Diagnosis of rye

Diagnosis of erysipelas is based on the characteristic clinical picture:

• acute onset with pronounced symptoms of intoxication:
• predominant localization of the local inflammatory process on the lower extremities and face;
• development of typical local manifestations with characteristic erythema, possible local hemorrhagic syndrome;
• development of regional lymphadenitis;
• absence of severe pain in the area of inflammation at rest.

^{In 40-60% of patients, moderately expressed neutrophilic leukocytosis (up to 10-12x10 9} /l) is observed in the peripheral blood. In some patients with severe erysipelas, hyperleukocytosis and toxic granularity of neutrophils are observed. Moderate increase in ESR (up to 20-25 mm/h) is recorded in 50-60% of patients with primary erysipelas.

Due to the rare isolation of beta-hemolytic streptococcus from the blood of patients and the site of inflammation, it is inappropriate to conduct conventional bacteriological studies. Of certain diagnostic value are an increase in 5 titers of antistreptolysin O and other antistreptococcal antibodies, bacterial antigens in the blood, saliva of patients, and secreted from bullous elements (RLA, RCA, IFA), which is especially important in predicting relapses in convalescents.

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Indications for consultation with other specialists

Consultations with a therapist, endocrinologist, otolaryngologist, dermatologist, surgeon, ophthalmologist are carried out in the presence of concomitant diseases and their exacerbations, as well as if differential diagnosis of erysipelas is necessary.

Indications for hospitalization

• Severe course.
• Frequent relapses.
• Severe concomitant diseases.
• Age over 70 years.

If erysipelas develops in patients in therapeutic and surgical hospitals, they must be transferred to specialized (infectious) departments. If the patient is not transportable, treatment in a box under the supervision of an infectious disease specialist is possible.

Differential diagnosis of erysipelas

Differential diagnostics of erysipelas is carried out with more than 50 surgical, skin, infectious and internal diseases. First of all, it is necessary to exclude abscess, phlegmon, hematoma suppuration, thrombophlebitis (phlebitis), dermatitis, eczema, shingles, erysipeloid, anthrax, erythema nodosum.

Differential diagnosis of erysipelas

Nosological form	General symptoms	Differential symptoms
Phlegmon	Erythema with edema, fever, inflammatory reaction of the blood	Fever and intoxication occur simultaneously with local changes or later. Nausea, vomiting, myalgia are not typical. The hyperemia focus has no clear boundaries, brighter in the center. Sharp pain on palpation and independent pain are typical.
Thrombophlebitis (purulent)	Erythema, fever, local tenderness	Moderate fever and intoxication. Often - varicose veins. Areas of hyperemia along the veins, palpable as painful cords
Shingles	Erythema, fever	The appearance of erythema and fever is preceded by neuralgia. Erythema is located on the face, trunk, always one-sided. within 1-2 dermatomes. Edema is not expressed. On the 2-3rd day, characteristic vesicular rashes appear.
Anthrax (erysipelas-like variant)	Fever, intoxication, erythema, edema	The process is localized more often on the hands and head. Local changes precede fever: the boundaries of hyperemia and edema are unclear, there is no local pain: in the center there is a characteristic carbuncle
Erysipeloid	Erythema	Absence of intoxication. Erythema is localized in the area of the fingers and hand. Edema is weakly expressed, there is no local hyperthermia. Individual foci merge with each other: interphalangeal joints are often affected
Eczema, dermatitis	Erythema, skin infiltration	Fever, intoxication, soreness of the lesion, lymphadenitis are absent. Itching, oozing, peeling of the skin, small blisters are characteristic.

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