Symptoms of erysipelas

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

Symptoms of erysipelas in the initial period are manifested by intoxication, which occurs before local manifestations for several hours - 1-2 days. Which is especially characteristic for erysipelas localized on the lower limbs. There are typical symptoms of erysipelas: headache, general weakness. Chills, myalgia, nausea and vomiting (25-30% of patients). Even in the first hours of the disease, patients noted a temperature increase of 38-40 ° C. On the skin areas, where later local lesions occur, some patients experience paresthesia, a feeling of bursting or burning, and soreness. Often there is pain in palpation of enlarged regional lymph nodes.

The heat of erypsipelas comes in a few hours - 1-2 days after the appearance of the first signs. At the same time, total toxic effects and fever reach their maximum; there are characteristic local symptoms of erysipelas. Most often, the inflammatory process is localized on the lower extremities (60-70%), the face (20-30%) and the upper extremities (4-7% of patients), rarely - only on the trunk, in the mammary gland, perineum, vulva. With timely treatment and uncomplicated course of the disease, the duration of the 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 inefficiency of etiotropic therapy. The longest febrile period is observed with a bullous-hemorrhagic erysipelas. In 70% of patients with erysipelas, regional lymphadenitis is detected (for all forms of the disease).

The temperature is normalized and intoxication disappears earlier than the local symptoms of erysipelas regress. Local signs of the disease are observed until the 5th-8th day. With hemorrhagic forms - up to 12-18 days or more. Residual erysipelas that persist for several weeks or months include sweating and pigmentation of the skin, congestive flushing in place of extinct erythema, dense dry crusts in place of bullae, edematous syndrome. An unfavorable prognosis and the likelihood of early relapse are indicated by the prolonged increase and soreness of the lymph nodes; infiltrative skin changes in the area of extinct inflammation; prolonged subfebrile condition; long-term preservation of lymphostasis, which should be considered as an early stage of secondary elephantiasis. Hyperpigmentation of the skin of the lower limbs in patients who have suffered a bully-hemorrhagic erysipelas can last a lifetime.

[1], [2]

Clinical classification of erysipelas (Cherkasov VL, 1986)

• By the nature of local manifestations:
  • erythematous;
  • erythematous-bullous;
  • erythematous-hemorrhagic;
  • Bull-hemorrhagic.
• By severity:
  • light (I);
  • moderate (II);
  • heavy (III).
• By the multiplicity of the flow:
  • primary;
  • repeated (with the recurrence of the disease in two years, another localization of the process);
  • relapsing (in the presence of at least three relapses of erysipelas per year, the definition of "often recurring mug" is appropriate)
• By the prevalence of local manifestations:
  • localized:
  • common (migratory);
  • Metastatic with the appearance of distant from each other foci of inflammation.
• Complications of erysipelas:
  • local (abscess, phlegmon, necrosis, phlebitis, periadenitis, etc.);
  • general (sepsis, pulmonary embolism, thromboembolism, etc.).
• Consequences of face:
  • persistent lymphostasis (lymphatic edema, lymphedema);
  • secondary elephantia (fibredema).

Erythematous mug can 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 after a few hours turns into a characteristic erythema erythema. Erythema - clearly delimited area of hyperemic skin with uneven borders in the form of teeth, tongues. Skin in the erythema area is tense, edematous, hot to the touch, it is infiltrated, moderately painful on palpation (more on the periphery of the erythema). In some cases, you can find a "peripheral cushion" - the infiltrated and elevated edges of the erythema. Characteristic increase, soreness of the femoral-inguinal lymph nodes and hyperemia of the skin above them ("pink cloud").

The erythematous-bullous mug appears in a few hours - 2-5 days against erythema erysipelas. The development of blisters is caused by increased exudation in the focus of inflammation and detachment of the epidermis from the dermis, accumulated fluid.

If the surface of the blisters is damaged or spontaneously ruptured, exudate flows out of them; erosion on the spot of the blisters; if the bubbles remain intact, they gradually shrink to form yellow or brown crusts.

Erythematous-hemorrhagic erysipelas occur 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 discharge ecchymosis.

Bullous-hemorrhagic erysipelas develops from the erythematous-bullous or erythematous-hemorrhagic form as a result of deep damage of the capillaries and blood vessels of the mesh and papillary dermis layers. There are extensive hemorrhages in the skin in the erythema region. Bullous elements are filled with hemorrhagic and fibrinous-hemorrhagic exudates. They can be of different sizes; have a dark color with translucent yellow inclusions of fibrin. Bubbles contain mainly fibrinous exudate. Perhaps the emergence of extensive, dense palpation of flattened blisters due to the significant deposition of fibrin in them. With active repair in the patients in place of the blisters quickly formed brown crusts. In other cases, it is possible to observe a rupture, the rejection of bubble covers together with clots of fibrinose-hemorrhagic contents and exposure of the eroded surface. In most patients, it gradually epithelialized. With significant hemorrhages in the bottom of the bladder and the thickness of the skin necrosis is possible (sometimes with the attachment of a secondary infection, the formation of ulcers).

Recently, hemorrhagic forms of the disease are more often recorded; erythematous-hemorrhagic and bullous-hemorrhagic.

The criterion of severity of erysipelas is the severity of intoxication and the prevalence of the local process. To an easy (I) form cases with insignificant intoxication, a subfebrile temperature, localized (more often erythematous) local process carry cases.

The medium-heavy (II) form is characterized by severe intoxication. Patients complain of the symptoms of erysipelas: general weakness, headache, chills, muscle pains, sometimes - for nausea, vomiting, fever up to 38-40 ° C. When a test is found, tachycardia; almost half of patients - hypotension. Local process can have both localized and widespread (captures two anatomical areas and more) character.

The severe (III) form includes cases with severe intoxication: with severe headache, repeated vomiting, hyperthermia (over 40 ° C). Darkening of consciousness (sometimes), meningeal symptoms, convulsions. Detect significant tachycardia, hypotension; in elderly and senile patients with late-onset treatment, it is possible to develop acute cardiovascular insufficiency. To the heavy form also carry a widespread bullous-hemorrhagic erysipelas with extensive blisters in the absence of pronounced intoxication and hyperthermia.

With different localization of the disease, its course and prognosis have their own peculiarities. Lower extremities are the most common localization of erysipelas (60-75%). Characteristic forms of the disease with the development of extensive hemorrhage, large blisters and the subsequent formation of erosion, other skin defects. For this localization, lesions of the lymphatic system in the form of lymphangites, periadenitis are most typical; chronically recurrent course.

The facial features (20-30%) are usually observed in the primary and secondary forms of the disease. With it, the recurrent course is relatively rare.

The timely treatment of erysipelas facilitates the course of the disease. Often the appearance of face faces are preceded by angina. Acute respiratory disease, exacerbation of chronic sinusitis, otitis, caries.

The erysipelas of the upper extremities (5-7%), as a rule, occur against a background of postoperative lymphostasis (elephantiasis) in women operated on for a breast tumor.

One of the main features of erysipelas as streptococcal infection is the tendency to a chronically recurring course (25-35% of cases). There are 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 late and seasonal relapse rye (the result of reinfection) in the clinical course are similar to a typical primary mug, but usually develop against a 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. More than 90% of patients often recurrent erysipelas occur against a background of various concomitant diseases in combination with disorders of trophic skin, a decrease in its barrier functions, and local immunodeficiency.

In 5-10% of patients observe local complications of erysipelas: abscesses, phlegmon, skin necrosis, pustulization bulla, phlebitis, thrombophlebitis, lymphangitis, periadenitis. The most common complications occur in patients with bully-hemorrhagic erysipelas. In thrombophlebitis, subcutaneous and deep veins of the lower leg are affected. Treatment of such complications is carried out in the departments of purulent surgery.

General complications (0.1-0.5% of patients) include sepsis, infectious-toxic shock, acute cardiovascular insufficiency, pulmonary embolism, etc. Lethality in face masks is 0.1-0.5%.

The effects of erysipelas include persistent lymphostasis (lymphedema) and the actual secondary elephantiasis (fibredema). Persistent lymphostasis and elephantiasis in most cases appear against the background of functional deficiency of lymphatic circulation of the skin (congenital, posttraumatic and other). The recurrent erysipelas arising on this background significantly increases lymph circulation disturbances (sometimes subclinical), leading to complications.

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