Erysipelas - a form of streptococcal infection, ha ¬ ized with acute or chronic course with about ¬ formation on the skin (rarely on mucous membranes) otgra indeterminate focal serous or serous-hemorrhagic inflammation, accompanied by general toxic phe ¬ niyami. The disease has a tendency to recurrent course. 

Etiology. Causative agent of erysipelas - p-hemolytic streptococcus group A, comprising a large number of serological variants. P-hemolytic streptococci - facultative anaerobes, stable ¬ chivye to the effects of environmental factors, but sensitive to heat up to 56 "C for 30 min, effects of base-fektantov disinfectant and antibiotics (penicillin, tetracycline, chloramphenicol, etc.). 

Epidemiology. The source of infection - erysipelas and equally other forms of streptococcal infection (scarlet fever, tonsillitis, pneumonia, streptoderma), as well as native p-gemoli-Atlantic streptococcus. Infection occurs as a result of penetration of streptomycin ¬ tokokka through broken skin or mucous membranes. Comte ¬ gioznost faces minor infections are more prone women tires and lime elderly. Incidence increases at age ¬ no-autumn period. 

Pathogenesis and pathological picture. Input in ¬ rotami infection are the skin (usually injured) and mucous membranes. Possible hematogenous drift exciter ¬ Telja of foci of streptococcal infection (endogenous integral ¬ large unfinished agenda). As a result, the impact of streptococcal and resorption of toxins develop serous or serous-gemorragiche ¬ skoe inflammation in the skin or mucous membranes of the shell and chkah obschetok ¬ The classical syndrome. The defining moment of the pathogenesis, apparently, is an individual predisposition to erysipelas acquired or congenital nature, including delayed-type hypersensitivity to hemolytic streptococci. Erysipelas - an infectious-allergic recurrent per ¬ eases.Pathogenesis of various forms of the course of erysipelas has significant differences. Primary, re-mug, and so on ¬ predicted by the later of relapses occur as an acute cyclic ¬ cally streptococcal infection. Recurrent erysipelas (with frequent and early relapses) refers to chronic endogenous streptococcal integral ¬ large unfinished agenda. In the pathogenesis of the latter are of great importance of E-form p-hemolytic streptococcus, persisting in the cells of the CMF skin, and pronounced allergic compo ¬ nents. Thus, the recurrence of the disease have a twofold ¬ Origin of walking: a) early due to the recovery of endogenous dormant foci of infection in the skin, and b) later, or ¬ iterated, the disease is predominantly a consequence of reinfection with new serovar streptococcus against pony ¬ zhennoy resistance of the organism,trophic disorders of skin and lymph. Paraallergicheskie impact (¬ skie physical, chemical and other factors) trigger the development of early and late recurrences of erysipelas. Morphological changes of ¬ with erysipelas presents with serous or serous-hemorrhoids-logical inflammation. Edema and lymphocytic perivascular infiltration in the dermis, as well as des ¬ organization of collagen and elastic fibers. Vessels become brittle, causing hemorrhage. Immunity after the disease does not arise. 

Clinical picture. The incubation period is 2-5 days, but can be shortened to several hours. The clinical classification of disease distinguish primary, recurrent and re-face, flowing ¬ schuyu

as mild, moderate and severe forms.In depen ¬ dence on the nature of local changes distinguish erythema-toznuyu and erythematous-bullous, erythematous-hemorrhagic-parameter and the bullosa hemorrhagic form, for which ha ¬ are characteristic signs of localized or metastatic foci of inflammation. Disease begins acutely: Appears chills, tempera ¬ tour of the body rises to 39-40 ° C. In severe cases, there may be vomiting, convulsions, delirium. A few hours more often on the face, extremities, at least - the body and even more rarely on mucous membranes of developing erysipelas. First, the patient feels the strain, burning, mild ¬ nuyu pain in the affected area, swelling, and then appear on ¬ krasnenie. 

In the case of erythematous form of erysipelas hyperemia is usually bright, has clear boundaries with healthy skin, the peripheral theory ¬ inflammatory focus is determined by the roll, the edges are uneven plot, reminiscent of the outlines of a map. Inflamed area rises above the level of health to ¬ Ms, hot to the touch and slightly painful. The degree of swelling is usually dependent on the localization of the erysipelas: most pronounced swelling of the face (especially on the eyelids), fingers, genitals. In uncomplicated course of illness vsko re ¬ starts reverse development process: quenched congestion, reduces swelling, peeling of the skin appears briefly. Occasionally in the area of erythema may form blood ¬ effusions in the epidermis and dermis. 

When erythematous-bullous erysipelas a few hours or for 2-3 days in some areas affected skin epidermis peels, are formed of different size n, ¬ zyri filled with serous fluid. Further ¬ ny zyri burst liquid follows form the crust for rejection which is visible to sensitive skin. Scarring in these forms of faces remains. 

When erythematous-hemorrhagic form against the background of erythema occur hemorrhage. 

Eullezno-haemorrhagic form is accompanied by krovoiz ¬ Effect of cavity bubbles and the surrounding tissue, vsledst ¬ condition which the contents of the bubbles becomes bluish-purple or brown. At the opening of their formation and erosion-yazvleniya out of the skin, often complicated by cellulitis or deep ¬ bokimi necrosis, leaving a scar and pigment ¬ tation. Around the affected area of skin usually watch ¬ Xia lymphangites. Regional lymph nodes are enlarged, painful. Local lesion in erysipelas disappeared by 5 - 15-th day (sometimes later). With primary erysipelas process often localized on the face and starts with the nose (Fig. 49, see color. Insert), at least - on top of them ¬ extremities, where there are mainly erythema-toznaya and erythematous-bullous form of the disease with pronounced ¬ GOVERNMENTAL common phenomena and severe pains in the course of lymph ¬ elliptic vessels and veins. High body temperature is held 5-10 days. Tempera ¬ ture curve can have a permanent, remittent or intermittent nature. Reduces the temperature often critical, sometimes shortened lysis. Toxic central nervous system is manifested by apathy, headache, insomnia, vomiting, cramps, sometimes meningeal syndrome and a loss cos ¬ naniya. Notes muted heart sounds. Pulse corresponds to ¬ exists a body temperature of or ahead of it. Develops hypo-tensor. Appetite from the first days was reduced, there is a delay in the chair. Marked oliguria and proteinuria in the urine sediment detected ¬ ruzhivayutsya erythrocytes,

leukocytes, hyaline and granular cylinders. In the blood, mild leukocytosis with a neutrophilic shift to the left of the formula. ESR is moderately increased. 

Recurrent erysipelas - a relapse into a period of several days to 2 years with the localization of the local inflammatory process with respect to ¬ in the primary tumor. Relapses po ¬ Ms. occur in 25-88% of cases. With frequent relapses febrile period may be shorter, and the local reactions ¬ tion - negligible. Relapsing form of the disease causing the expressed infringements of lymph, lymphostasis, elephantiasis and hyper ¬ perkeratoz.Primarily affecting the lower extremities ¬ In particular, it is often due to the presence of trophic lesions feet, chafing, abrasion, scuffs, creating the conditions ¬ tions for the emergence of new and revival of old foci of the disease. Recurrent erysipelas occurs more than 2 years after the primary disease. Foci often have a different localization ¬ tion. According to clinical presentation and course of repeated ¬ diseases do not differ from the primary faces. 

Complications. Cellulitis, phlebitis, deep skin necrosis, pneumonia and sepsis are rare. The prognosis for adequate treatment is favorable. 

Diagnosis. With significant changes in the skin diagnosis Host ¬ faces is made by an acute onset with symptoms of intoxication, bright demarcated redness, swelling and other characteristic changes in the affected area of skin area ¬. In the differential diagnosis should exclude ¬ chit erythema, dermatitis, eczema, abscesses, cellulitis, Trom ¬ boflebity superficial veins pseudoerysipelas and allergic dermatitis. 

Treatment. Complex treatment of erysipelas include antibiotics, use of corticosteroids, non-

specific stimulants and fiziotera ¬ pevticheskie procedure. The primary give birth and early recurrence can be cured by prolonged use of antibacterial preparations ¬ drugs. Penicillin prescribed in a daily dose of 1,3-3,0 million units in the mild form, up to 8,0 million units for the formula ¬ heavy metal; it is administered intramuscularly every 3-4 hours for 7-10 days. Upon completion of the course in order to prevent a recurrence of injected bitsillin. With frequent relapses of the disease using semisynthetic penicillins: oxacillin, methicillin, amoxicillin for 8-10 days, repeated ¬ raw chicken. Intolerance to penicillin, use of erythro ¬ Mycin, oleandomitsina, clarithromycin and azithromycin; WHO ¬ possible use of lincomycin, clindamycin. For treatment of recurrent erysipelas with frequent exacerbation ¬ niyami people young and middle age, to no avail ¬ le chennym earlier antibiotics prescribed glyukokortikoste-roidy (prednisolone at a dose of 30-40 mg per day, which is post ¬ gradually decreases). Apply autohemotherapy, donor immunoglobulin prodigiozan (5-7 injections per course), vita ¬ mine group, ascorbic acid with rutin, a symptom ¬ cal means. In the combined treatment include physio ¬ therapies. In the acute period prescribed ultra ¬ violet radiation in the erythemal doses and UHF with subsequent ¬ schim using ozokerite and radon baths. Effective low-intensity laser therapy. Local treatment for erythematous erysipelas should not apply, since it irritates the skin and increases the exudation. When bullous forms must be imposed on pre-notched bubbles bandage with a solution ethacridine daktata (1:1000), Frc (1:5000), kaffilinta. Primary erysipelas convalescents be dispensary ¬ th observation infectious diseases doctor. 

Prevention. Hospitalization of patients with erysipelas should be carried out mainly in infectious hospitals and offices, and for septic complications - in the surgical departments. With persistent recurrent erysipelas shows no ¬ continuous (all year) prevention bitsillina-5 for 2 years. Are essential hygiene, for ¬ shield integrity of the skin, decontamination centers of chronic ¬ Scoy streptococcal infection, establishment of full mustache ¬ conditions of work, excluding the supercooling and traumatism.