1. ERYSIPELAS
KAVITA NATHAN
Group 318

2. what is erysipelas ?
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.

3. Erysipelas on face

4. pathophysiology
Bacteria inoculation into an area of skin, trauma is the initial event in the developing erysipelas

7. 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.

8. Regional lymphnode swelling and tenderness

9. RISK FACTORS INCLUDE: A cut in the skin
Problem with drainage through the veins or lymph system
Skin sores( ulcers)

10. Predisposing Factors

11. Stasis ulceration:

13. Venous insufficiency

14. Surgical incisions

17. Diabetic foot

19. Lymphedema

21. Nephrotic syndrome

22. causes
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.

23. Recently, atypical forms reported to be caused by :
* Streptococcus pneumoniae,
*Klebsiella pneumoniae,
* Haemophilus influenzae,
*Yersinia enterocolitica,
*Moraxella species,

24. Causative agent * 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.

25. Erysipelas: related medical condition

26. Group A beta- hemolytic streptocci
Hemolytic streptococcus
Skin infection
Painful rashes
Erythematous rash
Edematous rash
Skin ulcer
Abrasions
Insect bite
eczema

27. clinical

28. symptoms 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

29. physical

30. Erysipelas begins as a small erythematous patch that progresses to a fiery-red, indurated , tense, and shiny plaque

31. Local signs of inflammation
The lesion classically exhibits raised sharply demarcated advancing margins.
Local signs of inflammation
warmth,
edema,
tenderness
are universal.

32. Lymphatic involvement often is manifested by overlying skin streaking and regional lymphadenopathy

33. More severe infections may exhibit numerous vesicles and bullae along with petechiae and even frank necrosis.

34. Erysipelas can occur in different region

35. Erysipelas on face

36. Erysipelas on leg

37. Erysipelas in buttock region

38. Signs and test
Erysipelas is diagnosed based on how the skin looks. A biopsy of the skin is usually not needed.

39. Differential diagnoses
1) Erythema Annulare Centri- fugum 2) Stasis Dermatitis
3) Cellulitis
4) Erysipeloid

40. Erythema annulare centrifugum
* Eruptions occur at any age.

41. Lesions most often appear on the thighs, legs, face, trunk and arms.
linked to underlying diseases , viral , bacterial or even tumor.

42. Stasis dermatitis

43. cellulitis

44. erysipeloid

45. * 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.

46. treatment

47. Antibiotics such as penicillin are used to eliminate the infection
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.

48. Medical care
* 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.

49. *A first-generation cephalosporin or macrolide, such as erythromycin or azithromycin, may be used if the patient has an allergy to penicillin.

50. Two new drugs:
roxithromycin & pristinamycin,
have been reported to be extremely effective in the treatment of erysipelas.

51. Expectation ( prognosis)
With treatment, the outcome is good. It may take a few weeks for the skin to return to normal. Peeling is common.

52. complications
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

53. abscess,
gangrene,
Thrombophlebitis .
acute glomerulonephritis ,
endocarditis ,
septicemia,
streptococcal toxic shock syndrome.

54. Recurrent erysipeals
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.

55. prevention
Keep your skin healthy by avoiding dry skin and preventing cuts and scrapes. This may reduce the risk for erysipelas.

56. activity
Patients with acute infections involving the extremities should be encouraged to limit their activity and keep the limb elevated to decrease swelling.

57. THANK
YOU…..