[Epidemiological, clinical, evolutionary and risk factors of erysipelas in three hospitals in Nouakchott-Mauritania]. / Aspects epidemiologiques, cliniques, evolutifs et facteurs de risque de l'erysipele dans trois hopitaux de Nouakchott-Mauritanie.

INTRODUCTION: Erysipelas is an acute non-necrotizing dermohypoderma of bacterial origin, mainly due to streptococcus. Its elective topography is the leg, it is a frequent reason for consultation and hospitalization in medicine. This is a potentially serious medical emergency that can be life threatening. Our study aims to determine the epidemiological and clinical characteristics, as well as the risk and prognosis factors of erysipelas in Mauritania. PATIENTS AND METHODS: This was a cross-sectional descriptive observational study from January 01, 2016 to July 30, 2017. The study population was represented by patients seen for an acute inflammatory placard, hot, painful and feverish. RESULTS: In the 61 patients, the mean age was 40 years with extremes of 1 and 73 years. A female predominance was observed. The locations were one-sided. In 93.4% of cases, erysipelas was found in the lower limbs. Satellite lymphadenopathy was present in 40 patients, ie 66% of cases. A fever greater than or equal to 38 ° C was observed in 87% of cases, it was associated with chills 10% of cases. Local risk factors are represented by a traumatic wound, acute eczema and intertrigo inter toe. General factors are obesity, taking nonsteroidal anti-inflammatory drugs and artificial depigmentation. The outcome of our patients is favorable in 95% of cases on antibiotics. 9 patients presented with abscess during the course, ie 15%. CONCLUSION: In our study, erysipelas was observed mainly in a young housewife in her forties. Clinically, the preferred location was that of the leg found in 93.4%. Several risk factors are associated with erysipelas in our study.

INTRODUCTION: L'érysipèle est une dermohypodermite aiguë non nécrosante d'origine bactérienne, essentiellement due au streptocoque.Sa topographie élective est la jambe, il constitue un motif fréquent de consultation et d'hospitalisation en médecine. Il s'agit d'une urgence médicale, potentiellement grave pouvant engager le pronostic fonctionnel et vital. Notre étude a pour objectif de déterminer les caractéristiques épidémiologiques, cliniques, ainsi que les facteurs de risque et pronostic de l'érysipèle en Mauritanie. PATIENTS ET MÉTHODES: Il s'agissait d'une étude observationnelle descriptive transversale du 01 Janvier 2016 jusqu'au 30 Juillet 2017. La population d'étude était représentée par les patients consultant pour un placard inflammatoire aigu, chaud, douloureux et fébrile. RÉSULTATS: Chez les 61 patients recrutés, l'âge moyen était de40 ans avec des extrêmes de 1 et 73 ans. Une prédominance féminine était observée. Les localisations étaient unilatérales. Dans 93,4% des cas, l'érysipèle siégeait aux membres inférieurs. Une adénopathie satellite était présente chez 40 patients soit 66% des cas. Une fièvre supérieure ou égale à 38°c était observée dans 87% des cas, elle était associée à des frissons 10% des cas. Les facteurs de risque locaux sont représentés par une plaie traumatique, un eczéma aigu et un intertrigo inter orteil. Les facteurs généraux sont l'obésité, la prise d'anti-inflammatoires non stéroïdiens et la dépigmentation artificielle. L'évolution de nos patients est favorable dans 95% des cas sous antibiotiques. 9 patients présentaient une abcédation au cours de l'évolution soit 15%. CONCLUSION: Dans notre étude, l'érysipèle est observé surtout chez une jeune femme au foyer de la quarantaine. Sur le plan clinque, la localisation préférentielle était celle de la jambe retrouvée dans 93,4%. Plusieurs facteurs de risque sont associés à l'érysipèle dans notre étude.

Polyarthritis caused by Erysipelothrix rhusiopathiae in three Austrian sheep flocks - diagnosis, treatment and management measures.

INTRODUCTION: Polyarthritis caused by Erysipelothrix rhusiopathiae is a well-known disease in pigs, and ovine erysipelas infection also commonly affects two-to-six month-old lambs. This report describes case histories of three sheep flocks where lambs exhibited swollen joints and lameness. Special emphasis was given to clinical and diagnostic imaging findings, synovia sampling and the treatment regime. Lambs with only mild lameness, liquid serofibrinous joint effusion and lambs showing no bone involvement, as revealed by ultrasonography or radiography, were treated with systemically administered antibiotics selected from results of antimicrobial susceptibility testing of E. rhusiopathiae isolated from synovial samples, and non-steroidal anti-inflammatory drugs. Lambs with severe lameness and severely swollen joints were euthanized, and routine necropsy was undertaken with a focus on the joints. Further, a herd-specific autogenous vaccine was produced by a specialized laboratory. In conclusion, E. rhusiopathiae infection should be considered as a differential diagnosis in herds associated with lameness and polyarthritis in lambs aged between two up to 17 months.

INTRODUCTION: La polyarthrite causée par Erysipelothrix rhusiopathiae est une maladie bien connue chez le porc. Chez les ovins, l'infection touche le plus souvent les agneaux âgés de deux à six mois. Ce rapport de cas décrit trois troupeaux de moutons où des agneaux présentaient des articulations enflées et une boiterie. Un accent particulier a été mis sur la clinique, les résultats de l'imagerie diagnostique, les prélèvements de synovie et le mode de traitement. Les agneaux présentant uniquement une légère boiterie, des épanchements articulaires séro-fibrineux et ceux ne présentant pas d'atteinte osseuse, révélée par échographie ou radiographie, ont été traités avec des antibiotiques administrés par voie systémique, sélectionnés à partir des résultats de la sensibilité d'E. Rhusiopathiae isolé sur les échantillons synoviaux, ainsi qu'avec des anti-inflammatoires non stéroïdiens. Les agneaux présentant une boiterie sévère et des articulations gravement enflées ont été euthanasiés et une autopsie de routine a été réalisée avec un accent particulier mis sur les articulations. De plus, un vaccin autogène spécifique au troupeau a été produit par un laboratoire. En conclusion, l'infection à E. rhusiopathiae doit être considérée comme un diagnostic différentiel dans les troupeaux où l'on constate des boiteries et des polyarthrites chez les agneaux âgés de 2 à 17 mois.

Haemophilus parainfluenzae-related cellulitis of the penis following tearing of a short frenulum.

INTRODUCTION: Infectious cellulitis is a common disease, mostly affecting the lower extremities and the face but only rarely the genitalia. OBSERVATION: A 24-year-old male patient presented with acute erythematous edema of the penile shaft and foreskin present for 48hours. Gentle retraction of the foreskin revealed a short frenulum with a small area (2-3mm) of erosion. He had had unprotected genital and orogenital sex three days before with his usual female partner and reported tearing of the frenulum during intercourse. Ampicillin-sensitive Haemophilus parainfluenzae was isolated from the swab taken from the erosion of the frenulum. Clinical remission was obtained following oral administration of amoxicillin and clavulanic acid. DISCUSSION: We describe not only the first case of Haemophilus parainfluenzae-associated cellulitis of the penis but also the first report of penile cellulitis following erosion of a short frenulum during sexual intercourse.

[Erysipelas without fever or biologic inflammation during tocilizumab therapy]. / Érysipèle sans fièvre ni syndrome inflammatoire lors d'un traitement par tocilizumab.

BACKGROUND: Tocilizumab (TCZ) is a monoclonal antibody that inhibits the interleukin 6 (IL-6) signalling pathway. This treatment is extremely effective in rheumatoid arthritis (RA), which may well be accompanied by serious infections presenting misleading clinical pictures. Herein we report a case of a typical bacterial dermo-hypodermitis in a female patient treated with TCZ. PATIENTS AND METHODS: An 80-year-old woman treated with methotrexate (MTX) and TCZ for RA presented dermo-hypodermitis on her left leg 8 days after receiving her 13th infusion of TCZ. She exhibited neither fever nor biological inflammatory syndrome. Oral amoxicillin (3g/d) was initiated on an outpatient basis. Two weeks later, the patient was apyretic and her laboratory results were normal, although local inflammatory signs persisted. TCZ infusion was postponed and she was given intravenous amoxicillin (4g/d) for 2days, followed by oral amoxicillin, resulting in rapid recovery. Subsequent courses of TCZ were administered without incident. DISCUSSION: During the course of treatment with TCZ, this patient presented delineated bacterial cellulitis in the form of erysipelas, which was noteworthy on account of the absence of fever and of biological inflammatory syndrome. While there have been reports of severe cases of cellulitis during TCZ treatment, to our knowledge, there have been none of erysipelas. Attenuation of local and systemic inflammatory symptoms is widely reported, and is directly associated with the anti-IL-6 action of TCZ. Patients with RA are especially susceptible to opportunistic or severe infections as a result of the disease itself and of associated treatments, and increased vigilance is called for with regard to infections that may be transformed and potentially more severe as a result of TCZ.

[Shifting cellulitis in a patient with X-linked hypogammaglobulinemia]. / Dermo-hypodermite bactérienne « à bascule ¼ chez un patient atteint d'hypogammaglobulinémie liée à l'X.

BACKGROUND: In cases of immunodeficiency, a systemic infection may be revealed by atypical symptoms, particularly those involving the skin. PATIENTS AND METHODS: The present case describes a 19-year-old male with X-linked hypogammaglobulinemia, or Bruton agammaglobulinemia, treated with intravenous immunoglobulin G antibodies. Over a 6-week period, the patient developed recurrent plaques in both legs, first on one and then on the other, without fever. Blood cultures were repeated and the fifth pair proved positive for Campylobacter jejuni. An abdominal scan showed appendicitis without intestinal signs. The patient was treated with azithromycin for 2 weeks, which resulted in full recovery from the skin lesions. DISCUSSION: Campylobacter bacteremia infections are severe and carry a 15% mortality rate at 30 days. The majority of affected patients present humoral immunodeficiency. The literature contains reports of 10 patients with C. jejuni-associated cellulitis, of whom 6 presented hypogammaglobulinemia. We postulate that the cutaneous manifestations were caused by septic metastases. The immunoglobulin replacement therapy mainly comprised IgG antibodies; IgA and IgM antibodies appear to play a key role in the response to C. jejuni infection, which could explain the susceptibility observed. The American guidelines recommend blood and skin cultures in patients with cellular immune defects. We suggest that this recommendation be extended to patients with humoral immunodeficiency.

[Risk factors associated with leg erysipelas (cellulitis) in sub-Saharan Africa: A multicentre case-control study]. / Facteurs de risque associés à l'érysipèle de jambe en Afrique subsaharienne: étude multicentrique cas-témoins.

BACKGROUND: Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors. RESULTS: During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5). CONCLUSION: The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.

[Pemetrexed-induced scleroderma-like changes in the lower legs]. / Sclérose cutanée des deux membres inférieurs sous pemetrexed.

BACKGROUND: Pemetrexed (Alimta(®)) is a new-generation antifolate used to treat malignant pleural mesothelioma and non-small cell lung cancer (NSCLC). We report two cases of a new toxicity induced by pemetrexed: scleroderma-like induration of the lower extremities. PATIENTS AND METHODS: The first case concerned a 66-year-old man diagnosed with pulmonary adenocarcinoma metastatic from the outset and in whom maintenance treatment comprised pemetrexed after first-line therapy comprising six courses of cisplatin-pemetrexed. After the fourth cycle of pemetrexed, he presented an erythematous oedema of the left leg, which was subsequently bilateral. Clinically, there was painful cellulitis associated with areas of bruising. The lesions had an appearance of erysipeloid-like infection, and there was no fever. The second case concerned a 70-year-old woman diagnosed with metastatic NSCLC. From the first course of pemetrexed, given as maintenance therapy, she presented erythematous oedema of both legs, without fever. After the second course, we observed the recurrence of the lesions consisting of erythemato-violaceous plaques on both legs, with severe bilateral indurated and painful oedema, associated with major functional disability. A diagnosis of bilateral erysipelas was made, and antibiotic treatment with cloxacillin was given. In both cases, pemetrexed was discontinued and the local outcome was very slowly favourable, with persistence of scleroderma. DISCUSSION: This cutaneous adverse effect is unrecognized, resulting in delayed diagnosis. It is often initially confused with bilateral erysipelas, despite absence of fever. According to some studies, the severity of the cutaneous toxicity may be connected with patients' folate status. Thus folate and vitamin B12 supplementation combined with dexamethasone could decrease the incidence of this side effect. There was no recurrence and no worsening with taxanes, chemotherapy agents known to induce scleroderma. We feel that this cutaneous toxicity must be recognised on account of its potential severity.

[Endogenous endophthalmitis as a complication in erysipelas]. / Endophtalmie endogène compliquant un érysipèle.

BACKGROUND: Endogenous endophthalmitis is a devastating infection of the eye that leads to blindness in about two-thirds of patients. It results from the haematogenous spread of a microorganism from a focus of sepsis, mainly gastro-intestinal, genitourinary or cardiac. PATIENTS AND METHODS: We describe the case of a diabetic subject presenting endogenous endophthalmitis following erysipelas of the leg due to Streptococcus agalactiae. The outcome was favourable thanks to prompt initiation of appropriate antibiotic treatment. DISCUSSION: Endogenous endophthalmitis as a complication of a skin infection is a rare entity, with only about 30 reported cases in the literature. Awareness of this condition among dermatologists would allow prompt intervention, which is essential for sparing of the patient's eyesight.