Symptoms of rye

The incubation period of erysipelas with exogenous infection lasts from several hours to 3-5 days. The overwhelming majority of patients experience an acute onset of the disease.

Symptoms of erysipelas in the initial period are manifested by intoxication, which occurs before local manifestations by several hours - 1-2 days, which is especially characteristic of erysipelas localized on the lower extremities. Typical symptoms of erysipelas occur: headache, general weakness, chills, myalgia, nausea and vomiting (25-30% of patients). Already in the first hours of the disease, patients note an increase in temperature to 38-40 ° C. In areas of the skin where local lesions will subsequently occur, some patients feel paresthesia, a feeling of distension or burning, pain. Often there is pain when palpating enlarged regional lymph nodes.

The peak of erysipelas occurs in a few hours - 1-2 days after the appearance of the first signs. In this case, general toxic manifestations and fever reach their maximum; characteristic local symptoms of erysipelas appear. Most often, the inflammatory process is localized on the lower limbs (60-70%), face (20-30%) and upper limbs (4-7% of patients), rarely - only on the trunk, in the area of the mammary gland, perineum, external genitalia. With timely treatment and uncomplicated course of the disease, the duration of fever is no more than 5 days. In 10-15% of patients, its duration exceeds 7 days, which indicates the generalization of the process and the ineffectiveness of etiotropic therapy. The longest febrile period is observed in bullous-hemorrhagic erysipelas. Regional lymphadenitis is found in 70% of patients with erysipelas (in all forms of the disease).

The temperature returns to normal and intoxication disappears before local symptoms of erysipelas regress. Local signs of the disease are observed up to the 5th-8th day. In hemorrhagic forms - up to the 12th-18th day and more. Residual effects of erysipelas, persisting for several weeks or months, include pastosity and pigmentation of the skin, stagnant hyperemia at the site of the faded erythema, dense dry crusts at the site of bullae, edematous syndrome. An unfavorable prognosis and the likelihood of an early relapse are indicated by prolonged enlargement and soreness of the lymph nodes; infiltrative changes in the skin in the area of the faded focus of inflammation; prolonged subfebrile condition; prolonged persistence of lymphostasis, which should be considered an early stage of secondary elephantiasis. Hyperpigmentation of the skin of the lower extremities in patients who have had bullous-hemorrhagic erysipelas can persist throughout life.

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Clinical classification of erysipelas (Cherkasov V.L., 1986)

• By the nature of local manifestations:
  • erythematous;
  • erythematous-bullous;
  • erythematous-hemorrhagic;
  • bullous-hemorrhagic.
• By severity:
  • light (I);
  • moderate (II);
  • heavy (III).
• By flow rate:
  • primary;
  • repeated (if the disease recurs after two years; other localization of the process);
  • recurrent (if there are at least three relapses of erysipelas per year, the definition of “frequently recurring erysipelas” is appropriate),
• By prevalence of local manifestations:
  • localized:
  • widespread (migratory);
  • metastatic with the occurrence of foci of inflammation distant from each other.
• Complications of erysipelas:
  • local (abscess, phlegmon, necrosis, phlebitis, periadenitis, etc.);
  • general (sepsis, IBS, pulmonary embolism, etc.).
• Consequences of erysipelas:
  • persistent lymphostasis (lymphatic edema, lymphedema);
  • secondary elephantiasis (fibredema).

Erythematous erysipelas may be an independent clinical form or the initial stage of other forms of erysipelas. A small red or pink spot appears on the skin, which in a few hours turns into characteristic erysipelas. Erythema is a clearly demarcated area of hyperemic skin with uneven borders in the form of teeth, tongues. The skin in the area of erythema is tense, edematous, hot to the touch, it is infiltrated, moderately painful upon palpation (more along the periphery of erythema). In some cases, a "peripheral ridge" can be detected - infiltrated and elevated edges of erythema. Enlargement, soreness of the femoral-inguinal lymph nodes and hyperemia of the skin above them ("pink cloud") are characteristic.

Erythematous-bullous erysipelas occurs after several hours - 2-5 days against the background of erythema erysipelas. The development of blisters is caused by increased exudation in the inflammation site and the detachment of the epidermis from the dermis, accumulated fluid.

If the surface of the blisters is damaged or if they rupture spontaneously, exudate flows out of them; erosions appear at the site of the blisters; if the blisters remain intact, they gradually dry out, forming yellow or brown crusts.

Erythematous-hemorrhagic erysipelas occurs against the background of erythematous erysipelas 1-3 days after the onset of the disease: typical symptoms of erysipelas are noted: hemorrhages of various sizes - from small petechiae to extensive confluent ecchymoses.

Bullous-hemorrhagic erysipelas develops from the erythematous-bullous or erythematous-hemorrhagic form as a result of deep damage to the capillaries and blood vessels of the reticular and papillary layers of the dermis. Extensive hemorrhages into the skin occur in the area of erythema. Bullous elements are filled with hemorrhagic and fibrinous-hemorrhagic exudate. They can be of different sizes; they are dark in color with translucent yellow inclusions of fibrin. The blisters contain mainly fibrinous exudate. It is possible for extensive, dense upon palpation flattened blisters to develop due to significant deposition of fibrin in them. With active reparation, brown crusts quickly form at the site of the blisters in patients. In other cases, rupture, rejection of the blister caps together with clots of fibrinous-hemorrhagic contents and exposure of the eroded surface can be observed. In most patients, it gradually epithelializes. With significant hemorrhages into the bottom of the blister and the thickness of the skin, necrosis is possible (sometimes with the addition of a secondary infection, the formation of ulcers).

Recently, hemorrhagic forms of the disease have been more frequently recorded: erythematous-hemorrhagic and bullous-hemorrhagic.

The severity of erysipelas is determined by the severity of intoxication and the prevalence of the local process. Mild (I) form includes cases with minor intoxication, subfebrile temperature, localized (usually erythematous) local process.

Moderate (II) form is characterized by pronounced intoxication. Patients complain of erysipelas symptoms: general weakness, headache, chills, muscle pain, sometimes nausea, vomiting, fever up to 38-40 °C. Examination reveals tachycardia; almost half of patients have hypotension. The local process can be either localized or widespread (involving two or more anatomical areas).

Severe (III) form includes cases with severe intoxication: with intense headache, repeated vomiting, hyperthermia (over 40 °C), loss of consciousness (sometimes), meningeal symptoms, convulsions. Significant tachycardia, hypotension are detected; in elderly and senile people, with late treatment, acute cardiovascular failure may develop. Severe form also includes widespread bullous-hemorrhagic erysipelas with extensive blisters in the absence of severe intoxication and hyperthermia.

Depending on the localization of the disease, its course and prognosis have their own characteristics. The lower extremities are the most common localization of erysipelas (60-75%). The disease forms with the development of extensive hemorrhages, large blisters and subsequent formation of erosions and other skin defects are characteristic. For this localization, the most typical lesions of the lymphatic system are lymphangitis, periadenitis; chronic relapsing course.

Facial erysipelas (20-30%) is usually observed in the primary and recurrent forms of the disease. Recurrent course is relatively rare.

Early treatment of erysipelas alleviates the course of the disease. Often, the development of erysipelas is preceded by tonsillitis, acute respiratory infections, exacerbation of chronic sinusitis, otitis, caries.

Erysipelas of the upper extremities (5-7%) usually occurs against the background of postoperative lymphostasis (elephantiasis) in women who have undergone surgery for a breast tumor.

One of the main features of erysipelas as a streptococcal infection is the tendency to a chronically recurring course (25-35% of cases). A distinction is made between late relapses (a year or more after the previous disease with the same localization of the local inflammatory process) and seasonal (annual for many years, most often in the summer-autumn period). Symptoms of erysipelas of late and seasonal relapses (the result of reinfection) are similar in clinical course to typical primary erysipelas, but usually develop against the background of persistent lymphostasis and other consequences of previous diseases.

Early and frequent (three or more per year) relapses are considered exacerbations of a chronic disease. In more than 90% of patients, frequently recurring erysipelas occurs against the background of various concomitant diseases in combination with skin trophic disorders, decreased barrier functions, and local immunodeficiency.

In 5-10% of patients, local complications of erysipelas are observed: abscesses, phlegmon, skin necrosis, pustulization of bullae, phlebitis, thrombophlebitis, lymphangitis, periadenitis. Most often, such complications occur in patients with bullous-hemorrhagic erysipelas. With thrombophlebitis, the subcutaneous and deep veins of the leg are affected. Treatment of such complications is carried out in purulent surgery departments.

Common complications (0.1-0.5% of patients) include sepsis, infectious toxic shock, acute cardiovascular failure, pulmonary embolism, etc. Mortality from erysipelas is 0.1-0.5%.

The consequences of erysipelas include persistent lymphostasis (lymphedema) and secondary elephantiasis (fibredema). Persistent lymphostasis and elephantiasis in most cases appear against the background of functional insufficiency of skin lymph circulation (congenital, post-traumatic, etc.). Recurrent erysipelas arising against this background significantly increases lymph circulation disorders (sometimes subclinical), leading to complications.

Successful anti-relapse treatment of erysipelas (including repeated courses of physiotherapy) significantly reduces lymphatic edema. In cases of already formed secondary elephantiasis (fibredema), only surgical treatment is effective.