Erysipelas

Erysipelas is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Superficial bacterial infection of the skin with prominent lymphatic involvement
  • Leukocytosis is common
  • Positive blood cultures in 3–5%
  • Involves the upper dermis including the superficial lymphatics
  • In contrast, cellulitis affects the deeper dermis and subcutaneous fat

Etiology

  • Group A β-hemolytic streptococcus is the causative organism (less commonly, group C or G streptococci)
  • Portals of entry:
    • Skin ulcers
    • Local trauma
    • Abrasions
    • Psoriatic or eczematous lesions
    • Fungal infections

Pediatric Considerations
  • Haemophilus influenzae type b (HIB) causes facial cellulitis in children that may appear similar to erysipelas:
    • Should be considered in unimmunized children
    • Many will be bacteremic and require admission
    • Cefuroxime or other appropriate H. influenzae coverage is important
    • H. influenzae is much less common since widespread use of the HIB vaccine
  • Group B streptococci can cause erysipelas in the newborn
  • Can develop from infection of umbilical stump


Pregnancy Considerations
  • Erythema of the breast in puerperal mastitis is often caused by Staphylococcus organisms, hence methicillin-resistant S. aureus (MRSA) should be covered

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Basics

Description

  • Superficial bacterial infection of the skin with prominent lymphatic involvement
  • Leukocytosis is common
  • Positive blood cultures in 3–5%
  • Involves the upper dermis including the superficial lymphatics
  • In contrast, cellulitis affects the deeper dermis and subcutaneous fat

Etiology

  • Group A β-hemolytic streptococcus is the causative organism (less commonly, group C or G streptococci)
  • Portals of entry:
    • Skin ulcers
    • Local trauma
    • Abrasions
    • Psoriatic or eczematous lesions
    • Fungal infections

Pediatric Considerations
  • Haemophilus influenzae type b (HIB) causes facial cellulitis in children that may appear similar to erysipelas:
    • Should be considered in unimmunized children
    • Many will be bacteremic and require admission
    • Cefuroxime or other appropriate H. influenzae coverage is important
    • H. influenzae is much less common since widespread use of the HIB vaccine
  • Group B streptococci can cause erysipelas in the newborn
  • Can develop from infection of umbilical stump


Pregnancy Considerations
  • Erythema of the breast in puerperal mastitis is often caused by Staphylococcus organisms, hence methicillin-resistant S. aureus (MRSA) should be covered

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