Erysipelas

BackgroundErysipelas is a common and severe infection where the aetiology and optimal management is not well-studied. Here, we investigate the clinical features, bacteriological aetiology, and treatment of erysipelas.MethodsEpisodes of erysipelas in a seven-years period in our institution were studied retrospectively using a pre-specified protocol and is presented with descriptive and comparative statistics.Results1142 episodes of erysipelas were identified in 981 patients. Patients had a median age of 61 years, 59 % were male, a majority had underlying diseases or predisposing conditions, and the leg was most often affected. Wound cultures were taken in 343 episodes and 56 grew group A streptococci (GAS), 53 grew group G streptococci (GGS), 11 grew group C streptococci (GCS), and 153 grew Staphylococcus aureus. Blood cultures were drawn in 49 % of episodes and 50 cultures were positive with GGS as the most common finding (21 cultures) followed by GAS in 13, group B streptococci in 5, S. aureus in 4, and GCS in 3 cultures. In 45 % of episodes, patients received antibiotics with activity against S. aureus.ConclusionsGGS is the most common streptococcus isolated in erysipelas and the role of S. aureus in erysipelas remains elusive.

BackgroundResults from previous trials suggest that daptomycin may result in faster clinical improvement than penicillinase-resistant penicillins or vancomycin for patients with complicated skin and skin structure infections.ObjectiveThe objective was to evaluate whether daptomycin treatment of cellulitis or erysipelas would result in faster resolution compared with vancomycin.DesignThe study was a prospective, evaluator-blinded, multi-centre trial. Patients were randomised to receive daptomycin 4 mg/kg once daily or vancomycin according to standard of care for 7-14 days.PatientsAdults diagnosed with cellulitis or erysipelas requiring hospitalisation and intravenous antibiotic therapy were eligible for enrolment.ResultsThe clinical success rates were 94.0% for daptomycin and 90.2% for vancomycin (95% confidence interval for the difference, -6.7%, 14.3%). There were no statistically significant differences between treatment arms in the time to resolution or improvement in any of the predefined clinical end-points. Both daptomycin and vancomycin were well tolerated.ConclusionsThere was no difference in the rate of resolution of cellulitis or erysipelas among patients treated with daptomycin or vancomycin. Daptomycin 4 mg/kg once daily appeared to be effective and safe for treating cellulitis or erysipelas.

BackgroundErysipelas is a common infection that often recurs, but the impact of specific risk factors for reoccurrence remains elusive. In the present study we aimed at clarifying predisposing conditions for reoccurrence.MethodsMedical records were reviewed from all patients ≥18 years of age diagnosed with erysipelas at the Department of Infectious Diseases at Skåne University Hospital, Sweden, from January 2007 to February 2011. 502 patients were included, of which 357 were single episode erysipelas and 145 had recurrent erysipelas. These two groups were compared regarding underlying conditions and clinical presentation.ResultsErysipelas in the lower limbs had the greatest propensity of recurrence. The associations between underlying conditions and recurrence were largely depending on the site of erysipelas. Overall, the most prominent risk factor for recurrence was lymphedema and other conditions causing a chronic impairment of the defence against microbes. Conditions temporarily disrupting the skin barrier (e.g. a local wound or toe web intertrigo), although likely being risk factors for erysipelas per se, did not seem to predispose to repeated episodes. Individuals with recurrent erysipelas tended to seek medical attention earlier, and were less likely to be hospitalized or receive intravenous antibiotics, but there was no evidence of any difference in inflammatory reaction when taking confounding factors into account.ConclusionsIn this large cross-sectional study of over 500 patients with erysipelas, lymphedema was the most prominent risk factors for recurrence although the distribution of predisposing conditions varies depending on the site of erysipelas.

BackgroundErysipelas, caused by infection with Erysipelothrix rhusiopathiae (ER), is an emerging disease in non-cage housed laying hens. According to Swedish field experience outbreaks seem more common in older flocks and may also occur in flocks vaccinated against erysipelas. This cross-sectional study aimed to assess single-dose vaccination outcome in laying hens with respect to antibody titres to ER and to monitor selected immune parameters to identify putative risk factors for erysipelas. Blood samples were collected from laying hen flocks at 30, 50 and 75 weeks of age. At each time point, 5 unvaccinated flocks and 5 flocks that had been vaccinated against erysipelas once at placement were sampled (20 hens/flock, total n=600).ResultsThe results showed that the majority of hens were positive for IgY to ER and that the antibody titres were higher in older hens irrespective of vaccination status. Vaccinated hens had significantly higher IgY titres to ER compared to those of unvaccinated hens. This difference was most prominent for the youngest age category. Among the different leukocyte populations studied, blood heterophil, monocyte and γ/δTCR+ T-cell counts were significantly higher in younger hens. Also, serum MBL-levels were significantly higher in younger hens and MBL-levels were positively correlated to heterophil and monocyte counts at the individual level.ConclusionsTaken together, results indicate that ER or antigenically similar bacteria are common in the hen environment and that this exposure results in antibodies recognising ER that are present at higher levels in older laying hens. In addition, a higher general pathogen load/level of subclinical infections was indicated by altered leukogram patterns and increased MBL-levels in the youngest age category. Nonetheless, among the parameters studied we found no evidence to suggest that antibody responses to single-dose vaccination should fail or why older flocks seem more susceptible to erysipelas outbreaks.