Erysipelas

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Background

  • Specific form of cellulitis involving the superficial levels of the dermis and subcutaneous tissues (including lymphatics)[1]
  • Majority of cases caused by streptococcus[1][2]
    • However, recent data indicates S. aureus (specifically, CA-MRSA) is a rising cause.
  • Usually affects lower extremities (face is also common)[3]

Clinical Features

  • Rash
    • Local erythema, warmth, swelling
    • Well demarcated and raised border[1]
  • Can be accompanied by fever, chills, malaise, headache, nausea/vomiting
Erysipelas well demarcated.JPG

Differential Diagnosis

Skin and Soft Tissue Infection

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Evaluation

Work-up

  • Unlike Necrotizing fasciitis and skin infections with purulent collections or exudates, bacteriology work-up (biopsy, blood culture, etc) generally does not yield results in erysipelas.[2]

Evaluation

  • Clinical diagnosis, based on history and physical exam

Management

Antibiotics

Coverage for S. pyogenes

  • Penicillin G 300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg (first line therapy[3]) OR
  • Clindamycin 450mg (5mg/kg) PO q8hrs x 10 days (if PCN allergic) OR
  • Cephalexin 500mg (6.25mg/kg) PO q6hrs x 10 days OR
  • Ceftriaxone 1g (50mg/kg) IV once daily x 10 days OR
  • Levofloxacin 500mg PO/IV daily x 10 days OR
  • Augmentin 500mg PO BID x 10 days (generally reserved for failure of first line therapy)

Bullous Erysipela or MRSA suspected: trimethoprim-sulfamethoxazole, clindamycin, doxycycline, or minocycline

Disposition

  • Generally may be discharged with outpatient treatment

See Also

References

  1. 1.0 1.1 1.2 Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012 Feb;64(2):148-55.
  2. 2.0 2.1 Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis. 2007 Apr;20(2):118-23.
  3. 3.0 3.1 Linke M, Booken N. Risk factors associated with a reduced response in the treatment of erysipelas. J Dtsch Dermatol Ges. 2015 Mar;13(3):217-25.