About the face: sovenok101 – LiveJournal

Apparently, it’s time to talk about the face. Erysipelas in this case is not a disgusting face, but a disease, and an infectious one.

Erysipelas is a bacterial infection of the skin, mucous membranes (rarely) and superficial lymphatic vessels. Caused by a bacterium called group A beta-hemolytic streptococcus. The same one that causes scarlet fever, most sore throats and rheumatism. A very difficult bacterium. Only a person suffers from it (anthroponosis). A person most often infects himself, transferring streptococcus from a focus of chronic infection – tonsillitis, caries, otitis media, all that. It is quite difficult to get infected from another patient with erysipelas, although it is possible.

This dirty trick gets into the skin through damage. Ranging from wounds to simple scratches. So the patient with the erysipelas of the hand from the previous post suffers from dermatitis and the streptococcus got inside precisely when combing.

But in general, erysipelas most often occurs on the legs and on the face. The face sounds optimistic, doesn’t it?

This attack is provoked by any situations that violate the integrity of the skin. For example, mycosis, diabetes, lymphostasis, venous insufficiency. Stress and insolation increase the likelihood of developing erysipelas.

What does streptococcus arrange in the skin? Inflammation, severe and rapidly developing. Streptococcus perfectly knows how to attach to tissues and hide from phagocytes – border guard cells that recognize bacteria, swallow them, cut them into pieces and present them to other cells of the immune system. Thanks to these abilities to dodge, streptococcus penetrates into the deep layers of the skin and the lymphatic capillaries located there and develops vigorous activity: it releases exotoxins, enzymes, fragments of the cell wall (the body reacts especially sharply to them) and multiplies rapidly.

The immune system, having slapped the initial stage of the invasion, here, in full, unfolds a war game called inflammation. By this time, toxins and other dirty tricks have already penetrated the bloodstream, and inflammatory mediators have also flown there, which are secreting immune cells with might and main – mainly neutrophilic leukocytes and macrophages – so that the whole body is included in the war.

By the way, streptococcus is not for nothing a master of provoking systemic problems like rheumatism. He knows how to translate arrows from his own antigens to body tissues. In the case of rheumatism, the tissues of the heart, joints, blood vessels of the brain and skin are affected. And in the case of the skin, it exposes the skin cells so that the immune system attacks them too.

It looks like this.

Suddenly, in the midst of complete well-being, a person’s temperature rises sharply, with chills, headache and severe weakness, sometimes nausea and vomiting. In very severe cases, consciousness may be disturbed, delirium and hallucinations may appear. Often the patient calls not just the day, but also the hour of the onset of the disease.

Somewhere in a day, changes appear on the skin.

It begins with the appearance of a red or pink spot on the skin, which quickly spreads and turns into erythema. In this area, the skin is edematous, tense, hot to the touch, sensitive to the periphery, where the infiltrated ridge is located (accumulation of cellular elements mixed with blood and lymph). This is what an erythematous erysipelas looks like.


Often, everything is limited by this: in 3-5 days the body copes with streptococcus, either by itself or with our help, and the patient recovers.

But sometimes the process goes further:

blisters appear (erythematous bullous erysipelas)

– hemorrhages (erythematous-hemorrhagic)

– both this and that (bullous-hemorrhagic)

– the last stage – the formation of necrosis

If the process is complicated by pus, phlegmon occurs. Which of the listed stages, and which complications of erysipelas – experts still argue. But it’s not that important.

This mess looks like this:

where the picture came from, I don’t remember, if you suddenly find a source, write, I will insert a link

where the picture came from, I don’t remember, if you suddenly find a source, write, I will insert a link

All this is accompanied by severe intoxication: fever up to 40C, shortness of breath, tachycardia, low blood pressure (septic shock), impaired consciousness. Often, very often acute renal failure occurs.

Our patients most often end up with exactly this: with kidney damage. First, the amount of urine decreases sharply, then urea, creatinine and potassium jump in the blood. The second most common reason for hospitalization in intensive care is shock. The third is a violation of consciousness. Sometimes patients are transferred to us because of a high, unremitting fever, realizing that kidney failure and shock are only a matter of time.

What will we treat?

First of all, antibiotics. The good news is that this streptococcus is most often sensitive to the simplest cephalosporins and fluoroquinolones. The bad news is that just antibiotics can be limited only with a mild course of the disease. In more severe cases, it is necessary to apply the whole complex of measures called detoxification – from massive infusion to an artificial kidney.

The erysipelas is usually treated by purulent surgeons or infectious disease specialists. Before the formation of necrosis or the development of phlegmon, all surgical treatment consists of dressings and observation. Necrosis is excised, and phlegmon is opened.

There is another nuance: if you do not expel this dirty trick from the body with kicks, read – with a good dose of antibiotics, then streptococcus will settle in the lymphatic system and will recur, that is, resume. Immunity to it almost does not develop. Do you need to remind about the benefits of sanitation of foci of chronic infection?

Can you die from erysipelas? In the case of the development of a severe form – easily. Can an erysipelas go away on its own without treatment? Quite. But without antibiotics, there is a risk of recurrence. Why, other things being equal, someone gets erysipelas, and someone does not? It is believed that there is a hereditary predisposition.

What should be remembered to assess the severity of the situation? The same as with any inflammation. Red flags:

  1. disturbance of consciousness
  2. shortness of breath more than 24 per minute
  3. decrease in pressure below 90 (at a rate of 120)
  4. decrease in the amount of urine below 500 ml

Indomitable headache and vomiting are also suspicious, but for other problems.

Things to remember: people with lymphedema, venous insufficiency, diabetes, and all sorts of skin problems should keep their ears open about erysipelas. Treat teeth, tonsils and other chronicles, monitor the skin and, if anything, consult a doctor. Erysipelas is an insidious thing, as is its immediate cause, streptococcus.



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