Erysipelas natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Erysipelas onset begins shortly after streptococcal infection, with initial symptoms of localized lesions with erythema and edema. Progression from the initial location is rapid, with raised and sharply demarcated boundaries from surrounding unaffected tissue. Systemic symptoms, including fever, chills, and vomiting may occur as the inflammation persists and spreads. Complications of erysipelas occur if the infectious pathogen is not treated and it spreads below the dermis and into the bloodstream, brain, bones, kidneys, and other subcutaneous tissue. Without treatment, the prognosis of erysipelas varies based on the presence of complications. Spread of infection below the dermis can result in hospitalization and can even be life-threatening. With treatment, the prognosis of erysipelas is good; Penicillin has been shown to effectively relieve symptoms and halt progression of the disease.
Natural History
Erysipelas onset begins shortly after streptococcal infection.[1]
- An initial lesion forms with localized erythema and edema
- Progression from the initial location is rapid, with raised and sharply demarcated boundaries from surrounding unaffected tissue
- Untreated, the lesions will spread, while the initial manifestation resolves
- Systemic symptoms, including fever, chills, and vomiting may occur as inflammation persists and spreads
If left untreated, erysipelas will not usually be self-resolved and can lead to life-threatening complications.[2]
Complications
Complications of erysipelas occur if the infectious pathogen is not treated, including the following:
- Increased severity of lesions, including haemorrhagic, bullous, abscessing, and necrotic (necrotizing fasciitis)[3][4]
- Osteoarticular complications, including bursitis, osteitis, tendinitis, and arthritis[5]
- Bacteremia, resulting from spread of infection from the epidermis to the bloodstream[6]
- Septic shock[7]
- Chronic, recurrent erysipelas due to increased susceptibility from damaged cutaneous lymph vessels[8]
- Meningitis (if the infection is localized in the face and spreads below the dermis and into the brain and spinal cord)
- Gangrene
- Acute glomerulonephritis[9]
- Thrombophlebitis[10]
- Lymphatic damage and lymphedema[2]
- Streptococcal toxic shock syndrome[1]
- Myocarditis[11]
Prognosis
Without treatment, the prognosis of erysipelas varies based on the presence of complications.
- Spread of infection below the dermis can result in hospitalization and can even be life-threatening.[12]
With treatment, the prognosis of erysipelas is good.
- Penicillin has been shown to effectively relieve symptoms and halt the progression of the disease.[13]
References
- ↑ 1.0 1.1 Ferretti JJ, Stevens DL, Fischetti VA, Stevens DL, Bryant AE. PMID 26866211. Missing or empty
|title=(help) - ↑ 2.0 2.1 "Erysipelas and cellulitis: Overview - National Library of Medicine - PubMed Health".
- ↑ Krasagakis K, Samonis G, Valachis A, Maniatakis P, Evangelou G, Tosca A (2011). "Local complications of erysipelas: a study of associated risk factors". Clin. Exp. Dermatol. 36 (4): 351–4. doi:10.1111/j.1365-2230.2010.03978.x. PMID 21198795.
- ↑ Pitché PV, Saka B, Diatta AB, Faye O, Diané BF, Sangaré A, Niamba P, Mandengue C, Kobengue L, Diop A, Ly F, Dieng MT, Dicko A, Soumah MM, Cissé M, Kourouma SH, Kouassi I, Boukari T, Akakpo S, Landoh DE, Tchangaï-Walla K (2015). "Risk factors associated with abscess formation among patient with leg erysipelas (cellulitis) in sub-Saharan Africa: a multicenter study". BMC Dermatol. 15: 18. doi:10.1186/s12895-015-0037-7. PMC 4678644. PMID 26666633.
- ↑ Coste N, Perceau G, Léone J, Young P, Carsuzaa F, Bernardeau K, Bernard P (2004). "Osteoarticular complications of erysipelas". J. Am. Acad. Dermatol. 50 (2): 203–9. doi:10.1016/S0190. PMID 14726873.
- ↑ "Erysipelas: MedlinePlus Medical Encyclopedia".
- ↑ "Septic shock: MedlinePlus Medical Encyclopedia".
- ↑ Koster JB, Kullberg BJ, van der Meer JW (2007). "Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies". Neth J Med. 65 (3): 89–94. PMID 17387234.
- ↑ Velciov S, Gluhovschi G, Feier V, Curescu M, Trandafirescu V, Petrică L, Gluhovschi C, Bob F, Bozdog G, Gadalean F, Florescu C, Bobu M, Chiliban A (2010). "Elements of renal injury in patients with erysipelas". Rom J Intern Med. 48 (2): 179–85. PMID 21428183.
- ↑ Gunderson CG, Chang JJ (2013). "Risk of deep vein thrombosis in patients with cellulitis and erysipelas: a systematic review and meta-analysis". Thromb. Res. 132 (3): 336–40. doi:10.1016/j.thromres.2013.07.021. PMID 23948644.
- ↑ Domínguez F, Cobo-Marcos M, Guzzo G, Cavero MA, Mirelis JG, Alonso-Pulpon L, Garcia-Pavia P (2013). "Erysipelas and acute myocarditis: an unusual combination". Can J Cardiol. 29 (9): 1138.e3–5. doi:10.1016/j.cjca.2012.12.021. PMID 23498835.
- ↑ Bonnetblanc JM, Bédane C (2003). "Erysipelas: recognition and management". Am J Clin Dermatol. 4 (3): 157–63. PMID 12627991.
- ↑ Bishara J, Golan-Cohen A, Robenshtok E, Leibovici L, Pitlik S (2001). "Antibiotic use in patients with erysipelas: a retrospective study". Isr. Med. Assoc. J. 3 (10): 722–4. PMID 11692544.