[Is compression therapy contraindicated for lower leg erysipelas? : Results of a retrospective analysis]. / Ist die Kompressionstherapie bei Erysipel des Unterschenkels kontraindiziert? : Resultate einer retrospektiven Analyse.

In many medical expert recommendations and guidelines, the use of compression therapy for acute erysipelas is designated as a contraindication. Due to the sometimes massive oedema, compression therapy is nevertheless used in some clinics. This led to the question whether compression therapy for erysipelas of the lower leg actually leads to complications due to the acute infection and thus represents a contraindication. For the period 01 January 2018 to 30 June 2019, the records of 56 inpatients with acute erysipelas of the lower leg who received compression therapy in addition to systemic antibiotic therapy were retrospectively evaluated. The duration of inpatient treatment, the infection parameters determined as part of the ward routine and any complications that occurred were evaluated. While treated as inpatients the blood parameters for infection clearly dropped. Compression therapy was started on admission day in 92.9% of patients and continued until discharge. None of the patients showed an increase in fever or clinical signs of sepsis during the hospital stay. In this retrospective analysis it could be shown for the first time that compression therapy does not cause a clinical worsening or trigger a septic clinical picture in patients with acute erysipelas. Therefore, the authors consider the declaration of acute erysipelas as contraindication for compression therapy as not justified.

[Bacterial skin and soft tissue infections]. / Bakterielle Haut- und Weichteilinfektionen.

Bacterial skin and soft tissue infections are frequent and represent one of the most important differential diagnoses in patients presenting with reddened and swollen skin and soft tissue. Among these infections, cellulitis (phlegmon), erysipelas and abscesses are the most frequent. Whereas erysipelas is almost exclusively caused by streptococci and can be successfully treated with penicillin, an effective antibiotic therapy targeted at Staphylococcus aureus should be empirically considered for abscesses and phlegmon; other pathogens, such as gram negative and anaerobic bacteria can be found in patients with the corresponding underlying disease and certain risk factors. Severe necrotizing soft tissue infections are acutely life-threatening and require rapid and broad antibiotic therapy followed by immediate surgery. Depending on the medical history or exposure (including bite wounds), other pathogens may have to be considered in special situations including the increasing prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) outside hospitals.

Clinical and epidemiological assessment of patients hospitalized for primary and recurrent erysipelas / Ocena kliniczna i epidemiologiczna pacjentów hospitalizowanych z powodu rózy pierwotnej i nawrotowej

INTRODUCTION: Erysipelas is a bacterial infection, caused by group A ß-hemolytic streptococci (Streptococcus pyogenes), rarely other bacteria. It is characterized by sudden onset and rapid course, with the presence of systemic symptoms. OBJECTIVE: A retrospective analysis of patients hospitalized for primary and recurrent erysipelas with particular consideration of clinical profile of patients, causes, complications and risk factors of the recurrence. MATERIAL AND METHODS: We have analyzed the medical records of patients hospitalized for erysipelas at the Dermatology and Venereology Department of the Medical University of Bialystok from 2011 to 2015. RESULTS: One hundred twenty female (53,8%) and 103 male (46,2%) were included in the study. The median age was 61. The first episode of clinical symptoms was observed in 78% patients, while 22% of them were diagnosed as recurrent erysipelas. Skin lesions in both cases were located in the lower extremities most often. Mechanical trauma was statistically more frequently cause of the disease in men, while venous insufficiency and ulcers in women. Complications such as abscess, ulceration, phlegmon and thrombosis were observed in 22% of patients, significantly more common in men. Patients who were hospitalized more than 10 days were more likely to have higher body mass index and higher indicators of inflammation than patients who required a shorter hospital stay. Recurrent erysipelas was more often diagnosed in patients with co-morbidities, including hypertension, overweight, venous insufficiency and diabetes. CONCLUSIONS: Erysipelas located in the lower extremities, high temperature on admission, higher indicators of the inflammation, complications and coexistence of obesity and diabetes are the risk factors of the prolonged hospital stay. Primary and recurrent erysipelas have a similar course, severity of the disease and duration of hospitalization.

[Cellulitis: clinical manifestations and management]. / Erysipèle: manifestations cliniques et prise en charge.

Cellulitis is an acute bacterial non-necrotizing dermal-hypodermal infection predominantly affecting the lower limbs. It is characterised by a circumscribed erythema with a raised border and fever. The predisposing factors are skin wounds, edema from any cause and systemic factors (diabetes, immunosuppression). The diagnosis is clinical and the most common complication is recurrence. Other complications include local abscess, fasciitis and bacteremia. The germ is rarely identified. The majority of infections (85%) is due to group A beta-hemolytic streptococcus. The treatment of cellulitis consists of an association of an antibiotic with rest of the concerned area.

[Diagnosis and therapy of erysipelas: A position paper of the Society Initiative Chronische Wunde (ICW) e. V.] / Diagnostik und Therapie des Erysipels: Ein Positionspapier der Initiative Chronische Wunden (ICW) e. V.

Erysipelas is a bacterial soft tissue infection caused by ß-haemolytic streptococci that spreads proximally along the lymphatic system of the skin. The entry sites of the pathogens can be minor injuries or chronic wounds. The diagnosis of erysipelas is made clinically by the spreading eythema and overheating of the skin, the reduced general condition with fever and chills as well as by means of serological inflammation parameters and must be distinguished from numerous differential diagnoses.Systemic therapy is carried out with penicillin usually. In local therapy, the value of measures such as compression therapy or cooling is currently still controversial. Long-term therapy of the lymphoedema and the consistent avoidance and treatment of entry sites are essential, especially for the prevention of recurrence.

[Indications for and Limits of conservative Treatment in Hand Infections]. / Indikationen und Grenzen der konservativen Therapie bei Infektionen an der Hand.

The treatment of infections of the hand is an important part in hand surgery. Despite oft new antibiotic therapy there is a major part of surgical intervention. But there are certain cases in which a conservative treatment is indicated if a closed control is provided. Important is a careful examination, a detailed anamnesis of profession, hobby, animal or human contact, journey and secondary disease. Apart from antibiotics, limited immobilisation, physical conservation, moist dressing and pain management are important factors. In case of a conservative therapy, attention must be payed to the kind of infection and secondary diseases because there is a higher risk for complications, combined Infections and atypical pathogens in immunosuppressed patients. Typical indications for conservative treatment are erysipelas, cellulitis, early stages of felon and paronychia. Rare indications are infections with Erysipelothrix rhusiopathiae, Herpes simplex and fungal pathogens. No indications are symptoms longer than 2 days, abscess, bacterial infections of tendons, necrotizing fasciitis and empyema.

[Non-Necrotizing Acute Dermo-Hypodermal Infections: Erysipela and Infectious Cellulitis]. / Dermo-Hipodermites Bacterianas Agudas Não Necrotizantes: Erisipela e Celulite Infeciosa.

Non-necrotizing acute dermo-hypodermal infections are infectious processes that include erysipela and infectious cellulitis, and are mainly caused by group A ß-haemolytic streptococcus. The lower limbs are affected in more than 80% of cases and the risk factors are disruption of cutaneous barrier, lymphoedema and obesity. Diagnosis is clinical and in a typical setting we observe an acute inflammatory plaque with fever, lymphangitis, adenopathy and leucocytosis. Bacteriology is usually not helpful because of low sensitivity or delayed positivity. In case of atypical presentations, erysipela must be distinguished from necrotizing fasciitis and acute vein thrombosis. Flucloxacillin and cefradine remain the first line of treatment. Recurrence is the main complication, so correct treatment of the risk factors is crucial.

As dermo-hipodermites bacterianas agudas não necrotizantes são processos infeciosos que incluem a erisipela e a celulite infeciosa, e são geralmente causadas por estreptococos ß­hemolíticos do grupo A. Em mais de 80% dos casos situam-se nos membros inferiores e são fatores predisponentes a existência de solução de continuidade na pele, o linfedema crónico e a obesidade. O seu diagnóstico é essencialmente clínico e o quadro típico baseia-se na presença de placa inflamatória associada a febre, linfangite, adenopatia e leucocitose. Os exames bacteriológicos têm baixa sensibilidade ou positividade tardia. Nos casos atípicos é importante o diagnóstico diferencial com a fasceíte necrotizante e a trombose venosa profunda. A flucloxacilina ou a cefradina são os fármacos de primeira linha. A recidiva constitui a complicação mais frequente, sendo fundamental o correto tratamento dos fatores de risco.

[Prognostic value of leukocytic migratory activity indices in patients with erysipelas].

Peripheral blood leukocytic migratory activity (LMA) was studied in patients with primary or recurrent erysipelas. A screening cell migration test (SCMT) was used in vitro and it established the prognostic value of MAL parameters at week 1 after the onset of erysipelas. It has been shown that a rapid transition of LMA from the phase of acceleration to that of inhibition characterizes the formation of an adequate immune response, corresponds to the good course of the disease, and has a low likelihood of recurrences. The probability of a recurrence is much higher than that when LMA tends to transit from suppression to acceleration and when LMA parameters are constant in the phase of suppression or acceleration. No transition of LMA to the phase of suppression in early convalescence suggests that the formation of an immune response to streptococcus is delayed.

[Evaluation of general practitioners' knowledge about diagnostic and therapeuthic management of erysipelas in the city of Marrakech]. / Evaluation de la prise en charge de l'érysipèle par les médecins généralistes de la ville de Marrakech.

INTRODUCTION: Erysipelas is the most common non necrotizing bacterial dermohypodermitis (NNBDH). This study aimed to evaluate the adequacy of general practitioners' knowledge about literature data on the diagnostic and therapeuthic management of erysipelas. METHODS: We conducted a cross-sectional descriptive and analytical survey of 167 general practitioners in the public and private sectors in Marrakech over the period from 19 May to 20 October 2014. RESULTS: The 114 questionnaires which had been returned revealed that local and general risk factors were often reported for erysipelas. 92 (80.7%) physicians thought that positive diagnosis of common types was based on clinical examination. 97(85.1%) physicians thought that it required only out-patient service and that hospitalization and para-clinical examinations should only be performed in patients with severe, atypical or complicated erysipelas. 25 (21.9%) physicians thought that oral amoxicillin should be the gold standard therapy. 15(13.2%) physicians thought that bi-antibiotic therapy including antistreptococcique molecule should be the gold standard. 16 doctors (14%) advocated anti-inflammatory drugs. The primary and secondary prevention levels generated interest from physicians of whom 108 (94.7%) were favorable to the treatment of the portals of entry in the skin while 53 (46.5%) to the antibioprophylaxis after the second recurrence. CONCLUSION: Our study highlights that erysipelas is relatively frequent in city medical practice; clinical diagnosis guidelines should be shared between the specialists in order to improve the diagnostic and therapeutic approch of our physicians.

[Bacterial dermohypodermitis: a retrospective single-center study of 244 cases in Guinea]. / Dermohypodermites bactériennes: étude monocentrique rétrospective de 244 cas observés en Guinée.

BACKGROUND: Dermo-hypodermal bacterial infections (erysipelas, cellulitis and necrotizing fasciitis) are frequent and may be life-threatening. PATIENTS AND METHODS: A retrospective study of a period of 4 years and 6 months (1 June 1999 to 31 December 2003) was carried out at the Donka University Hospital centre (Conakry-Guinea) in order to analyze the epidemiological, clinical and therapeutic characteristics of bacterial dermohypodermitis in a hospital environment. RESULTS: Two hundred and forty-four patients (188 women and 56 men) were hospitalized for bacterial dermohypodermitis. Mean age was 38 years. The site of dermohypodermitis comprised the entire lower limbs in 4 cases (2%), legs and feet in 200 cases (82%), thighs in 12 cases (4%), buttocks in 4 cases (2%) and upper limbs in 24 cases (10%). A previous history of dermohypodermitis, chronic alcoholism, use of non-steroidal anti inflammatory drugs, obesity and lymphoedema was identified. Necrotizing bacterial dermohypodermitis and necrotizing fasciitis were the main complications and were seen in 31 patients. These conditions were generally associated with use of non-steroidal anti inflammatory drugs (90% vs. 25%) (OR=27, CI 95=8-94), delayed initiation of suitable treatment and use of traditional medicine. CONCLUSION: Our study shows female predominance of bacterial dermohypodermitis. This is explained by cutaneous atrophy in women resulting from use of depigmenting drugs that facilitate skin breaks, thus allowing ingress of bacteria. NSAID intake, while frequent in our series, was far higher in the fasciitis group, suggesting a potentially aggravating role of these drugs.

[Erysipelas--course of disease, recurrence, complications; a 10 years retrospective study]. / Róza--przebieg choroby, nawroty, powiklania; 10-letnia obserwacja retrospektywna.

OBJECT: we studied erysipelas by conducting a retrospective analysis of 319 patients with erysipelas treated in Dermatology Department Jagiellonian University in Krakow between 1994 and 2004. METHODS: we performed a retrospective analysis of 319 patients hospitalized for erysipelas in our institution during a 10 year period. The statistical significance was examined by chi square and Kruskal-Wallis test (significant value p< or =0.05). RESULTS: there were 35% males and 65% females patients. Median age was 63 years. Most of the female patients were pensioners (32.7%), most of the male patients were physical workers (40.5%). Summer time was the most frequent season for hospitalization (32.3%), and winter time was the rarest (17%). Most of the erysipelas has involved the lower limb (59.2%). There was significant dependence between the regional risk factors and occupation. The recurrent cases occurred in 67.3% cases with lower limb localisation in 69.44% cases. The most rare recurrent cases found on upper limb (6%). The systemic risk factors were associated with recurrent erysipelas in 69.44%. Complications, such as abscess formation, lymphangitis, venous insufficiency, osteitis, arthritis, septic tendonitis and elephantiasis were found in 25%. CONCLUSIONS: after review of the literature and our experiences it is clear that there is a strong need for interdisciplinary treatment to avoid various potential complications of erysipelas.

[Compression is important in erysipelas treatment].

Erysipelas is a common skin infection involving the lymphatic vessels, which induces an oedema. This has a tendency of persisting after infection is treated. The lymphatic system plays an important role in the immune system, and the impaired lymph drainage leads to a state of local immune deficiency. This is essential to the pathogenesis of recurrent erysipelas, as each episode of erysipelas further damages the lymphatic system and increases the risk of a new infection. This vicious circle makes it important to treat both erysipelas and oedema appropriately to reduce recurrence and morbidity.

[Erysipelas].

The literature review presents statistical data, etiology, pathogenesis, clinical course and complications of erysipelas. Principles and treatment approaches of the disease, its prophylaxis and management of the complications are discussed in the article.

[Therapeutic effect of heating and bandage treatment for chronic lymphedema of extremities accompanied with erysipelas: a report of 80 cases].

OBJECTIVE: To investigate the therapeutic effect of heating and bandage treatment for chronic lymphedema of extremities accompanied with erysipelas. METHODS: From March 2004 to March 2013, 80 patients with chronic lymphedema of extremities accompanied with erysipelas were analyzed retrospectively. The patients underwent heating treatment (42 degree centigrade) with infrared light machine made by Shanghai Ninth People's Hospital, 2 hours a day, 20 hours for a session. Bandage treatment was adopted after heating treatment. 1 or 2 sessions were performed for each patient every year. The erysipelas occurring frequency, patients subjective feeling, treatment sessions and elastic material usage was recorded during the follow-up period. The erysipelas occurring frequency was tested by the method of rank and inspection. SPSS 17. 0 was used for statistical analysis. RESULTS: After heating and bandage treatment, the occurrence frequency of erysipelas was obviously controlled (Z = 7.598, P = 0.000). Erysipelas was not occurred any more in 60 (75%)patients. Remarkable reduction of occurrence frequency of erysipelas caused by various reasons was showed after treatment. Primary and secondary lymphedema after treatment were compared with those before treatment respectively, showing statistical difference (Z = 3.417 and 5.009, P = 0.001 and 0.000). Most of patients felt better subjectively. The relapse rate of erysipelas and lymphedema was lower if keeping using elastic material to give more pressure on extremities after therapy. CONLUSIONS: Heating and bandage treatment can obviously reduce the occurrence frequency of erysipelas. It can improve the quality of patients' lives. Simultaneously, the subsequent elastic material pressure therapy is essential.

[Infections Associated with Treatment with Hirudo medicinalis - Report of Two Cases and Review of the Literature]. / Infektionen im Zusammenhang mit der Anwendung von Hirudo medicinalis - Zwei Fallberichte und Literaturübersicht.

Medicinal leeches are well-established for promoting venous drainage in transplants/flaps and analgesia in osteoarthritis. Although medicinal leeches are bred and kept under controlled conditions, they are colonised by a genuine species-specific bacterial flora. Therapeutic application of leeches implies skin penetration carrying an a priori risk of infection. We report 2 cases with different indications for medicinal leech therapy. In both cases wound infection occurred in close temporal and spatial correlation or with evidence of a leech-associated germ that could be treated successfully. An unclarified complication rate warrants strict indications for the application of medicinal leeches. Preventive measures are currently tested.

Lymphedema after breast and gynecological cancer - a frequent, chronic, disabling condition in cancer survivors.

The goal of our study was to determine clinical characteristics of women cancer survivors treated for secondary lymphedema, the time from cancer treatment to the development of lymphedema, and the effect of therapy on reduction of lymphedema and occurrence of erysipelas. We performed a retrospective study of women with secondary lymphedema after breast cancer (BR) and gynecological (cervical, uterine, ovarian, vulvar) cancers (GYN) treated at our Department from 2004 to 2010. The average time from cancer treatment to the development of lymphedema in our patients was 2.2 and 4.75 years in the BR and GYN groups, respectively, ranging from within days after the procedure to as long as 31 years. The duration of lymphedema in our patients before they first received appropriate therapy was on average 4.1 and 2.65 years in the BR and GYN groups, respectively. In our series, untreated lymphedema was a strong predisposing risk factor for erysipelas, whereas no cases of erysipelas were noticed after the establishment of therapy. Compression therapy was shown to be an effective measure to reduce lymphedema. The duration of required initial decongesting therapy with short-stretch elastic bandages was longer in patients with more long-standing edema. Lymphedema may first appear several years after the cancer procedure. Our findings emphasize the need for awareness of lymphedema as a possible long-term iatrogenic complication in cancer survivors to avoid a delay in diagnosis and therapy. Physicians in care of cancer survivors should actively look for lymphedema. Untreated lymphedema is a strong predisposing risk factor for erysipelas.

Erysipelas: recognition and management.

Erysipelas is an acute bacterial infection of the dermis and hypodermis that is associated with clinical inflammation. It is a specific clinical type of cellulitis and, as such, it should be studied as a specific entity. Erysipelas is generally caused by group A streptococci; it is highly probable that streptococcal toxins also play a role, which could, in part, help explain the clinical inflammation. Erysipelas of the leg is the main clinical type encountered. The face, arm, and upper thigh are the other most common sites for the occurrence of erysipelas. After a sudden onset, areas of erythema and edema characteristically enlarge with well-defined margins. Athlete's foot is the most common portal of entry for the disease. Erysipelas is generally associated with high fever, and adenopathy and lymphangitis are sometimes present. At the time of diagnosis, it is important to look for clinical markers of severity (local signs and symptoms, general signs and symptoms, co-morbidity, social context) which would necessitate hospitalization. There are many differential diagnoses, particularly in the case of atypical dermo-hypodermitis. Some bacterial infections may have specific clinical aspects or may lead to a diagnosis of cellulitis. Necrotizing cellulitis or fasciitis are life-threatening diseases and a rapid diagnosis is important. Other noninfectious types of cellulitis have been reported in many diseases, both localized or generalized. The biology of typical erysipelas is of little value in diagnosis and a laboratory workup is usually not required. There are few local complications associated with erysipelas; abscess can occur in some patients and septicemia is rare. Recurrence is the more distressing complication. Treatment of patients with erysipelas has been evaluated in a small number of studies. In most of them, erysipelas has been included in therapeutic studies of 'severe cutaneous infections'. This is not justified as in fact erysipelas is usually sensitive to penicillin G. Amoxicillin and macrolides are also effective. However, comparative, cost-analysis studies need to be performed to determine the best therapeutic option. Bed rest with the leg elevated is also important. Anticoagulants are indicated in patients at risk of venous thromboembolism. The portal of entry will also require treatment. Long-term antibacterial therapy is required for patients with recurrence.