Infectious erythema

When various infections are affected, focal redness may appear on the skin - infectious erythema, which is a sign that the infection has caused a reaction in the form of increased blood flow to the skin area.

Due to the lack of terminological clarity in dermatology, some conditions with red spots on the skin can be called erythema. [1]

Epidemiology

Medical statistics cannot record cases of redness of the skin as a symptom of infectious skin lesions or systemic diseases, but monitors data on the etiological factors of alteration.

So, one of the most common causes of infectious erythema is streptococcal infection, which accounts for almost half of cases of infectious erythema nodosum in children and more than 40% of cases in adults. [2]

When children and adults are infected with parvovirus B19, there are no symptoms in 20% of cases. And with ixodid tick bites, characteristic erythema is observed in eight out of ten cases.[3], [4]

Parvovirus B19 infection in pregnant women can cause severe complications in the fetus. These complications include miscarriage, intrauterine death, and fetal dropsy. [5]The risk of fetal loss after an acute infection is approximately 5%. Mothers in the second trimester of pregnancy are at greatest risk of developing complications from parvovirus B19, but cases have been reported at all stages of pregnancy.[6]

Patients with sickle cell disease or other chronic hemolytic diseases may be more severely affected than other populations. [7]Parvovirus B19 infection destroys reticulocytes. This causes a decrease or temporary arrest of erythropoiesis. Such people can develop an aplastic crisis and lead to severe anemia. Often these patients will be much worse off because of fever, malaise, and lethargy. Patients with an aplastic crisis will have pallor, tachycardia, and tachypnea due to severe anemia.[8]

Causes infectious erythema

Any reddening of the skin  (erythros in Greek means red) is a natural concern , but a special case when the causes of erythema are associated with infections.

An example is skin lesions by the bacteria Streptococcus pyogenes, a group A beta-hemolytic streptococcus, which leads to the development of various  types of streptoderma , as well as erysipelas (erysipelas).

A reaction in the form of skin redness can be caused by the bacteria Staphylococcus aureus, Mycoplasma hominis, Yersinia enterocolitica, Erysipelothrix rhusiopathiae, as well as the herpes virus (including type IV - Epstein-Barr virus), erythroparvovirus (Primate erythroparvovirus 1). It is assumed that among the causes of  persistent erythema , which appears in the area of the joints with inflammation of the walls of skin capillaries (vasculitis), there may be an immune response to the bacteria Streptococcus spp. And Escherichia coli (Escherichia coli).

Infectious-allergic erythema refers to  allergic dermatoses . It can also be a microbial eczema  or  vasculitis of the skin of an  allergic and infectious origin complicated by an infection .

In cancer patients, systemic erythema may appear due to a bacterial infection, most often Streptococcus viridans and Arcanobacterium haemolyticum.

Infectious erythema in adults and children occurs when  skin lesions are caused by arthropods , primarily the ixodid tick, which carries the bacteria Borrelia burgdorferi [9]- the cause  of Lyme disease , which begins with the appearance of redness at the site of the bite -  erythema of the migrating chronic Afzelius-Lipschutz .[10], [11]

Risk factors

The main risk factors are a decrease in general and local immunity (and, accordingly, all conditions and pathologies that cause immunosuppression), foci of chronic bacterial or viral infection in the body - streptococcal, staphylococcal, herpesvirus, as well as increased sensitivity (sensitization) - with a tendency to allergic reactions.

Pathogenesis

The pathogenesis of the development of infectious erythema, as one of the  types of red spots on the skin of the body , is due to increased blood flow in the surface capillaries during an inflammatory reaction, which, in fact, is protective and is aimed at neutralizing antigens and toxins produced by pathogenic microorganisms.[12]

Which mediators trigger the defense mechanism and which immune cells ensure its functioning, in detail in the publication -  Syndrome of systemic inflammatory response .

For more information on how the most common bacterial and viral infections work, see:

• Streptococci
• Causes and pathogenesis of staphylococcal infection
• Herpesvirus infections

Symptoms infectious erythema

Attention should be paid to the types of infectious erythema, which are nosological units, and are traditionally distinguished by most dermatologists as separate diseases, but are not registered in the International Classification of Diseases.

Infectious erythema multiforme

Erythema exudative multiforme, erythema multiforme Gebra (named after the 19th century Austrian dermatologist F. Von Gebra who first described it), polyform or infectious erythema multiforme (ICD-10 code L51) is considered a cutaneous immune response to infection (as well as a number of drugs)... Often, this erythema is part of a specific response to the activation  of the herpes simplex virus  (HSV type I and II): in half of the cases, the patient's history has periodic herpetic eruptions on the lips.

As a rule, the incubation period of erythema multiforme does not exceed 48 hours, and its first signs are the appearance on the skin of the limbs of convex rounded redness with clearly defined contours, at first small, but rapidly increasing (up to 30 mm in diameter). Further, erythema spreads to the upper body and face, and in the center of the spots, hyperemia may become more intense; there may be pustules (blisters filled with serous fluid) or crusts. Itching is not excluded. The rash usually goes away after two to four weeks.[13]

In cases of severe erythema multiforme, Stevens-Johnson syndrome develops with fever, head and joint pain, ulceration of the oral mucosa and genitals, with redness of the eyes and their increased photosensitivity.

Read also -  Erythema multiforme exudative. Causes, symptoms, diagnosis, treatment

Infectious erythema nodosum

In addition to the fact that this type of skin redness is one of the symptoms of a secondary focal form of a zoonotic disease such as pseudotuberculosis, the causative agent of which is the enterobacterium Yersinia pseudotuberculosis, infectious erythema nodosum has ICD-10 code L52. [14]

It is associated with a bacterial infection - streptococcal or tuberculosis, as well as viral (infectious mononucleosis), and typical symptoms include fever, painful dense nodules in the skin and surrounding swollen red patches on the skin of the front of the legs, and joint pain.

The nodules can become inflamed and then flatten and disappear, leaving behind hematomas or depressions in the skin - like a trace after damage to the subcutaneous tissue. [15]

The redness may go away on its own after three to six weeks.

Rosenberg infectious erythema

Macular (macular) Rosenberg erythema (described by the Russian infectious disease specialist N. Rosenberg) suddenly occurs in adolescence and young age. The pathological condition is manifested by fever and chills, as well as headache and aching joints. Rashes on the legs, arms and torso appear after about four to five days - as separate red spots of a round shape.

Characterized by a rapid increase in spots in diameter (sometimes three to five times) and their fusion with the formation of extensive areas of hyperemia, which dermatologists call erythematous fields. The color of the rashes turns pale after three days, and after a few days they pass, and in their place peeling of the epidermis can be observed. Experience has shown that the duration of sudden spotted erythema varies from one to two weeks.

Infectious toxic erythema

According to ICD-10, toxic erythema has a code L53. In clinical practice, such systemic erythema is observed in toxic shock syndrome  caused by group A streptococcal infection. For details, see -  Symptoms of streptococcal infection .

In addition, Staphylococcus aureus infection, primarily Staphylococcus aureus toxins (Staphylococcus aureus), may be involved in the development of toxic shock - with diffuse erythema of the trunk and arms, fever, falling blood pressure, muscle pain and loss of consciousness.

In almost half of infants on the second to fifth day after birth, toxic erythema of newborns (Erythema toxicum neonatorum, code P83.1 according to ICD-10) appears - red spots on the skin with white or yellow nodules (or fluid-filled vesicles), which during one -two weeks disappear. Officially, this condition is considered iliopathic, but many researchers explain its etiology by the activation of the immune system of newborns in response to the formation of skin microflora in the neonatal period.

For details, see -  Erythema of the skin of newborns: causes, consequences, treatment

Infectious erythema in children - the fifth disease

What is Chamer's fifth disease or infectious erythema? It is a viral infection characterized by skin lesions (ICD-10 code B08.3); The causative agent is a parvovirus infection - erythrovirus (parvovirus) B19, which is now called simply the B19 virus of the genus Erythroparvovirus, which is transmitted by airborne droplets.[16]

It is common in children 5-15 years old (especially in the winter-spring period), but adults can also get sick. The incubation period is four days to two weeks, and the baby is contagious before the rash develops on the skin.

At the end of the 19th century, the disease was described by the Austrian doctor A. Chamer, who considered it a variant of German measles (rubella), and redness on the cheeks was called Chamer's erythema. And the fifth disease, because it was the fifth on the list of the six most common pediatric infectious diseases associated with rash.

For more information see -  Infectious erythema: antibodies to parvovirus B19 in the blood

Initial flu-like symptoms include headache, body aches, fever, and chills; may have a sore throat. In adults, there is no rash and erythema (but joints may hurt), and in children after two or three days a rash of bright red color appears on the cheeks, sometimes red mesh rashes on the limbs and trunk, which can last from 10 days to several weeks...

Complications and consequences

Among the complications of severe cases of infectious erythema multiforme, scar formation, focal inflammation of the subcutaneous tissue, eye damage, and inflammation of internal organs are noted. [17]

Also read -  Consequences and complications of streptoderma

Erythema in Lyme disease can be complicated by the development of local skin atrophy.

Infection with parvovirus 19 with weakened immunity or hematological diseases can damage the bone marrow and cause severe anemia. And in pregnant women who become infected before the 20th week, there is a risk of fetal death.[18]

Diagnostics infectious erythema

Clinical diagnosis of infectious diseases and conditions in which erythema appears on the skin involves a complete history of patients, including medications taken, recent travel, bites and other factors, as well as  examination of the skin , including the characteristics of the rash itself (localization, morphological features, etc.). Etc.). The same diagnostic technique is also used for erythema, isolated as independent nosological units (although in almost half of the cases, doctors cannot determine their causes).

Blood tests, in addition to general and biochemical ones, include the determination of bacterial antigens (IgA, IgG, IgM) in croca serum,  analysis for Staphylococcus aureus  and anti-  streptococcal antibodies,  analysis for herpes , etc. Biopsy of the affected skin is necessary for erythema nodosum.[19]

Instrumental diagnostics is carried out using  dermatoscopy .

Differential diagnosis

The main problem is the differential diagnosis of infectious erythema: with common dermatological diseases (dermatitis, lichen rosacea, erythrokeratoderma, fungal skin lesions), with allergic conditions (including drug toxicoderma), as well as with skin manifestations of childhood infections, systemic lupus erythematosus and others exanthema (rash) of various etiology. For example, with erythematous skin lesions in Wagner's disease (dermatomyositis) or glucagonoma (pancreatic tumors).[20]

Treatment infectious erythema

In some cases, for example, with parvovirus erythema in children and other rashes of viral origin, specific treatment is not required: the use of non-steroidal anti-inflammatory drugs (NSAIDs) is sufficient to relieve fever and headache. The exception is the herpes virus, for more details see -  Treatment of herpes simplex

What medicines are used most often for bacterial redness of the skin? These are systemic  antibiotics for streptoderma in children  and adults; various topical agents:

• Ointments for streptoderma
• Ointments for eczema
• Skin rash ointments
• If the reddened skin itches, then antihistamines help relieve itching  .

Also read:

• Treating streptococcal infection
• Antibiotics after a tick bite

The development of toxic shock with systemic toxic erythema associated with streptococcal or staphylococcal infection is life threatening and requires urgent medical attention.

And first aid is needed for arthropod bites related to hematophages; comprehensive information on what to do in the material -  Tick bites in humans .

Prevention

Non-specific preventive measures include good hygiene - frequent hand washing to reduce the likelihood of infection. You should also avoid contact with infected people.

Forecast

In the absence of complications, infectious erythema has a favorable prognosis. [21]Symptoms of erythema infection usually resolve on their own in immunocompetent patients. These symptoms are usually mild, and some people may not have symptoms. In immunocompromised patients or patients with hematologic disorders, symptoms may be more severe. Chronic infection and chronic anemia can occur in people with weakened immune systems. Acute infection and contact with the fetus can be fatal. The risk of fetal death is highest in infected pregnant women under 20 weeks of age.