According to ICD-10, erysipelas is coded as A46. The disease got its name from the Polish word róża. Belongs to the number of infectious, affects the mucous membranes, skin. Currently, the prevalence of pathology is quite high. Among other infectious skin lesions, erysipelas ranks fourth in terms of frequency of occurrence in the world, which makes it an extremely urgent medical problem. One of the forms of streptococcus can provoke the disease. You can get infected both from the patient and from the carrier. Pathology is manifested by a feverish condition, inflamed areas of red color on the skin, mucous membranes.
General information
Coded as A46 in the ICD-10, erysipelas can develop in a simple or complicated form. The second option is a severe pathology that affects soft tissues. The disease usually starts quickly and progresses rapidly.speed, while there is a strong intoxication of the body. The patient, as a rule, is contagious to a small extent. Pathologies are more prone to women, especially in the period shortly before menopause. Every third patient in the future faces relapses. By itself, pathology has been known to mankind for a very long time, and descriptions of the symptoms are present in the writings of ancient authors. In 1882, for the first time, it was possible to isolate the pathogen in its pure form under laboratory conditions. Among the scientists, through whose efforts the source of erysipelas was studied, Cherkasov, Galperin deserve special attention.
Currently, medicine knows about two dozen types of streptococci. Among them, categories A to G are the most common and most dangerous for humans. It is the beta-hemolytic forms belonging to the first group that can provoke erysipelas in children and adults. They also cause other pathologies - pustular skin diseases, soft tissue lesions, phlegmon. Streptococcus can cause osteomyelitis, provoke the appearance of a boil or cause an abscess. Against the background of infection of the body, a sore throat, bronchitis or scarlet fever is possible. Streptococci of the beta-hemolytic type can provoke toxic shock, cause rheumatism, pharyngitis. Any of the forms of streptococci classified as Category A can cause erysipelas.
Pathogen: know the enemy by sight
Bacteria that cause erysipelas are round in shape, arranged in chains, in rare cases in pairs. The bacterium can divide into two parts - it is by this mechanism that the colony reproduces. In pus, sputum, and other substances in the external environment, streptococcus is able to live for months. The causative agent does not die at low temperatures, it is resistant to freezing. Only certain disinfectants, heat and direct sunlight inhibit the vital functions of bacteria.
Erysipelas-causing streptococci are sensitive to antimicrobial compounds. Such bacteria acquire resistance to antibiotics, but rather slowly. In the process of life, microorganisms generate exo-, endotoxins, enzyme compounds that negatively affect the human body. If a colony of bacteria grows in a highly nutritious environment, the microorganisms are drop-shaped and shiny. Opaque colonies with jagged edges and gray tints are possible. There are also transparent, bulging life forms.
Where did the trouble come from
Erysipelas is a disease that is easiest to pick up in an already sick person or a carrier of the infection. It is these people who belong to the category of "reservoirs" - as it is called in the medical literature. The bacterium can penetrate the skin from an external source, an infectious focus. Prolonged use of steroid hormones, as statistics show, creates conditions for rapid infection and active development of streptococcal colonies. It is known that the risk of erysipelas is higher if a person is sick with tonsillitis in a chronic form, if the teeth are affected by caries, or diseases of the upper respiratory tract are observed. An open path to the body for infection - skin injuries, cracks, abrasions, wounds. Similardamage to the mucous membranes is another option for the penetration of streptococcus. Damage to the nasal cavity, genital organs - all this provokes the risk of erysipelas. Pathology is more often transmitted by contact or airborne droplets.
It is known that the causative agent of erysipelas occurs on the skin, mucous membranes of many he althy people, while the disease does not begin. Such people in medicine are called carriers of bacteria. The tendency to relapse with erysipelas is presumably due to a hereditary factor. The risk of inflammatory processes for women is higher during the period when the reproductive function is gradually fading away. The danger is increased if a person is sick with venous insufficiency, various edema, lymphostasis are revealed. The probability of infection is greater in the presence of colonies of fungi on the feet, as well as in the case of a trophic ulcer.
Features of the onset of the disease
Usually erysipelas of the skin is noted on the shins, face. Somewhat less often, the disease affects the hands, body, genitals and close to them skin, mucous membranes. Inflammation is localized in the dermis, that is, the main skin layer responsible for proper trophism, as well as supporting the function. The dermis is rich in fibers, capillaries, which provides harmful microorganisms with everything they need for active life. The inflammatory process during infection is both infectious and allergic. Substances that produce colonies quickly lead to intoxication of the body, which gives rise to a fever.
Erysipelas begins due to aggressivetoxic effect on organic tissues of enzymes, compounds, antigens secreted by streptococci, active substances produced by colonies. At the same time, small arteries are harmed, vessels that provide lymph flow, and veins suffer. Usually the inflammation is either serous or serous-hemorrhagic. Human skin antigens are somewhat similar to streptococcus polysaccharides, which causes an autoimmune reaction - the body's antibodies attack its own tissues. All this becomes the cause of damage to the vascular tissue, skin, blood begins to coagulate inside the vessels, the capillary walls are destroyed, a hemorrhagic syndrome is observed in the damaged area. Vasodilation leads to hyperemia of skin areas, serous, hemorrhagic vesicles are formed.
Losses: numerous
Erysipelas is accompanied by the release into the bloodstream of substances produced by colonies of microorganisms, as well as other active compounds, including histamine. This contributes to the flow of the form of the disease into hemorrhagic. At the same time, there is a lack of lymph flow, which causes swelling of the legs. Without adequate treatment, the vessels are replaced by fibrin, and this is the foundation for the appearance of elephantiasis. An infectious allergic focus actively consumes glucocorticoids, against the background of which insufficiency of the adrenal glands is possible. This leads to improper protein metabolism, water-s alt reactions.
You are more likely to experience symptoms of erysipelas if your genetic makeup makes you less resistant to the disease. Atsome people the body is characterized by increased sensitivity to substances that produce staphylo-, streptococci. The risk of getting erysipelas increases if the immune system weakens. This is observed against the background of various factors. It should be taken into account the reduction of all forms of natural protection - local, cellular, as well as humoral and non-specific factors. The risk group for erysipelas includes those suffering from metabolic disorders, the balance of active biological compounds, as well as patients who have detected abnormal functioning of the neuroendocrine system.
Disease: what happens
Before starting the treatment of erysipelas, you should figure out which class the pathology belongs to. Modern doctors distinguish seven forms of the disease:
This classification is based on the characteristics of the affected areas.
Based on the degree of severity, one can speak of a mild illness, moderate and severe. Also, erysipelas can be primary, repeated, relapse. Forms can be localized strictly in one place, widespread, migration of foci, metastases is possible. The widespread form begins with a localized, but gradually the focus spreads beyond the primary area. Migration is expressed by the formation of new affected areas near the existing ones, and there are connecting elements between them. Erysipelas metastases are new areas of inflammation, formed away from the primary ones. The causative agent of the disease provokes just such a form if it spreads throughout the body with the bloodstream. This formthe most severe and dangerous, there is a high probability of blood poisoning.
Dedicated to terminology
If the signs of erysipelas worry for the first time, they talk about the primary disease. When the situation repeats in the same area, a second diagnosis is made. At the same time, it is taken into account that at least two years have passed between the cases. A repeated face can be established if the time interval is less than two years, but the localization area is different. Relapses - an option when inflammatory processes appear repeatedly in the same area.
With mild erysipelas, the patient is worried about fever, but rather short-term. Poisoning of the body manifests itself as a weak symptomatology. This is more often observed if the disease has developed in an erythematous form. If the febrile state lasts up to five days, they speak of an average level of severity. The patient suffers from severe symptoms of poisoning. So erythematous, erythematous-bullous varieties can manifest themselves. If complications of erysipelas are observed (for example, sepsis), and the disease itself is diagnosed in a hemorrhagic form, the pathology is difficult to tolerate. The temperature often rises to 40 degrees, poisoning manifests itself with very vivid symptoms. There is a possibility of toxic shock.
If the disease metastasizes or occurs in a migratory form, it is characterized by a severe course. With proper therapy, started in a timely manner, it is possible to develop an erased form, interrupted. Both options are met with little frequency in practice.
First manifestations
The incubation period of streptococcus is up to five days. Usually the disease has an acute onset, you can accurately indicate at what hour the first symptoms appeared. The patient complains of headache, fever, weakness, muscle and joint pain, chills, nausea and vomiting. Perhaps a convulsive state, in some - disorders of consciousness. When toxins produced by streptococcal colonies enter the circulatory system, poisoning of the body develops. In parallel, local signs of the disease gradually appear. In some cases, they take up to ten hours to develop. As a rule, with erysipelas, swelling is one of the typical symptoms indicating a bacterial lesion.
A distinctive feature of the agent is its excellent survival in the lymph flow. It is here that the conditions for the reproduction of colonies are optimal, which leads to the almost instantaneous spread of pathological microorganisms to the lymph nodes on the periphery. This causes an increase in inflammatory foci. Symptoms of poisoning of the body bother up to a week, during this entire period the patient is in a fever. In rare cases, symptoms last longer. Any of the forms is associated with inflammatory processes in the lymphatic system, nodes and blood vessels suffer.
Some Features
Most often, doctors diagnose erysipelas of the leg, although lesions of the hands and face are also possible. Noticeably less often, foci are formed on the body, mucous membranes, in the genital area. There is a possibility of breast cancer. On the lower limb, the disease is due to a violation of the integrity of the skin. Usually thiscaused by trauma. Often the disease is observed against the background of fungal infection of the nails, feet. There is a higher risk of getting sick if there is poor circulation in the legs, diabetes mellitus is diagnosed, and excess weight. More often, erysipelas bothers smokers and those suffering from varicose veins. Disease can be caused by chronic infectious foci in different tissues and organs.
Erysipelas of the leg manifests itself as a pain syndrome in the affected area. Patients describe it as "bursting". It burns in the leg, the limb swells, the skin turns red. Already by these signs, you can suspect a face and urgently consult a doctor. In most cases, the disease is prone to relapse, the risk of this form is especially high if the pathology is not properly treated. Persons suffering from infectious inflammatory processes in the tissues of the body are at increased risk, especially if they occur in a chronic form. If relapses are frequent, over time, the skin changes, the fiber structure is disturbed, which leads to elephantiasis, lymphostasis.
Age and disease
In the elderly, treatment of erysipelas is more often required on the face. The disease manifests itself as a severe pain syndrome, accompanied by the risk of developing gangrene. Pathology regresses very slowly, it is characterized by a protracted course. But in childhood, the disease is rare and usually proceeds easily. Pathology can occur in various areas of the body, but the prognosis is almost always favorable. More often diagnosed with erythematous erysipelas. The disease is somewhat more severe in the one-year-oldage and younger. Inflammation is often localized on the face, in areas of diaper rash, but can spread to other parts of the body. If the form is phlegmonous, the probability of sepsis is high. If the face is affected, there is a danger of meningitis.
Streptococcus can get into a baby's umbilical wound. Such an erysipelas is distinguished by the severity of the course, quickly covers the back, arms, legs, buttocks, is accompanied by a pronounced general poisoning of the body. The child has a fever, possibly a convulsive condition, blood poisoning. It is among newborns that the likelihood of death is especially high.
Doctor, what am I sick with?
Before starting treatment, a diagnosis should be made. Erysipelas is established by analyzing the patient's complaints, medical history and the results of various studies. The importance of professional diagnosis should not be underestimated, as the symptoms of erysipelas are similar to some other skin pathologies. In the general case, differential diagnosis is made, but bacteriological tests are sometimes necessary. Usually these are prescribed if the doctor doubts the diagnosis.
The most likely to confuse erysipelas and dermatitis, erythema, lichen. It is possible to assume that the matter is in the erysipelas, if the disease begins acutely, the lymph nodes are enlarged, and the pain syndrome weakens at rest. Laboratory studies show streptococcus, allow you to determine which antimicrobial compounds it is sensitive to. Properly performed diagnosis helps to choose the optimal treatment program, although the method is not effective.always. True, it is worth understanding that it is undesirable to use folk remedies for erysipelas. The disease can cause severe complications and even death if the right treatment is not started, including antimicrobials of the doctor's choice. There is currently no specific method for detecting erysipelas in the laboratory, but it is known that with a disease in the blood, the concentration of leukocytes increases, the ESR increases.
What to do?
Normally, antibiotic treatment is practiced for erysipelas. The patient takes a course at home, regularly visiting a doctor to monitor the results of the selected program. If the disease is severe, there is a relapse, complications, comorbidities, it is possible to place the patient in a hospital. It is recommended to undergo inpatient treatment if the erysipelas struck a child or an elderly person. The mode is chosen, focusing on the localization of the disease. No special food is required. The doctor prescribes antibiotics - this is the main group of drugs against erysipelas. The best results are shown by penicillins of natural and artificial origin. Amoxicillin, Oxacillin have proven themselves well. Often, doctors advise stopping at Ampicillin or Benzylpenicillin.
If the patient does not tolerate penicillins, macrolides, cephalosporins (first, second generation) can be used. The least effective of the antimicrobial drugs are sulfonamides, nitrofurans, prescribed if the patient's body does not take the above types of medications. The duration of the antimicrobial course is up to ten days.
