Relapsing polychondritis.

This is a case report of a 67-year-old man with the rare autoimmune disease relapsing polychondritis. The patient was initially diagnosed by general practitioners with erysipelas around his left ear, which was found red, swollen, and painful. Due to the lack of effect from antibiotics, the patient was referred to an emergency department. A rheumatologist recognised the patterns of the rare disease, diagnosed the patient and initiated proper treatment. The case clarifies the difficulty in diagnosing relapsing polychondritis, mainly due to the rarity and lack of knowledge of the disease.

Can't Miss Infections: Endocarditis, Cellulitis, Erysipelas, Necrotizing Fasciitis, Cholecystitis.

This article reviews the presentation, physical examination findings, and diagnosis of selective common acute infectious diseases. In this article, we review nonpurulent skin infections, infective endocarditis, and acute cholecystitis.

[Soft tissue infections]. / Weichgewebeinfektionen.

Acute skin and soft tissue infections are among the most frequent infections in medicine. There is a broad spectrum including simple local infections as well as severe and life-threatening diseases. Along with Staphylococcus aureus, group A Streptococci are mainly responsible for these illnesses. The therapeutic approach ranges from antiseptic local treatments to administering systemic antibiotics or emergency surgery. Treating physicians often face challenges when presented with soft tissue infections due to a great discrepancy between the first impression of the disease compared to a possibly quick progression as well as the wide range of sometimes confusing historic terms and definitions being used in the English and German language, for instance pyoderma, erysipelas or phlegmon. A recently more popular collective term emphasized by clinical trials is "acute bacterial skin and skin structure infections" (ABSSSI).

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.

Erysipelas of the right arm due to Bordetella trematum: a case report.

BACKGROUND: Bordetella trematum is unknown to most clinicians and microbiologists. However, this Gram-negative opportunistic bacterium can be responsible for ulcer superinfection but also bacteremia and sometimes death by septic shock. CASE REPORT: We report the case of erysipelas due to B. trematum with bacteremia in an immunocompromised 88-year-old Caucasian patient. CONCLUSION: In immunocompromised patients, unusual microbial agents such as B. trematum can be responsible for cutaneous and systemic infections, requiring specific antibiotic therapy. Therefore, clinicians should be aware of the need for specific bacterial identification such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry and 16S ribosomal RNA sequencing in the context of atypical evolution of erysipelas in such patients.

Common Cutaneous Infections: Patient Presentation, Clinical Course, and Treatment Options.

This evidence-based review highlights cutaneous infections of bacterial, viral, and fungal origin that are frequently encountered by clinicians in all fields of practice. With a focus on treatment options and management, the scope of this article is to serve as a reference for physicians, regardless of field of specialty, as they encounter these pathogens in clinical practice.

[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.

[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.

[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.

Cellulitis.

Cellulitis is a common infection of the skin and subcutaneous tissue caused predominantly by gram-positive organisms. Risk factors include prior episodes of cellulitis, cutaneous lesions, tinea pedis, and chronic edema. Cellulitis is a clinical diagnosis and presents with localized skin erythema, edema, warmth, and tenderness. Uncomplicated cellulitis can be managed in the outpatient setting with oral antibiotics. Imaging often is not required but can be helpful. Recurrent cellulitis is common and predisposing conditions should be assessed for and treated at the time of initial diagnosis. For patients with frequent recurrences despite management of underlying conditions, antimicrobial prophylaxis can be effective.

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.

Rare coexistence of unilateral erythema nodosum with erysipelas in the area of previous adder bite.

INTRODUCTION: Erysipelas is an acute inflammation of skin and subcutaneous tissue. Erythema nodosum is the most frequent form of panniculitis considered as a reaction to different factors, most commonly infections, especially streptococcal. CASE PRESENTATION: A 74-year-old male presented to hospital due to skin lesions involving the same area he was bitten by an adder six months earlier. On the admission well-demarcated erythema and oedema on the right shin with accompanying fever were noted. Erysipelas was diagnosed and intravenous ceftriaxone was administered. Two days later a few tender nodules within that unilateral location appeared. Based on the clinical and histopathological picture diagnosis of Bävferstedt subtype (erythema nodusum migrans, ENM) was made. The treatment was continued, further followed by doxycycline orally resulting in clinical improvement. CONCLUSIONS: This case presents an unusual coexistence of erysipelas and erythema nodosum migrans, the more it was observed on the primary adder bite area and occurred in a man. Most probably, adder's venom could lead to disturbed blood and lymph flow what predisposed to erysipelas, which, as streptococcal infection, could trigger ENM.

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.

Diagnostic value of laboratory parameters for the discrimination between erysipelas and limited cellulitis.

BACKGROUND AND OBJECTIVES: Erysipelas, caused by beta-hemolytic streptococci, and limited cellulitis, frequently caused by Staphylococcus aureus or other bacteria, are skin and soft tissue infections characterized by typical clinical signs. However, despite the therapeutical relevance they are often not differentiated (e.g in clinical trials). Erysipelas are efficiently treated with penicillin, while limited cellulitis is treated with more wide-spectrum antibiotics. This study investigates whether parameters such as CRP, blood counts or novel parameters like immature granulocytes could serve as biomarkers to distinguish between these entities. PATIENTS AND METHODS: For this retrospective analysis 163 patients were included. We compared laboratory markers in patients with erysipelas (n = 68) to those with limited cellulitis (n = 41) of the leg. Both erysipelas and limited cellulitis were defined clinically, with an additional aspect for erysipelas being a prompt response to penicillin. RESULTS: Erysipelas were characterized by higher levels of inflammation. CRP and leukocyte counts are the best parameters to discriminate between both infections. A CRP value ≥ 3.27 mg/dl indicated the diagnosis of erysipelas with 75 % sensitivity and 73.2 % specificity. CONCLUSIONS: Our results support the thesis that erysipelas and limited cellulitis are distinct infections as defined in the German guidelines and that an assessment of CRP and leukocytes is useful for differential diagnosis.

Erysipelas on surgical scar: a case report.

Erysipelas is a non-necrotizing acute dermal hypodermatitis most often of streptococcal origin. It most often affects the lower limbs. Erysipelas on surgical scar has been rarely reported in the literature. Few cases have been published since the first descriptions of this pathological entity by Baddour et al in 1982. We report the case of a 47-year-old patient. Operated for right breast mucinous carcinoma, she had neo-adjuvant chemotherapy followed by a surgical treatment (Patey) which occured without incident. The evolution was marked by the appearance after 11 months of the intervention of an Erysipelas on Patey scar. The patient was put on cefazol for 7 days intravenously injectable. The evolution was marked by the complete disappearance of the rash and the edema.