Find out how pneumonia manifests itself. Symptoms of erysipelas. X-ray for pneumonia

The high rhythm of life, in which one has to constantly exist, does not always make it possible to pay close attention to one's health. Sometimes in the bustle you can not pay attention in time and miss serious diseases.

Therefore, every year statistics provide more and more frightening facts about the incidence of women.

AT last years the number of diseases of the sexual sphere has catastrophically increased, more and more patients suffer from infertility.

One of these common diseases was inflammation of the cervix.

Inflammation of the cervix is a symptom complex pathological changes that develop when an infectious agent enters.

Every third woman finds in herself some manifestations of inflammation of the cervix. But in practice, there are much more undiagnosed cases of the disease.

In connection with anatomical structure and topography, inflammation of the cervix practically does not occur in isolation. Therefore, it can be considered as one of the many manifestations of a genital tract infection. This means that almost always simultaneously there are signs of inflammation of the vaginal mucosa, the cervical canal itself, inflammation of the uterus, ovaries and fallopian tubes.

Features of the cervix leading to inflammation

Cervix anatomically- This is the lower part of the uterus protruding into the vagina. The cervix reliably separates the sterile uterine cavity and the vagina, populated by various microflora - conditionally pathogenic and pathogenic, penetrating from the outside. The cervix is ​​folded. The external and internal pharynx are anatomical constrictions that protect against infection. The external pharynx is visible in the mirrors. In this place, the cervix becomes inflamed. The cervical canal itself is closed with a protective mucous plug. Mucus is produced by special glandular cells lining it from the inside, and performs a barrier function.

Pathogenic microorganisms most often penetrate from the vagina. Normally, 98% of the entire flora of the vagina is made up of lactobacilli. There is also a conditional pathogenic microflora. Lactobacilli create a special protective film that traps infectious agents. In addition, lactobacilli are involved in the formation of lactic acid, which creates acidic contents in the vaginal cavity (pH 3.8 - 4.5). This is also one of protective functions.

If for some reason a failure occurs in defense mechanisms, infectious agents multiply and penetrate the cervix - inflammation develops.

Inflammation of the cervix - causes

The cause of inflammation of the cervix is ​​a variety of infections, in the first place among them - sexually transmitted infections (STIs). They are caused by chlamydia, trichomonads, ureaplasmas, mycoplasmas, gonococci, and various viruses.

In rare cases, the cause of inflammation of the cervix may be an allergy to latex, spermocytes, intimate hygiene products.

The causes of colpitis include fungi of the genus Candida, as well as conditionally pathogenic microflora: Escherichia coli, staphylococci, streptococci, etc. Under certain conditions, they become pathogenic.

Predisposing conditions are various defects and violations of the integrity of the mucous membrane of the cervix as a result of abortion, childbirth, surgical interventions, various medical manipulations, even gynecological examination or installation of a spiral, as well as when processing irritating concentrated solutions iodine, potassium permanganate, dimexide.

In women during menopause, inflammation of the cervix practically does not occur or is very rare. The risk group is predominantly young women.

Diagnosis of inflammation of the cervix

Inflammation of the cervix can often be asymptomatic. In this regard, the disease is often discovered by chance during the next medical examination or visit to the doctor about completely different diseases.

To diagnose inflammation of the cervix, a standard examination in the mirrors, colposcopy, microscopy and bacteriological culture smear, biopsy, and, if necessary, tests for specific infections.

Even knowing the symptoms, it is impossible to diagnose inflammation of the cervix on your own. This should be done by a specialist.

In many cases, a routine examination does not clarify the picture of the disease. Then, for a detailed and thorough study of the state of the mucous membrane of the cervix, colposcopy is used. The study is carried out using a colposcope - optical instrument, thanks to which you can see the surface of the cervix enlarged many times over. The examination procedure is completely painless. With such an examination, all defects and damage to the cervix, minimal in size and area, are visible.

Another important diagnostic method - conducting a microscopic examination of a smear from the cervical canal. If found a large number of leukocytes in the field of view - the diagnosis of inflammation of the cervix is ​​confirmed. In addition, you can see the bacteria that caused this inflammatory process.

This examination method is used to exclude the diagnosis of cancer and precancerous conditions.

Inflammation of the cervix - symptoms

Taking into account the localization of the inflammatory process, cervicitis is divided into two types:

Exocervicitis- inflammation of the vaginal part of the cervix. Often inflammation of the cervix from the vagina is a finding during the examination, when a woman went to see a doctor about other diseases.

Inflammation of the cervical canal is called endocervicitis. During a routine examination, it is impossible to detect endocervicitis. For this purpose, additional tests are prescribed and indirectly identify characteristic symptoms.

Clinical symptoms with developed inflammation of the cervix depends on general condition organism and the specific infection that caused the inflammation, as well as the prevalence of the infection.

There is a so-called "duet" of symptoms for inflammation of the cervix: discharge and pain.

by the most a clear symptom cervicitis is the presence of secretions. Purulent discharge - with acute specific, or serous - purulent (leucorrhoea) - with chronic process. At the same time, unexpressed erased pains in the lower abdomen are disturbing.

Chronic inflammation of the cervix can be hidden or with minor manifestations. Whites are practically absent or scarce. Complaints are also few: there may be unexpressed pulling discomfort lower abdomen. If the process captures neighboring organs, the symptoms become more diverse: subfebrile condition, frequent urination urge to urinate, weakness, general malaise. Itching in the vagina often worries, it can intensify during menstruation. In connection with changes in the cervix under the influence of inflammation, erosions, scars, adhesions, and dysplasia occur. In many cases, inflammation of the cervix can lead to cancer.

chronic course inflammation of the cervix due to the meager symptoms of the disease is diagnosed only upon examination. Since there are practically no complaints, and only a general malaise is felt, the visit to the doctor may be delayed. Due to late treatment, treatment may be lengthy and not always effective.

If chronic inflammation of the cervix still develops in a woman, then in the process of its further progression, erosion may occur. As it turned out, the advanced form of a chronic disease in almost all cases contributes to the appearance of erosion. If there is no treatment, and the infection continues to spread to neighboring organs, the development chronic inflammation cervix leads to infertility. If this whole process occurs in the presence of pregnancy, the result of inflammation may be a miscarriage.

To establish an accurate diagnosis, cytological examination. The results of cytology can not only confirm or refute the presence of inflammation of the cervix, but also objectively resolve the issue of its condition, detect any other pathology, including neoplasms, if any. And at least for the sake of excluding oncological neoplasms, it is worth consulting a doctor even with a slight discomfort or unusual sensations that have appeared.

Inflammation of the cervix - treatment

The primary and important task that needs to be solved when prescribing treatment for inflammation of the cervix is, first of all, the effect on the causative agent of the disease and the reduction of inflammation.

Self-treatment for inflammation of the cervix is ​​categorically contraindicated. This ban is due to the fact that improperly selected drugs in insufficient dosages can lead to a sluggish, intractable infection, and in the future - to serious complications(infertility, various violation menstrual cycle, ectopic pregnancy precancer, cancer). With this treatment, they may disappear external signs diseases, and the wrong impression is created about the supposedly complete cure.

Adequate treatment is individually selected by the doctor in each case. In the process of treating inflammation of the cervix, since it can drag on for a long time, the effectiveness of therapy is constantly monitored: examinations, smear cultures, blood tests.

Local treatment at acute inflammation will not bring any benefit, since the infection, as a rule, affects the deep layers of the cervix. Urgently appointed antibiotic therapy. Moreover, antibiotics are prescribed mainly parenterally. The use of drugs locally in the form of suppositories is ineffective, because they can only eliminate surface processes.

If a specific causative agent of the disease is identified, treatment should be started simultaneously for two sexual partners. The absence of complaints and objective data of the disease in a man does not mean that he does not have the disease. Some infections of the genital tract (chlamydia, trichomoniasis, gonorrhea) occur latently, without obvious objective signs and subjective sensations.

For the treatment of chlamydial cervicitis, the administration of tetracyclines is effective. In addition, macrolides, fluoroquinolones, azalides are widely used.

If candidiasis is detected, fluconazole, diflucan are prescribed. With inflammation of the cervix viral etiology used antiviral drug acyclovir.

After completing the course antibacterial agents it is necessary to continue treatment with eubiotics - drugs that restore the natural microflora of the vagina. Eubiotics contain lactic acid. They can be used as candles.

Treatment of chronic inflammation of the cervix is ​​not limited to conservative methods. It starts with antibiotics. Completion of the course of antibiotic therapy ends with the elimination of the infection. But to restore the structural integrity of the cervical mucosa, it is necessary to continue treatment. Surgical methods erosion, ulcers, cysts are removed. This is done with a laser, electrosurgical treatment, microwave therapy, cryotherapy. In parallel, the treatment of concomitant background diseases, restoration of reduced immunity.

When atrophic chronic inflammation of the cervix is ​​detected, when the mucous layer of the cervix is ​​thinned, it is necessary to use topically hormonal preparations. The most commonly used is Ovestin. It contains estrogens, which are female sex hormones. When Ovestin is taken, damaged cells restore their original structure, and their protective functions are restored.

Folk methods treatments for inflammation of the cervix are not used. Inflammation of the cervix cannot be cured with herbs, because the infections that are the source of inflammation are too serious and require immediate antibiotics. Therefore, such treatment is discussed with the doctor already at the stage of rehabilitation, when the use of general strengthening preparations to increase immunity is likely.

Rules for preparing for a visit to the doctor

There are certain rules for a successful examination by a gynecologist and a correct diagnosis.

1) Refusal to have sexual intercourse two days before the examination.

2) Stop douching and use all intimate hygiene products without exception - use only warm water.

3) For a few days, refuse to take local medicines in the form of suppositories, sprays.

4) intimate hygiene spend the night before with warm water only - without using special means or soap, in the morning, on the day of the study, it is not necessary to wash.

5) Two hours before the examination, it is advisable not to urinate.

Prevention of inflammation of the cervix - important points

To avoid long-term treatment, going to hospitals and other troubles associated with the occurrence of inflammation of the cervix, it is important to initially follow some preventive measures.

First of all, it is strictly adhere to certain rules and always follow the immutable laws of personal hygiene. It is necessary to use (or replace, if necessary, existing products) gentle delicate care and cleaning products. In addition, if there are no special indications for douching, they cannot be carried out uncontrollably, since these procedures can adversely affect the normal microflora of the vagina.

For the purpose of prevention sexually transmitted diseases mandatory use of condoms. In addition, they are reliable means contraception. It is necessary to pay attention and be interested in the health of the sexual partner, visit a gynecologist annually for an examination.

Need to remember about required quantity vitamins and minerals that increase the body's resistance to infections. Their intake leads to a real decrease in the chances of inflammation of the cervix, since one of the reasons is reduced immunity. In addition, hypothermia and overheating also adversely affect the immune system and is an impetus for the onset of inflammation of the cervix.

It is important to understand, that visiting a gynecologist several times a year is still preferable to long-term treatment in a hospital or outpatient treatment in the clinic with many expensive examinations. In addition, if cervicitis is detected during examination, adequate therapy will be prescribed in time. competent treatment effective drugs to prevent further development formidable complications.

Erysipelas - a disease infectious nature, called hemolytic streptococci. Inflammations and deformities affect a clearly defined area of ​​the skin, accompanied by fever and intoxication of the body.

Since the activity of group A streptococci is considered main reason, according to which a person has an erysipelas on his leg (see photo), the most effective treatment based on the use of penicillins and other antibacterial drugs.

Causes

Why does erysipelas appear on the leg, and what is it? Basic cause erysipelas streptococcus acts, which enters the bloodstream as a result of any damage to the skin, abrasions, microtraumas. Hypothermia and stress, excessive sunburn also play a role.

Among the factors that can lead to the development of erysipelas, an important place is occupied by stress and constant overload, both emotional and physical. Other determining factors are:

• sudden temperature changes (decrease and increase in temperature);
• damage to the skin (scratches, bites, injections, microcracks, diaper rash, etc.);
• excessive sunburn;
• various bruises and other injuries.

In the vast majority of cases, erysipelas develops on the arms and legs (feet, shins); much less often, inflammation occurs on the head and face, while inflammatory processes in the groin (perineum, genitals) and on the trunk (stomach, sides) are considered the most rare. The mucous membranes can also be affected.

Is erysipelas on the leg contagious?

Erysipelatous inflammation of the skin contagious disease, since the main cause of its occurrence is an infection that is safely transmitted from one person to another.

When working with a patient (treatment of the site of inflammation, healing procedures) it is recommended to use gloves, after contact, wash your hands thoroughly with soap and water. The main source of diseases caused by streptococcus is always a sick person.

Classification

Depending on the nature of the lesion, erysipelas occurs in the form of:

• bullous form - blisters appear on the skin with serous exudate. The extreme degree of this form is the occurrence of necrotic changes - skin cells die and practically do not regenerate in the affected area.
• Hemorrhagic form- at the site of the lesion, the vessels become permeable and bruising is possible.
• Erythematous form The leading symptom is redness and swelling of the skin.

For determining right tactics treatment of erysipelas, it is necessary to accurately determine the severity of the disease and the nature of its course.

Symptoms

The incubation period of the erysipelatous inflammatory process ranges from several hours to 3-4 days. Physicians classify pathology as follows:

• by severity- mild, moderate and severe stage;
• by the nature of the flow- erythematous, bullous, erythematous-bullous and erythematous-hemorrhagic form;
• by localization - localized (on one part of the body), widespread, metastatic lesion.

After incubation period the patient shows symptoms of erysipelas on the leg, including general weakness, weakness and malaise. After this, quite suddenly, the temperature rises, and chills appear and headache. The first few hours of manifestation of erysipelas are characterized by very high temperature, which can reach forty degrees. Also present muscle pain in the area of ​​​​the legs and lower back, the person has pain in the joints.

A characteristic feature inherent in the inflammatory process is the bright red color of the affected areas, similar to flames. Clearly marked edges have elevations along the periphery - the so-called inflammatory shaft.

A more complex form is erythematous-bullous. In this case, on the first or third day of the disease, vesicles form with clear liquid at the site of the disease. They burst, forming crusts. Favorable treatment leads to healing and the formation of young skin after it falls off. Otherwise, the formation of ulcers or erosions is possible.

Root leg: photo initial stage

Presenting for viewing detailed photos to see what it looks like this disease in the initial stage and not only.

How to treat erysipelas on the leg?

If a we are talking about mild severity, then treatment at home is quite enough. But in heavy advanced cases not to do without hospitalization in the surgical department.

The most effective treatment for erysipelas on the leg necessarily includes the appointment of antibiotics. To maximize their effect, the doctor must first find out the most effective of them in each case. For this, an anamnesis is required.

In the vast majority of cases, the following drugs are used:

• Lincomycin;
• Penicillin;
• Levomycetin;
• Erythromycin;
• Tetracycline.

In addition to antibiotics, drug treatment includes other assignments.

1. To relieve pain and severe manifestations diseases and symptomatic treatment diuretics and vascular agents are used.
2. Means that reduce permeability blood vessels- their reception is also necessary in some cases.
3. In cases where severe course the disease is complicated by intoxication; in the fight for health, detoxification agents are used - for example, reopoliglyukin and / or glucose solution.
4. Vitamins of groups A, B, C, etc.,
5. Anti-inflammatory drugs.

Also, a patient with erysipelas is shown cryotherapy and physiotherapy: local ultraviolet irradiation(UVI), exposure to high frequency current (UHF), exposure to weak discharges of electric current, laser therapy in the infrared light range.

Forecast

The prognosis of the disease is conditionally favorable, with adequate timely treatment high probability complete cure and rehabilitation. In some cases (up to a third), it is possible to form recurrent forms of the disease, which are much less amenable to treatment.

Complications

If it is not started during treatment or it is not carried out to the end, then the disease can provoke certain consequences that require additional therapy:

1. Edema and lymphostasis on the leg, leading to elephantiasis and malnutrition in the tissues.
2. If an additional infection enters, abscesses, phlegmon and may occur.
3. In a weakened or elderly person, the activity of the heart, blood vessels, kidneys may be disturbed, and cholangitis may also occur.
4. Damage to the veins located on the surface - phlebitis and periphlebitis. In turn, pulmonary embolism can become a complication of thrombophlebitis.
5. Erosions and ulcers that do not heal for a long time.
6. Necrosis, at the site of hemorrhage.

Carbuncle is a purulent necrotic inflammation of the epidermis or subcutaneous tissue. The disease affects the hair follicles and sebaceous glands, and infection is considered its causative agent. Non-medical people may confuse this problem with abscess or furuncle.

Carbuncle - causes

Inflammation begins with an abscess, which is bordered by severe reddening of the skin. The spread of infection and intoxication of the body are the main danger of a disease like carbuncle, the causes of its occurrence may be different. They are related:

• with disruption of work internal organs(liver or kidney) and immune system;
• with beriberi;
• with the abuse of alcohol, smoking, spicy foods;
• overweight;
• prolonged depression;
• with diseases of the biliary tract and intestinal tract.

Carbuncle can cause:

• coli;
• Proteus bacteria;
• enterococci and so on.

More purulent inflammation appears after:

• insect bite;
• non-compliance with hygiene;
• strong skin contamination, etc.

Carbuncle - symptoms

The disease begins with the appearance of dense internal nodules, which gradually merge together and form a spherical shape. Its size can exceed the palm of the baby. The carbuncle turns purple, becomes hot, and the skin around it swells strongly. The process affects the deep layers of tissues and causes:

• blueing of the epidermis;
• pain sensations;
• severe itching;
• unaesthetic formations.

If a person has an anthrax carbuncle, then the ulcers will affect all areas of the skin that are not covered by clothing. His hallmark are the following symptoms:

• a small spot grows rapidly and turns into a dark purple vesicle, bursting after the formation of an ulcer;
• black necrosis is formed in the center of the ulcer, which is accompanied by swelling and inflammation;
• inflammation of the lymph nodes without suppuration and pain;
• the area of ​​necrosis is accompanied by burning.

What does a carbuncle look like?

Many people are interested in questions about the carbuncle itself, a photo, what the inflamed area looks like and what to do with it. About a week after the onset of the disease, the focus swells strongly and becomes more painful. On the 12th day, white pustules will appear, similar to a cork. After opening, a necrotic mass with pus is released different color and an admixture of blood. Further, ulcers are formed with torn edges and a gray bottom.

The surface of necrosis resembles a sieve in its shape, and then it may turn black. Dead particles of the epidermis penetrate deep into the internal cells of the body and reach its muscular layer. Over time, the cavity in the skin will fill up granulation tissue, and a rough scar will appear at the site of the ulcer, which firmly “solders” the surrounding tissues together.

Carbuncle - home treatment

Treatment of carbuncle in the stage of infiltration can be carried out independently at home, but after visiting a doctor and his recommendations. If the disease proceeds without deterioration, then the patient is prescribed a general therapeutic course of medications:

• antibiotics;
• antibacterial drugs (, Furagin);
• medicines with analgesic (Analgin, No-shpa) and anti-inflammatory effects (Ibuprofen, Paracetomol).

With a complication of inflammation such as carbuncle, treatment involves:

• antiplatelet agents that prevent blood cells from uniting into blood clots (Pentoxifylline, Trental);
• UV irradiation;
• Preparations for removing staphylococcal toxins (Zorex, Polysorb);
• vitamin complex.

During the treatment of carbuncle, the surface of the inflamed skin is treated:

• disinfectant (ethyl alcohol);
• pricked with antibiotics;
• apply special external means (creams and ointments).

Treatment of carbuncle with antibiotics

Answering the question of which antibiotics should be used in the treatment of carbuncle, it should be said that you need to choose combined preparations. The main indicators for their appointment is reduced immunity, while large doses are recommended. The most popular medicines are:

• Diclosacillin - they drink it up to 10 days, 4 tablets per day;
• Cefalexin - the course is the same;
• Amoxicillin - the drug should be taken after 8 hours during the week;
• Azithromycin - drink 1 tablet per day for about 7 days;
• Vancomycin - the drug is prescribed in severe cases and administered intravenously.

Carbuncle - treatment, ointment

During therapy, it is important to know which effective ointment from the carbuncle will help alleviate the course of the disease. It is applied to the affected areas of the skin until complete healing. Drugs should stimulate the rejection of dead and non-viable cells. The best means are:

• Malavit;
• Baneocin;
• Vinylin;
• Levomekol;
• Vishnevsky ointment;
• Methyluracil, etc.

Carbuncle - folk remedies

You can self-medicate at home when the disease is mild and the affected area does not cause severe pain. A carbuncle on the face can cause a lot of inconvenience, therefore, to reduce swelling and relieve inflammation, various folk remedies:

1. Leaves of mallow, sweet clover and chamomile flowers pour boiling water and let it brew for 15-20 minutes. Thereafter medicinal herb wrap in gauze and attach to the carbuncle for half an hour.
2. Garlic compress will help stop the developing carbuncle - the treatment will accelerate. Pass the garlic through the press, and then make a compress from the gruel, which must be kept for about an hour.
3. Fresh leaves of plantain or aloe (optional) must be crushed and wrapped in gauze. Fix the compress on the affected area for several hours.
4. Add a tablespoon of salt to 1 liter of warm water. Soak a bandage in the solution and apply it to the affected area.

Carbuncle removal

If the inflammatory process has passed into the stage of necrosis, then it will be necessary to consult a doctor. Surgery carbuncle involves a small operation, which is performed under local anesthesia.

1. The affected area is opened crosswise, taking into account all layers of tissues saturated with pus and streaks with dead cells. In this case, general intoxication is removed, metabolism is restored, and the wound heals faster.
2. The process ends with the introduction of drainage tampons, which are impregnated with proteolytic enzymes and hypertonic saline. This is done for the outflow of purulent masses and the final death of necrosis.

Dressings are carried out in the clinic 2 times a day. After the wound begins to heal, it is treated with antiseptic and emollients. Ointments help to dissolve scar tissue(Zeraderm, Kelofibrase). They also put it on the hearth silicone patches to speed up healing. When a carbuncle of the face is detected in a timely manner, treatment can only be general, without surgical intervention.

represents infection caused by group A streptococcus, mainly affecting the skin and mucous membranes, characterized by the occurrence of limited serous or serous-hemorrhagic inflammation, accompanied by fever and general intoxication. Clinically, erysipelas is characterized by a typical bright red edematous skin lesion with clear boundaries and signs of lymphostasis. Complications of erysipelas include: the formation of necrotic foci, abscesses and phlegmon, thrombophlebitis, secondary pneumonia, lymphedema, hyperkeratosis, etc.

ICD-10

A46

General information

(erysipelas) is an infectious disease caused by group A streptococcus, mainly affecting the skin and mucous membranes, characterized by the occurrence of limited serous or serous-hemorrhagic inflammation, accompanied by fever and general intoxication. Erysipelas is one of the most common bacterial infections.

Exciter characteristic

Erysipelas is caused by group A beta-hemolytic streptococcus, most often of the species Streptococcus pyogenes, which has a diverse set of antigens, enzymes, endo- and exotoxins. This microorganism may be part of normal flora oropharynx, attend skin healthy people. The reservoir and source of erysipelas infection is a person, both suffering from one of the forms of streptococcal infection, and a healthy carrier.

Erysipelas is transmitted by aerosol mechanism mainly by airborne droplets, sometimes by contact. Entrance gates for this infection are damage and microtrauma of the skin and mucous membranes. oral cavity, nose, genitals. Since streptococci often live on the surface of the skin and mucous membranes of healthy people, the risk of infection if the rules are not followed basic hygiene extremely large. Individual predisposition factors contribute to the development of infection.

Women get sick more often than men, susceptibility increases with prolonged use of drugs of the group steroid hormones. The risk of developing erysipelas is 5-6 times higher in people suffering from chronic tonsillitis and other streptococcal infections. Facial erysipelas more often develops in people with chronic diseases of the oral cavity, ENT organs, caries. Damage to the chest and limbs often occurs in patients with lymphovenous insufficiency, lymphedema, edema of various origins, with fungal lesions of the feet, and trophic disorders. Infection can develop in the area of ​​post-traumatic and post-operative scars. There is some seasonality: the peak incidence occurs in the second half of summer - the beginning of autumn.

The pathogen can enter the body through damaged integumentary tissues, or with the existing chronic infection penetrate into the capillaries of the skin with blood flow. Streptococcus multiplies in the lymphatic capillaries of the dermis and forms a focus of infection, provoking active inflammation or latent carriage. Active reproduction of bacteria contributes to the massive release into bloodstream products of their vital activity (exotoxins, enzymes, antigens). The consequence of this is intoxication, fever, probably the development of toxic-infectious shock.

Erysipelas classification

Erysipelas are classified according to several criteria: by nature local manifestations(erythematous, erythematous-bullous, erythematous-hemorrhagic and bullous-hemorrhagic forms), according to the severity of the course (mild, moderate and severe forms depending on the severity of intoxication), according to the prevalence of the process (localized, widespread, migrating (wandering, creeping) and metastatic ). In addition, primary, repeated and recurrent erysipelas are distinguished.

Recurrent erysipelas is a recurring occurrence between two days and two years after the previous episode, or a recurrence occurs later, but the inflammation repeatedly develops in the same area. Repeated erysipelas occur no earlier than two years later, or are localized in a place different from the previous episode.

Localized erysipelas is characterized by the restriction of infection to a local focus of inflammation in one anatomical region. When the focus goes beyond the boundaries of the anatomical region, the disease is considered common. The addition of phlegmon or necrotic changes in the affected tissues are considered complications of the underlying disease.

Symptoms of erysipelas

The incubation period is determined only in the case of post-traumatic erysipelas and ranges from several hours to five days. In the vast majority of cases (more than 90%), erysipelas has an acute onset (time of onset clinical symptoms noted accurate to the hour), fever develops rapidly, accompanied by symptoms of intoxication (chills, headache, weakness, body aches).

Severe course is characterized by the occurrence of vomiting of central origin, convulsions, delirium. A few hours later (sometimes the next day) appear local symptoms: on a limited area of ​​\u200b\u200bthe skin or mucous membrane, there is a burning sensation, itching, moderate soreness by touch, pressure. Severe pain is characteristic of erysipelas of the scalp. There may be pain in regional lymph nodes during palpation and movement. Erythema and swelling appear in the focus area.

The peak period is characterized by the progression of intoxication, apathy, insomnia, nausea and vomiting, symptoms from the central nervous system (loss of consciousness, delirium). The focus area is a dense bright red spot with clearly defined uneven boundaries (symptom of "tongues of flame" or " geographical map"), with pronounced edema. The color of erythema can vary from cyanotic (with lymphostasis) to brownish (with trophic disorders). There is a short-term (1-2 s) disappearance of redness after pressure. In most cases, compaction, limited mobility and pain on palpation of regional lymph nodes are found.

Fever and intoxication persist for about a week, after which the temperature returns to normal, regression skin symptoms happens a little later. Erythema leaves behind fine scaly peeling, sometimes pigmentation. Regional lymphadenitis and skin infiltration may persist in some cases long time, which is a sign of a likely early relapse. Persistent edema is a symptom of developing lymphostasis. The erysipelas are most often localized on lower limbs, then, according to the frequency of development, there is an erysipelas of the face, upper limbs, chest (erysipelas of the chest is most characteristic of the development of lymphostasis in the area of ​​the postoperative scar).

Erythematous-hemorrhagic erysipelas is distinguished by the presence of hemorrhages from the area of ​​the local focus against the background of general erythema: from small (petechiae) to extensive, confluent. The fever in this form of the disease is usually longer (up to two weeks) and the regression of clinical manifestations is noticeably slower. In addition, this form of erysipelas may be complicated by necrosis of local tissues.

In the erythematous-bullous form, vesicles (bulls) form in the area of ​​erythema, both small and rather large, with transparent contents of a serous nature. Bubbles appear 2-3 days after the formation of erythema, open on their own, or they are opened with sterile scissors. Bulla scars with erysipelas usually do not leave. With a bullous-hemorrhagic form, the contents of the vesicles are serous-hemorrhagic in nature, and, often, are left after opening erosion and ulceration. This form is often complicated by phlegmon or necrosis; after recovery, scars and areas of pigmentation may remain.

Regardless of the form of the disease, erysipelas has features of the course in various age groups. In old age, primary and repeated inflammation is usually more severe, with an extended period of fever (up to a month) and exacerbation of existing chronic diseases. Inflammation of regional lymph nodes is usually not observed. Subsidence clinical symptoms occurs slowly, relapses are not uncommon: early (in the first half of the year) and late. The frequency of relapses also varies from rare episodes to frequent (3 or more times per year) exacerbations. Often recurrent erysipelas is considered chronic, while intoxication often becomes quite moderate, erythema has no clear boundaries and is paler, lymph nodes are not changed.

Complications of erysipelas

Most frequent complications erysipelas are suppuration: abscesses and phlegmon, as well as necrotic lesions of the local focus, ulcers, pustules, inflammation of the veins (phlebitis and thrombophlebitis). Sometimes secondary pneumonia develops, with a significant weakening of the body, sepsis is possible.

Long-term stagnation of the lymph, especially in the relapsing form, contributes to the occurrence of lymphedema and elephantiasis. Complications of lymphostasis also include hyperkeratosis, papillomas, eczema, lymphorrhea. Persistent pigmentation may remain on the skin after clinical recovery.

Diagnostics

Diagnosis of erysipelas is usually based on clinical symptoms. A consultation with a dermatologist may be required to differentiate erysipelas from other skin conditions. Laboratory tests show signs bacterial infection. Specific diagnosis and isolation of the pathogen, as a rule, are not performed.

Treatment of erysipelas

Erysipelas is usually treated on an outpatient basis. In severe cases, with the development of purulent-necrotic complications, frequent relapses, in senile and early childhood shows the placement of the patient in the hospital. Etiotropic therapy consists in prescribing a course of antibiotics of the cephalosporin series of the first and second generations, penicillins, some macrolides, fluoroquinolones lasting 7-10 days in medium therapeutic dosages. Erythromycin, oleandomycin, nitrofurans and sulfonamides are less effective.

At frequent relapses sequential administration of two types of antibiotics is recommended different groups: after beta-lactams, lincomycin is used. Pathogenetic treatment includes detoxification and vitamin therapy, antihistamines. With bullous forms of erysipelas, the blisters are opened and frequently replaced gauze wipes with antiseptic agents are applied. Ointments are not prescribed so as not to once again irritate the skin and not slow down healing. Topical preparations may be recommended: dexpanthenol, silver sulfadiazine. As a means of accelerating regression skin manifestations, physiotherapy is recommended (UHF, UFO, paraffin, ozokerite, etc.).

In some cases of recurrent forms, patients are prescribed courses of anti-relapse treatment with benzylpenicillin intramuscularly every three weeks. Persistently recurrent erysipelas is often treated with courses of injections for two years. With available residual effects after discharge, patients may be prescribed a course of antibiotic therapy for up to six months.

Forecast

Erysipelas of a typical course usually has a favorable prognosis and, with adequate therapy, ends in recovery. A less favorable prognosis occurs in the case of complications, elephantiasis and frequent relapses. The prognosis worsens in debilitated patients, persons old age, people suffering from beriberi, chronic diseases with intoxication, digestive disorders and lymphovenous apparatus, immunodeficiency.

Prevention

The general prevention of erysipelas includes measures for the sanitary and hygienic regime of medical institutions, compliance with the rules of asepsis and antiseptics when treating wounds and abrasions, prevention and treatment of pustular diseases, caries, streptococcal infections. Individual prevention consists in maintaining personal hygiene and timely treatment of skin lesions with disinfectants.