Diagnosis of erysipelas

Diagnosis of erysipelas is based on a characteristic clinical picture:

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

In 40-60% of patients in peripheral blood, moderate neutrophilic leukocytosis is noted (up to 10-12x10 ⁹ / l). Individual patients with severe erysipelas are followed by hyperleukocytosis, toxic neutrophil count. Moderate increase in ESR (up to 20-25 mm / h) is recorded in 50-60% of patients with primary erysipelas.

Due to the rare release of beta-hemolytic streptococcus from the blood of patients and the focus of inflammation, it is not practical to carry out routine bacteriological studies. The increase in 5 titers of antistreptolysin O and other anti-streptococcal antibodies, bacterial antigens in the blood, saliva of patients, separated from bullous elements (RLA, RKA, IFA) is of particular diagnostic importance, which is especially important in predicting relapses in convalescents.

[1], [2], [3], [4], [5], [6]

Indications for consultation of other specialists

Consultations of the therapist, endocrinologist, otolaryngologist, dermatologist, surgeon, ophthalmologist are performed in the presence of concomitant diseases and their exacerbations, and also if differential diagnosis of erysipelas is necessary.

Indications for hospitalization

• Heavy current.
• Frequent relapses.
• Severe concomitant diseases.
• Age over 70 years.

With the development of erysipelas, patients who are in therapeutic and surgical hospitals should be transferred to specialized (infectious) departments. In case of non-transportability of the patient, treatment in a box under the supervision of an infectious disease doctor is possible.

Differential diagnosis of erysipelas

Differential diagnosis of erysipelas is performed with more than 50 surgical, skin, infectious and internal diseases. First of all, it is necessary to exclude abscess, phlegmon, suppuration of hematoma, 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 blood reaction	The occurrence of fever and intoxication concurrently with local changes or later them. Nausea, vomiting, myalgia are not characteristic. The focus of hyperemia does not have clear boundaries, it is brighter in the center. Characterized by sharp pain during palpation and independent pain
Thrombophlebitis (purulent)	Erythema, fever, local soreness	Moderate fever and intoxication. Often - varicose veins. Areas of hyperemia along the veins, palpable in the form of painful cords
Shingles	Erythema, fever	The emergence 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 pronounced, On the 2nd-3rd day, characteristic bubble rashes occur
Anthrax (rozhistopodobny variant)	Fever, intoxication, erythema, edema	The process is localized more often on the hands and head. Local changes precede a fever: borders of a hyperemia and an edema are indistinct, there is no local morbidity: in the center - a characteristic carbuncle
Erisipeloid	Erythema	Absence of intoxication. Erythema is localized in the area of fingers, brushes. Swelling weakly absent local hyperthermia. Individual foci merge: often interphalangeal joints are affected
Eczema, dermatitis	Erythema, skin infiltration	Fever, intoxication, soreness of the focus, lymphadenitis are absent. Characteristic of pruritus, mocculation, skin peeling, small vesicles

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