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Causes and pathogenesis of erysipelas
Last reviewed: 23.04.2024
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Causes
The causative agent of erysipelas is beta-hemolytic streptococcus of group A. The poor seeding of streptococcus from the foci of erysipelas, its extremely rare excretion from the blood of the patients led to the search for other pathogens. However, the assumption of a dermatogenic serotype of streptococcus was not confirmed. It has also been established that staphylococcus and other pyogenic bacteria play an etiological role in complications of erysipelas. It is suggested 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. Local process is formed under the condition of initial skin sensitization to hemolytic streptococcus. In the origin of inflammatory changes in erysipelas, in addition to toxins of streptococcus, tissue biologically active substances such as histamine, serotonin and other mediators of allergic inflammation play an important role.
In the absence of allergies, the introduction of streptococcus leads to the development of a banal purulent process.
In favor of the allergic origin of the morphological changes in the skin, plasma imbibition of the dermis, serous or serous-hemorrhagic exudate with fibrin precipitation, cell necrosis, lysis of the elastic and collagen fibers of the skin, pronounced vascular changes in the form of fibrinous lesions of the vessel walls, swelling of the endothelium, perivascular cell infiltration from lymphoid, plasmacytic and reticulo-histiocytic elements.
It is shown that lymphocytes proliferating and differentiating in the skin are capable of an immune response without further migration to the peripheral lymphoid organs. In patients with erysipelas, the main process is localized in the dermis, in its papillate and reticular layers. Here there are lesions of blood vessels, hemorrhages and necrosis, in the development of which the immunopathological processes play an indisputable role. With relapsing forms of the disease, hemostasis disorders, regulation of capillary circulation and lymph circulation are revealed.
Primary and repeated erysipelas (acute streptococcal infection) occurs due to exogenous infection. Recurrent erysipelas (chronic endogenous streptococcal infection) often occurs in the treatment of hormones and cytostatics. In children, a recurring mug is rarely seen.
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