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ErysipelasAka: Beta-Hemolytic Streptococcal Cellulitis, Group A Streptococcus Cellulitis, Group A Strep Cellulitis, Saint Anthony's Fire

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  1. See Also
    1. Skin Infection
    2. Cellulitis
    3. Perianal Streptococcal Cellulitis
    4. Non-Group A Streptococcus Cellulitis
  2. History: St. Anthony's Fire
    1. Refers to epidemic gangrene of the 11th century
      1. Patients presented with bright red extremities
    2. Initially attributed to fungus ingestion and Ergotism
      1. Now believed those reactions were Erysipelas
    3. Some thought skin was consumed by holy fire
      1. Only relief was via 300 AD Egyptian Monk St. Anthony
  3. Epidemiology
    1. Common Ages
      1. Infants and Young children
      2. Older than age 60 years (face involvement)
    2. More common over summer months
    3. Usually occurs in isolated cases rather than epidemics
  4. Pathophysiology
    1. Acute Skin Infection with Beta-hemolytic Streptococcus
    2. Develops faster than Staphylococcus aureus Cellulitis
  5. Mechanisms
    1. Most cases do not have inciting wound
    2. Post-operative infection via surgical incision
      1. Occurs 6-48 hours after surgery
    3. Trauma site
    4. Insect Bite
    5. Nasopharyngeal source
  6. Causes: Beta-hemolytic streptococcal infection
    1. Group A Streptococcus (most common)
    2. See Non-Group A Streptococcus Cellulitis
      1. Group B Streptococcus
      2. Groups C, D, and G Streptococcus
  7. Risk Factors
    1. Immunocompromised patients
    2. Corticosteroid or Chemotherapy use
    3. Acquired Immunodeficiency Syndrome
    4. Nephrotic Syndrome
    5. Diabetes Mellitus
    6. Alcoholism
    7. Venous Insufficiency
    8. Lymphatic Insufficiency
  8. Symptoms
    1. Abrupt onset with rapid course
    2. Influenza-like prodrome
      1. Fever, Chills, Malaise
      2. Headache
      3. Vomiting
    3. Red rash with feeling of tightness and warmth
  9. Signs
    1. Same signs as for other forms of Cellulitis except
      1. Lesion indurated with elevated margins
      2. Irregular border that is sharply demarcated
    2. Lesions show staged progression
      1. Spreading erythema over 3-6 days
        1. Shiny, bright red erythema
        2. Painful, hot, edematous lesion
      2. Vesicles and bullae may develop and then crust
      3. Central clearing may then develop within 7-10 days
      4. Areas of involved skin may exfoliate
      5. Post-inflammatory Hyperpigmentation may occur
    3. Marked lymphangitis
    4. Hypotension may be first sign before erythema
    5. Common sites of involvement
      1. Legs
        1. Congenital Lymphedema (Milroy's Disease)
        2. CABG saphenous vein harvest
          1. See Non-Group A Streptococcus Cellulitis
      2. Face (less common now than legs, see below)
  10. Signs and Symptoms: Facial Erysipelas
    1. Pharyngitis may precede rash by several days
    2. Focal area on face of Paresthesia or pain
    3. Rash develops in area of sensory change
      1. Rash develops as described in signs (see above)
      2. May appear similar to SLE butterfly Malar Rash
    4. Edema may develop of eyes and cheeks
  11. Differential Diagnosis
    1. See Cellulitis
    2. Contact Dermatitis
    3. Angioneurotic edema
    4. Herpes Zoster
    5. Erysipeloid
    6. Erythema Chronicum Migrans (Lyme Disease)
  12. Labs
    1. Complete Blood Count
      1. Leukocytosis with Left Shift
    2. Antistreptolysin O titer increased
    3. Nasopharynx culture
      1. Positive for Beta-hemolytic Streptococcus
    4. Gram Stain and Culture of wound
      1. Compress wound margins for thin serous discharge
      2. Sample obtained from leading edge
      3. Painful and usually not indicated
  13. Other Skin Infections with Group A Streptococcus
    1. Pyoderma (Impetigo)
    2. Perianal Streptococcal Dermatitis
    3. Children with Chronic Perianal Cellulitis
      1. Intense perianal erythema
      2. Painful Defecation
      3. Blood streaked stools from Anal Fissures
  14. Management
    1. See Cellulitis for antibiotic selection
      1. Should be sensitive to Penicillin or Erythromycin
      2. However Staphylococcus aureus difficult to exclude
    2. Intravenous antibiotics may be required initially
    3. Total antibiotic course: 10-14 days
    4. Apply warm, moist compresses to affected area
  15. Complications
    1. Abscess
    2. Gangrene
    3. Superficial thrombophlebitis
    4. Acute Glomerulonephritis
    5. Sepsis
    6. Endocarditis
  16. References
    1. Gilbert (2002) Sanford Guide, p. 37
    2. Bratton (1995) Am Fam Physician 51(2):401
    3. Carroll (1996) Postgrad Med 100(3):311
    4. Stulberg (2002) Am Fam Physician 66(1):119

Erysipelas (C0014733)

Definition (MSH)An acute infection of the skin caused by species of STREPTOCOCCUS. This disease most frequently affects infants, young children, and the elderly. Characteristics include pink-to-red lesions that spread rapidly and are warm to the touch. The commonest site of involvement is the face.
ConceptsDisease or Syndrome (T047)
ICD9035
MSHD004886
EnglishErysipelas, Patch of erysipelas
Spanisherisipela, placa de erisipela
Parent ConceptsBacterial Infections (C0004623), Streptococcal Infections (C0038395), Skin Diseases, Bacterial (C0162627), Cellulitis of skin (C0406128), Streptococcal cellulitis (C0457220), Streptococcal skin disorder (C1299554), Duplicate concept (C1274013)
SourcesCOSTAR, CST, DXP, ICD9CM, LCH, MSH, MTH, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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