Erysipelas, also called St. Anthony's fire, is caused by infection by Group A Streptococci. This same type of bacteria is responsible for such infections as strep throat, and infections of both surgical and other kinds of wounds in the skin. The infection occurs most often in young infants and the elderly.
Causes and symptoms
Erysipelas usually occurs rather abruptly. When the preceding infection was strep throat, the rash begins on the face. Occasionally, when the preceding infection was of a wound from an injury or operation, the rash will appear on an arm or leg.
Classically, the usual presentation is a bright-red, butterfly-shaped rash appearing across the bridge of the nose and the cheeks. It is hot to the touch, painful, shiny, and swollen, with clearly defined margins. The edges of the rash are a raised ridge, hard to the touch. There may be fluid-filled bumps scattered along the area. The rash spreads rapidly. Some patients have swelling of the eyelids, sometimes so severe that their eyes swell shut. The patient may have fever, chills, loss of energy, nausea and vomiting, and swollen, tender lymph nodes. In severe cases, walled-off areas of pus (abscesses) may develop beneath the skin. If left untreated, the streptococcal bacteria may begin circulating in the bloodstream (a condition called bacteremia). A patient may then develop an overwhelming, systemic infection called sepsis, with a high risk of death.
The rash of erysipelas is very characteristic, raising the practitioner's suspicion towards that diagnosis, especially when coupled with a history of recent strep infection. Attempts to culture (grow) the bacteria from a sample of the rash usually fail. When the bacteria are present in the blood, they may be grown in a laboratory, and identified under a microscope. Other laboratory tests involve reacting fluorescently-tagged antibodies with a sample of the patient's infected tissue. This type of test may be successful in positively identifying the streptococcal bacteria.
Penicillin is the drug of choice for treating erysipelas. It can usually be given by mouth, although in severe cases (or in cases of diagnosed bacteremia) it may be given through a needle placed in a vein (intravenously).
Even with antibiotic treatment, swelling may continue to spread. Other symptoms, such as fever, pain, and redness, usually decrease rapidly after penicillin is started. Cold packs and pain relievers may help decrease discomfort. Within about five to 10 days, the affected skin may begin drying up and flaking off.
With prompt treatment, the prognosis from erysipelas is excellent. Delay of treatment, however, increases the chance for bacteremia and the potential for death from overwhelming sepsis. This is particularly true of people with weakened immune systems (babies, the elderly, and people ill with other diseases, especially Acquired Immunodeficiency Syndrome, or AIDS). Frequently, an individual who has had erysipelas will have it occur again in the same location.
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Rosalyn Carson-DeWitt, MD
Bacteremia—The presence of bacteria in the blood.
Streptococcus—A bacteria that causes erysipelas and strep throat, as well as other infections.