Erysipelas,the “Other” Cellulitis: A Practical Guide for Nurse Practitioners

Erysipelas is a skin and soft tissue infection, often confused with cellulitis, that is not well researched or understood in the medical literature. The incidence of erysipelas has been estimated to be from 10 to 100 cases per 100,000 individuals per year. However, these estimates may be inaccurate due to erysipelas cases being classified under the broader diagnosis of cellulitis. The aim of this article is to increase nurse practitioner awareness of erysipelas, how it manifests differently from cellulitis, and the latest evidence-based treatment guidelines for short- and long-term medical management of this condition.     

中西医结合治疗2型糖尿病合并下肢丹毒临床研究

目的:观察中西医结合治疗2型糖尿病合并下肢丹毒的临床疗效。方法:将60例就诊于本院的下肢丹毒患者,按照就诊时是否合并糖尿病分为糖尿病组和非糖尿病组,每组各30例。两组患者均采用中西医结合疗法。观察两组患者的临床疗效、治愈时间及症状、体征恢复至正常时间。结果:两组患者有效率均为100%,差异无统计学意义(P0.05)。糖尿病组愈合时间明显长于非糖尿病组,差异具有统计学意义(P0.05)。糖尿病组症状、体征恢复至正常时间均长于非糖尿病组,差异具有统计学意义(P0.05)。结论:2型糖尿病患者发作下肢丹毒年龄大,感染重,局部易出现水疱,疗程长。     

下肢丹毒合并糖尿病的护理体会

目的总结对合并糖尿病的下肢丹毒患者的护理体会。方法对13例下肢丹毒合并糖尿病患者进行抗细菌、抗真菌治疗,严格控制血糖,做好健康教育以及心理护理。结果 12例痊愈,1例好转。结论对于合并糖尿病的下肢丹毒患者,积极治疗和细致护理可有效的控制感染,提高疗效。     

Fungal foot infection,cellulitis and diabetes: a review

Aims To review the current evidence for the presence of fungal foot infection (tinea pedis and toenail onychomycosis) as a risk factor for the development of cellulitis within the lower limb, particularly for those individuals with diabetes. Methods A structured review of medline , embase and cinahl databases was undertaken to identify publications investigating fungal foot infection as a risk factor for the development of cellulitis. Results Sixteen studies were identified. Eight studies adopted a case–control methodology, with the remainder being cross‐sectional surveys. The majority of studies established the presence of tinea infection by clinical rather than established microbiological methods. Although the majority of papers suggested a link, only two case–control studies employed microbiological diagnosis to demonstrate that fungal foot infection was a risk for the development of lower limb cellulitis, particularly when infection was located between the toes. There were insufficient data to suggest that fungal foot infection posed an increased risk to patients with diabetes. Conclusion There is some evidence to suggest that fungal infection of the foot is a factor in the development of lower limb cellulitis, but further robust research is needed to confirm these findings and quantify the risk that fungi pose, particularly to the diabetic foot. Meanwhile, improved surveillance and treatment of tinea infections on the foot by healthcare professionals should be encouraged to reduce potential complications.     

矾冰纳米乳外治丹毒70例的疗效观察

目的 观察矾冰纳米乳外治下肢丹毒的临床疗效.方法 70例丹毒患者随机分为2组,均内服草薢渗湿汤,治疗组35例用矾冰纳米乳外敷,对照组35例用如意金黄散外敷,14 d为一个疗程,一个疗程后进行疗效比较.结果 治疗组治愈率和总有效率分别为85.7％和94.3％;对照组治愈率和总有效率分别为68.6％和80.0％,两组比较差异有统计学意义(P＜0.05).治疗组的平均治愈时间(6.2±1.3)d,明显短于对照组的平均治愈时间(10.3±3.2)d,差异有统计学意义(P＜0.05).结论 矾冰纳米乳外治下肢丹毒具有起效快,疗效好,疗程短,操作简单等优点.     

院内制剂金黄膏联合放血疗法对下肢丹毒病程及生活质量的影响

目的:探讨院内制剂金黄膏联合放血疗法对下肢丹毒病程及生活质量的影响。方法:选择2019年10月—2021年2月收治的下肢丹毒患者60例。按照随机数字表法分为对照组和观察组,每组30例。对照组采用常规治疗,观察组在对照组基础上使用院内制剂金黄膏外敷联合放血疗法,比较两组治疗前、治疗1个疗程后血清炎症因子和抗氧化因子水平;比较两组治疗期间局部皮温、生活质量及临床效果。结果:治疗后观察组超敏C反应蛋白(hs-CRP)和肿瘤坏死因子(TNF-α)低于对照组(P<0.05),抗氧化因子丙二醛(MDA)低于对照组(P<0.05),超氧化物歧酶(SOD)高于对照组(P<0.05);治疗后3 d和治疗后7 d,观察组局部皮温恢复正常且低于对照组(P<0.05),诺丁汉健康问卷评分显著高于对照组(P<0.05),痊愈率显著高于对照组(P<0.05),无效率低于对照组(P<0.05)。结论:针对急性下肢丹毒患者,使用院内自制金黄膏联合三棱针放血治疗,能有效控制机体炎症反应,提高抗氧化能力,缩短病程,提高患者生活质量。     

Mycosis fungoides mimicking erysipelas

Mycosis fungoides may rarely simulate facial erysipelas. In a patient with that clinical presentation, a biopsy specimen revealed a diffuse dermal infiltrate with numerous neutrophils that also mimicked erysipelas histopathologically. The diagnosis of mycosis fungoides was made on the basis of atypical lymphocytes with focal epidermo‐ and folliculotropism. It was confirmed by typical findings of mycosis fungoides in a second biopsy from a clinically inconspicuous patch. An identical T‐cell receptor γ‐gene rearrangement was detected in lymphocytes of both biopsy specimens.     

Erysipelas as a sign of subclinical primary lymphoedema: a prospective quantitative scintigraphic study of 40 patients with unilateral erysipelas of the leg

Background Erysipelas is a common skin infection that is usually caused by β‐haemolytic group A streptococci. After having had erysipelas in an extremity, a significant percentage of patients develops persistent swelling or suffers from recurrent erysipelas. We hypothesize that in cases of erysipelas without a clear precipitating agent, subclinical pre‐existing congenital or acquired disturbances in the function of the lymphatic system are present. The persistent swelling after erysipelas is then most likely caused by lymphoedema. Objectives We designed a study to examine if erysipelas of unknown origin is associated with a pre‐existent insufficiency of the lymphatic system. If our hypothesis is correct, patients with erysipelas of unkown cause without previously evident lymphoedema should have evidence of disturbed lymphatic transport in the unaffected extremity. Methods A prospective study, in which lymphoscintigraphy of both legs was performed in patients 4 months after presenting with an episode of erysipelas only in one leg. No patient had any known risk factor for erysipelas, such as diabetes mellitus, chronic venous insufficiency or clinical signs of lymphoedema. Lymphoscintigraphy was performed in 40 patients by subcutaneous injection of Tc‐99m‐labelled human serum albumin in the first web space of both feet. After 30 and 120 min, quantitative and qualitative scans were performed using a computerized gamma camera. During the lymphoscintigraphy, the patients performed a standardized exercise programme. Lymph drainage was quantified as the percentage uptake of Tc‐99m‐labelled human serum albumin in the groin nodes at 2 h after injection. Groin uptake of < 15% is pathological; uptake between 15–20% is defined as borderline, and uptake of > 20% as normal. Results The mean ± SD percentage uptake in the groin nodes in the affected limbs was 9·6 ± 8·5% vs. 12·1% ± 8·9% in the nonaffected limbs. The mean paired difference in uptake between the nonaffected vs. affected side was 2·5% (95% confidence interval 1·1–3·9%). This indicates that lymphatic drainage in the nonaffected limb was only slightly better than in the affected limb despite the infectious event in the latter. Of 33 patients with objective impairment of lymph drainage in the affected limb, 26 (79%) also had impaired lymph drainage in the nonaffected limb. Agreement in qualitative measurements between affected and nonaffected leg was less pronounced: 21 patients had abnormal qualitative results in the affected leg of whom nine also had impairment of the nonaffected leg (43%). Conclusions Erysipelas is often presumed to be purely infectious in origin, with a high rate of recurrence and a risk of persistent swelling due to secondary lymphoedema. In this study, we show that patients presenting with a first episode of erysipelas often have signs of pre‐existing lymphatic impairment in the other, clinically nonaffected, leg. This means that subclinical lymphatic dysfunction of both legs may be an important predisposing factor. Therefore, we recommend that treatment of erysipelas should focus not only on the infection but also on the lymphological aspects, and long‐standing treatment for lymphoedema is essential in order to prevent recurrence of erysipelas and aggravation of the pre‐existing lymphatic impairment. Our study may change the clinical and therapeutic approach to erysipelas as well as our understanding of its aetiology.     

Economic burden of hospital admissions for patients with acute bacterial skin and skin structure infections in the United States

ABSTRACT

Objectives: We estimated the total US hospital costs associated with acute bacterial skin and skin structure infection (ABSSSI) admissions as well as the admissions that may have been potential candidates for outpatient parenteral antimicrobial therapy (OPAT).

Methods: We assessed inpatient admissions for ABSSSI from the Premier database (2011–2014), focusing on all admissions of adults with length of stay (LOS) ≥ 1 days and a primary diagnosis of erysipelas, cellulitis/abscess, or wound infection. We performed a detailed analysis of 2014 admissions for patient, treatment, hospital, and economic characteristic variables. Using published selection criteria, we identified a subset of patients admitted in 2014 who may have been potential candidates for OPAT.

Results: We analyzed 277,971 admissions. In 2014, most admissions were for cellulitis without major complications or comorbidities; mean ± SD LOS was 4.0 ± 3.0 days, and total hospital cost per admission was $6400 ± $6874, 54% of which was attributable to room costs. Among 2014 admissions, 14% involved patients with clinical characteristics suggesting that they were consistent with guideline recommendations for exclusive treatment with OPAT. Compared with all admissions in the year, these admissions were of younger patients (aged 50 vs. 55 years), admitted more frequently for cellulitis (90% vs. 70%), with shorter LOS (2.8 ± 1.8 days), and lower mean total hospital cost per admission ($4080 ± $3066).

Conclusions: Admissions for ABSSSI impose a substantial cost to US hospitals, with half of costs attributable to room costs. When extrapolated to all US patients admitted to the hospital for ABSSSI during 2014, had OPAT guidelines been universally followed, admissions may have been reduced by 14%, thereby saving US hospitals $161 million.