Handheld infrared thermometer to evaluate cellulitis: the HI-TEC study

ObjectivesDifferentiating cellulitis from pseudocellulitis is challenging, and misdiagnosis leads to unnecessary antimicrobial use and increased healthcare expenditure. Clinical diagnosis remains the criterion standard and may involve expert consultation. Our objective was to evaluate the usefulness of a handheld infrared thermometer to improve diagnostic certainty in cases of suspected cellulitis.MethodsWe conducted a cross-sectional study from August 2018 to January 2020 at a tertiary-care hospital in Montreal, Canada. We enrolled adult patients with suspected limb cellulitis. Using the infrared thermometer, we compared the average temperature of the affected area with that of the contralateral limb, and we used Youden's method to determine the optimal temperature difference which best differentiated cellulitis from pseudocellulitis as determined by an independent and blinded infectious diseases specialist. We used bootstrapping to estimate 95% confidence intervals for the sensitivity, specificity, and area under the receiver operating curve.ResultsOf 65 patients screened for enrolment, 52 patients were recruited (median age: 64 years, IQR 52–76); 39 of these were diagnosed with cellulitis and 13 were not. The mean temperature difference between affected and unaffected limbs was 2.6°C (95%CI 2.1–3.1°C) for patients with cellulitis and 0.4°C (95%CI –1.2°C to 2.1°C) for patients without (p < 0.001). An average temperature difference between limbs of 0.8°C or more was 95% sensitive (95%CI 74–100%) and 69% specific (95%CI 44–95%) for the diagnosis of cellulitis (c-statistic 0.82).ConclusionsIn this proof-of-concept single-centre study, a handheld infrared thermometer was a useful aid to differentiate cellulitis from pseudocellulitis.     

Severe lower limb cellulitis: defining the epidemiology and risk factors for primary episodes in a population-based case-control study

ObjectiveTo describe the epidemiology and risk factors for primary episodes of severe lower leg cellulitis (LLC).MethodsThis was a longitudinal cohort study using state-wide data linkage of adults presenting to Western Australian (WA) hospitals with a first ever LLC from January 2002 to December 2013. The study aimed at determining risk factors, medical records from the index patient, together with comparable data from controls matched by age, sex, postcode, and month of admission.ResultsDuring the period, 36 276 patients presented with their first episode of LLC. The incidence increased by 4.7% per annum, reaching 204.8 (95% CI 198.6–211.1) per 100 000 population by December 2013. Analysis of 29 062 case-control pairs showed several conditions with lower limb pathology were independently associated with LLC, including varicose veins (AOR 2.95, 95% CI 2.50–3.48, p < 0.001), lymphoedema (AOR 2.65, 95% CI 1.71–4.10, p < 0.001), tinea pedis (AOR 3.05, 95% CI 1.45–6.42, p 0.003), and saphenous vein harvest during coronary artery bypass grafting (AOR 1.74, 95% CI 1.32–2.30, p < 0.001). Also associated with LLC was obesity (AOR 2.05, 95% CI 1.82–2.31, p < 0.001), renal disease (AOR 1.28, 95% CI 1.14–1.44, p < 0.001), rheumatologic conditions (AOR 2.12, 95% CI 1.72–2.60, p < 0.001), hemiplegia/paraplegia (AOR 1.31, 95% CI 1.13–1.52, p < 0.001), and liver disease (AOR 1.77, 95% CI 1.51–2.06, p < 0.001).ConclusionsLLC presents a major burden to the health sector and is increasing with an ageing population. Given the high rates of recurrence, long-term morbidity, and economic impact, efforts to reduce primary episodes should be incorporated into the infectious diseases and healthy ageing research agenda.     

自制黄金膏外敷治疗丹毒43例疗效观察

目的观察黄金膏外敷治疗丹毒的临床疗效。方法将2008年6月-2011年6月我院丹毒患者86例随机分为治疗组（黄金膏外敷）和对照组（50%硫酸镁湿敷）,每组各43例。分别观察两组患者丹毒治疗情况。结果治疗组43例,显效38例,有效5例,总有效率为100.0%;对照组43例,显效26例,有效10例,无效7例,总有效率为83.7%,两组比较差异有统计学意义（P〈0.05）。两组治愈时间比较,治疗组平均治愈时间为（5.8±1.8）d,对照组平均治愈时间为（11.6±3.0）d,两组比较差异有统计学意义（P〈0.05）,治疗组疗程优于对照组。结论黄金膏外敷治疗丹毒可缩短治愈时间,疗效好,安全可靠。     

皮肤针治疗丹毒皮肤硬肿疗效观察(英文)

目的:观察皮肤针治疗丹毒局部皮肤硬肿的临床疗效。方法:将150例局部皮肤硬肿的丹毒患者分为两组,针刺组110例,采用皮肤针叩刺配合金黄散外敷治疗;对照组40例,用金黄散外敷治疗,比较两组有效率。结果:针刺组总有效率为97.3%,对照组总有效率为75.0%,两组总有效率差异具有统计学意义(P<0.01)。结论:皮肤针叩刺结合金黄散外敷治疗丹毒局部皮肤硬肿疗效优于单纯金黄散外敷治疗。     

大溪地诺丽果汁治疗丹毒与银屑病

目的探索大溪地诺丽果汁治疗丹毒与银屑病的疗效。方法口服诺丽果汁40～100ml／d，伴适量局部外用。结果治疗丹毒有效率为66．6％，银屑病有效率46．1％。结论诺丽果汁虽是保健食品，但对丹毒与银屑病亦有良好疗效。     

中西医治疗下肢丹毒67例对照分析

目的 对照分析67例下肢丹毒两种方法 的治疗结果 .方法 治疗组用梅花针加火罐,对照组用鱼石脂软膏外敷,二组均配合青霉素治疗.结果 治疗组一周痊愈58.97%,总有效率94.87%,年内复发率10.71%,效果优于对照组(P＜0.05).结论 梅花针加火罐联合青霉素是下肢丹毒治疗和预防复发的有效方法 .     

壮医皮肤针治疗丹毒局部皮肤硬肿疗效观察

目的观察壮医皮肤针治疗丹毒局部皮肤硬肿的疗效。方法将150例丹毒局部皮肤硬肿患者分为两组，针刺组110例，用壮医皮肤针、金黄散配合治疗：对照组40例，用金黄散治疗，观察两组有效率。结果针刺组总有效率为97．3％，对照组总有效率为75．0％，针刺组总有效率高于对照组，两组比较差异具有统计学意义（P〈0．01）。结论壮医皮肤针配合金黄散治疗丹毒局部皮肤硬肿能提高其总有效率。     

Thrombotic Arteriopathy in Rheumatoid Erysipelas-Polyarthritis: Thrombosierende Arteriopathie bei der rheumatoid verlaufenden Rotlauf-Polyartluitis der Ratte

While the pathogenic importance of thrombosis is known for the latter, this possibility is also discussed for the former group.The topographic coincidence of coagulopathies, plasmatic insudation, mesenchymal activation and proliferation can be observed in experimental erysipelas, especially in the aorta and arteries. We attempted to standardize the corresponding intimal processes in relation to the age of the experimental animals.Material and methods: In 19 experiments a total of 625 rats were parenterally infected with standardized B-strain-T 28 (Table 1). To attain the rate of thrombosis 506 of these animals were subdivided into the following groups (Table 2): Group A<200 g body weight (b.w.), group B>200 g b.w., group C>200 g b.w. with additional ether nebulization stress. For the histomorphological examination, the heart and aorta were embedded in paraplast and, following sectioning and staining, were morphometrically examined for lesions. In addition the following histochemical reactions were carried out: acid and alkaline phosphatase, adenosine triphosphatase and succinodehydrogenase.Coagulation tests were also performed: 1. Thromboplastin time, 2. Partial thromboplastin time, 3. Thrombin time, 4. Determination of factors V, VII, XII and of thrombocytes (reagents: Merz and Dade Co.) and 5. of fibrinogen according to the Ratnoff-Menzie method. The skin temperature was studied with an infrared thermometer (Thermophil M 202).Results: One hour after subcutaneous injection erysipelas bacteria were in loose contact with the endothelium coinciding with an increase of pinocytotic activity in all three groups. First endothelial reactions occur 36 hours later: thrombocytes adhere, leucocytes and monocytes show the sticking effect.On the third day plasma containing fibrinogen is abundant beneath the aortic endothelium which shows arcadian formation. While the adjoining muscle cells proliferate with radial orientation to the cell axis, simultaneous disruption of the membrana elastica interna begins on the 4th day after inoculation. This is particularly apparent between the 6th and 12th day. Endothelial regression and thrombosis development occur in older rats only if subjected to stress (Group C). On the other hand, young rats (200 g b.w.) usually develop thrombosis (average 68.24% in S experiments) with its base at the aorta's origin. The subintimal transformation of muscle cells converts to foam cells in a transient form, healing as a fibroelastic plaque.In young animals cyanosis of the tail tip occurs 4-6 days following injection, leading to necrosis after 10-12 days. The smooth muscle cells of the aorta show an increase in acid and alkaline phosphatase (4-S days after injection) and ATP'ase (10-12 days after injection). There is marked consumption of factors V, VII, XII and of thrombocytes. Fibrinogen increases analogously from 200 to 700 mg/% in young rats.Discussion: Different arterial changes occur parallel to the manifestation of erysipelas arthritis, pending on age. While only a subintimal mesenchymal reaction is observed in the arteries following inoculation, coagulation crisis and exudation, the changes occurring in the connective tissue of joints and other organs infected with erysipelas have the symptomatology of rheumatoid arthritis. The pathogenetically important disturbances of coagulation are induced by the erysipelas bacteria, not by anaphylactoid immune processes. However, immune complexes exist in the chronic stages of erysipelas. The clear topographical behavior of the aortic intima during the exudative shock phase of the erysipelas infection is especially suitable for examining the effect of serum and plasma factors on the mesenchym.     

解毒化瘀汤治疗下肢丹毒临床观察

观察解毒化瘀汤治疗下肢丹毒的疗效。方法下肢丹毒１６２例,治疗组１０２例用自拟解毒化瘀汤治疗。水煎服,日１剂;对照组用青霉素１６０万单位,或先锋霉素Ｖ６ｇ加入５％葡萄糖注射液５００ｍｌ中静脉滴注。均以１０日为１疗程。结论解毒化毒汤治疗下肢丹毒疗效确切。     

中西医结合治疗丹毒疗效观察

目的：比较单纯西医治疗丹毒与中西医结合治疗丹毒的疗效。方法：回顾性分析2006年3月-2009年3月应用中西医结合的方法治疗下肢丹毒46例的治疗效果。结果：治疗组总有效率明显高于对照组,差异有统计学意义。结论：中西医结合治疗丹毒有较好的疗效,尽早应用能有效缩短治愈时间。