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Erysipelas in children
Last reviewed: 23.04.2024
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Erysipelas in children - one of the forms of streptococcal infections caused by beta-hemolytic streptococcus, manifests itself focal serous-exudative or serous-hemorrhagic inflammation of the skin and subcutaneous fat and general toxic manifestations.
ICD-10 code
A46 erysipelas
Epidemiology of erysipelas in children
Source of infection - a patient with streptococcal infection or bacterium carrier. It is often not possible to establish a source.
The mechanism of transmission of airborne and contact through infected objects, more often in violation of the integrity of the skin.
In the appearance of erysipelas, the individual predisposition of the child plays a role. More often ill children of early age, suffering from dermatitis and other skin diseases.
The erysipelas occurs as an exogenous and endogenous infection. Endogenous develops against a background of chronic lesions. Penetration of the pathogen by a contact route is promoted by microtraumas of the skin and wound surface.
The activation of the process with a recurrent erysipelas is promoted by a decrease in immune defense factors, auto- and heterosensitivity. Adverse factors, contusions, insect bites should be considered as unfavorable factors.
The highest incidence of erysipelas is noted at the end of the summer and in the autumn, more often in the form of sporadic cases.
Children get sick less often than adults. Infection of newborns can occur during childbirth from the mother or the medical staff, as well as through the infected dressing material.
Incidence of erysipelas in recent years has significantly decreased, the lethality is almost zero.
Causes of face
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 of erysipelas
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.
Symptoms of erysipelas in children
The incubation period lasts from several hours to 3-5 days. The disease usually begins sharply, but in some cases, the prodrome is observed in the form of malaise, a feeling of heaviness in the affected limb, paresthesia, tenderness in the region of regional lymph nodes.
The acute onset of the disease is accompanied by headache, chills, fever to 38-40 ° C; note weakness, nausea, vomiting. In severe forms, there may be delusions, phenomena of meningism.
Classification of face
By the nature of local manifestations distinguish erythematous, erythematous-bullous, erythematous-hemorrhagic and bully-hemorrhagic form of erysipelas.
By the severity of intoxication, light, moderate and severe forms of the disease are isolated.
By the multiplicity of the disease distinguish primary, repeated and recurrent erysipelas, according to the prevalence of the local process - localized, widespread, wandering, metastatic.
Isolate local (phlegmon, abscess, necrosis) and general (sepsis, pneumonia, etc.) complications of erysipelas.
Diagnosis of erysipelas in children
The erysipelas are diagnosed mainly on the basis of a clinical picture. Of secondary importance are laboratory data: in peripheral blood leukocytosis with neutrophil shift, eosinophilia, toxic granularity of neutrophils, increased ESR.
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Treatment of erysipelas in children
The most effective antibiotics in the treatment of erysipelas are cephalosporins of III and IV generations in usual doses for 5-7 days. If necessary, you can use macrolides - erythromycin, azithromycin or metacycline. It is possible to prescribe sulfonamides. It is expedient to prescribe ascorbic acid, rutin, B vitamins, nicotinic acid, probiotics (acipol, etc.). Prospective appointment immunomodulatory drug vobenzim, which enhances the effect of antibiotics with a simultaneous decrease in their side effects, and improves the lymph drainage.
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