective study. CONCLUSION: Isolated CH in conditions other than CTCL and cRDD is a histopathologic finding related mostly to leukocytoclastic vasculitis. Extensive investigations should be performed only if patients have other signs or symptoms of HLHS.
Asunto(s)
Linfohistiocitosis Hemofagocítica/patología , Fagocitosis , Vasculitis Leucocitoclástica Cutánea/patología , Vasculitis Leucocitoclástica Cutánea/fisiopatología , Acne Conglobata/patología , Acne Conglobata/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Plaquetas , Preescolar , Erisipela/patología , Erisipela/fisiopatología , Eritrocitos , Femenino , Humanos , Mordeduras y Picaduras de Insectos/patología , Mordeduras y Picaduras de Insectos/fisiopatología , Leucocitos , Lupus Eritematoso Cutáneo/patología , Lupus Eritematoso Cutáneo/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Síndrome de Sweet/patología , Síndrome de Sweet/fisiopatología , Adulto JovenRESUMEN
El estreptococo B hemolítico del grupo A es una bacteria aerobia Gram +, que puede producir una gran variedad de síndromes infecciosos en el puerperio. Hasta un tercio de las infecciones se complicará con un shock tóxico estafilocócico, caracterizado por shock y disfunción multiorgánica. Cultivos, diagnóstico y tratamiento precoces son vitales para el buen pronóstico. Presentamos el caso de una paciente puerperal con un síndrome de shock tóxico estreptocócico, complicado con una isquemia mesentérica masiva, donde tratamiento antibiótico y cirugía precoz fueron claves para la evolución
B hemolytic group A streptococcus is an aerobic Gram-positive bacteria that can produce a wide variety of infectious syndromes in the puerperium. Up to one-third of infections will be complicated by streptococcal toxic shock, characterized by shock and multiorgan dysfunction. Early cultures, diagnosis and treatment are vital to good prognosis. We present the case of a puerperal patient with streptococcal toxic shock, complicated by massive mesenteric ischemia, in whom antibiotic treatment and early surgery were the key to outcome
Asunto(s)
Femenino , Humanos , Embarazo , Isquemia Mesentérica/metabolismo , Isquemia Mesentérica/patología , Infecciones del Sistema Genital/diagnóstico , Infecciones Estreptocócicas/metabolismo , Infecciones Estreptocócicas/virología , Colitis Isquémica/metabolismo , Colitis Isquémica/patología , Erisipela/fisiopatología , Isquemia Mesentérica/complicaciones , Isquemia Mesentérica/diagnóstico , Infecciones del Sistema Genital/metabolismo , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Colitis Isquémica/complicaciones , Colitis Isquémica/enzimología , Erisipela/clasificaciónRESUMEN
AIM: To establish the features of clinical and laboratory changes in facial erysipelas in relation to its form. SUBJECTS AND METHODS: Twenty-three patients (15 women and 8 men) aged 31 to 78 years who were diagnosed with moderate facial erysipelas, primary facial erysipelas being present in 91% of cases were examined. The investigators studied the biochemical substrates and enzymes and composition of proteins in the serum by an electrophoretic method, the aggregation activity of red blood cells and platelets, plasma hemostasis (a coagulogram, levels of fibrinogen, antithrombin III, and D-dimer), and von Willebrand factor, a marker of vessel wall injury, on hospital admission at disease onset (days 1-3), over time (days 4-6, 7-9), and in convalescence (days 10-12), by obligatorily using control materials. CONCLUSION: Bleeding disorders in facial erysipelas correspond to the vasculite purpuric type of hemorrhagic diathesis (according to the classification developed by Z. S. Barkagan) with the laboratory signs of evolving disseminated intravascular coagulation: impairments in erythrocyte hemostasis and blood vessel endothelium. The changes in the functional properties of red blood cells match with the suppression of metabolic processes. And if the neuraminidase effect of ß-hemolytic streptococcus is shown at the level of the red blood cell membrane, the activity of NADase blocks processes in the entire macroenergetics. In the presence of a high fever reaction, the low levels of transaminases (aspartate aminotransferase, alanine aminotransferase) and membrane enzymes (alkaline phosphatase, creatinine phosphokinase) decrease the detoxification capacities of serum and increase a load on blood albumin and erythrocyte barriers. Rapid normalization of C-reactive protein levels enables one to use this simple and highly sensitive test to monitor the involution of erysipelatous inflammation and the efficiency of treatment. The changes in the hemostatic system and metabolic tests are less pronounced in patients with facial erysipelas than in those with lower-extremity erysipelas.
Asunto(s)
Trastornos de la Coagulación Sanguínea/fisiopatología , Erisipela/fisiopatología , Dermatosis Facial/fisiopatología , Hemostasis , Adulto , Anciano , Trastornos de la Coagulación Sanguínea/etiología , Proteína C-Reactiva/metabolismo , Electroforesis/métodos , Erisipela/sangre , Agregación Eritrocitaria , Eritrocitos/metabolismo , Dermatosis Facial/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agregación PlaquetariaRESUMEN
The aim of the investigation was to study the implication of infectious endotoxicosis in the pathogenesis of erysipelas, by measuring the level of malondialdehyde and the proinflammatory cytokine tumor necrosis factor-a (TNF-a) depending on the stage, severity, pattern of the disease, and possible complications. Fifty-six patients with erysipelas were followed up. Their blood level of malondialdehyde and TNF-a was determined at the height of the disease and during the reduction of clinical symptoms, and early convalescence. There was an increase in the study indicators, which depended on the period and severity of the disease and the presence of comorbidity and complications. The changes found in the study indicators characterize the development of intoxication syndrome in erysipelas and make possible their use to evaluate the severity of the diseases, the presence of complications, and the completeness of recovery.
Asunto(s)
Biomarcadores/sangre , Endotoxinas/efectos adversos , Erisipela/diagnóstico , Erisipela/etiología , Factor de Necrosis Tumoral alfa/sangre , Progresión de la Enfermedad , Erisipela/fisiopatología , Eritema , Femenino , Estudios de Seguimiento , Humanos , Inflamación , Peroxidación de Lípido , Masculino , Malondialdehído/sangre , RecurrenciaRESUMEN
The time course of changes in the values of proinflammatory tumor necrosis factor-alpha (TNF-alpha) and IL-8 and the anti-inflammatory cytokine IL-4 has been studied in 78 patients with erysipelas of different frequencies and pathomorphological forms of the disease. In erysipelas and its erythematous form, there is an increase in the levels of TNF-alpha and IL-8 in early phase of the disease, a decrease in these indices during convalescence, and a rise in the content of the cytokine IL-4, which are typical of an acute cyclic infectious process with a good outcome. In recurrent erysipelas and its most severe bullous-hemorrhagic form, there is imbalance in the production of cytokines that are suggestive of that there might be a disease recurrence. In erysipelas patients with a TNF-alpha value of 2.5 pg/ml or less at the onset of the disease, the relative risk for prolonged signs of systemic and local inflammatory reactions increases as compared with those who have a TNF-alpha level of more than 2.5 pg/ml.
Asunto(s)
Citocinas/sangre , Erisipela/sangre , Erisipela/inmunología , Erisipela/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Factores de TiempoRESUMEN
Erysipelas is an infectious disease caused by group A beta hemolytical streptococci which may produce renal lesions, most frequently glomerular disease. Renal injury although known is less studied in practice. Rarely bioptical exams have been performed, thus the problem of the relationship erysipelas glomerular disease is practically not solved. The aim of this study was a cross-sectional analysis of renal involvement produced by erysipelas in two departments where patients with erysipelas are diagnosed and treated: Dermatology and Infectious Diseases. We investigated 166 patients (86M, 80F; mean age 61.66 +/- 18.42) with erysipelas hospitalized in the Departments of Dermatology (55 patients-33%) and Infectious Diseases (111 patients-66%) during 2005-2009. The diagnosis was established on clinical and biological data. In these patients clinical and biological exam has been performed. We assessed GFR and urinalysis (hematuria and proteinuria). The control group consisted of 110 apparently healthy persons. Of the 166 patients with erysipelas we found asymptomatic urinary abnormalities in 82 (47%), isolated proteinuria in 19 (11%) patients and proteinuria associated with hematuria in 21 (13%) patients, and isolated hematuria in 38 (23%) patients. We did not find patients with nephrotic or nephritic syndrome. In the control group we found asymptomatic urinary abnormalities in 25 (23%) of the patients. A statistically significant difference was between the two groups (p < 0.01). Asymptomatic urinary abnormalities have been more frequent in patients with erysipelas from the Infectious Diseases Department compared to those from the Dermatology Department. A statistically significant difference has been found (p < 0.03). In patients with recurrent erysipelas (43 patients-26%) we found asymptomatic urinary abnormalities in 26 (54%) of the patients compared to the presence of asymptomatic urinary abnormalities in patients with acute erysipelas in 56 out of 123 (46%). Mean GFR in patients with erysipelas was of 73.94 +/- 27.79 ml/min. It was lower in patients with recurrent erysipelas, 72.13 +/- 24.74 mL/min respectively. Association of proteinuria with hematuria was more frequent in patients with recurrent erysipelas. Patients with asymptomatic urinary abnormalities during the course of erysipelas need to be closely monitored during antibiotic treatment.
Asunto(s)
Erisipela , Glomerulonefritis , Infecciones Estreptocócicas , Streptococcus pyogenes/patogenicidad , Adulto , Anciano , Antibacterianos/uso terapéutico , Enfermedades Asintomáticas , Estudios Transversales , Monitoreo de Drogas , Erisipela/tratamiento farmacológico , Erisipela/microbiología , Erisipela/fisiopatología , Erisipela/orina , Femenino , Tasa de Filtración Glomerular , Glomerulonefritis/diagnóstico , Glomerulonefritis/etiología , Glomerulonefritis/fisiopatología , Glomerulonefritis/orina , Hematuria/etiología , Humanos , Riñón/patología , Masculino , Persona de Mediana Edad , Proteinuria/etiología , Recurrencia , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/fisiopatología , Infecciones Estreptocócicas/orinaRESUMEN
Dermatologists frequently are consulted in the evaluation and management of the patient with cellulitic-appearing skin. For routine cellulitis, the clinical presentation and patient symptoms are usually sufficient for an accurate diagnosis. However, when the clinical presentation is somewhat atypical, or if the patient fails to respond to appropriate therapy for cellulitis because of routine bacterial pathogens, the differential diagnosis should be rapidly expanded. We discuss the approach to the patient with presumed cellulitis, with an emphasis on the differential diagnosis of cellulitis in both the immunocompetent and immunucompromised patient.
Asunto(s)
Antibacterianos/uso terapéutico , Neoplasias de la Mama/radioterapia , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/tratamiento farmacológico , Erisipela/diagnóstico , Recurrencia Local de Neoplasia/radioterapia , Radioterapia/efectos adversos , Celulitis (Flemón)/patología , Diagnóstico Diferencial , Erisipela/fisiopatología , Femenino , Humanos , Huésped Inmunocomprometido , Persona de Mediana EdadRESUMEN
Streptococcus pyogenes is considered as the primary cause of erysipelas and the virulence factors of this species are reviewed. The role of Staphylococcus aureus alone or associated with Streptococcus pyogenes remains unclear. Other etiologies are infrequent. Several techniques were used to detect bacteria (direct examination, culture, antigen or genome assay) in local samples (needle aspiration, swab.), in others sites (throat, blood cultures), or specific antibodies. The performance of the various diagnosis methods is evaluated. Despite the combination of 2 or more methods, the etiology remains unknown in almost 20 p. 100 of the cases.
Asunto(s)
Erisipela/microbiología , Erisipela/diagnóstico , Erisipela/fisiopatología , Humanos , Pruebas SerológicasRESUMEN
Erysipelas are common dermo-hypodermal infections. In spite of that, different questions are not clearly resolved. To improve our knowledge of this infection, it is important to have epidemiological, microbiological and diagnostical data. The current data are summarized in this article after a bibliographic research. The epidemiology has changed, with an increase of the number of erysipelas of the leg whereas face localization is less frequent. Some facilitating factors can be individualized, like circulatory insufficiency of the legs. There are only few data concerning pathophysiology. The diagnosis is mainly made on clinical symptoms. There is no specific diagnostic test. The bacteria that cause erysipelas is rarely isolated in clinical practice. The group A Streptococcus is the most frequent bacteria in erysipelas. It is important for physicians, to have a better knowledge of this infection, so that the efficacy of the treatment can be improved.
Asunto(s)
Erisipela/terapia , Erisipela/diagnóstico , Erisipela/epidemiología , Erisipela/microbiología , Erisipela/fisiopatología , Humanos , Factores de RiesgoRESUMEN
Erysipleas, also known as Saint Anthony's fire, is an acute infection of the skin caused, in most of cases, by group A streptococci. In the past, the most common site of involvement was the face and, in the pre-antibiotic era, mortality was high. In this retrospective study, we highlight the clinical and bacteriological features and report follow-up in 92 patients hospitalized in an internal medicine unit between 1st March 1992 and 31st December 1996 for 94 episodes of erysipelas. The involvement of the lower limbs predominated as involvement of the face is becoming very rare. Streptococci from others groups and Staphylococcus aureus have been implicated on occasions. Recovery is usual even if this infection may greatly weaken these often fragilized patients. In this paper, antibiotic treatment as well as the place of anticoagulants and Doppler ultrasound are discussed. Hospitalization is often necessary but it must not be systematic.
Asunto(s)
Erisipela/fisiopatología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Erisipela/diagnóstico por imagen , Erisipela/tratamiento farmacológico , Erisipela/microbiología , Dermatosis Facial/microbiología , Dermatosis Facial/fisiopatología , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Pierna/irrigación sanguínea , Dermatosis de la Pierna/diagnóstico por imagen , Dermatosis de la Pierna/microbiología , Dermatosis de la Pierna/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Cutáneas Estafilocócicas/fisiopatología , Streptococcus/clasificación , Streptococcus pyogenes/fisiología , Ultrasonografía Doppler , Trombosis de la Vena/diagnóstico por imagenRESUMEN
INCIDENCE AND GRAVITY: Invasive Streptococcus pyogenes infections are a common reason for hospitalization. Serious forms may occur in patients with no known risk factor, including young patients. Inversely, erysipela is observed more readily in the elderly population with a more vulnerable venous system. Disease gravity is related to the high risk of recurrence. For cellulitis, predominantly a disease of young subjects with no past history, severity is related to local extension and development of shock syndrome. Besides the immediate life-threatening situation, functional prognosis may be compromised, depending on the localization of the infection. PATHOGENESIS OF GROUP A STREPTOCOCCAL INFECTIONS: Adherence and invasion properties of group A streptococci, particularly the capsule and protein M, as well as streptococcal toxins cause severe septic and toxinic syndromes. Strains most frequently associated with invasive infections are: biotype 1, serotype M1 and biotype 3, serotype M3. TREATMENT: An antibiotic regimen by intravenous infusion of penicillin G is the gold standard treatment. Clindamycin should be added in case of septic shock. Extensive cellulitis or necrotizing fasciitis requires surgical debridement of the necrotic tissue and intensive care for the shock syndrome.
Asunto(s)
Celulitis (Flemón)/fisiopatología , Erisipela/fisiopatología , Penicilina G/uso terapéutico , Enfermedades Cutáneas Bacterianas/fisiopatología , Infecciones Estreptocócicas/fisiopatología , Streptococcus pyogenes , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/microbiología , Erisipela/tratamiento farmacológico , Humanos , Penicilinas/uso terapéutico , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/cirugíaRESUMEN
The practicing dermatologist is faced with an ever-changing epidemiologic spectrum of cutaneous bacterial diseases. Studies have stated that bacterial skin infections may account for up to 17% of clinical visits. It is hoped that the information presented in this article will enable the practicing dermatologist to provide improved patient care in the diagnosis and management of bacterial infections of the skin.
Asunto(s)
Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/terapia , Erisipela/diagnóstico , Erisipela/fisiopatología , Erisipela/terapia , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/fisiopatología , Fascitis Necrotizante/terapia , Foliculitis/diagnóstico , Foliculitis/fisiopatología , Foliculitis/terapia , Humanos , Impétigo/diagnóstico , Impétigo/fisiopatología , Impétigo/terapia , Linfangitis/diagnóstico , Linfangitis/fisiopatología , Linfangitis/terapia , Enfermedades Cutáneas Bacterianas/fisiopatologíaRESUMEN
The bacteriologic, serological, and clinical characteristics of 229 patients with erysipelas diagnosed during a 2-year period at a university hospital for infectious diseases in Sweden are presented. Beta-Hemolytic streptococci were detected in 34% of these patients. Group A was the dominant serogroup, but group G streptococci were found in about half as many cases. Bacteremia was present in 5%. A serological response with antistreptolysin O (ASO) and antideoxyribonuclease B (ADNase B) was seen primarily in patients harboring group A streptococci but also in those from whom no pathogen was isolated. ASO was also found in high titers in some patients with Group G streptococcal infection. The clinical course was usually benign, with few complications, but recurrences were common (occurring in 21% of the patients). No cases of streptococcal toxic shock were seen. Culture of skin biopsy specimens had low sensitivity; Beta-hemolytic were isolated from only two of 15 patients.
Asunto(s)
Erisipela , Adulto , Anciano , Anciano de 80 o más Años , Erisipela/complicaciones , Erisipela/microbiología , Erisipela/fisiopatología , Erisipela/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , RecurrenciaRESUMEN
Hemodynamic studies in 226 patients with erysipelas of the lower limbs with employment of tetrapolar rheography revealed a marked reduction in the intensity of regional blood flow correlated with the disease severity. Circulation recovery in the affected limb takes place as late as 3 months after the discharge from hospital in primary and secondary erysipelas, but deficient circulation persisted in recurrent disease. This grounds prognostic significance of the rheography. A positive trend in hemodynamic indices was registered upon UV-irradiated autoblood reinfusions which also decreased the relapses frequency.
Asunto(s)
Erisipela/fisiopatología , Pierna/fisiopatología , Adulto , Anciano , Celulitis (Flemón)/etiología , Celulitis (Flemón)/fisiopatología , Erisipela/complicaciones , Femenino , Hemodinámica , Humanos , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Pletismografía de Impedancia , Postura/fisiología , Recurrencia , Flujo Sanguíneo RegionalRESUMEN
A study is presented of 89 patients with primary and recurrent erysipelas of the lower extremities. Ultrasound sonography, dopplerography and tetrapolar rheography were used in the examination. It was found that disorders of the peripheral circulation remain stable in the inter-recurrence period, are manifested by lymphovenous insufficiency, continuous state of pre-edema, trophic disorders of the lower extremities.