Human disease from a bacterial infection of the skin
This article is about the disease called "erysipelas" in humans. For the disease called "erysipelas" in nonhuman animals, see Erysipelothrix rhusiopathiae.
Medical condition
Erysipelas
Other names
Ignis sacer, holy fire, St. Anthony's fire
Erysipelas of the face due to invasive Streptococcus
Erysipelas (/ˌɛrəˈsɪpələs/) is a relatively common bacterial infection of the superficial layer of the skin (upper dermis), extending to the superficial lymphatic vessels within the skin, characterized by a raised, well-defined, tender, bright red rash, typically on the face or legs, but which can occur anywhere on the skin. It is a form of cellulitis and is potentially serious.[1][2][3]
Erysipelas is usually caused by the bacterium Streptococcus pyogenes, also known as group A β-hemolytic streptococci, which enters the body through a break in the skin, such as a scratch or an insect bite. It is more superficial than cellulitis and is typically more raised and demarcated.[4] The term comes from the Greek ἐρυσίπελας (erysípelas), meaning red skin.[5]
In animals erysipelas is a disease caused by infection with the bacterium Erysipelothrix rhusiopathiae. In animals it is called Diamond Skin Disease and occurs especially in pigs. Heart valves and skin are affected. Erysipelothrix rhusiopathiae can also infect humans but in that case the infection is known as erysipeloid and is an occupational skin disease.[6]
Signs and symptoms
Symptoms often occur suddenly. Affected individuals may develop a fever, shivering, chills, fatigue, headaches and vomiting and be generally unwell within 48 hours of the initial infection.[1][2] The redplaque enlarges rapidly and has a sharply demarcated, raised edge.[4][7] It may appear swollen, feel firm, warm and tender to touch and have a consistency similar to orange peel.[2] Pain may be extreme.[7]
More severe infections can result in vesicles (pox or insect bite-like marks), blisters, and petechiae (small purple or red spots), with possible skin necrosis (death).[7]Lymph nodes may be swollen and lymphedema may occur. Occasionally a red streak extending to the lymph node can be seen.[8]
The infection may occur on any part of the skin, including the face, arms, fingers, legs and toes; it tends to favour the extremities.[1] The umbilical stump and sites of lymphoedema are also common sites affected.[7]
Fat tissue and facial areas, typically around the eyes, ears and cheeks, are most susceptible to infection.[9] Repeated infection of the extremities can lead to chronic swelling (lymphoedema).[2]
Erysipelas (ear)
Erysipelas (arm)
Erysipelas (leg)
Recurrent erysipelas
Cause
Most cases of erysipelas are due to Streptococcus pyogenes, also known as group A β-hemolytic streptococci, less commonly to group C or G streptococci and rarely to Staphylococcus aureus. Newborns may contract erysipelas due to Streptococcus agalactiae, also known as group B streptococcus or GBS.[7]
The infecting bacteria can enter the skin through minor trauma, human, insect or animal bites, surgical incisions, ulcers, burns and abrasions. There may be underlying eczema or athlete's foot (tinea pedis), and it can originate from streptococci bacteria in the subject's own nasal passages or ear.[7]
The rash is due to an exotoxin, not the Streptococcus bacteria, and is found in areas where no symptoms are present, e.g. the infection may be in the nasopharynx, but the rash is found usually on the epidermis and superficial lymphatics.[10]
Diagnosis
Erysipelas is usually diagnosed by the clinician looking at the characteristic well-demarcated rash following a history of injury or recognition of one of the risk factors.[2]
Erysipelas can be distinguished from cellulitis by two particular features: its raised advancing edge and its sharp borders. The redness in cellulitis is not raised and its border is relatively indistinct.[7] Bright redness of erysipelas has been described as a third differentiating feature.[13]
Recurrence of infection: Erysipelas can recur in 18–30% of cases even after antibiotic treatment. A chronic state of recurrent erysipelas infections can occur with several predisposing factors, including alcoholism, diabetes and athlete's foot.[16] Another predisposing factor is chronic cutaneous edema, such as can in turn be caused by venous insufficiency or heart failure.[17]
Necrotizing fasciitis, commonly known as ‘flesh-eating’ bacterial infection, is a potentially deadly exacerbation of the infection if it spreads to deeper tissue.[citation needed]
Epidemiology
There is currently no validated recent data on the worldwide incidence of erysipelas.[19] From 2004 to 2005 UK hospitals reported 69,576 cases of cellulitis and 516 cases of erysipelas.[19] One book stated that several studies have placed the prevalence rate between one and 250 in every 10,000 people.[20] The development of antibiotics, as well as increased sanitation standards, has contributed to the decreased rate of incidence.[21] Erysipelas caused systemic illness in up to 40% of cases reported by UK hospitals and 29% of people had recurrent episodes within three years.[19] Anyone can be infected, although incidence rates are higher in infants and elderly.[21] Several studies also reported a higher incidence rate in women.[21] Four out of five cases occur on the legs, although historically the face was a more frequent site.[3]
Chronic skin conditions such as psoriasis, athlete's foot, and eczema
Excising the saphenous vein
Immune deficiency or compromise, such as
Diabetes
Alcoholism
Obesity
Human immunodeficiency virus (HIV)
In newborns, exposure of the umbilical cord and vaccination site injury
Issues in lymph or blood circulation
Leg ulcers
Lymphatic edema
Lymphatic obstruction
Lymphoedema
Nasopharyngeal infection
Nephrotic syndrome
Pregnancy
Previous episode(s) of erysipelas
Toe web intertrigo
Traumatic wounds
Venous insufficiency or disease
Preventive measures
Individuals can take preventive steps to decrease their risk of catching the disease. Properly cleaning and covering wounds is important for people with an open wound. Effectively treating athlete's foot or eczema if they were the cause of the initial infection will decrease the chance of the infection occurring again. People with diabetes should pay attention to maintaining good foot hygiene.[20] It is also important to follow up with doctors to make sure the disease has not come back or spread. About one third of people who have had erysipelas will be infected again within three years.[19] Rigorous antibiotics may be needed in the case of recurrent bacterial skin infections.[20]
Marin Mersenne, French theologian, philosopher and mathematician (d. 1648). In one of his letters R. Descartes writes to Mersenne that he wants to find some cure for his erysipelas.[23]
George Herbert, 5th Earl of Carnarvon (d. 1923), English aristocrat and financial backer of the search for and excavation of Tutankhamun's tomb in the Valley of the Kings.[35]
Richard Wagner, opera composer, was prone to outbreaks of erysipelas throughout his adult life. He suffered notably from attacks throughout the year 1855 when he was 42.
Acute
Jair Bolsonaro, president of Brazil between 2019 and 2022, currently[when?] suffers from erysipelas.
Recovered
Lenin developed an infection in London, and party leadership was exercised by Martov until he recovered.[38][39][40]
Ernest Hemingway developed an infection near his left eye after being hit with an oar. He was treated at the Casa di Cura Morgagni in Padua.[41]
Fictional
In D. H. Lawrence's novel Sons and Lovers one of the major characters in the novel, William Morel, dies quickly from the complications of erysipelas in conjunction with pneumonia.
In Anton Chekhov's 1892 short story Ward No. 6 erysipelas is among the conditions suffered by the patients committed to a poorly run mental illness facility in a small town in tsarist Russia.
In Willa Cather's One of Ours, the main character, Claude, contracts the disease in "the queerest" way, after being dragged into wire by mules, and the next day continuing to work in the dust. The disease plays a key role in the novel, persuading him to marry Enid after she cares for him in recovery. (Book II, Chapter IV, p. 138).
In Season 1, Episode 4 of Downton Abbey, Isobel Crawley misdiagnoses her butler, Molesley, with erysipelas when he develops a rash on his hands. The Dowager Countess of Grantham correctly identifies the rash as an allergy to rue.
It was historically known as St Anthony's fire,[3] with past treatments including muriated tincture of iron,[43] a solution of Iron(III) chloride in alcohol.[44]
^"Cellulitis". The Lecturio Medical Concept Library. Retrieved 7 July 2021.
^"Erysipelas". The Lecturio Medical Concept Library. Retrieved 21 July 2021.
^"Erysipelas". The Lecturio Medical Concept Library. Retrieved 7 July 2021.
^Ashton, Leppard, Richard, Barbara (9 March 1989). Differential diagnosis in dermatology. Oxford: Radcliffe Medical Press. p. 44. ISBN9781870905206.{{cite book}}: CS1 maint: multiple names: authors list (link)
^Michael, Y.; Shaukat, N. M. (2022). "Erysipelas". National Center for Biotechnology Information, U.S. National Library of Medicine. PMID30335280. Retrieved 7 July 2021.
^Stevens, Dennis L.; Bryant, Amy E. (2016), Ferretti, Joseph J.; Stevens, Dennis L.; Fischetti, Vincent A. (eds.), "Impetigo, Erysipelas and Cellulitis", Streptococcus pyogenes: Basic Biology to Clinical Manifestations, University of Oklahoma Health Sciences Center, PMID26866211, retrieved 8 June 2020
^Nigar Kirmani; Keith F. Woeltje; Hilary Babcock (2012). The Washington Manual of Infectious Disease Subspecialty Consult. Lippincott Williams & Wilkins. ISBN9781451113648. Page 194
^"Overview: Erysipelas and cellulitis", InformedHealth.org [Internet], Institute for Quality and Efficiency in Health Care (IQWiG), 1 September 2022, retrieved 14 September 2024
^Dennis Butts, "Hofland, Barbara (bap. 1770, d. 1844)", Oxford Dictionary of National Biography (Oxford, UK: OUP, 2004 Retrieved 20 December 2015, pay-walled.