An unusual outbreak of erysipelas on a goat farm in Pennsylvania.

Erysipelothrix rhusiopathiae infection and septicemia occurred in a 5-d old Boer goat found dead on a farm in western Pennsylvania. On autopsy, there was moderate, focally extensive hemorrhage along the remnants of the urachus and umbilical arteries and the apex of the urinary bladder. Microscopic examination of immunohistochemical stained tissues revealed abundant intracellular and extracellular E. rhusiopathiae antigen-positive bacilli in all tissues stained, including lung, heart, liver, skeletal muscle, kidney, and thymus. Bacteria isolated from liver and urachus were identified as E. rhusiopathiae by MALDI-TOF mass spectrometry and further confirmed by a PCR assay. An epidemiologic investigation was conducted via an on-farm questionnaire after the owners noted a 70% mortality rate from the 2019 kidding season. The epidemiologic investigation showed that E. rhusiopathiae, an opportunistic zoonotic organism, was introduced to the farm through a breach in biosecurity and was likely perpetuated among the resident poultry species.

Predictors of persistent inflammation in children with familial Mediterranean fever.

OBJECTIVES: Persistent inflammation is an insidious feature of familial Mediterranean fever (FMF) that may cause chronic complications. This study aimed to investigate the predictors of persistent inflammation in children with FMF. METHODS: The medical charts of 1077 paediatric FMF patients were retrospectively collected. The patients were divided into two groups: with and without subclinical inflammation. RESULTS: A total of 133 (12%) patients had persistent inflammation. M694V homozygosity, colchicine resistance, positive family history for FMF, erysipelas-like erythema, leg pain, arthritis, chest pain, inflammatory comorbidities, early disease onset, high PRAS score, and long attack duration were established as independent predictors of persistent inflammation (P < .001, P < .001, P < .001, P < .001, P = 0.006, P < .001, P < .001, P = .014, P < .001, P < .001, and P < .001, respectively). However, gender, abdominal pain, fever, and attack frequency were not found to be independent risk factors for predicting persistent inflammation (P = .412, P = .531, P = .451, and P = .693, respectively). CONCLUSIONS: M694V homozygosity, colchicine resistance, positive family history, erysipelas-like erythema, leg pain, arthritis, chest pain, inflammatory comorbidities, early disease onset, high activity score, and long attack duration may be predictors of persistent inflammation in FMF. These predictors may help clinicians suspect the occurrence of subclinical inflammation and should aid in better disease management in FMF.

Potenciais fatores associados a maior chance de recidiva de erisipela / Posibles factores asociados a mayor probabilidad de recidiva de erisipela / Potential factors associated with increased chance of erysipelas recurrence

Resumo Objetivo Analisar os fatores relacionados à recidiva de erisipela em adultos e idosos. Métodos Estudo de coorte retrospectivo com 235 adultos e idosos admitidos em um hospital com diagnóstico de erisipela entre 2012 e 2019. Investigaram-se fatores sociodemográficos e clínicos relacionados a maior chance de recidiva de erisipela no período por meio de análises uni e bivariada, com p<0,05 considerado significativo. Resultados A prevalência de recidiva de erisipela foi de 25,5% (n=60). Os fatores significativamente associados à recidiva foram insuficiência venosa (p= 0,002; OR= 2,597; IC= 1,4-4,7) e uso de penicilina (p< 0,000; OR= 7,042; IC= 2,5-19,7). Conclusão a insuficiência venosa se associa a chance duas vezes maior de recidiva de erisipela e o uso de penicilina se associa a risco sete vezes maior para sua recidiva.

Resumen Objetivo Analizar los factores relacionados con la recidiva de erisipela en adultos y adultos mayores. Métodos Estudio de cohorte retrospectivo con 235 adultos y adultos mayores ingresados en un hospital con diagnóstico de erisipela entre 2012 y 2019. Se investigaron factores sociodemográficos y clínicos relacionados con una mayor probabilidad de recidiva de erisipela en el período mediante análisis uni y bivariados, con p<0,05 considerado significativo. Resultados La prevalencia de recidiva de erisipela fue del 25,5 % (n=60). Los factores significativamente asociados con la recidiva fueron insuficiencia venosa (p= 0,002; OR= 2,597; IC= 1,4-4,7) y uso de penicilina (p< 0,000; OR= 7,042; IC= 2,5-19,7). Conclusión La insuficiencia venosa está relacionada con una probabilidad dos veces mayor de recidiva de erisipela, y el uso de penicilina está relacionado con un riesgo siete veces mayor de recidiva.

Abstract Objective To analyze factors related to erysipelas recurrence in adults and older adults. Methods Retrospective cohort study with 235 adults and older adults admitted to a hospital diagnosed with erysipelas between 2012 and 2019. Sociodemographic and clinical factors related to a greater chance of erysipelas recurrence in the period were investigated through uni and bivariate analyses, with p<0.05 considered significant. Results The prevalence of erysipelas recurrence was 25.5% (n=60). Factors significantly associated with recurrence were venous insufficiency (p= 0.002; OR= 2.597; 95%CI= 1.4-4.7) and use of penicillin (p< 0.000; OR= 7.042; 95%CI= 2.5-19.7). Conclusion venous insufficiency is associated with a twice greater chance of erysipelas recurrence and the use of penicillin is associated with a seven times greater risk for its recurrence.

What factors affect the length of hospitalization in patients with erysipelas? A 10-year retrospective study of patients hospitalized in Lower Silesia, Poland.

BACKGROUND: Erysipelas is an acute skin infection caused by group A and G streptococci. This infection is associated with many comorbidities and often requires hospitalization. OBJECTIVES: The aim of this study was to identify the factors related to the length of hospitalization in patients with erysipelas. MATERIAL AND METHODS: This retrospective study included 153 admissions of 135 patients (63 women and 72 men) hospitalized due to erysipelas from January 2010 to December 2019. Clinical symptoms, test results, comorbidities, and antibiotic treatments were taken into consideration as factors affecting the length of hospital stay. RESULTS: The median length of hospitalization was 10 days (interquartile range (IQR) = 7-14). Women spent less time in the ward, but the difference was not significant. Features such as tinea pedis (15.5 days, IQR = 13.5-20; p = 0.002), anemia (11 days, IQR = 9-15; p = 0.02), chills (12 days, IQR = 9-15; p = 0.03), elevated serum C-reactive protein (CRP) level over 100 mg/L (11 days, IQR = 8-17; p = 0.02), and leukocytosis (11 days, IQR = 8-15, p = 0.005) were identified as prolonged hospitalization factors. Moreover, patients with erysipelas localized to the legs (p = 0.01) and with a gangrenous variant of erysipelas (p = 0.03) were hospitalized longer. The first-choice antibiotic was not significant in terms of prolonged hospitalization. Patients treated with clindamycin during hospitalization, regardless of whether it was a first-line or subsequent antibiotic, stayed in the ward significantly longer (p = 0.005). CONCLUSION: Patients suffering from erysipelas with the features identified above, have a higher risk of a prolonged stay in the hospital. Significantly increased inflammatory factors, anemia and tinea pedis contributed to prolonged hospitalization.

Predictors for readmission due to cellulitis among Japanese patients.

Cellulitis is an infection of the soft tissues of the skin. Some patients are hospitalized multiple times; lymphedema, chronic venous insufficiency, peripheral circulatory disturbance, and deep vein thrombosis are said to be risk factors for multiple admissions. Conversely, in Japan, elderly women and undernourished elderly have been reported to be at risk of multiple hospitalizations, suggesting a different patient background from that reported overseas. We investigated the characteristics of readmission cases for patients hospitalized for cellulitis in Japan. We retrospectively examined cases of cellulitis and erysipelas admitted between April 1, 2005 and March 31, 2018. Patients with cellulitis or erysipelas at multiple sites and those with osteomyelitis, pressure ulcer infection, and necrotizing fasciitis were excluded. In terms of recurrence, only hospitalizations for recurrence at the same site were considered. Patients with multiple hospitalizations had significantly lower blood albumin levels than those hospitalized only once. Furthermore, the rates of lymphedema, hypertension, and hyperlipidemia were significantly higher in patients hospitalized multiple times. Other laboratory and clinical factors were not statistically significant. Therefore, hypoalbuminemia with or without liver dysfunction, lymphedema, hypertension, and hyperlipidemia were suggested as risk factors for cellulitis recurrence. However, chronic venous insufficiency, peripheral circulatory disturbance, and deep vein thrombosis did not seem to be risk factors in Japanese cases. Japanese cases had a low body mass index (approximately 25 kg/m2 ), suggesting that the patient background may be different from that in existing reports. This suggests that the risk factors in Japanese cases may be different from those reported in other countries.

Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors. RESULTS: During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73). CONCLUSION: Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

Fungal infections of the feet in patients with erysipelas of the lower limb: is it a significant clinical problem?

BACKGROUND: Erysipelas is a bacterial infection of the superficial layers of the skin usually caused by Group A Streptococci, often seen in clinical practice. Fungal infections of the feet and elderly age are some of the most significant risk factors for the infection. The aim of the study was to evaluate the frequency of fungal infections from different regions of the feet in patients with erysipelas. METHODS: 56 patients with clinically diagnosed erysipelas and 56 healthy individuals were clinically examined and tested for fungal infection in three locations: toenails, interdigital space, and soles. The collected samples were evaluated under a microscope and then mycological cultures on Sabouraud's medium were prepared. After 4 weeks of incubation, the cultures were analysed with the identification of particular pathogens. RESULTS: 42.9% (24/56) of the patients with erysipelas had positive mycological cultures. Toenails and interdigital spaces (both 62.5%) were the most frequently affected areas, followed by soles (37.5%). The most common pathogen was T. rubrum (43.18%), followed by Candida spp. (27.27%), and T. mentagrophytes var.interdigitale (13.63%). Only 14.3% (8/56) of the samples taken from the control group were positive and T.rubrum was the only type of fungus cultured. CONCLUSIONS: Fungal infections of the feet are important risk factors for the first episode as well as recurrent erysipelas. Prevention and early treatment of fungal infections, especially in elderly people, can significantly reduce the incidence of erysipelas.

Factors associated with acute and recurrent erysipelas in a young population: a retrospective of 147 cases.

BACKGROUND: erysipelas is a common infection of the superficial layer of the skin, predominantly caused by groups A ß-hemolytic streptococci. It is an acute infection of the skin and frequently affects the legs. It is common in the elderly and favoured by the associated comorbidities. Its occurrence in young healthy people is rare. AIM: The present study aimed to elucidate factors associated with acute and recurrent erysipelas in a young population. METHODS: We retrospectively analyzed 147 cases of erysipelas admitted to the dermatology department of the Military Hospital of Tunis, Tunisia, over 18 years, identifying factors associated with recurrence. All patients were aged less than 35 years. RESULTS: During the study period, 147 patients were registered with the diagnosis of erysipelas. There were 125 military soldiers and 22 non-military patients. The prevalence of erysipelas was 2.23%. The median age was 25 years. Almost 86.2% of patients were male. The main favorable factors were: obesity (9%), alcoholism (8%), chronic venous insufficiency (6.5%), chronic lymphedema (3%), leg fracture (2%), and diabetes mellitus (1%). The lesions were mostly located in the lower limbs in 94.9%. According to our multivariate analysis, there was an association between recurrence and diabetes mellitus (p=0.02), female sex (p=0.004), onychomycosis (p=0.004), and plantar dyshidrotic eczema (p<0.005). CONCLUSION: Identifying factors associated with recurrent erysipelas in a young population remains essential for proposing primary and secondary prevention measures.

[Bacterial acute non necrosing cellulitis (erysipelas) in adult]. / Prise en charge de la dermo-hypodermite aiguë non nécrosante bactérienne de l'adulte.

Erysipelas is defined by a sudden onset (with fever) preceding the appearance of a painful, infiltrated, erythematous plaque, accompanied by regional lymphadenopathy. It is usually localized on the lower limbs, but it can occur on the face. It is due to ß-hemolytic streptococcus A and more rarely to staphylococcus aureus. It is important to establish the diagnosis and eliminate the non-bacterial causes of inflammatory edema. The other diagnoses frequently found are contact eczema, acute arthritis, bursitis, inflammatory flare-up of chronic dermohypodermitis of venous origin, flare-up of chronic multifactorial eczema (venous insufficiency, vitamin deficiencies, senile xerosis and/or contact eczema), rare familial periodic fevers, rare neutrophilic dermatoses or eosinophilic cellulitis. It is necessary to identify signs of severity that would justify hospitalization. In front of a typical acute bacterial dermohypodermitis and in the absence of comorbidity, no additional investigation is necessary. Systematic blood cultures have low profitability. Locoregional causes must be identified in order to limit the risk of recurrence which remains the most frequent complication. In uncomplicated erysipelas, amoxicillin is the gold standard; treatment with oral antibiotic therapy is possible if there is no sign of severity or co-morbidity (diabetes, arteritis, cirrhosis, immune deficiency) or an unfavorable social context. In case of allergy to penicillin, pristinamycin or clindamycin should be prescribed. Prophylactic antibiotic therapy with delayed penicillin is recommended in the event of recurrent erysipelas.

Burden, risk factors, and infectious complications of cellulitis and erysipelas in US adults and children in the emergency department setting.

BACKGROUND: Little is known about the use and burden of emergency department (ED) visits for cellulitis/erysipelas in the United States. OBJECTIVE: To determine the prevalence, risk factors, complications, and cost of emergency care for cellulitis/erysipelas in the United States. METHODS: Cross-sectional study of the 2006 to 2016 National Emergency Department Sample, including a 20% sample of US ED visits (N = 320,080,467). RESULTS: The mean annual incidence of ED visits with a primary diagnosis of cellulitis/erysipelas was 2.42 to 3.55 per million adult and 1.14 to 2.09 per million pediatric ED visits. ED visits for cellulitis/erysipelas decreased significantly from 2006 to 2015 (Rao-Scott chi-square, P < .0001). ED visits with versus without a primary diagnosis of cellulitis/erysipelas were associated with public or no insurance and lower household income quartiles, and were more likely to occur during weekends and summer months. The mean cost of ED visits for cellulitis/erysipelas more than doubled in adults (from $720 to $1680) and tripled in children (from $939 to $2,823) from 2006 to 2016. ED visits for cellulitis/erysipelas were associated with multiple risk factors and increased infectious complications. LIMITATIONS: No data on cellulitis and erysipelas treatment or recurrence. CONCLUSION: There is a substantial and increasing burden of ED visits for cellulitis/erysipelas in the United States. Many ED visits occurred for uncomplicated cellulitis/erysipelas, in part because of health care disparities.

Erysipelas-like erythema in children with familial Mediterranean fever.

OBJECTIVES: Erysipelas-like erythema (ELE) is a well-known pathognomonic skin lesion associated with familial Mediterranean fever (FMF). The aim of this study was to describe the clinical and demographic features and phenotypic differences between paediatric FMF patients with and without ELE. METHODS: We retrospectively collected the medical charts of paediatric patients who had been diagnosed with FMF and followed by the Paediatric Rheumatology Department of Gazi University, Turkey, from 2006 to 2016. RESULTS: Among 782 FMF patients, 59 (33 males and 26 females; median age, 11.1±5.1) were found to have ELE. More patients had arthritis in the ELE group than in the other group (p=0.011). Arthritis occurred in the ankle (77.4%), knee (19.3%) and hip (3.2%) joints. The coexistence of arthritis and ELE was seen in 12 (20.3%) patients. All ELE plaques were located on the lower legs and dorsum of the feet. Eleven patients (18.6%) presented with ELE as the initial symptom and were diagnosed with FMF, and 48 (81.4%) patients experienced ELE attacks while receiving colchicine therapy. The median dose of colchicine at last visit, PRAS activity score and M694V homozygous mutation status were significantly higher in the ELE group than in the other group (p=0.041, p=0.001 and p=0.023, respectively). CONCLUSIONS: ELE is an uncommon but important feature of FMF. In patients with ELE, arthritis is more frequently encountered, and M694V homozygous mutation is more frequently found. FMF patients with ELE have more severe disease activity, and they use higher doses of colchicine in relation to this severe disease course.

[Clinical and Laboratory Factors Associated with Prolonged Hospital Stay among Patients with Cellulitis/Erysipelas]. / Fatores Clínico-Laboratoriais Associados ao Internamento Prolongado em Doentes com Celulite/Erisipela.

INTRODUCTION: Cellulitis and erysipelas represent the most frequent cause of hospitalization in the dermatology department of Santa Maria Hospital in Lisbon, Portugal. The aim of this study was to investigate whether patient demographics, comorbidities, previous episodes of cellulitis/erysipelas, the presence of complications, laboratory markers at admission, microbial isolation or previous use of antibiotics, are associated with prolonged stays. MATERIAL AND METHODS: Retrospective analysis, including patients admitted with cellulitis/erysipelas in the inpatient dermatology department of Santa Maria Hospital between July 1st 2012 and June 30th 2017. RESULTS: There were 372 admissions, corresponding to 348 patients. The median length of stay was 11 days. Increased age (p = 0.002, OR 1.03, 95% CI 1.01 - 1.04), previous episode of cellulitis/erysipelas requiring hospitalization (p = 0.005, OR 4.81, 95% CI 1.63 - 14.23), the presence of cellulitis/erysipelas-associated complications (p = 0.001, OR 3.28, 95% CI 1.63 - 6.59), leukocytosis (p = 0.049, OR 1.81, 95% CI 1.00 - 3.30), high levels of C-reactive protein (p = 0.035, OR 1.03, 95% CI 1.00 - 1.06) and a positive culture result (p = 0.002, OR 2.59, 95% CI 1.41 - 4.79) were associated with prolonged hospitalization. DISCUSSION: Prolonged hospitalization for cellulitis/erysipelas is associated with higher costs, additional clinical investigation, invasive treatments, prolonged courses of antibiotic therapy, risk of nosocomial infections, and delayed return to activities of daily living. Thus, the investigation of clinical-laboratory factors associated with prolonged hospitalization for cellulitis / erysipelas is essential and may be useful for the construction of a severity score. CONCLUSION: The knowledge of the characteristics that are associated with prolonged stay among patients with cellulitis/erysipelas may be relevant to improve health care, by reducing the length of hospital stay and associated risks and costs.

Introdução: A celulite e a erisipela constituem a causa mais frequente de internamento no Serviço de Dermatologia do Hospital Santa Maria. Este estudo teve como objetivo investigar se as características demográficas, as comorbilidades, a existência de episódios prévios de celulite/erisipela, a presença de complicações associadas, os parâmetros laboratoriais na admissão, o isolamento de microrganismo em cultura ou o uso prévio de antibióticos estão associados a internamentos prolongados.Material e Métodos: Estudo retrospetivo, incluindo os doentes internados no Serviço de Dermatologia do Hospital Santa Maria com o diagnóstico de celulite/erisipela, entre 1 de julho de 2012 e 30 de junho de 2017.Resultados: Existiram 372 internamentos, correspondendo a 348 doentes. A mediana do tempo de internamento foi de 11 dias. A idade (p = 0,002, OR 1,03, 95% IC 1,01 ­ 1,04), a existência de internamento prévio por celulite/erisipela (p = 0,005, OR 4,81, 95% IC 1,63 ­ 14,23), a presença de complicações associadas à celulite/erisipela (p = 0,001, OR 3,28, 95% IC 1,63 ­ 6,59), a leucocitose (p = 0,049, OR 1,81, 95% IC 1,00 ­ 3,30), valores elevados de proteína C reativa (p = 0,035, OR 1,03, 95% IC 1,00 - 1,06) e o isolamento de microrganismo em cultura (p = 0,002, OR 2,59, 95% IC 1,41 ­ 4,79) estiveram associados a internamentos prolongados.Discussão: A par dos maiores custos associados, o internamento prolongado por celulite/erisipela está frequentemente associado à necessidade de investigação clínica adicional, a tratamentos invasivos, a cursos prolongados de antibioterapia, ao risco de infeções nosocomiais e ao atraso no retorno às atividades da vida diária. Assim, o estudo dos fatores clínico-laboratoriais associados ao internamento prolongado por celulite/erisipela é fundamental e poderá ser útil para a construção de um score de gravidade.Conclusão: O conhecimento de características clínicas e laboratoriais associadas ao internamento prolongado poderá ser relevante para melhorar os cuidados de saúde, através da redução dos tempos de internamento e dos seus riscos e custos associados.

Adherence to antibiotic guidelines for erysipelas or cellulitis is associated with a favorable outcome.

Outside areas of S. aureus strains resistant to methicillin (MRSA) in the community, no studies showed a relationship between the treatment for erysipelas or cellulitis and the outcome. We aimed to measure the impact of an internal therapeutic protocol, based on national guidelines on patients' outcome. This study was based on the dashboard of the infectious diseases department, which prospectively includes 28 parameters for all admitted patients. We included community-acquired erysipelas and cellulitis; exclusion criteria were abscesses at admission; ear, nose, throat, or dental cellulitis; pyomyositis; and length of stay ≤ 2 days. Adherence to guidelines was defined by the use of amoxicillin, amoxicillin/clavulanic acid, clindamycin, or pristinamycin, alone or in combination or successively. A poor outcome was defined by surgical procedure or intensive care requirement or death occurring after 5 days or more of antibiotic therapy. From July 2005 to June 2017, 630 cases of erysipelas or cellulitis were included. Blood cultures performed in 567 patients (90%) were positive in 39 cases (6.9%). Adherence rate to guidelines was 65% (410 cases). A poor outcome was recorded in 54 (8.5%) patients, less frequently in case of adherence to guidelines: 26/410 (6.3%) vs 28/220 (12.7%), p = 0.007. In logistic regression analysis, two risk factors were associated with a poor outcome: peripheral arterial disease, AOR 4.80 (2.20-10.49); and bacteremia, AOR 5.21 (2.31-11.76), while guideline adherence was the only modifiable protective factor, OR 0.48 (0.26-0.89). In erysipelas and cellulitis, adherence to guidelines was associated with a favorable outcome.

Trends in the epidemiology of erysipelas in Slovenia.

INTRODUCTION: Erysipelas is a common infection of the skin and subcutaneous tissue. Despite the relative frequency of erysipelas, data on its basic epidemiological characteristics are scant. This study describes the trends in erysipelas epidemiology in Slovenia. METHODS: Data on notified erysipelas cases from 2000 to 2016 were extracted from the electronic database of reportable communicable diseases and analyzed. RESULTS: There were 36,254 notified cases during the observed time period of 17 years. The yearly age-standardized incidence rate of erysipelas increased from 71.5 per 100,000 in 2000 to 111.3 per 100,000 in 2016, with the main rise in the ≥ 75 age group. Erysipelas was more common in women, but the sex-related difference lessened in the period observed. The hospitalization rate declined. Erysipelas was significantly more frequent in the warmer period of the year. The correlation between erysipelas incidence and average monthly temperature was stronger in the ≤ 64 age group than in the ≥ 65 age group. CONCLUSIONS: Retrospective observational data confirmed a rising trend in erysipelas cases, especially among the elderly. Aging of the population will continue to increase the burden of the disease, unless health promotion and prevention lowers the prevalence of the risk factors.

Benzathine penicillin G once-every-3-week prophylaxis for recurrent erysipelas a retrospective study of 132 patients.

OBJECTIVE: To evaluate effectivity, safety and patients' adherence to benzathine penicillin G (BPG) 1,200,000 units (1.2 MU) once-every-3-week intramuscularly prophylaxis for recurrent erysipelas. METHODS: Patients with documented two or more erysipelas episodes in last two years who received at least one of 10 planned doses of BPG 1.2 MU intramuscularly between January 2009 and December 2015 were analyzed in this retrospective study. Number of recurrences during the 30-week prophylaxis and in the 30-week follow-up period, frequency of adverse events, patients' adherence to the treatment and factors associated with the recurrence were analyzed. RESULTS: From 132 patients, 109 (82.6%) finished the 30-week prophylactic regimen successfully. The incidence of erysipelas was 8 per 100 patient-years during the prophylactic period and 28 per 100 patient-years in the follow-up period (incidence rate ratio = 0.20; 95% CI: 0.05-0.34; p < .01). In univariate analysis recurrence was significantly associated only with presence of any local risk factor concurrently with obesity (OR 3.40; 95% CI: 1.10-10.50; p < .05). CONCLUSION: Benzathine penicillin G 1.2 MU once every 3 weeks is an effective and well-tolerated prophylaxis of recurrent erysipelas with good patient adherence to the treatment. Further studies to determine the appropriate duration of prophylaxis are necessary.

Skin and soft tissue infections, active component, U.S. Armed Forces, 2013-2016.

During the 4-year surveillance period, there were 282,571 incident cases of skin and soft tissue infection (SSTI) among active component U.S. military members diagnosed in inpatient or outpatient settings, corresponding to an overall incidence of 558.2 per 10,000 person-years (p-yrs). An additional 10,904 cases occurred in theater of operations (460.0 per 10,000 p-yrs). Approximately half (49.4%) were classified as "other SSTI" (e.g., folliculitis, impetigo); 45.9% were cellulitis/abscess; 4.6% were carbuncles/furuncles; and 0.1% were erysipelas. Annual incidence rates declined by 46.6% over the surveillance period. In general, higher rates of SSTIs were associated with younger age, recruit trainee status, and junior enlisted rank. During the surveillance period, 238,924 service members were treated for SSTIs in outpatient or inpatient settings, which accounted for 395,361 medical encounters and 19,213 hospital bed days. The history of operational significance of skin infections in the military, the high healthcare costs associated with evaluating and treating skin infections, and the risk of infections by antibiotic-resistant organisms highlight the importance of prevention, early diagnosis, and definitive treatment of skin infections, particularly in high-risk settings such as new recruit/basic training populations.