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KAVITA NATHAN Group 318 Slide 2 It is a streptococcal infection of the superficial lymphatic vessels, usually associated with broken skin on the face. The area affected is erythematous and oedematous. The patient may be febrile and have a leucocytosis. Slide 3 Slide 4 Bacteria inoculation into an area of skin, trauma is the initial event in the developing erysipelas Slide 5 Slide 6 Slide 7 In erysipelas, the infection rapidly invades and spreads through the lymphatic vessels. This can produce overlying skin "streaking" and regional lymph node swelling and tenderness. Immunity does not develop to the inciting organism. Slide 8 Regional lymphnode swelling and tenderness Slide 9 A cut in the skin Problem with drainage through the veins or lymph system Skin sores( ulcers) Slide 10 Slide 11 Slide 12 Slide 13 Slide 14 Slide 15 Slide 16 Slide 17 Slide 18 Slide 19 Slide 20 Slide 21 Slide 22 Streptococcal toxins are thought to contribute to the brisk inflammation that is pathognomonic of this infection. they clearly coexist with streptococci at sites of inoculation. Slide 23 Recently, atypical forms reported to be caused by : * Streptococcus pneumoniae, *Klebsiella pneumoniae, * Haemophilus influenzae, *Yersinia enterocolitica, *Moraxella species, Slide 24 * Streptococci are the primary cause of erysipelas. * Most facial infections are attributed to group A streptococci, *lower extremity infections being caused by nongroup A streptococci. Slide 25 Slide 26 Group A beta- hemolytic streptocci Hemolytic streptococcus Skin infection Painful rashes Erythematous rash Edematous rash Skin ulcer Abrasions Skin ulcer Insect bite eczema Slide 27 Slide 28 Blisters Fever, shaking, and chills Painful, very red, swollen, and warm skin underneath the sore (lesion) Skin lesion with a raised border Sores (erysipelas lesions) on the cheeks and bridge of the nose Slide 29 Slide 30 Erysipelas begins as a small erythematous patch that progresses to a fiery-red, indurated, tense, and shiny plaque Slide 31 The lesion classically exhibits raised sharply demarcated advancing margins. Local signs of inflammation warmth, edema, tenderness are universal. Slide 32 Lymphatic involvement often is manifested by overlying skin streaking and regional lymphadenopathy Slide 33 More severe infections may exhibit numerous vesicles and bullae along with petechiae and even frank necrosis. Slide 34 Slide 35 Slide 36 Slide 37 Slide 38 Erysipelas is diagnosed based on how the skin looks. A biopsy of the skin is usually not needed. Slide 39 1) Erythema Annulare Centri- fugum 2) Stasis Dermatitis 3) Cellulitis 4) Erysipeloid Slide 40 * Eruptions occur at any age. Slide 41 Lesions most often appear on the thighs, legs, face, trunk and arms. linked to underlying diseases, viral, bacterial or even tumor. Slide 42 Slide 43 Slide 44 Slide 45 * acute bacterial infection of traumatized skin. * caused by Erysipelothrix rhusiopathiae (gram positive rod-shaped bacterium), which cause animal and human infections. * Direct contact between infected meat and traumatized human skin results in Erysipeloid. more common among farmers, butchers, cooks, homemakers. * Lesions most commonly affect the hands. Slide 46 Slide 47 Antibiotics such as penicillin are used to eliminate the infection. In severe cases, antibiotics may need to be given through an IV (intravenous line). Those who have repeated episodes of erysipelas may need long-term antibiotics. Slide 48 * Elevation and rest of the affected limb are recommended to reduce local swelling, inflammation, and pain. * Saline wet dressings should be applied to ulcerated and necrotic lesions and changed every 2-12 hours, depending on the severity of the infection. Slide 49 * A first-generation cephalosporin or macrolide, such as erythromycin or azithromycin, may be used if the patient has an allergy to penicillin. Slide 50 Two new drugs: roxithromycin & pristinamycin, have been reported to be extremely effective in the treatment of erysipelas. Slide 51 With treatment, the outcome is good. It may take a few weeks for the skin to return to normal. Peeling is common. Slide 52 In some patients, the bacteria may travel to the blood. This results in a condition called bacteremia. The infection may spread to the heart valves, joints, and bones. Other complications include: Return of infection Septic shock Slide 53 abscess, gangrene, Thrombophlebitis. acute glomerulonephritis, endocarditis, septicemia, streptococcal toxic shock syndrome. Slide 54 Patients with recurrent erysipelas should be educated regarding : local antisepstic. general wound care. Predisposing lower extremity skin lesions (eg, tineapedis, toe web intertrigo, stasis ulcers) should be treated aggressively to prevent super-infection. Slide 55 Keep your skin healthy by avoiding dry skin and preventing cuts and scrapes. This may reduce the risk for erysipelas. Slide 56 Patients with acute infections involving the extremities should be encouraged to limit their activity and keep the limb elevated to decrease swelling. Slide 57 THANK YOU..