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Patients with erysipelas are not contagious. Women get sick more often than men. More than 60% of cases of erysipelas are carried by people aged 40 and older. The disease is characterized by a distinct summer-autumn seasonality.

Erysipelas symptoms

The incubation period of erysipelas is from several hours to 3-5 days. In patients with a recurrent course, the development of the next attack of the disease is often preceded by hypothermia, stress. In the vast majority of cases, the onset is acute.

The initial period of erysipelas is characterized rapid development general toxic phenomena, which in more than half of the patients for a period of several hours to 1-2 days ahead of the occurrence of local manifestations of the disease. Are celebrated

• headache, general weakness, chills, muscle pain
• 25-30% of patients develop nausea and vomiting
• already in the first hours of the disease, the temperature rises to 38-40 ° C.
• on areas of the skin in the area of ​​future manifestations, a number of patients develop a feeling of fullness or burning, mild pain.

The height of the disease occurs within a period of several hours to 1-2 days after the first manifestations of the disease. General toxic manifestations and fever reach their maximum. There are characteristic local manifestations.

Most often, erysipelas is localized on the lower extremities, less often on the face and upper extremities, very rarely only on the trunk, in the area of ​​the mammary gland, perineum, in the area of ​​the external genitalia.

Skin manifestations

First, a small red or pink spot appears on the skin, which turns into a characteristic erysipelatous redness within a few hours. Redness is a clearly delimited area of ​​the skin with uneven boundaries in the form of teeth, "tongues". The skin in the area of ​​redness is tense, hot to the touch, moderately painful to the touch. In some cases, you can find a "marginal roller" in the form of raised edges of redness. Along with reddening of the skin, its edema develops, spreading beyond the redness.

The development of blisters is associated with increased effusion at the site of inflammation. If the bubbles are damaged or spontaneously rupture, fluid flows out, and in place of the bubbles, superficial wounds. While maintaining the integrity of the blisters, they gradually shrink with the formation of yellow or brown crusts.

The residual effects of erysipelas, which persist for several weeks and months, include swelling and pigmentation of the skin, dense dry crusts in place of the blisters.

Photo: website of the Department of Dermatovenereology of the Tomsk Military Medical Institute

Diagnosis of erysipelas

Diagnosis of erysipelas is carried out by a general practitioner or infectious disease specialist.

• certain diagnostic value have elevated titers of antistreptolysin-O and other antistreptococcal antibodies, detection of streptococcus in the blood of patients (using PCR)
• Inflammatory changes in the general blood test
• Violations of hemostasis and fibrinolysis (increased blood levels of fibrinogen, PDF, RKMF, increase or decrease in the amount of plasminogen, plasmin, antithrombin III, increase in the level of platelet factor 4, decrease in their number)

Diagnostic criteria for erysipelas in typical cases are:

• acute onset of illness severe symptoms intoxication, an increase in body temperature to 38-39 ° C and above;
• predominant localization of the local inflammatory process on the lower extremities and face;
• development of typical local manifestations with characteristic redness;
• swollen lymph nodes in the area of ​​inflammation;
• absence of severe pain in the focus of inflammation at rest

Erysipelas treatment

Treatment of erysipelas should be carried out taking into account the form of the disease, the nature of the lesions, the presence of complications and consequences. Currently, most patients with mild erysipelas and many patients with moderate forms are treated in a polyclinic. Indications for mandatory hospitalization in infectious diseases hospitals (departments) are:

• severe course;
• frequent relapses of erysipelas;
• the presence of severe common comorbidities;
• old age or childhood.

The most important place in the complex treatment of patients with erysipelas is occupied by antimicrobial therapy. When treating patients in a polyclinic and at home, it is advisable to prescribe antibiotics in tablets:

• erythromycin,
• oletethrin,
• doxycycline,
• spiramycin (course of treatment 7-10 days),
• azithromycin,
• ciprofloxacin (5-7 days),
• rifampicin (7-10 days).

In case of intolerance to antibiotics, furazolidone (10 days) is indicated; delagil (10 days).

It is advisable to treat erysipelas in a hospital with benzylpenicillin, a course of 7-10 days. At severe course diseases, the development of complications (abscess, phlegmon, etc.), a combination of benzylpenicillin and gentamicin, the appointment of cephalosporins are possible.

With severe inflammation of the skin, anti-inflammatory drugs are indicated: chlotazol or butadione for 10-15 days.

Patients with erysipelas need to prescribe a complex of vitamins for 2-4 weeks. In severe erysipelas, intravenous detoxification therapy is performed (hemodez, reopoliglyukin, 5% glucose solution, saline) with the addition of 5-10 ml of a 5% solution of ascorbic acid, prednisolone. Cardiovascular, diuretic, antipyretic drugs are prescribed.

Treatment of patients with recurrent erysipelas

Treatment of recurrent erysipelas should be carried out in a hospital setting. It is mandatory to prescribe reserve antibiotics that were not used in the treatment of previous relapses. Cephalosporins are prescribed intramuscularly or lincomycin intramuscularly, rifampicin intramuscularly. Well antibiotic therapy- 8-10 days. When especially persistent relapses two-course treatment is advisable. Consistently prescribe antibiotics that optimally act on streptococcus. The first course of antibiotic therapy is carried out with cephalosporins (7-8 days). After a 5-7-day break, a second course of treatment with lincomycin is performed (6-7 days). With recurrent erysipelas, immunity correction is indicated (methyluracil, sodium nucleinate, prodigiosan, T-activin).

Local therapy for erysipelas

Treatment of local manifestations of erysipelas is carried out only with its cystic forms with localization of the process on the limbs. The erythematous form of erysipelas does not require application local funds treatment, and many of them (ichthyol ointment, Vishnevsky balm, antibiotic ointments) are generally contraindicated. AT acute period in the presence of intact blisters, they are carefully incised at one of the edges, and after the release of fluid, bandages are applied to the inflammation site with a 0.1% solution of rivanol or a 0.02% solution of furacilin, changing them several times during the day. Tight bandaging is unacceptable.

In the presence of extensive weeping wound surfaces at the site of the opened blisters, local treatment begins with manganese baths for the extremities, followed by the application of the bandages listed above. For the treatment of bleeding, 5-10% dibunol liniment is used in the form of applications in the area of ​​​​the inflammation focus 2 times a day for 5-7 days.

Traditionally, in the acute period of erysipelas, ultraviolet irradiation is prescribed to the area of ​​​​the focus of inflammation, to the area of ​​\u200b\u200blymph nodes. Assign applications of ozocerite or dressings with heated naftalan ointment (on the lower limbs), paraffin applications (on the face), electrophoresis of lidase, calcium chloride, radon baths. The high efficiency of low-intensity laser therapy of a local focus of inflammation has been shown. The applied dose of laser radiation varies depending on the state of the focus, the presence of concomitant diseases.

Complications

Complications of erysipelas, mainly of a local nature, are observed in a small number of patients. To local complications include abscesses, phlegmon, skin necrosis, suppuration of blisters, inflammation of the veins, thrombophlebitis, inflammation lymphatic vessels. Common complications that develop in patients with erysipelas quite rarely include sepsis, toxic-infectious shock, acute cardiovascular insufficiency, pulmonary embolism, etc. The consequences of erysipelas include persistent lymph stagnation. According to modern concepts, lymph stagnation in most cases develops in patients with erysipelas against the background of already existing functional insufficiency of skin lymphatic circulation (congenital, post-traumatic, etc.).

Prevention of recurrence of erysipelas

Prevention of recurrence of erysipelas is integral part complex dispensary treatment of patients suffering from a recurrent form of the disease. Prophylactic intramuscular injection of bicillin (5-1.5 million units) or retarpen (2.4 million units) prevents relapses of the disease associated with reinfection with streptococcus.

With frequent relapses (at least 3 in the last year), continuous (year-round) bicillin prophylaxis is advisable for 2-3 years with an interval of 3-4 weeks for bicillin administration (in the first months, the interval can be reduced to 2 weeks). In case of seasonal relapses, the drug is started to be administered a month before the start of the morbidity season in this patient with an interval of 4 weeks for 3-4 months annually. In the presence of significant residual effects after suffering erysipelas, bicillin is administered at intervals of 4 weeks for 4-6 months.

Forecast and course

• At adequate treatment lungs and moderate forms- full recovery.
• Chronic lymphedema (elephantiasis) or scarring in a chronic relapsing course.
• In the elderly and debilitated, there is a high incidence of complications and a tendency to frequent recurrence.

Erysipelas or erysipelas- a common infectious-allergic disease of the skin and subcutaneous tissue, prone to relapse. It is caused by group A beta-hemolytic streptococcus. The name of the disease comes from the French word rouge and means red. This term indicates the external manifestation of the disease: a red edematous area forms on the body, separated from healthy skin by a raised roller.

Statistics and facts

The number of relapses over the past 20 years has increased by 25%. 10% of people experience a second episode of erysipelas within 6 months, 30% within 3 years. Repeated erysipelas in 10% of cases ends with lymphostasis and elephantiasis.

Doctors note an alarming trend. If in the 70s the number of severe forms of erysipelas did not exceed 30%, today there are more than 80% of such cases. At the same time, the number of mild forms has decreased, and the period of fever now lasts longer.

30% of cases of erysipelas are associated with impaired blood and lymph flow in the lower extremities, with varicose veins, thrombophlebitis of lymphovenous insufficiency.

Mortality from complications caused by erysipelas (sepsis, gangrene, pneumonia) reaches 5%.

Who is more likely to suffer from erysipelas?

• The disease affects people of all age groups. But the majority of patients (over 60%) are women over 50 years of age.
• There is also erysipelas in infants when streptococcus enters the umbilical wound.
• There is evidence that people with the third blood group are most susceptible to erysipelas.
• Erysipelas is a disease of civilized countries. On the African continent and in South Asia, people get sick extremely rarely.

At favorable course diseases and proper treatment on the fifth day the symptoms subside. Full recovery occurs in 10-14 days.

Interestingly, erysipelas, although it is an infectious disease, is successfully treated. traditional healers. Qualified doctors recognize this fact, but with the proviso that only uncomplicated erysipelas can be treated with folk methods. Traditional medicine explains this phenomenon by the fact that conspiracies are a kind of psychotherapy that relieves stress - one of the predisposing factors in the development of erysipelas.

The structure of the skin and the functioning of the immune system

Skin structure:

1. epidermis - superficial layer of the skin. The stratum corneum of the epidermis is keratinized cells of the epidermis, covered with a thin layer of sebum. it reliable protection from pathogenic bacteria and chemicals. Under the stratum corneum are 4 more layers of the epidermis: shiny, granular, spiny and basal. They are responsible for skin renewal and healing of minor injuries.
2. The actual skin or dermis- the layer below the epidermis. He is the one who suffers the most erysipelas. The dermis contains:
   • blood and lymph capillaries,
   • sweat and sebaceous glands,
   • hair bags with hair follicles;
   • connective and smooth muscle fibers.
3. Subcutaneous adipose tissue. Lies deeper than the dermis. It is a loosely located connective tissue fibers, and accumulations of fat cells between them.

The work of the immune system

The immune system includes:

1. Organs: bone marrow, thymus, tonsils, spleen, Peyer's patches in the intestine, The lymph nodes and lymphatic vessels
2. immune cells: lymphocytes, leukocytes, phagocytes, mast cells, eosinophils, natural killer cells. It's believed that total weight these cells reaches 10% of body weight.
3. protein molecules– antibodies must detect recognize and destroy the enemy. They differ in structure and function: igG, igA, igM, igD, IgE.
4. Chemical substances: lysozyme, hydrochloric acid, fatty acid, eicosanoids, cytokines.
Friendly microorganisms (commercial microbes) that inhabit the skin, mucous membranes, and intestines. Their function is to inhibit the growth of pathogenic bacteria.

1. Lymphocytes, or rather their receptors - immunoglobulins, recognize the bacterium.
2. react to the presence of bacteria T-helpers. They actively divide, secrete cytokines.
3. Cytokines activate the work of leukocytes, namely phagocytes and T-killers, designed to kill bacteria.
4. B cells make antibodies specific to a given organism that neutralize foreign particles (areas of destroyed bacteria, their toxins). After that, they are taken up by phagocytes.
5. After the victory over the disease, special T-lymphocytes remember the enemy by his DNA. When it enters the body again, the immune system is activated quickly, before the disease has had time to develop.

Causes of erysipelas

Streptococcus

Erysipelas is caused by one of the varieties of bacteria - group A beta-hemolytic streptococcus. This is the most dangerous of the whole family of streptococci.

If streptococcus enters the body of an immunocompromised person, then there is erysipelas, tonsillitis, scarlet fever, rheumatism, myocarditis, glomerulonephritis.

If streptococcus enters the human body with enough strong immunity, then he can become a carrier. Carriage of streptococcus was detected in 15% of the population. Streptococcus is part of the microflora, lives on the skin and mucous membranes of the nasopharynx without causing disease.

Source of erysipelas infection carriers and patients of any form of streptococcal infection can become. The causative agent of the disease is transmitted through contact, household items, dirty hands and by airborne droplets.

Streptococci are dangerous because they secrete toxins and enzymes: streptolysin O, hyaluronidase, nadase, pyrogenic exotoxins.

How streptococci and their toxins affect the body:

• Destroy (dissolve) the cells of the human body;
• They stimulate T-lymphocytes and endothelial cells to produce an excess amount of cytokines - substances that trigger the body's inflammatory response. Its manifestations: high fever and blood flow to the site of injury, pain;
• Reduce the level of antistreptococcal antibodies in the blood serum, which prevents the immune system from overcoming the disease;
• Destroy hyaluric acid, which is the basis of connective tissue. This property helps the pathogen to spread in the body;
• Leukocytes affect immune cells, disrupting their ability to phagocytosis (capture and digestion) of bacteria;
• Suppress the production of antibodies needed to fight bacteria
• Immune vascular damage. Toxins cause an inadequate immune response. Immune cells take the walls of blood vessels for bacteria and attack them. Other tissues of the body also suffer from immune aggression: joints, heart valves.
• Cause vasodilation and increase their permeability. The walls of the vessels pass a lot of fluid, which leads to tissue edema.

Skin properties

State of immunity

Factors that suppress the immune defense of the body:

1. Reception medicines immunosuppressive:
   • steroid hormones;
   • cytostatics;
   • chemotherapy drugs.
2. Metabolic diseases:
3. Diseases associated with changes in blood composition:
   • elevated level cholesterol.
4. Diseases of the immune system
   • hypercytokinemia;
   • severe combined immunodeficiency.
5. Malignant neoplasms
6. chronic diseases ENT organs:
7. Exhaustion as a result
   • lack of sleep;
   • malnutrition;
   • stress;
   • vitamin deficiency.
8. Bad habits
   • addiction;

• entry gate for infection - skin damage;
• violation of blood and lymph circulation;
• decrease in general immunity;
• hypersensitivity to streptococcal antigens (toxins and cell wall particles).

1. Leg. Erysipelas on the legs can be the result of a fungal infection of the feet, calluses, and injuries. Streptococci penetrate through skin lesions and multiply in the lymphatic vessels of the leg. Diseases contribute to the development of erysipelas causing violation circulation: obliterating atherosclerosis, thrombophlebitis, varicose veins.
2. Hand. Erysipelatous inflammation occurs in men aged 20-35 due to intravenous drug administration. Streptococci penetrate the skin lesions at the injection site. In women, the disease is associated with the removal of the mammary gland and stagnation of lymph in the arm.
3. Face. With streptococcal conjunctivitis, erysipelas develops around the orbit. Otitis media inflames the skin auricle, scalp and neck. The defeat of the nose and cheeks (like a butterfly) is associated with streptococcal infection in the sinuses or boils. Erysipelas on the face is always accompanied by severe pain and swelling.
4. Torso. Erysipelatous inflammation occurs around surgical sutures when patients do not comply with asepsis or through the fault of medical personnel. In newborns, streptococcus can penetrate the umbilical wound. In this case, the erysipelas proceeds very hard.
5. Crotch. The area around the anus, scrotum (in men) and labia majora (in women). Erysipelatous inflammation occurs at the site of scuffs, diaper rash, scratching. Particularly severe forms with damage to the internal genital organs occur in parturient women.

Symptoms of erysipelas, photo.

Against the background of reddened edematous skin may appear:

• hemorrhages- this is a consequence of damage to blood vessels and the release of blood into the intercellular space (erythematous-hemorrhagic form);
• Bubbles filled with transparent content. The first days they are small, but can increase and merge with each other (erythematous-bullous form).
• Blisters filled with bloody or purulent contents surrounded by hemorrhages (bullous-hemorrhagic form).

Such forms are more severe and often cause relapses of the disease. Repeated manifestations of erysipelas may appear in the same place or in other areas of the skin.

Diagnosis of erysipelas

Which doctor should I contact if symptoms of erysipelas appear?

At the doctor's appointment

In order to correctly diagnose and prescribe effective treatment, a specialist must distinguish erysipelas from other diseases with similar symptoms: abscess, phlegmon, thrombophlebitis.

The doctor will ask following Doctor will ask the following questions:

• How long ago did the first symptoms appear?
• Was the onset acute or did the symptoms develop gradually? When did the manifestations appear on the skin, before or after the temperature increase?
• How fast does inflammation spread?
• What sensations arise at the site of injury?
• How pronounced is intoxication, is there general weakness, headache, chills, nausea?
• Has the temperature risen?

On examination, the doctor discovers characteristics erysipelas:

• the skin is hot, dense, smooth;
• redness is uniform, against its background, hemorrhages and blisters are possible;
• uneven edges are clearly defined, have a marginal roller;
• the surface of the skin is clean, not covered with nodules, crusts and skin scales;
• pain on palpation, no severe pain at rest;
• pains mainly along the edge of the focus of inflammation, in the center the skin is less painful;
• nearby lymph nodes are enlarged, soldered to the skin and painful. A pale pink path stretches from the lymph nodes to the inflamed area in the direction of the lymph - an inflamed lymphatic vessel;

• the total and relative number of T-lymphocytes is reduced, which indicates the suppression of the immune system by streptococci;
• increased SOE (erythrocyte sedimentation rate) - evidence of an inflammatory process;
• the number of neutrophils is increased, which indicates an allergic reaction.

With erysipelas, a bacteriological examination is prescribed to determine which pathogen caused the disease and to which antibiotics it is most sensitive. This information should help the doctor choose the most effective treatment.

However, in practice, such a study is not very informative. Only in 25% of cases it is possible to establish the pathogen. Doctors attribute this to the fact that antibiotic treatment quickly stops the growth of streptococcus. A number of scientists believe that bacteriological examination in erysipelas is inappropriate.

Material for bacteriological research from the tissue is taken if there are difficulties in establishing the diagnosis. Examine the contents of wounds and ulcers. To do this, a clean glass slide is applied to the focus and an imprint containing bacteria is obtained, which is studied under a microscope. To study the properties of bacteria and their sensitivity to antibiotics, the obtained material is grown on special nutrient media.

Erysipelas treatment

How to increase immunity?

1. Identify foci of chronic infection that weaken the body. To fight the infection, you need to take a course of antibiotic therapy.
2. Restore normal microflora- consume daily dairy products. Moreover, the shorter their shelf life, the more they contain live lactobacilli, which will prevent streptococci from multiplying.
3. Alkaline mineral waters help to remove poisons from the body and eliminate the symptoms of intoxication. You need to drink them in small portions 2-3 sips throughout the day. During a fever, at least 3 liters of fluid should be consumed.
4. Easily digestible proteins: lean meat, cheese, fish and seafood. It is recommended to use them boiled or stewed. Proteins are needed by the body to create antibodies to fight streptococci.
5. Fats help the skin recover faster. Healthy fats contained in vegetable oils, fish, nuts and seeds.
6. Vegetables, fruits and berries: especially carrots, pears, apples, raspberries, cranberries, currants. These products contain potassium, magnesium, phosphorus, iron and a complex of vitamins necessary to strengthen the immune system.
7. Fight against anemia. A decrease in hemoglobin in the blood has a bad effect on immunity. In this situation, iron preparations, hematogen, apples, persimmons will help.
8. Strengthening the immune system. For one month, 2 times a year, it is recommended to take natural preparations to stimulate immunity: echinacea, ginseng, rhodiola rosea, eleutherococcus, pantocrine. Other mild immunomodulators are also effective: immunofan, likopid.
9. Fresh honey and perga- these bee products are rich in enzymes and chemical elements necessary for health promotion.
10. UV irradiation problem areas twice a year. Accept sunbathing must be dosed, starting with 15 minutes a day. Daily increase the time spent in the sun by 5-10 minutes. Sunburn can provoke a recurrence of erysipelas. You can go through the UFO and in the physical room of any clinic. In this case, the radiation dose is determined by the doctor.
. Be outdoors daily. Walking for 40-60 minutes a day 6 times a week provides a normal physical activity. It is advisable to do gymnastics 2-3 times a week. Yoga helps a lot. It helps to increase immunity, stress resistance and improve blood circulation.
11. Healthy sleep helps to restore strength. Set aside at least 8 hours a day for rest.
12. Don't let overwork, hypothermia, overheating, prolonged nervous tension. Such situations reduce the protective properties of the body.
13. Not recommended:
    • alcohol and cigarettes;
    • products containing caffeine: coffee, cola, chocolate;
    • spicy and salty foods.

Treatment of erysipelas

Antibiotics

1. Desensitizing (anti-allergic) drugs: tavegil, suprastin, diazolin. Take 1 tablet 2 times a day for 7-10 days. Reduce swelling and allergic reaction at the site of inflammation, contribute to the speedy resorption of the infiltrate.
2. Sulfonamides: biseptol, streptocide 1 tablet 4-5 times a day. Drugs disrupt the formation of growth factors in bacterial cells.
3. Nitrofurans: furazolidone, furadonin. Take 2 tablets 4 times a day. They slow down the growth and reproduction of bacteria, and in high dosages cause their death.
4. Glucocorticoids with emerging lymphostasis: prednisolone, the dose of which is 30-40 mg (4-6 tablets) per day. Steroid hormones have a strong anti-allergic effect, but at the same time they significantly depress the immune system. Therefore, they can only be used as prescribed by a doctor.
5. Biostimulants: methyluracil, pentoxyl. Take 1-2 tablets 3-4 times a day in courses of 15-20 days. Stimulate the formation of immune cells, accelerates the restoration (regeneration) of the skin in the damaged area.
6. Multivitamin preparations: ascorutin, ascorbic acid, panhexavit. Vitamin preparations strengthen the walls of blood vessels damaged by bacteria, and increase the activity of immune cells.
7. Thymus preparations: thymalin, taktivin. The drug is administered intramuscularly at 5-20 mg 5-10 injections per course. They are necessary to improve the functioning of the immune system and increase the number of T-lymphocytes.
8. Proteolytic Enzymes: lidase, trypsin. Daily subcutaneous injections are made to improve tissue nutrition and resorption of the infiltrate.

Treatment of the skin around the lesion

1. Applications with 50% dimexide solution. A gauze pad of 6 layers is moistened with a solution and applied to the affected area, so that it captures 2 cm of healthy skin. The procedure is carried out 2 times a day for 2 hours. Dimexide anesthetizes, relieves inflammation, improves blood circulation, has an antimicrobial effect and increases the effect of antibiotic treatment.
2. Enteroseptol in the form of powders. Clean, dry skin is sprinkled twice a day with powder from crushed Enteroseptol tablets. This drug causes the death of bacteria in the affected area and does not allow the attachment of other microorganisms.
3. Dressings with solutions of furacilin or microcide. A bandage of 6-8 layers of gauze is abundantly moistened with a solution, covered with compress paper on top and left on the affected skin for 3 hours in the morning and evening. Solutions of these medicines have antimicrobial properties and destroy bacteria in the thickness of the skin.
4. Aerosol of oxycyclosol. This remedy treats areas of erysipelas up to 20 sq.cm. The drug is sprayed, holding the balloon at a distance of 20 cm from the skin surface. You can repeat this procedure 2 times a day. This tool creates a protective film on the skin, which has an antibacterial, anti-inflammatory and anti-allergic effect.
5. It is forbidden to use synthomycin or ichthyol ointment, Vishnevsky liniment. An ointment bandage increases inflammation and can cause an abscess.

Local hygiene for erysipelas

1. Change your underwear and bedding daily. It must be washed at a temperature not lower than 90 degrees and ironed with a hot iron.
2. Clothing should provide air access to the affected area, it is advisable to leave it open. Wear clothes made from natural fabrics that prevent sweating.
3. Showering is recommended daily. The site of erysipelas is gently washed with soapy water, without using a sponge or washcloth. Failure to comply with this rule may cause the attachment of another infection, since the affected area is very susceptible to bacteria and fungi.
4. The water should be warm, hot baths are strictly prohibited and can cause the spread of infection throughout the body.
5. After washing, do not dry the skin, but dry it gently. For this, it is better to use disposable paper towels.
6. Wash the inflamed area 3 times a day with a decoction of chamomile and coltsfoot. Herbs are mixed in a 1:1 ratio. One tablespoon of the mixture is poured into a glass hot water, heated in a water bath for 10 minutes, allowed to cool.
7. At the healing stage, when peeling appears, the skin is lubricated kalanchoe juice or rosehip oil.
8. Erysipelatous inflammation on the face or genitals 2-3 times a day can be washed with a decoction of string or calendula. These herbs have bactericidal properties and reduce the manifestations of allergies.

1. UFO on the affected area with erythemal doses (until redness appears on healthy skin). Assign from the first days in parallel with antibiotics. The course of treatment is 2-12 sessions.
2. High frequency magnetotherapy to the area of ​​the adrenal glands. Radiation stimulates the adrenal glands to secrete more steroid hormones. These substances inhibit the production of inflammatory mediators. As a result, swelling, pain, and the attack of immune cells on the skin are reduced. It is also possible to reduce the allergic reaction to substances produced by bacteria. However, this method depresses the immune system, so it is prescribed at the beginning of treatment (no more than 5-7 procedures), only if autoantibodies are detected in the blood.
3. Electrophoresis with potassium iodide or lidase, Ronidase. Provides lymph drainage and reduces infiltration. Assign 5-7 days after the start of treatment. The course consists of 7-10 procedures.
4. UHF. It warms the tissues, improves their blood supply and relieves inflammation. Treatment is prescribed for 5-7 days of illness. 5-10 sessions are needed.
5. Infrared laser therapy. It activates protective processes in cells, improves tissue nutrition, accelerates local blood circulation, eliminates edema and increases the activity of immune cells. Appointed in the recovery phase. Promotes the healing of ulcers in complicated erysipelas.
6. Applications with warm paraffin applied 5-7 days after the onset of the disease. They improve tissue nutrition, contribute to the disappearance of residual effects. For the prevention of relapses, repeated courses of physiotherapy after 3, 6 and 12 months are recommended.

Prevention of erysipelas

1. Treat foci of chronic inflammation in a timely manner. They weaken the immune system and from them bacteria can spread through the circulatory system and cause erysipelas.
2. Observe personal hygiene. Take a shower at least once a day. A contrast shower is recommended. 3-5 times alternate warm and cool water. Gradually increase the temperature difference.
3. Use soap or shower gel with pH less than 7. It is desirable that it contains lactic acid. This helps to create a protective layer on the skin with an acidic reaction that is detrimental to fungi and pathogenic bacteria. Too much frequent washing and the use of alkaline soap deprives the body of this protection.
4. Avoid rashes. AT skin folds where the skin is constantly damp, use baby powder.
5. Massage if possible, take massage courses 2 times a year. This is especially true for people with impaired blood circulation and lymph movement.
6. Treat skin lesions with antiseptics: hydrogen peroxide, iodicyrin. These products do not stain the skin and can be used on exposed areas of the body.
7. Treat fungal infections of the feet in a timely manner. They often become the entrance gate for infections.
8. Sunburn, diaper rash, chapping and frostbite reduce the local immunity of the skin. For their treatment, use Panthenol spray or Pantestin, Bepanten ointments.
9. Trophic ulcers and scars you can lubricate 2 times a day camphor oil.
10. Wear loose clothing. It should absorb moisture well, allow air to pass through and not rub the skin.

Erysipelas or erysipelas (from Polish roza) is an infectious, fairly common disease of the skin and mucous membranes. In Latin - erysipelas(erythros translated from Greek - red, pellis - skin). Among all erysipelas takes the fourth place and today is one of the urgent problems in health care. The cause of erysipelas is group A beta-hemolytic streptococcus. Sick individuals and healthy carriers are sources of infection. The disease is characterized by severe fever, symptoms of intoxication and the appearance of skin or mucous membranes of areas of inflammation of a bright red color.

Complicated forms of erysipelas are the most severe soft tissue infections. They are characterized by rapid onset, rapid progression, and severe intoxication.

A patient with erysipelas is not contagious. Women get sick more often during the period of extinction of reproductive function. In a third of patients, the disease acquires a relapsing course.

Rozha has been known since ancient times. Its description was found in the works of ancient authors. A pure culture of the causative agent of erysipelas was isolated in 1882 by F. Felleisen. A huge contribution to the study of the disease was made by Russian scientists E. A. Galperin and V. L. Cherkasov.

Rice. 1. Erysipelas (erysipelas) on the leg (erysipelas of the lower leg).

Pathogen erysipelas

There are 20 types (serogroups) of streptococci. The most significant of these are serogroup A, B, C, D and G streptococci. Group A beta-hemolytic streptococci (Streptococcus pyogenes) are the cause of many dangerous diseases in humans - pustular diseases of the skin and soft tissues (abscesses, phlegmon, boils and osteomyelitis), tonsillitis and pharyngitis, bronchitis, rheumatism, scarlet fever and toxic shock. Erysipelas can be caused by any type of group A streptococcus.

bacteria have round shape. Arranged more often in chains, less often in pairs. They reproduce by dividing in two.

• In the external environment, including sputum and pus, bacteria persist for months and survive when low temperatures and freezing.
• High temperatures, sunlight and disinfectant solutions have a detrimental effect on microbes.
• Streptococci are highly sensitive to antibiotics, resistance to which they develop slowly.

Streptococci secrete a number of endo- and exotoxins and enzymes that cause their damaging effect.

Rice. 2. Streptococci are round in shape. Arranged more often in chains, less often in pairs.

Rice. 3. Group A beta-hemolytic streptococci, when growing on blood agar, form zones of hemolysis (light halos) that are 2–4 times larger than the diameter of the colonies themselves.

Rice. 4. When growing on nutrient media, streptococcal colonies are shiny, shaped like a drop, or gray, dull and granular with uneven edges, or convex and transparent.

Epidemiology of the disease

reservoir and source beta are sick and "healthy" bacteria carriers. Bacteria penetrate the skin from outside or from foci of chronic infection. Erysipelas in individuals with manifestations ( chronic tonsillitis, caries, diseases of the upper respiratory tract, etc.) occurs 5-6 times more often. Long-term use of steroid hormones is a predisposing factor in the development of the disease.

Minor injuries, cracks, abrasions, abrasions and wounds on the skin and mucous membranes of the nose, genitals, etc. are gateway for infection. Contact and airborne - the main ways of infection.

Group A streptococci often live on human skin and mucous membranes and do not cause disease. Such persons are called bacteria carriers. Erysipelas is more often recorded in women during the period of extinction of reproductive function. In some patients, erysipelas is recurrent, which, apparently, is associated with a genetic predisposition.

The disease often develops with lymphostasis and venous insufficiency, edema of various origins, trophic ulcers, and.

Rice. 5. Phlegmon and gangrene - formidable complications erysipelas.

How does erysipelas occur (pathogenesis of erysipelas)

Inflammation in erysipelas is most often localized on the face and legs, less often on the arms, trunk, scrotum, perineum and mucous membranes. The inflammatory process during the disease affects the main layer of the skin, its frame - the dermis. It performs supporting and trophic functions. The dermis contains many capillaries and fibers.

Inflammation in erysipelas is infectious and allergic in nature.

• Waste products and substances released during the death of bacteria cause the development of toxicosis and fever.
• The reason for the development of the inflammatory process is the effect on tissues of toxins, enzymes and antigens. hemolytic streptococci, as well as biologically active substances. Small arteries, veins and lymphatic vessels are damaged. Inflammation is serous or serous-hemorrhagic in nature.
• Human skin antigens are similar in structure to streptococcal polysaccharides, which leads to the development of autoimmune processes when the patient's antibodies begin to attack their tissues. Immune and autoimmune complexes cause damage to the skin and blood vessels. Intravascular coagulation develops, the integrity of the capillary walls is disturbed, and a local hemorrhagic syndrome is formed. As a result of vasodilation, a focus of hyperemia and vesicles appear on the skin, the contents of which are serous or hemorrhagic in nature.
• Biologically enter the bloodstream in large quantities active substances, including histamine, which is involved in the development of hemorrhagic forms of erysipelas.
• Insufficiency of lymphatic circulation is manifested by edema of the lower extremities. Over time, damaged lymphatic vessels are replaced by fibrous tissue, leading to the development of elephantiasis.
• The focus of infectious-allergic inflammation consumes a large amount of glucocorticoids. This leads to the development of extra-adrenal insufficiency. Protein and water-salt metabolism are disturbed.

Rice. 6. The inflammatory process during the disease affects the main layer of the skin, its frame - the dermis.

Factors affecting the development of erysipelas

The following factors influence the development of erysipelas:

• Individual predisposition to the disease, which is due to a genetic predisposition or hypersensitivity to allergens of streptococci and staphylococci.
• Decreased activity defensive reactions organism - nonspecific factors, humoral, cellular and local immunity.
• Disorders of the neuroendocrine system and imbalance of biologically active substances.

Erysipelas classification

1. There are erythematous, erythematous-bullous, erythematous-hemorrhagic and bullous-hemorrhagic (uncomplicated) and abscessing, phlegmonous and necrotic (complicated) forms of erysipelas. This classification of erysipelas is based on the nature of local lesions.
2. According to the severity of the course, erysipelas is divided into mild, moderate and severe.
3. According to the multiplicity of manifestations, erysipelas is divided into primary, repeated and recurrent.
4. There are localized, widespread, migratory and metastatic forms of erysipelas.

By prevalence

• When a limited area of ​​the lesion appears on the skin, they speak of localized face shape.
• The exit of the focus outside the anatomical region is regarded as common the form.
• When one or more new areas appear near the primary lesion, connected by "bridges", they speak of migratory form of erysipelas.
• When new foci of inflammation appear far from the primary focus, they speak of metastatic form of the disease. Streptococci are spread by the hematogenous route. The disease is severe and prolonged, often complicated by the development of sepsis.

By frequency of occurrence

• Erysipelas that occurs for the first time is called primary.
• When repeated case diseases in the same place, but not earlier than 2 years after the first case or in the event of a recurrent disease that occurred in another place earlier than this period, they speak of repeated erysipelas.
• Erysipelatous inflammation that occurs repeatedly in the same place is recurrent character.

By severity

• mild severity the disease is characterized by a short fever and mild symptoms of intoxication, which is characteristic of the erythematous form of erysipelas.
• Moderate severity characterized by a longer (up to 5 days) fever and more pronounced symptoms of intoxication, which is typical for the erythematous and erythematous-bullous forms of the disease.
• Severe course erysipelas is typical for hemorrhagic and complicated forms of the disease, which occur with high (up to 40 0 ​​C) body temperature, severe intoxication, the development in some cases of infectious-toxic shock and sepsis. A severe course is observed in migratory and metastatic forms of the disease.

Erased or abortive forms of the disease are noted with adequate, timely treatment. Rarely seen.

Rice. 7. In the photo, erysipelas of the skin.

Signs and symptoms of erysipelas in various forms of the disease

Signs and symptoms of erysipelas during the incubation period

The incubation period for erysipelas in case of infection from outside is from 3 to 5 days. As a rule, the disease begins acutely, with a precise indication of the hour of onset of the first symptoms and signs. Headache, general weakness, fever up to 39-40°C, chills, muscle and joint pain, often nausea and vomiting, less often convulsions and disorders of consciousness are the main signs and symptoms of erysipelas during this period. Intoxication with erysipelas develops as a result of release into bloodstream streptococcal toxins.

At the same time, the first signs of local damage appear. Sometimes local symptoms develop after 6-10 hours from the onset of the disease.

Streptococci have a tropism for lymphatic system, where they multiply rapidly and spread to the regional lymph nodes, which, as a result of developed inflammation, increase. Fever and toxicosis persist up to 7 days, less often - longer.

All forms of erysipelas are accompanied by inflammation of the lymphatic vessels and lymph nodes.

Rice. 8. In the photo, erysipelas (erysipelas) in children (erysipelas of the face).

Signs and symptoms of erysipelas of the skin in the erythematous form of the disease

A burning sensation and bursting pain at the site of the lesion are the first symptoms of erysipelas. Redness and swelling are the first signs of the disease. In the affected area, the skin is hot to the touch and tense. The inflammatory focus rapidly increases in size. The erysipelatous plaque is delimited from the surrounding tissues by a roller, has jagged edges and resembles flames. There are many streptococci in the tissues and capillaries of the affected area, which can be detected with a simple smear microscopy. The process continues up to 1 - 2 weeks. Redness disappears gradually, the edges of erythema are blurred, swelling subsides. The upper layer of the epidermis sloughs off and thickens, sometimes pigment spots appear. Persistent edema indicates the development of lymphostasis.

Rice. 9. In the photo, the erythematous form of erysipelas on the leg.

Signs and symptoms of erysipelatous inflammation of the skin in the erythematous-bullous form of the disease

The erythematous-bullous form of the disease is characterized by the appearance of vesicles and blisters on the affected area of ​​the skin. Bullous elements contain a light transparent liquid (exudate). Sometimes the exudate becomes cloudy, and the bubbles turn into pustules. Over time, the blisters subside, in their place, brown crusts form, dense to the touch. After 2-3 weeks, the crusts are torn off, exposing the erosive surface. Some patients develop trophic ulcers. Epithelialization of the affected surface occurs slowly.

Rice. 10. In the erythematous-bullous form of erysipelas, brown or black crusts form at the site of collapsed vesicles.

Signs and symptoms of erysipelas in the erythematous-hemorrhagic form of the disease

This form of erysipelas is becoming more common in recent times, and in some regions of our country it ranks first among all forms of this disease.

Burning sensation and bursting pain, redness, swelling and punctate (up to 3 mm) hemorrhages (petechiae) are the main signs and symptoms in the erythematous-hemorrhagic form of the disease. Hemorrhages at the site of the lesion are the result of the release of blood from damaged small blood vessels into the intercellular space.

The disease is characterized by a longer (up to 2 weeks) fever and slow regression. Skin necrosis is sometimes noted as a complication.

Rice. 11. Erysipelas of the arm. Petechial hemorrhages (petechiae) are the main symptom of the erythematous-hemorrhagic form of erysipelas.

Signs and symptoms of erysipelas with bullous-hemorrhagic form of the disease

The bullous-hemorrhagic form of erysipelas of the skin is characterized by the appearance of blisters with serous-hemorrhagic contents against the background of hyperemia. The outflow of blood is associated with deep damage to the capillaries. After the bubbles subside, an erosive surface is exposed, on which black crusts are located. Healing is slow. The disease is often complicated by skin necrosis and inflammation of the subcutaneous adipose tissue. After healing, scars and pigmentation remain.

Rice. 12. In the photo, gangrene of the lower limb, as a result of a complication of the bullous-hemorrhagic form of erysipelas.

Bullous and hemorrhagic forms of the disease lead to the development of lymphostasis.

Signs and symptoms of complicated forms of erysipelas

Phlegmonous and necrotic form erysipelas of the skin are regarded as complications of the disease.

When inflammation spreads to the subcutaneous adipose tissue and connective tissue develops phlegmonous inflammation. Bubbles filled with pus appear on the affected area of ​​the skin. The disease is severe, with severe intoxication. The affected area of ​​the skin is often infected with staphylococci. The phlegmonous form of erysipelas often causes sepsis.

Necrotic (gangrenous) form erysipelas develops in people with low immunity. Soft tissues undergo necrosis (complete destruction). The disease begins rapidly, proceeds with severe intoxication, and progresses rapidly. After healing, disinfecting scars remain.

The recovery period for severe and complicated forms of erysipelas is slow. Asthenic syndrome after recovery, it persists for many months.

Rice. 13. In the photo erysipelas (erysipelas), phlegmonous-necrotic form of the disease.

Features of erysipelas in certain parts of the body

Most often, erysipelas is recorded on the skin of the lower extremities, somewhat less often on the upper extremities and face, rarely on the trunk, mucous membranes, mammary gland, scrotum and perineum.

Erysipelas on the leg

Erysipelas on the leg develops as a result of a violation of the integrity of the skin, the occurrence of which is associated with injuries and bruises. Often the disease develops in patients with fungal infections of the feet and toenails, circulatory disorders in the lower extremities, which developed as a result of diabetes mellitus, varicose veins veins, smoking and overweight. The source of infection is also the foci of chronic infection in the patient's body.

A burning sensation, bursting pain at the site of the lesion, redness and swelling are the first signs and symptoms of erysipelas on the legs.

Erysipelas on the legs is often recurrent. Improper treatment and the presence of foci of chronic infection contribute to the development of a relapsing form of the disease.

Frequent relapses lead to the development of fibrotic changes in the dermis and subcutaneous tissue with the subsequent development of lymphostasis and elephantiasis.

Rice. 14. In the photo, erysipelas of the legs.

Erysipelas on the arm

Erysipelas on the hands often develops in drug addicts as a result of intravenous drug administration and in women against the background of lymph stagnation, as a result of a radical mastectomy.

Rice. 15. Erysipelas on the hands.

Rice. 16. In the photo, erysipelas of the hand.

Erysipelas on the face

Most often, the primary erythematous form of erysipelas occurs on the face. Redness often captures the cheeks and nose (like a butterfly) and, in addition to swelling and itching, is often accompanied by severe pain. Sometimes the focus of inflammation spreads to the entire face, hairy part head, occiput and neck region. In some patients, the disease is complicated by the development of abscesses in the thickness of the eyelids and the accumulation of pus under the scalp. With the spread of infection in the subcutaneous fatty tissue, phlegmon develops. Weakened persons and the elderly may develop gangrene.

The source of infection in erysipelas on the face is often a streptococcal infection of the sinuses and boils. The source of infection in erysipelas of the orbit is streptococcal conjunctivitis.

With streptococcal otitis media, erysipelas of the auricle sometimes develops, often inflammatory process spreads to the scalp and neck.

Rice. 17. An erythematous form of erysipelas occurs more often on the face.

Rice. 18. Erysipelas on the face. Redness often captures the area of ​​​​the cheeks and nose (like a butterfly).

Rice. 19. Sometimes the focus of inflammation spreads to the entire face, scalp, neck and neck.

Rice. 20. In the photo, erysipelas of the hand.

Erysipelas of the trunk

Erysipelatous inflammation sometimes develops in the area of ​​​​surgical sutures if the rules of asepsis are not followed. Erysipelas is severe when streptococci penetrate into the umbilical wound of a newborn. Erysipelatous inflammation of the mammary gland develops against the background of mastitis. The development of gangrene can lead to scarring with subsequent dysfunction of the organ.

Erysipelas of genital organs and perineum

With erysipelas of the scrotum, penis, female genital organs and perineum, the erythematous form of the disease most often develops with a pronounced edema of the underlying tissues. Developed tissue necrosis followed by scarring leads to testicular atrophy. Erysipelas in parturient women is extremely difficult. The inflammatory process often affects the internal genital organs.

Erysipelatous inflammation of the mucous membranes

With erysipelas of the mucous membranes, the pharynx, larynx, oral cavity and nasal mucosa are more often affected. With the defeat of the mucous membranes, the erythematous form of the disease develops. Hyperemia and significant edema develop in the area of ​​inflammation, often with foci of necrosis.

Rice. 21. The photo shows erysipelas of the oral mucosa.

Relapses of the disease

Erysipelatous inflammation that occurs repeatedly in the same place is recurrent in nature. Relapses are divided into early and late. Early relapses are considered repeated episodes of the disease that occur before 6 months, late - more than 6 months.

Promote recurrence of chronic venous insufficiency, lymphostasis, diabetes mellitus and improper treatment of the disease. Relapses are often observed in patients working in adverse conditions and in the elderly.

When multiplying in the lymphatic capillaries of the skin, streptococci form inflammatory focus in the dermis. Frequent relapses occur with small temperature body and moderate symptoms of intoxication. Oily erythema and edema appear on the skin. The delimitation from healthy areas is poorly expressed.

Frequent relapses lead to the development of fibrotic changes in the dermis and subcutaneous tissue, followed by the development of elephantiasis.

Rice. 22. In the photo erysipelas (erysipelas) of rare localization.

Erysipelas in the elderly

Erysipelas in older people often occurs on the face. The disease is accompanied by severe pain. Sometimes gangrene develops. Erysipelatous inflammation has a protracted course and slowly regresses.

Rice. 23. Erysipelatous inflammation of the face in the elderly.

Erysipelas in children

Erysipelas is rare in children. In older children, the disease is mild. The focus of erysipelas can occur in different places. The erythematous form develops more often. The prognosis is favorable.

In children under one year old, erysipelas is more severe. Foci of inflammation often appear in places of diaper rash and on the face, sometimes spreading to other parts of the body. At phlegmonous form diseases can develop sepsis, with erysipelas of the face - meningitis.

Erysipelas is severe when streptococci enter the umbilical wound in newborns. The process quickly spreads to the back, buttocks and limbs of the child. Intoxication increases, body temperature rises significantly, convulsions appear. Some patients develop sepsis. Mortality in erysipelas in newborns is extremely high.

Rice. 24. In the photo, erysipelas in children.

Complications of erysipelas

Complications of erysipelas occur in 4 - 8% of cases. A decrease in the activity of the body's defense reactions and inadequate treatment lead to the development of:

• lymphorrhea - leakage of lymph from damaged lymphatic vessels,
• ulcers - deep skin defects,
• abscess - an abscess surrounded by a dense capsule,
• phlegmon, when inflammation spreads to subcutaneous adipose tissue and connective tissue,
• gangrene - complete destruction of tissues affected by inflammation,
• thrombophlebitis - inflammation of the venous walls with the formation of blood clots,
• pneumonia in older people
• lymphostasis (lymphedema), which has developed as a result of a violation of the outflow of lymph and elephantiasis (fibreedema),
• infectious psychosis,
• at the site of inflammation, often with a prolonged or recurrent course, hyperkeratosis, eczema develops, and pigmentation appears.

Immunity after suffering erysipelas does not develop.

Most popular

In recent years, doctors have noted an increase in erysipelas, which manifests itself on the skin in the form of red areas with raised edges or separated from the dermis layer. More often, the disease is diagnosed in women after 50 years of age or in infants when the infection enters the umbilical region.

Erysipelas on the arm is dangerous with complications, if not treated, then can lead to sepsis, blood poisoning and death. It's pretty a rare event in civilized countries, but today there is a tendency to a constant increase in the number of cases. When the first symptoms appear, you should not hesitate to contact the doctors.

What kind of disease is erysipelas on the arm?

erysipelas- this is a manifestation of an infectious focus on the skin caused by streptococcal infection, in the form of reddening of the area, accompanied by fever and signs of intoxication. Streptococcus is a bacterium that can quickly penetrate through the pores of the skin through cuts, abrasions, insect bites.

At the same time, erysipelas is contagious. Streptococcal infections can spread quickly from one person to another. In order to avoid infection upon contact with the patient, it is necessary to use gloves, use antibacterial soap to wash hands, and immediately treat cut sites with antiseptics to prevent streptococcus from entering under the skin after contact with sick people.

Causes of the disease

Streptococcus lives in the body of almost every person, and many people are its carriers. But the development of erysipelas, another streptococcal disease does not occur if there are no provocative factors.

The occurrence of pathology is possible as a result of:

• damage to the dermis of a purulent, viral infection;
• circulatory disorders against the background of post-traumatic scars after the operation;
• decrease in immunity;
• taking a number of drugs - cytostatics, steroids;
• the presence of pathology in metabolic processes;
• diseases of the immune system;
• AIDS;
• availability bad habits.

Transmitted erysipelas by airborne droplets or by direct contact with patients. Rapidly begins to develop against the background of diabetes mellitus, sudden changes temperature, malnutrition, viral infectious diseases, chronic diseases in the body.

Provoking factors

Inflammation in the hand can be triggered by:

• surgery to remove the mammary glands in women;
• excessive insolation;
• overheating or hypothermia;
• infection of abrasions, scratches, bruises, cuts with sharp objects.

In addition, the risk group includes people with pathologies such as:

• diabetes;
• alcoholism;
• obesity;
• varicose veins;
• lymphostasis;
• tonsillitis;
• caries;
• periodontitis;
• fungal infection of the feet;
• thrombophlebitis.

The cream is a uniquely effective remedy for combating all types of fungal infections both on the skin and on the nails.

It not only eliminates pathogenic dermatophytes, pathogens of epidermycosis and trichomycosis, but also restores protective functions skin. Effectively eliminates itching, peeling and irritation from the first application.

Typical symptoms of erysipelas on the arm

Microorganisms, penetrating into the pores of the skin on the hand, first for some time remain in the stage of the incubation period until 2-3 days. Infection may not occur if the site is immediately treated with an antiseptic in case of an unexpected cut or with a fairly stable immune system.

Otherwise, the primary and characteristic signs of the development of erysipelas are as follows:

• a sharp increase in body temperature;
• nausea;
• dizziness;
• increased fatigue;
• body aches;
• chills;
• loss of appetite;
• redness appears on the arm in the form of a pink-red spot with tongues of flame or a roller with uneven edges;
• further - peeling, burning sensation, bursting at the site of the lesion;
• in some cases, hemorrhages or vesicles with serous or bloody fluid appear within the lesion.

Sometimes the first symptoms are similar to ordinary dermatitis. That is why when the first dangerous signs appear, you should not postpone going to the doctor. If similar symptoms suddenly appear, you should not hesitate to call an ambulance or go to the nearest clinic. By the way, the disease is observed in older people during gardening, so you need to be vigilant.

IT'S IMPORTANT TO KNOW!

The appearance of a pink spot when streptococcus penetrates under the skin occurs within a few hours. The place begins to burn, burn, blush, resembling flames. The skin becomes edematous, hot to the touch. The infection spreads quickly.

The inflammation begins with:

• soreness, aches in the joints and muscles;
• fever, fever;
• deterioration in general well-being;
• the appearance of nausea and vomiting;
• headache, dizziness;
• palpitations.

At first, erysipelas has an acute course and the symptoms are not specific. Through 1-2 days there is a strong intoxication of the body, some even have hallucinations and delusions. Toxic damage to the kidneys, heart can occur. The patient is nauseated, shivering, sleepy. On the initial stage erysipelas is similar to the flu.

Features of erysipelas on the arm

Feature of erysipelas on the hand in the fact that when it gets under the skin, the microorganism quickly penetrates into the deep layers of the dermis, leads to a sharp increase in temperature, chills up to loss of consciousness. it unpleasant disease, which can greatly worsen the quality of life, interferes with ordinary household chores.

If the disease is not treated, then the outcome of such a disease is extremely unfavorable. A slight lesion on the skin can lead to disruption of tissue trophism, gangrene.

In children, the disease is usually mild, but in older people it is more difficult to tolerate. A feverish state can last about 2 months, all chronic diseases in the body often become aggravated. Erysipelas tend to recur and are poorly treated. Those who are ill with suspected illness should not delay contacting a dermatologist, immunologist or infectious disease specialist.

Features of erysipelas on the leg

It has the following properties:

• Freely penetrates under the nail and interungual spaces
• Has an antibacterial effect. Relieves itching and inflammation in 1 application
• Removes cracks and itching between the fingers thanks to propolis
• Kills spores with alkaloids
• Golden mustache restores healthy nails

Complications

With proper treatment, erysipelas on the arm, after 2-3 weeks, can go away on its own. Redness and swelling will subside and will soon disappear altogether. But pigmentation may remain. Relapses are possible.

New erysipelas can subsequently lead to:

• stagnation of the lymph;
• insufficiency of lymphatic circulation;
• thromboembolism of the pulmonary artery;
• sepsis;
• necrosis of the skin;
• thrombophlebitis.

All this indicates untimely treatment and progression of the disease.

Complications, as a rule, are caused by untimely access to doctors, self-medication, joining secondary infection. The risk group includes people with diabetes, HIV-infected, meningitis, pneumonia.

Erysipelatous inflammation with complications can lead to the formation of trophic ulcers on the arm, lymphostasis, abscess, suppuration and thickening of the skin, which will greatly complicate the treatment, and even may endanger the life of the patient.

Treatment

When visiting the clinic, the doctor will first of all examine the integument of the skin, identify the nature, location, degree of damage and the shape of the erysipelas. Most likely, the patient with clearly expressed clinical signs will be referred for hospitalization in the infectious diseases department.

For the treatment of erysipelas appoint:

• antiallergic drugs(Suprastin, Diazolin, Tavegil);
• sulfonamides(Biseptol, Streptocid);
• nitrofurans(Furadonin, Furazolidone) to kill bacteria;
• corticosteroids(Prednisolone) to eliminate the infection;
• biostimulants(Pentoxyl, Methyluracil) to stimulate the formation of new healthy immune cells and skin regeneration;
• vitamins(ascorbic acid, Askorutin) to strengthen vascular walls damaged by bacteria, increase proteolytic enzymes (trypsin, lidase, taktivin).

Lack of treatment can lead to serious complications and lethal outcome. Self-medication with erysipelas is excluded. Only qualified specialist will be able to direct the treatment in the right direction.

In addition, treatment is carried out in a hospital with the appointment of:

• benzylpenicillin, as the main antibiotic for streptococcal infection;
• cephalosporins to suppress pathogenic flora in the event of an abscess, phlegmon. The course of treatment is up to 10 days.

Inflammation of the lungs from time immemorial has been one of the most urgent diseases of all mankind. Nowadays, medicine has an impressive amount of antibiotics, vaccines and other drugs. Doctors have long developed effective treatment regimens for patients with pneumonia, informative diagnostic methods and are working on effective measures to prevent this disease. And in most cases, when right approach, such patients recover without complications and consequences. But these measures do not allow to cope with the problem of mortality from pneumonia worldwide.

Some statistics!

Every year the number of cases of this disease is growing. This problem is especially relevant in the "poor" countries of Asia and Africa, where there is still a problem with access to antibiotics and medical care in general.

Flu epidemics, the spread of HIV infection and other diseases that reduce immunity, and the development of resistance of many bacteria to various antibiotics add fuel to the fire.

A little about the structure of the lungs

The right lung is wider and shorter than the left, which is explained by its location in the left side of the thoracic cavity of the heart. The right lung has three lobes and 10 segments, while the left has two lobes and 9 segments. When describing segments, indicate the letter S and the segment number (for example, S1, 2, etc.). All segments and lobes are separated by connective tissue partitions.

Characteristics of the organs of the respiratory system, their role in pneumonia

Respiratory system	Scheme	Main functions	Possible changes in pneumonia
Upper respiratory tract: nasal cavity and paranasal sinuses; oropharynx; nasopharynx; larynx.		Through the upper respiratory tract, air enters the lower respiratory tract and lungs. In the upper respiratory tract, the air is purified and warmed.	Often pneumonia develops as a complication of upper respiratory tract infections, meaning the inflammation travels down into the lungs.
bronchial tree. The trachea is divided into two main bronchi, which further branch like branches of a tree, this is the bronchial tree. The bronchi are of different caliber (diameter), the smallest of them are the bronchioles.		The trachea and bronchial tree belong to the lower respiratory tract. Normally, sputum is constantly secreted in the bronchi - mucus with immune cells, this is necessary to clean the respiratory tract from infections, dust and other foreign particles. The bronchi are covered with ciliated epithelium, the cilia, with their movements, promote sputum and particles of dust, infections towards the upper respiratory tract. In the bronchial tree, air is distributed and enters the lungs.	Damage to the bronchial mucosa often accompanies pneumonia - bronchopneumonia. Bronchitis and pneumonia are similar in symptoms and manifestations, and differential diagnosis is most often required for this.
Acinus - is the structural unit of the lung. Components of the acinus: bronchiole; blood vessel; alveolus.		Alveoli are sacs that end in the smallest bronchioles. Alveoli are normally filled with air. It is in them that gas exchange occurs - the entry of oxygen into the blood and the removal of carbon dioxide from it. Further, oxygen is carried with blood throughout the body to every organ, tissue and cell, from where carbon dioxide is collected, and so on in a circle.	With pneumonia, the inflammatory process occurs in the alveoli, which leads to disruption of gas exchange in the affected area, that is, breathing in them is not carried out in full.
Pleura is the serous membrane that covers the lung. It has two leaves, like a bag of two layers forms a pleural cavity.		The main function of the pleural cavity is to prevent friction of the lungs during breathing against the walls of the chest cavity during respiratory movements. Normally, this cavity contains a small amount of liquids. On the radiograph, the pleural cavity is not visible, only the pleural sinuses can be seen, they are small.	In severe cases of pneumonia, the pleura may also be involved in the process, pleuropneumonia develops. In this case, inflammatory fluid can enter the pleural cavity - pleurisy, air - pneumothorax , pus - pyopneumothorax .

Causes of pneumonia

infections

Infections that most commonly cause pneumonia include:

1. Bacteria:

• hemophilic bacillus;
• klebsiella.

• flu;
• adenoviruses;
• rhinoviruses;
• rhinosyncytial viruses and others.

• legionella.

• candida;
• pneumocystis;
• actinomycetes (aspergillosis).

• tuberculosis;

• helminthic invasion (roundworm, lamblia, etc.);
• foreign bodies in the bronchi and lungs;
• autoimmune diseases (when the immune system destroys its own tissues, mistaking them for others);
• chemical and thermal burns of the lungs (after a fire, inhalation of various chemicals and aerosols).

Factors that increase the risk of developing pneumonia

• children and old age;
• Availability chronic foci inflammation (chronic tonsillitis, bronchitis, caries and much more);
• HIV infection and other immunodeficiencies;
• diseases of the digestive system;
• oncological pathologies;
• autoimmune diseases, and so on.

3. Environmental condition:

• hypothermia or overheating;
• drafts;
• dry or too humid air;
• dusty, polluted air;
• harmful production conditions.

5. Chronic bronchial diseases, including bronchiectasis and bronchial asthma.

7. Cardiovascular diseases, which are manifested by heart failure.

8. A sedentary lifestyle leads to so-called congestive pneumonia.

9. Diseases of the nervous system, accompanied by a violation of swallowing, lead to aspiration pneumonia.

Pneumonia (pneumonia): definition, causes, modes of transmission, consequences and complications - video

Types and forms of pneumonia

Hospital and community-acquired pneumonia

Typical and atypical pneumonia

Acute and chronic inflammation of the lungs

Bacterial inflammation of the lungs

Purulent pneumonia

Viral inflammation of the lungs

• Primary viral pneumonia caused directly by the virus. This variant of pneumonia is always difficult, and within a short time (several hours or days) can lead to severe complications, including pulmonary edema. Most often, such inflammation of the lungs develops against the background of the flu. It is difficult that antibiotics for such pneumonia are ineffective.
• Secondary viral pneumonia associated with the addition of a bacterial infection on the background of a viral one. That is, it is a mixed version of pneumonia.

Fungal pneumonia (mycosis)

One variant of fungal pneumonia is pneumocystis pneumonia, which occurs only in HIV-positive patients and indicates the development of the AIDS stage. And, unfortunately, this is one of the common causes of death of HIV-infected people.

Aspiration pneumonia

Unilateral and bilateral pneumonia

Focal pneumonia

Croupous inflammation of the lungs

Interstitial pneumonia

Symptoms of pneumonia

Group of symptoms	Symptom	Development mechanism	How is it manifested?
Symptoms of intoxication	Increase in body temperature	Bacteria that live and multiply in the lungs release toxins and other waste products into the bloodstream that poison the body. At the same time, toxins act on the central nervous system, heart and blood vessels, liver, kidneys and other organs.	With pneumonia, the temperature can be either low, up to 38 o C (subfebrile), or very high. Sometimes the thermometer rises to 40-41 o C. Fever is often accompanied by chills. In more severe cases, a delusional state is possible.
	Weakness, general malaise		The patient cannot get out of bed, wants to sleep constantly.
	Headache		It can be strong or aching, usually occurs against the background of an increase in body temperature.
	Decreased appetite		Up to the complete refusal of food.
chest symptoms	Cough	Cough is defensive reflex an organism that is aimed at removing sputum, foreign particles or allergens from the bronchial tree. With inflammation of the lungs, a large amount of sputum (lung mucus) is produced, which contains anti-inflammatory immune cells, microbes and their waste products. Mucus irritates the nerve receptors of the bronchi and causes coughing. The lungs don't hurt. But the pleura can be involved in the inflammatory process. Pleurisy always gives pain in the chest. Also, with concomitant bronchitis with a strong cough, bronchial receptors may be irritated and chest pain may occur. Also, pain in the chest can be associated with tension in the respiratory muscles, namely the intercostal muscles and the diaphragm. This arises due to severe cough and shortness of breath (rapid and labored breathing).	Cough with pneumonia at first dry, that is, without sputum. Moreover, at the initial stage, the cough is very rare and does not bring much discomfort. Then it becomes more frequent, becomes exhausting, does not bring relief. After a few days, the cough becomes wet, with thick sputum. Over time, sputum discharge becomes easier. In adults, the cough may be wet from the start. Interestingly, with pneumonia, coughing is more of a concern in daytime days and is greatly enhanced in the evening, and at night it may not bother at all.
	Sputum		Sputum for different types of pneumonia may differ. Light thick or with gray tint sputum may be due to viral pneumonia. yellow-green sputum - with bacterial pneumonia. Purulent fetid sputum - at lung abscess or fungal pneumonia. rusty phlegm - with croupous pneumonia. Sputum streaked with blood may appear with any inflammation of the lungs, which is accompanied by a strong dry cough, but is more common with fungal pneumonia and tuberculosis. Foamy sputum may indicate the development of a complication of pneumonia - pulmonary edema.
	Chest pain or back		With pleurisy pains are localized in the area of ​​the affected half of the chest, can be given to the back, arm, stomach. The pain syndrome is aggravated by coughing, deep breathing, physical activity. With bronchitis pains are located in the sternum, greatly aggravated by coughing. With overstrain of the respiratory muscles pain occurs throughout the chest, aggravated by coughing and deep breathing. Also, the muscles of the abdomen, neck and shoulder girdle can hurt.
Symptoms associated with respiratory failure	Dyspnea	With inflammation of the lungs, the affected alveoli do not participate in respiration. With extensive pneumonia, respiratory failure occurs, that is, the body does not receive the necessary amount of oxygen. In response to this, breathing quickens, the body tries to replenish the oxygen necessary for life. From lack of air, hypoxia occurs, the functions of some organs are disrupted. Against the background of respiratory failure, heart failure can also develop.	Breathing in pneumonia rapid, noisy, may be accompanied by a sensation of wheezing in the chest. Inspiratory dyspnea (difficulty inhaling) can be observed, as well as mixed dyspnea, that is, difficulty in both inhalation and exhalation. Shortness of breath can be observed both during physical exertion, including coughing, and at rest. The severity of respiratory failure depends on this. With the development of heart failure, shortness of breath is accompanied by arrhythmia, edema, pain in the heart, "jumps" in blood pressure.
	hypoxia		Severe pallor of the skin; cyanosis (cyanosis) in the eyelids and nasolabial triangle; weakness, dizziness; heart palpitations and other manifestations.

Pneumonia usually begins acutely, rarely gradually, with the onset and intensification of classic symptoms.

Options for the course of pneumonia:

• easy flow;
• moderate severity;
• severe course.

How to recognize the onset of pneumonia?

But many people with colds do not immediately go to the doctor, trying to cope with the disease on their own with the help of folk remedies and the recommendations of pharmacists. We define the main indications for a mandatory visit to the doctor:

• high body temperature, which is poorly controlled by antipyretics;
• cough against the background of flu symptoms;
• the presence of weakness, loss of appetite;
• frequent cough, which is accompanied by chest pain;
• difficulty breathing, shortness of breath with little or no physical exertion;
• the appearance of unusual sputum.

Inflammation of the lungs - clinical manifestations and symptoms (fever, cough, chest pain, shortness of breath, etc.). Asymptomatic pneumonia. Hospital and community-acquired, aspiration, atypical pneumonia - video

Diagnosis of pneumonia

Medical examination

• Possible catarrhal changes (redness of the throat, discharge from the nose);
• the skin is often hyperemic or pale, moist to the touch;
• there may be blueness around the eyes and mouth;
• increased breathing more than 20-24 per minute;
• difficulty in breathing, inhalation and / or exhalation is possible;
• rales are heard over the affected areas of the lungs (crepitations, wet or dry rales);
• when tapping the chest (percussion), there is a dullness of sound over the inflamed area;
• heart palpitations (more than 90 beats per minute);
• Functional heart murmurs are possible.

X-ray for pneumonia

Pneumonia on x-ray is manifested by the presence of darkening of the lung tissue, it looks like white spots. Such changes can be in one or both lungs.

X-ray changes in pneumonia:

1. The presence of irregularly shaped lung tissue infiltration, without clear boundaries, which can be of various sizes:

• focal pneumonia - single changes up to 1 cm in diameter;
• segmental pneumonia - infiltration, occupying 1 segment of the lung;
• lobar or croupous pneumonia - infiltration can occupy a whole share;
• total pneumonia - pulmonary changes occupy the entire lung;
• abscessing pneumonia - the presence of enlightenment (dark spots) against the background of infiltration, a horizontal level of fluid (pus) can be detected;
• interstitial pneumonia - bilateral lung damage is more common, looks like a linear pattern, may resemble a fine mesh, usually located in the lower sections of both lungs.

3. Changes in the root of the lung. The root of the lung is the main bronchus, pulmonary artery and vein, intrathoracic lymph nodes, normally looks like a smooth arc on x-ray. With pneumonia, the root will retain its shape, but their heaviness appears, which is associated with the expansion of blood vessels. Rarely, mostly childhood, intrathoracic lymph nodes may increase, while the root of the lung is deformed and expanded.

4. Aperture changes. With lobar or segmental pneumonia, the lobe of the lung is compacted, so the diaphragm on the affected side rises.

5. Changes in the pleura usually occur with pleuropneumonia in the area affected by pneumonia, while the sinuses of the pleural cavity are not visible, the level of fluid in the pleural cavity and the displacement of the heart to the healthy side can be determined.

A photo: Plain radiograph of the chest organs in a direct projection with pneumonia.
1. Lung tissue infiltration in the lower lobe right lung.
2. Strengthening of the lung pattern.
3. Heaviness of the root of the lung.
4. High standing diaphragm dome.

Diagnosis: Lower lobe pneumonia of the right lung (croupous pneumonia).

Is fluorography (FG) prescribed for suspected pneumonia?

Is computed tomography (CT) used to diagnose pneumonia?

A photo: computed tomography (CT) of the lungs in interstitial pneumonia.

Do I need a control X-ray after pneumonia?

X-ray of the lungs is usually recommended to be repeated after 10-21 days. In the absence of improvement general condition against the background of treatment, the radiograph can be carried out in more early dates for determining further tactics therapy.

In the dynamics against the background of treatment, pneumonia gradually resolves. Usually by day 21 full recovery lung tissue. After inflammation of the lungs, areas of pneumosclerosis may remain (the formation of connective tissue, in fact, a "scar").

Complete blood count for pneumonia

Sputum analysis for pneumonia

Sputum is examined by smear and microscopy, which can provide a preliminary diagnosis. Also, this study can detect tuberculosis bacilli.

After microscopy, sputum is sown on nutrient media, and a few days later a culture of the pathogen is obtained, which is examined and the type of microorganism is accurately determined. With the right approach, sputum is examined not only for bacteria, but also for viruses and fungi.

Isolation of a bacterial culture allows a drug sensitivity test, that is, it is determined which antibiotics will be effective and which ones do not make sense to prescribe. This test will help you choose effective therapy in the absence of positive effects from the first antibiotics.

A general sputum analysis is also carried out, in which the content of immune cells is detected and the nature of inflammation is determined.

How to distinguish pneumonia from bronchitis and tuberculosis?

Inflammation of the lungs or tuberculosis?
Tuberculosis is also inflammation of the lungs, only specific, caused by Koch's wand.

The main criteria for the differential diagnosis of tuberculosis and pneumonia:

• Tuberculosis often has an asymptomatic or oligosymptomatic course, symptoms appear gradually, while with inflammation of the lungs, the disease begins acutely, violently, quickly.
• With tuberculosis, "we see a lot, we hear little", that is, with large changes on radiographs, wheezing in the lungs is practically absent.
• Pneumonia often affects the lower, and tuberculosis the upper lobes of the lungs, but this is a subjective sign.
• A blood test for pneumonia is almost always inflammatory, while a blood test for tuberculosis can be normal.
• The X-ray picture in tuberculosis may have its own characteristics (the presence of infiltrates, caverns, foci of varying intensity).
• In TB, sputum analysis can detect Mycobacterium tuberculosis (acid-fast bacteria or AFB).
• With a negative result of the sputum test for tuberculosis, time will help to finally distinguish these two diseases, that is, the absence of radiographic dynamics after receiving the course antibacterial pneumonia after 10-14 days. During this time, pneumonia will resolve or, in severe cases, become complicated, and nothing will happen to tuberculosis.

Diagnosis of pneumonia: x-ray, blood and urine tests, sputum culture. How to distinguish pneumonia from bronchitis or from the flu, from tuberculosis - video