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Causes and pathogenesis of rye
Last reviewed: 06.07.2025
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Reasons
The causative agent of erysipelas is beta-hemolytic streptococcus group A. The poor isolation of streptococcus from the erysipelas focus and its extremely rare isolation from the blood of patients prompted a search for other pathogens. However, the assumption of the existence of a dermatogenic serotype of streptococcus was not confirmed. It has also been established that staphylococcus and other pyogenic bacteria play an etiologic role in complications of erysipelas. It is assumed that L-forms of streptococcus are involved in the etiology of recurrent erysipelas.
Pathogenesis
Beta-hemolytic streptococcus, penetrating exo- or endogenously, multiplies in the lymphatic vessels of the dermis. The local process is formed under the condition of initial sensitization of the skin to hemolytic streptococcus. In the origin of inflammatory changes in erysipelas, along with streptococcal toxins, tissue biologically active substances such as histamine, serotonin and other mediators of allergic inflammation play a huge role.
In the absence of allergies, the introduction of streptococcus leads to the development of a banal purulent process.
The allergic origin of morphological changes in the skin is indicated by plasmatic impregnation of the dermis, serous or serous-hemorrhagic exudate with fibrin loss, cell necrobiosis, lysis of elastic and collagen fibers of the skin, pronounced vascular changes in the form of fibrinous damage to the walls of blood vessels, swelling of the endothelium, perivascular cellular infiltration of lymphoid, plasmacytic and reticulohistiocytic elements.
It has been shown that lymphocytes proliferating and differentiating in the skin are capable of an immune response without further migration to peripheral lymphoid organs. In patients with erysipelas, the main process is localized in the dermis, in its papillary and reticular layers. Here, vascular lesions, hemorrhages and necrosis occur, in the development of which immunopathological processes undoubtedly play a role. In recurrent forms of the disease, disorders of hemostasis, regulation of capillary blood circulation and lymph circulation are detected.
Primary and recurrent erysipelas (acute streptococcal infection) occurs as a result of exogenous infection. Recurrent erysipelas (chronic endogenous streptococcal infection) often occurs during treatment with hormones and cytostatics. Recurrent erysipelas is extremely rare in children.
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