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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%

Etiology

  • Group A β-hemolytic streptococcus is the causative organism (uncommonly, 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
    • See Mastitis

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Citation

Rosen, Peter, et al., editors. "Erysipelas." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307214/all/Erysipelas.
Erysipelas. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307214/all/Erysipelas. Accessed April 25, 2019.
Erysipelas. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307214/all/Erysipelas
Erysipelas [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307214/all/Erysipelas.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Erysipelas ID - 307214 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307214/all/Erysipelas PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -